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
Triploidy findings:
Result of complete extra set of chromosomes
Often occurs as result of ova being fertilized by two sperm
Estimated to occur in approximately 1% of conceptions; most fetuses will spontaneously abort in first trimester
Only 1 in 5000 will continue to 16 to 20 weeks of gestation sono: Hydatidiform placental degeneration Heart defects Renal anomalies Omphalocele Cranial defects Facial defects
Mosaic form of triploidy may be compatible with survival; infants affected with mental retardation
Turner’s Syndrome findings:
Turner’s syndrome (45 X) is genetic abnormality marked by absence of X or Y chromosome
Not associated with advanced maternal age
Occurs in 1 of every 2500 live births
Patients may present with elevated MSAFP when cystic hygroma present
sono: Cystic hygroma Heart defect Hydrops Renal ab Short femurs??? Prognosis especially grave when fetus presents with large cystic hygroma and edema or hydrops Female infants who survive will have immature sexual development, amenorrhea, short stature, webbed neck, cubitus valgus (abnormal elbow angle), shield chest with widely spaced nipples
May have poor hearing
Hormone replacement necessary for sexual development
Usually have normal intelligence
What fetal structures is AFP found in?
is produced by yolk sac in early gestation and later by fetal liver
AFP found in fetal spine, GI tract, liver, kidneys
High levels of AFP indicate what?
Neural tube defects, such as anencephaly and open spina bifida, common reasons for high AFP levels
, omphalocele and gastroschisis Bladder or cloacal exstrophy Ectopia cordis Limb–body wall complex Amniotic band syndrome
twin pregnancy
In multiple gestations with death of co-twin (fetus papyraceous) or one acardiac twin, AFP may be higher than normal
Annular pancreas Esophageal atresia Duodenal atresia Placental lesions heart failure Severely sensitized fetuses with Rh isoimmunization
Liver disease in mother or fetus may cause high AFP levels
Rare causes of elevated AFP Hepatitis Maternal herpes virus and resultant fetal liver necrosis Skin lesions Hepatocellular carcinoma Fetal liver tumors (hamartomas
the Quad screen evaluates all of the following markers:
AFP
Human chorionic gonadotropin (hCG)
Unconjugated estriol
dimeric inhibin A, improving sensitivity in detecting Down fetuses
abnormality in the number of chromosomes:
Aneuploidy is abnormality of number of chromosomes
Chromosomal abnormalities found in 1 of every 180 live births
early noninvasive means of assessing the risk of aneuploidy:
NT
thickened NT, cardiac abn, short femur and pyelectasis?
down tri 21
sono findings of choroid plexus cysts, cranial anomalies, facial abnormalites, and rockerbottom feet?
tri 18 (edwards) ?
Holoprosencephaly and probosis is most likely to be found in a fetal with what?
Trisomy 13 (patau’s)
Secondary to pregnancy induces hypertention, a coma, sezures, in a patient during the second and third tri represents what?
Eclampsia represents occurrence of seizures or coma in preeclamptic patient
Large cystic hygroma, hydrops, coarctation(split) of the aorta, seen in a fetus with what?
Turner’s syndrome
Pregnancy-Associated Plasma Protein A, what do they do during the pregnancy?
First trimester serum marker used to detect anomalies
PAPP-A is glycoprotein derived from trophoblastic tissue that is diffused into maternal circulation
Levels increase in maternal serum throughout pregnancy
PAPP-A levels found to be decreased in pregnancies affected by aneuploidy
AFP is produced early in gestation by which one of the following structures?
major protein in fetal serum; is produced by yolk sac in early gestation and later by fetal liver
MSAFP levels increase with advancing gestational age and peak from 15 to 18 weeks of gestation
AFAFP decreases with fetal age
common reason for elevated MSAFP?
incorrect dates
most common aneploidy condition is?
Tri 21 downs
Optimal collection site for an amniocentesis:
Away from fetus
Away from central portion of placenta
Away from umbilical cord
Near maternal midline to avoid maternal uterine vessels
MSAFP levels increase with age and peak at what age of gestation?
15 to 18
Free beta-hCG can be assessed for what during the first trimester?
Can be assessed in maternal serum in first trimester to evaluate for increased risk of Down syndrome
After amniocentesis the sonographer should demonstrate and document what?
fetal cardiac activity and if placenta has ben travesed the sited should be monitored for bleeding
continuous monitoring with ultrasound is invaluable in cases of what?
oligo, anterior placental position and premature rupture of membranes
Fetal death when the fetus is too large to reabsorb is called what?
Fetus papyraceous
fetus is markedly flattened from loss of fluid and most of the soft tissue.
Low AFP levels have been found in what?
Tri 21!
Biochemical screening in trisomy 21 fetuses reveals high hCG levels and decreased AFP and estriol levels
May suggest trisomy 18 when hCG, AFP, and estriol levels are all decreased
picture of chromo called what?
karyotype
46 choro
22 pair + 1 pair of sex
abnormal NT, increases fetal risk for all of the following:
NT measurement should be compared with gestational age or CRL to determine risk for aneuploidy and combined with maternal age and first trimester serum screenin
Increased NT associated with increased incidence of structural defects Cardiac Diaphragmatic Renal Abdominal wall anomalies
Spontaneous miscarriage
Perinatal death
know whats ass with turners
see other card
what included in a first tri serum screening?
PAPP-A and free beta hCG
conjoined twins
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
autosomal dominant disorder
caused by a single defective gene
usually from 1 parent
50% chance each preg will have the condition
autosomal recessive
caused by a pair of defective genes
one from each parent
each preg has a 25% chance of fetus having disorder
mulifactorial genetic condition
abnormal event that arises bc of the interaction of one or more genes and environmental factors- anencephaly
mosaicism gene mutation
occurance of a gene mutation or chromosomal abnormality in a portion of an individuals cells. diff to predict types of problems
