2nd and 3rd trimester complication Flashcards
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
chorion
endometrial
r =weeks 13 through 25 weeks and 6 days of gestation
=26 weeks of gestation through the estimated due date
Second trimester
• Third trimester
Second Trimester Complications
• Fetal Infections-TORCH infections –
-Toxoplasmosis
– Other (Syphilis, Parvovirus B19)
– Rubella
– Cytomegalovirus
– Herpes Simplex Virus
a coccidian parasite
- Essential reservoir-felines
- Acute infection–>devastating effects; risk of fetal infection ↑ with gestational age, but severity ↓ with gestational age
Toxoplasmosis
Transmission of Toxoplasmosis
o transplacental
o fecal-oral route
o risk of fetal infection increases with gestational age
o severity of fetal infection decreases with gestational age
You’re performing ultrasound on women during 2nd trimester and notice baby ahs intracranial calcifications, hydrocephalus and choretinitis, DX
Toxoplasmosis:
triad seen in 2nd semseter = hydrocephalus, intracranial calcifications, and chorioretinitis
Clincal manifestations of Toxoplasmosis during:
1st
2nd
3rd trimester
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
How do you Dx Toxoplasmosis in mom and baby
mom: +IgM and IgG titers
fetal PCR of amniotic fluic
a Gram-neg spirochete
• Transmission: – transplacental – sexual activity
Fetal Infections-Syphilis
• Treponema pallidum
Clincal manifestation of congentital syphillis
Clinical Manifestations-Congenital syphilis – spontaneous abortion (first trimester)
– Stillbirth
– non-immune hydrops (CV fail)
– preterm birth
– Hepatomegaly
– ascites
– anemia, thrombocytopenia
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?
at risk for still birthr or preterm baby:
has congenital syphillis
Dx for Syphillis
– Screening: RPR and VDRL
– FTA-ABS and microhemagglutination (MHA) test to confirm dx
– Dark-field microscopy and direct fluorescent- antibody testing
-a single-stranded DNA virus; see infection & lysis of erythroid progenitor cells–> hemolysis & transient aplastic crisis
• Parvovirus B19
Transmission of B19
Dx of B19
• Transmission
– Respiratory droplets
– Transplacental transfer
Diagnosis
– +IgM and IgG
– Viral DNA by PCR (amniotic fluid)
Clicnal manifestation of ParvoB19
anemia, acute myocarditis, edema/hydrops, intrauterine fetal demise
- Togavirus - a RNA virus
- Since licensure of an effective vaccine, frequency has ↓
• Transmission
– Transplacental
– Respiratory droplets
Rubella
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
Caused by Rubella
Effects eyes, ears and heart
think rubella
Dx of Rubella
Diagnosis
– ↑ IgM & IgG titers
– PCR of amniotic fluid
see lemon shaped skull
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) **
Cytomegalovirus
SEe Periventricular calcifications for new born:
Congenital CMV
periventricular calcifications, intrauterine growth restriction, developmental delay, microcephaly, sensorineural hearing loss, retinitis, jaundice, hepatosplenomegaly, thrombocytopenia, hypotonia
CMV
Histologically: presence of enlarged (cytomegalic) cells that have dense “owl’s eye” basophilic inclusion within the nucleus
CMV
Dx of Congenital CMV
presence of CMV in the infant’s urine during the first week of life
Transmission of HSV to baby
– Perinatal (contact with vagina during delivery)
– Contact after rupture of membranes
– Direct contact with affected areas
– **Transplacental infection is rare **
Clincal manifestations of congenital HSV 1 and 2 are rare:
microcephaly, ventriculomegaly, spasticity, echogenic bowel, hepatosplenomegaly, and _flexed extremities _
special dx of newborn with congenital HSV
HSV antibodies appear during the first weeks after infection and persist for life
or
Tzanck smear : multinucleated giant cells and viral inclusions
Definition: painless cervical shortening or dilation leading to pregnancy loss
how to tx it:
Cervical Insufficiency
tx: Cervical Cerclage
Risk factors of cervical insufficiency
– collagen abnormalities – uterine anomalies
– prior obstetric trauma – mechanical dilation
– prior 2nd trimester loss
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
Fetal Anomalies
risk:
– Chromosomal
– genetic abnormalities
– exposure to teratogens
Dx of fetal anomalies of seen during:
etal ultrasound during second trimester
tx varies depending on anomalie; some tx after birth, in utero or not compatible with life
chorioamniotic membrane rupture before the onset of labor in pregnancies at less than 37 weeks of gestation
Preterm Premature Rupture of Membranes (PPROM)
Risk factors for PPROM
Risk factors
– preterm labor
– short cervix
– advanced cervical dilation
Dx of PPROM
Diagnosis: direct visualization of fluid and ferning on microscopy
Preterm Premature Rupture of Membranes (PPROM)
Preterm Labor
Hemorrhage Secondary to Placental
Abnormalities
Intrauterine Fetal Demise
Intrauterine Growth Restriction
Macrosomia
all thrid trimester cause of preterm labor
- Labor/Birth between 20 weeks and 36 6/7 weeks
- # 1 cause of perinatal morbidity and mortality in developed countries
preterm labor
Risk factors for preterm labor
– premature activation of the maternal or fetal hypothalamic-pituitary-adrenal axis
– exaggerated inflammatory response/infection – abruption
– pathological uterine distension
– Placenta Previa
– Placenta Accreta
– Placenta Abruption
– Velamentous Cord Insertion
Hemorrhage Secondary to Placental Abnormalities
Third trimester complications
- Placenta located over or near internal cervical os
- Painless – No contractions present
- Caused by implantation within the **uterus too near the cervix **
Placenta Previa
Risk factors Placenta previa
– Smoking
– Advanced maternal age
– Multiple gestation
– Uterine anomalies
– Scarring from previous pregnancies
– Implantation extends into the basal zone of the endometrium, ↑ difficulty of removing the entire placenta during delivery
– Risk for hemorrhage and hysterectomy after delivery
Placenta Accreta
-implantation extends into myometrium
Placenta Increta
implantation extends into uterine serosa or adjacent organs
– Risk Factors: multiple cesarean sections, placenta previa
Placenta Percreta
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 **
Placenta Abruption
DX and risk factors for Placental abruption
- Diagnosis of exclusion
- Risk Factors: prior abruption, trauma, PPROM, HTN, smoking and cocaine use
- 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
Velamentous Cord Insertion
-estimated fetal weight>4500grams
– Risk Factors: incorrect dates, maternal diabetes, excessive weight gain, maternal obesity Macrosomia
Cervical insufficiency/short cervix can affect a low risk population, and therefore cervical length evaluation should be part of the routine anatomy scan ~
20 weeks gestation.
Preterm premature rupture of membranes, preterm labor , IUGR, and macrosomia have ____and is a serious problem in high risk populations.
multiple etiologies
