OB/GYN --- fetal Complications
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Created by:
mddcpasutah on March 16, 2012
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53 terms
Terms | Definitions |
|---|---|
 What is the 2nd leading cause of perinatal mortality behind preterm birth? | decreased growth |
| What is small for gestational age? | <10th percentile for growth |
| What % of babies are constitutionally small? | 70% |
| What other associated sx are with SGA? | No evidence of wasting and No increased risk of poor outcome |
| What is the Tx of SGA? | expectant management |
| What is intrauterine growth restriction? | = <10th % for growth with evidence of wasting (torso & limbs disproportionally small while the brain is preserved) |
| What in the increase risk associated with IUGR? | 6-10 x increase in perinatal mortality |
| What are some causes of IUGR? | Maternal factors = HTN, severe diabetes, anemia, malnutrition Placental factors = previa, chronic abruption, infarction, multiple gestation |
| What is the Tx of IUGR? | fetal monitoring, serial ultrasounds for growth, delivery if severe |
| What is large for gestational age? | estimated fetal wt. >90% |
| What is macrosomia? | birth wt. >4500 gm. (10lbs) |
| What are some risks in macrosomia? | = traumatic birth injury, shoulder dystocia (head comes out but shoulders get stuck), Erb's palsy, fetal hypoglycemia |
| What are some risk factors for macrosomia? | diabetes, obesity - maternal, post term >42wks, previous LGA |
| What is the dx of macrosomia? | fundal ht, ultrasound |
| What is the Tx of macrosomia? | prevention |
| What is the evaluation of amniotic fluid? | ultrasound. Amniotic fluid index |
| What is the AFI? | = measure largest vertical pocket of fluid in all 4 quadrant. The sum = AFI |
| What is the balance of fluid determined by? | production by fetal kidneys and lungs. Resorption by fetal swallowing. Interface between membranes and placenta |
| What is too little amniotic fluid? | oligohydramnios = AFI <5 |
| What is the significance of too little amniotic fluid? | 40 x increase in perinatal mortality - cord compression leading to asphyxia, associated congenital anomalies, growth restriction |
| What are some causes of amniotic fluid? | uteroplacental insufficiency, anomalies-kidneys, rupture of membranes (most common) |
| what is the tx in too little amniotic fluid? | delivery |
| What is too much amniotic fluid? | polyhydramnios = AFI > 20-25 |
| What is the significance of polyhydramnios> | increased risk of cord prolapse w/rupture of membranes, malpresentation of fetus Prolapse cord = emergency c/section |
| What are some causes of too much amnionic fluid? | congenital anomalies - NTD, neck, gastric. Maternal diabetes (osmotic diuretic) |
| What is the Tx of too much amniotic fluid? | expectant management: serial ultrasounds, amniocentesis for maternal comfort, with ROM assess for cord prolapse and feral presentation |
| What is Rn incompatibility? | Rh negative mother with Rh positive fetus |
| What is the epidemiology of RH? | Rh negative in approx. 20% population |
| what are the causes of Rh incompatibility? | occur w/blood transfusion or childbirth |
| What is the pathophysiology of Rh? | Maternal sensitization to fetal Rh antigen causes antibody formation. Antibodies cross placenta and cause hemolysis of fetal RBCs |
| What is the sensitivity of Rh? | can occur in third trimester, abdominal trauma, procedures (CVS, amniocentesis), child birth |
| What are the consequences of Rh? | = fetal anemia, erthroblastosis fetalis (aka hydrops), intrauterine death |
| What is etythroblastosis fetalis? | hyperdynamic heart failure from anemia, diffuse edema, pulmonary and pericardial effusions, ascites, hyperbilirubinemia (from destruction of fetal red cells) leads to jaundice and neurotoxic effects |
| What is the managment of Rh? | follow antibody titers every 4 wks. Antibody titers 1:16 or higher are associated with hydrops |
| When do you refer managment of Rh? | to perinatology to follow anemia & assess the need for fetal blood transfusion via the umbilical artery |
| What is prevention of Rh? | RhoGAM / anti D immunoglobulin (Rh IgG). Treat all Rh negative pregnancies as if fetus is at risk (assume the father is Rh positive) - estimates of misattributed paternity range from 5-10% |
| When is RhoGAm admnistered? | at 28 weeks gestation, for abdominal trauma, at time of amniocentesis or CVS, at time of miscarriage/abortion, at delivery if baby is Rh positive |
| What is considered a post term pregnancy? | >42 weeks (fetal complications increase after 40 weeks) |
| What is the occurrence of post term pregnancy? | 3-10% pregnancies |
| What are some causes of post term pregnancy? | = inaccurate dates (most common cause), anecephaly (no spontaneous labor) |
| What are some risks in post term pregnancy? | macrosomia, oligohydramnios, fetal death |
| What is the dx of post term pregnancy? | ultrasound for dating |
| what is the tx of post term pregnancy? | prevention - 1st or 2nd trimester ultrasound for accurate dating and delivery before 42 weeks. Fetal monitoring at 41 weeks if cervix is not favorable for labor |
| What is monozygotic? | one fertilized ovum divides into 2 separate cells - "identical" |
| What is dizygotic? | ovulation produces 2 ova which are fertilized by 2 sperm |
| what is the spontaneous twin rate? | 1/80 - 30% twins are monozygotic |
| What is the spontaneous triplet rate? | = 1/7000 |
| What are some complications of multiple gestations? | preterm birth, gestational diabetes, preeclampsia, malpresentation, small for gestational age |
| what is the management of multiple gestations? | co-manage w/perinatology. Serial ultrasounds for growth |
| what is the fetal monitoring of multiple gestations? | = fluid and heart beat |
| When to do vaginal delivery of twins? | do if 1st fetus is vertex - vertex/vertex (most common) or vertex/breech |
| When to do c/section of twins? | if 2st baby is breech |
| When to do c/section of triplets? | always |
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