OB Complications I -Castro Flashcards
What is Small for Gestational Age? How is this different from Intrauterine Growth Restriction (IUGR)?
-SGA is birth weight less than the 5-10th percentile for gestational age (diagnosis made at or after birth)
-IUGR relies on US biometry for estimated fetal weight less than the 10th percentile for GA
(or abd circumference < 10th percentile)
*both are based on weight/GA tables or growth curves
What is considered “preterm”?
< 37 weeks
What are some complications of IUGR?
- Increased fetal and neonatal mortality
- Increased neonatal morbidity (fetal distress, meconium aspiration, hyperviscosity syndrome, hypoglycemia, hypocalcemia, congenital anomalies)
- Increased rate of neurodevelopmental disorders (eg cerebral palsy)
- Increased incidence of hypertension, glucose intolerance and cardiovascular disease in later life
What is IUGR due to? What is the #1 cause of uteroplacental insufficiency that can lead to IUGR?
- decreased cell number, decreased cell size or both
- 1st trimester insults ==> dec cell number (anomalies, genetic defects)
- Hypertensive disease is the #1 cause of uteroplacental insufficiency
What are some fetal causes of IUGR?
- chromosomal
- biochemical abnormalities
- congenital malformations
- congenital infections (TORcH)
What is normal weight gain for a woman with a normal BMI? What can happen if a woman does not gain enough weight?
25-35 lbs
inc risk of IUGR
How is IUGR diagnosed?
- must have an accurate GA
- estimate fetal weight by US
- compare to population specific growth curves
- clinical assessment of risk status (if fundal weight is > 3 cm off from normal –> perform US)
How are IUGR fetuses monitored?
serial US’s to assess fetal growth but try to not over-expose
NST and biophysical profile (BPP) or modified BPP (AFI+ NST) done twice weekly
Doppler velocimetry of umbilical and uterine arteries to determine uteroplacental vs fetal etiology
What is the management for IUGR?
look for underlying cause of growth restriction in mom’s history, nutritional status, occupation, history, US looking for anomalies and consider karyotype
–> treat/eliminate the cause of the IUGR
When would you deliver a fetus with IUGR?
- Fetal testing is non-reassuring (decelerations, oligohydramnios or abnormal umbilical doppler studies)
- The fetus is term or fetal maturity is present
- No interval growth is present over 3 weeks
What is LGA? How is Macrosomia different from LGA? What are the causes of both?
- LGA is EFW (est. fetal weight > 90th % for GA)
- Macrosomia is EFW > 4000 or 4500 grams
- causes? Maternal obesity or excessive weight gain, diabetes (esp gestational)
What are the potential consequences of LGA/macrosomia?
- intrapartum problems (cephalopelvic disproportion/birth trauma/shoulder dystocia –> Erb’s Palsy)
- at risk for childhood and adult obesity and glucose intolerance
When should LGA/macrosomia be suspected? How is diagnosis confirmed?
- suspected with fundal height > 3 cm > than expected for GA (there are other causes)
- diagnosis confirmed by ultrasound
What is the management of LGA/macrosomia?
- address weight gain and glucose control
- be prepared for shoulder dystocia if vaginal delivery is planned
- individualize treatment
*elective c-section if EFW > 5000g recommended
What is intrauterine fetal demise (IUFD)?
- death occurring in utero at or before birth after 20 weeks gestation
- AKA stillbirth
