CF: 21-25 Flashcards
18 yo G2P1 @ 35 wk is taking PTU for graves. P/w 1 day hx of palpitations, nervousness, sweating, diarrhea. BP 150/110, HR 140, RR 25, temp 38.2. Anxious, disoriented, confused. Thyroid mildly tender and enlarged. DTRs 4+ w/ clonus. Leukocytosis.
Most likely Dx?
Best management?
- Thyroid storm
- BB, steroids, PTU
32 yo woman @ 33 wk who continues to blast cigs has US showing growth restricted fetus.
- Most likely Dx?
- 2 other things to check on US?
- Next step?
- 3 potential Cpx?
- IUGR
- Determine symm vs asymm IUGR, assess amniotic fluid
- Eval fetal well being
- PTB, fetal stress, intrauterine fetal demise
20 yo G1P0 @ 29 wk is being treated for pyelo w/ appropriate Abx and now c/o SOB.
- Dx?
- Mechanism?
- ARDS
- Endotoxin-mediated pulmonary injury
28 yo s/p C/S 1 wk ago p/w fever up to 102, myalgias, vomiting, hypoTN, confusion, and skin incision that’s infected with underlying tissue revealing brawniness and crepitance. Evidence of hemo-concentration and renal insufficiency.
- Dx?
- Next step in therapy (3)?
- Nec fasc
- Isotonic IVF, broad-spec Abx, and immediate surgical debridement
24 yo G1P1 s/p C/S 2 days ago for arrest of labor p/w fever to 102, no cough or dysuria. No abnormalities of breasts, lungs, CVAT, or incision. Fundus is somewhat tender.
- Dx?
- Most likely etiology?
- Best therapy?
- Endomyometritis
- Ascending infection of vaginal organisms (anaerobes > GNRs)
- IV Abx (gent and clinda)
For IUGR, how can you use US to determine asymm vs symm?
Look at HC vs FL and AC. HC is spared in asymm, while all 3 are decreased symmetrically in symm.
MCC of asymm IUGR?
Maternal vascular DO, like smoking, HTN, or drug use
MCC of symm IUGR?
Constitutionally small baby with no adverse problems
Name 8 major maternal factors for IUGR
- HTNsive disease
- Renal disease
- Cardiac disease
- respiratory disease
- Underweight and/or poor pregnancy weight gain
- Significant anemia
- Substances: tobacco, cocaine
- AMA
Name 3 major uterine/placental factors for IUGR
- Abruptio placenta
- Placenta previa
- Infection
Name 5 major fetal factors for IUGR
- multiple gestation
- aneuploidy
- congenital syndromes
- structural fetal malformations
- infection
How do you define IUGR?
Birthweight <10th percentile for gestational age
What is a biophysical profile?
Combo of US criteria and NST for fetal well-being conducted over 30 min. Assesses fetal breathing, movement, tone, and amniotic fluid
What sort of doppler flow study is helpful with IUGR?
Umbilical artery
What does reverse end-diastolic flow through the umbilical artery signify?
High stillbirth rate w/in 48 hr
What does absent end-diastolic flow through the umbilical artery signify?
Moderately high stillbirth risk- can obs in some cases
For suspected symmetric IUGR, how can you differentiate btwn dating error and actual IUGR?
Repeat US in 2-3 wk. If it shows adequate interval growth, then it’s probably just a dating error.
Early insults to fetal growth typically cause which type of IUGR?
Symm
How does perinatal morbidity and mortality change in infants born btwn 38-42 wk with bw 1500-2500 g?
30x incr from infants born btwn 10th-90th %ile
Name 6 neonatal morbidities assoc w/ IUGR?
- meconium aspiration
- NEC
- Hypoglycemia
- respiratory distress
- hypothermia
- thrmobocytopenia
Per the Baker hypothesis, what are 4 major long-term (adult) consequences of IUGR?
- CAD
- CVA
- HTN
- T2DM
Name 4 major infections associated with IUGR. Which of these is especially assoc w/ early-onset (<20 wk) IUGR?
- Toxo, hsv, parvo
- CMV is a/w early onset iugr
Is work-up for infection a/w IUGR always high yield?
No- after mid-gestation, yield becomes low
What’s often the earliest sign of IUGR detected on US?
Decreased AFI
Why is AFI low in IUGR?
Decr perfusion of fetal kidneys and decreased UOP
Pregnancies with the most severe ___________ have the highest perinatal mortality rate, incidence of anomalies, and incidence of IUGR
Oligohydramnios
Polyhydramnios + IUGR has been a/w high rate of what 2 things?
Structural and chromosomal abnormalities
How does increased resistance in the placental circulation manifest on doppler of umbilical arteries?
Increased doppler blood flow indices
Use of doppler flow measurements in IUGR can significantly decr what 2 things?
Perinatal death
Unnecessary induction of labor
If IUGR is diagnosed in fetus <34 wk, what drug should you give mom?
Steroids bc of incr risk of preterm delivery
Indications for delivery in IUGR <32 wk?
- Reverse end-diastolic flow
- Persistent non-reassuring fetal testing despitr measures to optimize placental perfusion
- Significant or ominous fetal testing results
Indications for delivery in IUGR 32-36 wk?
- Severe HTN despite therapy
- Absence of growth over 2-4 wk
- Non-reassuring fetal testing
- Absent or reverse end-diastolic flow on doppler
Indications for delivery in IUGR >36 wk?
Just deliver (risks of prematurity are low)
First step in eval of size > dates?
US
