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2nd Repro > 2nd and 3rd trimester complication > Flashcards

2nd and 3rd trimester complication Flashcards

1
Q

Placenta’s role: transport of nutrients and waste products to and from developing fetus; “fetomaternal organ”

• Fusion between fetal (____) and maternal (____) tissue for physiological exchange

A

chorion

endometrial

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2
Q

r =weeks 13 through 25 weeks and 6 days of gestation

=26 weeks of gestation through the estimated due date

A

Second trimester

• Third trimester

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3
Q

Second Trimester Complications

• Fetal Infections-TORCH infections –

A

-Toxoplasmosis
– Other (Syphilis, Parvovirus B19)
– Rubella

– Cytomegalovirus
– Herpes Simplex Virus

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4
Q

a coccidian parasite

  • Essential reservoir-felines
  • Acute infection–>devastating effects; risk of fetal infection ↑ with gestational age, but severity ↓ with gestational age
A

Toxoplasmosis

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5
Q

Transmission of Toxoplasmosis

A

o transplacental

o fecal-oral route

o risk of fetal infection increases with gestational age
o severity of fetal infection decreases with gestational age

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6
Q

You’re performing ultrasound on women during 2nd trimester and notice baby ahs intracranial calcifications, hydrocephalus and choretinitis, DX

A

Toxoplasmosis:

triad seen in 2nd semseter = hydrocephalus, intracranial calcifications, and chorioretinitis

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7
Q

Clincal manifestations of Toxoplasmosis during:

1st

2nd

3rd trimester

A

o First trimester-often results in death
o Second trimester-classic triad of hydrocephalus, intracranial calcifications, and chorioretinitis
o Third trimester-often asymptomatic at birth

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8
Q

How do you Dx Toxoplasmosis in mom and baby

A

mom: +IgM and IgG titers

fetal PCR of amniotic fluic

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9
Q

a Gram-neg spirochete

• Transmission: – transplacental – sexual activity

A

Fetal Infections-Syphilis
• Treponema pallidum

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10
Q

Clincal manifestation of congentital syphillis

A

Clinical Manifestations-Congenital syphilis – spontaneous abortion (first trimester)
– Stillbirth
– non-immune hydrops (CV fail)

– preterm birth
– Hepatomegaly
– ascites
– anemia, thrombocytopenia

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11
Q

you are doing an ultrasound on mom that is almost in her 2nd trimetser of pregnancy. You note abnormalities on ultrasound: ascites and hepatometagly. What is the mom at risk for or have?

A

at risk for still birthr or preterm baby:

has congenital syphillis

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12
Q

Dx for Syphillis

A

– Screening: RPR and VDRL

– FTA-ABS and microhemagglutination (MHA) test to confirm dx

– Dark-field microscopy and direct fluorescent- antibody testing

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13
Q

-a single-stranded DNA virus; see infection & lysis of erythroid progenitor cells–> hemolysis & transient aplastic crisis

A

• Parvovirus B19

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14
Q

Transmission of B19

Dx of B19

A

• Transmission
– Respiratory droplets
– Transplacental transfer

Diagnosis
– +IgM and IgG
– Viral DNA by PCR (amniotic fluid)

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15
Q

Clicnal manifestation of ParvoB19

A

anemia, acute myocarditis, edema/hydrops, intrauterine fetal demise

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16
Q
  • Togavirus - a RNA virus
  • Since licensure of an effective vaccine, frequency has ↓

• Transmission
– Transplacental
– Respiratory droplets

A

Rubella

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17
Q

Baby with: Deafness/ Eye defects (cataracts or retinopathy)/ CNS defects/ Cardiac malformations

– Other anomalies: microcephaly, mental retardation, pneumonia, fetal growth restriction, hepatosplenomegaly, hemolytic anemia, and thrombocytopenia

A

Caused by Rubella

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18
Q

Effects eyes, ears and heart

A

think rubella

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19
Q

Dx of Rubella

A

Diagnosis
– ↑ IgM & IgG titers
– PCR of amniotic fluid

see lemon shaped skull

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20
Q

double-stranded DNA virus of the herpes family

• Transmission: Transplacental: Perinatal (contact with vagina during delivery or breast milk after delivery): Contact with bodily fluids **(urine/saliva) **

A

Cytomegalovirus

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21
Q

SEe Periventricular calcifications for new born:

A

Congenital CMV

22
Q

periventricular calcifications, intrauterine growth restriction, developmental delay, microcephaly, sensorineural hearing loss, retinitis, jaundice, hepatosplenomegaly, thrombocytopenia, hypotonia

A

CMV

23
Q

Histologically: presence of enlarged (cytomegalic) cells that have dense “owl’s eye” basophilic inclusion within the nucleus

A

CMV

24
Q

Dx of Congenital CMV

A

presence of CMV in the infant’s urine during the first week of life

25
Q

Transmission of HSV to baby

A

– Perinatal (contact with vagina during delivery)

– Contact after rupture of membranes
– Direct contact with affected areas
– **Transplacental infection is rare **

26
Q

Clincal manifestations of congenital HSV 1 and 2 are rare:

A

microcephaly, ventriculomegaly, spasticity, echogenic bowel, hepatosplenomegaly, and _flexed extremities _

27
Q

special dx of newborn with congenital HSV

A

HSV antibodies appear during the first weeks after infection and persist for life

or

Tzanck smear : multinucleated giant cells and viral inclusions

28
Q

Definition: painless cervical shortening or dilation leading to pregnancy loss

how to tx it:

A

Cervical Insufficiency

tx: Cervical Cerclage

29
Q

Risk factors of cervical insufficiency

A

– collagen abnormalities – uterine anomalies
– prior obstetric trauma – mechanical dilation
– prior 2nd trimester loss

30
Q

Defects of organs or body parts due to an intrinsically abnormal developmental process where a structure is not formed, partially formed, or formed in an abnormal fashion

A

Fetal Anomalies

risk:

– Chromosomal
– genetic abnormalities

– exposure to teratogens

31
Q

Dx of fetal anomalies of seen during:

A

etal ultrasound during second trimester

tx varies depending on anomalie; some tx after birth, in utero or not compatible with life

32
Q

chorioamniotic membrane rupture before the onset of labor in pregnancies at less than 37 weeks of gestation

A

Preterm Premature Rupture of Membranes (PPROM)

33
Q

Risk factors for PPROM

A

Risk factors
– preterm labor
– short cervix
– advanced cervical dilation

34
Q

Dx of PPROM

A

Diagnosis: direct visualization of fluid and ferning on microscopy

35
Q

Preterm Premature Rupture of Membranes (PPROM)

Preterm Labor

Hemorrhage Secondary to Placental

Abnormalities

Intrauterine Fetal Demise

Intrauterine Growth Restriction

Macrosomia

A

all thrid trimester cause of preterm labor

36
Q
  • Labor/Birth between 20 weeks and 36 6/7 weeks
  • # 1 cause of perinatal morbidity and mortality in developed countries
A

preterm labor

37
Q

Risk factors for preterm labor

A

– premature activation of the maternal or fetal hypothalamic-pituitary-adrenal axis

– exaggerated inflammatory response/infection – abruption
– pathological uterine distension

38
Q

– Placenta Previa
– Placenta Accreta
– Placenta Abruption
– Velamentous Cord Insertion

A

Hemorrhage Secondary to Placental Abnormalities

Third trimester complications

39
Q
  • Placenta located over or near internal cervical os
  • Painless – No contractions present
  • Caused by implantation within the **uterus too near the cervix **
A

Placenta Previa

40
Q

Risk factors Placenta previa

A

– Smoking

– Advanced maternal age
– Multiple gestation
– Uterine anomalies
– Scarring from previous pregnancies

41
Q
A
42
Q

– Implantation extends into the basal zone of the endometrium, ↑ difficulty of removing the entire placenta during delivery

– Risk for hemorrhage and hysterectomy after delivery

A

Placenta Accreta

43
Q

-implantation extends into myometrium

A

Placenta Increta

44
Q

implantation extends into uterine serosa or adjacent organs

– Risk Factors: multiple cesarean sections, placenta previa

A

Placenta Percreta

45
Q

Placental separation due to hemorrhage into the decidual basalis before birth: Vaginal bleeding, uterine tenderness, and contractions, **with or without non-reassuring fetal heart tones **

A

Placenta Abruption

46
Q

DX and risk factors for Placental abruption

A
  • Diagnosis of exclusion
  • Risk Factors: prior abruption, trauma, PPROM, HTN, smoking and cocaine use
47
Q
  • Umbilical cord attaches to the chorion and amnion rather than the placenta
  • Umbilical vessels continue onto the placenta between the two membranes
  • Umbilical vessels may easily be torn causing serious blood loss
A

Velamentous Cord Insertion

48
Q

-estimated fetal weight>4500grams

– Risk Factors: incorrect dates, maternal diabetes, excessive weight gain, maternal obesity Macrosomia

A
49
Q

Cervical insufficiency/short cervix can affect a low risk population, and therefore cervical length evaluation should be part of the routine anatomy scan ~

A

20 weeks gestation.

50
Q

Preterm premature rupture of membranes, preterm labor , IUGR, and macrosomia have ____and is a serious problem in high risk populations.

A

multiple etiologies

2nd Repro (16 decks)

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