Term
| what is the best way to get the best gestational age |
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Definition
| see mom as soon as possible to the conception |
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Term
|
Definition
subtract 3mo from FDLMP and add 7 days to get gestational age
pregnancy duration is 280d +/- 14d |
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|
Term
| how often is a pregnancy on the expected delivery day, how often within 14d |
|
Definition
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Term
| what are the 6 best estimates of gestation dating in order from best to least |
|
Definition
1. last menstural period
2. uterine size (early gestation and umbilicus)
3. audible fetal heart size
4. fundal height (late gestation)
5. quickening (first perception of fetal movement)
6. positive pregnancy test |
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Term
| where is the fundus at 20wks |
|
Definition
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Term
| where is the fundus at >16wks |
|
Definition
approx 1cm/wk measured from the pubic symphysis
EX: 34 wks gestation should be 34cm from symphysis |
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Term
| what is the accepted discrepency for fundus height |
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Definition
| >4cm should alert doc of problem (in reality it is 2-3cm) |
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Term
| what are the ultrasound baby measurements 7 |
|
Definition
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Term
|
Definition
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Term
|
Definition
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Term
|
Definition
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Term
|
Definition
| head circumference/abd circumference ratio |
|
|
Term
|
Definition
| head circumference/ thorax circumference ratio |
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Term
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Definition
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Term
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Definition
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Term
| definie low, very low, and large birth weight, what is the prevelence, what is another name for large |
|
Definition
<2500g: low 8%
<1500g: very low 2%
>4000g: large (macrosomia) 10% |
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|
Term
|
Definition
| FETUS whose weight is <10th percentile at given gestational age |
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|
Term
|
Definition
| NEONATE whose birth weight is at or below the 10th percentile at gestational age |
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|
Term
|
Definition
| NEONATE whose birth weight is >90th percentile at gestational age |
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|
Term
| what are the two fetal growth types, define each |
|
Definition
early: hyperplastic: increase in cell number
late; hypertrophic: increase in cell size |
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Term
| symmetric growth: onset, cell number, BPD/HC, HC/AC, diminution |
|
Definition
onset: early
cell number: decreased
BPD/HC:small
HC/AC: normal
diminution: irreversible diminituion of organ size and function |
|
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Term
| asymmetric growth: onset, cell number, BPD/HC, HC/AC, diminution |
|
Definition
onset: late
cell number: decreased
BPD/HC: normal
HC/AC: increased
diminution: amendableto restoration of size and function of organs with adequate nutrition |
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Term
| what is the most important measurement in determine symmetric and asymmetric fetal growth |
|
Definition
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|
Term
| what is the #1 and #2 cause pf perinatal mortality |
|
Definition
|
|
Term
| mortality rate for IUGR: compared to normal babies, with corrected anomalies, without corrected anomalies |
|
Definition
normal compare: 7-10% increase
corrected: 100/1000
not corrected: 120/1000 |
|
|
Term
| what causes morbidity in IUGR babies 9 |
|
Definition
asphyxia
hypoglycemia
hypocalcemia
hypothermia
meconium aspiration
polycythemia/hyperviscosity syndrome
congenital anomalies
congenital infection
pulmonary hemorrhage |
|
|
Term
| maternal causes of IUGR 9 |
|
Definition
drugs
smoking
malnutrition
alcohol
DM
CT disease
pregnacy weight <50kg
chronic HTN (25-30%!!)
chronic maternal disease: cyanotic heart disease) |
|
|
Term
|
Definition
infection: viral, protozoal <5%
genetic and chromosome disorders 15%
congenital abnormalities |
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|
Term
| urterine/placental causes of IUGR 5 |
|
Definition
placental abruptions
placenta previa
multiple gestation
mullerian anomalies
marginal cord insertion |
|
|
Term
| what is the most common maternal factor associated with IUGR |
|
Definition
hypertension
chronic (pregestational) or PIH
25-30%!! |
|
|
Term
|
Definition
acurate and early dating and recording
EARLIEST ULTRASOUND IS MOST ACURATE
NEVER change estimated delivery date based on follow-up ultrasound!
physical exam - fundus height
ultrasound parameters
doppler studies S/D ratio
percutaneous umbilical cord sampling |
|
|
Term
| how does an untrasound S/D ratio help diagnose IUGR |
|
Definition
| as placental resistance increases, diastolic flow decreases |
|
|
Term
| what is the information obtained from percutaneous umbilical cord sampling 5 |
|
Definition
rapid karyotyping
congenital infection
hematologic parameters
nutrition
fetal blood gas |
|
|
Term
| we get awesome info from percutaneous umbilical cord sampling, why dont we do it on all babies |
|
Definition
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|
Term
| management of IUGR antepartum |
|
Definition
estimate cause
bed rest
fetal movement counting
serial sonography
NST: CST, BPP
doppler ultrasound
amniocentesis maturity studies
PUBS |
|
|
Term
|
Definition
| percutaneous umbilical cord sampling |
|
|
Term
| management of IUGR intrapartum |
|
Definition
electronic fetal monitoring
preparation for C section: amnionfusion
oxygen therapy
neonatal/anesthesia consultation |
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|
Term
| management of IUGR post partum |
|
Definition
pharyngeal suction
neonatal recussitation if needed
avoid hypoglycemia (decreased fat stores)
avoid hypothermia: O2 therapy
avoid hyperviscosity syndtome |
|
|
Term
| hyperviscosity syndrome: qualification, initial issue, 3 effects |
|
Definition
HCT>65%
polycythemia causes multiorgan thrombosis, heart failure, hyperbilirubinemia |
|
|
Term
| after birth of a IUGR baby what should be expected in their development 4 |
|
Definition
most catch up early on in growth (25% remain in <10th percentile through childhood)
at risk for neurological abnormalities
50% have learning dissability
brain sparing type: normal HC, associated with decreased neurological signs |
|
|
Term
| what is the risk of having multiple IUGR babies |
|
Definition
25% for subsequent pregnancies
after 2 IUGR pregnancies risk x4
rest is associated to the contributing factor for IUGR |
|
|
Term
| how can IUGR be prevented in a high risk mom (2) |
|
Definition
aspirin and dipyridamole
effective in a few small studies |
|
|
Term
|
Definition
| >90th percentile at given gestational age (>4000-45000g) |
|
|
Term
| cause of macrosomia (physiology in baby) 2 |
|
Definition
hyperinsulinemia
increased insulin like growth factors |
|
|
Term
| how does hyperinsulinemia in baby cause macrosomia 3 |
|
Definition
increased lipogenesis
increased glycogen synthesis
increased protein |
|
|
Term
| causes of macrosomia by mom 3 |
|
Definition
obesity
diabetes
excessive weight gain |
|
|
Term
| outcomes in macrosomia in baby 4 |
|
Definition
birth trauma
asyphxia
still birth
neurological damage |
|
|
Term
| management of macrosomia 3 |
|
Definition
control gestational DM
prepare for prolonged labor (esp descent) and C section |
|
|
Term
| when should a C section be done on a baby with macrosomia |
|
Definition
>5000g without DM
>4500g with DM |
|
|
Term
|
Definition
| impaction of fetal shoulder behind maternal pubic symphysis |
|
|
Term
| risk factors for shoulder dystonia 6 |
|
Definition
DM!!!!!
post-date (42wk+)
male fetus is larger
maternal obesity
second stage labor disorders
use of vaccume/forceps |
|
|
Term
| complications of shoulder dystonia and prevelence |
|
Definition
brachial plexus injury 95% of time
0.3-1% irreversible |
|
|
Term
| what does an irreversible brachial plexus injury cause |
|
Definition
|
|
Term
| what is the incidence of brachial plexus injury by weight of baby |
|
Definition
>4000g 10%
>4500g 20-30%
<4000g 50%!!! |
|
|
Term
| manuvers to help get baby with shoulder dystocia out 7 |
|
Definition
suprapubic pressure: nurse pushes down
McRoberts: exaggerated flexion of thighs on mom
episotomy
delivery of posterior shoulder: usually works
rubins/corkscrew: rotation
zavanelli |
|
|
Term
|
Definition
push baby with shoulder dystonia back in and do emergency C section
high mortality rate |
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