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47 Cards in this Set
- Front
- Back
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how is estimated fetal wt. measured?
a. what is Small for gestational age (SGA) b. LGA? c. symmetric d. asymmetric |
ultrasound
a. <10th percentile b. >90th c. proportionally small d. certain organs small - classically, torso and extremities small, head/brain large |
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How do you estimate GA after 20 weeks
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uterine fundal ht in cm = GA in weeks
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2 factors that lead to SGA
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decreased growth potential (Trisomies, Turners, Osteogenesis imperfecta, anencephaly, CMV, Rubella, teratogens)
or IUGR |
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IUGR
how does it differ when an insult presents before 20 weeks vs. after |
pre-20 weeks - hyperplastic -> symmetrical growth restriction
post-20 weeks - hypertrophy --> asymmetrical growth (often result from decreased nutrition and oxygen transmitted across the placenta) |
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Maternal risk factors for IUGR
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HTN, anemia, chronic renal disease, malnutrition, severe diabetes
+ Anti-phospholipid, SLE, vascular disease |
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Placental factors for IUGR
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Factors leading to diminished blood flow: placenta previa, chronic abruption, infarction, multiple gestations
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What should be done if fundal ht is 3cm below expected
How should you proceed in monitoring an infant at risk of IUGR or SGA |
do ultrasound
serial US every 2-3 weeks |
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What is the difference in growth patterns between a fetus with decreased growth potential and IUGR
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decreased growth potential = starts small and stays small
IUGR = falls off growth curve |
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How can you use Doppler to differentiate different etiologies of IUGR
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If diastolic decreases by >80%, is absent, or reverses --> indicates increased placental resistance (thrombosed or calcified placenta)
Reversed diastolic flow associated w/intrauterine fetal demise |
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Patient has a history of SGA associated with placental insufficiency, preeclampsia, collagen vascular disorder, or vascular disease
how should you manage |
give low dose aspirin
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Patient w/history of SGA due to placental thrombosis, thrombophilias, or antiphospholipid antibody
how should you proceed |
heparin and corticosteroids
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Definition of fetal macrosomia
increases risks for what conditions |
birth wt >4500g
shoulder distocia, birth trauma (ex brachial plexus injuries), low APGAR, hypoglycemia, polycythemia, hypocalcemia, jaundice, leukemia, Wilms, osteosarcoma |
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Mothers with LGA or macrosomic fetuses are at higher risk for what conditions
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cesarean, perineal trauma, postpartum hemorrhage
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2 major risk factors for macrosomia
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maternal diabetes or obesity (BMI>30 or wt >90)
Other factors include postterm pregnancy, multiparity, advanced maternal age |
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What is the measurement tool for measuring amniotic fluid
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amniotic fluid index - divide maternal abdomen into quadrants, measure the largest vertical pocket in each quadrant and sum them
oligohydramnios = AFI<5 Polyhydramnios = AFI > 20-25 |
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Oligohydramnios
a. what is the risk if combined with intact membranes and why b. associated with what types of anomalies c. physical findings in labor |
a. 40x increase in pernatal mortality b/c umbilical cord loses its cushion, more susceptible to compression --> fetal asphyxiation
b. congenital (GU), growth restriction c. nonreactive stress test, FHR decels, meconeum, c/s |
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Oligohydramnios
a. most common cause b. cause in growth restricted infants c. cause in congenital abnormality |
a. ROM
b. uteroplacental insufficiency (baby cannot maintain GFR) c. Renal agenesis (Potter), PCKD, obstruction of GU |
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Diagosis of oligohydramnios
when to screen |
AFI < 5
screen if size<dates, history of ROM, IUGR suspicion, postterm pregnancy |
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Patient has oligohydramnios w/ meconium or frequent decels on FHR
what do you do |
amniointfusion to dilute meconium and decrease variable decels caused by cord compression
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Polyhydramnios
defn associated w/what conditions |
AFI > 25
diabetes (circulating glucose can act as an osmotic diuretic), hydrops (secondary to high CO failure), multiple gestation (twin-twin transfusion syndrome), GI obstruction |
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Polyhydramnios
diagnosis reasons for screening |
ultrasound
diabetes, size>dates, multiple gestations |
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Risks associated with polyhydramnios
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Malpresentation, umbilical cord prolapse
perform ROM in controlled setting, only if head is truly engaged in pelvis |
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Erythroblastosis fetalis
what are the symptoms |
heart failure, diffuse edema, ascites, pericardial effusion (all result of serious anemia)
jaundice and neurotoxicity from bilirubin in neonate (not in fetus) |
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When should Rhogam be administered if neonate is Rh pos
What dose What if there is a placental abruption or antepartum bleeding |
28 weeks
0.3mg Rh IgG eradicates 15mL fetal RBCs If bleeding, do a kleihauer-Betke test for amount of fetal RBCs in maternal circulation and adjust dose |
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How should you proceed if antibody for Rh comes back positive in mom
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Treat as if fetus is at risk!
Amniocentesis - if titer < 1:16, ok, continue to monitor every 4wks If titer >1:16, serial amniocentesis (16-20wks) 1. fetal cells collected to see if Rh pos 2. if Rh pos, analyze light absorption by bilirubin, plot on Liley curve 3. If zone 1 - amniocentesis every 2-3wks zone 2 - amniocentesis every 1-2 wks zone3 - Percutaneous umbilical blood sampling (obtain Hct), intrauterine transfusion/intraperitoneal transfusion |
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Alternative screening method for fetal anemia (alternative to amniocentesis)
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Middle cerebral artery doppler
If anemic - should see incrased peak systolic velocity (to maintain brain oxygenation) |
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5 antigens (other than Rh) that cause fetal hydrops
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ABO
CDE Kell Duffy Lewis |
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What happens if Intrauterine fetal demise is retained >3-4 weeks
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hypofibrinogenemia secondary to thromboplastic substances being released from decomposing fetus, full blown DIC
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Diagnosis of Fetal demise
a. before 20 weeks b. after 20 weeks |
a. lack of uterine growth, loss of pregnancy symptoms, falling hCG and ultrasound
b. loss of fetal movement and uterine growth, ultrasound |
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How to treat fetal demise
a. early gestation b. after 20 weeks |
a. dilation and evaculation
b. induce labor w/prostaglandins or oxytocin Test for collagen vascular disease, hypercoagulable state fetal karyotype, TORCH titers, autopsy fetus |
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Defin of postterm pregnancy
INcreases risk of what |
>42 weeks or 294d since LMP
macrosomy, oligohydramnios, meconium aspiration, intrauterine fetal death, dysmaturity syndrome, double rate of c/s |
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3 rare conditions associated w/postterm pregnancy
what do these have in common |
anencephaly, fetal adrenal hypoplasia, absent fetal pituitary
diminished estrogens |
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Erythroblastosis fetalis
what are the symptoms |
heart failure, diffuse edema, ascites, pericardial effusion (all result of serious anemia)
jaundice and neurotoxicity from bilirubin in neonate (not in fetus) |
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When should Rhogam be administered if neonate is Rh pos
What dose What if there is a placental abruption or antepartum bleeding |
28 weeks
0.3mg Rh IgG eradicates 15mL fetal RBCs If bleeding, do a kleihauer-Betke test for amount of fetal RBCs in maternal circulation and adjust dose |
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How should you proceed if antibody for Rh comes back positive in mom
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Treat as if fetus is at risk!
Amniocentesis - if titer < 1:16, ok, continue to monitor every 4wks If titer >1:16, serial amniocentesis (16-20wks) 1. fetal cells collected to see if Rh pos 2. if Rh pos, analyze light absorption by bilirubin, plot on Liley curve 3. If zone 1 - amniocentesis every 2-3wks zone 2 - amniocentesis every 1-2 wks zone3 - Percutaneous umbilical blood sampling (obtain Hct), intrauterine transfusion/intraperitoneal transfusion |
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Alternative screening method for fetal anemia (alternative to amniocentesis)
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Middle cerebral artery doppler
If anemic - should see incrased peak systolic velocity (to maintain brain oxygenation) |
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5 antigens (other than Rh) that cause fetal hydrops
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ABO
CDE Kell Duffy Lewis |
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What happens if Intrauterine fetal demise is retained >3-4 weeks
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hypofibrinogenemia secondary to thromboplastic substances being released from decomposing fetus, full blown DIC
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Diagnosis of Fetal demise
a. before 20 weeks b. after 20 weeks |
a. lack of uterine growth, loss of pregnancy symptoms, falling hCG and ultrasound
b. loss of fetal movement and uterine growth, ultrasound |
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How to treat fetal demise
a. early gestation b. after 20 weeks |
a. dilation and evaculation
b. induce labor w/prostaglandins or oxytocin Test for collagen vascular disease, hypercoagulable state fetal karyotype, TORCH titers, autopsy fetus |
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Defin of postterm pregnancy
INcreases risk of what |
>42 weeks or 294d since LMP
macrosomy, oligohydramnios, meconium aspiration, intrauterine fetal death, dysmaturity syndrome, double rate of c/s |
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3 rare conditions associated w/postterm pregnancy
what do these have in common |
anencephaly, fetal adrenal hypoplasia, absent fetal pituitary
diminished estrogens |
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Plan for patients whose pregnancies go past 40 weeks
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1. NST during 41st week
2. NST and BPP in 42nd week If nonreassuring fetal testing or inducible cervix (Bishops >6), induce If>42 weeks, induce |
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what is twin twin transfusion syndrome
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placental vascular communication between 2 monochorionic diamniotic twins
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How do di di twins form
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separation of fertilized ovum separates before differentiation of trophoblast --> 2 chorions 2 amnions
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How do mo di twins form
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after trophoblast but before amnion formation (days 3-8) --> single placenta, 1 chorion, 2 amnion
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how do mo mo twins form?
how do siamese twins form |
division after amnion formation --> 1 chorion 1 amnion (days8-13)
days 13-15 |
