2nd to 3rd trimester complications

Question 1

implantation and placenta development

Answer 1

Placenta’s role- transport of nutrients and waste products to and from developing fetus (fetomaternal organ)
Fusion between fetal chorion and maternal endometrial tissue for physiological exchange

2nd trimester- weeks 13- 25 and 6 days of gestation

3rd- 26 weeks of gestation thru the estimated due date

Question 2

2nd trimester complications

Answer 2

Fetal infections- TORCH infections (Toxoplasmosis, Other (Syphilis, parvovirus b19, HIV, Zika), Rubella, CMV, herpes simplex virus

Cervical insufficiency, Fetal anomalies

Question 3

TORCHs

Answer 3

• Toxoplasmosis (fecal oral route)- hydrcephalus brain stuff
• Syphilis (sex blood)- heart failure,hydrops
• Parvovirus (respiratory droplet- fluid in heart, aplastic hydrops
• HIV - bloodd-
• Zika- mosquito - microcephaly
• Rubella- resp drop-microcephaly
• CM- Resp drom-
• herpes- Lesion to mucosa- rare, neuro

Question 4

Cervical insufficiency

Answer 4

Painless cervical shortening or dilation leading to pregnancy loss, risk factors- Collagen abnormalities, uterine anomalies, prior obstetric trauma, mechanical dilation, prior 2nd trimester loss

Question 5

Fetal anomalies

Answer 5

chromosomal, gneteic, teratogens, infections

Seen in fetal ultrasound during second trimester, treatment- varies depending on anomaly, most are treated after birth, some anomalies are not compatible with life, few can be treated in utero

Question 6

Third trimester complications

Answer 6

Preterm premature rupture of membranes, preterm labor, hemorrhage, intrauterine fetal demise, intrauterine growth restriction, macrosomia

Question 7

Preterm labor/birth

Answer 7

Risk factors- premature activation of maternal HPA axis, Exaggerated inflammatory response/infection, abruption, pathological uterine distension, diagnosis- regular contractions resulting in cervical dilation

Question 8

Hemorrhage secondary to placental abnormalities

Answer 8

Placenta previa (placenta abnormal insertion on ccervix), placenta accreta, placenta abruption, velamentous cord insertion

Smoking or uterine scars

Accreta -not good attachement , loose
Increta- Too deep
Percreta completely thru the wall

Question 9

Placenta abruption

Answer 9

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
Diagnosis of exclusion

Risk factors- prior abruption, trauma, PPROM (leaky bag), HTN, smoking and cocaine use

Question 10

vilamentous cord insertion

Answer 10

wierd non center attachment of cord in the placenta