Escolar Documentos
Profissional Documentos
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REFERENCES
1. Dr. Saluds lecture and PPT
2. Williams Obstetrics 24th Edition
NOTE: Unless otherwise specified, the information from this trans came
from the PowerPoint.
POSTTERM PREGNANCY
Delivery of a fetus at 42 completed weeks/294 days or greater from
the LMP
Factors affecting diagnostic accuracy:
o Wrong or unrecalled LMP
o Biological variations in menstrual cycle and ovulation dates
Confirmatory Test: Early Sonography
o To date pregnancy done
o Preferable in the 1st trimester
o Can also be done before the 24th week of pregnancy but error in
estimation is increased
Incidence: approximately 6% of 4 million infants born in the US are
born postterm
Predisposing factors
o Maternal
Nulliparity
Prior Postterm
o Fetoplacental
Adrenal hypoplasia
Dr. Salud
September 18, 2014
Intrapartum complications
Fetal distress
Neonatal Seizures
Induction of Labor
o Factors affecting success
Cervical dilatation
OBSTETRICS 3.3
Intrapartum Management
While being evaluated for active labor, we recommend that fetal heart
rate and uterine contractions be monitored electronically for variations
consistent with fetal compromise.2
If you rupture the bag of water and there is thickly stained meconium
and very scanty amniotic fluid volume, you may do remedial measures.
DETERMINANTS
FETAL GENOME
ENVIRONMENTAL
NUTRITIONAL
HORMONAL
OBSTETRICS 3.3
Classification (based on HC/AC ratio)
Symmetrical
o Reduced head and body size
o Usually occurs in infections
o Early insult - for example, global insults such as from chemical
exposure, viral infection, or cellular maldevelopment with
aneuploidy may cause a proportionate reduction of both head and
body size
o Results in decreased cell number and size
Asymmetrical
o Reduced body size
o Late pregnancy insult (e.g. placental insufficiency from
hypertension)
o Decreased cell size only
o Brain sparing normal head size and growth; most of the blood
will flow of the head which is more important than the body of the
fetus
Risk Factors
Social deprivation
o lifestylesmoking, addiction, and poor nutrition
Congenital malformations
o the more severe the malformation the more likely is the fetal IUGR
Chromosomal Aneuploidies
o Trisomy 21mild IUGR
o Trisomy 18severe IUGR
o Trisomy 16fatal
Teratogens
o Anticonvulsants, antineoplastic
Vascular Disease
o superimposed pre-eclampsia
o chronic hypertension
Pre-gestational Diabetes
o Maternal vascular disease (fetal substrate deprivation)
Chronic Hypoxia
o Uteroplacental hypoxia: preeclampsia, chronic hypertension,
asthma, smoking, high altitude (those that live in high altitude are
usually smaller than those living in sea level)
Genetics
o Inheritance of certain substance that interfere with folate
metabolism
Multiple Fetuses
o The higher the number of fetuses in the mothers womb the
higher the chance it will affect the growth of the fetuses
Identification of IUGR
Sonographic Measurements
o 16-20 weeks for identification of anomalies
o 32-34 weeks for growth monitoring
o Establish the diagnosis of IUGR by:
Femur length
Biparietal Diameter
mild dysfunction
progressive dysfunction
Guidelines
o Confirm diagnosis
o Assess fetal condition by surveillance
o Evaluate for anomalies
OBSTETRICS 3.3
< 34 weeks
o Observation & monitoring until fetal maturity is attained
o Qualifications:
Normal fetus
MACROSOMIA
Infants above the 90th percentile for a given age of gestation or
newborns weighing >4000g
o ACOG: Fetuses who weigh 4500g or more at birth
Risk Factors:
o Obesity
o Gestational diabetes and DM type 2
o Postterm gestation
o Multiparity
o Large size of parents
o Advancing maternal age
o Previous macrosomic infant
o Racial & ethnic factors
Diagnosis
o Sonographic fetal weight estimation - head, femur & abdominal
circumference
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Obstetrics 3.5
Dr. Salud
September 18, 2014
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