Brainscape's Knowledge GenomeTM

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


See full index

AP Exam 4 (UPenn) > Size/Dates > Flashcards

Size/Dates Flashcards

1
Q

“small for dates” uterine size

A

SGA: wt for gestational age below a given threshold; commonly defined <= 10th percentile.
Fundal height measurement of size less than dates >3cm in women with certain pregnancy dating

  • 70% of SGA neonates are normally developed, constitutionally small

VSGA: < 3rd percentile ~ commonly assoc w/ IUGR

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

SGA etiologies

A

Consider fetal sex and maternal characteristics of height, weight, parity, and ethnic origin

  • if true SGA by customized growth potential, then assoc w/: abnormal doppler studies, fetal intolerance in labor, need for c/s, NICU admission, stillbirth, neonatal death

other causes: aneuploidy, nonaneuploid syndromes, viral infection, placental disease

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

IUGR/FGR definition

A

IUGR/FGR: fetus that fails to reach potential growth. Growth less than or equal to 10th percentile.
- growth pattern slows

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

IUGR/FGR Multifactorial Causes

A 
1. Maternal prepregnancy conditions 
[vascular /heme/BMI issues] 
-Hypertension, cyanotic cardiac disease
-Diabetes 
-Renal disease
-Collagen vascular disease
-Autoimmune disorders (lupus) 
-Thrombophilias 
-Some hemoglobinopathies (sickle cell) 
-Severe anemia
-Prepregnancy BMI <20 or >/= 30
  1. Present pregnancy conditions
    - Multiple gestation
    - Inadequate weight gain
    - Placental abnormalities (circumvallate placenta, placenta accreta, single umbilical artery, partial placental infarction, hemangioma, placental abruption, placenta previa)
    - relative hypoglycemia on a 3hr OGTT
    - Unexplained abnormal biochemical markers on genetic screening
    - abnormal 2nd tri UA Doppler velocimetry
  2. Prior maternity and family hx
    - prior IUGR infant
    - family or personal hx of infant w/ chromosomal abnormalities, congenital malformations, or genetic syndromes
  3. Teratogens
    - Smoking
    - Substance use
    - Environmental exposures
5. Maternal exposure to infection
TORCHES~ 
-TOxoplasmosis
-Rubella
-CMV 
-HErpes SV
--Syphillis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Symmetric IUGR

A
  • Appears as uniform diminishment of fetal organs, length and weight – overall proportionally smaller newborn
  • Associated w/ 25% of IUGR
  • not usually improved w/ antenatal interventions

Causes:

  1. genetic– chromosomal, congenital anomalies
  2. infectious–CMV, rubella
  3. teratogens–smoking, alcohol, cocaine, narcotics, drugs i.e. phenytoin, valproate

Management: weigh risk of prematurity vs risk of adverse in utero environment

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

Asymmetric IUGR

A
  • Head sparing, abdomen and lower body experience delay in growth
  • Associated w/ 75% of IUGR

Causes

  • Uteroplacental insufficiency – causes chronic fetal hypoxemia and malnutrition in utero
  • HTN/PEC
  • Malnutrition
  • Diabetes
  • Renal disease
  • Abnormal placentation (circumvallate placenta, placenta previa)
  • Multiple gestation
  • Autoimmune disorders- lupus
  • Hemoglobinopathies - sickle cell anemia

Management:

  • Nutrition
  • Hydration
  • Improvement of uteroplacental blood flow
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Risks associated with LBW

A
  • Increased perinatal and neonatal mortality
  • Stillbirth
  • Neonatal mortality
  • Delayed effects of CP and adult onset of diseases
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Oligohydramnios

A

Less than normal amniotic fluid volume
AFI <=5
DVP <= 2
AFV <= 200-500

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

Oligo etiology

A

Fetal

  • renal agenesis
  • urinary tract obstruction
  • PPROM
  • Abnormal placentation
  • Elevation of maternal serum AFP
  • Pregnancy at or past 42 weeks’ gestation
  • Severe FGR

Maternal

  • dehydration
  • HTN disorders
  • uteroplacental insufficiency
  • antiphospholipid syndrome
  • unknown etiology
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Oligo risks

A
  • Oligo in 2T considered early onset, has a high mortality rate d/t etiologies associated with it
  • Oligo that develops in the 3T is more commonly associated with either uteroplacental insufficiency, prolonged pregnancy, or idiopathic
  • Idiopathic resolves spontaneously in -4 days or in response to maternal hydration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Oligo Dx

A
  • Accurate pregnancy dating and serial assessments of fundal height
  • US if not previously performed for dating
  • If EDD confirmed, targeted US to obtain anatomy scan and AFV
  • If PPROM suspected – sterile spec exam for pooling, nitrazine (pH) test, fern test
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Oligo management

A

Fetal surveillance

  • Serial doppler blood flow studies
  • Fetal kick counts
  • NST
  • BPP/modified BPP

Induction of labor at or after 41 wks GA

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

“large for dates” uterine size

A

LGA: newborn weight greater than or equal to 90th percentile for GA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

LGA associated etiologies

A
  • Diabetes
  • Abnormal 1hr OGTT with normal 3hr
  • Prev birth of infant >4000g
  • Maternal prepregnant obesity
  • Excessive prenatal weight gain
  • Prolonged pregnancy
  • Fetal male gender
  • High paternal birth weight
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Polyhydramnios defined

A

AFV >2100 mL
AFI >=25cm
LVP >8cm

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

Poly etiologies

A

Fetal

  • GI disorders
  • CNS abnormalities
  • Cystic hygromas
  • Nonimmune hydrops
  • Genetic syndromes–beckwith-wiedemann syndrome
  • Congenital infections – toxoplasmosis, rubella, CMV, HSV, parvovirus B19
  • Placental abnormalities
  • Twin gestation

Maternal

  • Idiopathic
  • Poorly controlled DM
  • Maternal-fetal hemorrhage
17
Q

Macrosomia defined

A

> 4000g (8lb 13oz) in a diabetic mother

>4500g in non-diabetic mother

18
Q

Macrosomia etiologies

A

[Same as LGA]

  • Diabetes
  • Abnormal 1hr OGTT with normal 3hr
  • Prev birth of infant >4000g
  • Maternal prepregnant obesity
  • Excessive prenatal weight gain
  • Prolonged pregnancy
  • Fetal male gender
  • High paternal birth weight
19
Q

Poly diagnosis

A
  • Serial fundal heights
  • AFI >=25
  • LVP >8
  • Medical and family hx for presence of diabetes and results of GDM should be reviewed
20
Q

Poly management

A
  • Serial dopplers
  • Fetal kick counts
  • NSTs
  • BPP/modified BPPs

Treatment:

  • indomethacin: to dec production of fetal urine, inc fluid reabsorption by fetal lungs, and inc intermembranous fluid movement from fetus to mother *but contraindicated after 32 wks
  • serial amniocentesis reduction (for severe poly). Must be repeated since amniotic fluid is regenerated every 48-72hrs. Risks include ROM, PTL, placental abruption if fluid decompressed too quickly.
21
Q

Macrosomia dx

A
  • > 4,000g diabetic, >4,500 non-diabetic
  • Confirm EDD
  • Fundal height >3cm for GA, possible macrosomia
  • EFW and anatomy scan to r/o anomalies
  • Measurements of BPD, HC/AC ratio, fetal weight, and AFV
  • Fetal AC of >35cm identifies more than 90% of macrosomic infants
22
Q

Macrosomia management

A
  • Serial growth US at 3-4 wk intervals to assess fetal growth curve
  • Leopolds and fundal heights
  • US
  • Include EFW, leopolds, sonographic findings, and woman’s own perception of fetal size when discussing mode of delivery
  • waiting to induce >41 weeks GA associated w/ lower c/s even in presence of macrosomia
23
Q

IUGR: primary underlying etiologies

A
  • aneuploidy
  • viral infection
  • nonaneuploid syndromes
  • placental insufficiency
    • US findings: small AC, normal anatomy, low or normal AFV, abnormal UA Doppler
24
Q

Absolute contraindications to ECV

A

antepartum hemorrhage within last 7 days, abnormal cardiotocography (FHTs), major uterine anomalies, ROM, multiple pregnancy (except delivery of 2nd twin), severe fetal growth restriction, known fetal compromise

AP Exam 4 (UPenn) (5 decks)

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