Exam 3 - Fetal Complications

Question 1

How is fetal growth restriction identified?

Answer 1

Ultrasound - based on estimated fetal growth below 10% for gestational age or small for gestational age

Question 2

When should intrauterine growth restriction be noted during routine prenatal care visits?

Answer 2

• Poor maternal weight gain
• Lagging fundal height
• Prescence of other maternal risk factors
  
  • Smoking
  • Preeclampsia
  • Infections
  • High altitude

Question 3

What is considered symmetrical IUGR?

Answer 3

Fetal body and fetal head are equally small and rank in the same percentile

Question 4

Symmetrical IUGR is caused by what?

Answer 4

Congenital anomalies associated with

• Severe maternal malnutrition, low pre-pregnancy weight, poor weight gain
• Multiple gestation
• Chromosomal abnormalities
• Perinatal infections
• Exposure to drugs or environmental teratogens

Question 5

Is prognosis for the fetus good or bad with symmetrical IUGR?

Answer 5

Poor

Question 6

What is asymmetrical IUGR?

Answer 6

Fetal head is normal size and fetal abdomen is smaller

Question 7

What causes asymmetric IUGR?

Answer 7

Decreased placental blood flow or decreased oxygenation to fetus

• Estimated fetal weight <10th percentile but head circumference is >10 percentile

Question 8

What conditions are associated with asymmetric IUGR?

Answer 8

• Maternal HTN
• Renal disease
• Microvascular disease of diabetes
• Heart disease
• Hemoglobinopathy
• Collagen vascular disease

Question 9

What conditions must be met to be considered fetal death (formerly stillbirth)?

Answer 9

Fetal loss after 20 weeks or when fetal weight is >350 g

Question 10

What is the first clinical sign of intrauterine fetal demise (IUFD)?

Answer 10

Patient’s perception of decreased or loss of fetal movement, undetectable fetal heart tones

Question 11

How would the provider confirm IUFD?

Answer 11

Ultrasound

• Accompany patient to ultrasound and notify technician that heart tones could not be heard

Question 12

How should the provider manage IUFD?

Answer 12

Expectant management - majority will go into spontaneous labor within 2 weeks following fetal demise

Induction of labor for delivery

• Most prefer not to wait more than one day or two; short wait may allow faily to grieve, mother to be supported by family and loved ones

Question 13

What myths should the provider dispel in terms of IUFD?

Answer 13

Not mother’s fault (e.g. a fall, raising arm over head, lifting heavy objects, consuming alcohol)