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98 Cards in this Set

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WHAT IS THE MOST COMMON CAUSE OF IUGR?

Mommy!

WHAT ARE SIGNIFICANT MATERNAL FACTORS FOR IUGR?

Previoushistory of fetus with IUGR


Significantmaternal hypertension


Historyof tobacco use


Presenceof uterine anomaly


Significantplacental hemorrhage


Placentalinsufficiency

HOW IS IUGR CLASSIFIED?

Based on morphologic characteristics of fetuses studied: SYMMETRIC and ASYMMETRIC

WHAT IS SYMMETRIC IUGR RESULT OF?

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

Fetuses are proportionately ________ throughout IUGR pregnancy.

Small

WHAT % OF IUGR CASES SYMMETRIC?

20-30%

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

True

WHEN DOES ASYMMETRIC IUGR BEGIN?

Late in 2nd or 3rd trimester

WHAT IS A PERINATOLOGIST?

A doctor that treats or manages fetuses

PRE-TERM PREGNANCY REPRESENTS?

Prematurity = a lady delievers b4 week 38

PULSED TERM DELIVERY REPRESENTS?

A lady delivered after week 42

INTRAUTERINE GROWTH RESTRICTION(IUGR)

Decreased rate of fetal growth

"RETARDATION"

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

IUGR COMPLICATES WHAT % OFPREGNANCIES?

3-7%

MACROSOMIA

Refers to a fetus that is too big

WHEN DO WE CALL A BABY THAT HASIUGR?

When fetal weight @ or below 10% based on GA

WHAT SHOULD WE NOT MISTAKE IUGR W/?

Ladies that are small for gestation age

WHAT ARE FETUSES W/ IUGR @ RISK FOR?

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

WHAT DOES ASYMMETRIC IUGR RESULT FROM?

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

WHAT IS MORE COMMON, ASYMMETRIC OR SYMMETRIC?

Asymmetric

WHAT DOES FETUS SHOW IN ASYMMETRIC IUGR?

headsparing at expense of abdominal and soft tissue growth

HOW IS ASYMMETRIC IUGR CHARACTERIZED?

appropriate BPD and HC, and small AC

AC SHOULD BE MEASURED WHERE?

LEVEL OF PORTAL-UMBILICAL VENOUS COMPLEX

WHAT HAPPENS WHEN GROWTH IS COMPROMISED?

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

WHAT IS THE SINGLE MOST SENSITIVE INDICATOR OF IUGR?

AC

IUGR DIAGNOSTIC CRITERIA

Multipleparameters are used:


•BPD


•HC toAC ratio


•FL toAC ratio


•FL


•AC


•Estimatingfetal weight


•Amnioticfluid evaluation (AFI)

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.

SYMMETRIC IUGR


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

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

IUGR

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

IUGR



T or F:


NOT ALL OLIGOHYDRAMNIOS IS CONSIDERED TO BE IUGR.

True



WHAT ARE CLINICAL SIGNS OF IUGR?


Decreasedfundal height and fetal motion

WHAT ARE KEY IUGR SONOGRAPHIC MARKERS?

Grade3 placenta before 36 weeks or decreased placental thickness

WHAT SHOULD BE SONOGRAPHER ACTION WHEN FINDING IUGR?

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

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

Dopplerfor increased resistance to flow,


S/D >3.0 after 30 LMP weeks consideredabnormal

HOW DO WE TEST FOR FETAL WELL BEING?

•Biophysicalprofile


•Non-stresstest


•Dopplerultrasound

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

5 BIOPHYSICAL PARAMETERS

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

high false-positive

WHAT IS THE GOAL FOR BIOPHYSICAL PROFILE TEST?

Finda way to predict and manage fetus with hypoxia

WHAT ARE THE 5 BIOPHYSICAL PARAMETERS?

1. Observation of fetal breathingmovements (FBM)


2. Grossfetal body movements (FM)


3. Fetaltone (FT)


4. Amnioticfluid volume (AFV)


5. Cardiacnon-stress test (NST)

WHAT 3 BIOPHYSICAL PARAMETERS ARE RELATED TO FETAL CNS?

1. Observation of fetal breathing movements (FBM)


2. Gross fetal body movements (FM)


3. Fetal tone (FT)

WHAT BIOPHYSICAL PARAMETER IS RELATED TO FETAL PLACENTA?

Amniotic fluid volume (AFV)

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

30 MINUTES

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

Eachvariable arbitrarily assigned score of:


2 when normal


0 when abnormal

WHAT BPP SCORE IS CONSIDERED NORMAL?

8 to 10



WHAT DOES A BPP SCORE OF 4 TO 6 MEAN?

No immediate significance

WHAT DOES A BPP SCORE OF 0 TO 2 INDICATE?

eitherimmediate delivery or extending test to 120 minutes



HOW IS FETAL BREATHING MOVEMENTS SEEN?

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

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

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




If absent, no points are given

HOW IS FETAL BREATHING MOVEMENTS SEEN?

HOW IS FETAL BREATHING MOVEMENTS SEEN?

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

WHAT IS MEANT BY GROSS FETAL BODY MOVEMENTS?

•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

BPP, FETAL BODY MOVEMENT


Elbow,forearm, and wrist.

Openfetal hand and wrist

WHAT IS FETAL TONE?

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

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.)

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)

WHAT IS AFV RELATED TO?

Fetal placenta

IS AFV INFLUENCED BY FETAL CNS?

No

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

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

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

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

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

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

NON STRESS TEST IS AKA?

FHR Fetal Heart Rate

HOW IS THE NON STRESS TEST PERFORMED?

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

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

Usually 40 min

HOW IS FETAL MOTION DETECTED ON NON-STRESS TEST?

As rapid rise on recording of uterine activity


or


PT noting fetal movements

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

•Twofetal heart rate accelerations of 15 bpm ormore


•Accelerationslasting at least 15 seconds


•Grossfetal movements noted over 20 minutes without late decelerations

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

DECREASE FLOW PATTERN

WHAT TWO VESSELS ARE SYSTOLIC TO DIASTOLIC RATIO OBTAINED FROM?

umbilicalartery and maternal uterine artery

RESISTIVE INDEX (RI) = ?

maximumsystolic velocity – diastolic velocity/systolicvelocity

SYSTOLIC/DIASTOLIC RATIO (S/D) = ?

maximumsystolic velocity/diastolic velocity

PULSATILITY INDEX (PI) = ?

maximumsystolic velocity – diastolic velocity/mean velocity

ACCELERATION TIME (ACC) =?

timefrom beginning of systole to peak systole

DECELERATION TIME (DCC)

timefrom peak systole to end diastole

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

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.

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

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

WHAT IS MACROSOMIA?

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

WHAT IS MACROSOMIA W/ RESPECT TO DELIVERY?

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

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

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

WHAT IS THE COMMON RESULT OF MACROSOMIA?

Matern diabetes mellitus

WHAT OF THE FETUS IS DISPROPORTIONATELY INCREASED IN MACROSOMIA?

Adipose tissue


Liver


Heart


Adrenal glands




all are reflected by an increased AC

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

Beckwith-Wiedemannsyndrome


Marshall-Smithsyndrome


Sotos’syndrome


Weaver’ssyndrome

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.

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.

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

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




Claviclesfracture


Brachialplexuses palsies


Meconiumaspiration


Perinatalasphxia


Neonatalhypoglacemia

WHAT ARE THE TWO TERMS THAT RELATE TO MACROSMIC FETUSES?

Mechanical macrosomia


Metabolic macrosomia

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

Type 1.Fetuses generally large


Type 2.Fetuses generally large but with especially large shoulders


Type 3.Fetuses with normal trunk but large head

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

Genetic factors


Prolonged pregnancy


Multiparity

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

Diabetic pregnancy

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

Genetic constitution or pathologic process such as hydrocephalus

WHAT IS ONE OTHER METHOD FOR DETECTING MACROSOMIA?

•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

WHAT ARE MACROSOMIA DIAGNOSTIC CRITERIA?

•BPD


•AC/FLratio


•Estimatefetal weight


•Chestcircumference


•Amnioticfluid


•Macrosomiaindex

IS BPD AN OPTIMAL PARAMETER FOR PREDICTION OF MACROSOMIA?

No

WHERE IS CHEST CIRCUMFERENCE MEASURED AT?

Level below heart pulsatation

HOW IS MACROSOMIA INDEX CALCULATED?

Subtract BPD from chest circumference