IUGR, Size, Fluid Flashcards

(34 cards)

1
Q

what does IUGR stand for?

A

Intrauterine growth restriction

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2
Q

What is IUGR and what is it caused by?

A

growth retardation in utero due to pathology therefore not reaching genetic potential

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3
Q

What does SGA stand for and what is it?

A

small for gestational age
<10th centile fetal growth
+/- pathological

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4
Q

Causes of IUGR?

A

foetal 3CS - chromosomal abnormalities, congenital abnormalities and congenital infection

Maternal - HTN, Placental insufficiency, aPL, smoking, poorly controlled DM

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5
Q

IUGR can be …. or …..

A

symmetrical or asymmetrical

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6
Q

Symmetrical %?
fetal or maternal?
abdo and brain affected?
mental problems?

A

30%
fetal deficits
abdo and brain proportionally affected growth
yes mental problems (delays)

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7
Q

Asymmetrical %?
fetal or maternal?
abdo and brain affected?
mental problems?

A

70%
Maternal placental insufficiency
Abdo and peripheral retardation
No brain involvement
no mental changes (no delay)

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8
Q

Comps of IUGR?

A

premature, still birth, cognitive delays

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9
Q

the 2 sizes a baby can be?

A

LGA large for gest age
SGA small for gest age

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10
Q

what does SGA + LGA mean ?

A

macrosomia
>90th centile for weight (>4.5kg)

<10th centile (<2.5kg)

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11
Q

LGA
Cause?
Ix?
Complications?

A

idiopathic , fHx (constitutional), Gest dm, polyhydromnios, post term

Regular USS
OGTT 24-28 WKS

Perineal tears, shoulder dystocia, PPH

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12
Q

SGA
Cause?

A

Idiopathic
fHx
placental insufficiency
congenital infection
chromosomal abnormality

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13
Q

What is shoulder dystocia?

A

when the baby’s shoulder is stuck behind the maternal pubis symphysis

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14
Q

MC complication of shoulder dystocia?

A

Erbs palsy
arm/shoulder muscle weakness

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15
Q

What is the treatment for shoulder dystocia?

A

Help
McRoberts maneuvre
Pressure on suprapubic area
episiotomy
Enter (internal rotation)
roll on all 4s

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16
Q

What are the 2 types of fluid levels and %?

A

Polyhydromnios (1-2%)
Oligohydromnios (6%)

17
Q

What is polyhydromnios?
Causes?
Exam?
Comps?

A

AFI (amniotic fluid index) >25 (>25cm) on USS, >2000ml

Causes - gest dm, atresia (oesophageal + duodenal deficit), TORCH

Exam - high SFH, Lack of foetal HB, indistinct features, fluid thrill

Cord prolapse, placental abruption, PPH, high risk UTI, stillbirth, premature

18
Q

What is oligohydromnios?
Causes?
Exam?
Comps?

A

AFI <5 (<5CM) <300ml

Causes- PPROM, Potter sequence (abnormal kidney growth + function due to low amniotic fluid), uteroplacental insufficiency

low SFH, Prominant features

comp - fetal deformity/IUGR, still birth, premature, chorioamnionitis

19
Q

Vomiting occurs in % of pregnancies?
Is it common and why?
When does it resolve?

A

80%
very common in 1/3 due to high beta hCG from syncytiotrophoblast
resolves by 16-20 weeks normally

20
Q

What is non severe and severe vomiting called in pregnancy?

A

Nausea and vomiting of preg - NVP
hyperemesis gravidarum

21
Q

RF for vomiting in preg?

A

Multiple pregnancies
molar preg
hyperthyroid
DKA

22
Q

Sx of hyperemesis in preg?

A

RCOG triad:
5% or more pre pregnancy wt loss
Dehydration (low turgor, pallor, thirst)
Electrolyte imbalance (ketoamine)

(+ decreased appetite, severe vomiting)

23
Q

Dx of hyperemesis gravidarum?

A

bloods (FBC, U+E, LFT, TFT, Clotting)
OGTT
Urine dip
TV USS + Serum bhCG (RULE OUT MOLAR)
BP, BMI, ECG
VBG

24
Q

What would be seen on VBG?

A

hypoK+
hypoCl-
metabolic alkalosis

25
What is used to classify the severity of NVP?
PUQE Pregnancy unique quantification of emesis
26
1st line treatment for Emesis?
Antihistamine (cyclizine or promethazine) or Phenothiazines (prochlorperazine or Chlorpromazine) or Comnination drug (doxylamine/pyridoxine - xonvea)
27
2nd line Tx for emesis?
Ondansetron
28
What is ondansetron? max time to take It for and why?
5-HT3 receptor antagonist max 5 days due to high risk of cleft lip/palate in 1/3
29
3rd line Tx for emesis?
Metoclopramide or Domperidone
30
Metoclopramide What type of medication is it? max time to take it for and why? how does it work?
Dopamine receptor antagonist (DA2R-i) Max 5 days due to extra pyramidal side effects (EPSE) ACTS centrally in chemoreceptor trigger zone by crossing BBB)
31
Domperidone What type of medication is it? max time to take it for and why? how does it work?
dopamine receptor antagonist max 7 days due to increased cardiovascular arrhythmias risk peripheral D2+3R-i therefore decrease GI motility
32
Other Tx for NVP?
Ginger Acupuncture Hypnosis
33
Complication of NVP? Tx for this?
Dehydration advice oral fluid rehydration, or last resort IV
34
Other complications of vomiting?
MW tear Hypo K+ hypotension