IUGR, Macrosomia & Stillbirth

Question 1

Maternal risk factors for stillbirth?

Answer 1

1- Obesity
2- AMA
3- African American 
4- Smoking/Substance Abuse
5- Nulliparity
6- IPV

Question 2

Risk factors for macrosomia?

Answer 2

1- Constitutional factors
2- Preexisting diabetes/GDM
3- Obesity
4- Excessive weight gain
5- Abnormal blood glucose levels
6- Dyslipidemia
7- Prior macrosomic newborn (weight more than 4,000 g), 
8- Postterm pregnancy

Question 3

Maternal etiologies of fetal growth restriction?

Answer 3

1-  Preexisting DM
2- Hypertension
3- Smoking/Substance abuse
4- APL syndrome
5- Autoimmune Dx (eg., SLE)

Question 4

Fetal etiologies of fetal growth restriction?

Answer 4

1- Multifetal Gestation
2- Teratogen
3- Infectious Diseases (TORCH)
4- Genetic and Structural Disorders (e.g., gastroschisis and cardiac anomalies

Question 5

Placental etiologies of fetal growth restriction

Answer 5

1- abnormal placentation
2- 2 Vessel cord
3- velamentous or marginal cord insertion

Question 6

Are placenta previa or placenta accreta associated with IUGR?

Answer 6

No

Question 7

Definition Large for gestational age?

Answer 7

Birth weight equal to or more than the 90th percentile for a given gestational age.

Question 8

Rate of macrosomia?

Answer 8

8% of all live-born newborns in the United States weigh 4,000 g or more. Only 1% weigh more than 4,500 g and 0.1% more than 5,000 g.

Question 9

Interventions shown to reduce macrosomia include?

Answer 9

1- Exercise during pregnancy
2- Control of maternal hyperglycemia in GDM
3- Prepregnancy bariatric surgery in class 2 or class 3 obesity.

Question 10

Defintion of stillbirth?

Answer 10

IUFD @20 wks GA or a weight > or equal to 350g if the GA is unknown
[The cutoff of 350 grams is the 50th percentile for weight at 20 weeks of gestation.]

Question 11

Stillbirth and late [>28wks] stillbirth rates?

Answer 11

0. 62%

0. 31%

Question 12

Pregnancy-associated risk factors for stillbirth?

Answer 12

1-  Multifetal Gestation
2- Comorbidities (eg, HTN, DM, SLE)
3- Previous stillbirth
4- Congenital & Karyotypic anomalies
5- Infections [TORCH]

Question 13

Most important tests in the evaluation of a stillbirth?

Answer 13

Fetal autopsy;
Examination of the placenta, cord, and membranes
Karyotype evaluation.

Question 14

Is induction of labor with vaginal misoprostol safe in patients with a prior cesarean delivery with a low transverse uterine scar before 28 weeks of gestation?

Answer 14

Yes