OB chapter 53&53 Flashcards

1
Q

Caudal regression syndrome is found in patients with what?

A

Diabetes
also diabetes can cause macrosomic, shoulder dystocia at birth(over4500g) or brachial plexus nerve injuries from birth.
poly may be present
PROM

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2
Q

What term defines the apperance of over lapping skull bones that indicates fetal death?

A

spaldings sign

others signs of fetal demise:
absent heartbeat, or movement, an exaggerated curvature of the fetal spine, or gas in the fetal abdomen

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3
Q

Sonographic findings of fetal hydrops:

A

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

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4
Q

If hydrops are caused by tachycardia what would the fetal heart rate be?

A

200-240 BPM

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5
Q

Increased incident of what because the mother is a patient of size?

A

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
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6
Q

What is Caudal regression syndrome?

A

lack of development of the caudal spine and cord is seen almost exclusively in diabetic individuals

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7
Q

skeletal and central nervous system defect that occur with diabetic mothers include all except the following…..

A

includes:
caudal regression syndrome,
Neural tube defects EXCLUDING anencephaly
anencephaly with or without herniation of neural elements
microcephaly

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8
Q

When is labor considered premature?

A
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
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9
Q

Rare anomaly occurring in monochorionic twins where one twin doesn’t have an upper chest or heart?

A

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.

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10
Q

Which one of the following about twin to twin transfusion is true……

A

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

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11
Q

Poly-oli is?

A

“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

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12
Q

When does the conjoined twins happen after conception?

A

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)
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13
Q

Diamnioic and Dichorionic pregnancies demonstrates what sonographic findings?

A

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)

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14
Q

If the division of one ferilized egg (monozygotic) happens 4-8 days after Fertilization what happens?

A

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
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15
Q

Predictors of the discordance of the growth of twins?

A

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

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16
Q

Most frequent cause of nonimmune hydrops?

A

Cardiovascular lesions often most frequent causes of NIH

Congestive heart failure may result from functional cardiac problems, as well as from structural anomalies

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17
Q

advantages to chorionic villi sampling?

A
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
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18
Q

cordocentesis is more commonly used for which one of the following procedures?

A

for guidance for transfusions to treat fetal isoimmunizaton

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19
Q

amniocentesis may be used for all the following except:

why preform?

A

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

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20
Q

twins that are from 2 separately fertilized ovum are what kind?

A

dizygotic twins(faternal)= always results in diamniotic, dichorionic

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21
Q

sonographic findings that may suggest a choronsomal anomoly include:

A

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

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22
Q

Tri 21 findings:

A

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
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23
Q

Tri 18 findings:

A

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

24
Q

Tri 13 findings:

A

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

25
Q

Triploidy findings:

A

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

26
Q

Turner’s Syndrome findings:

A

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

27
Q

What fetal structures is AFP found in?

A

is produced by yolk sac in early gestation and later by fetal liver

AFP found in fetal spine, GI tract, liver, kidneys

28
Q

High levels of AFP indicate what?

A

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
29
Q

the Quad screen evaluates all of the following markers:

A

AFP
Human chorionic gonadotropin (hCG)
Unconjugated estriol
dimeric inhibin A, improving sensitivity in detecting Down fetuses

30
Q

abnormality in the number of chromosomes:

A

Aneuploidy is abnormality of number of chromosomes

Chromosomal abnormalities found in 1 of every 180 live births

31
Q

early noninvasive means of assessing the risk of aneuploidy:

A

NT

32
Q

thickened NT, cardiac abn, short femur and pyelectasis?

A

down tri 21

33
Q

sono findings of choroid plexus cysts, cranial anomalies, facial abnormalites, and rockerbottom feet?

A

tri 18 (edwards) ?

34
Q

Holoprosencephaly and probosis is most likely to be found in a fetal with what?

A

Trisomy 13 (patau’s)

35
Q

Secondary to pregnancy induces hypertention, a coma, sezures, in a patient during the second and third tri represents what?

A

Eclampsia represents occurrence of seizures or coma in preeclamptic patient

36
Q

Large cystic hygroma, hydrops, coarctation(split) of the aorta, seen in a fetus with what?

A

Turner’s syndrome

37
Q

Pregnancy-Associated Plasma Protein A, what do they do during the pregnancy?

A

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

38
Q

AFP is produced early in gestation by which one of the following structures?

A

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

39
Q

common reason for elevated MSAFP?

A

incorrect dates

40
Q

most common aneploidy condition is?

A

Tri 21 downs

41
Q

Optimal collection site for an amniocentesis:

A

Away from fetus
Away from central portion of placenta
Away from umbilical cord
Near maternal midline to avoid maternal uterine vessels

42
Q

MSAFP levels increase with age and peak at what age of gestation?

A

15 to 18

43
Q

Free beta-hCG can be assessed for what during the first trimester?

A

Can be assessed in maternal serum in first trimester to evaluate for increased risk of Down syndrome

44
Q

After amniocentesis the sonographer should demonstrate and document what?

A

fetal cardiac activity and if placenta has ben travesed the sited should be monitored for bleeding

45
Q

continuous monitoring with ultrasound is invaluable in cases of what?

A

oligo, anterior placental position and premature rupture of membranes

46
Q

Fetal death when the fetus is too large to reabsorb is called what?

A

Fetus papyraceous

fetus is markedly flattened from loss of fluid and most of the soft tissue.

47
Q

Low AFP levels have been found in what?

A

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

48
Q

picture of chromo called what?

A

karyotype
46 choro
22 pair + 1 pair of sex

49
Q

abnormal NT, increases fetal risk for all of the following:

A

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

50
Q

know whats ass with turners

A

see other card

51
Q

what included in a first tri serum screening?

A

PAPP-A and free beta hCG

52
Q

conjoined twins

A

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
53
Q

autosomal dominant disorder

A

caused by a single defective gene
usually from 1 parent
50% chance each preg will have the condition

54
Q

autosomal recessive

A

caused by a pair of defective genes
one from each parent
each preg has a 25% chance of fetus having disorder

55
Q

mulifactorial genetic condition

A

abnormal event that arises bc of the interaction of one or more genes and environmental factors- anencephaly

56
Q

mosaicism gene mutation

A

occurance of a gene mutation or chromosomal abnormality in a portion of an individuals cells. diff to predict types of problems