7. Obstetrics: Complications of The Antenatal Period Flashcards
List six common antenatal complications
Amniotic fluid disorders Intrauterine growth restriction Cervical insufficiency Multiple gestation Fetal demise in utero (IUFD) Post term pregnancy
What can cause reduced or absent amniotic fluid
Premature rupture of membranes
True or False
Abnormal amniotic fluid disorders AFV may suggest fetal congenital anomalies, chromosomal abnormalities or fetal growth restriction
True
Describe what the qualitative assessment in ultrasound estimation of amniotic fluid volume includes
It is a subjective interpretation without sonographic measurements
What is the role of the sonographer doing qualitative assessment of amniotic fluid volume
They scan the uterine contents then report the amniotic fluid volume as oligohydramnios, normal or polyhydramnios based on his or her clinical expertise
List three semi quantitative methods for ultrasound estimation of amniotic fluid volume
Single deepest pockets/maximum vertical pockets/largest vertical pocket
Amniotic fluid index AFI
2 x 1cm/ 2 x 2cm pocket technique
Describe the single deepest pockets semi quantitive methods of estimation of amniotic fluid volume
The vertical dimension in centimeters of the largest pockets of amniotic fluid not persistently containing umbilical cord or fetal extremities
Which semi quantitative method of estimation of amniotic fluid volume is described as
The vertical dimension in centimeters of the largest pockets of amniotic fluid not persistently containing umbilical cord or fetal extremities
Single deepest pockets/maximum vertical pockets/largest vertical pocket
In the single deepest pockets semi quantitive methods of estimation of amniotic fluid volume the horizontal component of the vertical dimension must be at least what measurements
1cm
In single deepest pocket semi quantitive methods for estimation of amniotic fluid volume which depth is considered Oligohydramnios
Depth <2cm
In single deepest pocket semi quantitive methods for estimation of amniotic fluid volume which depth is considered normal
Depth >/= 2cm and <8cm
In single deepest pocket semi quantitive methods for estimation of amniotic fluid volume which depth is considered polyhydramnios
Depth>/= 8cm
How is amniotic fluid index calculated
It is calculated by dividing the uterus into four quadrants using the linea nigra for the right and left divisions and umbilicus for the upper and lower quadrant
Then the maximal vertical amniotic fluid pocket dial me to in each quadrant not containing cord or fetal extremities is summed
Which semi quantitive methods for estimation of amniotic fluid volume is calculated by dividing the uterus into four quadrants using the linea nigra for the right and left divisions and umbilicus for the upper and lower quadrant
Then the maximal vertical amniotic fluid pocket diameter in each quadrant not containing cord or fetal extremities is summed
Amniotic fluid index (AFI)
Which amniotic fluid index is considered oligohydramnios
AFI = 5cm
An AFI of less than or equal to 5 cm is considered oligohydramnios, normal or polyhydramnios
Oligohydramnios
Which amniotic fluid index is considered normal
AFI >5cm and <24cm
Which amniotic fluid index is considered polyhydramnios
AFI >/=24cm
An AFI of >/=5cm and <24cm is considered oligohydramnios, normal or polyhydramnios
Normal
An AFI of >/= 24cm is considered oligohydramnios, normal or polyhydramnios
Polyhydramnios
Describe the semi quantitive methods 2 x 1 cm or 2 x 2 cm pocket technique
Identification of at least one package of amniotic fluid with a minimum dimensions of 2 x 1 cm or 2 x 2 cm measured vertically and horizontally (or horizontally and vertically) not containing umbilical cord or fetal extremities
Which semi quantitative method is defined as the Identification of at least one package of amniotic fluid with a minimum dimensions of 2 x 1 cm or 2 x 2 cm measured vertically and horizontally (or horizontally and vertically) not containing umbilical cord or fetal extremities
2 x 1 cm or 2 x 2 cm pocket technique
Define oligohydramnios
It is amniotic fluid volume that is less than expected for the gestational age
Why is an adequate volume of amniotic fluid critical
To allow normal fetal movement and growth and to cushion the fetus and umbilical cord
List nine causes of polyhydramnios
Gestational diabetes Idiopathic Macrosomia (new born with excessive birth weight) Hydrops ( severe swelling in fetus) Twin to twin transfusion syndrome Fetal bowel obstruction Arthrogryposis, akinesia syndrome Congenital pulmonary malformation Placental chorioangioma
What is the term used to describe severe swelling of the fetus
Hydrops
What is a term used to describe a newborn with an excessive birthweight
Macrosomia
Define macrosomia
This is a new born with an excessive birth weights
What is twin to twin transfusion syndrome (TTTS)
This is a prenatal condition in which twins share on equal amounts of the placenta is blood supply resulting in the two fetus is growing at different rates
This is a prenatal condition in which twins share on equal amounts of the placenta is blood supply resulting in the two fetus is growing at different rates
Twin to twin transfusion syndrome (TTTS)
Intrauterine growth restriction can be detected by which type of examination
Ultrasound examination
List five important steps in prenatal care for a patient with intrauterine growth restriction
Confirming the suspected diagnosis
Determining the cause and the severity of fetal growth restriction
Counseling the parents
Closely monitoring fetal growth and well-being
Determining the optimal time for and a route of delivery
List some intrinsic fetal factors that can cause fetal growth restriction
Aneuploidy
Congenital malformations
Infection
Can fetal growth restriction resulting from intrinsic fetal factors be improved by any intervention
Nope
Which has a better prognosis fetal growth restriction from intrinsic fetal factors or those related to Utero placental insufficiency
Those Related to Utero placental insufficiency
Define intrauterine growth restriction
It is defined as less than 10th percentile weight for gestational age and this establishes the diagnosis as being small for gestational age
What are the three steps in management of intrauterine growth restriction
- Complete history and physical examination
- To assess for maternal disorders that have been associated with restricted fetal growth
- obstetrical imaging and laboratory evaluation’s are performed to look for fetal and Placental etiologies
- Fetal survey
- Fetal echocardiogram
- Fetal genetic studies
- Work up for infection
- Amniotic fluid DNA testing
Why is a fetal survey done when testing for intrauterine growth restriction
A detailed fetal anatomic survey should be performed in all cases since approximately 10% of fetal growth restriction accompanied by congenital anomalies
List for anomalies associated with intrauterine growth restriction
Omphalocele
Diaphragmatic hernia
Skeletal dysplasia
Some congenital heart defects
In the serial ultrasound evaluation for antepartum on management of intrauterine growth restriction which aspects are monitored
Fetal growth,
fetal behavior and
impedance to blood flow in fetal vessels
What is the name of the process that uses ultrasound to check blood flow in the umbilical cord or between the uterus and placenta
Doppler Velocimetry
What is the Doppler velocimetry
It is a process that uses ultrasound to check blood flow in the umbilical cord or between the uterus and placenta
What does the frequency of antepartum management for intrauterine growth restriction depend on
The severity of findings and whether the examinations are being done to monitor fetal well-being or fetal growth
In antepartum management of intrauterine growth restriction if the examinations are being done to monitor fetal well-being how often are these examinations done
1 to 7 times per week
In antepartum management for introduce you to in growth restriction if the examination is done to monitor fetal growth, how often is this examination done?
Every 1 to 4 weeks
Define cervical insufficiency
The term is used to describe painless cervical dilation leading to recurrent second trimester pregnancy losses/births of otherwise normal pregnancies
Also applied to women with one or two losses/births or at a risk for second trimester pregnancy loss/birth
Most second trimester los Reyes/berts. are caused by other disorders such as
Decidual inflammation/infection
Hemorrhage
Uterine overdistention
List three cervical insufficiency risk factors
Congenital cervical abnormalities
Acquired cervical abnormalities
Cervical trauma that may occur during labor or delivery
Which clinical findings would you have when taking the past obstetrical history for cervical insufficiency
Second trimester pregnancy losses/deliveries, often associated with short labor
Progressively earlier deliveries in successive pregnancies
What are some mild symptoms of cervical insufficiency
Pelvic pressure
Pre-menstrual like cramping or backache
Change in volume colour and consistency of vaginal discharge
Symptoms of cervical insufficiency may begin between which weeks of gestation
Weeks 14 and 20
List too late clinical presentations are cervical insufficiency
Advanced dilation and effacement, spotting, unprovoked grossly prolapse the membranes or ruptured membranes
Contractions that seem in adequate to explain the advanced effacement and dilation
After imaging has been done list three clinical findings Of cervical insufficiency
The cervix may be short (below the 10th percentile which is 25 mm)
The fetal membranes may be separated and debris (sludge) may be seen in the amniotic fluid
A rapid rate of decrease in cervical length overtime and cervical shortening before 20 weeks may be noted
What is the function of Cervicovaginal fetal fibronectin test
Cervicovaginal fetal fibronectin provides moderate to minimal prediction of preterm birth in women with multiple pregnancies
True or false a combination of a short cervix on ultrasound examination and a positive, fFN (cervicovaginal fetal fibronectin) result is predictive of an increased risk of preterm delivery
True
Which hormone supplement Tatian is administered for women with a history of spontaneous preterm birth
Progesterone supplementation
Define dizygotic twins
Fraternal twins occur from ovulation and fertilization of two oocytes
Define monozygotic twins
Identical twins and result from ovulation and fertilization of a single oocyte with subsequent division of the zygote
Describe the placentas in monozygotic twins
May have two separate placentas or one placenta that is monochorionic/ monoamniotic or monochorionic/diamniotic
What percent of dichorionic placentas are associated with dizygotic twins?
80%
What percentage of dichorionic placentas are associated with monozygotic twins
20 %
All monochorionic placentas are associated with monozygotic twins with which rare exception
Pregnancies conceived by Assisted reproductive technology ART
Twin pregnancies resulting in two placentas, two amnions, two Chorions which produce monozygotic twins is as a result of cleavage of the zygote during which period of time after fertilization
NB// this presentation usually results in dizygotic twins
During first three days after fertilization
Twin pregnancies resulting in one placentas, two amnions, one Chorions which produce monozygotic twins is as a result of cleavage of the zygote during which period of time after fertilization
4th to 8th day after fertilization
Twin pregnancies resulting in one placentas, one amnions, one Chorions which produce monozygotic twins is as a result of cleavage of the zygote during which period of time after fertilization
8th to 12th day
Describe the placenta and membranes in twin pregnancies where the cleavage of the monozygotic twins occurred during the first 3 days after fertilization
Two placentas, two amnions, two chorion
Describe the placenta and membranes in twin pregnancies where the cleavage of the monozygotic twins occurred from the fourth to eighth day after fertilization.
One placenta, one chorion, two amnion
Describe the placenta and membranes in twin pregnancies where the cleavage of the monozygotic twins occurred from 8th to 12th day after fertilization
One placenta, one chorion, one amnion
List eight maternal risks and complications of multiple gestation
Gestational hypertension and preeclampsia Gestational diabetes Acute Fatty Liver Pruritic urticarial papules and plaques of pregnancy (PUPPP) Intrahepatic cholestasis of pregnancy Iron deficiency anemia Hyperemesis gravidarum Thromboembolism
Define preeclampsia
A pregnancy complication characterized by high blood pressure and signs of damage to another organ system
A pregnancy complication characterized by high blood pressure and signs of damage to another organ system
Preeclampsia
What is Pruritic urticarial papules and plaques of pregnancy (PUPPP)
It is an itchy rash that appears in stretch marks of the stomach during late pregnancy
What is the name of the itchy rash that appears in stretch marks of the stomach during late pregnancy
Pruritic urticarial papules and plaques of pregnancy (PUPPP)
List 9 monochorionic Complications
Twin to twin transfusion Syndrome (TTTS) Twin anemia polycythemia sequence (TAPS) Selective fetal growth restriction (sFGR) Twin reversed arterial perfusion (TRAP) Monoamniotic twins (MA) Conjoined twins Discordant anomalies High-order monochorionic multiples Death of one twin
Twins is not a diagnosis what are the two correct terms
Dichorionic or monochorionic
When is the anatomic survey for a mono chorionic twin taken
At 18 to 22 weeks
When is the echocardiogram for a monochorionic twin taken
At 18 to 22 weeks
Which three tests are performedIn both monochorionic and dichorionic twin pregnancies between 11 and 14 weeks
Screening for trisomy 21
Chorionicity
Dating, labelling
Which three tests are done at 16 to 18 weeks for a monochorionic twin pregnancy
Fetal growth, deep vein pulse DVP
UA-PI (umbilical arterial pulsality index) UA-PI
Which four tests are done at 20 to 22 weeks in a dichorionic twin pregnancy
Detailed and not to me
Biometry
Amniotic fluid volume
Cervical length
What are some benefits of early detection of monochorionic complications
Allows for time the referral to treatment center
Allows the patient the opportunity to educate her self
What is the most common and potentially most serious monochorionic complication
Twin to twin transfusion syndrome TTTS
What percentage of all monochorionic gestation is affected by twin to twin transfusion syndrome TTTS
Approximately 10%
Which complication accounts for approximately half of all the deaths in monochorionic gestations
Twin to twin transfusion syndrome TTTS
What is the loss rate for a monochorionic gestation with twin to twin transfusion syndrome TTTS
Approximately 70 to 100%
Define twin to twin transfusion syndrome
It is a prenatal condition in which twins share an equal amounts of the placenta is blood supply resulting in the true fetus is growing at different rates
It is a prenatal condition in which twins share an equal amounts of the placenta is blood supply resulting in the true fetus is growing at different rates
Twin to twin transfusion Syndrome
What is the principal basis of twin to twin transfusion syndrome
There is a donor twin that transfers volume to the recipient twin
What happens to the donor twin in twin to twin transfusion syndrome
The donor twin becomes oliguric or Oligohydramnios and hypovolemic
What happens to the recipient twin in twin to twin transfusion syndrome
Recipient becomes polyuric or polyhydramnios and hypervolemic
What is the goal of intervention of twin to twin transfusion syndrome management
To restore more equitable blood flow Between the twins and thus halt or reverse cardiac decompensation in the recipient twin
