complications of pregnancy: post-term pregnancy, fetal growth abnormalities, obstetric procedures

≥42⁰⁄₇ weeks

define 'postterm' (prolonged gestation)

41⁰⁄₇ - 41⁶⁄₇

define Late term

Postterm ≠ late term. 42 weeks is the cutoff.

difference between post term and late term

Macrosomia

Shoulder dystocia

Birth trauma

Meconium aspiration syndrome

Oligohydramnios

complications of prolonged gestation

Thin, wrinkled skin

Long nails

Decreased subcutaneous fat

features of postmaturity syndrome

NST 1–2× weekly

BPP or modified BPP

Ultrasound for AFI

antenatal surveillance indicated at 41 weeks

✅ Recommended at 41⁰⁄₇ weeks

recommended induction of labor time after term

Cervical ripening (prostaglandins)

Mechanical dilation (balloon)

Oxytocin

Amniotomy (if favorable cervix)

induction methods available

confirm dates

always _______ before labeling postterm

Birth weight ≥4,000 g (some use ≥4,500 g)

OR >90th percentile for gestational age

define fetal macrosomia clinically

Estimated fetal weight <10th percentile for gestational age

clinical definition of fetal growth restriction

<3rd percentile

clinical definition of severe fetal growth restriction

Diabetes (most important)

Obesity

Excessive gestational weight gain

maternal etiologies of macrosomia

Male sex

Genetic syndromes (Beckwith-Wiedemann)

fetal etiologies of macrosomia

Beckwith-Wiedemann syndrome

a growth disorder syndrome synonymous with enlargement of several organs including the skull, tongue, and liver

Chronic HTN

Preeclampsia

Smoking, alcohol, drugs

Malnutrition

maternal factors leading to fetal growth restriction

Placental insufficiency

Placental abruption

Abnormal placentation

placental effects--> fetal growth restriction

Chromosomal abnormalities (trisomies)

Congenital infections (TORCH)

Multiple gestation

fetal factors leading to fetal growth restriction

uteroplacental insufficiency

fetal growth restriction is caused by _________ until proven otherwise

3 cm discrepancy from gestational age → evaluate

fundal height findings indicating fetal growth abnormalities

Biparietal diameter

Head circumference

Abdominal circumference (most sensitive for FGR)

Femur length

ultrasound findings to determine estimated fetal weight

EFW ≥5,000 g (no diabetes)

EFW ≥4,500 g (diabetes)

estimated fetal weight indicating need for C-section

Serial growth ultrasounds (q3-4 weeks)

NSTs / BPPs

Umbilical artery Dopplers

surveillance of fetal growth restriction

Erb-Duchenne palsy

upper brachial plexus injury causing paralysis of arm, wasting of hand muscles, and decreased sensation; arm held in characteristic "waiter's tip position;" recovery usually btwn 3-24 months

abdominal circumference

first thing to decrease in fetal growth restriction

Chorionic Villous Sampling (CVS)

Transcervical or transabdominal biopsy of placental villi

Performed 10–13 weeks

Early genetic diagnosis

Advanced maternal age

Abnormal screening test

Known genetic disorder

indications for chorionic villous sampling

Miscarriage

Infection

Limb defects if done <10 weeks

complications associated with chorionic villous sampling

performed 10-13 weeks

-limb defects if done <10 weeks

when can you do chorionic villous sampling

amniocentesis

Transabdominal needle aspiration of amniotic fluid

Performed ≥15 weeks

Genetic testing

Neural tube defect screening

Fetal lung maturity

Infection testing

indications for amniocentesis

neural tube defect screening

what can amniocentesis test for that CVS can't?

amniocentesis

which has lower miscarriage risk, amniocentesis or CVS?

Tachysystole

Fetal distress

Uterine rupture (rare)

complications associated with induction of labor

Shoulder dystocia

Operative vaginal delivery

Fetal distress requiring rapid delivery

indications for episiotomy

3rd-4th degree lacerations

Infection

Dyspareunia

Pain

complications of episiotomy

Prolonged second stage

Nonreassuring fetal heart tracing

Maternal exhaustion

indications for vacuum-assisted delivery

Cephalohematoma

Swelling caused by bleeding between the osteum and periosteum of the skull. This swelling does not cross suture lines.

subgaleal hemorrage

bleeding beneath scalp into connective tissue; bleeding may be present in subcutaneous tissue of neck; associated with vacuum extraction. Fluctuant mass of scalp, may increase in size after birth

Cephalohematoma

Subgaleal hemorrhage

Scalp lacerations

Failed vacuum → C-section

complications of vacuum-assisted delivery

Facial nerve injury

Skull fracture

Vaginal/cervical lacerations

Maternal trauma

complications associated with forceps delivery

breech presentation

birth position in which the buttocks, feet, or knees emerge first

frank breech

The fetal legs are flexed at the hips and extend toward the shoulders; this is the most common type of breech presentation. The buttocks present at the cervix

frank breech

-most breech should be a planned C-section

only type of breech that can maybe have a vaginal delivery

Infection

Hemorrhage

Thromboembolism

Future placental disorders (accreta)

complications associated with cesarean delivery

meatal stenosis

Narrowing of the urethral opening to the outside of the body

-complication of circumcision

Confirm intrauterine pregnancy

Accurate dating (most accurate in 1st trimester)

Determine number of fetuses (twins, chorionicity)

Confirm fetal viability (cardiac activity)

indications for first trimester ultrasound

13⁶⁄₇ weeks

last day of the first trimester

aneuploidy

nuchal translucency measurement screens for

~4.5-5 weeks

at what weeks can you identify gestation sac

5-5.5 weeks

at what weeks can you identify yolk sac on US

~5.5-6 weeks

at what weeks can you identify fetal pole on US

~6 weeks

at what weeks can you identify fetal cardiac activity on US

~7-8 weeks

at what weeks can you identify limb buds on US

~10 weeks

at what weeks can you see clear fetal anatomy on US

yolk sac

-can visualize at 5-5.5 weeks

_______ confirms true intrauterine pregnancy

18-22 weeks

what weeks do you do an anatomic survey?

Anatomic survey (18–22 weeks)

Placental location (rule out placenta previa)

Assessment of fetal growth

Amniotic fluid volume (AFI or single deepest pocket)

indications for second and third trimester ultrasound

first trimester

when can you get the most accurate fetal dating

gestational sac

yolk sac

fetal pole

limb buds

order of fetal finding on US