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OBGYN Ultrasound > Abnormal Fetal Growth > Flashcards

Abnormal Fetal Growth Flashcards

1
Q

Standard Routine Measurements

A 
Biparietal diameter (BPD)
Head circumference (HC)
Abdomen circumference (AC)
Femur length (FL)
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2
Q

Head Measurements

A 
BPD
HC
Cephalic index (CI)
Transverse Cerebellum
Binocular
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3
Q

Criteria for BPD

A 
CSP (Cavum septum pellucidum) & thalamus
No cerebellum
Hemispheres symmetrical
Ultrasound beam 90 degrees to midline echo
Calipers placed at widest part of skull
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4
Q

IUGR vs SGA

A

DO NOT confuse IUGR with term small for gestational age (SGA).
SGA describes fetus with weight below 10th percentile without reference to cause.
Fetal growth restriction describes subset of SGA fetuses with weight below 10th percentile as result of pathologic process from variety of maternal, fetal, placental disorders.

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5
Q

Symmetric IUGR

A 
All measurements small (BPD, HC, AC, FL)
genetic disorders (e.g., trisomy 18), fetal infections (e.g., rubella and cytomegalovirus), congenital malformations, and a variety of syndromes (e.g., Cornelia de Lange)
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6
Q

Asymmetric IUGR

A

Head measurements correlate with age (BPD, HC)
Other measurements small (AC, FL)
relative nutritional and oxygen deprivation

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7
Q

Prenatal effects of IUGR

A 
Increased mortality
Decrease in umbilical vein volume
Decreased cardiac output
Increased cerebral circulation
Heart failure
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8
Q

Postnatal effects of IUGR

A 
Increased 
Short and long term morbidity
Learning disabilities
Behavioral problems
Reduced cognitive function
High blood pressure
Diabetes
Acquired heart disease
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9
Q

Maternal risk factors with IUGR

A

Low socioeconomic status/ poor maternal nutrition
Coexisting maternal disease, infection or genetic disorder incl:
Collagen vascular disease ( i.e. systemic lupus erythematosus)
Chronic and severe renal cardiovascular or respiratory diseases
Hypertension and preeclampsia
Diabetes Antiphospholipid antibody syndrome
Inflammatory bowel disease
Lung disease
Sickle cell anemia
Maternal drug use/teratogenic exposure
Hx of child of unexplained low birth wt.
Hx of IUGR pregnancy
Hx. Preterm birth

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10
Q

Fetal risk factors with IUGR

A 
Aneuploidy 
Congenital infections ( CMV, varicella zoster)
Genetic syndromes 
Congenital anomalies 
Monochorionic twins 
Twin to twin transfusion 
Higher order multiples
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11
Q

Placental risk factors of IUGR

A 
Placental abruption 
Placenta previa 
Marginal or velamentous umbilical cord insertion 
Placental neoplasms 
Circumvillate placenta 
Advanced placental grade 
Placental mosaicism
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12
Q

weight-based theories

A 
Low birth weight
Varies with gestational age
IUGR 
Borderline at 25%
Diagnosed at 10%
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13
Q

weight-based theories requirements

A 
Gestational age
Estimated fetal weight (EFW) calculation
BPD, AC (Shepard)
HC, AC, FL (Hadlock)
Gestational age (weeks), HC, AC (multiplied by 2), FL (Sabbagha)
Third trimester measurements
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14
Q

echogenic bowel can indicate

A

Pathology

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15
Q

Doppler fetus IUGR

A

redistribution of blood within the fetus and placenta

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16
Q

what factors affect the fetal spectral waveform

A
  • patient position
  • fetal/maternal breathing
  • fetal cardiac abnormalities
  • maternal ingestion of pharmacologic agents
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17
Q

umbilical artery

A

normal-low resistance above the baseline

Abnormal-high resistance with no or little end-diastolic flow, possible flow reversal

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18
Q

Cerebral blood flow

A

Normal pregnancy there is continuous forward flow in the fetal MCA
MCA is the main lateral branch of the circle of Willis
High resistance circulation results in a high Doppler reading in a normal fetus (this is opposite of the case in other fetal vessels)
With fetal growth restriction, there is a marked decrease in cerebral resistance - Results in a low Doppler ratio

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19
Q

what occurs with growth restriction

A

Blood will be shunted towards the brain, which will change the MCA from being high resistant to low resistant and will have a low Doppler ratio

20
Q

what will occur in hypoxia

A

Blood will be shunted towards the braian, the heart and the adrenal gland

21
Q

with compensation, during diastolic

A

will see increased blood flow

22
Q

Uterine Artery Doppler

A

Uterine artery travels along the lateral aspect of the uterus from the level of the cervix
Most readily identifiable location for sampling the uterine artery with u/s is at the level of the cervix
In non pregnant women & early pregnancy ut artery has a notch at the beginning of the diastolic phase of the cardiac cycle
In the 2nd / 3rd trimester the presence of a notch or persistently elevated ratios – pregnancy may suffer inadequate nutrition or O2- this can lead to pre eclampsia and IUGR

23
Q

Macrosomic

A

Weight greater than 4200-4500 grams regardless of the GA

24
Q

Large for Gestational Age

A

LGA refers to a fetus or infant who is larger than expected for the age and gender. It can also mean an infant with a birth weight above the 90th percentile.

25
Q

large for gestational age complications

A

A baby that is large for gestational age has a higher risk of birth injury.
There is also a risk of complications of low blood sugar after delivery (if the LGA is due to maternal diabetes).

26
Q

Common causes of large for Gestational age

A

Gestational diabetes
Prolonged pregnancy
Erythroblastosis fetalis
Some non chromosomal genetic syndromes (e.g., Beckwith-Weidemann synrome)

27
Q

what is APGAR

A

Apgar is a quick test performed on a baby at 1 and 5 minutes after birth.

The 1-minute score determines how well the baby tolerated the birthing process.

The 5-minute score tells the doctor how well the baby is doing outside the mother’s womb.

In rare cases, the test will be done 10 minutes after birth.

28
Q

what are the five components of APGAR score

A 
Breathing effort
Heart rate
Muscle tone
Reflexes
Skin color

Each category is scored with 0, 1, or 2, depending on the observed condition.

29
Q

Biophysical components

A 
Nonstress test (NST)
Fetal
Breathing 
Movements
Tone
Qualitative amniotic fluid volume
30
Q

fetal movement

A

2 points if three or more discrete body or limb movements within 30 minutes of observation

31
Q

fetal tone

A

2 points if one or more episodes of extension of a fetal extremity or fetal spine with return to flexion

32
Q

fetal breathing

A

2 points if one or more episodes of rhythmic breathing movements of ≥30 seconds within a 30 minute observation period

33
Q

Amniotic fluid

A

2 points if a single pocket of fluid is present measuring ≥2 cm in 2 perpendicular planes

34
Q

Sonographic BPP score

A

Max of 8!!

35
Q

Score of less than 4

A

Indicates fetal compromise

36
Q

Maximum biophysical profile score

A

10 (includes stress test and sonographic things)

37
Q

Nonstress testing results

A

2 points if reactive, defined as at least 2 episodes of FHR accelerations of at least 15 bpm and at least 15 seconds duration from onset to return associated with fetal movement within a 30 (different sources give different times for the test 20-40 minutes) minute observation period

38
Q

Amniotic fluid index

A

Four quadrant measurement of fluid
Perpendicular measurement
Fluid pocket free of cord / fetal parts
Sum of all reported

39
Q

Amniotic fluid volume

A

largest vertical pocket

40
Q

Borderline AFI

A 
<5cm = Oligohydramnios
>25cm = Polyhydramnios
8-22 = normal
41
Q

Fetal causes of oligohydramnios

A 
Fetal asphyxial states / IUGR 
Premature rupture of fetal membranes 
Developmental anomalies of the genitourinary system 
Chromosomal abnormalities 
Congenital syndromes 
Intrauterine fetal demise
42
Q

Maternal cause of oligohydramnios

A

Uteroplacental insufficiency

Drugs

43
Q

Placental causes of oligohydramnios

A

Placental abruption

Twin - twin transfusion

44
Q

causes of polyhydramnios

A
  1. Increased Production of Amniotic Fluid.

2. Decreased Elimination of Amniotic Fluid.

45
Q

Single deepest pocket measurement

A

Measure the dimensions of the largest vertical pocket of amniotic fluid which is free of umbilical cord and fetal parts.
Pocket of fluid:
Less than 2 cm Oligohydramnios
Greater than 8 cm Polyhydramnios

OBGYN Ultrasound (5 decks)

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