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OBGYN > Fetal complications of pregnancy > Flashcards

Fetal complications of pregnancy Flashcards

1
Q

Growth disorders

A

If fundal ht differs by 3cm or more, get an U/S

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2
Q

SGA

A

< 10th %ile
Symmetric = think early insult
Asymmetric = think later
Skull > rest of body

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3
Q

Decreased growth potential

A

Trisomies, Turner, OI (osteogenesis imperfect), achondroplasia, NTDs, anencephaly, or intrauterine infections like CMV / rubella, or teratogens like chemo

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4
Q

IUGR:

A

Generally asymmetric (not enough nutrients getting across)

A/w smoking, antiphospholipid Ab, SLE, malnutrition, severe chronic renal dz, HTN, anemia in mom, or placental insufficiency (previa / marginal insertion / thrombosis +/- infarction), or multiples

Check cord doppler to see how placenta’s doing

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5
Q

Twin-twin transfusion should be suspected if

A

One big, one small twin

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6
Q

Monitor SGA with fetal testing

A

NST/OCT (oxytocin challenge test), BPP, and/or umbilical doppler

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7
Q

LGA

A

> 90th %ile

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8
Q

Macrosomia

A

= birth wt > 4,500g officially, but some use other definitions - e.g. to offer C/S if 3500g in diabetic mom, or 4000g otherwise

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9
Q

Risks of macrosomia

A

Big risk shoulder dystocia, brachial plexus injuries, low Apgars, hypoglycemia, polycythemia, hypoCa, jaundice; also childhood leukemia, Wilms tumor, osteosarcoma

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10
Q

Macrosomia is associated with

A

Maternal obesity, gDM or cDM, postterm, multiparity, AMA

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11
Q

Amniotic fluid disorders:

A

Max volume 800mL @ 28wks, then falls to 400mL by 40wks

AFI normal range: 5 to 20-25 (varies by EGA)

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12
Q

Oligohydramnios: Definition

A

AFI < 5

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13
Q

Oligohydramnios: Presenting symptoms

A

See nonreactive NST, FHR decels, meconium

Can lead to cord compression!

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14
Q

Oligohydramnios: Etiology

A

Not making (GU disorders: renal agenesis, polycystic kidney, obstruction; also chronic uteroplacental insufficiency) or losing too much (ROM) amniotic fluid.

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15
Q

Oligohydramnios: Management

A

Check BPP, cord doppler, U/S for anomalies
Induce if ROM at term
Can do amnioinfusion to decrease # of variable decels / “dilute meconium”

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16
Q

● Polyhydramnios: Definition

A

AFI > 20-25

Not as worrisome.

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17
Q

Polyhydramnios: Etiology

A

Not swallowing (GI tract abnormality, duodenal atresia), or making too much (infants of diabetic mothers → osmotic diuretic; or high-output cardiac failure / TTTS- twin twin transfusion syndrome)

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18
Q

Polyhydramnois: risk

A

Risk of cord prolapse

Only AROM if sure that head is engaged; check for cord after SROM

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19
Q

Rh incompatibility Management

A

All this applies to Rh negative moms only
RhoGAM (anti-D IgG)
If already sensitized, follow with middle cerebral artery dopplers (faster = more anemic); (spectrophotometer is another way, older)
Can do PUBS (Percutaneous Umbilical Cord Blood Sampling) / in utero transfusion if really anemic

20
Q

When to give RhoGAM

A

At 28 wks
Postpartum if neonate is Rh positive
Any time there’s bleeding!

21
Q

What is the dose of RhoGAM?

A

0.3mg = 1 dose

22
Q

How much fetal RBCs dose one dose of RhoGAM eradicate?

A

1 dose = eradicates 15 mL fetal RBCs. Good enough for normal delivery
Can do Kleihauer-Betke to quantify if abruption, antepartum bleeding

23
Q

Hydrops

A

Erythroblastosis fetalis
Heart failure, diffuse edema, fluid in 2+ compartments (ascites /pleural / pericardial effusions), all 2/2 anemia. Jaundice / neurotoxic effects of bilirubin too, but only after delivery (placenta clears it during pregnancy)

24
Q

Other causes of hydrops

A

Manage all with antibody titers, amnio, MCA doppler, PUBS / transfusion

Kelly kills = anti-Kell1 = hydrops
Duffy dies = anti-Duffy = hydrops
Lewis lives = anti-Lewis = cause mild hemolytic anemia
ABO causes mild hemolysis too

25
Q

Fetal demise Dx

A

If no explanation, usually attributed to a “cord accident”

Dx: lack of uterine growth, falling hCG, U/S (<20wks) or lack of fetal movement (> 20 wks)

26
Q

Fetal demise risk after 3-4 weeks

A

If > 3-4 wks, can lead to hypofibrinogenemia 2/2 release of thromboplastic substance from decomposing fetus, and even to DIC! so get a fibrinogen level!

27
Q

Fetal demise & multiples:

A

If one baby dies in utero, check fibrinogen level qweek / biweekly, esp if unusual bleeding (fibrinogen may decrease → coagulopathy!)

28
Q

Spalding sign

A

Overlapping of fetal skull bones suggesting fetal demise

29
Q

Tx of fetal demise

A

D&E if early, or induction of labor (prostaglandins / high dose oxytocin) if late.

30
Q

Work up after fetal demise

A

Test for TORCH, fetal karyotype, screen for collagen vascular dz / coagulopathies, get fetal autopsy

31
Q

Postterm pregnancy:

A

> 42 wks. Get a nst at 40 and 41 weeks - don’t just send home!

32
Q

Risks of postterm pregnancy

A

Higher risk to mom & baby

Macrosomia, oligo, meconium aspiration, intrauterine demise, dysmaturity syndrome - look like old man!

33
Q

1 cause of postterm pregnancy

A

Inaccurate dating

34
Q

Management of postterm pregnancy

A

Manage with more frequent visits, fetal testing (NST in wk 40, BPP & NST in 2 visits in wk 41)

Induce if nonreassuring testing or electively if Bishop > 6 @ wks 40-41; or no matter what > 42

35
Q

Risk of multiples:

A

Higher risk preterm delivery, congenital abnormalities, SGA, malpresentation.

36
Q

Twins delivery

A

Usually wks 36-37
Push up testing too
Twin delivery: Can do TOL if vtx/vtx or vtx/breech if twins concordant / presenting twin is larger & vtx (grab smaller second twin & pull out breech!)

37
Q

Triplets delivery

A

Usually wks 33-34
Push up testing too!
Triplet delivery: only if vtx/vtx/vtx (rare), usually C/S. Also C/S for more than 3.

38
Q

Dizygotic twins:

A

2 ova, 2 sperm. increased FSH can be hereditary, so dizygotic twins can be too

39
Q

Monozygotic twins:

A

Division of fertilized egg

40
Q

Dichorionic / diamniotic

A

DiDi if divides on days 1-3

All dizygotic twins are DiDi
Monozy twins can be whatever

DiDi: best outcome
See twin peak sign later in pregnancy

41
Q

Monochorionic / diamniotic

A

MoDi if divides on days 4-8
See two amniotic sacs, one chorion early on U/S.
Risk TTTS (twin twin transfusion syndrome)

42
Q

Monochorionic / monoamniotic

A

MoMo if divides on days 8-13

Risk conjoinment, fetal death 2/2 cord entanglement, etc.

43
Q

Conjoined

A

Conjoined if divides on days 13-15

44
Q

Selective reduction

A

Can consider selective reduction if triplets or above

45
Q

Twin-twin transfusion syndrome (TTTS, aka poly-oli sequence)

A

One small, oligohydramnios, growth restriction, anemia twin (donor), large, plethoric, hypervolemic, cardiac failure, polyhydramnios polycythemic / hydropic twin (recipient)

46
Q

Dx of TTTS

A

Dx with ultrasound, historically managed with serial amnioreduction, but now laser coagulation of artery by fetal surgeons improves outcomes.

OBGYN (32 decks)

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