Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

A - ObsNGynae > obs - fetal growth > Flashcards

obs - fetal growth Flashcards

1
Q

define small for getational age (sga) aka small for dates (sfd)

A

the weight of the fetus is less than the tenth centile for its gestation (so compared to sll other fetes of that gestation)

Other cut-off points (e.g. third centile) can also be used.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

define growth restriiction

A

fetuses that have failed to reach their own
‘growth potential’

they can either be normal weight or small for dates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is the difference between fetal distress and compromise?

A

distress :
an acute situation, such as hypoxia, that
may result in fetal damage or death if it is not reversed

compromise:
chronic situation - when conditions for the normal growth and development are not optimal - placental dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what are the negatives of fetal surveillance?

A

False positives - things over interpreted

Can identify but dont solve problems

Expensive

Can medicalise a normal pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

list some pre-pregnancy factors associated with a high risk pregnancy?

(and thus those who may likely need fetal surveillance)

A

o Poor PObsHx or very small baby
o Maternal disease
o Assisted conception

o Extremes of reproductive age
o Heavy smoking and/or drug abuse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

list some intra-pregnancy factors associated with a high risk pregnancy?

(and thus those who may likely need fetal surveillance)

A

o HTN / Proteinuria
o Vaginal bleeding
o SFD - small for dates

o Prolonged pregnancy
o Multiple pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is classifiied as an abnormal Uterine artery Doppler result? what does this mean?

A

Abnormal result; if resistance is NOT low

this means there is INCREASED resistance (in the circulation) =>

It identifies pregnancy at risk of adverse neonatal outcomes in the early third trimester:

Increased RISK of IUGR, Pre-eclampsia, Abruption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

when would a Uterine artery Doppler usually be done?

A

23 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

which hormone is used to help determine IUGR risk? what do the results mean?

A

PAPP-A

Low level = high risk IUGR, placental abruption and still birth
also - Down syndrome (1st trimester test)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

list some methods of fetal surveillance?

A
  1. Routine pregnancy care - more important in low risk pregnancies as the wont access the below:
  2. US assessment of fetal growth
  3. Doppler umbilical artery waveform
  4. Fetal circualtion dopplers;
    - MCA, Ductus venosus
  5. US assessment of amniotic fluid volume and
    movements -
  6. CTG, non stress test: low risk too
  7. Kick chart: no. of kicks felt. low risk
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

in low risks pregnancies (they dont get access to more specialist fetal surveillance), what is the cornerstone of the identification of the small or compromised fetus ?

A

serial measurement of the

symphysis fundal height
and other aspects of antenatal visits.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what does US assessment of fetal growth measure?

A

head, abdominal circumference

femur length

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

how does one tell the difference between small and growth restricted babies on US?

A
  1. Rate of growth:
    consistent (small), slowing (iugr)
  2. Pattern of smallness:
    thin/asymmetrical (iugr - blood diverted to brain)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

list the maternal and fetal arteries in which dopplers could be done?

A

Uterine artery - maternal

Umbilical artery - fetal
MCA - fetal
Ductus venosus* - fetal

*shunt for oxygenated blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

say, you cant tell the difference bewteen small a nd growth restricted fetus on US. what next?

A

Umbilical doppler - can actually tell the difference

Reduced flow in fetal diastole compared to systole shows high resistance circulation and placental dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

in dopplers of fetal circulation, what changes are usaully seen with fetal compromise ?

A

With fetal compromise, the MCA often develops a low resistance pattern in comparison to the
thoracic aorta or renal vessels

increased EDV end diastolic volume

anaemia - increased FV flow velocity seen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what are indications of dopplers of fetal venous circulation?

A

ductus venosus waveform is a measure
of a cardiac function,

is used to assess extremely
preterm fetuses (<28 weeks) as an alternative to CTG
monitoring, and is better <26 weeks.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

list some causes of IUGR (sfd and growth restricted fetuses) ?

A

Maternal factors;
o Drug use- cocaine
o Some medications
o extremes of age: <16, 35>

o Extreme malnutrition
o Maternal obesity
o Smoking
o Pre-existing maternal disease; Renal, Autoimmune
o Maternal pregnancy complications
   - Pre eclampsia

Placental factors:
Abnromal size, Abruption,
Placental infarction
Chorioangioma, Umbiilical cord abnormality

Fetal factors:
o Congenital abnormalities - hence amniocentesis done to ivx
o Infection - CMV
o Multiple pregnancy

19
Q

complications of IUGR?

A

Mother:
 Preterm delivery
 Maternal risks increase
 Increased Caesarean section

Fetal preiod:
 Stillbirth
 Acidaemia

Neonatal period:
 Cerebral palsy
 Polycythaemia
 Hypoglycaemia
 Apneoa

Adult life:
Diabetes, cardiovascular disease

20
Q

how is would you SCREEN for possible iugr/sfd baby ?

A

 Examination
o Serial measurement of SFH
o Reduced or slowing
o BP and urine checked -> PET associated with IUGR

 Investigations:
1. 3+ Minor risk factors (identified at booking)
- reassess at 20 weeks
- UTERINE artery doppler at 20-24 weeks
- 3rd trimester: normal -> assess fetal size and umbilical
doppler

  1. 1+ Major SGA risk factor
    - reassess at 20 weeks
    - assess fetal size and UMBILICAL doppler at 26-28 wks
  2. Unsuitable for monitoring via SFH (large fibroids, BMI>35)
    - assess fetal size and umbilical doppler at 26-28 wks
21
Q

briefly how would one manage sfd ?

A

SFDates only
o Growth rechecked with US at 2 week intervals
o No need for intervention is consistently growing with normal UA Doppler

22
Q

what are the risks of a prolonged pregnancy?

A

Still birth

Meconium passage into amniotic fluid -> meconium aspiration syndrome

Fetal distress

Neonatal illness and encephalopathy

23
Q

how is a prolonged pregnancy managed?

A

Induction before 41 weeks is inappropriate
unless complications are present

From 41 weeks :
Examine the patient vaginally and
OFFER induction
- failed induction -> C-Section

If doesnt want induction:
Sweep cervix and arrange daily (CTG)

If CTG abnormal Deliver whatever the condition of
the cervix, by caesarean

24
Q

if a woman develops sever gestational or other hypertension, pre-eclampsia, Antepartum haemorrhage (praaevia, abruption etc), in the 3rd trimester how should they be monitored?

A

serial assessments of:

  1. fetal size - US
  2. umbilical artery doppler
25
Q

list some factors identified that would make a woman unsuitable for monitoring by SFH?

A

large fibroids

BMI > 35

26
Q

how would you manage SFD/IUGR?

A

if conditions are found, move on to next investigation

  1. SFH < 10th centile or showing iugr
    or hx + biochemistry or Uterine artery doppler:
    -Identify high risk
  2. US Fetal biometry/Growth scan:
    abdominal circumference! head circum (biparietal),
    femur length
    or EFWeight < 10th
  3. Uterine artery doppler
    - management and delivery date depends on findings especially the end diastolic volume.
27
Q

with SFD/IUGR, what are the options following umbilical artery doppler results?

A

Normal UA doppler:

  • delivery by 37 weeks WITH senior clinician input
  • steoroids if c-section
  • can do by 34 wks, if static growth

UA doppler - Increased Resistance, PI, RI >2 but end-daiastolic volume normal:

  • deliver by 37 weeks (give steroids if by section)
  • can do by 34 wks, if static growth

o Absent OR Reversed end-diastolic flow -> admit, and daily CTG and UA and D Venosus dopplers!
- give steroids & deliver befrore 32 weeks

o Severe IUGR -> ELCS

28
Q

list some causes of small for dates pregnancy

A

Slow fetal growth (intrauterine growth restriction)

Too little amniotic fluid (oligohydramnios)

29
Q

list some causes of large for dates pregnancy

A

A multiple pregnancy
A significantly larger than average baby (fetal macrosomia)
Too much amniotic fluid (polyhydramnios)

30
Q

what are some causes of oligohydramnios?

A

Spontaneous rupture of membranes SROM
Renal agenesis
Placental insufficiency - pre-eclampsia

31
Q

what are some causes of polyhydramnios?

A

Diabetes

Oesophogeal atresia

32
Q

list some indications for US use on the labour ward?

A
  • Most common: unable to hear fetal HR (with doppler sonicaid)
  • Before instrumental birth
  • Placenta praevia: determine location before c-section (especially in anterior previa)
  • Determine fetal lie and presentation
  • To help site an epidural
33
Q

what are the 2 types of IUGR and epidemiology?

A
  1. Symmetric 20%
    - can be small for dates
  2. Assymetric: 80%
    - head bigger than abdomen ‘head sparing’
    - restricted
34
Q

define large for dates?

A

baby with weight above the 90th percentile

4.5kg

35
Q

classify the following weights;

Low birth weight,
Very low birht weight,
Extremely low birthweight

A

Low birth weight: 2500g

Very low birht weight: 1500g

Extremely low birth weight: 1000g

36
Q

the term IUGR covers which terms?

A

Fetal growth restriction

Small for GA

37
Q

define constitutional smallness.

causes?

A

baby is small because paretns are small

o Low maternal height and weight
o Asian ethnic group
o Female fetal gender

38
Q

maternal, fetal and placental factors cause which types of growth restriction?

A

Maternal, placental - Assymetric

fetal - symmetric

39
Q

List 3 tests that can be doneto confirm IUGR - though not the preferred initial tests?

A

Amniocentesis

CVS

Percutaneous umbilical blood sampling

40
Q

what is the role of the ductus venosus?

A

carries OXYGENATED blood from placenta to heart

41
Q

Poor flow in the ductus venosus doppler indcates?

A

poor prognosis

deliver by 32 weeks + steroids.

42
Q

what finding on the pulsatility index is associated with the ‘head sparing’ effect?

A

increased diastoloic flow on pulsatility index (PI)

43
Q

What is the end diastolic flow supposed to be in the different trimesters?

what is the meaning of a reversed EDF?

A

Doppler flow velocity waveforms of the umbilical artery in uncomplicated early pregnancies show ABSENT end-diastolic flow (AEDF) up to the 11th week of gestation.

Between the 11th and 14th weeks, positive diastolic flow emerges and remains detectable from then onwards.

So a reversed EDF is abnormal

44
Q

In babies with potential heart failure and twin–twin transfusion syndrome, which doppler might be most useful to do?

A

Ductus venosus - doppler of venous circulation.

A - ObsNGynae (37 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions