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OB review > size larger than dates > Flashcards

size larger than dates Flashcards

1
Q

what is the fundal height measurement?

A
  • with external palpation of the uterus and measurement of the distance from the symphysis pubis to the uterine fundas by the referring physician
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2
Q

fundal hight measurement if not highly accurate and may not always be a reflection of excessive fetal growth because is can be affected by multiple factors including? (5)

A
  • technique of clinician
  • maternal weight
  • fetal position
  • increase in amniotic fluid
  • size of the placenta
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3
Q

fetal weight estimation incorpotates several fetal parameter including? (4)

A
  • biparietal diameter
  • HC
  • AC
  • femur length
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4
Q

what is large for gestational age? (LGA)

A
  • Estimated fetal weight is greater than the 90th percentile for GA
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5
Q

what is macrosomia?

A

determined when the estimated fetal weight is greater than or equal to 4500g

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6
Q

macrosomia is defined as?

A
  • an abnormally large size of the body

- refers to entire fetus, neonate, or newborn

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7
Q

macrosomia in respect to delivery?

A

any fetus that is too large for the maternal pelvis through which it must pass is macrosomic

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8
Q

The most straightforward approach to the sonographic

determination of macrosomia is ?

A

to use estimated fetal weight

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9
Q

Risk factors of macrosomia?

A
  • gestational diabetes (40% of cases)

- enlargement of placenta

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10
Q

how is placental thickness obtained?

A
  • at a right angle to its long axis that measures >3cm before 20 weeks GA or
  • > 5cm before 40 weeks GA is considered abnormal
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11
Q

risk of macrosomia- perinatal complications? (8)

A 
Shoulder dystocia
soft tissue trauma
humeral and clavicular fractures
brachial plexus injury
facial palsies
meconium aspiration
prolonged labor
asphyxial injuries
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12
Q

shoulder dystocia occurs when?

A

the arm of the fetus prevents or complicates delivery and may result in serious traumatic injury

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13
Q

Evidence strongly suggests an increased risk of prenatal complications for pregnancies with fetuses weighing greater than?

A

4500 gms

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14
Q

The sonographic fetal AC measurement has been determined to be helpful in identification of?

A

potential macrosomic infants

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15
Q

Hydrops fetalis is also associated with macrosomia and may manifest sonographically with one or more of the following? (7)

A 
Increased placental thickness
Increased thickness of scalp 
Body wall greater than 5 mm 
Hepatosplenomegaly
Pleural and pericardial effusions
Ascites
Structural fetal anomalies
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16
Q

what is a single pocket assesment?

A

performed with identification of the largest vertical pocket of amniotic fluid and measurement of the anteroposterior depth

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17
Q

Polyhydramnios is indicated when the pocket exceeds?

A

8 cm

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18
Q

Oligohydramnios is indicated when the pocket is less than?

A

2cm

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19
Q

what does AFI method involve?

A

method involves dividing the maternal uterus into four quadrants and adding the anterior-to-posterior measurements of the amniotic fluid in each of the quadrants

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20
Q

The AFI total is normally?

A

10 to 13 ± 5 cm

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21
Q

The normal range for the AFI is usually

A

5-20 cm

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22
Q

A 21-year-old woman is seen for an obstetric examination with an indication of large for gestational age at 28 weeks by first-trimester sonography. The sonogram shows a fetus measuring 28 weeks. The AFI is 25 cm. What is the most likely diagnosis?

A

Polyhydramnios

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23
Q

A 29-year-old woman presents for obstetric sonography at 35 weeks’ gestation. She has a history of gestational diabetes in two prior pregnancies. Sonograms at 11 weeks and 23 weeks have confirmed gestational age and have been otherwise unremarkable. The current examination reveals an average sonographic age of 38 weeks, 4 days. The placenta appears generous in size, measuring 6.2 cm. What is the most likely diagnosis?

A

Microsomia

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24
Q

A 22-year-old woman is seen for an obstetric sonogram at 16 weeks’ gestation by LMP for increased uterine size and absent heart tones. The sonogram shows a large heterogeneous mass within the uterus. No identifiable fetus or amniotic fluid can be detected. What is the most likely diagnosis?

A

Hydatidiform mole

25
Q

25-year-old woman is referred for sonographic dating, with unknown LMP, no prior studies, and a fundal height measuring approximately 35 weeks. The average of four fetal parameters measured calculate to 32 weeks. AFI measures 17 cm. What is the most likely diagnosis?

A

The fetus is most likely normal, with mild polyhydramnios

26
Q

The functions of amniotic fluid are?

A

Preventing fetal injury, regulating temperature, providing mobility for practicing breathing, swallowing exercises, fighting infection, discouraging contractions, and maintaining cervical length and consistency

27
Q

Oligohydramnios?

A
  • significant decrease in the normal volume of amniotic fluid
  • patients may notice a decrease fetal activity
28
Q

Amniotic fluid volume (AFV) results from?

A

a balance between what enters and exists from the amniotic cavity

29
Q

a decrease in AFV is directly correlated with?

A

perinatal mortality and many serious morbidities

30
Q

Renal agenesis?

A
  • congenital absence of one or both kidneys from the complete lack of formation
  • incidence rate of renal agenesis is 1 in 3000 births in 1 in 250 still births
  • more common in males
31
Q

Bilateral absence of the kidneys is more common in?

A

twins than singletons

32
Q

Autosomal recessive polycystic kidney disease (ARPKD) si caused by?

A

mutations in the PKHD1 gene and is characterized by nonobstructive dilations of the collecting ducts in the kidneys and hepatic fibrosis

33
Q

Hydronephrosis

A

Dilation of the renal collecting system

34
Q

hydronephrosis mild, moderate, severe

A

Mild hydronephrosis: dilation of the renal pelvis

Moderate hydronephrosis: dilation of the renal pelvis and calyces

Severe hydronephrosis: gross dilation of the collecting system with a decrease in the renal cortical tissue

35
Q

mild pyelectasis has been associated with?

A

down syndrome

36
Q

Oligohydramnios occurs when?

A

the obstruction is severe, bilateral, or associated with a serious contralateral anomaly

37
Q

The most common congenital obstructive genitourinary anomalies?

A 
Ureteropelvic junction (UPJ) obstruction
Ureterovesical junction (UVJ) obstruction
Posterior urethral valves (PUV)
38
Q

Posterior urethral valves - PUV?

A

The most common cause of bladder outlet obstruction resulting from the development of abnormal valves in the posterior urethra

39
Q

PUV is accompanied by?

A
  • enlarged bladder
  • bilateral hydronephrosis
  • hydroureters
40
Q

PUV occurs in?

A

occurs only in male fetuses and may be accompanied by prune-belly syndrome

41
Q

female version of PUV?

A

has similar findings occurs with urethral atresia

42
Q

treatment when PUV is identified early in pregnancy?

A
  • Patients may be offered prenatal vesicoamniotic shunting to decompress the bladder and kidneys
  • Provides a pathway for fluid from the fetus into the amniotic cavity
  • If successful, this shunt also aids in fetal lung development and reduces fetal growth restriction anomalies
43
Q

Intrauterine growth restriction-IUGR refers to?

A

a fetus that has not reached growth potential because of genetic or environmental factors

44
Q

SGA is generally defined as?

A

a birth weight or fetal weight less than the 10th percentile at any given gestational age

45
Q

why must you distinguish SGA from IUGR?

A

IUGR is associated with stillbirth, neonatal death, and perinatal morbidity

46
Q

2 subdivisions of IUGR?

A
  • symmetric

- asymmetric

47
Q

symmetric IUGR?

A

20-30%

- both the fetal head and the abdomen are proportionately decreased

48
Q

symmetric IUGR is associated with?

A

with intrinsic insults, such as: chromosomal alterations or fetal infections (toxoplasmosis, cytomegalovirus)

49
Q

asymmetric IUGR?

A

(70-80%)
- a greater decrease in abdominal size is seen
Associated with extrinsic insults such as placental insufficiency

50
Q

asymmetric IUGR placental factors?

A

Tumors and placental or umbilical cord accidents or abnormalities (velamentous or marginal cord insertion)

51
Q

Maternal causes of IUGR?

A

Maternal diseases that compromise oxygen availability or cause endothelial vascular damage are associated with fetal growth restriction:

Hypertension
Renal disease
Insulin-dependent diabetes mellitus
Systemic lupus erythematosus
Sickle cell anemia
Severe lung disease
Cyanotic heart disease
52
Q

Pre-eclampsia is characterized by?

A

by the new onset of hypertension and proteinuria after 20 weeks of gestation

53
Q

pre-eclampsia risk factors?

A 
History of preeclampsia
first pregnancy
family history
multiple gestation
obesity
preexisting hypertension
renal disease
collagen vascular disease
advanced age
prolonged interval between pregnancies
change of partners between pregnancies
54
Q

Preeclampsia may cause?

A

fetal growth failure, especially when the onset is early

55
Q

The finding of IUGR in the context of preeclampsia?

A

makes that condition severe and is considered an indication for delivery

56
Q

Evaluation and management of fetuses suspected to have IUGR is based on?

A

serial sonographic examinations

57
Q

examination of symmetric IUGR?

A

Measurements of the fetal head, abdomen, and femur that all are below the expected values for a given gestational age

58
Q

examination of asymmetric IUGR?

A

The abdominal circumference is smaller than expected, but fetal head and femur measurements are appropriate for gestational age

59
Q

Doppler findings with IUGR?

A
  • An increase in the ratio of systolic to diastolic flow in the umbilical artery
  • An increase in the pulsatility index and resistive index are indicative of increasing placental resistance and poor fetal outcome
  • Diastolic flow may eventually disappear or may reverse in direction toward the fetus

OB review (10 decks)

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