fetal complications part I Flashcards

1
Q

IUGR vs SGA

A
  • IUGR = small b/c of pathology

- SGA = small, <10th percentile

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2
Q

causes of symmetric vs asymmetric IUGR

A
  • HC vs AC

symmetric

  • early insults
  • genetics, infections

asymmetric

  • later insult
  • placental insufficiency
  • impair cell hypertrophy
  • AC lags first (liver)
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3
Q

most important RF for IUGR

A

hx of IUGR

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4
Q

causes of IUGR

A

Fetal

  • chromosomal/trisomy
  • anomalies
  • infection (rarer): CMV, rubella, toxo, HSV, varicella, syphilis (TORCH)

Placenta

  • infarction
  • previa
  • circumvallate
  • prolonged preg
  • accreta
  • twins: fall off at 28wks

Mom

  • vascular: HTN disorder, DM
  • maternal hypoxemia (cyanotic heart disease, obstructive lung)
  • caloric restriction
  • smoking
  • alcohol, coumarin, hydantoin
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5
Q

risks of IUGR

A
  • asphyxia - diminished placental reserve
  • cord compression from oligo
  • hypoglycemia - less glycogen
  • hypoparathyroidism -> hypocalcemia
  • hyperP - tissue breakdown
  • hypoNa - renal function
  • polycythemia from hypoxia -> hyperbilirubinemia
  • childhood metabolic syndrome?
  • neurologic?
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6
Q

diagnosing IUGR

A
  • accurate dates - first trim US CRL
  • HC, AC, BPD, FL on US
  • HC/AC ratio - elevated in asymmetrical (is 1 at 32 wks)
  • FL/AC if HC can’t be measured (>23.5 - elevated after 21 wks)
  • fluid <2cm associated /w IUGR
  • EFW (not that accurate)
  • serial assessments helpful

FL/AC + fluid doesn’t rely on dates, use if inaccurate dating

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7
Q

management of IUGR

A

deliver if:

  • abnormal function
  • no growth
  • severe oligo

tx etiology

  • stop smoking, EtOH, drugs
  • tx HTN, asthma, IBD
  • rest may me helpful
  • adequate diet

US for congenital abnormalities:
- symmetric: follow /w cord sample, placental biopsy or amnio if desired to r/o lethal anomalies

monitor:

  • US for growth every 2-3 wks
  • NST 2x/ week
  • BPP
  • dopplers
  • no consensus on how often

if unknown dates:
- growth rate below 5th percentile prob IUGR

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8
Q

intrapartum management of IUGR

A
  • cont FHR monitor
  • scalp pH if needed
  • consider C/S if deterioration antepartum and cervix is unfavorable (vs induction)
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9
Q

causes of congentical anomalies

A
chromosomal
genetic
drugs/chemicals
infection
radiation
unknown - most
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10
Q

screening/RF for congenital anomaly

A
  • AMA (aneuploidy)
  • Ethicities: Jews, Frnch Can, Cajun (tay sachs), CF (whites), Asian, African (alpha thal), Mediterranian, SEA (beta thal), sickle cell (african)
  • prev hx
  • parental carrier of balanced rearragnement
  • multiple losses
  • consanguinity

Current preg with:

  • US abnormality
  • abnormal serum marker
  • exposure to teratogen
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11
Q

counselling process

A
  • questionnaire
  • 3 gen pedigree
  • non directive
  • after birth of abnormal neonate, wait 6 wks for definitive counselling
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12
Q

polyhydramnios definition + causes

A
  • AFI >25cm or max vertical pocket >8cm
  • anencephaly
  • absent stomach
  • esophag or duodenal atresia
  • tracheo esoph fistula
  • neuromusc disese
  • maternal DM (milder)
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13
Q

oligohydramnios

A
  • AFI <5cm or max pocket <3
  • IUGR
  • renal agenesis
  • bladder neck obstruction
  • fetal chromosomal abnormalities
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