2nd and 3rd Trimester Complications

Question 1

TORCH infections

Answer 1

Toxoplasmosis, Other (symphilis, parvovirus B19), rubella, cytomegalovirus, herpes simplex virus

Question 2

dx: infection transferred to fetus by pregnant mom who has pet cat

Answer 2

toxoplasmosis

Question 3

clinical presentations of toxoplasmosis during first, second, and third trimesters

Answer 3

first: death
second: classic triad of hydrocephalus, intracranial calcifications, and chorioretinitis
third: asymptomatic

Question 4

diagnosis of toxoplasmosis

Answer 4

IgM and IgG titers (maternal), PCR of amniotic fluid (fetal)

Question 5

dx: ultrasound shows baby with hydrocephalus, intracranial calcifications,

Answer 5

toxoplasmosis

Question 6

ddx: fetal infection leading to hydrops fetalis

Answer 6

syphilis (treponema pallidum), parvovirus B19

Question 7

dx: transmitted by sexual contact, gram negative spirochete

Answer 7

syphilis (treponema pallidum)

Question 8

clinical presentation of parvovirus B19

Answer 8

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

Question 9

dx: fetal infection causing anemia, acute myocarditis

Answer 9

parvovirus B19

Question 10

parvovirus B19: what kind of virus?

Answer 10

ssDNA virus

Question 11

rubella: what kind of virus?

Answer 11

togavirus (RNA virus)

Question 12

dx: fetal infection causing deafness, cataracts, patent ductus arteriosus, microcephaly

Answer 12

rubella

Question 13

CMV: what kind of virus?

Answer 13

dsDNA virus (herpes family)

Question 14

dx: fetal infection causing periventricular calcifications, hearing loss

Answer 14

CMV

Question 15

CMV: histology

Answer 15

enlarged cells that have dense “owl’s eye” basophilic inclusion within the nucleus

Question 16

what are the 3 major 2nd trimester complications of pregnancy?

Answer 16

fetal infections (TORCH), cervical insufficiency, fetal anomalies

Question 17

what does ferning on microscopy of the vaginal fluid indicate?

Answer 17

preterm premature rupture of membranes (PPROM)

Question 18

risk factors for preterm premature rupture of membranes (PPROM)

Answer 18

preterm labor, short cervix, advanced cervical dilation

Question 19

placenta previa: risk factors

Answer 19

smoking, advanced maternal age, multiple gestation, uterine anomalies, scarring from previous pregnancies

Question 20

placenta accreta: what is it, what does it increase risk for?

Answer 20

placental implantation that extends into the basal zone of the endometrium –> increased difficulty of removing the entire placenta during delivery
increases risk for hemorrhage and hysterectomy after delivery

Question 21

placenta increta: what is it

Answer 21

placental implantation that extends into myometrium

Question 22

placenta percreta: what is it, risk factors

Answer 22

placental implantation that extends into uterine serosa or adjacent organs; multiple C-sections, placenta previa

Question 23

placental abruption: placental separation due to hemorrhage into ______ before birth

Answer 23

decidua basalis

Question 24

dx: vaginal bleeding in third trimester, uterine tenderness, painful contractions, no fetal heart tones

Answer 24

placental abruption

Question 25

velamentous cord insertion: what is it

Answer 25

umbilical cord attached to the chorion and amnion rather than the placenta –> umbilical vessels continue onto the placenta between the two membranes –> vessels may easily be torn