OB - FETAL GROWTH ASSESSMENT Flashcards
WHAT IS CONSIDERED TERM?
BETWEEN 38 - 42 WEEKS
WHAT IS CONSIDERED PRETERM?
BEFORE 38 WEEKS
WHAT IS CONSIDERED POST TERM?
MORE THEN 42 WEEKS
WHAT DOES SGA & LGA STAND FOR?
SMALL FOR GESTATIONAL AGE
&
LARGE FOR GESTATIONAL AGE
THIS BEST DESCRIBES A DECREASED RATE OF FETAL GROWTH.
INTRAUTERINE GROWTH RESTRICITION (IUGR)
WHATS THE % OF PREGNANCIES WITH IUGR?
3-7%
IF THE FETAL WEIGHT IS AT OR BELOW ______ FOR A GIVEN GA IT IS CONSIDERED IUGR.
10%
WHAT RISKS DOES IUGR POSE FOR THE FETUS?
ANTEPARTUM DEATH, PERINATAL ASPHYXIA, NEONATAL MORBIDITY, LATER DEVELOPMENTAL PROBLEMS.
WHAT INCREASES WITH THE SEVERITY OF IUGR?
MORTALITY
WHAT ARE SOME OF THE FACTORS THAT CAN CAUSE IUGR?
MOTHER HAVING A HX OF PREVIOUS IUGR,
SEVERE HYPERTENSION, TOBACCO USAGE, UT ANOMALIES, PLACENTAL HEMORRHAGE
WHAT ARE OTHER CONSIDERATIONS FOR IUGR?
MATERNAL SIZE & RACE & THE GENDER OF NEONATE.
HISPANIC & ASIAN WOMEN TYPICALLY HAVE SMALLER BABIES
WHAT ARE THE CLINICAL FINDINGS FOR IUGR?
- DECREASED FUNDAL HEIGHT
- DECREASED FETAL MVMT
- GRADE 3 PLACENTA PRIOR TO 36 WEEKS
- DECREASED PLACENTAL THICKNESS
THIS RESULTS FROM SEVERE CHROMOSOMAL ABNORMALITIES OR INFECTION IN THE 1ST TRIMESTER?
SYMMETRIC IUGR
WHAT CHARACTERISTICS DOES SYMMETRIC IUGR HAVE?
PROPORTIONATELY SMALL FETUS
ALL PHYSICAL PARAMETERS (BPD, HC, AC, FL) ARE EQUAL
THIS IS CAUSED BY PLACENTAL INSUFFIECIENCY IN THE LATE 2ND & 3RD TRIMESTER.
ASYMMETRIC IUGR
WHICH IS THE MORE COMMON TYPE OF IUGR?
ASYMMETRIC IUGR
WHAT ARE THE CHARACTERISTICS OF ASYMMETRICAL IUGR?
- APPROPRIATE BPD & HC AND DISPROPORTIONATELY SMALL AC (BRAIN SPARING EFFECT)
WHAT CAUSES ASYMMETRICAL IUGR?
MATERNAL DISEASE (LIKE MATERNAL DIABETES), CHRONIC HYPERTENSION, ETC OR NO HIGH RISK FACTORS.
WHAT IS NOT A RELIABLE DETECTOR OF IUGR?
BPD BECAUSE THERE CAN BE THE BRAIN SPARING EFFECT OR OLIGOYDRAMNIOS CAUSES DOLICOCEPHALY OR BRACHYCEPHALY
WHAT IS A MORE EFFECTIVE PARAMETER FOR GA IN RELATION TO IUGR?
HC IS MORE CONSISTENT
THE HC TO AC RATIO IS ESPECIALLY USEFUL FOR DETECTING?
ASYMMETRIC IUGR. RATIO WILL INCREASE AS DIFFERENCE BETWEEN GA AND FETUS SIZE INCREASES
IS THE HC AC USEFUL IN PREDICTING SYMMETRIC IUGR?
NO BECAUSE THEY WILL BE EQUALLY SMALL
WHAT IS THE MOST RELIABLE TO OBTAIN ESTIMATED FETAL WEIGHT?
ALL FETAL PARAMETERS (BPD, HC, AC, FL)
WHAT IS USED FOR EFW WITH HADLOCK?
HC, AC, AND FL (NO BPD)
WHAT ZONE IS IT WHEN THE BABY SHOULD BE DLVD AS SOON AS THE LUNGS HAVE MATURED?
ZONE 3
WHAT ZONE SHOULD HAVE SERIAL SONOGRAMS AND FETAL HEART RATE MONITORING?
ZONE 2
THIS ZONE RULES OUT IUGR?
ZONE 1
HOW IS THE AMNIOTIC FLUID EVALUATED?
UT CAVITY IS DIVIDED INTO 4 EQUAL QUADRANTS & THE LARGEST POCKETS ARE MEASURED. THE SUM OF ALL 4 QUADRANTS IS THE AFI AMNIIOTIC FLUID INDEX.
WHAT IS THE NML AFI LEVELS?
BETWEEN 8-22 CM
WHAT AFI IS CONSIDERED OLIGOHYDRAMINIOS & POLYHYDRAMNIOS?
OLIGOHYD. IS < 5CM & POLY IS > 22CM
DURING THE BPP (BIOPHYSICAL PROFILE) WHAT SHOULD THE FETAL BREATHING MVMT BE?
EPISODES FOR 30S CONTINUOUS DURING A 30 MINUTE OBSERVATION
WHAT IS THE GROSS BODY MVMT?
3 SEPERATE UNPROVOKED BODY/LIMB MVMTS IN 30 MINS, CONTINUOUS MOVEMENT FOR 30 MINS IS COUNTED AS 1
WHAT IS THE FETAL TONE TEST?
1 EXTENSION & FLEXION OF LIMBS OR TRUNK
FETAL HEART RATE TEST aka NON STRESS TEST
2 EPISODES OF FHR ACCELERATIONS OF 15 BPM & IN 15 SEC DURATION IN A 20 MIN PERIOD
HOW MANY MINS ARE IN A FETAL SLEEP-WAKE CYCLE?
40 MINS
WHAT IS AN NML AFI IN 1 POCKET?
FLUID MEASURES AT LEAST 2CM OR MORE IN 2 PLANES.
WHAT IS A NML BPP SCORE?
8-10
WHAT BPP SCORE INDICATES AN IMMEDIATE DLVRY IS NECESSARY?
0-2
WHAT IS CONSIDERED A TRUE BREATHING MVMT?
SIMULTANEOUS INWARD MVMT OF THE CHX WALL WITH OUTWARD MVMT OF THE ANT ABD WALL DURING INSPIRATION.
THIS IS ALSO A SIGN OF FETAL BREATHING MVMTS.
FETAL KIDNEY MVMT IN LONG PLANE
HOW MANY BODY & TRUNK GROSS MVMTS NEED TO BE OBSERVED TO RECEIVE 2 POINTS?
3 IN 30 MINS
THIS TEST IS DONE USING DOPPLER TO RECORD FETAL HEART RATE AND ITS REACTIVITY TO STRESS OF UT CONTRACTIONS.
NONSTRESS TEST
WHAT ARE THE STAGES OF BRAIN DEVELOPMENT?
- FETAL TONE = 7.5 - 8.5 WEEKS
- FETAL MVMT = 9 WEEKS; DIAPHRAGMTATIC MVMT = 20 WKS
- HEART RATE REACTIVITY - LATE 2ND- EARLY 3RD
where should a doppler blood flow sample be taken from in a baby with IUGR?
umbilical vessels. if it shows decreased blood low the fetus will not recv enough blood, nutrients and oxygen from the placenta
THIS FORM OF DOPPLER LOOKS AT BLOOD FLOW AND VELOCITY?
QUANTITATIVE
THIS DOPPLER LOOKS AT CHARACTERISTICS OF THE WAVE FORM.
QUALATATIVE
THIS MEASURES PEAK SYSTOLE TO END DIASTOLIC BLOOD FLOW.
S/D RATIO (SYSTOLIC TO DIASTOLIC)
THE RESISTIVE INDED (RI) = ?
MAX SYSTOLIC VELOCITY - DIASTOLIC VELOCITY/SYSTOLIC VELOCITY
DOPPLER SONO SHOWS FETUSES WITH ASYMMETRIC IUGR VASCULAR RESISTANCE _____ IN THE AORTA & UMBILICAL AND ______ IN THE FETAL MIDDLE CEREBRAL ARTERY.
INCREASES & DECREASES
AN S/D RATIO OVER ____ IN THE UMBILICAL ARTERY AFTER ____ WEEKS IS CONSIDERED ABNML & SHOWS INCREASED RESISTANCE.
3.0 AFTER 30 WEEKS
A RATIO ABOVE ____ SUGGEST INCREASED VASCULAR RESISTANCE & INDICATES A ______ MATERNAL BLOOD SUPPLY TO THE UT.
2.6; DECREASED
WHAT IS CONSIDERED MACROSOMIA?
BIRTH WEIGHT OF 4000G (8.8LBS) OR > THEN 90TH %.
OR
TOO BIG TO PASS THROUGH THE PELVIS
WHEN IS MACROSOMIA FRQ SEEN WITH?
MULTIPARITY > 35 YRS OLD -PREPREGNANCY WEIGHT OF > 70K OR GAIN OF 20 KGS - POSTDATE PREGNANCY - HX OF LGA FETUSES
WHAT IS MACROSOMIA COMMONLY A RESULT OF?
POORLY CONTROLLED MATERNAL DIABETES MELLITUS
WHAT SYNDROMES ARE COMMON WITH MACROSOMIA?
BECKWITH-WIEDMANN SYNDROME
SOTO’S SYNDROME
WEAVER SYNDROME
MARSHALL-SMITH SYNDROME
THERE IS AN INCREASED INCIDENCE OF WHAT WITH MACROSOMIA?
HEAD AND SHOULDER INJURIES AND CORD COMPRESSION.
WHAT ARE THE 3 TYPES OF MECHANICAL MACROSOMIA?
- FETUSES THAT ARE GENERALLY LG
- FETUSES THAT “ “ BUT WITH LG SHOULDERS (DIABETIC PREGNANCIES)
- FETUSES THAT HAVE NML TRUNK BUT LG HEAD (GENETIC OR PATHOLOGIC)
