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21 Cards in this Set

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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
det of fetal growth
1. Genetic
-Gender: male>female
-mother's constitution

2.Hormonal:
*major-insulin, IGF-1
*minor-TH. GH

3. Environmental
-altitude
Mensutral history pregnancy dating (Obj 2)
-add 7 days to first day of LMP, then count back 3 months
(12 months-3= 9 months)
-predicts deliery date within 23 days
clinical parameters of pregnancy dating
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
pregnancy dating: ultrasound poarametes
1. First Trimester
*crown-rump length=most accurate biometric parameter

2. Second-Third Trimester
*2nd trimester biparietal (head) diameter=
2nd most accurate biometric parameter
most accurate biometric parameter for pregnancy dating?
crown-rump length in 1st trimester
2nd most accurate bioemtric parameter for pregnancy dating
biparieter diameter in 2nd trimester
Appropriate-for-Gestational-Age (AFGA)
weight b/w 10-90th percentiles
Small-for-Gestational-Age (SFGA)
weight <10th percentile
Large-for-Gestational Age
weight > 90th percentile
complications of fetal growht restriction
2nd most important cause of perinatal mortality
Etiology of Fetal Growth Restriction
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
strongest risk factor for FGR
prior FGR
what is responsible for most FGR's
maternal vascular dz,
i.e. chronic HTN, diabetic vassculopathy, preeclampsia
-decr uteroplacental flow
==>reduced nutrients to fetus
asymmetric vs. symmetric FGR
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
best predictor of FGR
serial ultrasound
(Abdominal circumference=single best parameter)
EXAM: MCC of FGR?
maternal vascular dz:
-chronic HTN
-diabetic vasculopathy
-pre-eclampsia
-collagen vascular dz
-Antiphospholipid Antibody syndrome

==>decr nutrients to fetus
EXAM-management of FGR
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
Et of LGA
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
complications of infants of diabetic mothers
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
EXAM: how manage LGA
1. Prevention (diabetic moms--good glycemia)
2. C-section if baby too big
3. shoulder dystocia precautions