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OB/GYN II DMS 250 > Fetal Growth Assessment Chapter 51 > Flashcards

Fetal Growth Assessment Chapter 51 Flashcards

0
Q

Between 38-42 weeks is called?

A

At term

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1
Q

Before 38 weeks is called?

A

Preterm

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2
Q

Later than 42 weeks is called?

A

post term

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3
Q

Decreased rate of fetal growth is known as what?

A

Intrauterine Growth Restriction (IUGR)

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4
Q

IUGR complicates less than _____% of pregnancies.

A

<10%

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5
Q

Fetal weight is at or below _____% for IUGR.

A

10%

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6
Q

IUGR posts a greater risk for what?

A

antepartum death, perinatal asphyxia, neonatal morbidity, later developmental problems, mortality increases six to ten fold

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7
Q

A fetus below the 10th percentile without reference to cause is considered what?

A

SGA (small for gestational age)

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8
Q

_____________ is a subset of the SGA as a result of a pathologic process.

A

IUGR

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9
Q

The causes for IUGR include….

A
  • Maternal Disease States - DM (diabetes mellitus), SLE (Systemic Lupus Erythematosus), HTN
  • Placental - Uteroplacental Insufficiency - UPI
  • Fetal - genetic/chromosomal
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10
Q

Extensive, primary placental infarctions leads to ________.

A

UPI

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11
Q

Maternal and placental factors lead to what?

A

asymmetric IUGR

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12
Q

Fetal factors for IUGR are associated with what?

A

symmetric IUGR

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13
Q

Describe symmetric IUGR.

A
  • Result of a long standing and/or severe maternal/placental cause.
  • Chromosomal/genetic anomalies
  • Infection (TORCH)
  • Associated with first trimester insults
  • Proportionally small in all physical parameters due to earlier impact
  • May appear sonographically BEFORE 20 weeks
  • Approximately 20% to 30% of all IUGR cases are symmetric
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14
Q

Describe asymmetric IUGR.

A
  • Cause usually related to maternal disease states or later developing placental causes
  • **last 8-10 weeks of pregnancy
  • Disproportionate growth of head/abdomen
  • Brain sparing - brain takes blood it needs at cost of abdomen growth
  • **typically develops AFTER 24 weeks
  • ***more common than symmetric
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15
Q

***The single most sensitive indicator of IUGR is?

A

AC -abdomen circumference

16
Q

The most important ratio sonographically for IUGR is what?

A

HC/AC

17
Q

Sonographic Parameters of IUGR include…

A
  • Oligohydramnios
  • Advanced placental grading (III between 34 to 36 weeks)
  • Thin placenta
  • Delayed appearance of epiphyseal sites
  • Elevated RI’s cord Doppler - increased Doppler resistance/impedance
18
Q

Biophysical Profile (BPP) assesses:

A
  • fetal breathing
  • fetal body movement
  • fetal muscle tone
  • AFI
  • fetal heart rate changes (assessed with NST not US)
19
Q

When does the CNS mature?

A

24 weeks & up

20
Q

What is acute hypoxia?

A

decrease in breathing, movement, and heart rate activity

21
Q

What is severe acute hypoxia?

A

absence of movement/tone

22
Q

What is chronic hypoxia?

A

result of UPI; oligo & decreased movement is common

23
Q

For BPP fetal breathing movements what must be seen?

A
  • inward movement of chest wall with outward movement of abdominal wall
  • 2 points if one episode of breathing lasts 30-60 sec within 30 minutes
  • If absent no points are given
24
Q

For BPP, what do you need to see for fetal gross movement?

A
  • Three definite extremity or trunk movements in 30 minutes for 2 points
  • Fewer than three scores zero points
25
Q

For BPP, what do you need to see for AFI?

A
  • 4 quadrants
  • largest vertical pocket measured
  • 1 pocket must measure at least 2 cm in two perpendicular planes
  • exclude fetal limbs or cord
  • normal is 5 to 22 cc based on age
26
Q

For BPP fetal tone, what needs to be seen?

A
  • extension and flexion of extremity or spine
  • one episode in the 30 minutes score 2 points
  • no episode scores 0 points
27
Q

What are the two types of Umbilical Cord Doppler?

A

Quantitative - measure velocity

Qualitative - Characteristics of wave form

28
Q

S/D of more than _______ in umbilical artery after 30 weeks is abnormal should never have absent or reversed end diastolic flow.

A

3.0

29
Q

S/D of more than ______ in the maternal uterine artery is abnormal with diastolic notching after 22 weeks.

A

2.6

30
Q

Fetus with IUGR- increase in vascular resistance/impedance reflects what?

A

Increased S/D ratio and RI

31
Q

Macrosomia is classically defined as….

A

birth weight of 4000 g or greater or above 90th percentile for estimated gestational age

32
Q

What two terms relate to macrosomic fetuses?

A

mechanical macrosomia and metabolic macrosomia.

33
Q

What are the three types of mechanical macrosomia?

A
  1. Fetuses generally large
  2. Fetuses generally large but with especially large shoulders
  3. Fetuses with normal trunk but large head
34
Q

Placental thickness greater than _____ is considered thick when measurement taken at right angles to its long axis

A

5 cm

OB/GYN II DMS 250 (1 decks)

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