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OBGYN > Chapter 54 > Flashcards

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

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2
Q

advanced maternal age (AMA) refers to a patient who will be

A

35 or older at time of delivery

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3
Q

1st trimester testing looks for the pattern of biochemical markers associated with

A

plasma protein A (PAPP-A) and free beta-hCG3

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4
Q

2nd trimester screening performed with

A

maternal serum quad screen lab value and targeted ultrasound exam

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5
Q

quad screen looks at the following serum markers

A

alpha fetoprotein (AFP)
human chorionic gonadotropin (HCG)
conjugated estriol (uE3)
inhibin A

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6
Q

hydrops fetalis

A

condition in which excessive fluid accumulates within fetal body cavities

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7
Q

2 classifications of fetal hydrops

A

immune hydrops
non immune hydrops

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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)

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9
Q

immune hydrops occur anytime a mother is exposed to

A

RBCs antigens different from her own

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10
Q

immune hydrops are

A

rare today and can be prevented if RhoGAM given

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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

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12
Q

sonographic findings of hydrops

A

scalp edema
pleural effusion
pericardial effusion
ascites
polyhydramnios
thickened placenta

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13
Q

hydrops can be due to

A

fetal anemia

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14
Q

another ultrasound too to predict fetal anemia is

A

doppler evaluation of middle cerebral artery (MCA)

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15
Q

anemia is a condition in which there are

A

fever RBSs, so blood viscosity is decreased

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16
Q

decrease in viscosity results in

A

decrease in resistance to flow

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17
Q

anemia is detected by

A

increase in velocity in MCA

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18
Q

amniocentesis can be used for

A

analysis of fetal chromosomes, prediction of Rh isoimmunization and lung maturity

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19
Q

reasons for amniocentesis

A

maternal age
previous child w/ chromosomal abnormalities
abnormal AFP level

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20
Q

cordocentesis

A

needle placed into fetal umbilical vein and blood sample obtained

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21
Q

corocentesis lab values sample for

A

fetal blood type, hematocrit and hemoglobin

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22
Q

cordocentesis is most commonly used for

A

guidance for transfusions to treat fetal isoimmunization

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23
Q

cordocentesis can also be used for

A

chromosomal analysis

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24
Q

with alloimmune thrombocytopenia

A

the mother develops antibodies to fetal platelets

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25
Q

nonimmune hydrops

A

group of conditions in which hydrops present in fetus but is not result of fetomaternal blood group incompatibility

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26
Q

most frequent causes of NIH

A

cardiovascular lesions

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27
Q

sonographic findings of NIH

A

scalp edema
pleural and pericardial effusions
ascites

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28
Q

main cause for 3rd trimester bleeding

A

placenta previa

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29
Q

if cervical os dilates with labor, vaginal bleeding is significant risk of

A

placenta detaching from uterus, resulting in maternal hemorrhage, loss of oxygen and blood supply to fetus

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30
Q

what is the best way to evaluate the relationship of cervical os to placental edge with vaginal bleeding

A

transvaginal sonography

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31
Q

rare condition with vaginal bleeding in which umbilical cord is presenting part

A

vasa previa

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32
Q

vaginal bleeding is what to the fetus

A

life threatening

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33
Q

vaginal bleeding is associated with

A

velamentous cord insertion or succenturiate lobe

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34
Q

with vaginal bleeding CD is used to evaluate

A

any structures in front of cervical os to see if vascular

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35
Q

insulin dependent diabetic mellitus (IDDM)

A

mothers at increased risk for pregnancy related complications, including early and late trimester pregnancy loss and congenital anomalies

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36
Q

what happens if glucose levels are very high and uncontrolled

A

fetus may also become macrosomic

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37
Q

macrosomia is defined as

A

fetus whose weight is > 90th percentile for gestational age

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38
Q

macrosomic infant may become

A

too large to fit through mothers pelvis
(would need c section)

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39
Q

hypertensive pregnancies may be associated with

A

small placentas

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40
Q

what happens if placenta develops poorly

A

blood supply to fetus may be restricted and growth restriction may result

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41
Q

toxemia

A

used to describe hypertensive disorders
(“toxin” in mothers bloodstream caused HTN)

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42
Q

currently, pregnancy induced HTN is considered to be caused by

A

prostaglandin abnormalities

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43
Q

pregnancy induced HTN

A

preeclampsia
severe preeclampsia
eclampsia

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44
Q

chronic HTN

A

present before women becomes pregnant

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45
Q

preeclampsia

A

pregnancy condition in which high blood pressure develops with proteinuria (protein in urine) or edema (swelling)

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46
Q

HTN generally indicates

A

patient must be delivered immediately

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47
Q

if you have HTN while pregnant

A

a sonography team may be called on to perform serial scans for fetal growth and to monitor for adequacy of AF

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48
Q

systemic lupus erythematosus (SLE)

A

chronic autoimmune disorder that can affect almost all organ systems in body

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49
Q

SLE is most common in

A

women of childbearing age

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50
Q

SLE may cause

A

multiple permpartum complications

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51
Q

SLE incidence of spontaneous abortion and fetal death is

A

22% to 49%

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52
Q

with SLE the placenta is affected by

A

immune complex deposits and inflammatory responses in placental vessels

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53
Q

hypermesis common symptoms associated with pregnancy

A

nausea and vomiting

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54
Q

hypermesis gravid arum exists when

A

pregnant women vomit so much they become dehydrated and have electrolyte imbalance

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55
Q

what is usually necessary if hospitalized with

A

IV fluid

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56
Q

pyelonephritis usually presents with

A

flank pain, fever, and WBC in urine

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57
Q

hydronephrosis also presents with

A

flank pain

58
Q

pregnancy is normally associated with

A

mild hydronephrosis

59
Q

hydronephrosis may result from

A

a combination of effects

60
Q

progesterone has a

A

dilatory effect on smooth muscle of ureter

61
Q

enlarging uterus also compresses ureters at

A

pelvic brim causing hydronephrosis or obstruction

62
Q

maternal obesity is associated with

A

increased incidence of neural tube defects

63
Q

more obese women start pregnancy with

A

chronic HTN than women who are of normal weight

64
Q

obese women are also at increased risk for

A

pregnancy induced HTN

65
Q

if the growth of uterine fibroids are very rapid

A

the fibroid may outgrow its blood supply and undergo necrosis

66
Q

uterine fibroids may cause

A

pain and premature labor

67
Q

premature labor

A

onset of labor before 37 weeks of gestation

68
Q

premature infants are at greater risk for having

A

respiratory distress syndrome
intracranial hemorrhage
bowel immaturity
feeding problems

69
Q

potential etiologies of preterm labor

A

Premature rupture of membranes
Intrauterine infection
Bleeding
Fetal anomalies
Polyhydramnios
Multiple pregnancy
Growth restriction
Maternal illness (diabetes or hypertension)
Incompetent cervix
Uterine abnormalities

70
Q

ultrasound assessment of preterm labor patient should include

A

Amniotic fluid assessment
Cervical assessment
Fetal number
Placental assessment
Targeted ultrasound

71
Q

intrauterine fetal death accounts for

A

roughly half of all perinatal mortality

72
Q

1st trimester pregnancy loss may be diagnosed when patient presents with

A

vaginal bleeding
cramping
passage of tissue

73
Q

2nd trimester pregnancy landmarks

A

Uterine fundal height should have risen to umbilicus
Uterus should measure approximately 20 cm above symphysis pubis

74
Q

mother should perceive fetal movements on daily basis beginning between

A

16 and 20 weeks of gestation

75
Q

absence of fetal heart rate usually prompt clinician to obtain

A

ultrasound examination

76
Q

cessation of fetal movements should prompt an

A

immediate search for fetal heart tones

77
Q

if no fetal heart tones are present, an ultrasound examination will

A

confirm or rule out intrauterine fetal demise

78
Q

ultrasound findings associated with fetal death

A

Absent heart beat
Absent fetal movement
Overlap of skull bones (Spalding’s sign)
Exaggerated curvature of fetal spine; gas in fetal abdomen

79
Q

Brief ultrasound examination of fetus for structural anomalies should be performed and biometry obtained to determine

A

estimated weight for delivery

80
Q

what should be given to family to not add to their emotional stress during fetal death

A

care and consideration

81
Q

SGA can be due to

A

chromosomal anomalies
intrauterine infection
genetics
placental insufficiency

82
Q

if chromosomal anomalies are etiology for fetus measuring small

A

growth often symmetrically affects

83
Q

with SGA, all fetal measurements with be

A

smaller than expected for gestational age

84
Q

when placenta insufficiency is cause of SGA

A

fetuses often develop asymmetrical IUGR

85
Q

SGA results in

A

normal HC with small AC and smaller than expected limb growth

86
Q

mother with multiple gestations are

A

at increased risk for obstetric complications

87
Q

multiple pregnancy is at increased risk of

A

premature delivery and congenital anomalies

88
Q

a twin has 5 times greater chance of

A

perinatal death than singleton fetus

89
Q

twin pregnancies, by virtue of having 2 fetuses rather than 1, are associated with

A

elevations of MSAFP

90
Q

with multiple gestation monographer needs to evaluate

A

placentation type

91
Q

placentation type refers to

A

number of chorions (chronicity) and amnions (amnionicity)

92
Q

2 types of twins

A

dizygotic (fraternal)
monozygotic (identical)

93
Q

dizygotic twins arise from

A

2 separately fertilized ova

94
Q

with dizygotic twins, placentas may

A

implant in different parts of uterus and be distinctly separate or may implant adjacent to each other and fuse

95
Q

although placentas are fused with dizygotic twins

A

their blood circulations remain distinct and separate from each other

96
Q

monozygotic twins arise from a

A

single fertilized egg that divides, resulting in 2 genetically identical fetuses

97
Q

depending on whether fertilized egg divides early or late in monozygotic twins, there may be

A

1 or 2 placentas, chorions, and amniotic sacs

98
Q

If division occurs early, 0 to 4 days postconception, in monozygotic twins, there will be

A

2 amnions and 2 chorions (dichorionic, diamniotic)

99
Q

If division occurs at 4 to 8 days in monozygotic twins, there will be

A

1 chorion and 2 amniotic sacs (monochorionic, diamniotic)

100
Q

if division occurs after 8 days in monozygotic twins, 2 fetuses present with

A

1 chorion and 1 amnion (monochorionic, monoamnionic)

101
Q

if division occurs after 13 days in monozygotic twins

A

division may be incomplete resulting in conjoined twins

102
Q

monozygotic twins is a

A

very high risk situation

103
Q

monozygotic twins are associated with

A

increased incidence of fetal anomalies

104
Q

if there is only 1 amniotic sac with monozygotic twins

A

they may entangle their umbilical cords, cutting off their blood supplies

105
Q

Because circulations of monozygotic twins communicate through single placenta, they are at increased risk for

A

syndrome known as twin-to-twin transfusion

106
Q

vanishing twin

A

once reabsorbed, products of conception of this twin will no longer be seen on ultrasound

107
Q

if demise occurs very early

A

complete resorption of both embryo and gestational sac or early placenta may occur

108
Q

fetus papyraceous

A

when fetus dies after reaching size too large for resorption, fetus markedly flattened from loss of fluid of most of soft tissue

109
Q

poly-oli sequence

A

stuck twin syndrome

110
Q

poly-oli sequence is characterized by

A

diamniotic pregnancy with polyhydramnios in one sac

111
Q

poly-oli sequence has

A

severe oligohydramnios

112
Q

stuck twin syndrome may result due to

A

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
Q

in poly-oli sequence

A

arterial blood of one twin is pumped into venous system of other twin

114
Q

When oligohydramnios exists in one sac and polyhydramnios in other

A

small twin may appear stuck in position within uterus

115
Q

in poly-oli sequence twin has less

A

blood flow through kidneys, urinates less, develops oligohydramnios

116
Q

in poly-oli sequence recipient twin gets

A

too much blood flow

117
Q

in poly-oli sequence twin may be

A

normal or large in size

118
Q

in poly-oli sequence fetus has excess

A

blood flow through kidneys and urinates too much, leading to polyhydramnios

119
Q

in poly-oli sequence twin may even go into

A

heart failure and become hydopic

120
Q

if twin-to-twin transfusions exists in poly-oli sequence

A

both twins at risk of dying

121
Q

treatments for stuck twin syndrome include

A

Serial amniocentesis
Selective feticide
Umbilical cord ligation of one twin
Laser occlusion of anastomosing placental vessels

122
Q

Acardiac

A

rare anomaly occurring in monochorionic twins where one twin develops without a heart and often absence of upper half of body

123
Q

Cardiac anomaly occurs to do

A

artery to artery connection in placenta that leads to perfusion of abnormal twin via co-twin

124
Q

reserved direction of blood flow in abnormal twin with Acardiac alters

A

hemodynamic properties needed for normal cardiac information

125
Q

conjoined twins occurs from

A

incomplete division of embryo after 13 days from conception

126
Q

5 types of conjoined twins

A

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
Q

twin A

A

sac and fetus directly over internal os

127
Q

Important role of first trimester sonography is to

A

determine pregnancy number (singleton, twin, or higher-order multiple gestation)

128
Q

After 6 weeks of gestational age, determining pregnancy number easily accomplished by

A

counting embryos in uterus

129
Q

Before 6 weeks, embryo not consistently visualized; sonographer must

A

count gestational sacs and small yolk sacs

130
Q

When scanning multiple gestations always attempt to determine

A

whether there are one or two amniotic sacs by locating membrane that separates sacs

131
Q

if 2 sacs are seen, pregnancy are known to be

A

diamniotic, but sonography will not be able to indicated whether twins are identical

132
Q

both monozygotic and dizygotic twins may have

A

two amniotic sacs

133
Q

documentation of membrane separating fetuses confirms

A

presence of diamniotic pregnancy

134
Q

Membrane, composed of amnion with or without chorion, exhibits characteristic appearance that permits

A

distinction from other membranes of pregnancy

135
Q

In twin pregnancy with two separate placentas, membrane extends between

A

fetuses obliquely across uterus from edge of placenta to contralateral edge of other placenta

136
Q

If only one placental site exists, membrane extends between

A

fetuses away from central portion of placental site

137
Q

what should be be determined with when assessing the placenta

A

location and number

138
Q

Twins are smaller in size at birth than

A

singleton fetuses of comparable gestational age

139
Q

Reported predictors of discordance of growth between twins:

A

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

OBGYN (2 decks)

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