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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
Q

What is the normal range for AFI

A

5-22cm

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26
Q

Is the normal range of AFI absolute? Why or why not

A

no, different values from different sources, normal values change with gest age

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27
Q

Describe placental grade 0

A

homogenous smooth chorion plate, medium gray

28
Q

Describe placental grade 1

A

small hypoechoic/cystic spaces

29
Q

Describe placental grade 2

A

small hypoechoic/cystic spaces, calcifications maternal border

30
Q

Describe placental grade 3

A

cumulous cloud, heterogenous with calcifications, swirled septations

31
Q

What percentage of pregnancies will actually have a grade 3 placenta

A

10-15%

32
Q

A grade 3 placenta before 34-36 weeks can indicate what

A

IUGR or placental insufficiency

33
Q

What is the BPP used for

A

fetal well being, predict hypoxia

34
Q

Describe the parameters involved in performing a BPP: fetal breathing motions

A

one episode that lasts at least 30 sec within 30 min

35
Q

Describe the parameters involved in performing a BPP: gross body movement

A

3 large movements within 30 mins

36
Q

Describe the parameters involved in performing a BPP: fetal tone

A

one episode flexion/extension of spine or extremity within 30 mins

37
Q

Describe the parameters involved in performing a BPP: fetal heart rate

A

increase 15bpm for 15 sec within 30 mins

38
Q

Describe the parameters involved in performing a BPP: amniotic fluid index

A

5-22cm

39
Q

The BPP parameters were designed to correlate with the _____ that is calculated after birth

A

APGAR

40
Q

Describe the scoring of the BPP

A

0 of 2, out of 8 to 10

41
Q

What is the main goal of the BPP

A

detect and manage fetal hypoxia

42
Q

Describe when the centers for each of the BPP parameters develop: fetal tone

A

7.5-8.5 weeks

43
Q

Describe when the centers for each of the BPP parameters develop: fetal movement

A

9 weeks

44
Q

Describe when the centers for each of the BPP parameters develop: fetal breathing

A

20-21 weeks

45
Q

Describe when the centers for each of the BPP parameters develop: reactive heart rate

A

2nd-3rd trimester

46
Q

Which centers are the first to be affected by hypoxia

A

reactive HR, fetal breathing

47
Q

Is CW doppler used in obstetric imaging

A

no

48
Q

With IUGR the umbilical artery will have an ____ S/D ratio

A

increased

49
Q

With IUGR the circle of willis will have an _____ S/D ratio

A

decreased

50
Q

Why does the circle of willis demonstrate increased diastolic flow in the presence of IUGR

A

shunting of blood to the brain for protection

51
Q

What is the upper limit normal for the umbilical artery S/D ratio after 30 weeks

A

3.0

52
Q

What fetal complications are associated with elevated umbilical artery S/D ratios

A

fetal compromise and death, early delivery, NICU

53
Q

Why does placing the patient on bed rest to the LLD position help improve S/D ratio in the umbilical artery

A

takes pressure of the uterus off the aorta and IVC, improving maternal flow to uterus

54
Q

When would S/D ratio not be able to be measured

A

no diastolic flow

55
Q

What are the maternal risk factors for macrosomia

A

multiparous, 35+ year old, post term pregnancy, diabetes, LGA fetus

56
Q

How does unregulated maternal diabetes contribute to macrosomia

A

due to decreased maternal blood flow to the placenta, causes hyperinsulinemia, Miracle-Gro

57
Q

What birth complications are associated with macrosomia

A

clavicular fractures, facial/brachial palsies, meconium aspiration, perinatal asphyxia, neonatal hypoglycemia, cord compression

58
Q

List 3 types of mechanical macrosomia and their associated causes

A
  1. generally large post term 2. large shoulders diabetic pregnancy 3. large head, hydrocephalus
59
Q

Why is it important to have very accurate measurements when calculating fetal weight

A

small errors in measurement can be big errors in weight calculation

60
Q

Describe the chest circumference measurement and how is it used to detect macrosomia

A

trans just below heart

61
Q

How is the macrosomia index calculated

A

chest diameter - BPD

62
Q

What is the upper limit of normal for macrosomia index

A

1.3-1.4

63
Q

Why would detection of polyhydramnios cause the attending physician to order a glucose tolerance test

A

polyhydramnios is often seen with diabetic pregnancy

64
Q

Why is the placenta often thickened in macrosomic babies

A

because it is stimulated by the increased levels of insulin in the fetal blood

65
Q

Which fetal measurement is about as accurate as the BPD in determining gestational age

A

femur length

OB/GYN II (13 decks)

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