Fetology Flashcards
Mention causes of PTB
Fetal: PPROM, Chorioamnionitis, uterine overdistension, fetal growth abnormalities and fetal death, congenital anomalies
Maternal: uterine causes, endocrine (DM & hypothyroidism), immunological and thrombophilias, maternal infections (some chronic infections
List complications of PTL
LBwt, birth injuries, resoiratory distress, CVS, hypothermia, hyper/hypoglycemia, NEC, anemia, iatrogenic complications, neonatal mortality, hyperbilirubinemia, long-term sequalae (growth impairment, CP, impaired lungs, inc insulin resistance, high BP), recurrence.
Mention prerequisites of PTL inhibition
GA not >34 wks not <24 (26) wks
Obs conditions: no ROM, no chorioamnionitis, no APHge w/hemodynamic instability
No fetal distress, IUFD, or CFMF incompatible w/ life
Medical condition of mother: no severe maternal illness that precludes continuation of pregnancy such as severe PE OR CI to tocolysis
Mention iinvestigations done for evaluation of PTL
For mother: urine culture for asymptomatic bacteruria, GBS culture, screening for gonorrhea and chlamydia, screening for drug abuse
For fetus: US to confirm resentation, assess amniotic fluid and EFwt, NST, BPP, Doppler US as indicated
List CCC of postterm pregnancy
Fetal: Macrosomia (80%), postmaturity or dymaturity (long thin dry body with long scalp hair and nails and dec lanugo hair), non-reassuring FHR and meconium passage, oligohydramnios. Inc perinatal mortality
Maternal: obstructed labour, failed induction and inc CS
Mention CCC of of SGA
- Preterm deliver: hypothermia, hypoglycemia, impaired immune function
- Intrauterine hypoxia: polycythemia, hyperviscosity, perinatal asphxia, fetal distress
- Fetal, neonatal and perinatal mortality
Mention role of US in SGA
- Diagnosis
- Determining cause: anomaly sacn at 18-20 wks, accelerated placental aging
- Doppler study for fetal blood flow
- Associated oligohydramnios
- Type of FGR: symmetrical or asymmetrical
Prevention of SGA
Antiplatelet+/- anticoagulants in next pregnancy
Smoking cessation
Mention CCC of macrosomia
Maternal: infection, genital tract lacerations especially uterine rupture, PPhge, exhaustion
Fetal: infection, birth trauma, IChge, HIE, asphyxia, perinatal mortality,CCC of IDM
Mention CCC of oligohydramnios
During pregnancy: deformities Potter facies + lung hypoplasia + limb contracture deformities & fetal distress dt uteroplacental insufficiency and cord compression, meconium aspiration
During labour: PTL, prolonged labour
Perinatal mortality
Mention CCC of polyhydramnios
1, pressure: dyspnea, dyspepsia, pyelonephritis, PIHTN, IVC compression
2. ROM: placental abruption, splanchnic shock, PLT, CA, umbilical cord prolpapsa
3. PTL, prolonged labot, PPHge, puerperal sepsis
Mention CCC of PROM
- Oligohydramnios
- Chorioamnionitis
- PLT
- Placental abruption
- Cord complications
- VTE
- Perinatal asphyxia and fetal distress
Describe Abx regimen in PPROM
1st regimen: Ampicillin 2g/8hrs for 48 hrs followed by amoxicillin 500 mg orally 3 times per day for 5 days
Azithromycin 1 gm on admission then 5 days later
2nd regimen: erythromycin 250 mg orally/6hr for 10 days
Mention obstetric CCC of chorioamnionitis
Maternal: PTL, PPhge, puerperal sepsis, labor abnormalities
Fetal: morbidity of PTL, asphyxia, neonatal sepsis, IVH, CP
Mention diagnostic criteria for chorioamnionitis
- Maternal fever >38degC +2 or more of following
Maternal or fetal tachycardia uterine tenderness, foul odor of AF, maternal leukocytosis >15,000
Describe management of CA
Stabilize pt
Abx: ampicillin as PPROM, + gentamycin 1.5 mg/kg IV/8 hrs). Clindamycin (900 mg IV)
Delivery and postpastrum care
Describe intervention done when MCA-PSV reaches >1.5 MoM according to GA
- More than 35: TOP
- 18-35: intrauterine transfusion
- Less than 18: wait
Mention CCC of MFP
As pressure and ROM CCC in polydramnios:
Maternal medical illness: anemia, PE, GDM, HE, VTE
Anterpartum hge: PP and PA and vasa previa
Fetal CCC: abortions, congenital malormations, SGA, FGR, LBwt, IUFD, TTTS, AF disorders.
Mention indications of CS in MFP
- 1st twin breech or transverse lie
- Monoamniotic twins
- Retained 2nd living twins
- Conjoint twins
- Triplet or more
Other standard indications of CS
