Chapter 54 Sonography & High Risk Pregnancy Flashcards
Screening for fetal anomalies is performed in either the _____ trimester
1st or 2nd
First trimester testing looks for the pattern of biochemical markers associated with
PAPP-A and Beta-hCG
Second trimester screening is performed with ____
maternal serum quad screen lab value and a target ultrasound
Quad screen consists of
HCG
AFP
Inhibin-A
Uncongugated Estriol
AMA refers to a patient who ___
Will be 35 by the day of delivery
Risk of Down syndrome at age 35
1 in 385
Risk of Down syndrome at age 45
1 in 32
Condition in which excess fluid accumulates within fetal body cavities
Hydrops fetalis
Fluid surrounding the abdominal/pelvic organs
Ascites
When skin Adema is massive, encasing the majority of the body
Anasarca
When the maternal clinical symptoms mimic the clinical features of the fetus
Mirror syndrome
In mirror syndrome the mother will exhibit features of
Edema, rapid weight gain, hypertension, and mild proteinurea
Two classifications of fetal hydrops
Immune and non-immune
Hydrops caused by RH-sensitization
Immune
How is RH sensitization prevented?
RhoGAM shot
Maternal(RH-) and fetus’(RH+) blood mix, mother develops antibody(___) which causes ____
IgG, hemolysis
IgG attaches to fetal RBC and destroys them
Hemolysis
Hemolysis can result in
Fetal anemia, congestive heart failure, anasarca(edema of tissues)
The placenta will be _____ in immune hydrops
Thickened
Doppler of _____ can predict fetal anemia
middle cerebra artery(MCA)
Doppler of MCA with fetal anemia :
Decrease viscosity results in decrease resistance to flow
This is detected by an increase in velocity in the MCA
Increase of velocity in the MCA indicates:
Decrease in viscosity/resistance to flow—- fetal anemia
Where is the MCA located?
Circle of Willis
Procedure where the needle is placed into the fetal umbilical vein and a blood sample is obtained
Cordocentesis
Nonimmune hydrops is caused by
Anything other than RH-sensitization
Most frequent cause of nonimmune hydrops(NIH)
Cardiovascular lesions
Prognosis of NIH is poor, with a mortality rate of
50-98%
The primary fuel for growth is _____
Glucose
If glucose levels are very high and uncontrolled, the fetus may become
Macrosomic
Hypertension is associated with _____ placentas
Small
Pregnancy condition in which high blood pressure develops with proteinuria and edema
Preeclampsia
Severe hypertension and proteinurea refers to
Severe preeclampsia
Occurrence of seizures in the preeclamptic patient
Eclampsia
Chronic hypertension is diagnosed in patients that have high blood pressure before ____
20 weeks gestation
Chronic hypertension can result from ____
Primary/secondary hypertension
Umbilical artery Doppler can provide information regarding
Fetal and maternal circulatory status and help determine risk of IUGR
Chronic autoimmune disorder that can affect almost all organ systems in the body
Lupus
Lupus is most common in women of ____ age
Childbearing age
Incidence of miscarriage and fetal death in patients with lupus is ___ %
22-49%
In patients with lupus the fetus must be monitored to rule out
Congenital heart block and pericardial effusion
In patients with lupus the placenta is affected by
Immune complex deposits and inflammatory responses in placental vessels
If UTIs are left untreated, the patient may develop
Pylonephritis
Maternal obesity is associated with increased incidence of fetal anomalies, especially;
Neural tube defects
Uterine fibroids may cause ___
Pain and premature labor
Uterine fibroids may be stimulated by
Excess growth in pregnancy hormones, especially estrogen
With premature labor, _____ of cases there is no cause or association identified
Half/50%
Ultrasound assessment should include
AFI Cervix length Fetal # Placental assessment Targeted ultrasound
Fetal death causes cannot be determined in ____ of the cases
About half
Approximately ___% of fetal deaths occur in the first trimester
80%
Overlapping of skull bones _____ sign
Spalding sign
Gas in fetal abdomen—-___ sign
Roberts sign
A twin has ____ times greater chance of perineal death than a singletons fetus
5 times
Two types of twins
Monozygotic(identical)
Dizygotic(fraternal)
Arise from two separately fertilized eggs
Dizygotic twins
Dizygotic is ALWAYS _____
Dichorionic and diamniotic
Arise from single fertilized egg that then divides
Monozygotic
Monozygotic:
If division occurs 0-4 days post conception:
Dichorionic/Diamniotic
Monozygotic:
If division occurs 4-8 days post conception:
Monichorionic/Diamniotic
If division occurs after day 8 post conception
Monochorionic/monoamniotic
If division occurs after 13 days
Conjoined twins
____% of pregnancies that begin as twins end as singletons
70%
Conjoined twin
Thoracopagus:
Thorax
Conjoined twin
Omphalopagus:
Anterior wall
Conjoined twin
Craniopagus:
Cranium
Conjoined twins with one head:
Syncephalus
Conjoined twins
Pyopagus:
Ischial region
Conjoined twins
Ischiopagus
Buttocks
If fetus dies after reaching a size too large for absorption—fetus is markedly flattened from loss of fluid and most soft tissue
Fetus Papyraceous/Paper doll twin
Aka stuck twin
Poly-Oli sequence
Characterized by a Diamniotic pregnancy with polyhydramnios in one sac and severe oligohydramnios in the other.
Poly-Oli twin sequence
Poly-oli twin sequence usually manifests between ____
16-26 weeks
Exists with vascular connection shared within the placenta, arterial flow of one twin is pumped into the venous system of the other twin.
TTTS
Smaller twin in TTTS is at risk for dying because
Nutritional & oxygen rich blood supply is restricted
Larger twin in TTTS is at risk for death because
Heart failure—overworked
Aka TRAP syndrome
Acardiac anomaly
One twin develops w/o a heart and often absence of upper body. This twin has no direct vascular connection to the placenta
TRAP syndrome / acardiac anomaly
Twin Reversed Arterial Perfusion syndrome
The donor or “pump” twin in TRAP syndrome may develop
Cardiomegaly, heart failure, hydrops
In addition to the required anatomy, the preliminary report should include:
Chorionicity/amnionicity
Gender
Biometric data
Anomalies
When scanning multiple gestational always document the _______ separating the sac
Membrane
If only 1 placenta is seen, and a membrane can’t be visualized, it’s most likely a ______ pregnancy
Mono/mono
Male & female fetus’ are always ____ pregnancies
Di/di
Twin pregnancy with intertwined umbilical cords, conjoined twins or greater than 3 vessels in the umbilical cord:
Monozygotic, monochorionic, and monoamniotic
Body of placenta should be scanned to determine whether line of separation can be see: ____ sign
Twin peak/ lambda sign
Discordant growth of the twins can occur when there is a difference in EFW of ___%
20%
If growth discordance is between twins but one is male and one is female, then ____
TTTS cannot occur
Can be common in twins due to crowding ______
Dolichocephaly
No flow/reversal of flow are both signs of ___
Fetal jeopardy and prompt delivery
Multifetal pregnancy reductions is performed when?
Toward the end of the 1st trimester
