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OB/GYN II > Ch. 53 Quiz > Flashcards

Ch. 53 Quiz Flashcards

1
Q

Babies that are smaller than 90% of babies of the same gestational age are called

A

small for gestational age

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2
Q

Babies that are larger than 90% of babies of the same gestational age are called

A

large for gestational age

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3
Q

Macrosomia is a term used to describe babies that are

A

large for gestational age

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4
Q

What percentage of pregnancies are affected by IUGR

A

3-7%

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5
Q

IUGR is defined as

A

an EW at or below the growth percentile and an AC that is 2 weeks or more behind the head and femur measurements

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6
Q

Babies that have IUGR are at greater risk for what complications

A

fetal death, perinatal asphyxia, neonatal morbidity, developmental problems

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7
Q

List the material risk factors for IUGR

A

maternal hypertension, smoking, uterine anomaly. large retroplacental bleed

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8
Q

Why is it necessary to have an accurate determination of gestational age to diagnose IUGR

A

in order to diagnose abnormal growth

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9
Q

What causes symmetrical IUGR

A

small parents, infection, alcohol abuse, first trimester insults

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10
Q

Describe the appearance of symmetrical IUGR

A

all measurements are small

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11
Q

What causes asymmetrical IUGR

A

placental insufficiency, maternal diabetes, hypertension, smoking, alcohol, drugs

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12
Q

Describe the appearance of asymmetrical IUGR

A

small AC by 2 weeks, normal FL & HC

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13
Q

Why is the AC the first measurement affected by asymmetrical IUGR

A

the liver is the main source for glucose storage

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14
Q

Why is the head the last area affected by asymmetrical IUGR

A

last organ to be deprived of nutrients, head sparing

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15
Q

What are the clinical signs of IUGR

A

decreased fundal height and fetal motion

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16
Q

What are the key IUGR sonographic markers

A

small AC before 36 weeks, grade 3 placenta, decreased placental thickening

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17
Q

The _____ is the most useful measurement for assessing fetal growth/size

A

AC

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18
Q

The _____ is useful for determining the type of IUGR that is present

A

HC/AC ratio

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19
Q

Which EFW calculation is more accurate

A

One which incorporates BPD/HC/AC/FL

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20
Q

Symmetrical IUGR can be diagnosed with a single sonogram

A

false

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21
Q

How can serial sonograms be used to differentiate between SGA and symmetrical IUGR fetus

A

plot interval growth and consider maternal/fetal and familial factors

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22
Q

What other factors besides interval growth must be considered when determining SGA vs IUGR

A

parents, maternal hypertension, paternal size, ethnicity, fetal growth and well being

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23
Q

List 3 causes of oligohydramnios

A

renal problems, demise, post dates, PROM, preeclampsia

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24
Q

Which measurement is used to determine the normality of the fetal head shape

A

CI

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25
What is the normal range for AFI
5-22cm
26
Is the normal range of AFI absolute? Why or why not
no, different values from different sources, normal values change with gest age
27
Describe placental grade 0
homogenous smooth chorion plate, medium gray
28
Describe placental grade 1
small hypoechoic/cystic spaces
29
Describe placental grade 2
small hypoechoic/cystic spaces, calcifications maternal border
30
Describe placental grade 3
cumulous cloud, heterogenous with calcifications, swirled septations
31
What percentage of pregnancies will actually have a grade 3 placenta
10-15%
32
A grade 3 placenta before 34-36 weeks can indicate what
IUGR or placental insufficiency
33
What is the BPP used for
fetal well being, predict hypoxia
34
Describe the parameters involved in performing a BPP: fetal breathing motions
one episode that lasts at least 30 sec within 30 min
35
Describe the parameters involved in performing a BPP: gross body movement
3 large movements within 30 mins
36
Describe the parameters involved in performing a BPP: fetal tone
one episode flexion/extension of spine or extremity within 30 mins
37
Describe the parameters involved in performing a BPP: fetal heart rate
increase 15bpm for 15 sec within 30 mins
38
Describe the parameters involved in performing a BPP: amniotic fluid index
5-22cm
39
The BPP parameters were designed to correlate with the _____ that is calculated after birth
APGAR
40
Describe the scoring of the BPP
0 of 2, out of 8 to 10
41
What is the main goal of the BPP
detect and manage fetal hypoxia
42
Describe when the centers for each of the BPP parameters develop: fetal tone
7.5-8.5 weeks
43
Describe when the centers for each of the BPP parameters develop: fetal movement
9 weeks
44
Describe when the centers for each of the BPP parameters develop: fetal breathing
20-21 weeks
45
Describe when the centers for each of the BPP parameters develop: reactive heart rate
2nd-3rd trimester
46
Which centers are the first to be affected by hypoxia
reactive HR, fetal breathing
47
Is CW doppler used in obstetric imaging
no
48
With IUGR the umbilical artery will have an ____ S/D ratio
increased
49
With IUGR the circle of willis will have an _____ S/D ratio
decreased
50
Why does the circle of willis demonstrate increased diastolic flow in the presence of IUGR
shunting of blood to the brain for protection
51
What is the upper limit normal for the umbilical artery S/D ratio after 30 weeks
3.0
52
What fetal complications are associated with elevated umbilical artery S/D ratios
fetal compromise and death, early delivery, NICU
53
Why does placing the patient on bed rest to the LLD position help improve S/D ratio in the umbilical artery
takes pressure of the uterus off the aorta and IVC, improving maternal flow to uterus
54
When would S/D ratio not be able to be measured
no diastolic flow
55
What are the maternal risk factors for macrosomia
multiparous, 35+ year old, post term pregnancy, diabetes, LGA fetus
56
How does unregulated maternal diabetes contribute to macrosomia
due to decreased maternal blood flow to the placenta, causes hyperinsulinemia, Miracle-Gro
57
What birth complications are associated with macrosomia
clavicular fractures, facial/brachial palsies, meconium aspiration, perinatal asphyxia, neonatal hypoglycemia, cord compression
58
List 3 types of mechanical macrosomia and their associated causes
1. generally large post term 2. large shoulders diabetic pregnancy 3. large head, hydrocephalus
59
Why is it important to have very accurate measurements when calculating fetal weight
small errors in measurement can be big errors in weight calculation
60
Describe the chest circumference measurement and how is it used to detect macrosomia
trans just below heart
61
How is the macrosomia index calculated
chest diameter - BPD
62
What is the upper limit of normal for macrosomia index
1.3-1.4
63
Why would detection of polyhydramnios cause the attending physician to order a glucose tolerance test
polyhydramnios is often seen with diabetic pregnancy
64
Why is the placenta often thickened in macrosomic babies
because it is stimulated by the increased levels of insulin in the fetal blood
65
Which fetal measurement is about as accurate as the BPD in determining gestational age
femur length

OB/GYN II (13 decks)

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