High Risk Pregnancy Flashcards
What are the screening tests for high risk?
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
What are the factors for a high risk pregancy?
advanced maternal age (AMA)
abnormal maternal lab values
vaginal bleeding
insulin-dependent diabetes mellitus (IDDM)
hypertension
preeclampsia
maternal systemic disease
what is hydrops fetalis?
condition in which excessive fluid accumulates within fetal body cavities
Immune hydrops and non-immune hydrops
What is the Indirect combs test
checks for maternal antibodies
prevents antibody production
What is anasarca?
skin edema
What is the cutoff for pericardial effusion?
2-3 mm
what is VSD?
ventricular septum defect
What are the quad screen markers?
alpha-fetoprotein (AFP)
Human chorionic gonadotropin (HCG)
Unconjugated estriol (uE3)
inhibin A
What are the factors of hydrops fetalis?
anasarca (massive edema)
ascites
pericardial effusion
pleural effusion
placental edema
polyhydramninos
What causes immune hydrops?
fetomaternal blood group incompatibility
blood group isoimmunization
Rh isoimmunization
indicatd by presence of maternal serum antibody acting against fetal RBC antigen-sensitization
What happens with RH sensitization?
Antibodies attack RBC’s
fetal hemolysis
hemolytic anemia
cardiac output > eventually leads to generalized hydrops and erythroblastosis fetalis
How do you fix RH sensitization?
may need blood transfusion in utero
O-blood tranfused into umbilical vein
What is the sonographic appearance of immune hydrops?
scalp edema
pleural effusion
pericardial effusion
ascites
polyhydramnios
thickened placenta > 5cm
how can the potential of fetal anemia be determined?
ultrasound surveillance (doppler of middle cerebral artery ^ velocity)
amniocentesis
cordocentesis
What does an amniocentesis test for?
direct Rh testing of fetus
delta optical density measuring bilirubin in AF
sent for spectrophotometric analysis
how is a cordocentesis performed?
needle placed into fetal umbilical vein and blood sample obtained
transfusion if nessesary
Why is immune hydrops rare today?
the RhoGAM
What is alloimmune thrombocytopenia?
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)
What is caused by any thing other than blood incompatibility?
nonimmune hydrops
what disorders are found with nonimmune hydrops?
cardiovascular, chromosomal, hematologic, urinary, pulmonary
twin pregnancies
infectious disease
antibody screen needed to make diagnosis of NIH
What accounts for approx 90% of all hydrops cases?
nonimmune hydrops
What is the sonographic appearance of nonimmune hydrops?
scalp edema
pleural effusion
pericardial effusion
ascites
cardiac abnormalities
What is bleeding in the second and third trimester associated with?
placental anomalies
placenta previa
placenta abruption
What is the main cause for the third trimester bleeding?
placenta previa
What is placenta previa?
placenta covers internal cervical os and prohibits vaginal delivery of fetus
What is vasa previa?
rare condition in which umbilical cord is presenting part
Why would you use color doppler in from of the cervical os?
to evaluate for structures in front of the os to see if its vascular
What are the reasons a placenta might be thicker than 1 to 2 cm other than abruption?
uterine contraction
contractions should resolve in 20 to 30 minutes and typically have central blood flow
how do you determine placental abruption?
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
What are the two categories of maternal diabetes?
overt
gestational
What is overt diabetes?
diabetes prior to pregnancy (IDDM)
What is IDDM?
insulin dependent diabetic mellitus
NIDDM - non-insulin dependent diabetes mellitus
What is gestational diabetes?
manifests during pregnancy (GDM)
What anomalies are found in IDM’s (infants of diabetic moms)?
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
What is the most exclusive anomaly of a diabetic mother?
caudal regression syndrome
What is affected by caudal regression syndrome?
sacral agenesis***
bowel
renal
bladder
musculoskeletal
What happens with gestational diabetes to the baby?
high blood glucose levels in mother
bring extra glucose to baby
causes baby to put on extra weight
What are the sonographic findings of gestational diabetes?
macrosomia (>4000 grams 9lbs)
increased placental thickness >5cm
polyhydramnios
What are the three stages of hypertension?
PIH
Chronic HTN (essential HTN)
Chronic HTN aggravated by pregnancy
What condition is associated with HTN?
small placentas
What issues does the mother have if she has preeclampsia:?
high blood pressure
proteninuria
edema
What is eclampsia?
pre-eclampsia + seizures
severe preeclampsia = deliver immediately
which kind of hypertension causes abnormal cord dopplers?
PIH
What is supine HYPOtension syndrome?
IVC is compressed creating hypotension
mother feels nauseated, dizzy, sweaty
What is systemic lupus erythematosus?
chronic autoimmune disorder
inflammatory responses in the placental vessels
incidence of spontaneous abortion and fetal death (22% to 49%)
If the mother has systemic lupus erythematosus what will you monitor in the fetus?
r/o congenital heart block and pericardial effusion
What is HELLP Syndrome?
Hemolysis
Elevated L Enzymes
Low Platelets
pre-eclampsia findings
multi-systemic idiopathic disorder > may lead to serious fetal compromise
What is hyperemesis graviarum?
vomiting - dehydration and electrolyte imbalance
hospitalization with IV
associate with H-mole and twin pregnancy
What are the urinary tract diseases with high risk pregnancy?
pyelonephritis with flank pain
hydronephrosis
what kind of adnexal cysts might you find with pregnancy?
physiologic ovarian cysts
What uterine pathology might cause pain and premature labor?
uterine fibroid (leiomyoma)
What are some factors in premature labor?
maternal illness
epidemiological factors
class
age
weight/height
smoking
cervical injury
coitus
bleeding
PROM
infections
multiple pregnancy
If you are assessing preterm labor what should your US study include?
amniotic fluid assessment
cervical assessment
fetal number
placental assessment
targeted ultrasound
What accounts for roughly half of all perinatal mortality?
intrauterine fetal death
50% of the time cause of death cannot be determined
What are known causes of intrauterine fetal death?
infection
congenital or chromosomal abnormalities
preeclampsia
placental abruption
diabetes
growth restriction
blood group isoimmunization
what are the sonographic findings of fetal death?
absent heart beat
absent fetal movement
overlap of skull bones (Spalding’s sign)
exaggerated curvature of fetal spine
gas in fetal abdomen
Which multiple gestations which fetus is named “A”
fetus closest to internal os
What must you determine with multiple gestations?
number of sacs
number and location of placenta
gender of fetuses
biometry
presence of anomalies
What causes multifetal pregancy?
older age of childbearing
assisted reproductive technologies (ART)
What are multifetal pregnancies at risk for?
IUGR
incompetent cervix
premature delivery
What are the predictors of discordant growth?
EFW difference > 20%
BPD difference of 6 mm
AC difference of 20mm
FL difference of 5mm
What does dizygotic mean?
2 ova fertilized most common
what does monozygotic mean?
1 ovum fertilized
What is the criteria for dizygotic twins (fraternal)?
two separately fertilized ova
each ovum implants separately
two placentas - may be fused
two chorion/two amnion
NOT genetically identical
diamniotic, dichorionic
what is the criteria for monozygotic twins?
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)
What does dichorionic mean?
two placentas
What does monochorionic mean?
single placenta
Describe the four different kinds of membranes
twin peak sign or Lambda - DC/DA
thick membrane - DC/DA
Thinner membrane - MC/DA
Absence of Membrane - MC/MA
What is twin to twin transfusion (TTS)?
typically monochorionic/diamnionic
due to arteriovenous communication within the placenta
What happens to the donor and the recipient with TTS?
Donor Recipient
severe IUGR polyhydramnios
oligohydramnios hydrops fetalis
“stuck twin”
What is poly-oli sequence (stuck twin)?
poly in one sac (recipient) and oligo in the other sac (donor)
16-26 weeks gestation
monochorionic/diamniotic
What are the five different types of conjoined twins?
thoracopagus - thorax
ompalopagus - anterior wall
craniopagus - cranium
pygopagus - ischial
ischiopagus - buttocks
What is TRAP?
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
What is fetus papyraceous?
a fetus which dies in the second trimester of pregnancy and becomes compressed and parchment-like
