Fetal Growth Assessment Quiz

Color Index

• Red - Important
• Green - Doctor's notes
• Yellow - Golden notes
• Blue - Reference book
• Gray - Extra
• Highlighted in red/yellow - High yield
• Highlighted in purple - Doctor's review

Table of Contents

• Lecture: Anatomy of fetal skull
• Lecture: UTI & Anemia in pregnancy
• Lecture: Thromboembolic disease
• Lecture: Abnormal presentation (Fetal Malpresentation)
• Lecture: Operative Deliveries and C-section
• VC: Preconception
• VC: Antepartum Care
• Lecture: Antenatal fetal assessment
• VC: Intrapartum Fetal Surveillance
• VC: Intrapartum Care
• VC: Postpartum Care
• Lecture: Induction of Labor
• VC: Postterm Pregnancy
• VC: Vaginal bleeding in 1st trimester & Spontaneous Abortion
• VC: Ectopic Pregnancy
• VC: Antepartum Hemorrhage
• VC: Postpartum Hemorrhage
• VC: Abnormal Uterine Bleeding
• VC: Preterm labor
• VC: PROM & pPROM
• VC: IUGR
• VC: IUFD
• VC: Hypertensive Pregnancy Disorders
• Lecture: Gestational Diabetes Mellitus
• VC: Menopause
• VC: Puerperal Sepsis
• Lecture: Anatomy of placenta and fetal circulation
• VC: Multiple pregnancies
• VC: Cervical Intraepithelial Neoplasia (CIN) and Cancer
• Lecture: Postmenopausal bleeding & endometrial cancer
• VC: Uterine fibroids
• VC: Benign & Malignant ovarian tumors
• VC: Gestational Trophoblastic Tumors
• Lecture: PolyCystic Ovarian Syndrome
• VC: Pelvic Organ Prolapse & Urinary incontinence
• VC: Rhesus Alloimmunization
• VC: Family planning
• Lecture: Embryology overview
• Lecture: Anomalies of female genital tract
• Lecture: Disorders of Sexual Development
• Lecture: Amenorrhea
• Lecture: Dysmenorrhea
• VC: Endometriosis
• VC: Vulvovaginitis (lower genital tract infection) & Benign vulvar conditions
• VC: PID (upper genital tract infection)
• VC: Infertility
• Lecture: Patient Safety
• EXTRA Topics (VERY important)

Gravity & Parity

• Gravity (G): number of times a woman has been pregnant, including current pregnancy and past pregnancies
• Parity (P): number of pregnancies that have reached 24 weeks gestation
• Abortions (A): pregnancies that were less than 20 weeks
• Practice Q based on GTPAL system
• Estimated date of delivery (EDD): related to cycle length.
• Apgar Score: standardized clinical assessment of newborns at 1 and 5 minutes after birth

Anatomy of fetal skull

• Bones: frontal, parietal, occipital
• Sutures: coronal, sagittal, lambdoid
• Skull areas: fontanelles, glabella, and sinciput
• Circumferences

UTI & Anemia in pregnancy

• Infections of the bladder, urethra, ureters, or kidneys
• Causative agents: Enteric bacteria (E.coli most common), Beta hemolytic A, Beta hemolytic B
• Lactobacilli is normal vaginal flora
• Classification based on Clinical presentation, location, severity
• Risk factors: female gender, anemia, functional obstruction, pregnancy

Physiological hydronephrosis

• Right kidney more affected than the left
• Hydroureters (right ureter more affected than left)
• Urinary stasis in bladder, due to mechanical compression by uterus
• Hormonal changes cause dilation and urine stasis

UTI recurrence

• Relapse: infection by same organism with 2-3 weeks.
• Reinfection: fully treated patient infected with a different organism within 12 weeks
• Superinfection: infection with a new organism within 12 weeks of treatment

About/Consequences/Clinical presentation/Diagnosis/Management of UTI in pregnancy

• Most common infection in pregnancy
• Untreated can lead to acute pyelonephritis
• Clinical presentation: asymptomatic, suprapubic pain, fever, dysuria, hematuria, frequency, urgency, anorexia, tachycardia, nausea and vomiting, costovertebral angle tenderness
• Diagnostics: urinalysis, urine culture & sensitivity + blood culture and sensitivity if indicated
• Management: outpatient treatment with oral antibiotics or inpatient treatment with IV antibiotics depending on the severity

About/Consequences/Clinical presentation/Diagnosis/Management of Anemia in pregnancy

• Most common medical disorder in pregnancy due to poor dietary habits
• Risk factors: dietary deficiencies(iron, folate, B12), hemoglobinopathies (sickle cell, thalassemia)
• A condition with lower than normal circulating levels of Hb
• Classification based on Hemoglobin level (mild, moderate, severe, very severe)
• Clinical presentation: weakness, fatigue, dizziness, difficulty concentrating, rapid heart rate, shortness of breath, pale skin, cold extremities
• Diagnoses: Hemoglobin/hematocrit, checking different types of anemia
• Management: correcting underlying cause, oral or IV iron and folic acid supplements as required

Abnormal presentation (Fetal Malpresentation)

• Cephalic presentations: head first-vertex (most common), forehead, brow, face presentations
• Breech presentations: feet or buttocks first-complete, footling, and Frank breech
• Shoulder presentations: shoulder first
• Compound presentations: more than one part of the fetus over the inlet at the same time

Fetal lie

• Longitudinal: fetus parallel to the mother
• Oblique: 45 degrees
• Transverse: 90 degrees

Abnormal presentation (Fetal Malpresentation)

• Occiput anterior position
• Right/left Occiput Anterior (ROA/LOA)
• Occiput posterior position (ROP/LOP)

Management/mode of delivery/complications of breech presentation

• Cesarean Section is the usual mode
• Internal cephalic version (ECV): rotation of breech baby, used before 37 weeks, done in the OR.
• Contraindicated: contracted pelvis, previous scarred uterus, previous multiples, hypertension, or previous history of complicated deliveries.

Anatomy/bones/sutures/circumferences of the fetal skull

• Two frontal bones
• Two parietal bones
• One occipital bone
• Frontal, sagittal, coronal, and lambdoid sutures
• Submentobregmatic, mentoanterior, mentoposterior, Mentovertical/mentovertex, suboccipito-bregmatic, occipito-frontal circumferences

Operative Vaginal Delivery, Indications for operative therapy

• Instruments used for delivery: forceps, vacuum (ventouse extractor)
• Inversion of uterus, prior uterine surgery, cardiac issues, poor maternal effort, abnormal fetal presentation, fetal distress

Cesarean section (CS)

• Indications
• Complications

Vaginal bleeding in the first trimester

• Threatened: bleeding before 20 weeks, not severe
• Inevitable: bleeding & opening of the cervix, but no passage of fetal tissue
• Incomplete: bleeding & passage of some, but not all, of the fetal tissue
• Complete: passage of all fetal tissue
• Missed: fetal death and no expulsion/passage of fetal tissue

Spontaneous abortion

• Loss of pregnancy before 20 weeks
• 80% occur in the first 12 weeks
• Risk factors: Cervical insufficiency/incompetence, chromosomal abnormalities, genetic predisposition, systemic diseases(diabetes, hyperthyroidism), infections, anatomical issues, smoking

Ectopic Pregnancy

• Pregnancy outside the uterus (most common is fallopian tube).
• Risk factors: prior ectopic pregnancy. Pelvic inflammatory disease, prior tubal surgery, IUD, smoking
• Clinical presentation: vaginal bleeding, lower abdominal pain, amenorrhea
• Diagnostics: β-hCG levels, transvaginal ultrasound
• Management: medical (methotrexate) or surgical

Hypertensive Pregnancy Disorders

• Sustained BP of 140/90 or higher
• Risk factors: prior preeclampsia (with and without complications), family history, nulliparity, extreme maternal age, multiple gestations, chronic conditions, obesity
• Features: proteinuria and organ damage-does not last > 12 weeks postpartum
• Diagnoses: blood pressure, urine testing for protein, ultrasound to visualize blood vessels, fetal monitoring
• HELLP: hemolysis, elevated liver enzymes, low platelets

Gestational Diabetes Mellitus

• Diagnosed at 24-28 weeks.
• Risk factors: extreme maternal age obesity, prior hx of GDM, family hx DM, unexplained fetal demise with prior pregnancies, unexplained previous IUFD, recurrent pregnancy loss, PCOS
• Management: dietary modifications, regular exercise+blood glucose monitoring+insulin regimen
• Complications: maternal and fetal: increased risk of macrosomia, birth defects, higher mortality rates, risk of pre-eclampsia/eclampsia/PPH

Postterm pregnancy

• Continuation of pregnancy after 42 weeks of gestation or 294 days post last period
• Risk factors: inaccurate estimation of gestational age, irregularities, prior post term pregnancy, lower socioeconomic status, nulliparity, obesity
• Management: inducing labor, cesarean delivery
• Complications:
• Risk maternal and fetal: fetal hypoxia, macrosomia, meconium aspiration syndrome,

IUGR & Macrosomia

• IUGR (intrauterine growth restriction): estimated weight <10th percentile at given gestational age.
• Macrosomia: estimated weight > 90th percentile at given gestational age
• Risk factors: Maternal: smoking, drug use, chronic issues, obesity, infections. Fetal: abnormalities, infections
• Diagnostics: fundal height, physical exam, ultrasound (multiple measurements-BPD, HC, AC, FL)
• Doppler velocimetry, measuring ratio of systolic/diastolic pressures)
• Management: early identification and intensive monitoring, correct any underlying issue and prepare for delivery as appropriate.
• Complications: intraventricular hemorrhage, meconium aspiration, respiratory distress syndrome. Other

Fetal Demise

• Fetal death in utero > 20 weeks
• Risk factors: Maternal and fetoplacental associated with pregnancy complications, chromosomal abnormalities
• Management: Induction of labor, or immediate delivery
• Complications: Possible DIC (disseminated intravascular coagulation)

Premature rupture of membranes (PROM) & Preterm premature rupture of membranes (pPROM)

• PROM = rupture before onset of labor at term
• pPROM = rupture before onset of labor at before term
• Infection risk most important cause of complications
• Treatment: early delivery based upon gestational age in case of imminent danger

Puerperal sepsis

• A medical emergency.
• Risk factors: prolonged labor, multiple vaginal exams, infections
• Clinical presentation: high fever, lower abdominal tenderness, foul smelling/discharge, uterine tenderness, symptoms/signs of sepsis
• Management: IV antibiotics, appropriate supportive measures

Lower segment/upper segment (uterine)

• Advantages and disadvantages for vaginal deliveries
• Management/complications

Pelvic Organ Prolapse (POP)

• Protrusion of bladder, rectum, intestines, uterus, cervix, or vaginal apex into the vagina due to relaxation of pelvic floor support
• Risk factors: genetic predisposition, vaginal childbirth, multiparity, intra-abdominal pressure, advanced age, prior pelvic surgery, connective tissue disorders

Urinary incontinence

• Inability to control urine, involuntary leakage
• Types: Stress, Urge, Mixed, Overflow (hypotonic)
• Risk factors: increased intra-abdominal pressure, age, pregnancy, prior pelvic surgery

Cervical Incompetence/Insufficiency

• Painless cervical dilation with or without prolapsed membranes
• Risk factors: prior pregnancy loss, prior surgical procedures, short cervix on ultrasound
• Management: cerclage, delivery at latest indicated time

Rhesus Isoimmunization

• Mother Rh-, fetus Rh+ → maternal antibodies form in first pregnancy, these antibodies cross the placenta and destroy fetal RBCs in subsequent pregnancies.
• Risk factors: Mother Rh-, father Rh+, recurrent pregnancy loss
• Diagnostics: indirect Coombs test(assess for antibodies), ultrasound to identify fetal risk
• Management: RhoGAM within 72 hours of birth or delivery, if Rh+ fetus

Types of pelvic organ prolapse

• Cystocele
• Rectocele
• Uterine prolapse

Lower Anogenital Squamous Terminology System (LAST)

• Cytology, results of pap smear.
• Histology results from colposcopy - Grading
• LSIL (low-grade squamous intraepithelial lesions), ASC-H (atypical squamous cells), HSIL(high-grade squamous intraepithelial lesions)
• CIN 1-3 (cervical intraepithelial neoplasia 1-3)
• Management if abnormal findings are present

Cervical cancer

• Staging
• Management approaches

Pathophysiology of FHR changes

• Normal fetus withstands brief temporary reduction in blood flow during contractions because of adequate oxygen exchange.
• Hypoxia, when severe occurs due to anaerobic metabolism and release of lactic/pyruvic acid → fetal acidosis.

Fetal growth restriction (IUGR) & Macrosomia

• IUGR (intrauterine growth restriction): estimated weight <10th percentile at given gestational age.
• Macrosomia: estimated weight > 90th percentile at given gestational age
• Risk factors: Maternal - smoking, drug use, chronic issues, obesity, infections. Fetal - abnormalities, infections
• Diagnostics: fundal height, physical exam, ultrasound (multiple measurements-BPD, HC, AC, FL)
• Doppler velocimetry, measuring ratio of systolic/diastolic pressures)
• Management: early identification and intensive monitoring, correct any underlying issue and prepare for delivery as appropriate.
• Complications: intraventricular hemorrhage, meconium aspiration, respiratory distress syndrome. Other

Vaginal & vulvar discharge

Bacterial vaginosis Trichomonas Candidiasis

• Risk factors
• Clinical presentation
• Diagnostics
• Management
• Complications.

Other

• Brachial plexus nerve injuries
• Difficulties in delivering the head and intracranial bleeding
• Anatomy of placenta and fetal circulation
• Postnatal circulation
• Types of multiple pregnancies (di-di, di-mo, mo-mo)
• Twin-twin transfusion syndrome (TTTS) and fetal complications
• Fetal alcohol syndrome (FAS): dysmorphic features, intellectual disabilities
• Cervical ectropion (benign lesion)
• Neonatal GBS infection
• Umbilical cord prolapse
• Amniotic membrane rupture
• Exomphalos, abdominal wall defect.
• Subgaleal hematoma
• Cephalohematoma
• Congenital infections (Torch infections): Toxoplasmosis, Syphilis, Rubella, Cytomegalovirus (CMV), Herpes simplex virus (HSV) infection, Hepatitis B
• Anti-D immunoglobulin (RhoGAM) for Rh-negative mothers with Rh+ fetuses
• Various complications of pregnancy and labour.
• Indications for blood transfusion
• Indications for delivery
• Treatment of complications
• Types of pain during labor: visceral (visceral organ - uterine muscle contractions) and somatic (involves nerves)
• Pathology of all features mentioned.

Test your knowledge on the measurements used to assess fetal growth and development during pregnancy. This quiz covers various parameters like Abdominal Circumference, Femur Length, and the stages of labor. Prepare to understand critical fetal assessments for better management in obstetrics.