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