Ch. 54 Test Flashcards
List 3 ways that sonography plays an important role in the management of obstetric patients
guide invasive procedures, placental location, determine gest age, fetal growth
List two ways that sonography has improved patient care
needle guide for amniocentesis, chorionic villous sampling, intrauterine transfusion without radiation
Why are all multiple pregnancies considered high risk
3rd trimester bleeding, preeclampsia, premature delivery, prolapsed umbilical cord, congenital anomalies, 5 times more likely for fetal death
What must be seen on the 1st trimester sonogram to definitely diagnose multiple pregnancy
multiple fetal poles with heart beats
What are three clinical findings that would lead the attending physician to suspect multiple pregnancy
elevated AFP, elevated HCG, increased fundal height
A complication of pregnancy characterized by increasing hypertension, proteinuria, and edema is
toxemia and pre eclampsia
_____ is a type of monozygotic twinning that occurs when the egg divides into twins after 13 days
conjoined
______ refers to coma and seizures in the 2nd or 3rd trimester patient due to pregnancy induced HTN
eclampsia
______ refers to excessive vomiting caused by pregnancy leading to dehydration and electrolyte imbalance
hyperemesis gravidarum
_____ is a lack of development of the lower limbs of the fetus
caudal regression syndrome
_____ twins come from two ova
fraternal
_____ times come from the same ovum
identical, monozygotic
______ is the result of an AV fistula in a multiple pregnancy with a single placenta. It results in one fetus being starved while the other goes into fluid overload
twin twin transfusion
_______ MSAFP is associated with neural tube defects
increased
Which is the safest type of twinning
di, di
Which is the most dangerous type of twinning
mono, mono
Why is it so important to document the presence/absence of a membrane between fetuses in a multiple pregnancy
If there are 2 separate sacs, the risk goes down
_____ of pregnancies that begin as twins end up as singleton pregnancies
70%
How does fetus papyraceous occur
fetus too large to be reabsorbed, when fetus dies, becomes compressed, dehydrated
In twin twin transfusion, the _____ twin develops oligohydramnios and the ______ twin develops polyhydramnios
donor, recipient
What is stuck twin
donor pushed against uterine wall because it has oligohydramnios
If there is discordant growth between twins, does it definitely mean that twin twin transfusion is present
no
What must be included in the report of a multiple gestation sonogram
gest sacs, # and location of placentas, gender, fetal measurements, detailed anatomical survey, biometrical data, presence of anomalies
Can sonography determine whether or not twins are identical? How or why not?
yes/sometimes, gender and presence of membrane
If the sonographer fails to detect a membrane separating the fetuses in a multiple pregnancy, does it automatically mean that the pregnancy is monoamniotic
no
What other parameters can be used to determine the chorionicity and amnioticity of a multiple pregnancy
gender/dizygotic, entwined cords/monozygotic, more than 3 vessels in umbilical cord/mono amnionicity
Why is it important to determine the gender of the fetuses in a multiple pregnancy
rule out twin twin transfusion
What is hydrops fetalis
excessive accumulation of fluid in two or more fetal tissues/body cavities
Immune hydrops is caused by _______ which is caused by
erythroblastosis fetalis, baby is Rh+ and mother is Rh- (isoimmunization)
Erythroblastosis fetalis is prevented in sensitized women giving them ______ shots
RhoGAM
Once a fetus develops erythroblastosis fetalis, how is the condition treated
intrauterine transfusion
Name the 2 most current methods of detecting and assessing fetal anemia
portosynthesis, doppler MCA in fetus
Describe the sonographic findings in fetal hydrops
ascites, pericardial effusions, edema, thickened placenta, polyhydramnios, pleural effusion, skin thickening
Describe the two methods of performing fetal transfusion
intraperitoneal (old) needle to peritoneal cavity
intravascular (new) via umbilical vein
__________ is a rare condition in which a mother becomes sensitized to fetal platelets, much like a Rh reaction, resulting in a fetus with an extremely low platelet count. What can happen to a fetus in this condition
alloimmune thrombocytopenia, fetal intracerebral hemorrhage (spontaneous bleeds in fetus)
What is non-immune hydrops
hydrops is present in fetus but not a result of fetomaternal blood group incompatibility
What are the most frequent/common causes on non-immune hydrops
cardiovascular lesions, hydrops due to any cause other than Rh sensitation
List five other causes of non immune hydrops
chromosomal, twins, urinary problems, GI problems, placenta/limb problems, infetions
Why is a pregnancy high risk if the mother is diabetic
liver controls serious infections, macrosomia, stillbirth, congenital anomalies, preterm labor, caudal regression syndrome
______ is the primary fuel for fetal growth
glucose
List three things that are associated with poor glucose control
macrosomia, 3rd trimester loss, respiratory distress, polyhydramnios, PROM
List eight congenital anomalies that are associated with maternal diabetes
caudal regression syndrome, congenital heart defects, neural tube defects, duodenal atresia, renal agenesis, hydronephrosis, ventricular septal defect, microcephaly
What fetal tests are done to determine lung maturity
LS ratio, PG levels, aminocentesis, lung surfacant
What negative effects does maternal hypertension have on a pregnancy
oligohydramnios, preeclampsia, IUGR, placenta abruption, eclampsia, small placenta
What is thought to cause pregnancy induced hypertension
prostaglandin abnormalities
How does lupus affect a pregnancy
placenta affected by immune complex deposits and inflammatory responses in placental vessels, increased spontaneous abortions, stillbirths, IUGR
What are symptoms of lupus
butterfly rash on face, BUN and creatine elevated
What role does sonography play in evaluating hyperemesis gravidarum
rule out trophoblastic disease and gallstones, multiple gestations
What maternal complications are obese women at increased risk for
hypertension, preeclampsia, UTI, gestational diabetes
How can uterine fibroids complicate pregnancy
cause premature birth, obstruct pathway for delivery, poor placental prefusion (IUGR), interfere with placental growth
Which trimester has the highest rate of fetal death
1st
What landmarks are followed in the doctor’s office during the 2nd trimester
fetal heart tones, fundal height, fetal movements felt by mom
The primary sonographic indicator of fetal demise is _____. What are the indicators?
absent heartbeat, absent fetal movement, overlap of skullbones (spaulding sign), exaggerated curved spine, gas in fetal abdomen, Duels sign (halo)
If the fetus has died, why is it important for the sonographer to still do a complete sonogram
obtain structural anomalies and biometry to determine estimated weight for delivery
______ is defined as the onset of labor before 37 weeks
preterm
_____ is the inhibition of labor
tocolysis
The more premature a baby is, the more problems it will have
true
What is the role of sonography in preterm labor
assess AFI, assist for amniocentesis, fetal weight
Why is amniocentesis often done on patients in premature labor
determine lung maturity
What are the two views on management of patients with premature rupture of membranes
conservative-observe and wait to induce for fetal distress/infection
active- deliver within 48 hours to prevent infection
What is external cephalic version
external manipulation to put baby head down
Why is external cephalic version performed
to avoid c-section
What are the contra-indications for external cephalic version
low fluid, obese, prior c section, anterior placenta, tight abdomen
List the functions of amniotic fluid
protect, cushion, allows movement, maintain intraunterine temperature
What is produced by umbilical cord and membranes, the fetal lungs, skin and kidneys
amniotic fluid
Which method is used for visual assessment of AFV
subjective assessment of fluid
Fetal production of urine and ability to swallow begin in what weeks
8-11 weeks
Amniotic sheets are believed to be caused by what
synechiae (uterine scars)
