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OB20 Obstetrics
Obstetrical Complications Toronto Notes 2019
• complications
■ prone to meconium aspiration, asphyxia, polycythemia, hypoglycemia, hypocalcemia,
hypophosphatemia hyponatremia, and mental retardation ■ greater risk of perinatal morbidity and mortality
Investigations
• SFHmeasurementsateveryantepartumvisit(ensureaccurateGA) • ifmotherathighriskorSFHlags>2cmbehindGA
■ U/S for biparietal diameter, head and abdominal circumference ratio, femur length, fetal weight, and AFV (decrease associated with IUGR), decrease in the rate of growth
■ ±BPP
■ Doppler analysis of umbilical cord blood flow
Management
• preventionviariskmodificationpriortopregnancyisideal
• modifycontrollablefactors:smoking,alcohol,nutrition,andtreatmaternalillness
• serialBPP(monitorfetalgrowth)anddeterminecauseofIUGR,ifpossible
• deliverywhenextrauterineexistenceislessdangerousthancontinuedintrauterineexistence(abnormal
function tests, absent growth, severe oligohydramnios) especially if GA >34 wk
• as IUGR fetuses are less likely to withstand stresses of labour, they are more likely to be delivered by
caesarean section
Macrosomia
Definition
• infantweight≥90thpercentileforaparticularGAor>4,000g
Etiology/Risk Factors
• maternalobesity,GDM,pasthistoryofmacrosomicinfant,prolongedgestation,multiparity
Clinical Features
• increasedriskofperinatalmortality
• CPDandbirthinjuries(shoulderdystocia,fetalbonefracture)morecommon • complicationsofDMinlabour(seeTable14,OB28)
Investigations
• serialSFH
• furtherinvestigationsifmotherathighriskorSFH>2cmaheadofGA • U/Spredictors
■ polyhydramnios
■ third trimester AC >1.5 cm/wk ■ HC/ACratio<10thpercentile ■ FL/ACratio<20thpercentile
Management
• preventing hyperglycemia in women with DM, pregnancy weight loss in obese women
• prophylacticC/SisareasonableoptionwhereEFW>5,000ginnon-diabeticwomanandEFW>4,500g
in diabetic woman
■ no evidence that prophylactic C/S improves outcomes
• risksandbenefitsofearlyinduction(riskofC/Svs.riskofdystocia)mustbeweighedindiabetic mothers, need for person-centered and shared decision-making