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ACOG Practice Bulletins > 204 - Fetal Growth Restriction > Flashcards

204 - Fetal Growth Restriction Flashcards

1
Q

Definition of IUGR

A

<10%ile

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2
Q

Etiologies of IUGR - Maternal

A
  • pregestational DM
  • SLE
  • Renal disease
  • HTN
  • Cyanotic heart disease
  • Substances (alcohol, tobacco 3.5x, cocaine, narcotics)
  • APLS
  • teratogens (cyclophosphamide, valproic, warfarin)
  • malnutrition/calorie restricting <600-900kcal/d
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3
Q

Etiologies of IUGR - Fetal

A
  • infections (malaria, CMV, rubella, toxo, VZV, syphilis)
  • genetics: trisomy 18 (50%), trisomy 13 (50%), placental mosaicism, congenital heart disease, gastroschisis (25%)
  • multiples: twins 25%, triplets/quads 60%. mono/mono via TTTS and unequal placental sharing
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4
Q

Etiologies of IUGR - Placental

A
  • placental disorders: abruption, infarction, circumvallate shape, hemangioma, and chorioangioma. (NOT accreta or previa)
  • cord abnormalities: velamentous or marginal cord insertion
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5
Q

Do inherited thrombophilias predispose to IUGR?

A

NO! only autoimmune mediated i.e. ALPS, SLE

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6
Q

infections cause what % of IuGR?

A

5-10%

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7
Q

Most common cause of infectious IUGR worldwide?

A

Malaria

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8
Q

Most common cause of IUGR

A

placental insufficiency

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9
Q

prevalence of 2 vessel cord and relation to IUGR

A

1%, mixed data

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10
Q

Risk of fetal death at <10%ile?

A

1.5%

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11
Q

Risk of fetal death at <5%ile?

A

2.5%

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12
Q

At what GA can you use fundal height as a screening for IUGR?

A

24-38wks

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13
Q

Sensitivity and specificity for detecting IUGR at 32-34wks?

A

Sensitivity: 65-85%
Specificity: 96%

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14
Q

How much are sonos off by?

A

95% up to 20% off

5% more than 20% off

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15
Q

What UA doppler findings are associated with increased fetal mortality?

A

Absent and elevated

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16
Q

Rate of perinatal death is reduced by what percent when umbilical artery Doppler velocimetry is added to standard antepartum testing in the setting of fetal growth restriction?

A

29%

17
Q

Utility of ductus venosus flow?

A

Does NOT affect fetal/perinatal mortality
TRUFFLE (Trial of umbilical fetal flow in Europe) showed better neurodevelopmental outcomes at 2 yrs when delivered based on this as opposed to FHRT

18
Q

Fundal height off by how many weeks is a positive screen?

A

3

19
Q

risk of recurrent SGA in a subsequent pregnancy?

A

20% - can screen with growth sonos but nothing else

20
Q

Food/drugs to help prevent SGA?

A

NONE proven (including diets and aspirin)

21
Q

IUGR + structural anomalies: thing of?

A

Aneuploidy, offer invasive testing especially if in 2nd trimester

22
Q

Antepartum testing for growth of IUGR fetus

A
  • growth every 3-4 weeks (minimum 2wks)

- AFI/BPP/NST

23
Q

When to deliver isolated growth restricted singleton?

A

38-39+6 weeks

24
Q

When do deliver singleton with other risk factors (oligo, abnormal UA dopplers, maternal risk factors, or comorbidities)?

A

32-37+6 weeks

ACOG Practice Bulletins (9 decks)

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