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FALL 2014 OB > High Risk Pregnancy > Flashcards

High Risk Pregnancy Flashcards

0
Q

What are the screening tests for high risk?

A

first trimester: looks for the pattern of biochemical markers assoc with plasma protein A (PAPP-A) and free beta-hCG3

Second trimester screening: performed with maternal serum quad screen lab value and targeted ultrasound exam

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1
Q

What are the factors for a high risk pregancy?

A

advanced maternal age (AMA)

abnormal maternal lab values

vaginal bleeding

insulin-dependent diabetes mellitus (IDDM)

hypertension

preeclampsia

maternal systemic disease

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2
Q

what is hydrops fetalis?

A

condition in which excessive fluid accumulates within fetal body cavities

Immune hydrops and non-immune hydrops

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3
Q

What is the Indirect combs test

A

checks for maternal antibodies

prevents antibody production

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4
Q

What is anasarca?

A

skin edema

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5
Q

What is the cutoff for pericardial effusion?

A

2-3 mm

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6
Q

what is VSD?

A

ventricular septum defect

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7
Q

What are the quad screen markers?

A

alpha-fetoprotein (AFP)

Human chorionic gonadotropin (HCG)

Unconjugated estriol (uE3)

inhibin A

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8
Q

What are the factors of hydrops fetalis?

A

anasarca (massive edema)

ascites

pericardial effusion

pleural effusion

placental edema

polyhydramninos

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9
Q

What causes immune hydrops?

A

fetomaternal blood group incompatibility

blood group isoimmunization

Rh isoimmunization

indicatd by presence of maternal serum antibody acting against fetal RBC antigen-sensitization

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10
Q

What happens with RH sensitization?

A

Antibodies attack RBC’s

fetal hemolysis

hemolytic anemia

cardiac output > eventually leads to generalized hydrops and erythroblastosis fetalis

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11
Q

How do you fix RH sensitization?

A

may need blood transfusion in utero

O-blood tranfused into umbilical vein

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12
Q

What is the sonographic appearance of immune hydrops?

A

scalp edema

pleural effusion

pericardial effusion

ascites

polyhydramnios

thickened placenta > 5cm

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13
Q

how can the potential of fetal anemia be determined?

A

ultrasound surveillance (doppler of middle cerebral artery ^ velocity)

amniocentesis

cordocentesis

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14
Q

What does an amniocentesis test for?

A

direct Rh testing of fetus

delta optical density measuring bilirubin in AF

sent for spectrophotometric analysis

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15
Q

how is a cordocentesis performed?

A

needle placed into fetal umbilical vein and blood sample obtained

transfusion if nessesary

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16
Q

Why is immune hydrops rare today?

A

the RhoGAM

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17
Q

What is alloimmune thrombocytopenia?

A

rare

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

she develops antibodies to fetal platelets

result can be fetus with dangerously low platelet count (thrombocytopenia)

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18
Q

What is caused by any thing other than blood incompatibility?

A

nonimmune hydrops

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19
Q

what disorders are found with nonimmune hydrops?

A

cardiovascular, chromosomal, hematologic, urinary, pulmonary

twin pregnancies

infectious disease

antibody screen needed to make diagnosis of NIH

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20
Q

What accounts for approx 90% of all hydrops cases?

A

nonimmune hydrops

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21
Q

What is the sonographic appearance of nonimmune hydrops?

A

scalp edema

pleural effusion

pericardial effusion

ascites

cardiac abnormalities

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22
Q

What is bleeding in the second and third trimester associated with?

A

placental anomalies

placenta previa

placenta abruption

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23
Q

What is the main cause for the third trimester bleeding?

A

placenta previa

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24
Q

What is placenta previa?

A

placenta covers internal cervical os and prohibits vaginal delivery of fetus

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25
Q

What is vasa previa?

A

rare condition in which umbilical cord is presenting part

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26
Q

Why would you use color doppler in from of the cervical os?

A

to evaluate for structures in front of the os to see if its vascular

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27
Q

What are the reasons a placenta might be thicker than 1 to 2 cm other than abruption?

A

uterine contraction

contractions should resolve in 20 to 30 minutes and typically have central blood flow

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28
Q

how do you determine placental abruption?

A

use color flow doppler

blood clots from abruption will not exhibit color flow

retroplacental area hypoechoic due to large number of blood vessels (mainly veins)

sweep with color doppler retroplacentally lookinf for flow void; if flow void is present be suspicious of abruption

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29
Q

What are the two categories of maternal diabetes?

A

overt

gestational

30
Q

What is overt diabetes?

A

diabetes prior to pregnancy (IDDM)

31
Q

What is IDDM?

A

insulin dependent diabetic mellitus

NIDDM - non-insulin dependent diabetes mellitus

32
Q

What is gestational diabetes?

A

manifests during pregnancy (GDM)

33
Q

What anomalies are found in IDM’s (infants of diabetic moms)?

A

cardiac - most common occurrence* transposition of great vessels and VSD

single umbilical artery

polyhydraminos

IUGR - due to UPI secondary to vascular insufficiency

thin placenta

caudal regression syndrome

34
Q

What is the most exclusive anomaly of a diabetic mother?

A

caudal regression syndrome

35
Q

What is affected by caudal regression syndrome?

A

sacral agenesis***

bowel

renal

bladder

musculoskeletal

36
Q

What happens with gestational diabetes to the baby?

A

high blood glucose levels in mother

bring extra glucose to baby

causes baby to put on extra weight

37
Q

What are the sonographic findings of gestational diabetes?

A

macrosomia (>4000 grams 9lbs)

increased placental thickness >5cm

polyhydramnios

38
Q

What are the three stages of hypertension?

A

PIH

Chronic HTN (essential HTN)

Chronic HTN aggravated by pregnancy

39
Q

What condition is associated with HTN?

A

small placentas

40
Q

What issues does the mother have if she has preeclampsia:?

A

high blood pressure

proteninuria

edema

41
Q

What is eclampsia?

A

pre-eclampsia + seizures

severe preeclampsia = deliver immediately

42
Q

which kind of hypertension causes abnormal cord dopplers?

A

PIH

43
Q

What is supine HYPOtension syndrome?

A

IVC is compressed creating hypotension

mother feels nauseated, dizzy, sweaty

44
Q

What is systemic lupus erythematosus?

A

chronic autoimmune disorder

inflammatory responses in the placental vessels

incidence of spontaneous abortion and fetal death (22% to 49%)

45
Q

If the mother has systemic lupus erythematosus what will you monitor in the fetus?

A

r/o congenital heart block and pericardial effusion

46
Q

What is HELLP Syndrome?

A

Hemolysis

Elevated L Enzymes

Low Platelets

pre-eclampsia findings

multi-systemic idiopathic disorder > may lead to serious fetal compromise

47
Q

What is hyperemesis graviarum?

A

vomiting - dehydration and electrolyte imbalance

hospitalization with IV

associate with H-mole and twin pregnancy

48
Q

What are the urinary tract diseases with high risk pregnancy?

A

pyelonephritis with flank pain

hydronephrosis

49
Q

what kind of adnexal cysts might you find with pregnancy?

A

physiologic ovarian cysts

50
Q

What uterine pathology might cause pain and premature labor?

A

uterine fibroid (leiomyoma)

51
Q

What are some factors in premature labor?

A

maternal illness
epidemiological factors

class

age

weight/height

smoking

cervical injury

coitus

bleeding

PROM

infections

multiple pregnancy

52
Q

If you are assessing preterm labor what should your US study include?

A

amniotic fluid assessment

cervical assessment

fetal number

placental assessment

targeted ultrasound

53
Q

What accounts for roughly half of all perinatal mortality?

A

intrauterine fetal death

50% of the time cause of death cannot be determined

54
Q

What are known causes of intrauterine fetal death?

A

infection

congenital or chromosomal abnormalities

preeclampsia

placental abruption

diabetes

growth restriction

blood group isoimmunization

55
Q

what are the sonographic findings of fetal death?

A

absent heart beat

absent fetal movement

overlap of skull bones (Spalding’s sign)

exaggerated curvature of fetal spine

gas in fetal abdomen

56
Q

Which multiple gestations which fetus is named “A”

A

fetus closest to internal os

57
Q

What must you determine with multiple gestations?

A

number of sacs

number and location of placenta

gender of fetuses

biometry

presence of anomalies

58
Q

What causes multifetal pregancy?

A

older age of childbearing

assisted reproductive technologies (ART)

59
Q

What are multifetal pregnancies at risk for?

A

IUGR

incompetent cervix

premature delivery

60
Q

What are the predictors of discordant growth?

A

EFW difference > 20%

BPD difference of 6 mm

AC difference of 20mm

FL difference of 5mm

61
Q

What does dizygotic mean?

A

2 ova fertilized most common

61
Q

what does monozygotic mean?

A

1 ovum fertilized

62
Q

What is the criteria for dizygotic twins (fraternal)?

A

two separately fertilized ova

each ovum implants separately

two placentas - may be fused

two chorion/two amnion

NOT genetically identical

diamniotic, dichorionic

63
Q

what is the criteria for monozygotic twins?

A

single fertilized ovum divides

genetically identical fetuses - same gender

early division - 0-4 days (2 chorion, 2 amnion DC/DA)

Division - 4-8 days *most common (1 chorion, 2 amnion MC/DA)

Division - after 8 days (1 chorion, 1 amnion MC/MA)

Division 0 after 13 days (incomplete -conjoined twins MC/MA)

64
Q

What does dichorionic mean?

A

two placentas

65
Q

What does monochorionic mean?

A

single placenta

66
Q

Describe the four different kinds of membranes

A

twin peak sign or Lambda - DC/DA

thick membrane - DC/DA

Thinner membrane - MC/DA

Absence of Membrane - MC/MA

67
Q

What is twin to twin transfusion (TTS)?

A

typically monochorionic/diamnionic

due to arteriovenous communication within the placenta

68
Q

What happens to the donor and the recipient with TTS?

A

Donor Recipient

severe IUGR polyhydramnios
oligohydramnios hydrops fetalis
“stuck twin”

69
Q

What is poly-oli sequence (stuck twin)?

A

poly in one sac (recipient) and oligo in the other sac (donor)

16-26 weeks gestation

monochorionic/diamniotic

70
Q

What are the five different types of conjoined twins?

A

thoracopagus - thorax

ompalopagus - anterior wall

craniopagus - cranium

pygopagus - ischial

ischiopagus - buttocks

71
Q

What is TRAP?

A

twin reversed arterial perfusion

must be monchorionic pregnancy

vein to vein and artery to artery anastamosis

one twin is acardiac and nonviable

other one normally formed twin is “pump” twin

72
Q

What is fetus papyraceous?

A

a fetus which dies in the second trimester of pregnancy and becomes compressed and parchment-like

FALL 2014 OB (4 decks)

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