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21 Cards in this Set
- Front
- Back
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nl fetal growth patterns (Obj 1)
-human growth curve -growth variations based on age? |
-human growth curve is sigmoidal
-more variations in growth as gestational age incr |
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det of fetal growth
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1. Genetic
-Gender: male>female -mother's constitution 2.Hormonal: *major-insulin, IGF-1 *minor-TH. GH 3. Environmental -altitude |
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Mensutral history pregnancy dating (Obj 2)
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-add 7 days to first day of LMP, then count back 3 months
(12 months-3= 9 months) -predicts deliery date within 23 days |
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clinical parameters of pregnancy dating
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1. fundal height
-distance from symphysis pubis to top of uterine fundus 2. quickening (initial motion of fetus felt by mom) 3. auscultation of fetal heart sounds * > 2 clinical parameters or 3 fundal height measurements= accuracy of LMP pregnancy dating |
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pregnancy dating: ultrasound poarametes
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1. First Trimester
*crown-rump length=most accurate biometric parameter 2. Second-Third Trimester *2nd trimester biparietal (head) diameter= 2nd most accurate biometric parameter |
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most accurate biometric parameter for pregnancy dating?
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crown-rump length in 1st trimester
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2nd most accurate bioemtric parameter for pregnancy dating
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biparieter diameter in 2nd trimester
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Appropriate-for-Gestational-Age (AFGA)
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weight b/w 10-90th percentiles
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Small-for-Gestational-Age (SFGA)
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weight <10th percentile
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Large-for-Gestational Age
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weight > 90th percentile
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complications of fetal growht restriction
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2nd most important cause of perinatal mortality
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Etiology of Fetal Growth Restriction
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1. FETAL
A. Genetic -Chrom abnl: -Trisomy 21, 18, 13 -Turners -Congenital malformation B. Congenital Infxn "TORCHHS": Toxoplasmosis Rubella CMV Herpes C. multiple gestation 2. PLACENTAL -placental abrupta, placenta previa, placental infarct 3. MATERNAL a. *Maternal vascular dz **Resp for most FGR's -poor circulation (HTN, DM)==>reduced nutrient transfer to fetus b. Poor oxygenation -hemoglobinopathies -sickle cell dz -high altitude c. Malnutrition -malnutrition during 3rd trimester had biggest effect on growth 4. Environemnal -smoking, EtOH, cocaine |
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strongest risk factor for FGR
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prior FGR
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what is responsible for most FGR's
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maternal vascular dz,
i.e. chronic HTN, diabetic vassculopathy, preeclampsia -decr uteroplacental flow ==>reduced nutrients to fetus |
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asymmetric vs. symmetric FGR
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When did insult occur?
Symmetric FGR: -insult occurred early in gestation -decr in overall cell NUMBER -everything decreased in size (so proportional) -Et: -chrom abnl -congenital infxn B. Asymmetric FGR -insult occurred late in gestation -decr in cell SIZE -AC (abdominal circumference) decreased, but head and long bones spared -Et: -maternal vascular dz -maternal malnutrition -multiple gestation -placental dz |
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best predictor of FGR
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serial ultrasound
(Abdominal circumference=single best parameter) |
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EXAM: MCC of FGR?
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maternal vascular dz:
-chronic HTN -diabetic vasculopathy -pre-eclampsia -collagen vascular dz -Antiphospholipid Antibody syndrome ==>decr nutrients to fetus |
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EXAM-management of FGR
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1. Initial work-up
-evaluate for underlying maternal cause -targetee ultraound to evlauate for abnl -do karyotype if suspicious of chrom abnl 2. Follow-up A. serial ultrasounds 3. Delivery A. deliver at term is best, if possbile B. deliver preterm if: -fetus losing weight -non-reassuring fetal testing -oligohydramnios |
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Et of LGA
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1. Constitution
2. Post-term gestation *incidence of macrosmia=25% 3. Primary fetal growth excess -insulin-secreting tumors 4. Maternal a. Maternal diabetes ==>hyperinsulinemia in fetus, which can be prevented by optimizing maternal glycemia b. obesity c. previous large infant d. excessive wt gain |
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complications of infants of diabetic mothers
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1. Weight distribution is different==>Birth trauma
(Shoulder dystocia) 2. incr perinatal mortality 3. metabolic abnl 4. predisposition of baby to obesity and diabetes later in life |
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EXAM: how manage LGA
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1. Prevention (diabetic moms--good glycemia)
2. C-section if baby too big 3. shoulder dystocia precautions |
