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OB/GYN review > Test 3 part 2 > Flashcards

Test 3 part 2 Flashcards

1
Q

what is the size expected for gestational age based on?

A

patients LMP and a fundal height measurment

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2
Q

what is the fundal height measurment?

A

with external palpation of the uterus and measurement of the distance from the symphysis pubis to the uterine fundus by the referring physician

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3
Q

what does the fundal height roughly correlate with?

A

gestational age in weeks in centimeters

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4
Q

what can fundal height be affected by?

A
  • technique of the clinician
  • maternal weight
  • fetal position
  • increase in amnitoic fluid
  • size of the placenta
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5
Q

when may size greater than dates in fundal height be suspected?

A

when the patient has had a significant weight gain

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6
Q

when may the uterus present with large for dates when measureing fundal height?

A

leiomyomas are present or when ovarian masses mimic an enlarged uterus or hamper the ability to measure the uterus accurately

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7
Q

what measurments incorporates several fetal parameters?

A
  • biparietal diameter
  • HC
  • AC
  • femur length
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8
Q

Sonographic determination of fetal weight has been estimated to be _____ discrepant of the actual weight

A

10%

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9
Q

when is large for gestational age determined?

A

fetal weight greater than the 90th percentile for gestational age

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10
Q

when is macrosomia determined?

A

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

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11
Q

what is increased when fetal growth discreptancy becomes greater?

A

increases the risk for morbidity and mortality

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12
Q

what is macrosomia?

A

defined as an abnormally large size of the body

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13
Q

Fetal macrosomia complicates more than ______ of all pregnancies in the United States

A

10%

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14
Q

what is the most straightforward approach to the sonographic determination of macrosomia?

A

use estimated fetal weight

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15
Q

what is the major risk factor for macrosomia?

A

gestational diabetis

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16
Q

what is macrosomia associated with?

A

enlargement of the placenta

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17
Q

what measurment of the placenta is considered abnormal?

A

obatined at right angle to its long axis

  • 3cm before 20 weeks
  • greater than 5cm before 40 weeks
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18
Q

what are perinatal complications of macrosomia?

A
  • shoulder dystocia
  • soft tissue trauma
  • humeral and clavicular fractures
  • brachial-plexus injury
  • facial palsies
  • meconium aspiration
  • prolonged labour
  • asphyxial injuries
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19
Q

when does shoulder dystocia occur?

A

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

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20
Q

what is helpful in determining the identification of potential macrosomic infants?

A

fetal AC measurment

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21
Q

what is hydrops fetalis associated with?

A

macrosomia

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22
Q

what may hydrops fetalis manifest with?

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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23
Q

what may increase fundal height?

A
  • multiple gestation
  • conjoined twins
  • twin-twin transfusion
  • hydatiform mole
  • polyhydramnois
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24
Q

when is polyhydramnois indicated with the single pocket assessment?

A

exceeds 8cm

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25
when is oligohydramnios indicated with the single pocket assessment?
less than 2 cm
26
what is often used to assess amniotic fluid?
amniotic fluid index (AFI)
27
how is AFI measured?
dividing the maternal uterus into 4 quadrents and adding the anterior to posterior measurments of the amniotic fluid in each of the quadrents
28
when is the AFI total normaly?
10 to 13 +/- 5cm
29
what is the normal range of AFI?
usually 5-20cm
30
how may a patient detect Oligohydramnios?
patients may notice decreased fetal activity
31
how does amniotic fluid volume result?
from a balance between what enters and exits from the amniotic cavity
32
what are the functions of amniotic fluid?
- preventing fetal injury - regulating temperature - providing mobility for practicing breathing - swallowing exercises - fighting infection - discouraging contractions - maintaing cervical length and consistency
33
what is a decrease in AFV directly correlated with?
perinatal mortality and many serious morbidities
34
what can result in amniotic fluid loss?
- result of decreased fetal urinary production or excretion - kidneys are dysplastic and with severe IUGR - urinary outlet obstructioon
35
when can PROM be suggested?
with the finding of decreased amniotic fluid on sonography and a fetus that is of an appropriate size without structural anomalies
36
what are some causes of oligohydramnois?
- fetal anomalies - medication or drug use by the mother - maternal medical disease - placental insufficency - chromosome alterations
37
what can chronic oligohydramnois with or without fetal abnormalities cause?
- pulmonary hypoplasia - abnormal chest wall compliance - contractures - infection
38
who is renal agenesis more common in?
males
39
what is bilateral absence of the kidneys more common in?
twins than in singletons
40
how does bilateral renal agenesis occur?
result of maldevelopment of the metanephros before 4 weeks of embryonic stage
41
how is autosomal recessive polycystic kidney disease (ARPKD) caused?
caused my mutations in the PKHD1 gene and is characterized by non obstructive dilations of the collecting ducts in the kidneys and hepatic fibrosis
42
what can severe cases of ARPKD result in?
perinatal death with pulmonary hypoplasia
43
what is mild hydronephrosis?
dilation of the renal pelvis
44
what is moderate hydronephrosis?
dilation of the renal pelvis and calyces
45
what is severe hydronephrosis?
gross dilation of the collecting system with a decrease in the renal cortical tissue
46
what has mild pylectasis been associated with?
down syndrome
47
when does oligohydramnois occur with hydronephrosis?
obstruction is sever, bilateral, or associated with a serious contralateral anomaly
48
what are the most common congenital obstructive genitourinary anomlaies?
- uteropelvic junction obstruction (UPJ) - uretovesical junction obstruction (UVJ) - posterior urethral valves (PUV)
49
how much fluid is seen in the renal pelvis before 33 weeks?
<4 mm
50
how much fluid is seen in the renal pelvis at 33 weeks to term?
<7 mm
51
what is the most common cause of bladder outlet obstruction?
posterior urethral valve
52
what is posterior urethral valve anomaly accompanied by?
- enlarged bladder - bilateral hydronephrosis - hydroureters
53
in male fetuses, what may PUV be accompanied by?
prune belly syndrome
54
in female fetuses, what may PUV be accompanied by?
urethral atresia
55
what is the treatment of PUV when its identified early in the pregnancy?
- 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
56
what does the PUV treatment aid in, if successful?
aids in fetal lung development and reduces fetal growth restriction anomalies
57
what is IUGR?
refers to a fetus that has not reached growth potential becuase of genetic or environmental factors
58
what can normal birth weight be affected by?
- gender of the infant - race - parity - body mass index of the mother - environemental factors
59
what is SGA defined as?
birth weight or fetal weight less than 10th percentile at any given gestational age
60
why must you distinguish SGA from IUGR?
IUGR is associated with stillbirth, neonatal death, and perinatal morbidity
61
what are the 2 growth restriction patterns?
symmetric form | asymmetric form
62
is symmetric or asymmetric growth restriction more common?
asymetric form
63
what is symmetric growth restriction?
both the fetal head and abdomen are proportionately decreased
64
what is symmetric growth restriction associated with?
intrinsic insults - chromosomal alterations - fetal infections
65
what is asymmetric form of growth restriction?
a greater decrease in abdominal size is seen
66
what is asymmetric form of IUGR associated with?
extrinsic insults | -placental insufficency
67
what are placental factors for asymmteric IUGR?
tumors and placental or umbilical cord accidents or abnormalities (velamentous or marginal cord insertion)
68
what are maternal diseases that compromise oxygen availability or cause endothelial vascular damage that are associated wth fetal growth restriction?
- hypertension - renal disease - insulin-dependen diabetes mellitus - systemic lupus erythematousus - sickel cell anemia - severe lung disease - cyanotic heart disease
69
how is pre-eclampsia characterized?
by the new onset of hypertension and proteinuria after 20 weeks of gestation
70
what are the risk factors of pre-ecplampsia?
- history of preeclampsia - first pregnancy - fam history - multiple gestation - obesity - preexisting hypertension - renal disease - collagen vascular disease - advanced age - prolonged interval between pregnancies - and a change of partners between pregnancies
71
what may pre-eclampsia cause?
fetal growth failure, especially when the onset is early
72
what is measured for symmetric IUGR?
fetal head, abdomen, and femur that all are below the expected values for a given gestational age
73
what is measured for asymmetric IUGR?
the abdominal circumference is smaller than expected but the fetal head and femur measurements are appropriate for gestational age
74
what are the doppler findings with IUGR?
- increase in the ratio of systolic to diastolic flow in the umbilical artery - increase in the pulsatility index and resistive index are indicative of increasing placental resistance and poor fetal outcome - diastolic flow may disappear
75
what is warranted for further evaluation when looking at doppler with IUGR?
- ductus venosus may demonstrate reversal of flow during the a-wave - middle cerebral artery may demonstrate reduced flow resistance - umbilical vein may become pulsatile
76
Most women with PROM at term go into spontaneous labor within the first ______________
24 hours
77
what does development of pulmonary hypoplasia depend on with PROM?
gestational age at which rupture occurs and on the amount of residual amniotic fluid volume and duration of oligohydramnios
78
what does PROM before 37 weeks (PPROM) have an increased risk of?
- chorioamnionitis - fetal morbidity and death - having a c-section

OB/GYN review (8 decks)

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