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Fall 2014 - OB II > High Risk Pregnancy ✔️ > Flashcards

High Risk Pregnancy ✔️ Flashcards

0
Q

describe 1st trimester testing

A

looks for pattern of biochemical markers associated with plasma protein A (PAPP-A)

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1
Q

maternal high risk factors

A 
advanced maternal age - AMA
abn maternal lab values
vaginal bleeding
insulin dependent diabetes mellitus
HTN
preeclampsia
maternal systemic disease
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2
Q

describe 2nd trimester screening

A

performed with maternal serum quad screen lab value and targeted US exam

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3
Q

quad screen looks at following serum markers:

A

AFP
HCG
uE3
inhibin-A

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4
Q

define hydrops fetalis

A

condition in which excessive fluid accumulates within fetal body cavities

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5
Q

2 classifications of fetal hydrops

A

immune hydrops

non-immune hydrops

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6
Q

what is hydrops fetalis associated with

A 
anasarca - massive edema
ascites
pericardial effusion
pleural effusion
placental edema
polyhydramnios
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7
Q

describe immune hydrops

A

results from fetomaternal blood group incompatibility

blood group isoimmunization

Rh isoimmunization

indicated by presence of maternal serum antibody acting again fetal RBC antigen - sensitization

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8
Q

immune hydrops (IHF) Rh sensitization:

A

Rh- mom

Rh+ fetus

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9
Q

describe Rh sensitization

A

antibodies attack RBC’s
fetal hemolysis
hemolytic anemia
cardiac output > eventually leads to hydrops & erythroblastosis fetalis

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10
Q

what may be needed if Rh sensitization is present

A

blood transfusion in utero

O- blood transfusedd into umbilical vein

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11
Q

immune hydrops - perinatal death rate for Rh-sensitized pregnancies is _____% to _____% before intrauterine transfusions performed

A

25-35

**perinatal death rate has decreased significantly with modern treatment and care

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12
Q

an Rh ______ father and an Rh ______ mother my conceive an Rh positive baby

A

positive father

negative mother

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13
Q

immune hydrops sonographically

A 
scalp edema
pleural effusion
pericardial effusion
ascites
polyhydramnios
thickened placental > 5 cm
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14
Q

what does the indirect coomb’s test check for

A

maternal Rh antibodies

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15
Q

immune hydrops - potential of fetal anemia can be determined by

A

US surveillance - doppler of MCA

amniocentesis

cordocentesis

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16
Q

immune hydrops is rare today dut to ______

A

RhoGam

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17
Q

describe alloimmune thrombocytopenia

A

rare

mother may develop immune response to fetal platelets in manner similar to that of RBC’s

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18
Q

describe nonimmune hydrops

A

not a result of fetomaternal blood group incompatibility

disorders - cardio, chromo, hematologic, urinary, pulmonary, twin pregnancies, infectious diseases

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19
Q

to make a diagnosis of NIH (nonimmune hydrops), isoimmunization ruled out with _______ _______

A

antibody screening

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20
Q

nonimmune hydrops statistics

A

1 in 1500 to 1 in 3800 pregnancies

accounts for 90% of all hydrops cases

accounts for 3% of fetal mortality

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21
Q

nonimmune hydrops sonographically

A 
scalp edema
pleural effusion
percardial effusion
ascites
cardiac abn's
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22
Q

bleeding in the 2nd and 3rd trimesters can be associated with what placental anomalies

A

placenta previa

placenta abruption

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23
Q

_______ _______ is the main cause for 3rd trimester bleeding

A

placenta previa

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24
describe placenta previa
placenta covers internal cervical os and prohibits vaginal delivery of fetus
25
______ ______ is a rare condition in which umbilical cord is presenting part
vasa previa
26
_______ ________ is used to evaluate any structures in front of the cervical os to see if vascular
color doppler
27
________ ________ may cause vaginal bleeding during pregnancy
placental abruption
28
describe placental abruption
hypoechoic and 1-2 cm thick thicker than 1-2 cm may be due to abruption or contraction contraction should resolve within 20-30 minutes - use color doppler
29
retroplacental area will look __________ due to large number of blood vessels present
hydoechoic **blood clots from abruption will not ehibit color flow
30
when sweeping with color doppler retroplacentally looking for flow void, if flow void is ________, be suspicious of abruption
present
31
2 categories of maternal diabetes
overt gestational
32
describe overt diabetes
prior to pregnancy (IDDM or NIDDM)
33
describe gestational diabetes
manifests during pregnancy (GDM)
34
anomalies in IDM's (infants of diabetic moms)
**CARDIAC - most common in occurance - transposition of great vessels and VSD single umbilical artery polyhydramnios IUGR - due to UPI secondary to vasc insufficiency thin placenta **Caudal Regression Syndrome - most exclusive anomaly of a diabetic mother
35
describe caudal regression syndrome
``` broad spectrum of findings: sacral agenesis** bowel renal bladder msk ```
36
gestational diabetes sono findings
macrosomia - > 4,000 g (> 9 lbs) increased plcental thickness - > 5 cm polyhydramnios
37
3 stages of hypertension
PIH - pregnancy induced HTN - younder moms chronic HTN (essential) HTN - older moms chronic HTN aggrevated by pregnancy
38
hypertension is associated with
small placentas preeclampsia - high HTN, proteinuria, edema severe preeclampsia - deliver immediately eclampsia - preeclampsia + seizures/coma = death
39
PIH (pregnancy induced hypertension) involves what 3 things...
preeclampsia severe preeclampsia eclampsia
40
describe supine hypotension syndrome
IVC is compressed > hypotension > mother feels nausated, dizzy, sweaty
41
describe systemic lupus erythematosus
chronic autoimmune disorder inflammatory responses in the placental vessels > incidence of spontaneous abortion & fetal death monitor fetus to r/o congential heart block & pericardial effusion incidence of spontaneous abortion and fetal death is 22%-49%
42
describe HELLP syndrome
Hemolysis Elevated Liver Enzymes Low Platelets Pre-eclampsia findings multisystemic ideopathic disorder > may lead to serious fetal compromise
43
describe hyperemesis gravidarum
vomiting - dehydration and electrolyte imbalance hospitalization with IV associated with H-mole and twin pregnancy
44
name 2 urinary tract diseases
pyelonephritis with flank pain hydronephrosis
45
example of an adnexal cysts
physiologic ovarian cysts
46
uterine fibroids can cause _______ and _______ _______
pain and premature labor
47
premature labor can be caused by
``` maternal illness epidemiologic factors class age weight/height smoking cervial injury coitus bleeding PROM infections multiple pregnancy ```
48
US assessment of preterm labor patient should include
``` amniotic fluid assesssment cervical assessment fetal number placental assessment targeted US ```
49
intrauterine fetal death accounts for roughtly ______ of all perinatal mortality
1/2
50
US findings associated with fetal death are
absent heart beat absent fetal movement overlap of skull bones (spalding's sign) exaggerated curvature of fetal spine; gas in fetal abd
51
multiple gestation pregnancy basics
fetus closest to internal os is A in 1st tri, if side by side, position may change document membrane separating the fetus - diamniotic gender is important cord doppler
52
what should be documented during an exam for multiple gestations
``` number of sacs number and location of placenta gender of fetuses biometry presence of anomalies ```
53
increased incidence and risk of multifetal pregnancy
incidence: due to older age of childbearing assisted reproductive technologies risk: IUGR, incompetent cx, premature delivery
54
clincal findings of multiple gestations
``` LGA abn quad screen 2 heart beats palpate 2 heads unsuspected ```
55
multiple gestation growth measurements
predictors of discordant growth EFW difference > 20% BPD difference of 6 mm AC difference of 20 mm FL difference of 5 mm
56
2 types of twinning
**dizygotic - 2 ova fertilized monozygotic - 1 ovum fertilized
57
describe dizygotic twins (fraternal)
``` 2 separately fertilized ova each ovum implants separately 2 placentas - may be fused 2 chorion/2 amnion NOT genetically identical diamniotic, dichorionic ```
58
describe monozygotic twins
single fertilized ovum divides | genetically identical fetuses - game gender
59
early division monozygotic twins
0-4 days 2 chorion and 2 amnion (DC/DA)
60
divison of monozygotic twins days 4-8
MOST COMMON 1 chorion and 2 amnion (MC/DA)
61
division of monozygotic twins after 8 days
1 chorion and 1 amnion (MC/MA)
62
division of monozygotic twins after 13 days
incomplete - conjoined twins (MC/MA)
63
2 placentas are called
dichorionic
64
1 placentas is called
monochorionic
65
Chorionicity/Amnionicity in relation to: twin peak sign or lambda thick membrane thinner membrane absence of membrane
twin peak sign or lambda - DC/DA thick membrane - DC/DA thinner membrane - MC/DA absence of membrane - MC/MA
66
describe twin to twin transfusion (TTS)
typically MC/DA due to A-V communication within the placenta
67
twin to twin transfusion donor and recipient
donor: severe IUGR oligohydramnios "stuck twin" recipient: polyhydramnios hydrops fetalis
68
describe poly-oli sequence (stuck twin)
poly in one sac (recipient) and oligo in the other sace (donor) 16-26 weeks gestation MC/DA
69
describe conjoined twins
incomplete division of the embryo after 13 days
70
types of conjoined twins
``` thoracopagus - thoras omphalopagus - anterior wall craniopagus - cranium pygopagus - ischial ischiopagus - buttocks ```
71
describe twin reversed arterial perfusion (trap)
must be monochorionic pregnancy vein to vein and artery to artery anastamosis one twin is acardiac and nonviable other twin normally formed twin is "pump" twin
72
describe fetus papyraceous
a fetus which dies in the 2nd trimester of pregnancy and becomes compressed and parchment-like

Fall 2014 - OB II (12 decks)

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