OB Proper (Fetus and Placenta)

Question 1

Risk factors for IUGR

Answer 1

Maternal weight <10th percentile
Previous IUGR
Mat. vascular/cardiac disease
Smoker, alcoholic, drug addict mother

Question 2

Clinical finding of IUGR

Answer 2

Poor maternal weight gain
Fundal height is >3cm less than expected
Diminished fetal movement
Reduced AFV

Question 3

Normal AFI

Answer 3

5-24

24 poly

Question 4

Enumerate: Key complications of Polyhydramnios (3)

Treatment of polyhydramnios (2)

Answer 4

• abruptio
• uterine dysfunction
• PPH

Treatment:

• Amniocentesis (1.5-2 L AF)
• Indomethacin (impedes liquid production, beware premature PDA closure!)

Question 5

Enumerate: Key complications of Oligohydramnios (3)

Treatment

Answer 5

• Pulmonary hypoplasia
• Potter Sequence (Pulmonary hypoplasia, oligohydramnios, twisted face, twisted skin

Treatment: amnioinfusion

Question 6

IUFD

Gold standard diagnosis

Answer 6

UTZ: absence of fetal heart activity, scalp edema, fetal maceration
Radiographic signs
Robert sign: gas bubble in fetal heart, super sagittal sinus
Spalding sign: overlapping skull bones
Ball sign: exaggeration of fetal spinal curvature

Question 7

When does DIC occur in IUFD?

Answer 7

Fetus > 14 weeks AOG

Death more than 4 weeks prior

Question 8

Placental abnormalities

Multiple placenta with a single fetus

Answer 8

Bipartite

Question 9

Placental abnormalities

One or more accessory lobes in the membranes at a distance from the periphery of the main placenta

Answer 9

Succenturiate

Question 10

Placental abnormalities

Placenta with a central depression surrounded by thickened grayish white membrane

Answer 10

Circumvallate

Circummarginate has a thinner ring

Question 11

UTZ finding in placenta accreta

Answer 11

lack of normal hypoechoic retroplacental zone

Question 12

3 types of abnormal umbilical cord insertion

Answer 12

Marginal insertion (battledore placenta)
Velamentous insertion (cord inserts at a distance from the placenta)
Vasa previa (associated with velamentous insertion)

Question 13

Cord abnormalities

True vs. false knot

Answer 13

True: from active fetal movements
False: kinking of vessels

Question 14

Cord abnormalities

Torsion

Answer 14

Cord becomes twisted

Question 15

Cord abnormalities

Stricture

Answer 15

extreme focal deficiency of Whartons jelly

Question 16

Cord abnormalities

True vs. false cyst

Answer 16

True: remnant of umbilical vesicles
False: liquefaction of Wharton’s Jelly

Question 17

Cord abnormalities

Edema

Answer 17

Associated with fetal edema and maceration

Question 18

Most common form of twinning

Answer 18

Monochorionic, Diamniotic

twin-twin transfusion possible

Question 19

Timeline of twinning

Answer 19

Day 0-3: Dichorionic diamniotic
Day 4-8: Monochorionic diamniotic
Day 9-12: Monochorionic monoamniotic
>Day 13-14: Conjoined twins

Question 20

Twinning type with highest mortality

Answer 20

Mono-mono

Associated with cord entanglement, twin-twin transfusion, fetal death, abnormal vascular connection

Question 21

Fertility augmentation drugs

Answer 21

Clomiphene (8-13% rate)
HMG (42% rate)
Bromocriptine (1.2-1.8%)

Question 22

Key differences of Symmetrical IUGR and Asymmetrical IUGR

Answer 22

Symmetric
BPD, AC, HC, FL decreased
Fetal etiology

Asymmetric
only AC is decreased
Placental and maternal etiology