Fetal Growth Assessment Chapter 51

Question 0

Between 38-42 weeks is called?

Answer 0

At term

Question 1

Before 38 weeks is called?

Answer 1

Preterm

Question 2

Later than 42 weeks is called?

Answer 2

post term

Question 3

Decreased rate of fetal growth is known as what?

Answer 3

Intrauterine Growth Restriction (IUGR)

Question 4

IUGR complicates less than _____% of pregnancies.

Answer 4

<10%

Question 5

Fetal weight is at or below _____% for IUGR.

Answer 5

10%

Question 6

IUGR posts a greater risk for what?

Answer 6

antepartum death, perinatal asphyxia, neonatal morbidity, later developmental problems, mortality increases six to ten fold

Question 7

A fetus below the 10th percentile without reference to cause is considered what?

Answer 7

SGA (small for gestational age)

Question 8

_____________ is a subset of the SGA as a result of a pathologic process.

Answer 8

IUGR

Question 9

The causes for IUGR include….

Answer 9

• Maternal Disease States - DM (diabetes mellitus), SLE (Systemic Lupus Erythematosus), HTN
• Placental - Uteroplacental Insufficiency - UPI
• Fetal - genetic/chromosomal

Question 10

Extensive, primary placental infarctions leads to ________.

Answer 10

UPI

Question 11

Maternal and placental factors lead to what?

Answer 11

asymmetric IUGR

Question 12

Fetal factors for IUGR are associated with what?

Answer 12

symmetric IUGR

Question 13

Describe symmetric IUGR.

Answer 13

• Result of a long standing and/or severe maternal/placental cause.
• Chromosomal/genetic anomalies
• Infection (TORCH)
• Associated with first trimester insults
• Proportionally small in all physical parameters due to earlier impact
• May appear sonographically BEFORE 20 weeks
• Approximately 20% to 30% of all IUGR cases are symmetric

Question 14

Describe asymmetric IUGR.

Answer 14

• Cause usually related to maternal disease states or later developing placental causes
• **last 8-10 weeks of pregnancy
• Disproportionate growth of head/abdomen
• Brain sparing - brain takes blood it needs at cost of abdomen growth
• **typically develops AFTER 24 weeks
• ***more common than symmetric

Question 15

***The single most sensitive indicator of IUGR is?

Answer 15

AC -abdomen circumference

Question 16

The most important ratio sonographically for IUGR is what?

Answer 16

HC/AC

Question 17

Sonographic Parameters of IUGR include…

Answer 17

• Oligohydramnios
• Advanced placental grading (III between 34 to 36 weeks)
• Thin placenta
• Delayed appearance of epiphyseal sites
• Elevated RI’s cord Doppler - increased Doppler resistance/impedance

Question 18

Biophysical Profile (BPP) assesses:

Answer 18

• fetal breathing
• fetal body movement
• fetal muscle tone
• AFI
• fetal heart rate changes (assessed with NST not US)

Question 19

When does the CNS mature?

Answer 19

24 weeks & up

Question 20

What is acute hypoxia?

Answer 20

decrease in breathing, movement, and heart rate activity

Question 21

What is severe acute hypoxia?

Answer 21

absence of movement/tone

Question 22

What is chronic hypoxia?

Answer 22

result of UPI; oligo & decreased movement is common

Question 23

For BPP fetal breathing movements what must be seen?

Answer 23

• inward movement of chest wall with outward movement of abdominal wall
• 2 points if one episode of breathing lasts 30-60 sec within 30 minutes
• If absent no points are given

Question 24

For BPP, what do you need to see for fetal gross movement?

Answer 24

- Three definite extremity or trunk movements in 30 minutes for 2 points - Fewer than three scores zero points

Question 25

For BPP, what do you need to see for AFI?

Answer 25

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

Question 26

For BPP fetal tone, what needs to be seen?

Answer 26

- extension and flexion of extremity or spine - one episode in the 30 minutes score 2 points - no episode scores 0 points

Question 27

What are the two types of Umbilical Cord Doppler?

Answer 27

Quantitative - measure velocity | Qualitative - Characteristics of wave form

Question 28

S/D of more than _______ in umbilical artery after 30 weeks is abnormal should never have absent or reversed end diastolic flow.

Answer 28

3.0

Question 29

S/D of more than ______ in the maternal uterine artery is abnormal with diastolic notching after 22 weeks.

Answer 29

2.6

Question 30

Fetus with IUGR- increase in vascular resistance/impedance reflects what?

Answer 30

Increased S/D ratio and RI

Question 31

Macrosomia is classically defined as....

Answer 31

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

Question 32

What two terms relate to macrosomic fetuses?

Answer 32

mechanical macrosomia and metabolic macrosomia.

Question 33

What are the three types of mechanical macrosomia?

Answer 33

1. Fetuses generally large 2. Fetuses generally large but with especially large shoulders 3. Fetuses with normal trunk but large head

Question 34

Placental thickness greater than _____ is considered thick when measurement taken at right angles to its long axis

Answer 34

5 cm