Chapter 32: Fetal Growth Restriction Flashcards
chemical substance that is the subject of analysis
analyte
abnormal chromosome number
aneuploidy
combined observation of four separate fetal biophysical variables (fetal breathing, fetal body movement, fetal tone, amniotic fluid index? obtained via ultrasound. This can be done with or without NST
Biophysical profile
Noninvasive ultrasound test that assesses blood flow velocity profiles from which indices of impedance can be obtained or flow volumes can be calculated.
Doppler velocitremy
estimated fetal weight or abdominal circumference less than the 10th percentile for gestational age
fetal growth restriction (FGR) or IUGR
low oxygen blood level
hypoxemia
without known cause
idiopathic
birth weight below 2500 g or 5 lbs 8 ox
low birth weight
incidence of a specific disease in a population for a set amount of time
morbidity
frequency of deaths in a specific population
mortality
method of assessing fetal well-being by observing fetal heart rate accelerations
nonstress test
low amniotic fluid levels
oligohydramnios
condition characterized by the discrepancy between the chromosomal makeup of the fetus and placenta
placental mosaicism
hypertension, and protein in the urine, occurring during second half of pregnancy
preeclampsia
the proportion of people who test positive for a disease who actually have the disease
sensitivity
diagnosis used to describe an infant that is smaller than expected for the gestational age
small for gestational age
having three copies of a specific chromosome
trisomy
A newborn’s _____ closely relates to risks for early death and long-term morbidity
birth weight
Stillbirth rates _____ as fetal weight increases.
decrease
premature infant
37 weeks or earlier
LBW infants are likely a result of:
fetal growth restriction
a sonographic estimated fetal weight or abdominal circumference that is less than the 10th percentile for gestational age
fetal growth restriction
newborns identifying a neonate with a birth weight less than 2500 g or 5 lbs 8 oz
small for gestational age
Growth restricted fetuses are at an increased risk of _____, ______, and ______.
intrauterine demise
neonatal morbidity
neonatal death
the interval between the onset of fetal viability and the end of the neonatal period
perinatal period
onset of fetal viability
24 weeks
end of neonatal period
28 days after delivery
second leading cause of perinatal mortality and morbidity
FGR
leading cause of perinatal mortality and morbidity
preterm delivery
A fetus with _______ has a fivefold to tenfold increase in risk for perinatal mortality
poor intrauterine growth
In FGR the overall general risk of fetal death
1.5%
risk of fetal death when the fetal weight is less than the 5th percentile
2.5%
__% of stillborn infants are SGA
26
FGR is a major group associated with stillbirth, accounting for up to __%
43
Meconium aspiration is increased with FGR infants because:
chronic hypoxia leading to meconium-stained liquor and aspiration
Hypoglycemia is increased with FGR infants because:
decreased glycogen stores, increased sensitivity to insulin, decreased adipose tissue, and decreased ability to oxidize free fatty acids and triglyceride effectively
Hypocalcemia is increased with FGR infants because:
decreased transfer of calcium in utero
Hypothermia is increased with FGR infants because:
proper care of temperature maintainence is not done
Polycythemia and other hematologic complications is increased with FGR because:
increased sythesis of erythropoietin seconday to chronic intrauterine hypoxia
Several studies suggest that the intact survival rates are less than 50% for fetuses with FGR at gestations under ____
28 weeks
Childhood increased risks for FGR infants
learning disabilities
behavioral problems
worse performance in school than term infants
Children affected by FGR have been found to have _____ blood pressure
higher
Most infants with FGR catch up on growth by:
18 years
Fetuses that are below the third percentile tend to have _____ and ____
lower weights
shorter statures
Adults who had FGR are at a much higher risk for ______, _______, and _____ later in life.
acquired heart disease
lipid abnormalities
diabetes
the in utero environment leads to the fetal origins of adult disease that persist into infancy, childhood, and adulthood
Barker hypothesis
Risk factors or etiologies of FGR
maternal
fetal
placental
Maternal medical conditions that affect blood circulation result in a:
decrease in uteroplacental blood flow
_______ in pregnancy is one of the leading causes of FGR
materal hypertension
Maternal age less than ___ years or greater than ___ years increase risk for FGR
16
35
Maternal tobacco use reduce birth weight by roughly ___-___g
150-200
leading cause of preventable FGR
tobacco use
___% of FGR cases can be credited to tobacco consumption
13
_____ is associated with the most severe growth deficits
preeclampsia
The most common chromosomal abnormalities that increase a fetus’ riskfor FGR are:
trisomy 13 Patau’s syndrome
trisomy 21 Down syndome
trisomy 18 Edwards syndrome
_____ is predominantly at risk for FGR, with 35% of these fetuses having FGR
trisomy 18
______ account for 5% of FGR cases.
congenital infections
______ is associated with the majority of cases of FGR.
placental insufficiency
Alterations in the ____ and _____ circulations are the most common placental conditions.
ureteroplacental
fetal placental
Incomplete trophoblastic invasion of the spiral arteries in the placental bed causes:
diminished maternal ureteroplacental blood flow
Reduced maternal uteroplacental function leads to:
inadequate supply of nutrients and oxygen to support normal aerobic growth
Villous damage to the placenta from under perfusion leads to:
increased placental resistance
_____ and ______ occur more frequently in FGR fetuses
placental abruption
placental infarcts
Two categories of FGR
symmetric
asymmetric
proportional reduction in all biometric measurements
symmetric growth restriction
Symmetric growth restriction accounts for __-__% of FGR infants
20
30
caused by a decrease in fetal cellular proliferation of all organs and is an impairment that occurs in the first or second trimester
symmetric growth restriction
occurs when an infant has a smaller abdominal size compared to head size
Asymmetric growth restriction
A head circumference to AC ratio of greater than the 95th percentile is usually used as the limit for:
asymmetric growth restriction
Asymmetric growth restriction is attributed to the ______
head sparing phenomenon
most common form of FGR occuring in 70-80% of FGR cases
asymmetric growth restriction
______ abnormalities have been suggested to be responsible for the changes in the concentration of serum placental products.
Trophoblastic invasion
In the absence of structural abnormalities or aneuploidy, an increased _______ has been linked with an increased risk of LBW
maternal AFP
A low level of ______ has been associated with LBW
pregnancy associated plasma protein A (PAPP-A)
distance from the top of the pubic symphysis to the top of the uterine fundus in centimeters
fundal height measurement
The fundal height measurement in centimeters should equal:
the gestational age in weeks
After 20 weeks, a difference greater than __cm in fundal height is suspicious for fetal growth restriction
3
It is still recommended by the ACOG that a fundal height measurement be done at every prenatal visit after ___ weeks
24
Obtaining measurement such as ___, ___, ____, and ____ can be used to calculate EFW
BPD
AC
HC
FL
The _____ formula is consistently better than other formulas
Hadlock
