Fetal Environment and Maternal Complications Flashcards
1
Q
The placenta normally weighs :
A
450-550 g
2
Q
the placenta has a diameter of :
A
16-20 cm
3
Q
Maternal contribution of the placenta:
A
decidua basalis is the endometrium beneath the developing placenta
4
Q
The chorion frondosum is the portion derived from:
A
blastocyst and contains the chorionic villi
5
Q
The fetal contribution of the placenta
A
chorion frondosum
6
Q
The placenta consists of approximately 10-30 _______ which are groups or lobes of chroinic villi:
A
cotyledons
7
Q
The placenta produces _______ which maintains the corpus luteum of the ovary.
A
hCG
8
Q
Major function of the placenta:
A
acts as excretory organ for the fetus
9
Q
In later pregnancy the placenta also produces :
A
estrogen and progesterone
10
Q
The placenta effectively becomes the means of:
A
respiration for the fetus
11
Q
The definitive placenta may not be identified sonographically until after:
A
10-12 weeks
12
Q
The placenta consists of 3 parts:
A
chorionic plate, the placental substance, the basal layer or basal plate
13
Q
The chorionic plate is the element of the placenta _______ to the fetus.
A
closest
14
Q
The basal layer is :
A
the area adjacent to the uterus
15
Q
Functions of the placenta:
A
gas transfer, excretory function, water balance, pH maintenance, hormone production, defensive barrier
16
Q
The placental substance:
A
contains the functional parts of the placenta, and is located between the chorionic plate and the basal layer
17
Q
Venous lakes aka:
A
maternal lakes or placental lakes
18
Q
Pools of maternal blood within the placental substance are termed:
A
venous lakes, maternal lakes, placental lakes
19
Q
How do venous lakes appear:
A
anechoic or hypoechoic areas, may contain swirling blood.
20
Q
________ placenta consists of two separate discs of equal size
A
bilobed
21
Q
________ placenta, which are additional smaller lobes located separate from the main segment of the placenta.
A
succenturiate lobe / accessory lobe
22
Q
An abnormally shaped placenta caused by the membranes inserting inward from the edge of the placenta, producing a curled-up placental contour:
A
circumvallate placenta
23
Q
A circumvallate placenta may lead to:
A
vaginal bleeding and placental abruption, among other complications
24
Q
The thickness of the placenta should be evaluated and not exceed:
A
4 cm
25
Thick or large placenta are termed:
placentomegaly
26
A thin placenta are associated with:
maternal and or fetal abnormalities
27
Uninterrupted chorionic plate and homogeneous placental substance (what grade placenta)
grade 0
28
Subtle indentations on the chorionic plate, with some small calcifications within the placental substance (what grade placenta)
Grade 1
29
Moderate indentations in the chorionic plate with "comma-like" calcification in the placental substance (what grade placenta)
Grade 2
30
Prominent indentation in the chorionic plate that extends to the basal layer with diffuse echogenic and anechoic areas noted within the placental substance (what placental grade)
Grade 3
31
Implantation of the placenta may occur within the LUS this will often lead to :
placenta previa
32
Placenta previa is evident when the placenta:
covers the internal os of the cervix
33
Placenta previa is a common cause of:
painless vaginal bleeding in the 2nd and 3rd trimesters`
34
Placenta previa is discovered more often in women with a history of:
multiparity, advanced maternal age, previous abortion, and prior cesarean section
35
Possible causes of a thick placenta :
diabetes mellitus, maternal anemia, infection, fetal hydrops, rh isoimmunization, multiple gestation
36
Possible causes of a thin placenta:
diabetes mellitus (long standing), Intrauterine growth restriction, placental insufficiency, polyhydramnios, preeclampsia, small for dates fetus
37
Placenta previa is not routinely diagnosed until:
late 2nd or third trimester
38
The placenta should be evaluated for placenta previa after:
20 weeks with an empty maternal bladder
39
False positive placenta previa can be caused by:
Fully distended bladder, painless myometrial contractions that can occur in the LUS
40
Placenta covers the internal os completely:
complete previa (total)
41
Placenta partially covers the internal os:
partial previa
42
Placenta lies at the edge of the internal os:
marginal previa
43
Placental edge extends into the LUS but ends more than 2 cm away from the internal os:
low-lying previa
44
The complication of fetal vessels resting over the internal os of the cervix is referred to as:
Vasa previa
45
With Vasa Previa vessels are prone to rupture as the cervix dilates, this can lead to :
exsanguination of the fetus
46
Total blood loss; to bleed out
exsanguination
47
Vasa previa is often associated with:
velamentous cord insertion and possible a succenturiate lobe
48
Sonographic findings of vasa previa
identification of vessels over the internal os of the cervix with the use of color doppler, velamentous cord insertion
49
Premature separation of the placenta from the uterine wall before the birth of the fetus, causing hemorrhage:
Placental abruption
50
The most severe type of abruption:
complete abruption
51
A complete abruption often results in the development of a :
retroplacental hematoma
52
retroplacental hematoma is located :
between the placenta and the myometrium
53
Partial abruption often results in only:
a few cm of separation
54
Marginal abruption often to as:
subchorionic hemorrhage
55
Most common placental hemorrhage identified with sonography, lies at the edge of the placenta:
marginal abruption, subchorionic hemorrhage
56
Maternal conditions that are linked to the development of placental abruption:
hypertension, preeclampsia, cocaine use, cigarette smoking, poor nutrition, and trauma
57
Clinically patients with placental abruption may present
vaginal bleeding, abdominal pain, uterine contractions, and uterine tenderness
58
Sonographic findings of placental abruption:
hematoma located wither at the edge of the placenta or between the placenta and the myometrium
59
Adherence of the placenta to the myometrium, loss of normal hypoechoic interface between the placenta and the myometrium :
Placenta accreta
60
Invasion of the placenta within the myometrium, loss of normal hypoechoic interface between the placenta and myometrium with invasion into the myometrium
placenta increta
61
Penetration of the placenta through the serosa and possibly into adjacent organs, loss of normal hypoechoic interface between the placenta and the myometrium with penetration beyond the serosa:
placenta percreta
62
With placenta percreta, the placenta can invade the urinary bladder and cause:
urinary complications
63
Clinical findings of placenta accreta, increta, and percreta:
previous c sectoin or uterine surgery, painless vaginal bleeding if placenta previa is present, possibly asymptomatic
64
Sonographic findings of placenta accreta, increta, and percreta:
placenta previa (frequently associated finding), Loss of the normal hypoechoic interface between the placenta and the myometrium
65
Most common placental tumor:
chorioangioma
66
Chorioangiomas are commonly asymptomatic but may produce an :
elevation in maternal serum alpha-fetaprotein
67
Most common location for chorioangiomas:
adjacent to the umbilical cord insertion site at the placenta
68
Larger chorioangiomas have been associated with:
polyhydramnios, IUGR, fetal hydrops
69
Sonogrpahically a chorioangioma will appear:
well circumscribed hypoechoic or hyperechoic mass within the placental substnace
70
AKA amniotic sheets, are linear bands of scar tissue within the uterus
uterine synechia(e)
71
Uterine synechia are the result of :
intrauterine adhesions, as seen with Asherman Syndrome
72
Sonographically a uterine synechia appears as:
linear echogenic band traversing the uterine cavity
73
Uterine synechia have veen assicaited with:
premature rupture of membranes, premature delivery, and placental abruption
74
The umbilical cord normally inserts into the :
middle of the placenta
75
The umbilical cord is surrounded by gelatinous material called
Wharton jelly
76
The cord develops from the fusion of the :
yolk stock and the Vitelline duct (omphalomesenteric duct)
77
The umbilical vein carries:
oxygenated blood from the placenta to the fetus
78
Umbilical vein enters the fetal abdomen and proceeds __________ to connect the LPV within the liver.
cephalad
79
The umbilical arteries enter the fetal abdomen and carry:
deoxygenated blood from the fetus to the placenta
80
The arteries once they enter the abdomen proceed _______ around the bladder to connect to the fetal internal iliac arteries.
caudal
81
The most common abnormality of the umbilical cord:
2VC
82
The umbilical cord normally inserts into the :
cental portion of the placenta
83
Abnormal cord insertions sites are described as either:
marginal or velamentous
84
The umbilical cord may be seen encircling the fetal neck this is termed:
nuchal cord
85
A mass that may be noted in the umbilical cord adjacent to the umbilical vessels, most often found found near the fetal abdomen and have been seen in connection with omphalocele and aneuploidy:
allantoic cyst
86
Focal dilation of the abdominal portion of the umbilical vein, a cystic appearing mass:
umbilical vein varix
87
Most common tumor of the umbilical cord:
hemangioma
88
Sonographic appearance of hemangiomas of the umbilical cord:
solid hyperechoic mass within the umbilical cord , most often noted close to the cord insertion into the placenta
89
Umbilical cord Doppler - the S/D ratio assess the:
vascular resistance in the placenta by taking a sample of the umbilical artery
90
Normally, the S/D ratio will ____ with advancing gestation.
decrease
91
An elevated S/D ratio is assocaited with:
increased placental resistance and an increase in the risk of perinatal mortality and morbidity
92
Absence or reversal of diastolic flow in the umbilical artery is considered :
irregular and is associated with increased incidence of IUGR and oligohydramnios
93
Echogenic debris in the amniotic fluid may be:
vernix or meconium
94
Important functions of the amniotic fluid:
protecting the fetus from trauma, temperature regulation, musculoskeletal maturity, and normal lung and GI development
95
In the second half of the pregnancy, what produces the majority of amniotic fluid:
fetal kidneys and lungs - urine being the greatest contributor
96
The maximum vertical pocket should contain:
no fetal parts or umbilical cord and measure at least 2 cm, with a normal range between 2-8 cm
97
For an AFI measurement the transducer must be placed:
perpendicular to the floor
98
When oligohydramnios is observed abnormalities of the ___________ should be suspected
urinary system
99
When polyhydramnios is observed abnormalities of the ________ should be suspected.
gastrointestinal system
100
An acronym that stands for toxoplasmosis, other infections, rubella, cytomegalovirus, and herpes simplex virus:
TORCH
101
Sonographic findings or TORCH:
Intracrainial calcifications, microcephaly, microopthalmia, ventriculomegaly, hepatosplenomegaly
102
Most common congenital infection:
cytomegalovirus
103
Fetal malformation and complications associated with oligohydramnios:
bilateral MCDK disease, bilateral renal agenesis, Infantile polycystic kidney disease, IUGR, PUV, PROM
104
Fetal malformations and complications associated with polyhydramnios:
Cardiac and/ or chest abnormalities, chromosomal abnormalities, duodenal atresia, esophageal atresia, gastroschisis, neural tube defects, omphalocele, Rh incompatibility, twin -twin transfusion syndrome
105
Children exposed to alcohol in utero have been shown to have an:
increase risk for growth restriction, mental impairment, physical abnormalities, immune dysfunction
106
Fetal alcohol syndrome has been cited as the most common cause of :
intellectual disability
107
Sonographic findings of fetal alcohol syndrome:
microcephaly, dysgenesis of the corpus callosum, long round philtrum, malformed ears, microphthalmia, cleft palate, heart defects such as VSD
108
IUGR is defined as EFW that is below:
10th percentile
109
IUGR typically results from the:
inadequate transfer of nutrients from the mother to the fetus, and thus is the dysfunction of the placenta
110
The fetus is at risk for IUGR if the mother suffers from:
chronic disease, drinks alcohol, smokes cigerettes, has poor nutrition, is younger than 17 or older than 35, or has a hx of previous pregnancies that were growth restricted
111
IUGR can be either:
symmetric - the entire fetus is small
| asymmetric - femur length is normal while all other measurements are small for gestation
112
Which measurement should be scrutinized closely in fetuses that are at risk for growth restrictions:
AC
113
Suspected causes of symmetric intrauterine growth restriction:
Genetic disorders, fetal infections, congenital malformations, syndromes
114
Suspected causes of asymmetric intrauterine growth restriction:
nutritional deficiency, oxygen deficiency
115
The right and left MCAs are branches of the:
anterior portion of the circle of willis
116
Doppler of the maternal uterine artery in an IUGR is normally taken :
the portion of the main uterine artery as it crosses over the external iliac artery
117
The normal flow pattern for a doppler of the uterine artery should be:
low resistance
118
The obese fetus is defined as a fetus that has an EFW of :
greater than 90th percentaile
119
The neonate that measures more than 4500g in nondiabetic mothers and 4000g in diabetic mothers:
macrosomnic
120
Mothers who are prone to have a macrosomnic fetus are those who suffer from:
diabetes
121
A macrosomnic fetus is predisposed to ______ secondary to fetal size, and have an increased risk of hypoglycemia and life long struggles of obesity.
shoulder dystocia
122
Translabial scanning is also referred to as :
transperineal scanning
123
Translabial scanning should be performed with:
empty maternal bladder
124
Painless dilation of the cervix in the second or early trimester:
cervical incompetence or incompetent cervix
125
________ is a result of the premature opening of the internal os and the subsequent bulging of the membranes into the dilated cervix
funneling
126
Patients who are at risk for cervical incompetence include:
those with uterine malformations, previous pregnancy loss in the second trimester, and intrauterine exposure to diethylstilbestrol
127
The assessment of cervical incompetence is the length measurement taken from:
the internal os to the external os
128
The cervical length should measure atleast:
3 cm
129
The shorter the cervical length the more likely the patient will suffer from:
preterm delivery
130
The treatment of an incompetent cervix is a:
cerclage
131
the two most commonly performed cerclage techniques are :
shirodkar and mcdonald
132
The suture of the cerclage may be seen during a follow-up examination and will appear:
echogenic structures within the cervix that may produce some posterior shadowing
133
Clinical findings of cervical incompetence:
painless dilation of the cervix, premature rupture of membranes, vaginal bleeding
134
Sonographic findings of cervical incompetence:
cervical length less than 3 cm, funneling of the cervix U or V shaped.
135
Occurs when there is an accumulation of fluid within at least two fetal body cavities:
fetal hydrops/ hydrops fetalis
136
Fluid can collect within the :
chest - pleural effusion, abdomen - ascites, or around the heart - pericardial
137
Hydrops may also be defined as:
anasarca
138
Fetal hydrops can be categorized as either :
immune or nonimmune
139
Immune hydrops is caused by:
absence of a detectable circulating fetal antibody against the red blood cells in the mother - resulting in incompatibility between the fetal maternal red blood cells
140
Incompatibility between the fetal and maternal RBCs, a condition known as:
erythroblastosis fetalis
141
Maternal Rh sensitization AKA Rh isoimmunization occurs when:
the mother has Rh-neg blood and the fetus has Rh-positive
142
The prevention of immune hydrops caused by Rh-sensitization is the administration of:
RhoGAM - at approximately 28 weeks gestation
143
When the fetus of a second pregnancy is Rh-positive and mother is Rh-neg the antibodies cross the placenta and begin to destroy the fetal RBCs resulting in:
fetal anemia, enlargement of fetal liver and spleen, and the accumulation of fluid within the fetal body cavities
144
A syndrome in which the mother suffers from edema and fluid build up similar to hydropic fetus:
mirror syndrome
145
Presence of pregnancy induced hypertension accompanied by proteinuria:
preeclampsia
146
Uncontrolled preeclampsia leads to:
eclampsia
147
Patients with eclampsia will have:
headaches and often suffer from convulsions
148
Patients that are at an increased risk for preeclampsia include:
advanced maternal age, diabetic patients, and those who have gestational trophoblastic disease
149
Sonographic findings of preeclampsia and eclampsia
oligohydramnios, IUGR, GTD, placental abruption, elevated S/D ratio
150
Clinical findings of preeclampsia:
maternal hypertension, maternal edema, maternal proteinuria
151
Clinical findings of eclampsia:
long-standing, uncontrolled preeclampsia, headaches, and seizures
152
Maternal diabetes can be described as:
pregestational diabetes, or gestational diabetes
153
_______ is the most common type of diabetes during pregnancy.
gestational diabetes
154
Women are screened for diabetes at the end of second trimester around:
26 weeks gestation
155
Major risk for the fetus of a mother with gestational diabetes is :
macrosomnia
156
Sonographically with gestational diabetes:
placenta may appear enlarged, there may be polyhydramnios, and the AC typically measures significantly larger than other measurements
157
Mothers with pregestational diabetes have a higher risk of:
miscarriage and toxemia, and the fetus has an increased risk for congenital anomalies, hypoglycemia, respiratory distress, perinatal mortality, and IUGR
158
The congenital anomalies most often encountered with pregestational diabetes include:
cardiac defects, neural tube defects, caudal regression syndrome, sirenomelia, and renal anomalies
159
Causes of nonimmune hydrops:
chorioangioma,CCAM, diaphragmatic hernia, fetal (nonimmune) anemia, fetal infections, idopathic, structural anomalies of the cardiac and lymphatic systems, trisomy 13, trisomy 18, trisomy 21, turner syndrome
160
A bladder flap hematoma may result from:
C section
161
A bladder flap hematoma can appear
anechoic although it most likely will appear as a complex mass greater than 2 cm
162
A bladder flap hematoma will be located:
adjacent to the scar between the LUS and the posterior bladder wall
163
Maternal hydronephrosis - Dilation of the renal collecting system is most often secondary to the :
large size of the uterus
164
The normal postpartum uterus returns to its nongravid size:
6-8 weeks after delivery
165
Excessive and sustained postpartum vaginal bleeding may be the result of:
retained products of conception
166
Sonographically retained products of conception may be seen as:
echogenic intracavitary mass that may contain some calcifications
color doppler signals within the retained placental tissue
167
Retained products of conception is treated typically with:
Dilation and curettage
