Ch. 21 Fetal Complications

Question 1

What constitutes a fetus with IUGR aka FGR?

Answer 1

An infant weighing below the 10th percentile for GA

Question 2

What is one of the most major physiological factors/causes of IGUR

Answer 2

A decrease in uterine plasma volume

Question 3

List some maternal factors that could negatively affect plasma volume, leading to an IUGR fetus

Answer 3

Poor nutritional status
Smoking
Multiple gestations
Drug/ alcohol abuse
Severe anemia
Diabetes
Chronic renal disease
Rh sensitization
Severe chronic asthma
Under 17 or over 35 years of age
Heart disease
High altitude

Question 4

List some placental factors that could negatively affect plasma volume, leading to an IUGR fetus

Answer 4

Placental infarcts and hemangiomas
Small placenta
Single umbilical artery (2VC)
Placental abruption
Placental insufficiency

Question 5

List some fetal factors that could negatively affect plasma volume, leading to an IUGR fetus

Answer 5

Genetic or chromosomal defects
Intrauterine infection

Question 6

What are the two types of IUGR? Describe each.

Answer 6

Systemic IUGR (25%) - Growth restriction that affects the entire fetus. Etiology is often genetic or due to maternal infection. Sono finds include all measurements more than two weeks below expected GA, consistent with dates transcerebellar diameter when other parameters are less than expected, oligo, mature plac earlier than expected, low BPP score

Asymmetric or “Brain Sparing” IUGR (75%) - Occurs in the last 8-10 weeks of pregnancy. The fetus body tries to protect the brain by sending all of the nutrient-rich blood to it first. This causes an asymmetry between HC and AC. Sono finds include an abnormal HC/AC ratio, AC measuring >2 weeks behind, oligi, mature placenta earlier than expected

Question 7

A systolic/diastolic ratio greater than —- is abnormal after 30 weeks

Answer 7

> 3.0

Question 8

What is the best spot along the cord for doppler?

Answer 8

Close to the PCI. Dopplers taken by the ACI will have a higher SD ratio

Question 9

Describe the Ductus Venosum waveform

Answer 9

Triphasic forward flow
Flow should never go below the baseline
abnormal dopplers are associated with chromosomal abnormalities and IUGR (reversed flow)

Question 10

Term for destruction of the fetal RBCs by antibodies with subsequent fetal or neonatal complications

Answer 10

Erythroblastosis Fetalis (results in congestive heart failure, hydrops fetalis, fetal death)

Question 11

What is the most common cause of Erythroblastosis Fetalis

Answer 11

Rh incompatibility

Question 12

Type of hydrops that is caused by anything other than Rh sensitization

Answer 12

Non-immune hydrops

Question 13

List causes of Non-immune hydrops

Answer 13

Cardiac anomalies, infection (TORCH), chromosome abnormalities, TTTS

Question 14

What is the earliest sign of non-immune hydrops

Answer 14

Pericardial effusion

Question 15

List sono finds of non-immune hydrops fetalis

Answer 15

Pericardial effusion
ascites
Anasarca (fetal skin thickening >5mm)
Placental thickening (>5cm AP)
Pleural effusion
Hepatosplenomegaly
Poly
Enlarged UV (>1cm)

Question 16

What causes Immune hydrops, describe the process

Answer 16

immune hydrops is caused by Rh incompatibility. This occurs when the mother is Rh - and the father is Rh +. This creates a Rh + fetus. Maternal bodies recognize the Rh antigens in the fetal RBCs as foreign and begin to attack to destroy them. The destruction of RBCs results in Erythroblastosis Fetalis and fetal anemia, which results in hydrops

Question 17

What immunization is given to prevent immune hydrops

Answer 17

Rh immunoglobulin aka RhoGam

Question 18

Explain how the MCA doppler is obtained, what it tells us, what it should be below..

Answer 18

MCA is examined 2 mm from its origin of the internal carotid artery
The angle of interrogation should be ZERO degrees, NO ANGLE CORRECTION.
Risk of anemia is highest in fetuses with a peak systolic velocity of 1.5 times the median or higher.

Question 19

What type of sampling is most accurate for fetal anemia to determine if hemolysis is occurring

Answer 19

Percutaneous umbilical blood sampling. aka PUBS. (retrieval of blood from the umbilical vein)

Question 20

What is Robert’s sign?

Answer 20

Echogenic foci (gas) in pulmonary vessels or abdomen - This is a delayed finding, about one week after a demise)

Question 21

Overlapping skull bones - delayed finding seen about a week after fetal demise is known as

Answer 21

Spalding’s sign

Question 22

Term used for the halo effect that is seen radiographically secondary to subcutaneous scalp edema in fetal demise

Answer 22

Deuel’s sign aka Halo sign