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Fall 2014 - OB II > Fetal Growth Assessment ✔️ > Flashcards

Fetal Growth Assessment ✔️ Flashcards

0
Q

what is at term birth

A

38-42 weeks

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1
Q

what is pre term birth

A

before 38 weeks

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2
Q

what is post term birth

A

later than 42 weeks

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3
Q

describe fetal weight

A

small for GA (SGA)
appropriate for GA
large for GA (LGA)

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4
Q

describe intrauterine growth restriction

A

decreased rate of fetal growth

complicates <10% of pregnancies

fetal weight at or below 10%

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5
Q

what is IUGR

A

intrauterine growth restriction

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6
Q

greater risk factors for IUGR

A 
antepartum death
perinatal asphyxia
neonatal morbidity
later development problems
mortality increases 6-10 fold
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7
Q

SGA is a fetus below _____ percentile without reference to cause

A

10th

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8
Q

IUGR is a subset of the SGA as a result of a ___________ ____________

A

pathologic process

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9
Q

causes of IUGR

A

maternal disease states - diabetes, hypertension

placental uteroplacental insufficiency - UPI

fetal - genetic/chromosomal

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10
Q

maternal factors with IUGR

A 
poor nutrition
poor pregnancy weight gain
maternal use of drugs
previous history of fetus with IUGR
significant maternal HTN
presence of uterine anomaly
significant placental hemorrhage
placental insufficiency
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11
Q

placental factors with IUGR

A

extensive primary placental infarctions - leads to UPI

**maternal & placental factors lead to asymmetric IUGR

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12
Q

fetal factors for IUGR

A

primary fetal developmental anomalies
chronic fetal infections
usually result of 1st trimester insult

**associated with symmetric IUGR

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13
Q

symmetric IUGR

A

result of a long standing severe maternal/placental cause

chromosomal/genetic anomalies

infection (TORCH)

proportionally small in all parameters

**may appear before 20 weeks

**associated with 1st trimester insults

20-30% of all IUGR cases are symmetric

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14
Q

asymmetric IUGR

A

cause usually related to maternal disease states or later developing placental causes

**last 8-10 weeks of pregnancy

disproportionate growth of head/abd

brain sparing

**typically develops after 24 weeks

**more common than symmetric

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15
Q

describe accurate age

A

last menstrual period

first trimester US

standard BPD, HC, AC, and FL

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16
Q

clinical observations for interruption in aging

A

decreased fundal height

decreased fetal motion

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17
Q

sonographic parameters showing issues with growth

A

AC/HC most important ratio

   HC - symmetric = less than 3rd% of age
           asymmetric = normal growth until very late

   IUGR affects the fetal liver

   AC - single most sensitive indicator of IUGR
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18
Q

sonographic parameters for IUGR

A 
oligohydramnios
advanced placental grading
thin placenta
delayed appearance of epiphyseal sites
elevated RI's cord doppler - increased doppler resisstance/impedance
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19
Q

what do you assess for BPP

A 
fetal breathing
fetal movement
fetal muscle tone
AFI
fetal HR changes
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20
Q

what is BPP

A

biophysical profile

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21
Q

babies go through normal _____ min sleep-wake cycles

A

30

22
Q

fetal breathing becomes regular at ________ weeks

A

20-21

23
Q

fetal HR changes in response to fetal movement at ______ weeks

A

12-14

24
Q

as the central nervous system matures (24 weeks & up), HR ________ with fetal movement

A

accelerates

25
Q

what is acute hypoxia

A

decrease in breathing, movement, and HR activity

26
Q

what is severe acute hypoxia

A

absence of movement/tone

27
Q

what is chronic hypoxia

A

result of UPI; oligo & decreased movement is common

28
Q

guidelines for BPP

A

timed 30 mins
score of 2 for each parameter

8= normal
4-6= no immediate significance
0-2= immediate delivery or extend testing
29
Q

describe fetal breathing movements

A

inward movement of chest wall with outward movement of abd wall

2 pts if one episode of breathing last 30-60 sec within 30 mins

if absent no points are given

30
Q

describe fetal growth movement

A

3 definite extremity or trunk movements in 30 mins for 2 points

fewer than 3 scores 0 points

31
Q

describe AFI

A 
4 quadrants
largest vertical pocket is measured
1 pocket must measure at least 2 cm in 2 perpendicular planes
exclude fetal limbs or cord
normal is 5-22 cc based on age
32
Q

describe fetal tone

A

extension and flexion of extremity or spine
one episode in the 30 mins scores 2 pts
no episodes score 0 pts

33
Q

what 4 things make up a BPP

A

fetal breathing movements
fetal gross movment
AFI
fetal tone

34
Q

describe a non stress test (NST)

A

40 mins
non-imaging test uses stimuli to test fetal reactivity
doppler to record HR
should demonstrate at least 2-5 fetal heart accelerations
reactivity to the stress of uterine contraction

35
Q

describe normal NST

A

2-5 fetal HR’s of 15 beats/min or more
acceleration lasting 15 sec
gross fetal movements over 20 mins

36
Q

umbilical cord doppler quantitative measures

A

velocity

37
Q

umbilical cord doppler qualitative shows

A

characteristics of wave form

38
Q

cord doppler ratio formulas:

S/D = ?
RI = ?
PI = ?
A

S/D = ratio-systolic/diastolic

RI = systole minus diastole/systole

PI = peak systole - end diastole/mean velocity

39
Q

S/D of more than _____ in umbilical artery after _____ weeks is abnormal

A

3.0

30

should never have absent or reversed end diastole flow

40
Q

S/D of more than _____ in the maternal uterine artery is abnormal with diastolic notching after _____ weeks

A

2.6

22

41
Q

fetus with IUGR - _______ in vascular resistance/impedance reflects ______ S/D ratio and RI

A

increase

increased

42
Q

describe macrosomia

A

classically defined as birth weight of 4000 g or greater or above 90th percentile for estimated gestational age

with respect to delivery, any fetus too large for pelvis through which it must pass is macrosomic

43
Q

Macrosomia is 1.2-2.0 times more frequent than normal in women who…

A 
multiparous
35+ yrs old
pre-pregnancy weight of >70 kg or 154 lb
PI in upper 10%
pregnancy weight gain of > or = 20 kg or 44 lb
postdate pregnancy
history of delivering LGA fetus
44
Q

macrosomia is common result of poorly controlled maternal ________ _______

A

diabetes mellitus

45
Q

with macrosomia, in addition to adipose tissue, the liver, heart, and adrenal glands are disproportionately increased in size, which can be reflected by an increased ______

A

AC measurement

46
Q

name 4 malformation syndromes in which fetal increase in size, with or without organomegaly

A

beckwith-wiedemann
marshall-smith
soto’s
weaver’s

47
Q

what are the 2 terms relating to macrosomic fetuses

A

mechanical macrosomia

metabolic macrosomia

48
Q

what are 3 types of mechanical macrosomia

A

type 1: fetuses generally large

type 2: fetuses generally large but with especially large shoulders

type 3: fetuses with normal trunk but large head

49
Q

type 1 mechanical macrosomia can results from what

A

genetic factors
prolonged pregnancy
multiparity

50
Q

type 2 mechanical macrosomia is found in what type of pregnancy

A

diabetic

51
Q

type 3 mechanical macrosomia can be caused by what

A

genetic constitution or pathologic process (hydrocephalus)

52
Q

name 2 other methods for detecting macrosomia

A

placentas can become significantly large and thick because not immune to growth enhancing effects of fetal insulin

placental thickness >5 cm considered thick when measurement taken at right angles to its long axis

Fall 2014 - OB II (12 decks)

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