OB II Test 3 Review Ch 52 & 53

Question 1

What complications can occur in a pregnancy with a diabetic mother?

Answer 1

Macrosomia, Caudal regression syndrome, Neural tube defects excluding anencephaly, Anencephaly with or without herniation of neural elements, Microcephaly, Transposition of the great vessels with or without ventriular septal defect, Ventricular septal defect, Atrial septal defect, Coarctation of the aorta with or without ventricular septal defect, Cardiomegaly, Hydronephrosis, Renal agenesis, Ureteral duplication, Duodenal atresia, Anorectal atresia, Small left colon syndrome, Single umbilical artery, Polyhydramnios, PROM, and IUGR (In diabetic mothers with vasculopathy)
Pg. 1177

Question 2

What day does the division of the egg take place for conjoined twins to occur?

Answer 2

After 13 days

Pg. 1183

Question 3

Know all about twinning: diamniotic dichorionic, monoamniotic monochorionic (multiple questions)

Answer 3

Diamniotic/Dichorionic: Fraternal twins. Twins that arise from two separately fertilized ova. Each ovum implants separately in the uterus and develops its own placenta, chorion and amniotic sac. Placentas may implant in different parts of the uterus and be distinctly separate or may implant adjacent to each other and fuse. Even when fused, the placentas are separate from each other. Egg division occurs 0-4 days postconception.

Monochorionic/Diamniotic: Twins with one chorion and two amniotic sacs. Egg division occurs 4-8 days postconception.

Monochorionic/Monoamniotic: Identical twins. Twins that arise from a single fertilized egg which divides, resulting in two genetically identical fetuses. Egg division occurs 8 days postconception. After 13 days, division may be incomplete and conjoined twins result. Monozygotic twins are high-risk.

Pg. 1182-1183

Question 4

What is it called when a pregnancy induces hypertension, a coma and seizures?

Answer 4

Eclampsia

Pg. 1178

Question 5

Hypertension, protein in the urine, edema are complications of what?

Answer 5

Preeclampsia

Pg. 1178

Question 6

What is immune hydrops?

Answer 6

Immune hydrops is hydrops initiated by the presence of maternal serum immunoglobulin G (IgG) antibody against one of the fetal RBC antigens in a process known as sensitization. This can occur anytime a mother is exposed to RBC antigens other than her own. These antibodies can pass through the placenta and cause anemia.
Pg. 1172
Hydrops itself causes excessive fluid accumulates within the fetal body cavities and may result in anasarca, ascites, pericardial effusion, pleural effusion, placental edema or poly. Prevented with RhoGAM.
Pg. 1171

Question 7

What is nonimmune hydrops?

Answer 7

A group of conditions where hydrops is present in the fetus but is not a resut of fetomaternal bood group incompatibility.
Pg. 1174

Question 8

What are some complications from a hypertensive mother?

Answer 8

In a fetus: Small placenta, poor blood supply to the fetus, IUGR, fetal distress, and death in utero.

In a mother: Preeclampsia: Hypertension, proteinuria, and edema
Eclampsia: Seizures or coma in a preeclamptic mother.

Pg. 1178

Question 9

What is the overlapping of the skull bones referred to as?

Answer 9

Spalding’s Sign

Pg. 1180

Question 10

What is a tachycardia heart rate?

Answer 10

200-240 for fetal abnormalities and hydrops
Per Beth

Above 200
Pg. 819

Question 11

What is there is an increased incidence of with obese mothers?

Answer 11

Neural tube defects as well as pregnancy induced hypertension, severe eclampsia, multiple births and UTI’s
Pg. 1179

Question 12

What is caudal regression syndrome?

Answer 12

A lack of development of the caudal spine and cord found almost exclusively in diabetic individuals
Pg. 1178

Question 13

Who is at risk for caudal regression syndrome?

Answer 13

Diabetic mothers

Pg. 1178

Question 14

What weeks is considered premature labor?

Answer 14

Before 37 weeks

Pg. 1179

Question 15

What is an acardiac twin?

Answer 15

A rare cardiac anomaly in monochorionic twins when one twin develops without a heart and often without the upper half of the body. It has been suggested that this occurs because of an artery-to-artery connection in the placenta that leads to perfusion of the abnormal twin via the co-twin. The abnormal twin also has other anomalies such as abeset head, absent organs in the thorax and abdomen and absent or abnormal limbs.
Pg. 1187

Question 16

What is twin to twin?

Answer 16

When there is an arteriovenous shunt within the placenta, arterial blood of one twin is pumped into the venous system of the other. The donor twin has restricted blood flow and develops anemia, IUGR, and oligo. The recipient twin has too much blood flow and develops poly and may be normal or large for size. This twin may also go into heart failure or become hydropic. Both twins are at risk of dying.
Pg. 1186

Question 17

What day does the division of the egg take place for mono mono twins?

Answer 17

After 8 days

Pg. 1183

Question 18

Predictors of discordance of growth in twins?

Answer 18

Predictors of discordance of growth between twins includes a difference in estimated fetal weight of more than 20%, a difference in BPD of 6mm, a difference in AC of 20mm and a difference in femur length of 5mm.
Pg. 1188

Question 19

What is CVS?

Answer 19

Chorionic villus sampling is an ultrasound guided biopsy of the placenta or chorionic villi (the active trophoblastic tissue that becomes the placenta). Used to obtain a fetal karyotype.

Performed at 10-14 weeks with results available within a week.
Pg. 1191

Question 20

What is amniocentesis?

Answer 20

First used as a technique to relieve poly, predict Rh immunization and document fetal lung maturity. Now used to identify normal and abnormal chromosomal patterns.

Offered to expectant patients who are at risk for a chromosomal abnormality or biochemical disorder. Results are available between 1-3 weeks with limited results within 24 hours.
Pg. 1192

Question 21

What is cordocentesis?

Answer 21

Also PUBS. Another method to analyze chromosomes where fetal blood is obtained through needle aspirations of the umbilical cord. Results are processed within 2-3 days. More commonly used for guidance for transfusions to treat fetal isoimmunization.
Pg. 1194

Question 22

What are some of the reasons to perform an amniocentesis?

Answer 22

Expectant patients who are at risk for a chromosomal abnormality or biochemical disorder that may be prenatally detectable.

Advanced maternal age, a history of a valance rearrangement in a parent or previous child with a chromosomal abnormality, a history of an unexplained AFP level or triple screen and a fetus with a congenital anomaly.
Pg. 1192

Question 23

Which chromosomal anomaly does not fit?

Answer 23

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Question 24

Where is AFP found in the fetal structures?

Answer 24

AFP is found in the fetal spine, GI tract, liver, and kidneys

Produced by the yolk sac in early gestation and later by the fetal liver, the protein is transported into the amniotic fluid by urination.

Pg. 1194

Question 25

What can high AFP levels lead to?

Answer 25

Common reasons include neural tube defects such as anencephaly and open spina bifida.

There is a long list in the green box on Pg. 1195.

Question 26

What is on a quad screen?

Answer 26

AFP, hCG, unconjugated estriol and dimeric inhibin A

Pg. 1197

Question 27

What does multifactorial mean?

Answer 27

A multifactoral condition is an abnormal event that arises because of the interaction of one or more genes and environmental factors.
Pg. 1197

Question 28

Anencephaly is what kind of finding?

Answer 28

Multifactoral

Pg. 1197

Question 29

What is an early means of assessing for aneuploidy?

Answer 29

PAPP-A or Pregnancy-Associated Plasma Protein A.
Found to be decreased in pregnancies with aneuploidy.
Pg. 1197

Question 30

What is Edward’s syndrome?

Answer 30

Trisomy 18 is the second most common chromosomal abnormality. Fetuses often spontaneously abort. Quad screens show low everything.

Physical features include cardiac anomalies, dolichocephaly, microcephaly, hydrocephalus, agensis of the corpus callosu, cerebellar hypoplasia, encephalocele, strawberry shaped head, choriod plexus cysts, low set ears, micrognathia, cleft lip and palate, clenched hands, talipes, rocker-bottom feet, radial aplasia, omphalocele, congenital diaphragmatic hernia, neural tube defects, cystic hygroma and renal anomalies.
Pg. 1200

Question 31

What is Patau syndrome?

Answer 31

Lethal anomaly trisomy 13 with most fetuses presenting cranial and cardiac issues .

Physical features include holoprosencephaly, agenesis of the corpus callosum, microcephaly, hypotelorism, proboscis, cyclopia, single nostril nose, cleft lip and palate, microphthalmia, micrognathia, ventricular septal defect, atrial septal defect, hypoplastic left heart, omphalocele, renal anomalies, meningomyelocele, polydactyly, talipes, rocker-bottom feet, overlapping fingers, cystic hygroma, and echogenic cordae tendineae.
Pg. 1201-1203

Question 32

What is Turner’s syndrome?

Answer 32

Genetic abnormality marked by the absence of the X or Y chromosome. Not associated with AMA. Quad screens shows low everything except when a cystic hygroma is present (then a possible elevated MSAFP). Fetuses typically spontaneously abort.

Cystic hygroma is the most common finding followed by cardiac anomalies, specifically coarctation of the aorta.

Other physical features include general lymphedema, hydrops, horseshoe kidney, renal agenesis, hydronephrosis, hypoplastic kidney and short femurs.
Pg. 1204

Question 33

What is the most common aneuploid condition?

Answer 33

Downs Syndrome

Pg. 1197

Question 34

What should the sonographer demonstate pre and post amniocentesis?

Answer 34

Heart Rate

Per Beth

Question 35

True or False questions: multifactorial

Answer 35

A multifactoral condition is an abnormal event that arises because of the interaction of one or more genes and environmental factors.
Pg. 1197

Question 36

What is mosaic?

Answer 36

Mosaicism is the occurrence of a gene mutation or chromosomal abnormality in a portion of an individuals cells. It is difficult to predict the types of problems that will occur when mosaicism is present.
Pg. 1197

Question 37

What is recessive?

Answer 37

A recessive disorder (autosomal recessive) is caused by a pair of defective genes, one inherited from each parent. With each pregnancy, the parents have a 25% chance of having a fetus with the disorder.
Pg. 1197

Question 38

What is dominant?

Answer 38

A dominant disorder (autosomal dominant) is a condition caused by a single defective gene. It is usually inherited from one parent who is also affected but may arise as a new mutation. An inherited dominant disorder carries a 50% chance that each time pregnancy occurs the fetus will have the condition.
Pg. 1197

Question 39

Poly-Oli Sequence?

Answer 39

Stuck twin syndrome is a diamniotic pregnancy with poly in one sac and severe oligo and a smaller twin in the other sac. This manifests between 16-26 weeks mostly in monochorionic pregnancies. If twin-to-twin exsits as well, the growth of the twins will be discordant with the donor twin falling off the growth curve.
Pg. 1186