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NURS783 Exam 4 > Size and Date Discrepancies > Flashcards

Size and Date Discrepancies Flashcards

1
Q

Define small for gestational age (SGA)

A

≤10th percentile

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2
Q

Define very small for gestational age (VSGA)

A

<3rd percentile

  • associated w/ increased risk of poor outcome
  • often associated w/ IUGR
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3
Q

IUGR vs SGA

A

IUGR = growth restriction

VS

SGA = constitutionally small

  • if otherwise normal, no intervention required
  • no antenatal surveillance required
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4
Q

What is the best method to identify SGA vs IUGR?

A

customized growth potential: assesses individual growth potential for each baby in each pregnancy based on:

  • fetal sex
  • maternal height
  • weight
  • parity
  • ethnic origin
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5
Q

Define IUGR/FGR

A

fetus that fails to reach potential growth

OR

failure of fetus to achieve genetic growth potential in utero

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6
Q

What are the 4 underlying etiologies of IUGR?

A

1) aneuploidy
2) viral infection
3) nonaneuploid syndromes
4) placental insufficiency

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7
Q

What are maternal prepregnancy conditions that are associated w/ IUGR?

A
  • HTN
  • pre-GDM
  • renal disease
  • autoimmune disease
  • thrombophilias
  • severe anemia, malabsorptive disease, malnutrition
  • 20>BMI>/=30
  • high altitutude
  • tobacco/substance abuse
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8
Q

What are pregnancy conditions that are associated w/ IUGR?

A
  • multiple gestation
  • inadequate weight gain (esp low protein intake)
  • placental abnormalities (e.g. previa, abruption, mosaicism)
  • relative hypoglycemia (i.e. “flat response” on 3h GTT)
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9
Q

How does symmetric IUGR occur?

A

early alteration in process of cell division –> smaller number and size of cells

  • occurs during hyperplasia
  • fetal cell number decreased
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10
Q

When/How can symmetric IUGR be seen?

A

at early 2nd tri U/S

  • uniform diminishment of fetal organs, length, body weight
  • body and head growth usually similarly affected
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11
Q

What causes symmetric IUGR?

A

genetic, infectious, or teratogenic insults

1) chromosomal or congenital anomalies
2) infections (e.g. CMV, rubella)
3) teratogens (e.g. smoking, alcohol, cocaine, narcotics, valproate)

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12
Q

What are antenatal interventions for symmetric IUGR?

A

there aren’t any!

not usually improved w/ antenatal interventions

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13
Q

How does asymmetric IUGR occur?

A
  • occurs during hypertrophy
  • fetal cell number normal
  • cell size is small
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14
Q

What does asymmetric IUGR look like?

A
  • abdomen and lower body experience delay

- head growth spared

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15
Q

What maternal conditions are risk factors to assymetric IUGR?

A
  • uteroplacental insufficiency
  • maternal HTN (preeclampsia)
  • malnutrition (esp protein/glucose restriction)
  • diabetes
  • renal disease
  • placental abnormalities
  • multiple gestation
  • autoimmune disorders
  • hemoglobinopathies
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16
Q

What are antenatal interventions for asymmetric IUGR?

A
  • nutrition
  • hydration
  • improvement of uteroplacental blood flow
  • optimize timing of delivery
17
Q

What are fetal risk factors for IUGR?

A

1) chromosomal or congenital anomalies
2) teratogen exposure
3) fetal infection
4) genetic disorders
5) structural abnormalities

18
Q

What are neonatal risks associated w/ IUGR?

A

1) increased risk respiratory distress, NEC, intraventricular hemorrhage, clotting disorders, multiorgan failure
2) increased mortality
3) meconium aspiration
4) hypoglycemia
5) electrolyte abnormalities
6) hypocalcemia
7) impaired renal function
8) polycythemia, anemia, thrombocytopenia, hyperbili
9) hypothermia

19
Q

What is prognosis of IUGR?

A
  • expected to have normal growth curves and height as adults, esp if IUGR only close to delivery
  • earlier onset/prolonged IUGR may be related to growth lag
  • head circumference <10th percentile –> 2-3x more serious neuro sequelae
20
Q

Define oligohydramnios

A

AFI≤5cm or DVP≤2cm

21
Q

What are possible causes of early onset oligo?

A

1) renal agenesis
2) renal dysplasia
3) renal obstructive disorders

–> lack of urine production OR inability to pass urine produced

4) HTN
5) IUGR

22
Q

What are possible causes of 3rd tri oligo?

A

1) uteroplacental insufficiency
2) prolonged pregnancy (>42wks –> fluid volume decrease)
3) idiopathic - resolves w/ time or w/ hydration

23
Q

What are risks associated w/ oligo at 42wks?

A

1) meconium stained amniotic fluid
2) fetal intolerance of labor
3) NICU admission
4) increased perinatal morbidity and mortality

24
Q

What is the clinical hallmark of IUGR?

A

fundal height < 3cm from sure dates

25
Q

How should S

A
  • evaluate for PPROM

- order U/S (anatomy, AFV)

26
Q

How should IUGR be managed?

A
  • serial Doppler blood flow studies
  • serial growth scans q3-4wks (include BPD, HC/AC ratio, EFW, AFV)
  • ongoing fetal surveillance (NST, mBPP)
27
Q

Define large for gestational age (LGA)

A

> /= 90th percentile

28
Q

Define macrosomia

A

nondiabetic gestational carrier: 4500g

diabetic gestational carrier: 4000g

29
Q

Define polyhydramnios

A

AFV>2100ml or AFI >/= 25cm or DVP>8cm

30
Q

What are risk factors for macrosomia?

A

1) DM
2) abnormal 1h GTT w/ normal 3h GTT
3) hx of infant>4000g
4) maternal prepregnant obesity
5) excessive prenatal weight gain
6) prolonged pregnancy
7) fetal male sex
8) high paternal birth weight

31
Q

What are fetal causes of poly?

A

1) congenital anomalies
2) GI disorders
3) CNS disorders (e.g. anencephaly, NTDs)
4) cystic hygromas
5) nonimmune hydrops
6) genetic syndromes
7) congenital infections
8) placental abnormalities
9) twin gestation
10) twin-to-twin transfusion

32
Q

What are maternal causes of poly?

A

1) idiopathic
2) poorly controlled DM
3) maternal-fetal hemorrhage

33
Q

What are risks associated w/ poly?

A

1) macrosomia
2) cardiac anomalies
3) aneuploidy
4) PTB
5) fetal intolerance of labor
6) meconium stained amniotic fluid
7) emergency c/s
8) cord pH<7
9) low 5min APGAR
10) increased NICU admission
11) placental abruption
12) PP hemorrhage

34
Q

What is management for macrosomia?

A

1) anatomy U/S to detect fetal anomalies as cause

2) serial growth q3-4wks (include BPD, HC/AC ratio, EFW, AFV) - AC>35cm identifies 90% macrosomia

35
Q

Describe MOA of indomethacin

A

prostaglandin synthetase inhibitor

  • decreases production of fetal urine
  • increases fluid reabsorption by fetal lungs
  • increases amt of intermembranous fluid movement from fetus to gestational carrier
36
Q

What is the outcome of indomethacin?

A

reduces AFV w/in 24h

37
Q

How can indomethacin be used safely?

A
  • 72h = safe time course

- avoid after 31-32wks –> premature closure of ductus arteriosus and renal abnormalities

38
Q

Describe amnioreduction

A

removal of 1-5L fluid

  • usually only done in setting of maternal cardiopulmonary decompensation d/t poly
  • repeated amnioreduction may prolong pregnancy

NURS783 Exam 4 (11 decks)

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