OB chapter 53&53 Flashcards
Caudal regression syndrome is found in patients with what?
Diabetes
also diabetes can cause macrosomic, shoulder dystocia at birth(over4500g) or brachial plexus nerve injuries from birth.
poly may be present
PROM
What term defines the apperance of over lapping skull bones that indicates fetal death?
spaldings sign
others signs of fetal demise:
absent heartbeat, or movement, an exaggerated curvature of the fetal spine, or gas in the fetal abdomen
Sonographic findings of fetal hydrops:
Scalp edema, pleural and pericardial effusions, ascites
If hydrops the result of cardiac tachyarrhythmia, HR of 200 to 240 bpm is common
If diaphragmatic hernia present, bowel visible in chest cavity
If hydrops are caused by tachycardia what would the fetal heart rate be?
200-240 BPM
Increased incident of what because the mother is a patient of size?
Maternal obesity associated with increased incidence of neural tube defects
More obese women start pregnancy with chronic hypertension also at risk for: Severe eclampsia Multiple births Urinary tract infections
What is Caudal regression syndrome?
lack of development of the caudal spine and cord is seen almost exclusively in diabetic individuals
skeletal and central nervous system defect that occur with diabetic mothers include all except the following…..
includes:
caudal regression syndrome,
Neural tube defects EXCLUDING anencephaly
anencephaly with or without herniation of neural elements
microcephaly
When is labor considered premature?
Before 37 weeks. 15-20% of pregnancies premies greater risk for: respiratory syndrome, intracranial hemorrahage, bowel immaturity, and feeding problems Potential etiologies of preterm labor Premature rupture of membranes Intrauterine infection Bleeding Fetal anomalies Polyhydramnios Multiple pregnancy Growth restriction Maternal illness (diabetes or hypertension) Incompetent cervix Uterine abnormalities
Rare anomaly occurring in monochorionic twins where one twin doesn’t have an upper chest or heart?
Acardiac Anomaly
unique to twin gestations
Proposed that this occurs due to artery to artery connection in placenta that leads to perfusion of abnormal twin via co-twin
Reversed direction of blood flow in abnormal twin alters hemodynamic properties needed for normal cardiac formation.
Which one of the following about twin to twin transfusion is true……
one cause of poly-oli!!
TTS exists when there is arteriovenous shunt within placenta
Arterial blood of one twin is pumped into venous system of other twin
Donor twin becomes anemic and growth restricted
one Twin has less blood flow through kidneys, urinates less, develops oligohydramnios
other:
Recipient twin gets too much blood flow
Twin may be normal or large in size
Fetus has excess blood flow through kidneys and urinates too much, leading to polyhydramnios
Twin may even go into heart failure and become hydropic
both twins at risk of dying
Smaller one because its nutritional and oxygen rich blood supply is severely restricted
Larger one because of heart failure
Poly-oli is?
“stuck twin” characterized by a diamniotic pregnancy with polyhydramnios in one sac and severe oligo and a smaller twin in the other sac
usually manifests by 16-26 weeks(know!)
may result from fetal anomality in one sac causing poly= pressing other or could be caused by TTS
Treatments for stuck twin syndrome include:
Serial amniocentesis
Selective feticide
Umbilical cord ligation of one twin
Laser occlusion of anastomosing placental vessels
When does the conjoined twins happen after conception?
Occur from incomplete division of embryo after 13 days from conception
Five types of conjoined twins Thoracopagus (joined at thorax) Omphalopagus (joined at anterior wall) Craniopagus (joined at cranium; syncephalus is conjoined twins with one head) Pygopagus (joined at ischial region) Ischiopagus (attached at buttocks)
Diamnioic and Dichorionic pregnancies demonstrates what sonographic findings?
2 amnions 2 chorions (can be from monozygotic twins that seperated 0-4 days postconception or can be dizygotic twins with means they are separtately fertilized egg and have its each of everything)
If the division of one ferilized egg (monozygotic) happens 4-8 days after Fertilization what happens?
there will be one chorion and two amniotic sacs (monochorionic,diamniotic)
chorionic = # of placentas 0-4 ( dichorionic,diamnioic) 4-8 ( monochorionic,diamniotic) after 8 days (monochorionic,monoamniotic) after 13 days conjoined twins possible
Predictors of the discordance of the growth of twins?
A differnce in setimated fetal weight of mote than 20% a diff in BPD of 6mm a diff in AC of 20mm and a diff in femur lenght of 5 mm
stuck twin, poli-oli, twin to twin transfussion
Fetal surveillance increased when growth discordance, oligohydramnios, or polyhydramnios discovered
Most frequent cause of nonimmune hydrops?
Cardiovascular lesions often most frequent causes of NIH
Congestive heart failure may result from functional cardiac problems, as well as from structural anomalies
advantages to chorionic villi sampling?
is dorected biopsu of the placnta or chorionic villi ( chorion frondosum, becomes placenta 10-14wks is the window advantages: it is performed early results are available within 1 week earlier results= more options
cordocentesis is more commonly used for which one of the following procedures?
for guidance for transfusions to treat fetal isoimmunizaton
amniocentesis may be used for all the following except:
why preform?
between 15-20weeks
can be used for:
relieve poly, predict Rh isoimmunization, to document fetal lung maturity and fetal chromosomes analysis.
History of balance rearrangement in parent or previous child with chromosomal abnormality
History of unexplained abnormal AFP level or abnormal triple screen
Fetus with congenital anormalty
advanced maternal age
twins that are from 2 separately fertilized ovum are what kind?
dizygotic twins(faternal)= always results in diamniotic, dichorionic
sonographic findings that may suggest a choronsomal anomoly include:
Abnormal fluid collection behind fetal neck strongly associated with aneuploidy
NT reported as late first trimester finding identified between 10 and 14 weeks of gestation
8:28
Tri 21 findings:
downs- most common
1.21 in 1000
advanced maternal age
quad:Biochemical screening in trisomy 21 fetuses reveals high hCG levels and decreased AFP and estriol levels
sono: Nuchal thickness Hygroma Heart defects Duodenal atresia Shortened femurs Mild pyelectasis Mild ventriculomegaly Echogenic bowel
Tri 18 findings:
Known as Edwards’ syndrome
Second most common chromosomal trisomy
Occurs in 3 of 10,000 live births
quad:
May suggest trisomy 18 when hCG, AFP, and estriol levels are all decreased
sono: Heart defects Choroid plexus cysts Clenched hands Micrognathia Talipes Renal anomalies Cleft lip and palate Omphalocele CDH Cerebellar hypoplasia
Fetus with trisomy 18 will often spontaneously abort
Infants profoundly retarded
Considered lethal anomaly, with 90% of infants dying within first year of life
Tri 13 findings:
Trisomy 13, known as Patau’s syndrome, occurs in 1 in 5000 – 20,000 births
Result of extra chromosome 13
Extremely severe anomaly consists of multiple anomalies; many involve brain
sono: Holoprosencephaly Heart defects Cleft lip and palate Omphalocele Polydactyly Talipes Echogenic chordae tendineae Renal anomalies Meningomyelocele Micrognathia
Prognosis for trisomy 13 extremely poor, with 80% of infants dying within first month
Considered lethal anomaly
Survivors profoundly retarded, with multiple deficits and problems
