1
Q
what is spine hypotensve syndrome?
A
a temporary acute disorder due to compression of the IVC by the weight of the pregnant uterus
2
Q
how is spine hypotensive syndrome detected?
A
when a pregnant women feel faint while laying on her back
3
Q
what are risk factors for hypertensive disorders?
A
- chronic hypertension
- diabetis mellitus
- multiple pregnancy
- chronic renal disease
4
Q
what is chronic hypertension?
A
blood pressure 140/90 mmHg or greater prior to pregnancy in the absence of hydatiform molemole or hypertension that persists for more than 42 days postpartum.
5
Q
what are most affected in preeclampsia?
A
- kidney
- liver
- hematologic system
6
Q
what are significant fetal complications associated with hypertensive disorders?
A
- IUGR
- hypoxia (fetal distress)
- fetal dealth
- placenta in severe hypertensive disease may be small or prematurely calcified
7
Q
what is the clinical classification of hypertensive disorders?
A
- chronic hypertension
- pregnancy-induced hypertension
- preclampsia
- eclampsia
- HELLP syndrome
8
Q
what is an abnormal doppler waveform in hypertensive patients?
A
- early diastolic notch
- reduced end diastolic flow resulting in high pulsatility index
- high resistive index
- RI above 95th percentile for GA
9
Q
what are the 3 common types of gestational hypertension?
A
- chronic hypertension
- gestational hypertension
- preeclampsia
10
Q
what is hypertension define as?
A
systolic >140mmHg
diastolic >90mmHg
11
Q
what may increase the risk of developing gestational hypertension?
A
- first time mom
- fam history
- multiple gestation
- younger than 20 or older than 40
- high blood pressure or kidney disease prior to pregnancy
12
Q
what are the signs and symptoms of pregnancy induce hypertension?
A
- blood pressure over 140/90
- proteinuria >5gm/24 hours
- oliguria (small amounts of urine)
- edema
- weight gain
- headaches, visual disturbance
13
Q
what is preeclampsia?
A
term describing hypertension with proteinuria, generalized edema, or both
14
Q
what are some symptoms of preclampsia?
A
oliguria, cerebral or visual disturbances (headache, blurred vision)
15
Q
what is associated with mild preeclampsia?
A
- HBP
- water retention
- protein in the urine
16
Q
what is associated with severe preeclampsia?
A
- headaches
- blurred vision
- inability to tolerate bright light
- fatigue
- nausea/vomiting
- urinating small amounts
- RUQ pain
- shortness of breath
- tendency to bruise easily
17
Q
what is eclampsia?
A
development of seizure or coma without an underlying neurologic or febrile origin (epilepsy or systemic infection) in a patient with preeclampsia
18
Q
what is hellp an accronym for?
A
Hemolysis
ELevated liver enzymes
Low Platelets
19
Q
what are complications associated with hellp?
A
- acute renal failure
- hepatic rupture
- adult respiratory distress syndrome
- disseminated intravascular coagulation
20
Q
what is diabetes mellitus?
A
medical disease that leads to hyperglycemia and glycosuria as the hyperglycemia increases
21
Q
what is the classification of diabetes?
A
- insulin-dependant diabestis
- non-insulin-depandant diabetis
- gestational diabetis
- impaired glucose tolerance
- diabetis associated with certain known conditions and symptoms
22
Q
what is insulin dependant diabetis (type 1)?
A
the deficiency of insulin accelerates the break down of the body’s reserve of fat resulting in the production of organic acids called ketones
23
Q
what are the complications of diabetes mellitus?
A
- loss of vision due to cataracts
- severe kidney disorders
24
Q
what is the most common diabetis?
A
Non-insulin-dependant diabetis
25
which diabetes is associated with obesity?
non-insulin-dependant diabetes
26
how is diabettis controlled?
mild and the high glucose levels in the blood can usually be controlled by diet alone or with anti-diabetic drugs
27
what are risk factors of Gestational diabetes?
- strong family history
- fasting glycosuria (glucose in urine)
- previous unexplained prenatal loss
- preious large for dates infant
- previous gestational diabetis and maternal obesity
28
what are the maternal risks of diabetis mellitus?
- preeclampsia and eclampsia in patients with vascular disease
- infection (acute pyelonephritis)
- fetal macrosomia
- C-section
- risk of pre term labour
- post pardum hemorrhage
29
what are the fetal risks of diabetis mellitus?
intrauterine demise
- perinatal morbidity
- IUGR in patients with vascular disease
- fetal congenital anomalies
30
what are the most common fetal anomalies with diabetes mellitus?
- caudal regression syndrome
- situs inversus
- holoprosencephaly
- renal anomalies
- duplex kidney
- renal agenesis
31
what are the cardiac anomalies that may happen with diabetis?
- VSD, ASD (most common)
| - transposition of the great vessels
32
what are the neural tube defects with diabetis mellitus?
- ancephalocele
| - meningomyelocele
33
why may ultrasound in diabetic pregnancy be helpful?
assess:
- macrosomia
- polyhydramnois
- IUGR
34
what may happen to the urinary system during pregnancy?
dilation of renal collecting system (hydronephrosis) from compression of enlarging uterus
35
what urinary tract infection besides hydronephrosis is common?
ureteral reflux is common
36
what are the ultrasound findings associated with acute pyelonephritis?
- renal enlargment
- generalized decrease in echogenicity of the cortex and medulla
- decreased sound attenuation due to increased fluid content of the edematous inflamed kidney
37
what is ultrasound most valuable to assess in the biliary system?
- extrahepatic biliary tree for obstruction
- cholelithiasis/acute cholecystitis
- pregnancy increases the risk of cholelthiasis and cholecystitis
38
what does budd-chiari syndrome do to other places in the body?
- abdominal pain
- acites
- hepatosplenomegaly
- porta hypertension
39
what are harmful infections known as in pregnancy?
TORCH
40
what does TORCH stand for?
```
Toxoplasmosis
Others
-syphillis
-varicella or chicken pox
-parovirus B19 infection
-hepatitis B
Rubella
Cytomegalovirus
Herpes simplex
```
41
when does toxoplasmosis usually occur?
third trimester
42
in severe toxoplasmosis, what is the classic triad of anomalies?
- chorioentinitis
- hydrocephaly or microcephaly
- cerebral calcification
43
what may hydrops be associated with?
fetal infection
44
what is maternal infection occuring in the 1st trimester not associated with?
fetal disease
45
When Rubella infections occur in the first month of pregnancy, there is a________chance of congenital anomalies.
50%
46
what is important in rubella virus (german measles)?
timing of the infection
47
what happens if rubulla virus occurs in week 6?
catacract
48
what happens if rubulla virus occurs in week 7?
deafness
49
having rubella infection in the first 3 months increases the risk of what?
having a misscariage
50
what are associations associated with cytomegalovirus?
- hydrops
- microcephaly
- hydrocephaly
- chorioetinitis
- hepatosplenomagaly
- cerebral calcification
- mental retardation
- heart block
- petechia
51
what are the congenital anomalies associated with herpes simplex virus?
- microcephaly
- chorioentintis
- cerebral calcification
- microphthalmia (one or both eyeballs are abnormally small)
- encephalitis
52
what is the definition of preterm labour?
regular uterine contractions that cause progressive dilation of the cervix BEFORE 37 weeks gestation
53
what are the main complications of preterm labour?
- prematurity
| - associated neonatal complications
54
Arrestation of preterm labour is contraindicated in the presence of any of the following conditions:
- fetal maturity is indicated
- fetal demise
- fetal anomaly incompatible with life
- fetal distress
- active bleeding associated with moderate or severe placental abruption or placenta previa
- chorioamniotitis
- severe preeclampsia
55
what are the ultrasound results indicating preterm delivery?
- cervical length <25 mm=shortnened cervix
| - funneling of internal os >5mm before 30weeks
56
what are postpardum complications?
- uterine bleeding
- uterine atony
- lacerations
- retained placental fragments
- inversion of the uterus
- placenta accreta
- uterine infection
57
what is uterine entrapment syndrome?
acute problem of early pregnancy due to pelvic entrapment of a retroverted or retroflexed uterus
58
what are the symtoms of uterine entrapment syndrome?
- pelvic pain
- back ache
- urethra is compressed and elongated causing urinary frequency and infection
59
what is the prognosis of uterine entrapment syndrome?
spontaneous correction between the 9th and 12th weeks
60
how can uterine entrapment syndrome be fixed?
manual compression
61
amniocentesis permits safe access to the fluid avoiding what?
- fetus
- umbilical cord
- large uterine blood vessels
- placenta
62
how do we know if needle traverses the placenta in amniocentesis?
blood is streaming from the placenta into amniotic fluid as soon as needle is removed
63
what are the indications of an amniocentesis?
- assess the risk of open neural defect
- assess the risk of down syndrome
- checking for fetal lung maturity is most common indication in 3rd trimester
- checking for fetal hemoglobin breakfdown products in cases of suspected hemolysis due to maternal antibodies to fetal blood
64
what are the risks of an amniocentesis?
- amniotic fluid leak
- chorioamnionitis
- unexplained post-procedure fetal demise
- pregnancy loss rate after second trimester amniocentesis has been estimated to be approx 0.4%
65
when is amniocenteisis preformed?
16 week pregnancy
66
what can amniocentesis provide information about?
- neural tube defects
- blood type of fetus
- genetic disorders (sickle cell)
- fetal infection
- readiness of fetus's lungs to live outside of uterus
67
does CVS disturb amniotic sac?
no
68
where are samples from CVS sent?
lab for genetic analysis
69
what is the purpose of CVS?
- assess fetal karyotype
- biochemical test of fetal cells for evaluation of disease status
- detects gentic disorders
70
when is CVS preformed?
10-13 weeks
71
what is the indication of CVS?
more quickly than amniocentesis. can detect chromosomal abnormalities and can see if termination is needed
72
is pregnancy loss higher with CVS or amniocentesis?
CVS
73
what is mosaicism?
when an organism has two genetically distinct cell lines derived from a single fertilization
74
what are contraindications for a CVS?
- placenta problems
- history of premature labour
- incompetent cervix
75
what is another name for PUBS?
cordocentesis
76
what is PUBS?
A diagnostic test that examines blood from the fetus to detect fetal abnormalities
77
when is cordocentesis preformed?
17 weeks into pregnancy
78
where should the puncture be made in posterior placenta?
1-2 cm from the placenta insertion site of cord
79
what does PUBS detect?
chromosome abnormalities
| blood disorders
80
what disorders can cordocentesis detect?
- malformation of the fetus
- fetal infection
- fetal platelet count in the mother
- fetal anemia
- isoimmunisation
81
what is fetoscopy?
endoscopic procedure during pregnancy to allow access to the fetus, the amniotic cavity, the umbilical cord, and the fetal side of the placenta
82
what 3 conditions use fetoscopy?
- twin to twin trasfusion
- amniotic band syndrome
- congenital diaphragmatic hernia
Abnormal OB
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