Chapter 53 Flashcards by Sophia Fain

Intrauterine Growth Restriction (IUGR)

decreased rate of fetal growth

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IUGR is commonly defined as

fetal weight at or below 10% for given gestational age

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significant maternal factors for IUGR

previous history of fetus with IUGR
significant maternal hypertension
history of tobacco use
presence of uterine anomaly
significant placental hemorrhage
placental insufficiency

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Small Gestational Age (SGA)

weight below 10th percentile WITHOUT reference to cause

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subset of SGA fetuses with weight below 10th percentile is a result of

pathologic process from variety of maternal, fetal, & placental disorders

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what is one of the most severely affected organs which therefore alters AC measurement in IUGR

fetal liver

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symmetric IUGR result of 1st trimester insult

chromosomal abnormality or infection

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symmetric IUGR results in fetus as

proportionately small throughout pregnancy

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asymmetric IUGR begins late in

2nd or 3rd trimester

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asymmetric IUGR usually results from

placental insufficiency

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clinical signs of IUGR

decreased fundal height & fetal motion

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key IUGR sonographic markers

grade 3 placenta before 36 weeks or decreased placental thickness

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with IUGR you assess umbilical artery doppler for

increase resistance to flow

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what happens if you use BPD alone in fetus with unusual head shape

poor indicator of IUGR

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HC to AC ratio is useful in

determining type of IUGR

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FL may decrease in size with

symmetric IUGR

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AC is the single most

indicator of IUGR

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EFW parameters

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oligohydramnios occurs if

fetal urine output reduced

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polyhydramnios develops if

fetus cannot swallow

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amniotic fluid pocket may represent IUGR if it is less than

1 to 2 cm

normal AFI should range between

8 and 22 cm

what is not always associated with IUGR

oligohydramnios

5 parameters of BPP

cardiac nonstress test (NST)
observation of fetal breathing movements (FMB)
gross fetal body movements (FM)
fetal tone (FT)
amniotic fluid volume (AFV)

what is BPP specified time limit to observe parameters

30 minutes

what is the score of each variable arbitrarily

2 when normal 0 when abnormal

what is the BPP scare to be considered normal

8 to 10

what score has no immediate significance

4 to 6

score 0 to 2 indicates either

immediate delivery or extending test to 120 minutes

what is the alternative area to watch for breathing

fetal kidney movement in longitudinal plane

2 points are given if one episode of breathing lasts

30 seconds within 30 minute period

what happens if fetal breathing movements are absent

no points are given

fetal central nervous system initiates and regulates what

frequency of fetal breathing movements (patterns vary with sleep-wake cycles)

2 points given with fetal breathing movement when

one episode for 30 seconds continuous during 30 minute observation

2 points given with gross body movement when

at least 3 distinct body or limb movements in 30 minutes unprovoked (continuous movement for 30 minutes should be counted as 1 movement)

BPP of fetal tone

active extension and flexion of 1 episode of limbs or trunk

BPP of fetal heart rate (FHR)

at least 2 episodes of FHR changes of 15 bpm and at least 15 seconds duration in 20 minute period (also known as NST)

BPP of amniotic fluid index (AFI)

1 pocket of amniotic fluid at least 2 cm in two perpendicular places or AFI total fluid measures of 8 to 22 cm

NST is done using doppler to record

FHR and reactivity to stress of uterine contraction

time expended for NST

40 minutes

with NST fetal motion detected as

rapid rise on recording of uterine activity or patient noting fetal movements

increased vascular resistance to fetus is reflected by an

increase in both s/d ratio and pulsatility index

Macrosomia is classically defined as

birth weight of 4000 g or greater or above 90th percentile for estimated gestational age

macrosomia is shown to be 1.2 to 2 times more frequent than normal women who

- are multiparous - are 35 years or older - have prepregnancy weight of > 70 kg (154 lb) - have PI in upper 10% - have pregnancy weight gain of ≥ 20 kg (44 lb) - have a postdate pregnancy - have history of delivering LGA fetus

macrosomia is a common result of

poorly controlled maternal diabetes mellitus

malformation syndromes in which fetal increase in size, with or without organomegaly

- Beckwith Wiedmann syndrome - Marshall Smith syndrome - Sotos' syndrome - Weaver's syndrome

macrosomic fetus has increase incidence of morbidity and mortality as a result of

head and shoulder injuries and cord compression

2 terms relating to macrosomic fetuses

- mechanical macrosomia - metabolic macrosomia

3 types of mechanical macrosomia identified

- fetuses generally large - fetuses generally large but with especially large shoulders - fetuses with normal trunk but large head

placentas can become significantly large and thick because

not immune to growth enhancing effects of fetal insulin

placental thickness > 5 cm is considered thick when

measurement is taken at right angles to its long axis

calculating macrosomic index can be performed by

subtracting the BPD from the chest circumference