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Chapters 30-32 > Fetal Environment and Maternal Complications > Flashcards

Fetal Environment and Maternal Complications Flashcards

1
Q

The placenta normally weighs :

A

450-550 g

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2
Q

the placenta has a diameter of :

A

16-20 cm

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3
Q

Maternal contribution of the placenta:

A

decidua basalis is the endometrium beneath the developing placenta

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4
Q

The chorion frondosum is the portion derived from:

A

blastocyst and contains the chorionic villi

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5
Q

The fetal contribution of the placenta

A

chorion frondosum

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6
Q

The placenta consists of approximately 10-30 _______ which are groups or lobes of chroinic villi:

A

cotyledons

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7
Q

The placenta produces _______ which maintains the corpus luteum of the ovary.

A

hCG

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8
Q

Major function of the placenta:

A

acts as excretory organ for the fetus

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9
Q

In later pregnancy the placenta also produces :

A

estrogen and progesterone

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10
Q

The placenta effectively becomes the means of:

A

respiration for the fetus

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11
Q

The definitive placenta may not be identified sonographically until after:

A

10-12 weeks

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12
Q

The placenta consists of 3 parts:

A

chorionic plate, the placental substance, the basal layer or basal plate

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13
Q

The chorionic plate is the element of the placenta _______ to the fetus.

A

closest

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14
Q

The basal layer is :

A

the area adjacent to the uterus

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15
Q

Functions of the placenta:

A

gas transfer, excretory function, water balance, pH maintenance, hormone production, defensive barrier

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16
Q

The placental substance:

A

contains the functional parts of the placenta, and is located between the chorionic plate and the basal layer

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17
Q

Venous lakes aka:

A

maternal lakes or placental lakes

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18
Q

Pools of maternal blood within the placental substance are termed:

A

venous lakes, maternal lakes, placental lakes

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19
Q

How do venous lakes appear:

A

anechoic or hypoechoic areas, may contain swirling blood.

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20
Q

________ placenta consists of two separate discs of equal size

A

bilobed

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21
Q

________ placenta, which are additional smaller lobes located separate from the main segment of the placenta.

A

succenturiate lobe / accessory lobe

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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

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23
Q

A circumvallate placenta may lead to:

A

vaginal bleeding and placental abruption, among other complications

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24
Q

The thickness of the placenta should be evaluated and not exceed:

A

4 cm

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25
Q

Thick or large placenta are termed:

A

placentomegaly

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26
Q

A thin placenta are associated with:

A

maternal and or fetal abnormalities

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27
Q

Uninterrupted chorionic plate and homogeneous placental substance (what grade placenta)

A

grade 0

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28
Q

Subtle indentations on the chorionic plate, with some small calcifications within the placental substance (what grade placenta)

A

Grade 1

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29
Q

Moderate indentations in the chorionic plate with “comma-like” calcification in the placental substance (what grade placenta)

A

Grade 2

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30
Q

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)

A

Grade 3

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31
Q

Implantation of the placenta may occur within the LUS this will often lead to :

A

placenta previa

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32
Q

Placenta previa is evident when the placenta:

A

covers the internal os of the cervix

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33
Q

Placenta previa is a common cause of:

A

painless vaginal bleeding in the 2nd and 3rd trimesters`

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34
Q

Placenta previa is discovered more often in women with a history of:

A

multiparity, advanced maternal age, previous abortion, and prior cesarean section

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35
Q

Possible causes of a thick placenta :

A

diabetes mellitus, maternal anemia, infection, fetal hydrops, rh isoimmunization, multiple gestation

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36
Q

Possible causes of a thin placenta:

A

diabetes mellitus (long standing), Intrauterine growth restriction, placental insufficiency, polyhydramnios, preeclampsia, small for dates fetus

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37
Q

Placenta previa is not routinely diagnosed until:

A

late 2nd or third trimester

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38
Q

The placenta should be evaluated for placenta previa after:

A

20 weeks with an empty maternal bladder

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39
Q

False positive placenta previa can be caused by:

A

Fully distended bladder, painless myometrial contractions that can occur in the LUS

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40
Q

Placenta covers the internal os completely:

A

complete previa (total)

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41
Q

Placenta partially covers the internal os:

A

partial previa

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42
Q

Placenta lies at the edge of the internal os:

A

marginal previa

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43
Q

Placental edge extends into the LUS but ends more than 2 cm away from the internal os:

A

low-lying previa

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44
Q

The complication of fetal vessels resting over the internal os of the cervix is referred to as:

A

Vasa previa

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45
Q

With Vasa Previa vessels are prone to rupture as the cervix dilates, this can lead to :

A

exsanguination of the fetus

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46
Q

Total blood loss; to bleed out

A

exsanguination

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47
Q

Vasa previa is often associated with:

A

velamentous cord insertion and possible a succenturiate lobe

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48
Q

Sonographic findings of vasa previa

A

identification of vessels over the internal os of the cervix with the use of color doppler, velamentous cord insertion

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49
Q

Premature separation of the placenta from the uterine wall before the birth of the fetus, causing hemorrhage:

A

Placental abruption

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50
Q

The most severe type of abruption:

A

complete abruption

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51
Q

A complete abruption often results in the development of a :

A

retroplacental hematoma

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52
Q

retroplacental hematoma is located :

A

between the placenta and the myometrium

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53
Q

Partial abruption often results in only:

A

a few cm of separation

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54
Q

Marginal abruption often to as:

A

subchorionic hemorrhage

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55
Q

Most common placental hemorrhage identified with sonography, lies at the edge of the placenta:

A

marginal abruption, subchorionic hemorrhage

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56
Q

Maternal conditions that are linked to the development of placental abruption:

A

hypertension, preeclampsia, cocaine use, cigarette smoking, poor nutrition, and trauma

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57
Q

Clinically patients with placental abruption may present

A

vaginal bleeding, abdominal pain, uterine contractions, and uterine tenderness

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58
Q

Sonographic findings of placental abruption:

A

hematoma located wither at the edge of the placenta or between the placenta and the myometrium

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59
Q

Adherence of the placenta to the myometrium, loss of normal hypoechoic interface between the placenta and the myometrium :

A

Placenta accreta

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60
Q

Invasion of the placenta within the myometrium, loss of normal hypoechoic interface between the placenta and myometrium with invasion into the myometrium

A

placenta increta

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61
Q

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:

A

placenta percreta

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62
Q

With placenta percreta, the placenta can invade the urinary bladder and cause:

A

urinary complications

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63
Q

Clinical findings of placenta accreta, increta, and percreta:

A

previous c sectoin or uterine surgery, painless vaginal bleeding if placenta previa is present, possibly asymptomatic

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64
Q

Sonographic findings of placenta accreta, increta, and percreta:

A

placenta previa (frequently associated finding), Loss of the normal hypoechoic interface between the placenta and the myometrium

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65
Q

Most common placental tumor:

A

chorioangioma

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66
Q

Chorioangiomas are commonly asymptomatic but may produce an :

A

elevation in maternal serum alpha-fetaprotein

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67
Q

Most common location for chorioangiomas:

A

adjacent to the umbilical cord insertion site at the placenta

68
Q

Larger chorioangiomas have been associated with:

A

polyhydramnios, IUGR, fetal hydrops

69
Q

Sonogrpahically a chorioangioma will appear:

A

well circumscribed hypoechoic or hyperechoic mass within the placental substnace

70
Q

AKA amniotic sheets, are linear bands of scar tissue within the uterus

A

uterine synechia(e)

71
Q

Uterine synechia are the result of :

A

intrauterine adhesions, as seen with Asherman Syndrome

72
Q

Sonographically a uterine synechia appears as:

A

linear echogenic band traversing the uterine cavity

73
Q

Uterine synechia have veen assicaited with:

A

premature rupture of membranes, premature delivery, and placental abruption

74
Q

The umbilical cord normally inserts into the :

A

middle of the placenta

75
Q

The umbilical cord is surrounded by gelatinous material called

A

Wharton jelly

76
Q

The cord develops from the fusion of the :

A

yolk stock and the Vitelline duct (omphalomesenteric duct)

77
Q

The umbilical vein carries:

A

oxygenated blood from the placenta to the fetus

78
Q

Umbilical vein enters the fetal abdomen and proceeds __________ to connect the LPV within the liver.

A

cephalad

79
Q

The umbilical arteries enter the fetal abdomen and carry:

A

deoxygenated blood from the fetus to the placenta

80
Q

The arteries once they enter the abdomen proceed _______ around the bladder to connect to the fetal internal iliac arteries.

A

caudal

81
Q

The most common abnormality of the umbilical cord:

A

2VC

82
Q

The umbilical cord normally inserts into the :

A

cental portion of the placenta

83
Q

Abnormal cord insertions sites are described as either:

A

marginal or velamentous

84
Q

The umbilical cord may be seen encircling the fetal neck this is termed:

A

nuchal cord

85
Q

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:

A

allantoic cyst

86
Q

Focal dilation of the abdominal portion of the umbilical vein, a cystic appearing mass:

A

umbilical vein varix

87
Q

Most common tumor of the umbilical cord:

A

hemangioma

88
Q

Sonographic appearance of hemangiomas of the umbilical cord:

A

solid hyperechoic mass within the umbilical cord , most often noted close to the cord insertion into the placenta

89
Q

Umbilical cord Doppler - the S/D ratio assess the:

A

vascular resistance in the placenta by taking a sample of the umbilical artery

90
Q

Normally, the S/D ratio will ____ with advancing gestation.

A

decrease

91
Q

An elevated S/D ratio is assocaited with:

A

increased placental resistance and an increase in the risk of perinatal mortality and morbidity

92
Q

Absence or reversal of diastolic flow in the umbilical artery is considered :

A

irregular and is associated with increased incidence of IUGR and oligohydramnios

93
Q

Echogenic debris in the amniotic fluid may be:

A

vernix or meconium

94
Q

Important functions of the amniotic fluid:

A

protecting the fetus from trauma, temperature regulation, musculoskeletal maturity, and normal lung and GI development

95
Q

In the second half of the pregnancy, what produces the majority of amniotic fluid:

A

fetal kidneys and lungs - urine being the greatest contributor

96
Q

The maximum vertical pocket should contain:

A

no fetal parts or umbilical cord and measure at least 2 cm, with a normal range between 2-8 cm

97
Q

For an AFI measurement the transducer must be placed:

A

perpendicular to the floor

98
Q

When oligohydramnios is observed abnormalities of the ___________ should be suspected

A

urinary system

99
Q

When polyhydramnios is observed abnormalities of the ________ should be suspected.

A

gastrointestinal system

100
Q

An acronym that stands for toxoplasmosis, other infections, rubella, cytomegalovirus, and herpes simplex virus:

A

TORCH

101
Q

Sonographic findings or TORCH:

A

Intracrainial calcifications, microcephaly, microopthalmia, ventriculomegaly, hepatosplenomegaly

102
Q

Most common congenital infection:

A

cytomegalovirus

103
Q

Fetal malformation and complications associated with oligohydramnios:

A

bilateral MCDK disease, bilateral renal agenesis, Infantile polycystic kidney disease, IUGR, PUV, PROM

104
Q

Fetal malformations and complications associated with polyhydramnios:

A

Cardiac and/ or chest abnormalities, chromosomal abnormalities, duodenal atresia, esophageal atresia, gastroschisis, neural tube defects, omphalocele, Rh incompatibility, twin -twin transfusion syndrome

105
Q

Children exposed to alcohol in utero have been shown to have an:

A

increase risk for growth restriction, mental impairment, physical abnormalities, immune dysfunction

106
Q

Fetal alcohol syndrome has been cited as the most common cause of :

A

intellectual disability

107
Q

Sonographic findings of fetal alcohol syndrome:

A

microcephaly, dysgenesis of the corpus callosum, long round philtrum, malformed ears, microphthalmia, cleft palate, heart defects such as VSD

108
Q

IUGR is defined as EFW that is below:

A

10th percentile

109
Q

IUGR typically results from the:

A

inadequate transfer of nutrients from the mother to the fetus, and thus is the dysfunction of the placenta

110
Q

The fetus is at risk for IUGR if the mother suffers from:

A

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
Q

IUGR can be either:

A

symmetric - the entire fetus is small

asymmetric - femur length is normal while all other measurements are small for gestation

112
Q

Which measurement should be scrutinized closely in fetuses that are at risk for growth restrictions:

A

AC

113
Q

Suspected causes of symmetric intrauterine growth restriction:

A

Genetic disorders, fetal infections, congenital malformations, syndromes

114
Q

Suspected causes of asymmetric intrauterine growth restriction:

A

nutritional deficiency, oxygen deficiency

115
Q

The right and left MCAs are branches of the:

A

anterior portion of the circle of willis

116
Q

Doppler of the maternal uterine artery in an IUGR is normally taken :

A

the portion of the main uterine artery as it crosses over the external iliac artery

117
Q

The normal flow pattern for a doppler of the uterine artery should be:

A

low resistance

118
Q

The obese fetus is defined as a fetus that has an EFW of :

A

greater than 90th percentaile

119
Q

The neonate that measures more than 4500g in nondiabetic mothers and 4000g in diabetic mothers:

A

macrosomnic

120
Q

Mothers who are prone to have a macrosomnic fetus are those who suffer from:

A

diabetes

121
Q

A macrosomnic fetus is predisposed to ______ secondary to fetal size, and have an increased risk of hypoglycemia and life long struggles of obesity.

A

shoulder dystocia

122
Q

Translabial scanning is also referred to as :

A

transperineal scanning

123
Q

Translabial scanning should be performed with:

A

empty maternal bladder

124
Q

Painless dilation of the cervix in the second or early trimester:

A

cervical incompetence or incompetent cervix

125
Q

________ is a result of the premature opening of the internal os and the subsequent bulging of the membranes into the dilated cervix

A

funneling

126
Q

Patients who are at risk for cervical incompetence include:

A

those with uterine malformations, previous pregnancy loss in the second trimester, and intrauterine exposure to diethylstilbestrol

127
Q

The assessment of cervical incompetence is the length measurement taken from:

A

the internal os to the external os

128
Q

The cervical length should measure atleast:

A

3 cm

129
Q

The shorter the cervical length the more likely the patient will suffer from:

A

preterm delivery

130
Q

The treatment of an incompetent cervix is a:

A

cerclage

131
Q

the two most commonly performed cerclage techniques are :

A

shirodkar and mcdonald

132
Q

The suture of the cerclage may be seen during a follow-up examination and will appear:

A

echogenic structures within the cervix that may produce some posterior shadowing

133
Q

Clinical findings of cervical incompetence:

A

painless dilation of the cervix, premature rupture of membranes, vaginal bleeding

134
Q

Sonographic findings of cervical incompetence:

A

cervical length less than 3 cm, funneling of the cervix U or V shaped.

135
Q

Occurs when there is an accumulation of fluid within at least two fetal body cavities:

A

fetal hydrops/ hydrops fetalis

136
Q

Fluid can collect within the :

A

chest - pleural effusion, abdomen - ascites, or around the heart - pericardial

137
Q

Hydrops may also be defined as:

A

anasarca

138
Q

Fetal hydrops can be categorized as either :

A

immune or nonimmune

139
Q

Immune hydrops is caused by:

A

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
Q

Incompatibility between the fetal and maternal RBCs, a condition known as:

A

erythroblastosis fetalis

141
Q

Maternal Rh sensitization AKA Rh isoimmunization occurs when:

A

the mother has Rh-neg blood and the fetus has Rh-positive

142
Q

The prevention of immune hydrops caused by Rh-sensitization is the administration of:

A

RhoGAM - at approximately 28 weeks gestation

143
Q

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:

A

fetal anemia, enlargement of fetal liver and spleen, and the accumulation of fluid within the fetal body cavities

144
Q

A syndrome in which the mother suffers from edema and fluid build up similar to hydropic fetus:

A

mirror syndrome

145
Q

Presence of pregnancy induced hypertension accompanied by proteinuria:

A

preeclampsia

146
Q

Uncontrolled preeclampsia leads to:

A

eclampsia

147
Q

Patients with eclampsia will have:

A

headaches and often suffer from convulsions

148
Q

Patients that are at an increased risk for preeclampsia include:

A

advanced maternal age, diabetic patients, and those who have gestational trophoblastic disease

149
Q

Sonographic findings of preeclampsia and eclampsia

A

oligohydramnios, IUGR, GTD, placental abruption, elevated S/D ratio

150
Q

Clinical findings of preeclampsia:

A

maternal hypertension, maternal edema, maternal proteinuria

151
Q

Clinical findings of eclampsia:

A

long-standing, uncontrolled preeclampsia, headaches, and seizures

152
Q

Maternal diabetes can be described as:

A

pregestational diabetes, or gestational diabetes

153
Q

_______ is the most common type of diabetes during pregnancy.

A

gestational diabetes

154
Q

Women are screened for diabetes at the end of second trimester around:

A

26 weeks gestation

155
Q

Major risk for the fetus of a mother with gestational diabetes is :

A

macrosomnia

156
Q

Sonographically with gestational diabetes:

A

placenta may appear enlarged, there may be polyhydramnios, and the AC typically measures significantly larger than other measurements

157
Q

Mothers with pregestational diabetes have a higher risk of:

A

miscarriage and toxemia, and the fetus has an increased risk for congenital anomalies, hypoglycemia, respiratory distress, perinatal mortality, and IUGR

158
Q

The congenital anomalies most often encountered with pregestational diabetes include:

A

cardiac defects, neural tube defects, caudal regression syndrome, sirenomelia, and renal anomalies

159
Q

Causes of nonimmune hydrops:

A

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
Q

A bladder flap hematoma may result from:

A

C section

161
Q

A bladder flap hematoma can appear

A

anechoic although it most likely will appear as a complex mass greater than 2 cm

162
Q

A bladder flap hematoma will be located:

A

adjacent to the scar between the LUS and the posterior bladder wall

163
Q

Maternal hydronephrosis - Dilation of the renal collecting system is most often secondary to the :

A

large size of the uterus

164
Q

The normal postpartum uterus returns to its nongravid size:

A

6-8 weeks after delivery

165
Q

Excessive and sustained postpartum vaginal bleeding may be the result of:

A

retained products of conception

166
Q

Sonographically retained products of conception may be seen as:

A

echogenic intracavitary mass that may contain some calcifications
color doppler signals within the retained placental tissue

167
Q

Retained products of conception is treated typically with:

A

Dilation and curettage

Chapters 30-32 (3 decks)

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