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Penny ob/gyn > Ch. 32 Fetal Environment and Maternal Complications > Flashcards

Ch. 32 Fetal Environment and Maternal Complications Flashcards

1
Q

The _______ is a vital organ to the fetus during pregnancy. It normally weighs between 450 and 550 g and has a diameter of 16 to 20 cm. The _______ is derived from both fetal and maternal cells.

A

placenta; placenta

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2
Q

The _________, the maternal contribution of the placenta, is the endometrium beneath the developing placenta. The ____________, the portion derived from the blastocyst and containing the chorionic villi, is the fetal contribution to the placenta.

A

decidua basalis; chorion frondosum

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3
Q

The placenta consists of approximately 10 to 30 ________, which are groups or lobes of chorionic villi.

A

cotyledons

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4
Q

groups or lobes of chorionic villi

A

cotyledons

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5
Q

the endometrial tissue at the implantation site, and the maternal contribution of the placenta

A

decidua basalis

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6
Q

the part of the chorion, covered by chorionic villi, that is the fetal contribution of the placenta

A

chorion frondosum

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7
Q

The placenta produces __________, which maintains the corpus luteum of the ovary. In later pregnancy, the placenta also produces _______ and _________, taking over that function from the corpus luteum.

A

human chorionic gonadotropin; estrogen and progesterone

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8
Q

One major function of the placenta is to act as an _______ organ for the fetus, performing imperative exchanges of waste products and gases with valuable nutrients and oxygen from the mother. The placenta effectively becomes the means of ________ for the fetus.

A

excretory; respiration

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9
Q

A definitive placenta may not be identified sonographically until after 10 to 12 weeks. It will appear as an ________ thickening surrounding part of the gestational sac.

A

echogenic

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10
Q

What 3 parts does the placenta consist of?

A

(i) the chorionic plate, (ii) the placental substance, and (iii) the basal layer or basal plate.

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11
Q

The _______ is the element of the placenta closest to the fetus. The _______ is the area adjacent to the uterus. The _________ contains the functional parts of the placenta and is located between the chorionic plate and the basal layer

A

chorionic plate; basal layer; placental substance

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12
Q

There are several normal variants seen within the placental substance that can distort the typical _________appearance of this organ.

A

homogenous

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13
Q

Venous lakes, also referred to as maternal lakes or placental lakes, are pools of _______ within the placental substance.They appear as anechoic or hypoechoic areas and may contain swirling blood. These are of little clinical significance.

A

maternal blood

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14
Q

A _______ placenta consists of two separate discs of equal size.

A

bilobed

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15
Q

There may also be an accessory lobe or a _______lobe of the placenta, which are additional smaller lobes located separate from the main segment of the placenta

A

succenturiate

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16
Q

a ________ placenta is an abnormally shaped placenta caused by the membranes inserting inward from the edge of the placenta, producing a curled-up placental contour. A ________ placenta may lead to vaginal bleeding and placental abruption, among other complications.

A

circumvallate

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17
Q

____________ of the placenta

Gas transfer

Excretory function

Water balance

pH maintenance

Hormone production

Defensive barrier

A

Functions

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18
Q

Calcifications may be noted within the placenta, and indentations may be seen within the basal and chorionic plates with _______ gestation.

A

advancing

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19
Q

The thickness of the placenta should be evaluated with sonography. It should not exceed ______. Both a thick or large placenta, termed _________, and a thin placenta are associated with maternal and/or fetal abnormalities

A

4cm; placentomegaly

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20
Q

Placental Grade:______

Sonographic Findings:
Uninterrupted chorionic plate and homogeneous placental substance

A

Grade 0

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21
Q

Placental Grade:______

Sonographic Findings:
Subtle indentations on the chorionic plate, with some small calcifications within the placental substance

A

Grade II

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22
Q

Placental Grade:______

Sonographic Findings:
Moderate indentations in the chorionic plate with “comma-like” calcification in the placental substanc

A

Grade II

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23
Q

Placental Grade:______

Sonographic Findings:
Prominent indentation in the chorionic plate that extends to the basal layer with diffuse echogenic and anechoic areas noted within the placental substance

A

Grade III

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24
Q

Possible causes of a ________ placenta

Diabetes mellitus

Maternal anemia

Infection

Fetal hydrops

Rh isoimmunization

Multiple gestations

A

thick

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25
Q

Possible causes of a ______ placenta

Diabetes mellitus (long standing)

Intrauterine growth restriction

Placental insufficiency

Polyhydramnios

Preeclampsia

Small-for-dates fetus

A

thin

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26
Q

the term used for the isthmus of the uterus during pregnancy

A

lower uterine segment

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27
Q

intrauterine growth restriction

A

a fetus that is below the 10th percentile for gestational age (small for gestational age) and whose growth is impeded for some reason

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28
Q

Placenta previa is a common cause of painless _______ in the second and third trimesters.

A

vaginal bleeding

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29
Q

__________ is discovered more often in women with a history of multiparity, advanced maternal age, previous abortion, and prior cesarean section (C-section). The correlation with C-section is theorized to be the result of uterine scar formation from surgery, with the subsequent implantation of the next placenta in that area.

A

Placenta previa

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30
Q

Term Associated with Placenta Previa:
_________

Sonographic Description:
Placenta covers the internal os completely

A

Complete (total) previa

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31
Q

Term Associated with Placenta Previa:
_________

Sonographic Description:
Placenta partially covers the internal os

A

Partial previa

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32
Q

Term Associated with Placenta Previa:
_________

Sonographic Description:
Placenta lies at the edge of the internal os

A

Marginal previa

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33
Q

Term Associated with Placenta Previa:
_________

Sonographic Description:
Placental edge extends into the lower uterine segment but ends >2 cm away from the internal os

A

Low-lying previa

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34
Q

The placenta should be evaluated for placenta previa after 20 weeks with an _____ maternal bladder using a transabdominal approach, because the fully distended bladder may lead to a _______ diagnosis of placenta previa. Another cause of false-positive placenta previa is painless _________ that occur in the lower uterine segment. However, these should resolve as the sonographic examination continues.

A

empty; false-positive; myometrial contractions

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35
Q

Placenta can be evaluated for placenta previa with ________and _________or transperineal scanning can be extremely beneficial, especially with advanced gestation when the fetal head or fetal parts obscure the internal os.

A

transvaginal and translabial

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36
Q

Clinical Findings of __________

1.Previous C-section or uterine surgery
2.Painless vaginal bleeding
3.Possibly asymptomatic

A

Placenta Previa

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37
Q

The complication of fetal vessels resting over the internal os of the cervix is referred to as ________. These vessels are prone to rupture as the cervix dilates. This, in turn, can lead to _________ of the fetus.

A

vasa previa; exsanguination

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38
Q

total blood loss; to bleed out

A

exsanguination

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39
Q

the abnormal insertion of the umbilical cord into the membranes beyond the placental edge

A

velamentous cord insertion

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40
Q

Vasa previa is often associated with __________ cord insertion and, possibly, a succenturiate lobe.

A

velamentous cord insertion

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41
Q

Sonographic Findings of ________

1.Identification of vessels over the internal os of the cervix with the use of color Doppler
2.Velamentous cord insertion

A

Vasa Previa

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42
Q

__________, also referred to as abruptio placentae, is the premature separation of the placenta from the uterine wall before the birth of the fetus, thus causing _________.

A

placental abruption; hemorrhage

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43
Q

Placental abruption may be further described as complete abruption, partial abruption, marginal abruption, or be defined by its location. A ________abruption, which is the most severe, often results in the development of a retroplacental hematoma, which is located between the placenta and the myometrium

A

complete

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44
Q

_________abruption often results in only a few centimeters of separation. Marginal abruption, often referred to as a ___________, lies at the edge of the placenta and is the most common placental hemorrhage identified with sonography.

A

Partial; subchorionic hemorrhage

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45
Q

Maternal conditions that are linked to the development of placental abruption include _______, preeclampsia, cocaine use, ________, poor nutrition, and _____.

A

hypertension; cigarette smoking; trauma

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46
Q

Clinical Findings of __________

1.Abdominal pain (often sudden onset)
2.Possible vaginal bleeding
3.Uterine contraction
4.Uterine tenderness

A

Placental Abruption

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47
Q

Sonographic Findings of _________

1.Hematoma located either at the edge of the placenta or between the placenta and the myometrium

A

Placental Abruption

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48
Q

________ is frequently used as a universal term to describe the condition that is defined as the abnormal adherence of the placenta to the myometrium in an area where the decidua is either absent or minimal.The placenta may attach to a ________ following a previous C-section and/or after uterine surgery. This explains the association between anterior placenta previa and placenta accreta. As a result of this abnormal adherence, the placenta does _____ detach at birth.

A

Placenta accreta; uterine scar; not

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49
Q

With placenta percreta, the placenta can even invade the ________, thus causing urinary complications. ___________is a helpful imaging modality to confirm the diagnosis of placenta accreta.

A

urinary bladder; Magnetic resonance imaging

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50
Q

Clinical Findings of __________

1.Previous C-section or uterine surgery
2.Painless vaginal bleeding if placenta previa is present
3.Possibly asymptomatic

A

Placenta Accreta, Placenta Increta, and Placenta Percreta

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51
Q

Sonographic Findings of _________

1.Placenta previa (frequent associated finding)
2.Loss of the normal hypoechoic interface between the placenta and the myometrium

A

Placenta Accreta, Placenta Increta, and Placenta Percreta

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52
Q

_________ is the most common placental tumor. Clinically, chorioangiomas are commonly asymptomatic but may produce an elevation in maternal serum __________.

A

Chorioangioma; alpha-fetoprotein

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53
Q

The most common location of this mass (chorioangiomas) is _______________.

A

adjacent to the umbilical cord insertion site at the placenta

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54
Q

Sonographic Findings of a ______

1.Solid hypoechoic or hyperechoic mass within the placenta
-Vascularity within mass

A

Chorioangioma

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55
Q

Chorionagnioma’s typically do not carry any risks to the fetus or mother, although ________ chorioangiomas have been associated with polyhydramnios, intrauterine growth restriction (IUGR), and fetal hydrops.

A

larger

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56
Q

Differentials for the chorioangioma include other solid-appearing focal hypoechoic areas within the placenta, that is, the ________and __________.

A

placental infarct and placental fibrin deposits

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57
Q

_________, also referred to as amniotic sheets, are linear bands of scar tissue within the uterus. These synechiae are the result of intrauterine ________, as seen with Asherman syndrome.They can result from uterine surgery.

A

Uterine synechiae; adhesions

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58
Q

Sonographic Findings of ________

1.Linear, echogenic band of tissue traversing the uterine cavity
2.The band does not involve fetal parts, and the normal fetus appears to move freely

A

Uterine Synechia(E)

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59
Q

Although typically isolated, uterine synechiae have been associated with _________, premature delivery, and _______. _________ are typically thinner, or may not be seen, and are associated with fetal anomalies.

A

premature rupture of membranes (PROM); placental abruption; Amniotic bands

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60
Q

The umbilical cord, which normally inserts into the _________ of the placenta, has ______ arteries and ______ vein. These vessels are surrounded by a gelatinous material called _______, all of which is covered by a single layer of amnion.

A

middle; two; one; Wharton jelly

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61
Q
A

Wharton jelly

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62
Q

The cord develops from the fusion of the yolk stalk and the __________(omphalomesenteric duct) early in gestation.

A

vitelline duct

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63
Q

The _________, which carries oxygenated blood from the placenta to the fetus, enters the fetal abdomen and proceeds cephalad to connect to the left portal vein within the liver. The _________enter the fetal abdomen and carry deoxygenated blood from the fetus to the placenta.

A

umbilical vein; umbilical arteries

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64
Q

The umbilical arteries, once they enter the abdomen, proceed caudal around the ______ to connect to the fetal internal iliac arteries. Therefore, color Doppler can establish that there is a __________, by placing the color Doppler box over the fetal bladder and identifying both arteries adjacent to the bladder. A 3VC may also be obtainable in the __________ view of the umbilical cord

A

bladder; three-vessel cord (3VC); transverse

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65
Q

A single umbilical artery, or __________, has been cited as the most common abnormality of the umbilical cord. It has been reported in association with abnormalities of ________and ______. Fetuses with a 2VC have an approximate 20% chance of having additional abnormalities, and thus a thorough examination of the fetus for other findings is warranted.

A

two-vessel cord (2VC); major organ systems and IUGR

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66
Q

The umbilical cord normally inserts into the _______portion of the placenta.

A

central

67
Q

________ cord insertion is at the edge of the placenta. This is also referred to as a battledore placenta.

A

Marginal

68
Q

_________ cord insertion denotes the insertion of the umbilical cord into the membranes beyond the placental edge. This type of abnormal insertion is often seen in association with _________

A

Velamentous; vasa previa

69
Q
A

nuchal cord

70
Q

A nuchal cord can be confirmed with color Doppler. It does not always indicate fetal distress, even though, on occasion, multiple ____ of cord may be noted around the _______. Nonetheless, this abnormality should be documented, particularly if additional signs of fetal distress are evident.

A

loops; neck

71
Q

An ________ is a mass that may be noted in the umbilical cord adjacent to the umbilical vessels.

A

allantoic cyst

72
Q

Umbilical cord cysts are most often found near the fetal ________ and have been seen in connection with omphalocele and aneuploidy, especially if noted in the second or third trimester.

A

abdomen

73
Q

Another cystic-appearing mass that may be noted within the abdomen of the fetus, appearing to be adjacent to the umbilical cord, is an ____________, which is essentially the focal dilatation of the abdominal portion of the ________. It has been associated with fetal aneuploidy, growth restriction, hydrops, and demise. Color Doppler can be used to prove the vascularity of this abnormality.

A

umbilical vein varix; umbilical vein

74
Q

The ________ is the most common tumor of the umbilical cord, although it is exceedingly rare. These masses, unlike allantoic cysts, appear as solid _________ masses and are more often located near the cord insertion site into the _________.

A

hemangioma; hyperechoic; plancenta

75
Q

Sonographic Findings of ________

1.Cystic mass within the umbilical cord
2.Most often noted close to the fetal abdomen

A

Allantoic Cysts

76
Q

Sonographic Findings of ________ of the Umbilical Cord

1.Solid hyperechoic mass within the umbilical cord
2.Most often noted close to the cord insertion into the placenta

A

Hemangiomas

77
Q
A

hemangioma

78
Q

Term Associated with Placenta Accreta:
________

Definition:
_______ of the placenta to the myometrium

Sonographic Finding:
Loss of normal hypoechoic interface between the placenta and the myometrium

A

Placenta accreta; Adherence

79
Q

Term Associated with Placenta Accreta:
________

Definition:
_______ of the placenta within the myometrium

Sonographic Finding:
Loss of normal hypoechoic interface between the placenta and the myometrium with invasion into the myometrium

A

Placenta increta; Invasion

80
Q

The ________ assesses the vascular resistance in the placenta by taking a sample of the umbilical artery. It can be performed anywhere along the length of the cord, although a free loop of cord will tend to offer the most accurate measurement.

A

S/D ratio (systolic-to-diastolic) ratio

81
Q

Normally, the S/D ratio will ________ with advancing gestation. An elevated S/D ratio is associated with increased ________ and an increase in the risk of perinatal mortality and morbidity.

A

decrease; placental resistance

*Normal S/D ratio <3.0

82
Q

Absence or reversal of diastolic flow in the umbilical artery is considered _______ and is associated with an increased incidence of _______ and oligohydramnios

A

irregular; IUGR

83
Q

Echogenic debris in the amniotic fluid may be _____ or meconium, with meconium being the least likely to be observed during an otherwise normal examination. Amniotic fluid has a number of important functions, including protecting the fetus from trauma, temperature regulation, musculoskeletal maturity, and normal lung and gastrointestinal development.

A

vernix

84
Q
A

vernix

85
Q

The maximum vertical pocket, also referred to as the ________, may be used. This pocket should contain no fetal parts or umbilical cord and measure at least ______, with a normal range between________cm.

A

deepest vertical pocket; 2cm; 2 and 8cm

86
Q

The AFI is measured using the anteroposterior dimensions obtained from the ______ quadrants of the amniotic sac and adding them together. Once more, these measurements should not include fetal parts or umbilical cord. _____ can be used to ensure that no cord is included. For the measurement, the transducer must be placed perpendicular to the floor.

A

four; Color Doppler

87
Q

An excessive amount of amniotic fluid is termed _______, whereas a deficient amount is termed _________. When an abnormality is noted in the amount of amniotic fluid, a thorough evaluation of the fetal _________ system and _________ system for abnormalities should be conducted, although other systems may be the reason for the imbalance

A

polyhydramnios; oligohydramnios; genitourinary and gastrointestinal

88
Q

When oligohydraminos is observed abnormalities of what system should initially be suspected? When polyhydraminos is observed abnormalities of what system should be initially suspected?

A

urinary system; gastrointestinal

89
Q
A

Premature rupture of membranes (PROM)

90
Q

TORCH, an acronym that stands for ______, _______, ______, _______, and _______, is a group of infections that can cross the placenta and influence the development of the fetus.

A

toxoplasmosis, other infections, rubella, cytomegalovirus, and herpes simplex virus

91
Q

___________ is listed as the most common congenital infection.

A

cytomegalovirus

92
Q

a common sonographic finding of fetal infections, especially with cytomegalovirus, is the presence of ____________.

A

intracranial calcifications

93
Q

Sonographic Findings of _______

1.Intracranial calcifications
2.Microcephaly
3.Microphthalmia
4.Ventriculomegaly
5.Hepatosplenomegaly
-heart abnormalities

A

Torch

94
Q

Recently, the _____ virus has also been linked with microcephaly, decreased brain tissue, and limb abnormalities such as clubfoot.

A

Zika

95
Q

___________includes a wide variety of deleterious effects of alcohol exposure upon the fetus caused by the maternal consumption of alcohol.

A

Fetal alcohol syndrome (FAS)

96
Q

_______ has been cited as the most common cause of intellectual disability in the United States. Alcohol, which is a ______, and its metabolites, have been proven to cross the placenta and inflict irreversible damage on the fetal central nervous system.

A

FAS; teratogen

97
Q

Children exposed to _______ in utero have been shown to have an increased risk for growth ______, _____ impairment, physical abnormalities, and _______ dysfunction

A

alcohol; restriction; mental; immune

98
Q

Sonographic and clinical findings of __________include 1.microcephaly 2.dysgenesis of the corpus callosum
3.long round ________
4.malformed ears 5.microphthalmia 6.heart defects such as ventricular septal defects
7.cleft palate

A

Fetal alcohol syndrome; philtrum

99
Q

Occasionally, small for dates or large for dates may be suspected clinically during an assessment of the mother’s (uterine) ___________

A

fundal height

100
Q

______, or fetal growth restriction, is defined as an estimated fetal weight (EFW) that is below the _______ percentile at a given gestational age.

A

IUGR; 10th

101
Q

IUGR typically results from the inadequate transfer of nutrients from the mother to the fetus and thus is the dysfunction of the _______. The fetus is at risk if the mother suffers from chronic disease, drinks alcohol, smokes cigarettes, has poor nutrition, is younger than 17 or older than 35 years, or has a history of previous pregnancies that were considered growth restricted.

A

placenta

102
Q

IUGR can be either __________, in which the entire fetus is small, or _________, wherein the femur length is typically normal while all other measurements are small for gestation.

A

symmetric; asymmetric

103
Q

The measurement that should be scrutinized closely in fetuses that are at risk for growth abnormalities is the ______, because it carries a sensitivity of greater than 95% for the diagnosis of IUGR. The discrepancy in the AC will yield an abnormal_______________ratio and a femur length/AC ratio.

A

abdominal circumference (AC); head circumference/AC ratio

104
Q

The fetus with IUGR can be monitored with sonography by evaluating the flow within the umbilical artery with the ________

A

S/D ratio

105
Q
A

biophysical profile

106
Q
A

hypoxia

107
Q

An abnormally high S/D ratio, resulting from a ______ or _______ of _________within the umbilical artery, is associated with a poor outcome.

A

reversal or absence of diastolic flow

108
Q

Doppler assessment of the middle cerebral artery has also been shown effective at evaluating for _______in a fetus that is measuring ______ for dates. The right and left middle cerebral arteries are branches of the _______ portion of the circle of Willis. Just like umbilical artery Doppler, the pulsatility index of the middle cerebral artery varies with gestational age but normally _______ as the pregnancy progresses toward term. When comparing the two Doppler signals, the middle cerebral artery should generate a ________ resistance flow pattern than the umbilical artery.

A

hypoxia; small; anterior; decreases; higher

109
Q

Maternal uterine artery Doppler may be useful at anticipating the progression of IUGR in high-risk pregnancies. In the first trimester, the uterine artery is analyzed with spectral Doppler before it enters the uterus at the level ______. Occasional, the portion of the main uterine artery as it crosses over the ________ may be utilized for this sample in the second/third trimester.

A

cervix; external iliac artery

110
Q

The normal flow pattern in uterine artery is said to be ________. Therefore, an abnormal flow pattern will yield _________ (high impedance index) within the uterine artery when IUGR is present. Abnormal flow may also be a forewarning of _______ and preterm delivery.

A

low resistance; high resistance; preeclampsia

111
Q

The obese fetus is defined as a fetus that has an EFW of greater than the ______ percentile.

A

90th percentile

112
Q
A

neonatal period

113
Q
A

macrosomia

114
Q

In the neonatal period, _________ is technically defined as the neonate that measures more than 4,500 g in nondiabetic mothers and 4,000 g in diabetic mothers.

A

macrosomia

115
Q

Mothers who are prone to have a macrosomic fetus are those who suffer from ________, whether pregestational or gestational.

A

diabetes

116
Q

A macrosomic fetus is predisposed to ________ secondary to fetal size and has an increased risk of hypoglycemia and lifelong struggles with obesity. Therefore, they will most often be delivered by means of C-section.

A

shoulder dystocia

117
Q
A

shoulder dystocia

118
Q

_________, also referred to as transperineal scanning, can offer a useful, noninvasive glimpse at the cervix. The sonographer can evaluate the length of the cervix and the proximity of the placenta to the internal os, and for signs of cervical incompetence using a translabial approach.

A

Translabial scanning

119
Q

Translabial scanning should be performed with an _____ maternal bladder. The covered transducer, whose size and frequency may vary with institution, is placed against the labia. The cervical length measurement can be obtained with a measurement from the _______ to the _______ in the sagittal transducer position, or notch up

A

empty; internal os; external os

120
Q

If the cervix is not seen because of shadowing from the pubic bone, the patient can slightly lift her _____off of the bed for an improved view of the external os.

A

hips

121
Q

It is again important to note that the ______ can undergo dynamic changes and thus cervical _______ may fluctuate slightly. Therefore, a judicious examination should be conducted and the _______ measurement of the cervix recorded. A cine loop recording may be helpful in this situation as well.

A

cervix; length; shortest

122
Q

_________, or an incompetent cervix, is the painless ______ of the cervix in the second or early third trimester. ______ of the cervix is a result of the premature opening of the internal os and the subsequent bulging of the membranes into the dilated cervix.

A

Cervical incompetence; dilation; Funneling

123
Q

Patients who are at risk for cervical incompetence include those with uterine ______, previous pregnancy loss in the _______trimester, and intrauterine exposure to _______.

A

malformations; second; diethylstilbestrol

124
Q
A

diethylstilbestrol

125
Q

The cervical length should measure at least ____. Therefore, the shorter the cervical length, the more likely the patient will suffer from ______ delivery.

A

3cm; preterm

126
Q

Sonographic Findings of _______

1.Cervical length of less than 3 cm
2.Funneling of the cervix (can produce a “U” or “V” shape) (The width of the funnel can also be measured)

A

Cervical Incompetence

127
Q

The treatment of an incompetent cervix is a ________. The two most commonly performed cerclage techniques are the Shirodkar and the McDonald. The suture of the cerclage may be seen during a follow-up examination and will appear as _______ structures within the cervix that may produce some __________.

A

cerclage; echogenic; posterior shadowing

128
Q

Clinical Findings of __________

1.Painless dilation of the cervix
2.PROM
3.Vaginal bleeding

A

Cervical Incompetence

129
Q

___________, also referred to as hydrops fetalis, occurs when there is an accumulation of fluid within at least _____ fetal body cavities. Fluid can collect within the chest (_______), the abdomen (_______), or around the heart (_______).

A

Fetal hydrops; two; pleural effusion; ascites; pericardial

130
Q

Hydrops may also be defined as _______ and fluid in at least one of the previously listed body cavities(chest, abd, heart etc.). Fetal hydrops can be categorized as either ______ or _______

A

anasarca; immune or nonimmune

131
Q
A

anasarca

132
Q

________ hydrops is caused by the absence of a detectable circulating fetal antibody against the red blood cells in the mother. This results in incompatibility between the fetal and maternal red blood cells, a condition known as ________

A

Immune; erythroblastosis fetalis

133
Q

________ hydrops is associated with erythroblastosis fetalis and Rh isoimmunization.

A

Immune

134
Q

Maternal Rh sensitization, also referred to as _______, occurs when the mother has________ and the fetus has ________. Cells from the Rh-positive fetus enter the mother’s bloodstream during her ______ pregnancy. Although antibodies are created in the maternal circulation, this pregnancy will progress _______. With the mother’s next pregnancy, the Rh-positive fetus is attacked as a result of the antibodies produced during the first pregnancy.

A

Rh isoimmunization; Rh-negative blood; Rh-positive blood; first; normally

135
Q

With Rh isoimmunization, these antibodies cross the placenta and begin to destroy the fetal ______, resulting in fetal _______, enlargement of the fetal ______ and _____, and the accumulation of ______ within the fetal body cavities.

A

red blood cells; anemia; liver and spleen; fluid

136
Q

The prevention of immune hydrops caused by Rh sensitization is the administration of ________, also referred to as Rh immune globulin, at approximately ______ gestation. Treatment for fetal hydrops may be conducted via intrauterine transfusion of donor red blood cells to treat the anemic fetus. This is typically performed under sonographic guidance.

A

RhoGAM, 28 weeks’

137
Q

Maternal ________is a rare disorder in which the mother suffers from edema and fluid buildup similar to her hydropic fetus. The reason for this syndrome is ________.

A

mirror syndrome; unknown

138
Q

Sonographic Findings of ________

1.Fluid accumulation within at least two fetal body cavities (pleural effusion, ascites, skin edema, pericardial effusion)
2.Fetal hepatosplenomegaly
3.Polyhydramnios
4.Thickened placenta

A

Fetal Hydrops

139
Q
A

Cystic adenomatoid malformation

140
Q
A

Diaphragmatic hernia

141
Q

Causes of ________ hydrops

Chorioangioma

Cystic adenomatoid malformation

Diaphragmatic hernia

Fetal (nonimmune) anemia

Fetal infections

Idiopathic

Structural anomalies of the cardiac and lymphatic systems

Trisomy 13

Trisomy 18

Trisomy 21

Turner syndrome

A

nonimmune

142
Q

Preeclampsia is defined as the presence of pregnancy-induced ________ accompanied by _________. The mother may also suffer from edema in the hands, face, and legs.

A

hypertension; proteinuria

143
Q

Uncontrolled preeclampsia leads to ________, which is potentially fatal. Patients with eclampsia will have headaches and often suffer from convulsions.

A

eclampsia

144
Q

Those with an increased risk of preeclampsia include ________ maternal age, ________ patients, and those who have ____________disease.

A

advanced; diabetic; gestational trophoblastic disease

145
Q

HELLP syndrome, which stands for ______, ____________, and _____________, was said to be a variant of preeclampsia initially, but now it appears to be a separate entity.

A

hemolysis, elevated liver enzymes, and low platelet count

146
Q

Sonographic Findings of _______, _______, and ______ Syndrome

1.Oligohydramnios
2.IUGR
3.Gestational trophoblastic disease
4.Increased risk for placental abruption
5.Elevated S/D ratio
6.Right upper quadrant pain, nausea, and vomiting simulating gallbladder disease with HELLP syndrome

A

Preeclampsia, Eclampsia, and HELLP Syndrome

147
Q

Clinical Findings of _________

1.Hemolysis
2.Elevated liver enzymes
3.Low platelet count

A

Hellp Syndrome

148
Q

Clinical Findings of _________

1.Long-standing, uncontrolled preeclampsia
2.Headaches
3.Seizures

A

Eclampsia

149
Q

Clinical Findings of _________

1.Maternal hypertension
2.Maternal edema
3.Maternal proteinuria

A

Preeclampsia

150
Q
A

gestational diabetes

151
Q

Maternal diabetes can be described as either pregestational diabetes or gestational diabetes. With ________, the mother already has a history of diabetes. __________, which is the most common type of diabetes during pregnancy, is pregnancy induced.

A

pregestational diabetes; Gestational diabetes

152
Q

Women are screened for diabetes at the end of the second trimester, around _________gestation. The major risk for the fetus of a mother with gestational diabetes is ________. Sonographically, the placenta may appear ______ (placentomegaly), measuring greater than ______ thick. There may also be ________, and the AC typically measures significantly _______ than the other measurements.

A

26 weeks’; macrosomia; enlarged; 4 cm; polyhydramnios; larger

153
Q

Mothers with pregestational diabetes have a higher risk of ______ and _____, and the fetus has an increased risk of ______ anomalies, hypoglycemia, _______ distress, perinatal mortality, and ______.

A

miscarriage and toxemia(preeclampsia); congenital; respiratory; IUGR

154
Q

The congenital anomalies most often encountered with pregestational diabetes include _______ defects, _______ defects, caudal regression syndrome, sirenomelia, and ______ anomalies.

A

cardiac; neural tube; renal

155
Q

A _________ may result from a C-section. This mass can appear anechoic, although it most likely will appear as a _______ mass greater than 2 cm. It will be located adjacent to the scar between the ______ and the _______.

A

bladder flap hematoma; complex; lower uterine segment and the posterior bladder wall

156
Q

A ________, commonly referred to as a fibroid, is a common benign smooth muscle uterine tumor. They are often asymptomatic during pregnancy, although they may be associated with some pregnancy complications, such as an elevated pregnancy loss rate and increased risk of placental abruption.

A

leiomyoma

157
Q

Fibroids should be differentiated from normal myometrial contractions. ________typically resolve within 15 to 30 minutes, whereas _______will not change in shape.

A

Myometrial contractions; fibroids

158
Q

Sonographic Findings of a _______

1.Hypoechoic mass within the uterus
2.Posterior shadowing from mass
3.Degenerating fibroids may have calcifications or cystic components
4.Multiple fibroids appear as an enlarged, irregularly shaped, diffusely heterogeneous uterus

A

Leiomyoma

159
Q

Maternal ________ is common during pregnancy. Dilation of the renal collecting system is most often secondary to the _____ size of the uterus, with subsequent transient painless obstruction of the ______. However, maternal hydronephrosis can also be caused by urinary ______, in which case the patient will suffer from renal colic, flank pain, and hematuria.

A

hydronephrosis; large; ureters; calculi

160
Q

time directly after giving birth and extending to about 6 weeks

A

postpartum

161
Q

The normal postpartum uterus returns to its nongravid size ___to ___ weeks after delivery. Excessive and sustained postpartum vaginal bleeding may be the result of _________. Most often, part of the placenta is left behind at the time of delivery. There are several predisposing factors, including adhesions, accessory lobes of the placenta, and placenta accreta.

A

6 to 8 weeks; retained products of conception (RPOC)

162
Q
A

retained products of conception (RPOC)

163
Q

Sonographic Findings of ________

1.Echogenic intracavitary mass that may contain some calcifications
2.Color Doppler signals within the retained placental tissue

*typically treated with dilatation and curettage

A

Retained Products of Conception

164
Q
A

Penny ob/gyn (17 decks)

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