Keppler fetal growth abnormalities

Question 1

What is looked at when assessing fetal growth?

Answer 1

1. Fundal height

2. Head circumferance and biparietal diameter

Question 2

What constitutes Macrosomia

Answer 2

LGA, S>D

Question 3

When would you consider intrauterine growth retardation?

Answer 3

1. Child is SGA

2. Fetal growth restriction

Question 4

What are some causes of Macrosomia?

Answer 4

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

Question 5

How can you diagnose Macrosomia?

Answer 5

1. Fundal height measurement exceeding expectations

2. fetal ultrasound showing excessive growth

Question 6

What is the accuracy of a fetal ultrasound?

Answer 6

this has an accuracy of +/- 20%

Question 7

What percentile of fetal size is considered significant?

Answer 7

> 90%ile

Question 8

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

Answer 8

Whether the baby is symmetric or asymmetric

Question 9

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

Answer 9

4500g

Question 10

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

Answer 10

5000g

Question 11

What are some causes of fetal growth restrictions?

Answer 11

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

Question 12

How do you diagnose fetal growth restrictions?

Answer 12

1. fundal height measurement lagging expectations

2. Fetal ultrasound showing smaller than expected fetus

Question 13

What percentile is considered significant for fetal growth restrictions?

Answer 13

<10%ile generally considered significant

Question 14

Management of fetal growth restriction?

Answer 14

1. Detailed fetal ultrasound

2. Serology (TORCH) and labs

Question 15

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

Answer 15

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

Question 16

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

Answer 16

True

Question 17

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

Answer 17

low resistance

Question 18

What does increasing resistance mean on a doppler cord eval?

Answer 18

This means the heart is pumping harder/faster

Question 19

What is the source of amniotic fluid?

Answer 19

The source amniotic fluid is the babies urine

Question 20

What level of amniotic fluid is considered oligohydramnios?

Answer 20

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

2. Single deepest pocket <2cm

Question 21

What level of amniotic fluid is considered polyhrdramnios?

Answer 21

AFI >= 24cm

SDP >= 8cm

Question 22

Causes of oligohydramnios?

Answer 22

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

Question 23

Risks of oligohydramnios?

Answer 23

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

Question 24

What is the management of oligohydramnios?

Answer 24

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

Question 25

Causes of Polyhydramnios?

Answer 25

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

Question 26

risks of polyhydramnios?

Answer 26

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

Question 27

Management of polyhydramnios?

Answer 27

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