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High Risk Flashcards

1
Q

Who would have a high risk pregnancy?

A

Multiple gestation, immune/nonimmune hydrops, maternal disease, AMA, hx of anomalies

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2
Q

What increases the risk for complications in multiple pregnancies?

A
  • PEC
  • bleeding
  • prolapsed cord
  • large for dates
  • poly
  • premature birth
  • anomalies
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3
Q

How much greater is the risk for fetal death in multiple gestations?

A

five times greater

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4
Q

What percentage of twins end in a singleton pregnancy?

A

70%, many losses occur before it is known

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5
Q

What is monozygotic?

A

multiple gestations that occur from one fertilized ovum (zygote)- 1 ova, 1 sperm

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6
Q

What is dizygotic?

A

multiple gestations that occur from two fertilized ova- 2 ova, 2 sperm

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7
Q

What are dizygotic twins AKA?

A

fraternal, can be confirmed DI if opposite genders

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8
Q

How frequently do dizygotic twin pregnancies occur and what amount of twin pregnancies do they make up?

A

1 in 80 conceptions, 2/3 of all twins

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9
Q

How many chorions, amnions and placentas do dizygotic twins have?

A

2 of each

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10
Q

What are monozygotic twins AKA?

A

identical

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11
Q

If division occurs at the morula stage, what kind of pregnancy is it?

A

Dichorionic/diamniotic, 2 chorion, 2 amnion, 1-2 placentas

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12
Q

If division occurs at the blastocyst stage (1st week), what kind of pregnancy is it?

A

Mono/di, 1 chorion, 2 amnion, 1 placenta

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13
Q

If division occurs at the blastocyst stage (2nd week) what kind of pregnancy is it?

A

Mono/mono, 1 chorion, 1 amnion, 1 placenta

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14
Q

What happens if the embryonic disc divides after day 13?

A

conjoined twins

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15
Q

What are the clinical findings of multiples?

A
  • increased hCG
  • increased MSAFP
  • increased uterine size (large for dates)
  • embryonic or fetal reduction
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16
Q

What are maternal complications of multiples?

A
  • HTN
  • Preeclampsia/eclampsia
  • placental abruption
  • PP hemorrhage
  • preterm labor
  • anemia
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17
Q

What are fetal complications of multiple pregnancy?

A
  • prolapse, entanglement, compression
  • cord knots in mono/mono
  • IUGR due to placental insufficiency
  • hypoxia
  • increased risk of fetal anomalies
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18
Q

What is vanishing twin?

A

Demise of twin in late 1st or early 2nd tri, embryo and sac are absorbed

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19
Q

What can vanishing twin have a similar appearance to?

A

SCH

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20
Q

What is TTTS?

A

twin to twin transfusion syndrome, occurs in mono twins (mo/di or mo/mo)
abnormal development of vascular supply in shared placenta

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21
Q

TTTS is a form of what?

A

AVM, shunts blood away from donor twin to recipient twin, potentially morbid for both twins

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22
Q

How does TTTS appear sonographically?

A
  • 20% difference in fetal weights or AC
  • recipient: poly, large for dates, edema, hydrops
  • donor: oligo, small for dates, “stuck position”
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23
Q

What is twin embolization?

A

Blood clots or thromboplastic material from the demise of one fetus to the live fetus

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24
Q

How does twin embolization occur?

A

shared placental vascular supply

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25
Q

What are results of twin embolization?

A

Neurologic, GI, GU abnormalities

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26
Q

What is the sono app of twin embolization?

A
  • demise of one twin
  • hydrops
  • poly
  • intraplacental hemorrhage
  • abnormal cranial contents
  • enlarged, echogenic kidneys
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27
Q

What is acardiac twinning?

A

One twin has no vascular connection to placenta, umbilical arterial-arterial connection shunts blood from donor to “acardiac” twin

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28
Q

What is the result of acardiac twinning to the donor twin and the acardiac twin?

A

Donor: typically normal but with cardiomegaly, may develop heart failure & hydrops
Acardiac: multiple anomalies, no cardiac activity, may move and grow, anencephaly/microcephaly, cystic hygroma

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29
Q

What type of gestation does acardiac twinning occur in?

A

mono/mono only

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30
Q

What are conjoined twins?

A

incomplete division of embryonic disk after 13 days gestation

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31
Q

How are conjoined twins described?

A
  • thoracopagus: thoracic MC
  • omphalopagus: xiphoid to umbilicus
  • pyopagus: sacrum
  • ischiopagus: ischium/pelvis
  • craniopagus: cranium
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32
Q

What are the 4 possible combinations of twin deliveries?

A

Both vertex: vaginal
A vertex, B breech: OB decision, version is possible
A breech, B vertex: c-section
Both breech: c-section

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33
Q

What is hydrops fetalis?

A

Serious condition where fluid accumulates in 2 or more fetal compartments, immune or nonimmune

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34
Q

Nonimmune hydrops constitutes what percentage of hydrops cases?

A

90%

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35
Q

What causes nonimmune hydrops?

A

Disease or condition that affects body’s ability to manage fluid levels

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36
Q

What are the main causes of nonimmune hydrops?

A
  • anything other than Rh sensitivity
  • cardiac anomalies
  • infection
  • chromosomal abnormalities
  • TTTS
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37
Q

What is the sono appearance of nonimmune hydrops?

A
  • pericardial effusion (earliest sign), pleural effusion
  • ascites, poly
  • fetal skin thickening (anasarca) >5 mm
  • placental thickening
  • hepatosplenomegaly
  • enlarged umbilical vein
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38
Q

What is immune hydrops caused by?

A

Rh incompatibility
- Rh- mom, Rh+ dad= Rh+ fetus
- Destruction of RBC= erythroblastosis fetalis + anemia= hydrops

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39
Q

How is immune hydrops treated?

A
  • Fetal RBC only enter maternal circulation at delivery
  • RhoGam is given after each pregnancy to prevent antibody formation
40
Q

How can immune hydrops be determined sonographically?

A

MCA doppler is used to help determine fetal anemia & IUGR, high resistance waveform

41
Q

What are the causes of infertility for a minimum of 1 year?

A

Both: 5-10%
Unexplained: 5-10%
Male: 40%
Female: 40%

42
Q

What are female factors that can cause infertility?

A
  • abnormal ovulation & tubal transportation
  • endometriosis
  • myomas & uterine anomalies
  • PCOS
  • cervical factors
43
Q

What is IVF?

A

ovarian stimulation, needle aspiration or oocytes, incubation with sperm, catheter delivery of 2-4 embryos into uterus

44
Q

What is ZIFT?

A

zygote intrafallopian tube transfer, embryo (zygote) is placed into fallopian tube

45
Q

What is GIFT?

A

Gamete intrafallopian tube transfer, sperm and ova are placed into fallopian tube

46
Q

What is IUI?

A

intrauterine insemination, cases of male infertility, catheter guidance of sperm into fundal uterus

47
Q

What are complications of assisted reproductive technologies?

A

ovarian hyperstimulation syndrome and multiple gestations

48
Q

What is ovarian hyperstimulation syndrome?

A
  • results from excessive hormonal stimulation
  • mild cases: resolves with next cycle
  • severe: fluid/electrolyte imbalance, resulting in 50% mortality rate
  • large ovarian cysts, ascites, pleural effusion
49
Q

What is hyperemesis gravidarum?

A

Dehydration & electrolyte imbalance due to excessive vomiting, IV administration is necessary, more common with multiple fetuses

50
Q

What is supine hypovolemic syndrome? What does it cause?

A
  • IVC syndrome
  • large, heavy gravid uterus compresses IVC when pt is supine & decreases blood pressure
  • causes faintness, nausea, lightheadedness, sweating
51
Q

How do you counteract supine hypovolemic syndrome?

A

turn patient on side

52
Q

How does diabetes affect pregnancy?

A

insulin dependent diabetes = increased risk of complications, glucose drives fetal growth

53
Q

What is the result of high uncontrolled glucose levels?

A

macrosomia, fetal weight > 90th percentile or 4000g, too large for vaginal birth

54
Q

What can diabetes cause?

A

Poly- PROM & caudal regression syndrome

55
Q

What is gestational diabetes?

A

glucose intolerance during pregnancy, pathologically different than DM

56
Q

What causes GD?

A

hormone & metabolic changes, typically 3rd trimester occurrence associated with macrosomia

57
Q

What is hypertension in pregnancy associated with?

A

Associated with small placentas due to effects on blood vessels, restricts blood supply to fetus = growth restriction

58
Q

What is PIH?

A

Pregnancy-induced hypertension: Preeclampsia and chronic HTN

59
Q

What is preeclampsia?

A

High blood pressure develops with proteinuria or edema

60
Q

What is eclampsia?

A

seizures or coma

61
Q

What is HELLP syndrome?

A

hemolysis, elevated liver enzymes, low platelets

62
Q

What are infections affecting pregnancy?

A

TORCH:
- toxoplasmosis
- other (syphilis)
- rubella
- cytomegalovirus
- herpes (genital)

63
Q

What is Rh incompatibility?

A

Presence of Rh factor in blood, mother and fetus have different factors = maternal antibodies attack fetal blood

64
Q

What can be done to prevent Rh incompatibility?

A

Screening and preventative treatments

65
Q

What is erythroblastosis fetalis?

A

destruction of fetal RBCs by antibodies

66
Q

What causes erythroblastosis fetalis?

A
  • Rh incompatibility
  • ABO incompatibility
  • isoimmune disease
  • additional blood disorders
67
Q

What is IUGR?

A

spectrum of fetal weight below 10th percentile for GA, asymmetric & symmetric

68
Q

What are the most common causes of IUGR?

A
  • uterus
  • placenta & transfer rate
  • AFI
69
Q

What is symmetric IUGR?

A
  • 25% of cases
  • restriction affects entire fetus
  • genetic or maternal infection
  • occurs earlier
70
Q

What is the sono appearance of symmetric IUGR?

A
  • all measurements more than 2 weeks below GA
  • oligo
  • early mature placenta
  • low BPP score
71
Q

What is asymmetric IUGR?

A
  • 75% of cases
  • occurs in last 8-10 weeks
  • fetus attempts to protect the brain, receive nutrient blood first
72
Q

What is the sono appearance of asymmetric IUGR?

A
  • asymmetry between HC & AC >2 SD
  • AC > 2 wks behind HC
  • oligo
  • early mature placenta
73
Q

What are maternal causes of IUGR (3rd tri/asymm)?

A
  • poor nutrition
  • smoking, drug, alcohol abuse
  • multiple gest
  • severe anemia
  • diabetes
  • CKD
  • Rh sensitization
  • asthma
  • under 17, over 35
  • heart disease
  • high altitude
74
Q

What are placental causes of IUGR (3rd tri/asymm)?

A
  • infarcts & hemangiomas
  • small size
  • SUA
  • abruption
  • insufficiency
75
Q

What are fetal causes of IUGR (2nd tri/symm)?

A
  • genetic/chromosomal defects
  • intrauterine infections
76
Q

What can occur as a result of erythroblastosis fetalis?

A

CHF, hydrops, death

77
Q

What is amniotic band syndrome?

A

Early disruption of amnion, bands of non-stretchable tissue free floats in amniotic fluid and entrap fetal body parts

78
Q

What does amniotic band syndrome cause?

A
  • Limb defects: amputation, clubfeet, constriction ring/band, syndactyly
  • Craniofacial defects: asymmetric anencephaly, encephalocele, facial cleft, severe facial dysmorphia
  • Visceral defects: gastroschisis, ectopia cordis
79
Q

What is uterine rupture?

A

Spontaneous tearing of uterus caused by labor pressure & previous c scar, fetus is expelled into peritoneal cavity
results in hemorrhaging & mat-fetal death

80
Q

What is PROM?

A

spontaneous rupture of membranes prior to labor

81
Q

What is pre-term labor? What are risk factors for it?

A

Onset of labor prior to 37 wks
- previous uterine sx/ut anomalies
- multiple gestations
- smoking
- stress
- infection

82
Q

What are signs of fetal death within days of it occuring?

A
  • subcutaneous edema
  • unnatural position: extreme flexion/extension
  • Spaulding’s sign: overlapping of skull bones
  • loss of definition of fetal abdominal structures
  • Robert’s sign: gas within abdomen
  • Maceration: skin breaks down and appears as echoes within amniotic fluid
83
Q

What is the puerperal period?

A

Biochemical and physical changes beginning with expulsion of placenta and ending with maternal anatomy returning to non-gravid state

84
Q

How long does the puerperal period last?

A

4-6 wks after delivery

85
Q

What is the size of the PP uterus and how does it appear?

A

14x7x7cm, large, hypoechoic, fluid in endo, open internal os

86
Q

What is the most lethal complication of the puerperal period?

A

hemorrhage

87
Q

What constitutes hemorrhaging?

A

blood loss over 500 ml following vaginal delivery, over 1000 ml for c-section

88
Q

How can hemorrhaging be controlled?

A

Medication, manual compression of uterus, surg

89
Q

What are clinical signs of hemorrhage?

A

Shock, heavy bleeding, decreased hematocrit

90
Q

What is hemorrhage associated with?

A

RPOC, uterine atony, uterine overdistention, uterine manipulation

91
Q

What is the sonographic appearance of hemorrhage?

A

normal ut, expanded endo cavity

92
Q

When should an infection be questioned?

A

Fever over 100.4 any 2 out of first 10 days PP

93
Q

What causes PP infection and what is it associated with?

A

Pathogens introduced by vagina
Assoc. with:
- poor hygiene & nutrition
- anemia
- vaginitis/cervicitis
- invasive fetal monitoring devices
- c-section
- prolonged labor

94
Q

What is abscess and what causes it?

A

Localized collection of pus, serous fluid anywhere in abdominal or pelvic cavities, causes by predisposing factors of infection

95
Q

What is the sonographic appearance of abscess?

A
  • complex/anechoic fluid collection
  • internal debris
  • shadowing when gas is present
96
Q

What is hematoma? What is the most common location?

A

Occurs from excessive bleeding, post-op for c-section
Bladder flap hematoma is MC, located between uterus & posterior bladder wall

97
Q

What is ovarian vein thrombosis and what is it caused by?

A

Clotting of ovarian/iliac vein PP caused by injury during labor to vessels & vascular changes due to pregnancy

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