Beckman Fetal Growth Abnormalities

Question 1

IUGR is fetus/infant whose weight is less than:

Answer 1

10th percentile (@ given gestational age)

Question 2

Early in pregnancy, fetal growth occurs through ____ _____; later in pregnancy, through ____ _____

Answer 2

early: cellular hyperplasia (division)
later: cellular hypertrophy

Question 3

why is late onset growth restriction possibly related to uteroplacental insufficiency?

Answer 3

Placenta maxes out growth by 37 weeks, after which there is a steady decline in SA and microinfarctions of vascular system

Question 4

maternal infections ass. with IUGR

Answer 4

rubella, varicella, CMV

Question 5

rate of growth restriction is ____x higher among babies born to moms who smoke during preg.

Answer 5

3-4x

Question 6

meds ass. with IUGR

Answer 6

anticonvulsants, warfarin, folic acid antagonists

Question 7

Inherent growth potential of the individual is determined: _____

Answer 7

genetically

Question 8

T/F: Male and female fetuses are at same risk for IUGR

Answer 8

False…Females have higher risk

Question 9

Screening test for IUGR

Answer 9

serial measurements of fundal height (but low Se and Sp)

Question 10

between 20-36 weeks gestation, fundal height should increase:

Answer 10

1cm/week, consistent with gestational age in weeks

Question 11

Significant discrepancy of ____cm may indicate IUGR and the need for an ______ exam

Answer 11

2 cm; Ultrasound (US)

Question 12

if IUGR is suspected based on risk factors/clinical assessment, what’s the next step?

Answer 12

Ultrasound…assess fetal size and growth.

Question 13

what are the four standard fetal measurements

Answer 13

1. biparietal diameter
2. head circumference
3. abdominal circumference (AC)
4. femur length

Question 14

An _____ _____ within the normal range reliably excludes growth restriction

Answer 14

Abdominal Circumference (AC)

Question 15

why perform amniocentesis if concerned about fetal growth?

Answer 15

assess lung maturity. Fetal karyotyping, viral cultures, and PCR can also be performed on fluid obstained by amnio.

Question 16

The systolic-diastolic ratio in the umbilical artery indirectly measures:

Answer 16

Impedance/resistance downstream within placental vessels

Question 17

Mechanisms of fetal surveillance (used to manage pregnancy with IUGR)

Answer 17

fetal movement counting, NST, BPP, Doppler

Question 18

Neonatal mgmt of IUGR infants includes preparation for:

Answer 18

1. Neonatal respiratory compromise
2. hypoglycemia
3. hypothermia
4. hyperviscosity syndrome

Question 19

What does hyperviscosity syndrome result from?

Answer 19

Fetus’s attempt to compensate for poor placental oxygen transfer by increasing the hematocrit to >65%

Question 20

What complications can the polycythemia from hyperviscosity syndrome cause?

Answer 20

Multiorgan thrombosis, heart failure, hyperbilirubinemia

Question 21

Is the prognosis ever good for a growth-restricted infant?

Answer 21

Yes, generally good if they survive the neonatal period

Question 22

fetal macrosomia typically refers to an estimated weight >____g

Answer 22

4000-4500g

Question 23

large for gestational age implies brith weighth of >____%

Answer 23

90th percentile for a given gestational age

Question 24

macrosomia is based on______ alone and LGA is based on _____ and ______

Answer 24

M: Weight

LGA: Weight and gestational age

Question 25

Fetal risk factors for LGA (3)

Answer 25

1. Genetic potential
2. Specific gene disorders
3. Male sex

Question 26

Maternal risk factors for infant LGA (5)

Answer 26

1. hx of previous macrosomic preg
2. metabolism
3. body composition
4. pregnancy wt gain
5. parity

(ethinicity, gest. age>40wks, maternal age<17, and positive 50g glucose screen with eng result on 3hr GTT are also factors)

Question 27

Is nulliparous or multiparous ass. with larger babies?

Answer 27

Multip

Question 28

Maternal infections associated with macrosomia:

Answer 28

UTI (for women undergoing elective c-section)

Puerperal fever (women undergoing trial of labor)

Question 29

Intrauterine growth may predict the foundations of :

Answer 29

lifelong physiologic function

i.e. IUGR infants more likely ot be overweight later in life

Question 30

2 primary methods for clinical estimation of fetal weight:

Answer 30

Leopold manuevers

Uterine fundal height

Question 31

what is the value of ultrasound in mgmt of macrosomia?

Answer 31

It’s ability to rule out the dx

Question 32

DDx for an enlarged uterus (5)

Answer 32

1. large fetus
2. multiple gestation
3. polyhydranios
4. large placenta (molar pregnancy)
5. Large uterus (leiomyomata/uterine anomaly/gyn tumor)

Question 33

at what estimated fetal weight is C-section recommended?

Answer 33

5000g if no diabetes; 4500g if maternal diabetes