Fetal Growth Assessment By Sonography�

Front 1

WHAT IS THE MOST COMMON CAUSE OF IUGR?

Back 1

Mommy!

Front 2

WHAT ARE SIGNIFICANT MATERNAL FACTORS FOR IUGR?

Back 2

Previoushistory of fetus with IUGR

Significantmaternal hypertension

Historyof tobacco use

Presenceof uterine anomaly

Significantplacental hemorrhage

Placentalinsufficiency

Front 3

HOW IS IUGR CLASSIFIED?

Back 3

Based on morphologic characteristics of fetuses studied: SYMMETRIC and ASYMMETRIC

Front 4

WHAT IS SYMMETRIC IUGR RESULT OF?

Back 4

1st trimester insult such as: chromosomal abnormality, infection, fetal alcohol syndrome, and maternal malnutrtion

Front 5

Fetuses are proportionately ________ throughout IUGR pregnancy.

Back 5

Small

Front 6

WHAT % OF IUGR CASES SYMMETRIC?

Back 6

20-30%

Front 7

T or F: IN SYMMETRIC IUGR, BPD, HC, AC, AND FL ARE ALL SMALL.

Back 7

True

Front 8

WHEN DOES ASYMMETRIC IUGR BEGIN?

Back 8

Late in 2nd or 3rd trimester

Front 9

WHAT IS A PERINATOLOGIST?

Back 9

A doctor that treats or manages fetuses

Front 10

PRE-TERM PREGNANCY REPRESENTS?

Back 10

Prematurity = a lady delievers b4 week 38

Front 11

PULSED TERM DELIVERY REPRESENTS?

Back 11

A lady delivered after week 42

Front 12

INTRAUTERINE GROWTH RESTRICTION(IUGR)

Back 12

Decreased rate of fetal growth

Front 13

"RETARDATION"

Back 13

Often used in place of "restriction" and meanssimply that it is not growing properly

Front 14

IUGR COMPLICATES WHAT % OFPREGNANCIES?

Back 14

3-7%

Front 15

MACROSOMIA

Back 15

Refers to a fetus that is too big

Front 16

WHEN DO WE CALL A BABY THAT HASIUGR?

Back 16

When fetal weight @ or below 10% based on GA

Front 17

WHAT SHOULD WE NOT MISTAKE IUGR W/?

Back 17

Ladies that are small for gestation age

Front 18

WHAT ARE FETUSES W/ IUGR @ RISK FOR?

Back 18

fetuses are at risk for ant partum death, perinatalasphyxia, and increases neonatal morbidity

Front 19

WHAT DOES ASYMMETRIC IUGR RESULT FROM?

Back 19

placentalinsufficiency, maternal diseases such as diabetes, hypertension, cardiac /renaldiseases, multiple pregnancy, and uterine anomaly

Front 20

WHAT IS MORE COMMON, ASYMMETRIC OR SYMMETRIC?

Back 20

Asymmetric

Front 21

WHAT DOES FETUS SHOW IN ASYMMETRIC IUGR?

Back 21

headsparing at expense of abdominal and soft tissue growth

Front 22

HOW IS ASYMMETRIC IUGR CHARACTERIZED?

Back 22

appropriate BPD and HC, and small AC

Front 23

AC SHOULD BE MEASURED WHERE?

Back 23

LEVEL OF PORTAL-UMBILICAL VENOUS COMPLEX

Front 24

WHAT HAPPENS WHEN GROWTH IS COMPROMISED?

Back 24

AC affected secondary to reduced adipose tissue and depletion of glycogen storage in liver

Front 25

WHAT IS THE SINGLE MOST SENSITIVE INDICATOR OF IUGR?

Back 25

AC

Front 26

IUGR DIAGNOSTIC CRITERIA

Back 26

Multipleparameters are used:

•BPD

•HC toAC ratio

•FL toAC ratio

•FL

•AC

•Estimatingfetal weight

•Amnioticfluid evaluation (AFI)

Front 27

Back 27

SYMMETRIC IUGR

Second-trimesterfetus with trisomy 18 shows symmetric intrauterine growth restriction. Both thehead and abdomen measured well below expected growth curves. Echogenic bowel (B)is seen.

Front 28

Back 28

SYMMETRIC IUGR

Imageshows the small cranium (C) and abdomen (A).F, Fundus;C, towardthe cervix; AF, amniotic fluid; (LT),left;P, placenta; (RT),right.

Front 29

EFW THAT IS BELOW 10TH PERCENTILE IS CONSIDERED TO BE WHAT?

Back 29

IUGR

Front 30

AMNIOTIC FLUID POCKET THAT MEASURES <1 TO 2 CM IS CONSIDERED TO BE WHAT?

Back 30

IUGR

Front 31

T or F:

NOT ALL OLIGOHYDRAMNIOS IS CONSIDERED TO BE IUGR.

Back 31

True

Front 32

WHAT ARE CLINICAL SIGNS OF IUGR?

Back 32

Decreasedfundal height and fetal motion

Front 33

WHAT ARE KEY IUGR SONOGRAPHIC MARKERS?

Back 33

Grade3 placenta before 36 weeks or decreased placental thickness

Front 34

WHAT SHOULD BE SONOGRAPHER ACTION WHEN FINDING IUGR?

Back 34

Alertphysician, determine cause (maternal history, habits, environmental exposure,viruses, diseases, drug exposure), carefully evaluate placenta and fetalanatomy with sonography as well as umbilical cord

Front 35

HOW WOULD SONOGRAPHER ASSESS UMBILICAL CORD IN THE CASE OF IUGR?

Back 35

Dopplerfor increased resistance to flow,

S/D >3.0 after 30 LMP weeks consideredabnormal

Front 36

HOW DO WE TEST FOR FETAL WELL BEING?

Back 36

•Biophysicalprofile

•Non-stresstest

•Dopplerultrasound

Front 37

WHAT IS ASSESSED INDIVIDUALLY AND IN COMBINATION FOR FETAL WELL BEING?

Back 37

5 BIOPHYSICAL PARAMETERS

Front 38

Each biophysical test had _________________ rate that was greatly reduced when all fivevariables were combined.

Back 38

high false-positive

Front 39

WHAT IS THE GOAL FOR BIOPHYSICAL PROFILE TEST?

Back 39

Finda way to predict and manage fetus with hypoxia

Front 40

WHAT ARE THE 5 BIOPHYSICAL PARAMETERS?

Back 40

1. Observation of fetal breathingmovements (FBM)

2. Grossfetal body movements (FM)

3. Fetaltone (FT)

4. Amnioticfluid volume (AFV)

5. Cardiacnon-stress test (NST)

Front 41

WHAT 3 BIOPHYSICAL PARAMETERS ARE RELATED TO FETAL CNS?

Back 41

1. Observation of fetal breathing movements (FBM)

2. Gross fetal body movements (FM)

3. Fetal tone (FT)

Front 42

WHAT BIOPHYSICAL PARAMETER IS RELATED TO FETAL PLACENTA?

Back 42

Amniotic fluid volume (AFV)

Front 43

WHAT IS THE TIME LIMIT ON BPP TO OBSERVE ALL 5 PARAMETERS?

Back 43

30 MINUTES

Front 44

EACH VARIABLE OF BPP IS ASSIGNED WHAT IN ORDER TO DISTINGUISH FROM NORMAL TO ABNORMAL?

Back 44

Eachvariable arbitrarily assigned score of:

2 when normal

0 when abnormal

Front 45

WHAT BPP SCORE IS CONSIDERED NORMAL?

Back 45

8 to 10

Front 46

WHAT DOES A BPP SCORE OF 4 TO 6 MEAN?

Back 46

No immediate significance

Front 47

WHAT DOES A BPP SCORE OF 0 TO 2 INDICATE?

Back 47

eitherimmediate delivery or extending test to 120 minutes

Front 48

HOW IS FETAL BREATHING MOVEMENTS SEEN?

Back 48

Simultaneousinward movement of the chest with outward movement of the abdomen, or fetalkidneys movement

Front 49

WHEN ARE 2 POINTS GIVEN IN BPP FOR FETAL BREATHING MOVEMENTS?

Back 49

If one episode of breathing lasting 30 secs within 30 minute period noted by practitioner

If absent, no points are given

Front 50

HOW IS FETAL BREATHING MOVEMENTS SEEN?

Back 50

FETAL BREATHING MOVEMENTS

Fetalbreathing may be seen as the chest wall moves inward and the anterior abdominalwall moves outward; breathing may also be seen by watching the movement of thekidney in the longitudinal plane. This coronal-oblique view shows therelationship of the urinary bladder, stomach, diaphragm, and heart

Front 51

WHAT IS MEANT BY GROSS FETAL BODY MOVEMENTS?

Back 51

•Atleast 3 discrete body or limb movements in 30 minutes period to score 2 point.

•Shouldbe unprovoked; continuous movement for 30 minutes will count as one movement

Front 52

Back 52

BPP, FETAL BODY MOVEMENT

Elbow,forearm, and wrist.

Front 53

Back 53

Openfetal hand and wrist

Front 54

WHAT IS FETAL TONE?

Back 54

Active extension and flexion of one episode of limbs or trunk and such movement would score 2 points

Front 55

Back 55

Thisview of the upper extremity is shown in flexion.

(Fetaltone is characterized by the presence of at least one episode of extension andimmediate return to flexion of an extremity or the spine.)

Front 56

Back 56

This image shows the hand wide open, with allfingers and thumb extended

(one active extension and flexion of an open and closed hand is a good example of positive fetal tone)

Front 57

WHAT IS AFV RELATED TO?

Back 57

Fetal placenta

Front 58

IS AFV INFLUENCED BY FETAL CNS?

Back 58

No

Front 59

AMNIOTIC FLUID VOLUME HAS TO BE WHAT IN ORDER TO RECEIVE 2 POINTS?

Back 59

One pocket of amniotic fluid must be at least 2 cm in two perpendicular planes

or

AFI total fluid measures of 5 to 22 cm

Front 60

Back 60

Thefour-quadrant technique of amniotic fluid assessment. This technique producesan amniotic fluid index (AFI). The uterus is divided into four equal parts, andthe largest vertical pocket of amniotic fluid in each quadrant is measured,excluding fetal limbs or umbilical cord. The sum of the four quadrants is theAFI, which, in this case, equals 14.2 cm at 31 weeks. This is within normallimits

Front 61

Back 61

Thefour-quadrant technique of amniotic fluid assessment. This technique producesan amniotic fluid index (AFI). The uterus is divided into four equal parts, andthe largest vertical pocket of amniotic fluid in each quadrant is measured,excluding fetal limbs or umbilical cord. The sum of the four quadrants is theAFI, which, in this case, equals 14.2 cm at 31 weeks. This is within normallimits

Front 62

Back 62

Thefour-quadrant technique of amniotic fluid assessment. This technique producesan amniotic fluid index (AFI). The uterus is divided into four equal parts, andthe largest vertical pocket of amniotic fluid in each quadrant is measured,excluding fetal limbs or umbilical cord. The sum of the four quadrants is theAFI, which, in this case, equals 14.2 cm at 31 weeks. This is within normallimits

Front 63

Back 63

Thefour-quadrant technique of amniotic fluid assessment. This technique producesan amniotic fluid index (AFI). The uterus is divided into four equal parts, andthe largest vertical pocket of amniotic fluid in each quadrant is measured,excluding fetal limbs or umbilical cord. The sum of the four quadrants is theAFI, which, in this case, equals 14.2 cm at 31 weeks. This is within normallimits

Front 64

NON STRESS TEST IS AKA?

Back 64

FHR Fetal Heart Rate

Front 65

HOW IS THE NON STRESS TEST PERFORMED?

Back 65

Using Doppler to record FHR and reactivity to stress of uterine contraction

Front 66

HOW LONG IS TIME EXPANDED FOR THIS PORTION OF THE EXAMINATION?

Back 66

Usually 40 min

Front 67

HOW IS FETAL MOTION DETECTED ON NON-STRESS TEST?

Back 67

As rapid rise on recording of uterine activity

or

PT noting fetal movements

Front 68

WHAT CONDITIONS WILL INDICATE REACTIVE NST OR NORMAL NST ALONG W/ A SCORE OF 2 POINTS?

Back 68

•Twofetal heart rate accelerations of 15 bpm ormore

•Accelerationslasting at least 15 seconds

•Grossfetal movements noted over 20 minutes without late decelerations

Front 69

FETUSES W/ IUGR WILL HAVE UMBILICAL VESSELS WITH WAVE FORMS THAT HAS A WHAT PATTERN?

Back 69

DECREASE FLOW PATTERN

Front 70

WHAT TWO VESSELS ARE SYSTOLIC TO DIASTOLIC RATIO OBTAINED FROM?

Back 70

umbilicalartery and maternal uterine artery

Front 71

RESISTIVE INDEX (RI) = ?

Back 71

maximumsystolic velocity – diastolic velocity/systolicvelocity

Front 72

SYSTOLIC/DIASTOLIC RATIO (S/D) = ?

Back 72

maximumsystolic velocity/diastolic velocity

Front 73

PULSATILITY INDEX (PI) = ?

Back 73

maximumsystolic velocity – diastolic velocity/mean velocity

Front 74

ACCELERATION TIME (ACC) =?

Back 74

timefrom beginning of systole to peak systole

Front 75

DECELERATION TIME (DCC)

Back 75

timefrom peak systole to end diastole

Front 76

Back 76

FIGURE 51-7 Typicalumbilical artery Doppler waveform representing a normal systolic to diastolicratio. The ratio measures peak-systolic to end-diastolic flow. The calipersshould be placed at the top of the systolic peak and at the bottom of the diastolictrough. Note the normal amount of diastolic flow. D,Diastole

Front 77

Back 77

Umbilicalartery Doppler waveform demonstrating increased vascular resistance (lessdiastolic flow) in the fetal umbilical circulation. The systolic to diastolic(S/D) ratio is 3.8. Some authors consider an S/D ratio of more than 3.0 after30 weeks of gestation to be abnormal.

Front 78

Back 78

Umbilicalartery waveform with absent end-diastolic velocity (AEDV). The S/D ratio cannotbe measured in these cases because of the missing diastolic flow. The patientshould be followed closely because AEDV has been associated with adverseperinatal outcome

Front 79

Back 79

Thisumbilical Doppler waveform is the most severe Doppler finding and has beenassociated with adverse fetal outcomes. This finding is called completereversal of end-diastolic velocity. Note how the diastolic flow dipsbelow the baseline. These results should be reported immediately to the patient’sphysician

Front 80

WHAT IS MACROSOMIA?

Back 80

birthweight of 4000 g or greater or above 90th percentile for estimated gestationalage

Front 81

WHAT IS MACROSOMIA W/ RESPECT TO DELIVERY?

Back 81

any fetus too large for pelvis through whichit must pass is macrosomic

Front 82

MACROSOMIA IS SHOWN TO BE 1.2 TO 2 TIMES MORE FREQUENT IN WOMEN WHO...?

Back 82

Aremultiparous

Are35 years or older

Havepre-pregnancy weight of >70 kg (154 lb)

HavePI in upper 10%üHaveregnancyweight gain of ≥20 kg (44 lb)

Havea postdate pregnancy

Havehistory of delivering LGA fetus

Front 83

WHAT IS THE COMMON RESULT OF MACROSOMIA?

Back 83

Matern diabetes mellitus

Front 84

WHAT OF THE FETUS IS DISPROPORTIONATELY INCREASED IN MACROSOMIA?

Back 84

Adipose tissue

Liver

Heart

Adrenal glands

all are reflected by an increased AC

Front 85

WHAT ARE 4 MALFORMATION SYNDROMES IN WHICH FETUS INCREASE IN SIZE, W/ OR W/O ORGANOMEGALY?

Back 85

Beckwith-Wiedemannsyndrome

Marshall-Smithsyndrome

Sotos’syndrome

Weaver’ssyndrome

Front 86

Back 86

Transverse section through a macrosomic fetal abdomen. Note the fat rind (calipers) encircling the entire abdomen compared with a severely intrauterine growth-restricted fetus whose growth is 8 weeks behind. The fetal skin is almost transparent and difficult to differentiate from other surrounding organs.

Front 87

Back 87

Transverse section through a macrosomic fetal abdomen. Note the fat rind (calipers) encircling the entire abdomen compared with a severely intrauterine growth-restricted fetus whosegrowth is 8 weeks behind. The fetal skin is almost transparent and difficult todifferentiate from other surrounding organs.

Front 88

WHY DO MACROSOMIC FETUSES HAVE INCREASED INCIDENCE OF MORBIDITY AND MORTALITY?

Back 88

Result of head and shoulder injuries and cord compression such as:

Claviclesfracture

Brachialplexuses palsies

Meconiumaspiration

Perinatalasphxia

Neonatalhypoglacemia

Front 89

WHAT ARE THE TWO TERMS THAT RELATE TO MACROSMIC FETUSES?

Back 89

Mechanical macrosomia

Metabolic macrosomia

Front 90

WHAT ARE THE 3 TYPES OF MECHANICAL MACROSOMIA ID'd?

Back 90

Type 1.Fetuses generally large

Type 2.Fetuses generally large but with especially large shoulders

Type 3.Fetuses with normal trunk but large head

Front 91

IN TYPE 1 MECHANICAL MACROSOMIA WHERE FETUSES ARE GENERALLY LARGE, WHAT CAN IT BE A RESULT FROM?

Back 91

Genetic factors

Prolonged pregnancy

Multiparity

Front 92

IN TYPE 2 MECHANICAL MACROSOMIA WHERE FETUSES ARE GENERALLY LARGE BUT WITH ESPECIALLY LARGE SHOULDERS, WHAT IS IT USALLY FOUND IN?

Back 92

Diabetic pregnancy

Front 93

IN TYPE 3 MECHANICAL MACROSOMIA WHERE FETUS IS WITH NORMAL TRUNK BUT LARGE HEAD, WHAT CAN IT BE CAUSED BY?

Back 93

Genetic constitution or pathologic process such as hydrocephalus

Front 94

WHAT IS ONE OTHER METHOD FOR DETECTING MACROSOMIA?

Back 94

•Placentascan become significantly large and thick because not immune to growth-enhancingeffects of fetal insulin

•Placentalthickness >5 cm considered thick when measurement taken at right angles toits long axis

Front 95

WHAT ARE MACROSOMIA DIAGNOSTIC CRITERIA?

Back 95

•BPD

•AC/FLratio

•Estimatefetal weight

•Chestcircumference

•Amnioticfluid

•Macrosomiaindex

Front 96

IS BPD AN OPTIMAL PARAMETER FOR PREDICTION OF MACROSOMIA?

Back 96

No

Front 97

WHERE IS CHEST CIRCUMFERENCE MEASURED AT?

Back 97

Level below heart pulsatation

Front 98

HOW IS MACROSOMIA INDEX CALCULATED?

Back 98

Subtract BPD from chest circumference