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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
Q

when is oligohydramnios indicated with the single pocket assessment?

A

less than 2 cm

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26
Q

what is often used to assess amniotic fluid?

A

amniotic fluid index (AFI)

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27
Q

how is AFI measured?

A

dividing the maternal uterus into 4 quadrents and adding the anterior to posterior measurments of the amniotic fluid in each of the quadrents

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28
Q

when is the AFI total normaly?

A

10 to 13 +/- 5cm

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29
Q

what is the normal range of AFI?

A

usually 5-20cm

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30
Q

how may a patient detect Oligohydramnios?

A

patients may notice decreased fetal activity

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31
Q

how does amniotic fluid volume result?

A

from a balance between what enters and exits from the amniotic cavity

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32
Q

what are the functions of amniotic fluid?

A
  • preventing fetal injury
  • regulating temperature
  • providing mobility for practicing breathing
  • swallowing exercises
  • fighting infection
  • discouraging contractions
  • maintaing cervical length and consistency
33
Q

what is a decrease in AFV directly correlated with?

A

perinatal mortality and many serious morbidities

34
Q

what can result in amniotic fluid loss?

A
  • result of decreased fetal urinary production or excretion
  • kidneys are dysplastic and with severe IUGR
  • urinary outlet obstructioon
35
Q

when can PROM be suggested?

A

with the finding of decreased amniotic fluid on sonography and a fetus that is of an appropriate size without structural anomalies

36
Q

what are some causes of oligohydramnois?

A
  • fetal anomalies
  • medication or drug use by the mother
  • maternal medical disease
  • placental insufficency
  • chromosome alterations
37
Q

what can chronic oligohydramnois with or without fetal abnormalities cause?

A
  • pulmonary hypoplasia
  • abnormal chest wall compliance
  • contractures
  • infection
38
Q

who is renal agenesis more common in?

A

males

39
Q

what is bilateral absence of the kidneys more common in?

A

twins than in singletons

40
Q

how does bilateral renal agenesis occur?

A

result of maldevelopment of the metanephros before 4 weeks of embryonic stage

41
Q

how is autosomal recessive polycystic kidney disease (ARPKD) caused?

A

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
Q

what can severe cases of ARPKD result in?

A

perinatal death with pulmonary hypoplasia

43
Q

what is mild hydronephrosis?

A

dilation of the renal pelvis

44
Q

what is moderate hydronephrosis?

A

dilation of the renal pelvis and calyces

45
Q

what is severe hydronephrosis?

A

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

46
Q

what has mild pylectasis been associated with?

A

down syndrome

47
Q

when does oligohydramnois occur with hydronephrosis?

A

obstruction is sever, bilateral, or associated with a serious contralateral anomaly

48
Q

what are the most common congenital obstructive genitourinary anomlaies?

A
  • uteropelvic junction obstruction (UPJ)
  • uretovesical junction obstruction (UVJ)
  • posterior urethral valves (PUV)
49
Q

how much fluid is seen in the renal pelvis before 33 weeks?

A

<4 mm

50
Q

how much fluid is seen in the renal pelvis at 33 weeks to term?

A

<7 mm

51
Q

what is the most common cause of bladder outlet obstruction?

A

posterior urethral valve

52
Q

what is posterior urethral valve anomaly accompanied by?

A
  • enlarged bladder
  • bilateral hydronephrosis
  • hydroureters
53
Q

in male fetuses, what may PUV be accompanied by?

A

prune belly syndrome

54
Q

in female fetuses, what may PUV be accompanied by?

A

urethral atresia

55
Q

what is the treatment of PUV when its identified early in the 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
56
Q

what does the PUV treatment aid in, if successful?

A

aids in fetal lung development and reduces fetal growth restriction anomalies

57
Q

what is IUGR?

A

refers to a fetus that has not reached growth potential becuase of genetic or environmental factors

58
Q

what can normal birth weight be affected by?

A
  • gender of the infant
  • race
  • parity
  • body mass index of the mother
  • environemental factors
59
Q

what is SGA defined as?

A

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

60
Q

why must you distinguish SGA from IUGR?

A

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

61
Q

what are the 2 growth restriction patterns?

A

symmetric form

asymmetric form

62
Q

is symmetric or asymmetric growth restriction more common?

A

asymetric form

63
Q

what is symmetric growth restriction?

A

both the fetal head and abdomen are proportionately decreased

64
Q

what is symmetric growth restriction associated with?

A

intrinsic insults

  • chromosomal alterations
  • fetal infections
65
Q

what is asymmetric form of growth restriction?

A

a greater decrease in abdominal size is seen

66
Q

what is asymmetric form of IUGR associated with?

A

extrinsic insults

-placental insufficency

67
Q

what are placental factors for asymmteric IUGR?

A

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

68
Q

what are maternal diseases that compromise oxygen availability or cause endothelial vascular damage that are associated wth fetal growth restriction?

A
  • hypertension
  • renal disease
  • insulin-dependen diabetes mellitus
  • systemic lupus erythematousus
  • sickel cell anemia
  • severe lung disease
  • cyanotic heart disease
69
Q

how is pre-eclampsia characterized?

A

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

70
Q

what are the risk factors of pre-ecplampsia?

A
  • 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
Q

what may pre-eclampsia cause?

A

fetal growth failure, especially when the onset is early

72
Q

what is measured for symmetric IUGR?

A

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

73
Q

what is measured for asymmetric IUGR?

A

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

74
Q

what are the doppler findings with IUGR?

A
  • 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
Q

what is warranted for further evaluation when looking at doppler with IUGR?

A
  • 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
Q

Most women with PROM at term go into spontaneous labor within the first ______________

A

24 hours

77
Q

what does development of pulmonary hypoplasia depend on with PROM?

A

gestational age at which rupture occurs and on the amount of residual amniotic fluid volume and duration of oligohydramnios

78
Q

what does PROM before 37 weeks (PPROM) have an increased risk of?

A
  • chorioamnionitis
  • fetal morbidity and death
  • having a c-section

OB/GYN review (8 decks)

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