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OB/GYN > fetal complications of pregnancy > Flashcards

fetal complications of pregnancy Flashcards

1
Q

what is SGA? LGA?

A

small for gestational age - < 10%ile

large for gestational age - > 90th %ile

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2
Q

how does an asymmetric SGA baby look?

A

torso & extremities are smalll but skull is normal.

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3
Q

what is decreased growth potential?

A

factors that result in SGA 2/2 congenital abnormalities, chromosomal disorders, intrauterine infections, teratogens.

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4
Q

what are the 2 most common teratogens causing SGA?

A

alcohol

cigarettes

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5
Q

what are the 2 phases of fetal growth?

A

hyperplasia before 20 weeks

hypertrophic after 20 weeks

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6
Q

an insult causing growth restriction prior to 20 weeks will most likely => what kind of growth restriction?

A

symmetric

asymmetric after 20 weeks

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7
Q

which is more common, asymmetric or symmetric IUGR?

A

asymmetric

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8
Q

what causes asymmetric IUGR?

A

decreased nutrition & o2 delivery to baby

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9
Q

IUGR can be caused by what 2 types of factors?

A

placental

maternal

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10
Q

any time a fundal height is _____ less than expected, an u/s s/b ordered to check fetal growth.

A

3 cm

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11
Q

how should umbilical a. flow look?

A

higher during systole but only drops by 50 to 80% during diastole.
Never any reversal of flow.

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12
Q

what is aspirin used for during pg’y?

A

low-dose aspirin c/b given in cases of SGA in moms w/a hx of placental insuff’y, preeclampsia, collagen vasc disorders, vascular dis

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13
Q

T or F: an SGA infant who has been small throughout pregnancy should be induced.

A

F. Only if fetal status is nonreassuring

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14
Q

how to manage SGA babies?

A

frequent NSTs, OCTs, BPPs, weekly u/s for growth monitoring, antenatal corticosteroids

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15
Q

what is macrosomia?

A

birth weight > 4.5kg

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16
Q

what is most common RF for macrosomia?

A

pregestational or gestational DM

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17
Q

other RFs for macrosomia?

A 
maternal obesity
postterm pg'y
previous LGA 
maternal stature
multiparity
AMA
male infant
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18
Q

mgt of LGA babies:

A

if GDM, control sugars well!
if obese mom, gain less weight (but don’t lose)
induce labor before macrosomia happens, maybe elective c/s, otherwise prepare for shoulder dystocia with vag delivery

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19
Q

LGA babies are at higher risk for what?

A 
birth trauma
hypoG
jaundice
lower Apgar scores
childhood tumors
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20
Q

what is AFI?

A

amniotic fluid index, meas’d by u/s
< 5 is oligohydramnios
> 20 is polyhydramnios

21
Q

what is the most common cause of oligohydraminos?

A

ROM

22
Q

other causes of oligohydramnios?

A

renal agenesis
PCKD
GU system obstr’n
uteroplacental insuff’y

23
Q

mgt of oligohydramnios:

A

if IUGR, obtain BPP, umb a. doppler flow, GA, find cause of IUGR.
Induce if at term.
refer to genetic counseling if congenital abnormalities.
if ROM at term but not in labor, induce.
Amnioinfusion if meconium present or frequent decels

24
Q

which is mroe concerning, oligohydramnios or polyhydramnios?

A

oligo

25
Q

what is polyhydramnios ass’d with?

A

congenital anomalies.

seen in pg’ies w/ DM, hydrops, multiple gestation

26
Q

causes of polyhydramnios

A

GI tract obstruction
DM (increased G => osmotic diuresis)
hydrops 2/2 high-output HF
multiple gestation twin-twin transfusion syndrome

27
Q

what m/b considered when doing an AROM in a pt w/ polyhydramnios?

A

only do it if head is truly engaged in pelvis, b/c increased risk of cord prolapse w/polyhydramnios

28
Q

what is erythroblastosis fetalis (hydrops fetalis)?

A

when Rh- moms make antibodies against Rh+ fetal Ag’s that enter mom’s blood transplacentally and cause anemia in fetus.

29
Q

nat hist of hydrops fetalis

A

heart failure, diffuse edema, ascites, pericardial effusion, jaundice, kernicterus

30
Q

what to do for unsensitized Rh - pts?

A

draw an Ig screen at first prenatal visit. Give RhoGam at 28 weeks and postpartum if neonate is Rh+.

31
Q

what to do for a sensitized Rh - pt?

A

draw antibody titers at initial visit and follow them q4weeks. If titer is < 1:16, expectant management. If > 1:16, do serial amnios to analyze fetal cells for Rh factor.

32
Q

what to do if you have a sensitized Rh- mom, Rh+ baby detected on amnio?

A

serial amnios to eval for amt of biliriubin, indicating amt of hemolysis. Use Liley curve to predict severity of disease. If zone 3 of lLiley curve, do intrauterine transfusion

33
Q

RhoGam should not only be given to Rh- women who are currently pregnant, but who else?

A

Rh- women who have miscarried, placental abruption, undergoing amniocentesis, or with ectopic pg’y

34
Q

what can happen with a retained POC in intrauterine fetal demise?

A

if retained longer than 3-4weeks, hypofibrinogenemia, DIC

35
Q

postterm pg’ies are at increased risk of what?

A

fetal demise
macrosomia
meconium aspiration
oligohydramnios

36
Q

what is most common reason for postterm pg’y?

A

inaccurate dating

37
Q

mgt of postterm pg’y:

A

NST at 41w
induce labor if non-reassuring fetal testing
NST and BPP at 42w
induce regardless if beyond week 42

38
Q

how are monozygotic twins formed?

A

a fertilized ovum divides into 2 separate embryos

39
Q

how are dizygotic twins formed?

A

mom ovulates 2 eggs

40
Q

what is rate of twinning?

A

1 in 80

41
Q

what is average GA for delivery of twins? triplets?

A

36-37

33-34

42
Q

what is monochorionic?

A

one outer membrane

43
Q

what is diamnionic

A

two amniotic sacs (inner membranes)

44
Q

what is Mo-Di? Mo-Mo? Di-Di? Mo-Di?

A 
Mo-Di = one outer mem, 2 amniotic sacs, each has own placenta but they can fuse.  Can dvp twin-to-twin transfusion syndrome.
Mo-Mo = one outer sac, one placenta, one amniotic sac.  High mort rate 2/2 cord entanglement. 
Di-Di = zygote splits before diff'n of trophoblast => 2 chorion, 2 amnions.
Mo-Di = embryo splits after diff'ation of trophoblast but before amnion formation => one placenta, one chorion, 2 amnions.
45
Q

which form of twinning runs in famillies?

A

dizygotic

more common in African descent

46
Q

what is twin-to-twin transfusion syndrome

A

unequal flow b/w vascular communications b/w twins with a shared placenta => one twin becomes donor and the other a recipient of the unequal blood flow

47
Q

mgt of Mo-Mo twins:

A

frequent antenatal testing, early delivery via c/s

48
Q

how can twins be delivered?

A

if vertex/vertex, trial of labor.
if vertex/nonvertex, trial of labor if presenting one is larger.
C/s if nonvertex/nonvertex

OB/GYN (29 decks)

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