fetal size problems

Question 1

intrauterine fetal demise - definition

Answer 1

fetal death at 20 or more wks

Question 2

intrauterine fetal demise - diagnosis

Answer 2

abscense of fetal cardiac activity on U/S

Question 3

intrauterine fetal demise - management

Answer 3

20-23 weeks: dilation + evacuation or vaginal delivery
24 or more: vaginal delivery (regardless fetal presentation: cephalic , breech etc)
the delivery can be delayed for the parents to accept it, but retention of the fetus several weeks can cause coagulopathy

Question 4

intrauterine fetal demise - complications

Answer 4

coagulopathy after several weeks of fetal retention

Question 5

evaluation of fetal demise

Answer 5

fetal - autopsy, gross + microscopic examination of placental, membranes and cord, Karyotype + genetic studies
maternal: Kleihauer-Betke test for fetomaternal hemorrhage, antiphsphoipid anomalies, coagulation studies

Question 6

Fetal growth restriction - definition

Answer 6

weight less than 10th percentile for gestational age

Question 7

fetal growth restriction - RF

Answer 7

1. maternal hypertension
2. pregestational DM
3. genetic abnormalities
4. congenital infection

Question 8

fetal growth restriction - appearance

Answer 8

large anterior fontanel
2, thin umbilical cord
3. loose peeling skin
4. minimal subcutaneous fat

Question 9

fetal growth restriction - evaluation

Answer 9

1. placenta histopathilogy

2. consider karyotype, urine toxicology, serology

Question 10

fetal growth restriction - neonatal complications

Answer 10

1. polycythemia
2. hypoglycemia
3. hypocalcemia
4. poor thrmoregulation

Question 11

symmetric vs asymmetric fetal growth restriction regarding onset

Answer 11

symmetric: 1st trimester
asymmetric: 2nd/3rd trimester

Question 12

symmetric vs asymmetric fetal growth restriction regarding etiology

Answer 12

sym: ch abnormalities, congenital infection
asym: uteroplacental insuf, maternal malnutrition

Question 13

fetal growth restriction - management

Answer 13

1. weekly biophysical profiles
2. serial umbilical artery Doppler sonography
3. serial growth U/S

Question 14

type 2 osteogenesi imperfecta - pathophys

Answer 14

AD, type 1 collagen

Question 15

type 2 osteogenesi imperfecta - U/S

Answer 15

multiple fractures, short femur, hypoplastic thoracic cavity, fetal growth restriction, intrauterine demise

Question 16

type 2 osteogenesi imperfecta - prognosis

Answer 16

lethal

Question 17

delivery planning for a nonviable fetus - fetal diagnosis

Answer 17

1. anencephaly
2. bilateral renal agenesis
3. holoprosencephaly
4. acardia
5. thanatophoric dwarfism
6. intrauterine fetal demise

Question 18

delvery planning for a nonviable fetus - obstetric management

Answer 18

vaginal delivry

no fetal monitoring

Question 19

delivery planning for nonviable fetus - neonatal management

Answer 19

palliative care if not stillborn