Fetal Macrosomia Quiz

Fetal Macrosomia

• Defined as a fetus exceeding the 90th percentile for weight or > 4500 g.
• Common causes include placental insufficiency, preeclampsia, maternal obesity, and diabetes.
• Complications during delivery include prolonged labor, uterine rupture, vaginal lacerations, postpartum hemorrhage, and shoulder dystocia, which can injure the neonate's brachial plexus.

Preparation for Labor

• Pre-Pregnancy & First Trimester Classes: Focus on health, nutrition, lifestyle changes, fetal development, and preventing complications.
• Second & Third Trimester Classes: Discuss labor processes, postpartum care, infant stimulation techniques, and birth safety.
• Adolescent Classes: Help young mothers adapt to pregnancy and labor.

Bradley Method

• Emphasizes natural childbirth through 12 weekly classes for couples.
• Focus on maternal health, pain management, and bonding exercises.
• Teaches relaxation and pain control techniques without medication or intervention.

Lamaze Method

• Encourages control over the birthing process, minimizing interventions.
• Promotes movement during labor and recommends upright positions to facilitate delivery.
• Advocates for skin-to-skin contact and rooming-in post-birth.

Kitzinger Method

• Views childbirth as a natural process; encourages home births and alternative settings.
• Teaches breathing techniques, visualization, and movement to alleviate discomfort.
• Involves creating a personalized birth plan.

HypnoBirthing Method

• Combines self-hypnosis and relaxation techniques to reduce fear and stress.
• Focuses on breathing techniques and visualization during labor.
• Partners are trained to provide support through touch and prompts.

Braxton-Hicks Contractions

• Also known as "false labor"—irregular, non-progressive uterine contractions in the third trimester.
• Unlike true labor contractions, they do not lead to cervical changes.

True Labor Contractions

• Begin irregularly and progressively become more frequent and intense.
• Typically cause pain starting from the lower back that moves to the abdomen.
• Result in cervical effacement and dilation.

Signs of Impending Labor

• Lightening: Engagement of the fetal head reduces pressure on the diaphragm.
• Increased Braxton-Hicks activity and a surge of energy often indicate approaching labor.
• Bloody show: Expulsion of mucous plug, indicating the cervix is beginning to efface.
• Gastrointestinal disturbances may occur as labor nears.
• Rupture of membranes: Can happen before labor and requires medical attention if not followed by labor.

Evaluation Procedures for Onset of Labor

• History-taking focuses on contraction onset and membrane integrity.
• Leopold maneuvers assess fetal position.
• Vaginal exams check for effacement and dilation.

Common Discomforts of Pregnancy

• Heartburn: Caused by progesterone affecting GI motility. Managed by dietary changes and antacids.
• Ankle/Foot Edema: Resulting from hormonal changes and circulatory issues; managed by elevating legs and minimizing restrictions.
• Nasal Stuffiness/Bleeding: Due to increased estrogen; managed with humidifiers and avoiding nasal sprays.
• Vaginal Discharge: May lead to infections; management includes hygiene practices and antifungal treatments.

Nausea and Vomiting in Pregnancy

• Common in the first trimester due to hormone changes; may continue due to uterine pressure.
• Management includes small, frequent meals and specific medications for severe cases.

Hyperemesis Gravidarum

• Severe form of nausea and vomiting occurring in approximately 2% of pregnancies, leading to dehydration and weight loss.
• Treatment typically involves IV fluids and antiemetic medications.

Antepartum Tests

• Alpha-Fetoprotein (AFP): Measured around week 15 to assess for neural tube and congenital defects.
• Chorionic Villus Sampling (CVS): Tests placenta for abnormalities; involves ultrasound-guided sampling.
• Percutaneous Umbilical Blood Sampling (PUBS): Involves blood sampling from the umbilical cord for genetic testing.

Management of Pregnancy Discomforts

• Leg Cramps: Caused by calcium imbalance; management involves stretching and dietary modifications.
• Constipation: Hormonal effects slow intestinal motility; increasing fluids and fiber can help.
• Hemorrhoids: Related to pressure and constipation; management includes topical treatments and lifestyle changes.
• Urinary Frequency: Increased bladder pressure managed by fluid adjustments and urination habits.
• Varicose Veins: Caused by venous congestion; managed through elevation and support stockings.### Neural Tube Defects and Testing
• Alpha-fetoprotein (AFT) test is primarily used to detect neural tube defects (NTDs) during the first trimester.
• AFT can be measured in both amniotic fluid and maternal serum.
• Triple screening includes serum AFT levels tested in the second trimester, followed by ultrasound and amniocentesis if results are positive.
• Increased AFT levels can indicate NTDs, abdominal wall defects, and congenital nephrosis.
• Most accurate AFT test results are obtained between weeks 15-16 of gestation.

Antepartal Tests

Chorionic Villus Sampling (CVS)

• CVS involves obtaining a sample of chorionic villi from the placenta for genetic testing, performed within the first trimester (up to 210 weeks).
• CVS does not detect neural tube disorders but enables early diagnosis of genetic abnormalities.
• Miscarriage risk from CVS is approximately 1 in 1600, similar to amniocentesis.
• Ultrasound aids the procedure to detect the placental location, requiring the mother to drink fluids beforehand.
• Sampling methods include transcervical and transabdominal approaches.

Percutaneous Umbilical Blood Sampling (PUBS)

• PUBS (cordocentesis) retrieves fetal blood from the umbilical cord for diagnosing blood disorders, infections, and chromosomal abnormalities.
• An ultrasound locates the umbilical cord and vein for precise needle insertion using a spinal needle.
• A paralytic agent is used to minimize fetal movement during the procedure.
• Miscarriage risk with PUBS is approximately 2%.

Amniocentesis

• Conducted at 15-20 weeks for genetic diagnoses and at 30-35 weeks to assess fetal lung maturity.
• Ultrasound guides the needle insertion to avoid major structures and ensure safe withdrawal of 15-20 ml of amniotic fluid.
• Initial fluid drops are discarded, and the collected fluid must be shielded from light.

Fetal Lung Maturity

• Tests for fetal lung maturity are crucial if early pregnancy termination is indicated, directly impacting neonatal survival.
• The Lecithin/sphingomyelin (L/S) ratio changes throughout pregnancy:
  • 0.5:1 early, 1:1 at 30-32 weeks, and 2:1 at 35 weeks; RDS risk is low at a 2:1 ratio.
• Phosphatidylglycerol (PG) appears in surfactant around week 35 in complicated cases and week 36 in healthy pregnancies, indicating lung maturity.
• Both L/S ratio and PG tests are employed together for confirmation of fetal lung maturity.

Biophysical Profile (BPP)

• The BPP includes five components: fetal heart rate, respiratory effort, body movements, muscle tone, and amniotic fluid volume.
• Fetal heart rate is assessed via nonstress test (NST); normal results show ≥2 accelerations of 15 bpm within 20-40 minutes.
• Fetal movements should be ≥3 in 30 minutes to score normal, while at least one episode of rhythmic breathing for ≥30 seconds is required for normal respiration.
• Amniotic fluid is assessed as normal if there is a single vertical pocket >2 cm.
• The maximum score for the BPP is 10, indicating normal fetal status and varying levels of risk for asphyxia.

Ultrasound

• Ultrasound utilizes high-frequency sound waves to create detailed images of fetal conditions and is commonly performed at around five weeks and 20 weeks of gestation.
• First-trimester ultrasound aims to estimate gestational age, assess vaginal bleeding, determine multiple pregnancies, and check for birth defects.
• Second-trimester ultrasound focuses on confirming gestational age and examining major fetal conditions including defects.
• Third-trimester ultrasound supports evaluation of fetal viability and amniotic fluid volume, with an accuracy of +/- 2-3 weeks for gestational age.

Test your knowledge on fetal macrosomia, a condition defined as an exceptionally large fetus. This quiz covers its causes, implications for delivery, and key indicators such as fundal height measurements. Assess your understanding of the factors involved in this pregnancy complication.