Fetal Complications of Pregnancy

Question 1

Definition of small for gestational age (SGA)

Answer 1

EFW < 10th percentile; Factors that result in infants being SGA can be divided into:

• decreased growth potential
• intrauterine growth restriction (IUGR)

Question 2

Definition of large for gestational age (LGA)

Answer 2

EFW > 90th percentile

Question 3

Definition of intrauterine growth restriction (IUGR)

Answer 3

Fetus whose growth has been interfered by some pathologic fashion

Question 4

Decreased growth potential examples

Answer 4

• Genetic and chromosomal abnormalities
• Intrauterine infections
• Teratogenic exposure
• Substance abuse
• Radiation exposure
• Small maternal stature
• Pregnancy at high altitudes
• Female fetus

Question 5

Intrauterine growth restriction causes

Answer 5

Maternal:
- Hypertension
- Anemia
- CRD
- Malnutrition
- Severe diabetes
Placental:
- Placenta previa
- Chronic abruption
- Placental infarction
- Multiple gestations

Question 6

Two phases of fetal growth and results if insult

Answer 6

Hyperplastic: before 20 wks, symmetric
Hypertrophic: after 20 wks, if prolonged, asymmetric

Question 7

Doppler investigation of umbilical artery shouldn’t show a reversal or decrease of blood flow during diastole larger than ____

Answer 7

50-80%

Question 8

Tests to assess risk of prolonging SGA gestation

Answer 8

Nonstress test (NST), oxytocin challenge test (OCT), biophysical profile (BPP) and umbilical Doppler velocimetry; if testin is nonreassuring → delivery

Question 9

Definition of macrosomia

Answer 9

Birth weight >4500 g

Question 10

Calculation of amniotic fluid index (AFI)

Answer 10

Divide maternal abdomen in to quadrants, measure the largest vertical pocket of fluid in each quadrant and sum them

Question 11

Definition of oligohydramnios

Answer 11

AFI < 5

Question 12

Definition of polyhydramnios

Answer 12

AFI > 20-25

Question 13

Classification of polyhydramnios

Answer 13

• Mild AFI 25-30 or DVP 8-12
• Moderate AFI 30-35 or DVP 12-16
• Severe AFI >35 or DVP >16

Question 14

Definition of fetal hydrops

Answer 14

Accumulation of fluid in the extracellular space in at least 2 body compartments

Question 15

Syndrome of fetal hydrops

Answer 15

• Hyperdynamic state
• High-output heart failure
• Diffuse edema
• Ascites
• Pleural/pericardial effusion

Question 16

When is RhoGAM administered in the unsensitized mother with Rh+ fetus?

Answer 16

At 28 weeks and postpartum; any other time when the mother might be exposed to fetal blood

Question 17

What should be done if suspicion that mom may be exposed to >30 mL of fetal blood?

Answer 17

Kleihauer-Betke test; perhaps more RhoGAM doses

Question 18

What should be done if mom is Rh sensitized?

Answer 18

Blood type of father to determine fetus’ risk; check titer every 4 weeks, if > 1:16 amniocentesis as early as 16-20 wks to test fetus’ Rh status; if positive, screen for fetal anemia using fetal middle cerebral artery (MCA) Doppler measurements

Question 19

Liley curve zones

Answer 19

• Zone 1, follow-up 2-3 wks
• Zone 2, follow-up 1-2 wks
• Zone 3, likely that fetus has anemia

Question 20

Management and treatment of fetal anemia

Answer 20

Percutaneous umbilical blood sampling (PUBS) to measure hematocrit and verify anemia; treat with intrauterine transfusion (IUT)

Question 21

Which antibodies lead to suppression of marrow besides hemolytic anemia?

Answer 21

anti-Kell