Antenatal fetal assessment and IUGR Flashcards

1
Q

what are the goals of fetal surveillance

A

prevent fetal death

prevent neonatal morbidity

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2
Q

what are some ways to assess fetal wellbeing in the office

A

s/sx of disorders of hx–> gestational HTN, general maternal health

fetal movement–at least 6 movements within 2 hours, starting after 26 weeks

BP

maternal weight gain

symphysis-fundal height (SFH)

fetal HR with doptone

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3
Q

indications for antenatal fetal assessment/surveillance

A

pre-existing medical conditions–> pre-existing diabetes, hypertension, cardiac disease, lupus

pregnancy related–> multiple gestation, oligohydramnios, postdates, PPROM, 2nd/3rd trimester bleeding (?abruption or placenta previa)

previous fetal demise

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4
Q

what does oligohydramnios make us worry about?

A

amniotic fluid is a measure of fetus fluid status–> i.e low amniotic fluid means baby urine output is down–> sign of poor placental perfusion

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5
Q

define IUGR

A

estimated fetal weight is less than 10th percentile

abdominal circumference is less than 10th percentile

includes many normal fetuses–> 25-75% are constitutionally small

excludes fetuses that stopped growing

clinical definition postnatally is birth weight below the 10th percentile

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6
Q

how does SGA differ from IUGR

A

IUGR is pathological, SGA can be normal and just happens to be small

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7
Q

symmetrical IUGR definition

A

all measurements are small for GA

likely due to:
congenital infection 
chromosomal abnormality
congenital malformation
maternal drug ingestion
alcohol abuse 
genetic syndromes
constitutional
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8
Q

asymmetrical IUGR

A

this is likely due to deficiency in nutrients

results in large head (because spares nutrients for brain) whereas rest of body is small

mostly a placental functioning issue

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9
Q

why do we care about IUGR

A

second most common cause of perinatal mortality

fetal death increases x8 between the 10th and 3rd percentiles

fetal death is x20 when birth weight is less than 3rd percentile

30% of infants who die of SIDS were IUGR

more susceptible to asphyxia

higher rates of meconium aspiration

hypoglycemia due to decreased glycogen reserves

hypocalcemia–> second to hyperparathyroid

hypothermia

polycythemia–x3-4

hypercoagulability

hyperbilirubinemia–due to polycythemia

thrombocytopenia

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10
Q

what usually causes variable decelerations

A

cord compressions–not too worrying

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11
Q

what usually causes late decelerations

A

hypoxia–worry–consider making sure delivers quickyl

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12
Q

what usually causes decelerations timed with contractions

A

head compression/vagal response from fetus–not too worrying

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13
Q

how do you interpret a BPP score

A

any score 4 or less–> DELIVER BABY

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14
Q

how much of the placenta has been affected (placental arteries obliterated) when you get reversed end-diastolic flow

A

70%

measuring end diastolic flow (biophysical profile–BPP) with doppler is the one test we have that actually can have an impact on fetal outcomes

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15
Q

how often do you check fetal growth when monitoring for IUGR

A

every 2 weeks

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