Chapter 54 Flashcards
1
Q
maternal high risk factors
A
advanced maternal age
abnormal maternal lab values
vaginal bleeding
insulin dependent diabetes mellitus (IDDM)
hypertension (HTN)
preeclampsia
maternal systemic disease
2
Q
advanced maternal age (AMA) refers to a patient who will be
A
35 or older at time of delivery
3
Q
1st trimester testing looks for the pattern of biochemical markers associated with
A
plasma protein A (PAPP-A) and free beta-hCG3
4
Q
2nd trimester screening performed with
A
maternal serum quad screen lab value and targeted ultrasound exam
5
Q
quad screen looks at the following serum markers
A
alpha fetoprotein (AFP)
human chorionic gonadotropin (HCG)
conjugated estriol (uE3)
inhibin A
6
Q
hydrops fetalis
A
condition in which excessive fluid accumulates within fetal body cavities
7
Q
2 classifications of fetal hydrops
A
immune hydrops
non immune hydrops
8
Q
immune hydrops is initiated by the presence of
A
maternal serum immunoglobulin G (IgG) antibody against one of the fetal RBC antigens (known as sensitization)
9
Q
immune hydrops occur anytime a mother is exposed to
A
RBCs antigens different from her own
10
Q
immune hydrops are
A
rare today and can be prevented if RhoGAM given
11
Q
in immune hydrops mixing occurs and the mother develops antibody when
A
maternal IgG able to cross maternal fetal barrier and enter fetal circulation
12
Q
sonographic findings of hydrops
A
scalp edema
pleural effusion
pericardial effusion
ascites
polyhydramnios
thickened placenta
13
Q
hydrops can be due to
A
fetal anemia
14
Q
another ultrasound too to predict fetal anemia is
A
doppler evaluation of middle cerebral artery (MCA)
15
Q
anemia is a condition in which there are
A
fever RBSs, so blood viscosity is decreased
16
Q
decrease in viscosity results in
A
decrease in resistance to flow
17
Q
anemia is detected by
A
increase in velocity in MCA
18
Q
amniocentesis can be used for
A
analysis of fetal chromosomes, prediction of Rh isoimmunization and lung maturity
19
Q
reasons for amniocentesis
A
maternal age
previous child w/ chromosomal abnormalities
abnormal AFP level
20
Q
cordocentesis
A
needle placed into fetal umbilical vein and blood sample obtained
21
Q
corocentesis lab values sample for
A
fetal blood type, hematocrit and hemoglobin
22
Q
cordocentesis is most commonly used for
A
guidance for transfusions to treat fetal isoimmunization
23
Q
cordocentesis can also be used for
A
chromosomal analysis
24
Q
with alloimmune thrombocytopenia
A
the mother develops antibodies to fetal platelets
25
nonimmune hydrops
group of conditions in which hydrops present in fetus but is not result of fetomaternal blood group incompatibility
26
most frequent causes of NIH
cardiovascular lesions
27
sonographic findings of NIH
scalp edema
pleural and pericardial effusions
ascites
28
main cause for 3rd trimester bleeding
placenta previa
29
if cervical os dilates with labor, vaginal bleeding is significant risk of
placenta detaching from uterus, resulting in maternal hemorrhage, loss of oxygen and blood supply to fetus
30
what is the best way to evaluate the relationship of cervical os to placental edge with vaginal bleeding
transvaginal sonography
31
rare condition with vaginal bleeding in which umbilical cord is presenting part
vasa previa
32
vaginal bleeding is what to the fetus
life threatening
33
vaginal bleeding is associated with
velamentous cord insertion or succenturiate lobe
34
with vaginal bleeding CD is used to evaluate
any structures in front of cervical os to see if vascular
35
insulin dependent diabetic mellitus (IDDM)
mothers at increased risk for pregnancy related complications, including early and late trimester pregnancy loss and congenital anomalies
36
what happens if glucose levels are very high and uncontrolled
fetus may also become macrosomic
37
macrosomia is defined as
fetus whose weight is > 90th percentile for gestational age
38
macrosomic infant may become
too large to fit through mothers pelvis
(would need c section)
39
hypertensive pregnancies may be associated with
small placentas
40
what happens if placenta develops poorly
blood supply to fetus may be restricted and growth restriction may result
41
toxemia
used to describe hypertensive disorders
("toxin" in mothers bloodstream caused HTN)
42
currently, pregnancy induced HTN is considered to be caused by
prostaglandin abnormalities
43
pregnancy induced HTN
preeclampsia
severe preeclampsia
eclampsia
44
chronic HTN
present before women becomes pregnant
45
preeclampsia
pregnancy condition in which high blood pressure develops with proteinuria (protein in urine) or edema (swelling)
46
HTN generally indicates
patient must be delivered immediately
47
if you have HTN while pregnant
a sonography team may be called on to perform serial scans for fetal growth and to monitor for adequacy of AF
48
systemic lupus erythematosus (SLE)
chronic autoimmune disorder that can affect almost all organ systems in body
49
SLE is most common in
women of childbearing age
50
SLE may cause
multiple permpartum complications
51
SLE incidence of spontaneous abortion and fetal death is
22% to 49%
52
with SLE the placenta is affected by
immune complex deposits and inflammatory responses in placental vessels
53
hypermesis common symptoms associated with pregnancy
nausea and vomiting
54
hypermesis gravid arum exists when
pregnant women vomit so much they become dehydrated and have electrolyte imbalance
55
what is usually necessary if hospitalized with
IV fluid
56
pyelonephritis usually presents with
flank pain, fever, and WBC in urine
57
hydronephrosis also presents with
flank pain
58
pregnancy is normally associated with
mild hydronephrosis
59
hydronephrosis may result from
a combination of effects
60
progesterone has a
dilatory effect on smooth muscle of ureter
61
enlarging uterus also compresses ureters at
pelvic brim causing hydronephrosis or obstruction
62
maternal obesity is associated with
increased incidence of neural tube defects
63
more obese women start pregnancy with
chronic HTN than women who are of normal weight
64
obese women are also at increased risk for
pregnancy induced HTN
65
if the growth of uterine fibroids are very rapid
the fibroid may outgrow its blood supply and undergo necrosis
66
uterine fibroids may cause
pain and premature labor
67
premature labor
onset of labor before 37 weeks of gestation
68
premature infants are at greater risk for having
respiratory distress syndrome
intracranial hemorrhage
bowel immaturity
feeding problems
69
potential etiologies of preterm labor
Premature rupture of membranes
Intrauterine infection
Bleeding
Fetal anomalies
Polyhydramnios
Multiple pregnancy
Growth restriction
Maternal illness (diabetes or hypertension)
Incompetent cervix
Uterine abnormalities
70
ultrasound assessment of preterm labor patient should include
Amniotic fluid assessment
Cervical assessment
Fetal number
Placental assessment
Targeted ultrasound
71
intrauterine fetal death accounts for
roughly half of all perinatal mortality
72
1st trimester pregnancy loss may be diagnosed when patient presents with
vaginal bleeding
cramping
passage of tissue
73
2nd trimester pregnancy landmarks
Uterine fundal height should have risen to umbilicus
Uterus should measure approximately 20 cm above symphysis pubis
74
mother should perceive fetal movements on daily basis beginning between
16 and 20 weeks of gestation
75
absence of fetal heart rate usually prompt clinician to obtain
ultrasound examination
76
cessation of fetal movements should prompt an
immediate search for fetal heart tones
77
if no fetal heart tones are present, an ultrasound examination will
confirm or rule out intrauterine fetal demise
78
ultrasound findings associated with fetal death
Absent heart beat
Absent fetal movement
Overlap of skull bones (Spalding’s sign)
Exaggerated curvature of fetal spine; gas in fetal abdomen
79
Brief ultrasound examination of fetus for structural anomalies should be performed and biometry obtained to determine
estimated weight for delivery
80
what should be given to family to not add to their emotional stress during fetal death
care and consideration
81
SGA can be due to
chromosomal anomalies
intrauterine infection
genetics
placental insufficiency
82
if chromosomal anomalies are etiology for fetus measuring small
growth often symmetrically affects
83
with SGA, all fetal measurements with be
smaller than expected for gestational age
84
when placenta insufficiency is cause of SGA
fetuses often develop asymmetrical IUGR
85
SGA results in
normal HC with small AC and smaller than expected limb growth
86
mother with multiple gestations are
at increased risk for obstetric complications
87
multiple pregnancy is at increased risk of
premature delivery and congenital anomalies
88
a twin has 5 times greater chance of
perinatal death than singleton fetus
89
twin pregnancies, by virtue of having 2 fetuses rather than 1, are associated with
elevations of MSAFP
90
with multiple gestation monographer needs to evaluate
placentation type
91
placentation type refers to
number of chorions (chronicity) and amnions (amnionicity)
92
2 types of twins
dizygotic (fraternal)
monozygotic (identical)
93
dizygotic twins arise from
2 separately fertilized ova
94
with dizygotic twins, placentas may
implant in different parts of uterus and be distinctly separate or may implant adjacent to each other and fuse
95
although placentas are fused with dizygotic twins
their blood circulations remain distinct and separate from each other
96
monozygotic twins arise from a
single fertilized egg that divides, resulting in 2 genetically identical fetuses
97
depending on whether fertilized egg divides early or late in monozygotic twins, there may be
1 or 2 placentas, chorions, and amniotic sacs
98
If division occurs early, 0 to 4 days postconception, in monozygotic twins, there will be
2 amnions and 2 chorions (dichorionic, diamniotic)
99
If division occurs at 4 to 8 days in monozygotic twins, there will be
1 chorion and 2 amniotic sacs (monochorionic, diamniotic)
100
if division occurs after 8 days in monozygotic twins, 2 fetuses present with
1 chorion and 1 amnion (monochorionic, monoamnionic)
101
if division occurs after 13 days in monozygotic twins
division may be incomplete resulting in conjoined twins
102
monozygotic twins is a
very high risk situation
103
monozygotic twins are associated with
increased incidence of fetal anomalies
104
if there is only 1 amniotic sac with monozygotic twins
they may entangle their umbilical cords, cutting off their blood supplies
105
Because circulations of monozygotic twins communicate through single placenta, they are at increased risk for
syndrome known as twin-to-twin transfusion
106
vanishing twin
once reabsorbed, products of conception of this twin will no longer be seen on ultrasound
107
if demise occurs very early
complete resorption of both embryo and gestational sac or early placenta may occur
108
fetus papyraceous
when fetus dies after reaching size too large for resorption, fetus markedly flattened from loss of fluid of most of soft tissue
109
poly-oli sequence
stuck twin syndrome
110
poly-oli sequence is characterized by
diamniotic pregnancy with polyhydramnios in one sac
111
poly-oli sequence has
severe oligohydramnios
112
stuck twin syndrome may result due to
Fetal anomaly in one sac resulting in polyhydramnios
Compressing blood flow in normal twin’s placenta, resulting in oligohydramnios
Placental insufficiency in one placenta
TTS
113
in poly-oli sequence
arterial blood of one twin is pumped into venous system of other twin
114
When oligohydramnios exists in one sac and polyhydramnios in other
small twin may appear stuck in position within uterus
115
in poly-oli sequence twin has less
blood flow through kidneys, urinates less, develops oligohydramnios
116
in poly-oli sequence recipient twin gets
too much blood flow
117
in poly-oli sequence twin may be
normal or large in size
118
in poly-oli sequence fetus has excess
blood flow through kidneys and urinates too much, leading to polyhydramnios
119
in poly-oli sequence twin may even go into
heart failure and become hydopic
120
if twin-to-twin transfusions exists in poly-oli sequence
both twins at risk of dying
121
treatments for stuck twin syndrome include
Serial amniocentesis
Selective feticide
Umbilical cord ligation of one twin
Laser occlusion of anastomosing placental vessels
122
Acardiac
rare anomaly occurring in monochorionic twins where one twin develops without a heart and often absence of upper half of body
123
Cardiac anomaly occurs to do
artery to artery connection in placenta that leads to perfusion of abnormal twin via co-twin
124
reserved direction of blood flow in abnormal twin with Acardiac alters
hemodynamic properties needed for normal cardiac information
125
conjoined twins occurs from
incomplete division of embryo after 13 days from conception
126
5 types of conjoined twins
Thoracopagus (joined at thorax)
Omphalopagus (joined at anterior wall)
Craniopagus (joined at cranium; syncephalus is conjoined twins with one head)
Pygopagus (joined at ischial region)
Ischiopagus (attached at buttocks)
127
twin A
sac and fetus directly over internal os
127
Important role of first trimester sonography is to
determine pregnancy number (singleton, twin, or higher-order multiple gestation)
128
After 6 weeks of gestational age, determining pregnancy number easily accomplished by
counting embryos in uterus
129
Before 6 weeks, embryo not consistently visualized; sonographer must
count gestational sacs and small yolk sacs
130
When scanning multiple gestations always attempt to determine
whether there are one or two amniotic sacs by locating membrane that separates sacs
131
if 2 sacs are seen, pregnancy are known to be
diamniotic, but sonography will not be able to indicated whether twins are identical
132
both monozygotic and dizygotic twins may have
two amniotic sacs
133
documentation of membrane separating fetuses confirms
presence of diamniotic pregnancy
134
Membrane, composed of amnion with or without chorion, exhibits characteristic appearance that permits
distinction from other membranes of pregnancy
135
In twin pregnancy with two separate placentas, membrane extends between
fetuses obliquely across uterus from edge of placenta to contralateral edge of other placenta
136
If only one placental site exists, membrane extends between
fetuses away from central portion of placental site
137
what should be be determined with when assessing the placenta
location and number
138
Twins are smaller in size at birth than
singleton fetuses of comparable gestational age
139
Reported predictors of discordance of growth between twins:
Difference in estimated fetal weight of >20%
Difference in BPD of 6 mm
Difference in AC of 20 mm
Difference in femur length of 5 mm
