fetal complications part I Flashcards
1
Q
IUGR vs SGA
A
- IUGR = small b/c of pathology
- SGA = small, <10th percentile
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)
3
Q
most important RF for IUGR
A
hx of IUGR
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
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?
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
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
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)
9
Q
causes of congentical anomalies
A
chromosomal genetic drugs/chemicals infection radiation unknown - most
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
11
Q
counselling process
A
- questionnaire
- 3 gen pedigree
- non directive
- after birth of abnormal neonate, wait 6 wks for definitive counselling
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)
13
Q
oligohydramnios
A
- AFI <5cm or max pocket <3
- IUGR
- renal agenesis
- bladder neck obstruction
- fetal chromosomal abnormalities