Module 5 Unit B Flashcards
What is the pattern of fundle height measurement with signs greater than dates?
fundal height growth pattern >3cm more than expected for gestation, particularly if performed serially by the same examiner, is an initial indicator of macrosomia
Fundal height measurements started at 20 wks generally correspond to weeks gestation +/- 2 weeks.
What is the clinical definition of macrosomia?
Weight of 4000 to 4500 g regardless of gestational age
OR
Greater than or = the 97th percentile 4 gestational age
What is the difference between macrosomia and large forgestational age?
Large for debt gestational age the weight is greater than or = the 90th percentile 4 gestational age
What are the risk factors for macrosomia?
Diabetes (all types, including gestational)
Abnormal 1-hr glucose screen with a normal 3 hours GTT
Previous birth of an infant >4000g
Maternal prepregnancy obesity
Excessive prenatal weight gain
Prolonged pregnancy
Male fetus
High maternal birth weight
What is the clinical presentation for macrosomia and large for gestational age?
Larger fundal height than dates
Excessive weight gain
How can the nurse midwife diagnose macrosomia and large for gestational age?
he diagnosis of fetal macrosomia is imprecise. For suspected fetal macrosomia, the accuracy of estimated fetal weight using ultrasound biometry is no better than that obtained with clinical palpation
A fundal height >3cm more than expected for gestation, particularly if performed serially by the same examiner
A woman’s perception of fetal size has been found to have as good a marker to actual birth weight as fetal weight estimation by Leopold maneuvers and or US for EFW
Serial fetal growth ultrasounds at 3-4 week intervals to assess the fetal growth curve
The fetal AC of >35cm identifies more than 90% of macrosomic infants
What are the potential maternal implications of macrosomia and large for gestational age?
Labor problems.
Fetal macrosomia can cause a baby to become wedged in the birth canal, sustain birth injuries, or require the use of forceps or a vacuum device during delivery (operative vaginal delivery). Sometimes a C-section is needed.
Genital tract lacerations.
During childbirth, fetal macrosomia can cause a baby to injure the birth canal — such as by tearing vaginal tissues and the muscles between the vagina and the anus (perineal muscles).
Bleeding after delivery.
Fetal macrosomia increases the risk that your uterine muscles won’t properly contract after you give birth (uterine atony). This can lead to potentially serious bleeding after delivery.
Uterine rupture.
If you’ve had a prior C-section or major uterine surgery, fetal macrosomia increases the risk of uterine rupture — a rare but serious complication in which the uterus tears open along the scar line from the C-section or other uterine surgery. An emergency C-section is needed to prevent life-threatening complications.
Where are the potential fetal and neonatal implications of macrosomia and large for gestational age?
Potential fetal and neonatal implications
Lower than normal blood sugar level.
A baby diagnosed with fetal macrosomia is more likely to be born with a blood sugar level that’s lower than normal.
Childhood obesity.
Research suggests that the risk of childhood obesity increases as birth weight increases.
Metabolic syndrome.
If your baby is diagnosed with fetal macrosomia, he or she is at risk of developing the metabolic syndrome during childhood.
Metabolic syndrome is a cluster of conditions — increased blood pressure, a high blood sugar level, excess body fat around the waist or abnormal cholesterol levels — that occur together, increasing the risk of heart disease, stroke and diabetes.
What are the antenatal management options for macrosomia and large for gestational age fetuses?
Suspected fetal macrosomia is not an indication for induction of labor, because induction does not improve maternal or fetal outcomes
Pregnant women with suspected fetal macrosomia should be provided individualized counseling about the risks and benefits of vaginal and c-section based on the degree of macrosomia
In women without DM studies have documented an increased risk of cesarean birth in women induced prior to 41 weeks
Awaiting the onset of labor or delaying induction until >41 weeks gestation is associated with a lower rate of c-section even with macrosomia
Women should be counseled that ACOG recommends that elective c-section be considered for suspected fetal macrosomia with and EFW of AT LEAST 5000g IN WOMEN WITHOUT DM AND AT LEAST 4500g IN WOMEN WITH DM
What is the midwifery intrapartum management for macrosomic and large for gestational age fetuses?
With an estimated fetal weight of greater than 4500g a prolonged second stage of labor or arrest of descent in the second stage is an indication for c-section
What is the midwiffer management level for macrosomic and large for gestational age fetuses?
COLLABORATION/ REFERRAL DEPENDS ON PRACTICE MODEL AND SETTING
How can macrosomia be prevented?
Prevent DM and GDM- or well controlled with diet and exercise
Weight loss to healthy BMI prepregnancy
Steady weight gain during pregnancy (gain recommended amount)
What is the clinical definition of polyhydramnios?
Excessive amount of amniotic fluid (> 2100ml or 2.1 L)
AFI of 24cm or more, or a maximum vertical pocket that is 8cm or more
What is the clinical presentation of polyhydramnios?
Measuring large for dates with fundal height
Large weight gain
Hard to determine lie with Leopolds
Ballotable fetus
Fluid thrill
What are the risk factors for polyhydramnios?
Fetal structural anomalies
Tracheoesophageal fistula
Anencephaly
Meningomyelocele
Multifetal gestation
Monozygotic twins
Twin-to-twin transfusion syndrome
Diabetes
Fetal infection
Fetal chromosomal abnormalities
