Keppler fetal growth abnormalities Flashcards

1
Q

What is looked at when assessing fetal growth?

A
  1. Fundal height

2. Head circumferance and biparietal diameter

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2
Q

What constitutes Macrosomia

A

LGA, S>D

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3
Q

When would you consider intrauterine growth retardation?

A
  1. Child is SGA

2. Fetal growth restriction

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4
Q

What are some causes of Macrosomia?

A
  1. Constitutional
  2. Diabetes, gestational diabetes
  3. Excessive maternal weight gain
  4. Rare genetic syndromes
  5. inaccurate dating
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5
Q

How can you diagnose Macrosomia?

A
  1. Fundal height measurement exceeding expectations

2. fetal ultrasound showing excessive growth

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6
Q

What is the accuracy of a fetal ultrasound?

A

this has an accuracy of +/- 20%

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7
Q

What percentile of fetal size is considered significant?

A

> 90%ile

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8
Q

What is one thing you should look at when assessing macrosomia?

A

Whether the baby is symmetric or asymmetric

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9
Q

At what weight does the baby have a 3% chance of shoulder dystocia if mother has diabetes?

A

4500g

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10
Q

What weight does the baby have a 3% chance of shoulder dystocia if no diabetes is present?

A

5000g

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11
Q

What are some causes of fetal growth restrictions?

A
  1. Placental insufficiency
  2. Infections
  3. Genetic syndromes/aneuploidy
  4. Inaccurate dating
  5. Constitutional
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12
Q

How do you diagnose fetal growth restrictions?

A
  1. fundal height measurement lagging expectations

2. Fetal ultrasound showing smaller than expected fetus

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13
Q

What percentile is considered significant for fetal growth restrictions?

A

<10%ile generally considered significant

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14
Q

Management of fetal growth restriction?

A
  1. Detailed fetal ultrasound

2. Serology (TORCH) and labs

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15
Q

What things should you evaluate with close followups for fetal growth restriction?

A
  1. serial ultrasound to follow up on growth. Timing important
  2. Doppler studies (umbilical artery, middle cerebral artery)
  3. Fetal surveillance
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16
Q

True or False: Absent or reversed diastolic flow in umbilical arteries is ominous sign of imminent fetal demise

A

True

17
Q

is the placenta normally a low or high resistance vascular system?

A

low resistance

18
Q

What does increasing resistance mean on a doppler cord eval?

A

This means the heart is pumping harder/faster

19
Q

What is the source of amniotic fluid?

A

The source amniotic fluid is the babies urine

20
Q

What level of amniotic fluid is considered oligohydramnios?

A
  1. Amniotic fluid index (4 quadrants) <5cm

2. Single deepest pocket <2cm

21
Q

What level of amniotic fluid is considered polyhrdramnios?

A

AFI >= 24cm

SDP >= 8cm

22
Q

Causes of oligohydramnios?

A
  1. Placental insufficiency
  2. Congenital abnormalities; especially renal and collecting systems
  3. Preterm rupture of membranes
23
Q

Risks of oligohydramnios?

A
  1. Cord accident or compression
  2. Fetal demise
  3. Fetal malformation including contractures, lung development
24
Q

What is the management of oligohydramnios?

A
  1. Perinatology evaluation
  2. Fetal surveillance
  3. Timing of delivery?
25
Q

Causes of Polyhydramnios?

A
  1. Diabetes/ gestational diabetes
  2. Congenital abnormalities, GI tract / esophagus
  3. Genetic syndromes
  4. Fetal anemia
26
Q

risks of polyhydramnios?

A
  1. preterm labor or preterm rupture of membranes
  2. Cord prolapse
  3. Fetal malpresentation
27
Q

Management of polyhydramnios?

A
  1. perinatology evaluation
  2. Fetal surveillance +/-
  3. Theraputic amniocentesis
  4. Timing of delivery 37-39 weeks depending on severity, possibly in the late preterm period