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OBGYN > Chapter 53 > Flashcards

Chapter 53 Flashcards

1
Q

Intrauterine Growth Restriction (IUGR)

A

decreased rate of fetal growth

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2
Q

IUGR is commonly defined as

A

fetal weight at or below 10% for given gestational age

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3
Q

significant maternal factors for IUGR

A
  • 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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4
Q

Small Gestational Age (SGA)

A

weight below 10th percentile WITHOUT reference to cause

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5
Q

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

A

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

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6
Q

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

A

fetal liver

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7
Q

symmetric IUGR result of 1st trimester insult

A

chromosomal abnormality or infection

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8
Q

symmetric IUGR results in fetus as

A

proportionately small throughout pregnancy

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9
Q

asymmetric IUGR begins late in

A

2nd or 3rd trimester

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10
Q

asymmetric IUGR usually results from

A

placental insufficiency

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11
Q

clinical signs of IUGR

A

decreased fundal height & fetal motion

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12
Q

key IUGR sonographic markers

A

grade 3 placenta before 36 weeks or decreased placental thickness

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13
Q

with IUGR you assess umbilical artery doppler for

A

increase resistance to flow

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14
Q

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

A

poor indicator of IUGR

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15
Q

HC to AC ratio is useful in

A

determining type of IUGR

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16
Q

FL may decrease in size with

A

symmetric IUGR

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17
Q

AC is the single most

A

indicator of IUGR

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18
Q

EFW parameters

A
  • BPD
  • HC
  • AC
  • FL
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19
Q

oligohydramnios occurs if

A

fetal urine output reduced

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20
Q

polyhydramnios develops if

A

fetus cannot swallow

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21
Q

amniotic fluid pocket may represent IUGR if it is less than

A

1 to 2 cm

22
Q

normal AFI should range between

A

8 and 22 cm

23
Q

what is not always associated with IUGR

A

oligohydramnios

24
Q

5 parameters of BPP

A
  1. cardiac nonstress test (NST)
  2. observation of fetal breathing movements (FMB)
  3. gross fetal body movements (FM)
  4. fetal tone (FT)
  5. amniotic fluid volume (AFV)
25
Q

what is BPP specified time limit to observe parameters

A

30 minutes

26
Q

what is the score of each variable arbitrarily

A

2 when normal
0 when abnormal

27
Q

what is the BPP scare to be considered normal

A

8 to 10

28
Q

what score has no immediate significance

A

4 to 6

29
Q

score 0 to 2 indicates either

A

immediate delivery or extending test to 120 minutes

30
Q

what is the alternative area to watch for breathing

A

fetal kidney movement in longitudinal plane

31
Q

2 points are given if one episode of breathing lasts

A

30 seconds within 30 minute period

32
Q

what happens if fetal breathing movements are absent

A

no points are given

33
Q

fetal central nervous system initiates and regulates what

A

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

34
Q

2 points given with fetal breathing movement when

A

one episode for 30 seconds continuous during 30 minute observation

35
Q

2 points given with gross body movement when

A

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

36
Q

BPP of fetal tone

A

active extension and flexion of 1 episode of limbs or trunk

37
Q

BPP of fetal heart rate (FHR)

A

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

38
Q

BPP of amniotic fluid index (AFI)

A

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

39
Q

NST is done using doppler to record

A

FHR and reactivity to stress of uterine contraction

40
Q

time expended for NST

A

40 minutes

41
Q

with NST fetal motion detected as

A

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

42
Q

increased vascular resistance to fetus is reflected by an

A

increase in both s/d ratio and pulsatility index

43
Q

Macrosomia is classically defined as

A

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

44
Q

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

A
  • 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
45
Q

macrosomia is a common result of

A

poorly controlled maternal diabetes mellitus

46
Q

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

A
  • Beckwith Wiedmann syndrome
  • Marshall Smith syndrome
  • Sotos’ syndrome
  • Weaver’s syndrome
47
Q

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

A

head and shoulder injuries and cord compression

48
Q

2 terms relating to macrosomic fetuses

A
  • mechanical macrosomia
  • metabolic macrosomia
49
Q

3 types of mechanical macrosomia identified

A
  • fetuses generally large
  • fetuses generally large but with especially large shoulders
  • fetuses with normal trunk but large head
50
Q

placentas can become significantly large and thick because

A

not immune to growth enhancing effects of fetal insulin

51
Q

placental thickness > 5 cm is considered thick when

A

measurement is taken at right angles to its long axis

52
Q

calculating macrosomic index can be performed by

A

subtracting the BPD from the chest circumference

OBGYN (2 decks)

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