Keppler fetal growth abnormalities Flashcards
What is looked at when assessing fetal growth?
- Fundal height
2. Head circumferance and biparietal diameter
What constitutes Macrosomia
LGA, S>D
When would you consider intrauterine growth retardation?
- Child is SGA
2. Fetal growth restriction
What are some causes of Macrosomia?
- Constitutional
- Diabetes, gestational diabetes
- Excessive maternal weight gain
- Rare genetic syndromes
- inaccurate dating
How can you diagnose Macrosomia?
- Fundal height measurement exceeding expectations
2. fetal ultrasound showing excessive growth
What is the accuracy of a fetal ultrasound?
this has an accuracy of +/- 20%
What percentile of fetal size is considered significant?
> 90%ile
What is one thing you should look at when assessing macrosomia?
Whether the baby is symmetric or asymmetric
At what weight does the baby have a 3% chance of shoulder dystocia if mother has diabetes?
4500g
What weight does the baby have a 3% chance of shoulder dystocia if no diabetes is present?
5000g
What are some causes of fetal growth restrictions?
- Placental insufficiency
- Infections
- Genetic syndromes/aneuploidy
- Inaccurate dating
- Constitutional
How do you diagnose fetal growth restrictions?
- fundal height measurement lagging expectations
2. Fetal ultrasound showing smaller than expected fetus
What percentile is considered significant for fetal growth restrictions?
<10%ile generally considered significant
Management of fetal growth restriction?
- Detailed fetal ultrasound
2. Serology (TORCH) and labs
What things should you evaluate with close followups for fetal growth restriction?
- serial ultrasound to follow up on growth. Timing important
- Doppler studies (umbilical artery, middle cerebral artery)
- Fetal surveillance
True or False: Absent or reversed diastolic flow in umbilical arteries is ominous sign of imminent fetal demise
True
is the placenta normally a low or high resistance vascular system?
low resistance
What does increasing resistance mean on a doppler cord eval?
This means the heart is pumping harder/faster
What is the source of amniotic fluid?
The source amniotic fluid is the babies urine
What level of amniotic fluid is considered oligohydramnios?
- Amniotic fluid index (4 quadrants) <5cm
2. Single deepest pocket <2cm
What level of amniotic fluid is considered polyhrdramnios?
AFI >= 24cm
SDP >= 8cm
Causes of oligohydramnios?
- Placental insufficiency
- Congenital abnormalities; especially renal and collecting systems
- Preterm rupture of membranes
Risks of oligohydramnios?
- Cord accident or compression
- Fetal demise
- Fetal malformation including contractures, lung development
What is the management of oligohydramnios?
- Perinatology evaluation
- Fetal surveillance
- Timing of delivery?
Causes of Polyhydramnios?
- Diabetes/ gestational diabetes
- Congenital abnormalities, GI tract / esophagus
- Genetic syndromes
- Fetal anemia
risks of polyhydramnios?
- preterm labor or preterm rupture of membranes
- Cord prolapse
- Fetal malpresentation
Management of polyhydramnios?
- perinatology evaluation
- Fetal surveillance +/-
- Theraputic amniocentesis
- Timing of delivery 37-39 weeks depending on severity, possibly in the late preterm period
