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Phase 3a Obstetrics + sexual health > IUGR, Size, Fluid > Flashcards

IUGR, Size, Fluid Flashcards

1
Q

what does IUGR stand for?

A

Intrauterine growth restriction

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2
Q

What is IUGR and what is it caused by?

A

growth retardation in utero due to pathology therefore not reaching genetic potential

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3
Q

What does SGA stand for and what is it?

A

small for gestational age
<10th centile fetal growth
+/- pathological

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4
Q

Causes of IUGR?

A

foetal 3CS - chromosomal abnormalities, congenital abnormalities and congenital infection

Maternal - HTN, Placental insufficiency, aPL, smoking, poorly controlled DM

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5
Q

IUGR can be …. or …..

A

symmetrical or asymmetrical

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6
Q

Symmetrical %?
fetal or maternal?
abdo and brain affected?
mental problems?

A

30%
fetal deficits
abdo and brain proportionally affected growth
yes mental problems (delays)

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7
Q

Asymmetrical %?
fetal or maternal?
abdo and brain affected?
mental problems?

A

70%
Maternal placental insufficiency
Abdo and peripheral retardation
No brain involvement
no mental changes (no delay)

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8
Q

Comps of IUGR?

A

premature, still birth, cognitive delays

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9
Q

the 2 sizes a baby can be?

A

LGA large for gest age
SGA small for gest age

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10
Q

what does SGA + LGA mean ?

A

macrosomia
>90th centile for weight (>4.5kg)

<10th centile (<2.5kg)

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11
Q

LGA
Cause?
Ix?
Complications?

A

idiopathic , fHx (constitutional), Gest dm, polyhydromnios, post term

Regular USS
OGTT 24-28 WKS

Perineal tears, shoulder dystocia, PPH

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12
Q

SGA
Cause?

A

Idiopathic
fHx
placental insufficiency
congenital infection
chromosomal abnormality

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13
Q

What is shoulder dystocia?

A

when the baby’s shoulder is stuck behind the maternal pubis symphysis

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14
Q

MC complication of shoulder dystocia?

A

Erbs palsy
arm/shoulder muscle weakness

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15
Q

What is the treatment for shoulder dystocia?

A

Help
McRoberts maneuvre
Pressure on suprapubic area
episiotomy
Enter (internal rotation)
roll on all 4s

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16
Q

What are the 2 types of fluid levels and %?

A

Polyhydromnios (1-2%)
Oligohydromnios (6%)

17
Q

What is polyhydromnios?
Causes?
Exam?
Comps?

A

AFI (amniotic fluid index) >25 (>25cm) on USS, >2000ml

Causes - gest dm, atresia (oesophageal + duodenal deficit), TORCH

Exam - high SFH, Lack of foetal HB, indistinct features, fluid thrill

Cord prolapse, placental abruption, PPH, high risk UTI, stillbirth, premature

18
Q

What is oligohydromnios?
Causes?
Exam?
Comps?

A

AFI <5 (<5CM) <300ml

Causes- PPROM, Potter sequence (abnormal kidney growth + function due to low amniotic fluid), uteroplacental insufficiency

low SFH, Prominant features

comp - fetal deformity/IUGR, still birth, premature, chorioamnionitis

19
Q

Vomiting occurs in % of pregnancies?
Is it common and why?
When does it resolve?

A

80%
very common in 1/3 due to high beta hCG from syncytiotrophoblast
resolves by 16-20 weeks normally

20
Q

What is non severe and severe vomiting called in pregnancy?

A

Nausea and vomiting of preg - NVP
hyperemesis gravidarum

21
Q

RF for vomiting in preg?

A

Multiple pregnancies
molar preg
hyperthyroid
DKA

22
Q

Sx of hyperemesis in preg?

A

RCOG triad:
5% or more pre pregnancy wt loss
Dehydration (low turgor, pallor, thirst)
Electrolyte imbalance (ketoamine)

(+ decreased appetite, severe vomiting)

23
Q

Dx of hyperemesis gravidarum?

A

bloods (FBC, U+E, LFT, TFT, Clotting)
OGTT
Urine dip
TV USS + Serum bhCG (RULE OUT MOLAR)
BP, BMI, ECG
VBG

24
Q

What would be seen on VBG?

A

hypoK+
hypoCl-
metabolic alkalosis

25
Q

What is used to classify the severity of NVP?

A

PUQE
Pregnancy unique quantification of emesis

26
Q

1st line treatment for Emesis?

A

Antihistamine (cyclizine or promethazine)
or
Phenothiazines (prochlorperazine or Chlorpromazine)
or
Comnination drug (doxylamine/pyridoxine - xonvea)

27
Q

2nd line Tx for emesis?

A

Ondansetron

28
Q

What is ondansetron?
max time to take It for and why?

A

5-HT3 receptor antagonist
max 5 days due to high risk of cleft lip/palate in 1/3

29
Q

3rd line Tx for emesis?

A

Metoclopramide
or
Domperidone

30
Q

Metoclopramide
What type of medication is it?
max time to take it for and why?
how does it work?

A

Dopamine receptor antagonist (DA2R-i)
Max 5 days due to extra pyramidal side effects (EPSE)
ACTS centrally in chemoreceptor trigger zone by crossing BBB)

31
Q

Domperidone
What type of medication is it?
max time to take it for and why?
how does it work?

A

dopamine receptor antagonist
max 7 days due to increased cardiovascular arrhythmias risk
peripheral D2+3R-i therefore decrease GI motility

32
Q

Other Tx for NVP?

A

Ginger
Acupuncture
Hypnosis

33
Q

Complication of NVP?
Tx for this?

A

Dehydration
advice oral fluid rehydration, or last resort IV

34
Q

Other complications of vomiting?

A

MW tear
Hypo K+
hypotension

Phase 3a Obstetrics + sexual health (15 decks)

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