Ch. 32 Fetal Environment and Maternal Complications Flashcards
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.
placenta; placenta
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.
decidua basalis; chorion frondosum
The placenta consists of approximately 10 to 30 ________, which are groups or lobes of chorionic villi.
cotyledons
groups or lobes of chorionic villi
cotyledons
the endometrial tissue at the implantation site, and the maternal contribution of the placenta
decidua basalis
the part of the chorion, covered by chorionic villi, that is the fetal contribution of the placenta
chorion frondosum
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.
human chorionic gonadotropin; estrogen and progesterone
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.
excretory; respiration
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.
echogenic
What 3 parts does the placenta consist of?
(i) the chorionic plate, (ii) the placental substance, and (iii) the basal layer or basal plate.
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
chorionic plate; basal layer; placental substance
There are several normal variants seen within the placental substance that can distort the typical _________appearance of this organ.
homogenous
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.
maternal blood
A _______ placenta consists of two separate discs of equal size.
bilobed
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
succenturiate
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.
circumvallate
____________ of the placenta
Gas transfer
Excretory function
Water balance
pH maintenance
Hormone production
Defensive barrier
Functions
Calcifications may be noted within the placenta, and indentations may be seen within the basal and chorionic plates with _______ gestation.
advancing
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
4cm; placentomegaly
Placental Grade:______
Sonographic Findings:
Uninterrupted chorionic plate and homogeneous placental substance
Grade 0
Placental Grade:______
Sonographic Findings:
Subtle indentations on the chorionic plate, with some small calcifications within the placental substance
Grade II
Placental Grade:______
Sonographic Findings:
Moderate indentations in the chorionic plate with “comma-like” calcification in the placental substanc
Grade II
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
Grade III
Possible causes of a ________ placenta
Diabetes mellitus
Maternal anemia
Infection
Fetal hydrops
Rh isoimmunization
Multiple gestations
thick
Possible causes of a ______ placenta
Diabetes mellitus (long standing)
Intrauterine growth restriction
Placental insufficiency
Polyhydramnios
Preeclampsia
Small-for-dates fetus
thin
the term used for the isthmus of the uterus during pregnancy
lower uterine segment
intrauterine growth restriction
a fetus that is below the 10th percentile for gestational age (small for gestational age) and whose growth is impeded for some reason
Placenta previa is a common cause of painless _______ in the second and third trimesters.
vaginal bleeding
__________ 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.
Placenta previa
Term Associated with Placenta Previa:
_________
Sonographic Description:
Placenta covers the internal os completely
Complete (total) previa
Term Associated with Placenta Previa:
_________
Sonographic Description:
Placenta partially covers the internal os
Partial previa
Term Associated with Placenta Previa:
_________
Sonographic Description:
Placenta lies at the edge of the internal os
Marginal previa
Term Associated with Placenta Previa:
_________
Sonographic Description:
Placental edge extends into the lower uterine segment but ends >2 cm away from the internal os
Low-lying previa
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.
empty; false-positive; myometrial contractions
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.
transvaginal and translabial
Clinical Findings of __________
1.Previous C-section or uterine surgery
2.Painless vaginal bleeding
3.Possibly asymptomatic
Placenta Previa
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.
vasa previa; exsanguination
total blood loss; to bleed out
exsanguination
the abnormal insertion of the umbilical cord into the membranes beyond the placental edge
velamentous cord insertion
Vasa previa is often associated with __________ cord insertion and, possibly, a succenturiate lobe.
velamentous cord insertion
Sonographic Findings of ________
1.Identification of vessels over the internal os of the cervix with the use of color Doppler
2.Velamentous cord insertion
Vasa Previa
__________, 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 _________.
placental abruption; hemorrhage
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
complete
_________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.
Partial; subchorionic hemorrhage
Maternal conditions that are linked to the development of placental abruption include _______, preeclampsia, cocaine use, ________, poor nutrition, and _____.
hypertension; cigarette smoking; trauma
Clinical Findings of __________
1.Abdominal pain (often sudden onset)
2.Possible vaginal bleeding
3.Uterine contraction
4.Uterine tenderness
Placental Abruption
Sonographic Findings of _________
1.Hematoma located either at the edge of the placenta or between the placenta and the myometrium
Placental Abruption
________ 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.
Placenta accreta; uterine scar; not
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.
urinary bladder; Magnetic resonance imaging
Clinical Findings of __________
1.Previous C-section or uterine surgery
2.Painless vaginal bleeding if placenta previa is present
3.Possibly asymptomatic
Placenta Accreta, Placenta Increta, and Placenta Percreta
Sonographic Findings of _________
1.Placenta previa (frequent associated finding)
2.Loss of the normal hypoechoic interface between the placenta and the myometrium
Placenta Accreta, Placenta Increta, and Placenta Percreta
_________ is the most common placental tumor. Clinically, chorioangiomas are commonly asymptomatic but may produce an elevation in maternal serum __________.
Chorioangioma; alpha-fetoprotein
The most common location of this mass (chorioangiomas) is _______________.
adjacent to the umbilical cord insertion site at the placenta
Sonographic Findings of a ______
1.Solid hypoechoic or hyperechoic mass within the placenta
-Vascularity within mass
Chorioangioma
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.
larger
Differentials for the chorioangioma include other solid-appearing focal hypoechoic areas within the placenta, that is, the ________and __________.
placental infarct and placental fibrin deposits
_________, 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.
Uterine synechiae; adhesions
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
Uterine Synechia(E)
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.
premature rupture of membranes (PROM); placental abruption; Amniotic bands
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.
middle; two; one; Wharton jelly
gelatinous material that is located within the umbilical cord around the umbilical vessels
Wharton jelly
The cord develops from the fusion of the yolk stalk and the __________(omphalomesenteric duct) early in gestation.
vitelline duct
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.
umbilical vein; umbilical arteries
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
bladder; three-vessel cord (3VC); transverse
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.
two-vessel cord (2VC); major organ systems and IUGR
The umbilical cord normally inserts into the _______portion of the placenta.
central
________ cord insertion is at the edge of the placenta. This is also referred to as a battledore placenta.
Marginal
_________ 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 _________
Velamentous; vasa previa
condition of having the umbilical cord wrapped completely around the fetal neck
nuchal cord
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.
loops; neck
An ________ is a mass that may be noted in the umbilical cord adjacent to the umbilical vessels.
allantoic cyst
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.
abdomen
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.
umbilical vein varix; umbilical vein
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 _________.
hemangioma; hyperechoic; plancenta
Sonographic Findings of ________
1.Cystic mass within the umbilical cord
2.Most often noted close to the fetal abdomen
Allantoic Cysts
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
Hemangiomas
a benign tumor composed of blood vessels
hemangioma
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
Placenta accreta; Adherence
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
Placenta increta; Invasion
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.
S/D ratio (systolic-to-diastolic) ratio
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.
decrease; placental resistance
*Normal S/D ratio <3.0
Absence or reversal of diastolic flow in the umbilical artery is considered _______ and is associated with an increased incidence of _______ and oligohydramnios
irregular; IUGR
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.
vernix
protective fetal skin covering
vernix
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.
deepest vertical pocket; 2cm; 2 and 8cm
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.
four; Color Doppler
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
polyhydramnios; oligohydramnios; genitourinary and gastrointestinal
When oligohydraminos is observed abnormalities of what system should initially be suspected? When polyhydraminos is observed abnormalities of what system should be initially suspected?
urinary system; gastrointestinal
the rupture of the amniotic sac before the onset of labor
Premature rupture of membranes (PROM)
TORCH, an acronym that stands for ______, _______, ______, _______, and _______, is a group of infections that can cross the placenta and influence the development of the fetus.
toxoplasmosis, other infections, rubella, cytomegalovirus, and herpes simplex virus
___________ is listed as the most common congenital infection.
cytomegalovirus
a common sonographic finding of fetal infections, especially with cytomegalovirus, is the presence of ____________.
intracranial calcifications
Sonographic Findings of _______
1.Intracranial calcifications
2.Microcephaly
3.Microphthalmia
4.Ventriculomegaly
5.Hepatosplenomegaly
-heart abnormalities
Torch
Recently, the _____ virus has also been linked with microcephaly, decreased brain tissue, and limb abnormalities such as clubfoot.
Zika
___________includes a wide variety of deleterious effects of alcohol exposure upon the fetus caused by the maternal consumption of alcohol.
Fetal alcohol syndrome (FAS)
_______ 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.
FAS; teratogen
Children exposed to _______ in utero have been shown to have an increased risk for growth ______, _____ impairment, physical abnormalities, and _______ dysfunction
alcohol; restriction; mental; immune
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
Fetal alcohol syndrome; philtrum
Occasionally, small for dates or large for dates may be suspected clinically during an assessment of the mother’s (uterine) ___________
fundal height
______, or fetal growth restriction, is defined as an estimated fetal weight (EFW) that is below the _______ percentile at a given gestational age.
IUGR; 10th
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.
placenta
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.
symmetric; asymmetric
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.
abdominal circumference (AC); head circumference/AC ratio
The fetus with IUGR can be monitored with sonography by evaluating the flow within the umbilical artery with the ________
S/D ratio
method of fetal monitoring with sonography to produce a numerical scoring system that predicts fetal well-being
biophysical profile
a shortage of oxygen or decreased oxygen in the blood
hypoxia
An abnormally high S/D ratio, resulting from a ______ or _______ of _________within the umbilical artery, is associated with a poor outcome.
reversal or absence of diastolic flow
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.
hypoxia; small; anterior; decreases; higher
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.
cervix; external iliac artery
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.
low resistance; high resistance; preeclampsia
The obese fetus is defined as a fetus that has an EFW of greater than the ______ percentile.
90th percentile
the first 28 days of life
neonatal period
an estimated fetal weight of greater than the 90th percentile or the neonate that measures more than 4,500 g
macrosomia
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.
macrosomia
Mothers who are prone to have a macrosomic fetus are those who suffer from ________, whether pregestational or gestational.
diabetes
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.
shoulder dystocia
when the shoulder of the fetus cannot pass through the birth canal during pregnancy
shoulder dystocia
_________, 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.
Translabial scanning
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
empty; internal os; external os
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.
hips
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.
cervix; length; shortest
_________, 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.
Cervical incompetence; dilation; Funneling
Patients who are at risk for cervical incompetence include those with uterine ______, previous pregnancy loss in the _______trimester, and intrauterine exposure to _______.
malformations; second; diethylstilbestrol
a drug administered to pregnant women from the 1940s to the 1970s to treat threatened abortions and premature labor that has been linked with uterine malformation in the exposed fetus
diethylstilbestrol
The cervical length should measure at least ____. Therefore, the shorter the cervical length, the more likely the patient will suffer from ______ delivery.
3cm; preterm
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)
Cervical Incompetence
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 __________.
cerclage; echogenic; posterior shadowing
Clinical Findings of __________
1.Painless dilation of the cervix
2.PROM
3.Vaginal bleeding
Cervical Incompetence
___________, 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 (_______).
Fetal hydrops; two; pleural effusion; ascites; pericardial
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 _______
anasarca; immune or nonimmune
diffuse edema
anasarca
________ 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 ________
Immune; erythroblastosis fetalis
________ hydrops is associated with erythroblastosis fetalis and Rh isoimmunization.
Immune
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.
Rh isoimmunization; Rh-negative blood; Rh-positive blood; first; normally
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.
red blood cells; anemia; liver and spleen; fluid
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.
RhoGAM, 28 weeks’
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 ________.
mirror syndrome; unknown
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
Fetal Hydrops
a mass consisting of abnormal bronchial and lung tissue that develops within the fetal chest
Cystic adenomatoid malformation
the herniation of the abdominal contents into the chest cavity through a defect in the diaphragm
Diaphragmatic hernia
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
nonimmune
Preeclampsia is defined as the presence of pregnancy-induced ________ accompanied by _________. The mother may also suffer from edema in the hands, face, and legs.
hypertension; proteinuria
Uncontrolled preeclampsia leads to ________, which is potentially fatal. Patients with eclampsia will have headaches and often suffer from convulsions.
eclampsia
Those with an increased risk of preeclampsia include ________ maternal age, ________ patients, and those who have ____________disease.
advanced; diabetic; gestational trophoblastic disease
HELLP syndrome, which stands for ______, ____________, and _____________, was said to be a variant of preeclampsia initially, but now it appears to be a separate entity.
hemolysis, elevated liver enzymes, and low platelet count
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
Preeclampsia, Eclampsia, and HELLP Syndrome
Clinical Findings of _________
1.Hemolysis
2.Elevated liver enzymes
3.Low platelet count
Hellp Syndrome
Clinical Findings of _________
1.Long-standing, uncontrolled preeclampsia
2.Headaches
3.Seizures
Eclampsia
Clinical Findings of _________
1.Maternal hypertension
2.Maternal edema
3.Maternal proteinuria
Preeclampsia
diabetes acquired as a result of pregnancy
gestational diabetes
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.
pregestational diabetes; Gestational diabetes
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.
26 weeks’; macrosomia; enlarged; 4 cm; polyhydramnios; larger
Mothers with pregestational diabetes have a higher risk of ______ and _____, and the fetus has an increased risk of ______ anomalies, hypoglycemia, _______ distress, perinatal mortality, and ______.
miscarriage and toxemia(preeclampsia); congenital; respiratory; IUGR
The congenital anomalies most often encountered with pregestational diabetes include _______ defects, _______ defects, caudal regression syndrome, sirenomelia, and ______ anomalies.
cardiac; neural tube; renal
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 _______.
bladder flap hematoma; complex; lower uterine segment and the posterior bladder wall
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.
leiomyoma
Fibroids should be differentiated from normal myometrial contractions. ________typically resolve within 15 to 30 minutes, whereas _______will not change in shape.
Myometrial contractions; fibroids
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
Leiomyoma
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.
hydronephrosis; large; ureters; calculi
time directly after giving birth and extending to about 6 weeks
postpartum
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.
6 to 8 weeks; retained products of conception (RPOC)
when additional placental tissue remains within the uterus after the bulk of the placenta has been delivered
retained products of conception (RPOC)
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
Retained Products of Conception
Clinical Findings of ________
Postpartum vaginal bleeding
Retained Products of Conception
Term Associated with Placenta Accreta:
________
Definition:
_______ of the placenta through the serosa and possibly into adjacent organs
Sonographic Finding:
Loss of normal hypoechoic interface between the placenta and the myometrium with penetration beyond the serosa
Placenta percreta
Fetal malformation and complications associated with oligohydramnios or polyhydraminos?
Bilateral multicystic dysplastic kidney disease
Bilateral renal agenesis
Infantile polycystic kidney disease
Intrauterine growth restriction
Posterior urethral valves
Premature rupture of membranes (PROM)
Oligohydramnios
Fetal malformations and complications associated with oligohydramnios or polyhydramnios?
Cardiac and/or chest abnormalities
Chromosomal abnormalities
Duodenal atresia
Esophageal atresia
Gastroschisis
Neural tube defects
Omphalocele
Rh incompatibility
Twin–twin transfusion syndrome
Polyhydramnios
Suspected causes of ________ intrauterine growth restriction
Genetic disorders
Fetal infections
Congenital malformations
Syndromes
symmetric
Suspected causes of _________ intrauterine growth restriction
Nutritional deficiency
Oxygen deficiency
asymmetric
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
nonimmune
Which of the following is not associated with FAS?
a. cleft palate
b. microphthalmia
c. malformed ears
d. macrocephaly
d. macrocephaly
All of the following are associated with a thin placenta except?
a. preeclampsia
b. IUGR
c. fetal hydrops
d. long-standing diabetes
c. fetal hydrops
All of the following are associated with oligohydramnios except:
a. bilateral renal agenesis
b. infantile polycystic kidney disease
c. PROM
d. duodenal atresia
d. duodenal atresia
which of the following is describes as the situation in which the placental edge extends into the lower uterine segment but ends more than 2 cm away from the internal os?
a. low-lying placenta
b. marginal previa
c. partial previa
d. total previa
a. low-lying placenta
All of the following are associated with a thick placenta except:
a. fetal infections
b. Rh isoimmunization
c. placental insufficiency
d. multiple gestations
placental insufficiency
