Fetal Growth Assessment ✔️ Flashcards by Marissa Teramae

what is at term birth

38-42 weeks

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what is pre term birth

before 38 weeks

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what is post term birth

later than 42 weeks

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describe fetal weight

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

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describe intrauterine growth restriction

decreased rate of fetal growth

complicates <10% of pregnancies

fetal weight at or below 10%

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what is IUGR

intrauterine growth restriction

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greater risk factors for IUGR

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

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SGA is a fetus below _____ percentile without reference to cause

10th

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

pathologic process

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causes of IUGR

maternal disease states - diabetes, hypertension

placental uteroplacental insufficiency - UPI

fetal - genetic/chromosomal

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maternal factors with IUGR

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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placental factors with IUGR

extensive primary placental infarctions - leads to UPI

**maternal & placental factors lead to asymmetric IUGR

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fetal factors for IUGR

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

**associated with symmetric IUGR

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symmetric IUGR

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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asymmetric IUGR

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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describe accurate age

last menstrual period

first trimester US

standard BPD, HC, AC, and FL

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clinical observations for interruption in aging

decreased fundal height

decreased fetal motion

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sonographic parameters showing issues with growth

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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sonographic parameters for IUGR

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

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what do you assess for BPP

fetal breathing
fetal movement
fetal muscle tone
AFI
fetal HR changes

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what is BPP

biophysical profile

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babies go through normal _____ min sleep-wake cycles

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fetal breathing becomes regular at ________ weeks

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20-21

fetal HR changes in response to fetal movement at ______ weeks

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12-14

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

accelerates

what is acute hypoxia

decrease in breathing, movement, and HR activity

what is severe acute hypoxia

absence of movement/tone

what is chronic hypoxia

result of UPI; oligo & decreased movement is common

guidelines for BPP

timed 30 mins score of 2 for each parameter ``` 8= normal 4-6= no immediate significance 0-2= immediate delivery or extend testing ```

describe fetal breathing movements

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

describe fetal growth movement

3 definite extremity or trunk movements in 30 mins for 2 points fewer than 3 scores 0 points

describe AFI

``` 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 ```

describe fetal tone

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

what 4 things make up a BPP

fetal breathing movements fetal gross movment AFI fetal tone

describe a non stress test (NST)

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

describe normal NST

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

umbilical cord doppler quantitative measures

velocity

umbilical cord doppler qualitative shows

characteristics of wave form

cord doppler ratio formulas: ``` S/D = ? RI = ? PI = ? ```

S/D = ratio-systolic/diastolic RI = systole minus diastole/systole PI = peak systole - end diastole/mean velocity

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

3.0 30 should never have absent or reversed end diastole flow

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

2.6 22

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

increase increased

describe macrosomia

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

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

``` 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 ```

macrosomia is common result of poorly controlled maternal ________ _______

diabetes mellitus

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 ______

AC measurement

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

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

what are the 2 terms relating to macrosomic fetuses

mechanical macrosomia metabolic macrosomia

what are 3 types of mechanical macrosomia

type 1: fetuses generally large type 2: fetuses generally large but with especially large shoulders type 3: fetuses with normal trunk but large head

type 1 mechanical macrosomia can results from what

genetic factors prolonged pregnancy multiparity

type 2 mechanical macrosomia is found in what type of pregnancy

diabetic

type 3 mechanical macrosomia can be caused by what

genetic constitution or pathologic process (hydrocephalus)

name 2 other methods for detecting macrosomia

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

Fetal Growth Assessment ✔️ Flashcards

(53 cards)