Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Practice bulletins > #216 Macrosomia > Flashcards

#216 Macrosomia Flashcards

1
Q

What is the definition of large for gestational age?

A

Implies a birth weight equal to or more than the 90th percentile for a given gestational age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the definition of macrosomia?

A

Implies growth beyond an absolute birth weight, historically 4,000 g or 4,500 g, regardless of the gestational age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

True or false: Increasing birth weight increases the likelihood of labor abnormalities, shoulder dystocia, birth trauma, and permanent injury to the newborn increases.

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What % of all live-born newborns in the US weigh more than 4,000g? What % more than 4,500g? What % more than 5,000g?

A

7.8%; 1%; 0.1%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Rate of LGA in normal weight women vs obese women (without GDM)? Rate of LGA in normal weight women vs obese women with GDM?

A
  1. 7% in normal BMI women w/o GDM
  2. 7% in obese women w/o GDM
  3. 6% in normal BMI women w/ GDM
  4. 3% in obese women w/ GDM
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What maternal factors predispose a newborn to macrosomia?

A

constitutional factors, preexisting diabetes and GDM, maternal prepregnancy obesity, excessive gestational weight gain, abnormal fasting and postprandial glucose levels, dyslipidemia, prior macrosomic newborn, postterm pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Maternal hyperglycemia can lead to fetal macrosomia via the release of what in the fetus?

A

insulin, insulin-like growth factors, and growth hormone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Is an elevated fasting blood glucose or elevated postprandial more strongly associated with fetal macrosomia?

A

Fasting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Is the risk of macrosomia increased in women with GDM even with treatment?

A

Yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

By how much does GDM increase the risk of macrosomia?

A

2-3 fold

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the rate of LGA in women with GDMA1, GDMA2, and preexisting diabetes?

A

29% - GDMA1
30% - GDMA2
38% - preexisting diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Does the type of macrosomia related to maternal hyperglycemia differ compared to macrosomia related to other risk factors (postterm, prev macrosomic child)? If so, how?

A

Yes. More total body fat, larger shoulder and upper-extremity circumferences, higher upper-extremity skin-fold measurements, and smaller head-to-abdominal-circumference ratios

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Do newborns of women with diabetes have increased risk of shoulder dystocia, clavicular fracture, or brachial plexus palsy regardless of weight, compared to women without DM?

A

Yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the single strongest individual risk factor for macrosomia?

A

History of macrosomia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Does maternal birth weight have an impact on risk of macrosomia in offspring?

A

Yes, women who exceeded 3600g at birth are twice as likely to give birth to baby weight >4000g than someone who was born at 2700-3500g.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Do multiparity and/or grand multiparity increase the risk of macrosomia?

A

Both increase the risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How can you make an accurate diagnosis of macrosomia?

A

Weight the child after birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Does ultrasound prediction of fetal weight improve or worsen with increasing fetal weight?

A

Worsens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the sensitivity of ultrasound for predicting fetal weight > 4000g? Specificity?

A

56% sensitivity. 96% specificity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Does individual growth-curve modeling improve the prediction of macrosomia?

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Do longitudinal ultrasound examinations improve the prediction of macrosomia?

A

no

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Does MRI or ultrasound have better sensitivity to detect macrosomia? Specificity?

A

MRI has better sensitivity and specificity at detection of macrosomia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How does physical exam compare to ultrasound to estimate fetal weight?

A

No studies have shown that ultrasonography is superior to physical examination in a clinically meaningful way

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How does a parous woman’s prediction of fetal weight compare to ultrasound exam and physical exam estimates?

A

Predict just as well

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the primary maternal risk associated with macrosomia?

A

Increased risk of cesarean birth

26
Q

How does the rate of cesarean section for women with a baby >4500g compare to women with smaller babies

A

Risk for cesarean section is at least 2x

27
Q

Is labor protraction more common with macrosomia?

A

Yes

28
Q

Are arrest disorders more common with macrosomia?

A

Yes

29
Q

Does a predelivery prediction of macrosomia (despite actual birth weight) affect the rate of diagnosis of labor abnormalities and cesarean birth?

A

Yes!

30
Q

Does macrosomia increase the risk of postpartum hemorrhage?

A

Yes

31
Q

Does macrosomia increase the risk of chorioamnionitis?

A

yes

32
Q

Does macrosomia increase the risk of significant vaginal lacerations?

A

Yes

33
Q

Shoulder dystocia occurs in what % of all vaginal deliveries?

A

0.2-3%

34
Q

What is the risk of shoulder dystocia when birth weight is >4500g in all comers? In those with diabetes?

A

All comers: 9-14%

Diabetics: 20-50%

35
Q

Injury to what nerve roots of the brachial plexus lead to Erb-Duchenne paralysis?

A

C5 and C6

36
Q

Injury to nerve roots C5 and C6 of the brachial plexus cause what sort of paralysis?

A

Erb-Duchenne paralysis

37
Q

Fracture of the clavicle complications what % of all births? How does macrosomia affect this risk (fold change)?

A

0.4-0.6%. 10-fold increased risk with macrosomia

38
Q

What is the rate of neonatal brachial plexus palsy in the US?

A

Incidence of both transient and persistent neonatal brachial plexus palsy is 1.5 per 1,000 total births

39
Q

What is the rate of neonatal brachial plexus palsy (both transient and persistent) in neonates with birth weight > 4500g?

A

Between 2.6-7%

40
Q

Can brachial plexus injury occur in the absence of shoulder dystocia? At cesarean birth?

A

yes and yes

41
Q

Are most cases of brachial plexus palsy temporary or persistent?

A

Temporary

42
Q

What % of cases of brachial plexus palsy resolve by 1 year?

A

80-90%

43
Q

Does macrosomia increase risk of being overweight or obese in later life?

A

yes

44
Q

Is macrosomia associated with increased rates/prolonged NICU stays?

A

yes

45
Q

Does maternal obesity affect the reliability of clinician estimates of fetal weight?

A

No, we still don’t do great at it no matter the BMI

46
Q

What is the sensitivity of fundal height for the detection of macrosomia?

A

20-70% (specificity 90%, better at ruling out)

47
Q

What is the mean absolute percent error for the Hadlock formula for EFW in newborns weighing >4500g compared to nonmacrosomic newborns?

A

Non macrosomic : 8%

>4500g : 13%

48
Q

Do estimations from ultrasound more often over or underestimate actual birth weight?

A

Overestimate

49
Q

What inventions have been shown to reduce macrosomia?

A

Exercise during pregnancy, low glycemic diet in women with GDM, and prepregnancy bariatric surgery in women with class 2 or class 3 obesity.

50
Q

Does prenatal exercise increase the risk of SGA? Preterm delivery?

A

No and No

51
Q

How does prenatal exercise affect the rate of cesarean section?

A

Decreases by 20%

52
Q

True or false: addition of insulin to diet therapy for women with GDM decreases the rate of macrosomia?

A

True

53
Q

Does bariatric surgery for women with class 2 or 3 obesity decrease odds of having GDM or LGA newborn?

A

yes to both

54
Q

True or false: prior bariatric surgery is not associated with an increase in SGA newborns?

A

False. It is associated. Possibly also associated with increase in preterm delivery

55
Q

True or false: ACOG supports prepregnancy counseling of morbidly obese patients regarding the benefits and risks of bariatric surgery?

A

True. Due to the known health benefits, particular for pregnancy outcomes

56
Q

What is ACOGs stance on induction for macrosomia?

A

At this time, suspected macrosomia or LGA fetus is not an indication for IOL before 39w0d ass there is insufficient evidence that benefits of reducing shoulder dystocia risk would outweigh the harms of early delivery

57
Q

Transient brachial plexus palsy occurs in what % of births complicated by shoulder dystocia? What % of these persist at 1 year after birth?

A

1-17%.

3-33% persist at 1 year

58
Q

At what EFW cut off would scheduled cesarean section may be beneficial for newborns with suspected macrosomia in women w/ and w/o diabetes?

A

5000g w/o diabetes
4500g w/ diabetes
However, planned CS for suspected macrosomia is controversial and based on expert opinion

59
Q

How many CS would need to be performed for suspected macrosomia (>4500g) to prevent one permanent injury in women w/o diabetes? What additional cost would this have to prevent one injury? Compared to a woman with diabetes?

A

No diabetes: 3,695 cesarean births; $8.7 million additional cost
With diabetes: 443 cesarean births; $930k additional cost

60
Q

Is suspected macrosomia a contraindication for TOLAC?

A

No

Practice bulletins (83 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions