Flashcards in Fetal complications Deck (60):
Defined as a fetus weighing below the 10th percentile for gestational age
Intrauterine growth retardation IUGR/ Fetal growth restrictions
The most accurate dating of a pregnancy is by the first trimester ________ _________ _______or a firmly known _______ _______ __________ ___________
Crown rump length, or a firmly known last menstrual period date
There are many causes of IUGR with most of them relating to conditions related to the __________, _________, and ________ __________ _________
Uterus, placenta, and placental transfer rate
A decreasing uterine plasma volume is thought to be a ________ physiologic factor in IUGR
What will happen to the developing fetus when it does not receive enough nutrition to provide for normal metabolic needs?
It won't grow
Maternal conditions which may affect uterine plasma volume
Poor nutritional status
Smoking, drug or alcohol abuse
Chronic renal disease
Severe chronic asthma
Extremes of age under 17 or over 35
Placental conditions which may affect uterine plasma volume
Placental infarcts and hamangiomas/ chorioangiomas
Single umbilical artery
Fetal conditions which may affect uterine plasma volume
Chromosomal or genetic abnormalities
Growth restricted fetuses are born with diminished stores of fat and glycogen and therefore, likely to be _________
Nutritional support is needed until the infant ____________ it's glycogen and fat deposits
Clinical signs or IDGR include?
Uterus measuring small for dates
History of maternal condition which is associated with IUGR
IUGR can be ___________ or __________
Symmetric or asymmetric
Accounts for 25%
Affects the entire fetus
Etiology is often genetic or due to maternal infection
Onset may be earlier in gestation
Sono findings for Symmetric IUGR
All measurements are more than two wks below expected in the 2nd trimester or below three wks in the 3rd trimester
(remember the 1, 2, 3 rule about size in 1st, 2nd, and 3rd trimester)
Low biophysical profile score
What are the two things that all measurements are based on?
either a firm LMP date or on a first trimester ultrasound
The __________ ___________ is usually consistent with dates when the other parameters are less than expected
Accounts for 75% or the vast majority of intrauterine growth retardation
Occurs usually in the last 8-10 wks of pregnancy
Asymmetric IUGR- brain sparing IUGR
____________ patterns in the fetus attempt to protect the fetal brain so it receives most of the nutrient rich blood first, and as a result, there is __________ between the head size and the abdominal size
Ultrasound findings for Asymmetric IUGR
-The head to body ratio for HC/ AC ratio is greater than two standard deviations above normal
-The abdominal circumference measures greater than two weeks behind the head circumference
**The head is of normal size and the abdomen is smaller
What Doppler technique has been proven as diagnostic for IUGR?
There is no single Doppler technique that has been proven as a diagnostic for IUGR
The predictive value of Doppler in IUGR has been shown to be, ?
Measurements of _________ ____________ resistance are the most widely accepted
Normally, there is a progressive decrease in the resistance in the umbilical artery during the course of
Why is the umbilical artery low during pregnancy?
to make it easy for the fetus to get rid of wastes back to the placenta
Resistive index should be
less than 0.8
Systolic/ diastolic ratio greater than ______is considered abnormal after _______ wks
Ratios can be higher if measured closer to the fetal cord insertion so they should be taken closer to the
Placental cord insertion
Absent or reverse flow in the umbilical artery is an
What is the proper technique to measure the resistance and the systolic/ diastolic ratio
have an angle of insonation as close to zero with respect to the umbilical artery (as parallel as possible to the artery)
Destruction of fetal red blood cells by antibodies with subsequent fetal or neonatal complications
What are the causes of Erythroblastosis fetalis
Iso immune disease
other minor blood group incompatibilities
What are the clinical manifestations for erythroblastosis fetalis?
Congestive heart failure
An excessive accumulation of fluid in fetal tissues and body cavities. Interstitial edema, plural and pericardial effusion's and ascites
Name the two types of hydrops
-Secondary to Rh incompatibility (Rh isoimmunization)
-Occurs when Rh negative mother and an Rh positive father have a baby
-The fetus is Rh positive
-Maternal antibodies recognize Rh antigens on fetal blood cells as foreign
The maternal antibodies attack and destroy __________
Red blood cells
What does the destruction of red blood cells result in?
Fetal anemia, which results in hydrops
Fetal red blood cells generally do not cross the placenta so exposure of fetal cell to maternal circulation occurs at
During which pregnancy does the most trouble occur, due to maternal antibodies?
In the second pregnancy due to prior blood mixing after delivery of the first baby
What is given to the mother after each pregnancy and also after amniocentesis to prevent antibodies from forming, and to protect future pregnancies?
RhoGAM or Rh isoimmunization
Middle cerebral artery Doppler can help determine the likelyhood of ?
The MCA (middle cerebral artery) is examined close to its origin from the ?
Internal carotid artery
When measuring the MCA Doppler at what angle of the ultrasound beam and the direction of blood flow be?
The risk of anemia is highest in fetuses with a pre-transfusion peak systolic velocity of _______ times the median or higher
True or False
The fetal heart is pumping with a higher velocity and often, a higher rate in an effort to get oxygen to the tissues. Because the number of red blood cells is low, due to destruction the body compensates by doing this.
Red blood cell destruction
A byproduct of the destruction of red blood cells
The patient may need serial amniocentesis to determine if ____________ is occurring by testing the bilirubin levels in the amniotic fluid.
What is more accurate for fetal anemia to determine if hemolysis is occurring?
Cordocentesis or percutaneous blood sampling (PUBS)
Intrauterine transfusions using ultrasound guidance can be performed to treat ___________, ideally after the onset of anemia but before the onset of fetal hydrops
Hydrops due to any other cause besides Rh sensitization
What are the causes of Non-immune hydrops?
Cardiac anomalies/ arrhythmia
Infections like torch and fifths disease
Congenital blood disorders
Twin/twin transfusion syndrome
Abdominal or pulmonary masses which lead to venous obstruction
What are the Ultrasound findings in hydrops?
Pericardial effusion (earliest sign)
Fetal skin thickening/edema/anasarca
Placental thickening >5cm in AP dimensions
Enlarged umbilical vein, >1cm
Occurs during the second or third trimester,
What does the sonographic appearance of fetal demise depend on?
It depends on when after the demise the fetus is examined`
What are the ultrasound findings of fetal demise?
Absent cardiac activity
Exaggerated fetal position, flexion
Duels sign/halo sign
Echogenic foci which represents gas in pulmonary vessels or in the abdomen, this is a delayed finding, occuring after a wk after demise
Overlapping skull bones, also a delayed finding seen about a wk after demise
A halo seen radiographically secondary to subcutaneous scalp edema
Duels sign/ Halo sign