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OBGYN Abnormal BOARDS > Simtics - fetal growth and high risk preg > Flashcards

Simtics - fetal growth and high risk preg Flashcards

1
Q

s/s may indicate presence of fetal/maternal disease (6)

A
  • fetus large/small for dates
  • maternal lower abdo pain
  • vag bleed
  • premature labour
  • pre eclampsia
  • maternal RF
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2
Q

what is pre-eclampsia. what does it present as (3)

A

a multisystem disorder linked to placental implantation.

  • maternal hypertension (130/90)
  • proteinuria
  • edema
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3
Q

what may develop along with eclampsia? (2)

A
  • fatal seizures

- HELLP syndrome (Hemolytic anemia, Elevated Liver enzymes, Low Platelet count)

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4
Q

pre-eclamsia is a significant cause of fetal what

A

fetal IUGR

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5
Q

in measuring amniotic fluid volume (single pocket assessment), polyhydraminos is when

A

MVP >8 cm

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6
Q

in measuring amniotic fluid volume (single pocket assessment), oligohydraminos is when

A

MPV <2 cm

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7
Q

in measuring amniotic fluid volume (amniotic fluid index), what is the normal range?

A

when Q1+Q2+Q3+Q4 = 5-20 cm

oligo <5 cm
poly >18-20 cm

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8
Q

Macrosomia

A

when estimated fetal weight ≥ 4000 g

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9
Q

large for gestational age

A

a fetal weight at or above the 10th percentile for gestational age

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10
Q

macrosomia risk factors

A
  • gestational diabetes

- enlargement placenta

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11
Q

raised maternal AFP could mean (2)

A
  • multiple pregnancy

- neural tube defects

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12
Q

twin peak sign occurs with

A

aka lambda sign

dichorionic-diamniotic

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13
Q

pathology assoc with multiple preg (4)

A
  • poly-oli/stuck twin
  • TTT syndrome
  • conjoined twins
  • acardiac anomaly
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14
Q

fetal risk for pump/donor twin and recipient twin

A

pump/donor: reduced o2 = less kidney blood flow thus output = oligohydramnios

recipient = poly and heart failure

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15
Q

most common conjoined twin

A

Thoracopagus: they are joined at the chest and have a cardiac connection.

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16
Q

IUGR

A

fetal weight at or below the 10th percentile for gestational age.

A fetus that is IUGR is a SGA fetus with a maternal, placental, or fetal pathological process involved.

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17
Q

risk factors for IUGR (7)

A
  • previous IUGR pregnancy
  • uterine anomaly
  • multiple pregnancy
  • significant placental hemorrhage
  • maternal hypertension (with or without pre-eclampsia)
  • maternal diabetes
  • tobacco/drug/alch
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18
Q

IUGR babies have an increased risk of

A 
antepartum death (death before birth)
and neonatal morbidity
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19
Q

small for gestational age

A

a fetus with a weight below the 10th percentile, but with no known cause

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20
Q

EFW paramaters (4)

A

BPD
HC
AC
FL

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21
Q

what is more common : symmetric or asymmetric IUGR

A

asymmetric IUGR

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22
Q

causes of asymmetric IUGR

A
  • uteroplacental insufficiency
  • maternal diabetes
  • pre-eclampsia -chronic hypertension
  • smoking
  • uterine anomaly
  • placental hemorrhage.
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23
Q

asymmetric IUGR measures present as

A

small AC with normal BPD and HC

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24
Q

Early ultrasound markers of uteroplacental insufficiency include (4)

A
  • decreased fetal biometry
  • echogenic bowel
  • mild cardiomegaly -abnormal uteroplacental/fetal Doppler studies
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25
Q

what is a major indicator (measurement) for IUGR or macrosomia?

A

AC - will be disproportionally small compared to HC and BPD in IUGR and
AC will be disproportionally large in macrosomia

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26
Q

BPD alone is not a reliable predictor of IUGR

A

true - fetal head may be dolichocephalic/brachycephalic due to its position in the uterus or to oligohydramnios. HC is more useful in this instance

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27
Q

dolichocephalic head seen in what positions

A

transverse or breech position

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28
Q

what is useful to differentiate symetric IUGR from asymmetric IUGR?

A

HC:AC ratio

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29
Q

in asymmetric IUGR how does the HC:AC ratio change?

A

the ratio increases (HC proportionally greater than AC) due to reduction in subcutaneous tissue and fat in the fetus with IUGR

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30
Q

how does the HC:AC ratio NORMALLY change as gestational age increases?

A

HC:AC ratio decreases as gestational age increases (HC smaller than AC)

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31
Q

most common cause of IUGR

A

uteroplacental insufficiency

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32
Q

normal ductus venosus waveform

A

saw-tooth

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33
Q

how does amniotic fluid volume increase with GA? until when?

A

increases proportionally with gestational age until approximately 34 weeks;

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34
Q

fetal causes of polyhydramnios (7)

A
  • CNS disorders
  • GI problems (including hydrops)
  • skeletal disorders
  • upper GI tract obstruction
  • renal disorders
  • fetal macrosomia
  • rh isoimmunization
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35
Q

polyhydramn clinically presents as

A

uterus larger than expected for calculated dates

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36
Q

most common cause of polyhydramnios is

A

maternal diabetes

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37
Q

prolonged oligohydramnios associated with (2)

A

limb contractures such as talipes or club foot

38
Q

fetal (4) & other (2) anomalies assoc with oligohydro include

A
  • bilateral renal agenesis
  • polycystic kidney
  • multicystic dysplastic kidneys
  • bladder outflow obstruction
  • ureteroplacental insufficiency
  • IUGR
39
Q

grade I placenta

A

mid second, early third trimester

  • subtle indentations chorionic plate
  • random echogenic densities 2-4mm
40
Q

grade II placenta

A

late third trimester

  • “comma” indentations
  • basal area has echogenic densities
41
Q

grade II placenta

A

very late third trimester

  • complete indentations
  • hypoechoic densities
  • large echogenic with shadowing
42
Q

most women with placenta previa experience what

A

placental migration

43
Q

complications placenta previa (4)

A
  • premature delivery
  • hemorrhage (maternal & post partum)
  • placental accreta
  • IUGR
44
Q

placenta accreta grades

A

AIP

accreta: chorionic vili invades decidua basalis
increta: chorionic vili invade myometrium
percreta: chorionic vili penetrate uterine serosa

45
Q

placental thickness > ? cm is abnormal

A

5 cm

46
Q

Name of rare placental tumour, and when its ominous

A

chorioangioma, >5 cm

47
Q

chorioangioma is associated with (4)

A

polyhydramnios
hydrops
IUGR
demise

48
Q

extreme nausea and vomiting, vaginal bleed, large uterus for dates and pre-eclampsia may indicate

A

trophoblastic disease

49
Q

swiss cheese or bunch of grapes indicates

A

hydatidiform mole

50
Q

risk factors for accreta, increta and percreta (

A
  • placenta previa
  • previous C section
  • prev curettage
  • multiple preg
51
Q

indication for total hysterectomy

A

placenta accreta

52
Q

umbilical cord diameter greather than ____ cm is abnormal

A

6 cm

53
Q

what is baddledore insertion

A

marginal insertion of umbilical cord into placenta

54
Q

painless bleeding in 3rd trimester

A

placenta previa

55
Q

low lying placenta is within ___ cm of the IO

A

2 cm

56
Q

when the cord is inserted into the membranes before it enters the placenta

A

velamentous (membranous) insertion

57
Q

5 aspects of biophysical profile

A
  1. breathing movements (BM)
  2. body/trunk movement (FM)
  3. fetal tone (FT)
  4. amniotic fluid volume
  5. cardiac non-stress test (NST)
58
Q

2 points for breathing movements in biophysical profile

A

at least 30 seconds of continuous breathing

59
Q

2 points for body/trunk movement

A

at least 3 unprovoked extremity or trunk movements - flexion of extremity, arching of back, twisting of the trunk

60
Q

2 points for fetal tone

A

at least 1 episode of extension with immediate return of flexion of an extremity

61
Q

2 points for AFV

0 points for AFV

A

2 points: AFI 5-22

0 points: < 5 cm

62
Q

what is cardiac non-stress test

A

measures the spontaneous changes in fetal heart rate and maternal uterine activity

63
Q

2 points for cardiac non-stress test

A

at least 2 episodes of fetal heart rate acceleration of at least 15 bpm above the baseline and of 15 sec duration, in a 20 min period

64
Q

there is a ___ min time limit for which biophysical profile measures

A

30 minutes for FM, FM, FT, AFV

20-40 min for cardiac nonstress test

65
Q

sonographic findings for hydrops (6)

A

hydrop if at least two of:

  • scalp edema <5mm
  • pleural effusion
  • pericardial effusion
  • ascites
  • polyhydramnios
  • placentomegaly
66
Q

maternal diabetes risk on mother (2)

A

pre-eclampsia and eclampsia

67
Q

maternal diabetes risk on fetus (4)

A
  • macrosomia
  • IUGR
  • placental abruption & intrauterine demise
  • anomalies (NTDs ie caudal regression syndrome, transposition great vessels, tetralogy of fallot)
68
Q

what systems does pre-eclampsia include? (3)

what is it linked to?

A
  • cardiovascular (hypertension)
  • renal (proteinuria)
  • hematological (edema)

poor implantation of placenta

69
Q

what is eclampsia?

A

the occurrence of seizures or coma during pregnancy, or shortly after childbirth

70
Q

what is chronic maternal hypertension?

what is the risk?

A

HTN present prior to pregnancy, or BEFORE 20 weeks’ gestation

placental abruption

71
Q

if pre-eclampsia is neglected, what can develop?

A

eclampsia or HELLP syndrome

72
Q

what is HELLP (3)

A
  • hemolytic anemia
  • elevated liver enzymes
  • low platelet count (thrombocytopenia)
73
Q

pre-eclampsia is a significant cause of

A

IUGR

74
Q

another term for pre-eclampsia

A

toxemia

75
Q

proteinuria lab values

A

> 300 Mg in 24 hr urine collect

76
Q

what is gestational hypertension?

A

transient HTN of pregnancy.
HTN that develops after 20 weeks in pregnancy and goes away after delivery.

NO PROTEINURIA

77
Q

funneling of internal os AKA

what is it?

A

early herniation of fetal membranes

  • a protrusion of the amniotic membranes by 3 mm or more into internal os
78
Q

cervical incompetence

A

painless cervical dilation and patients with recurrent second trimester pregnancy loss

79
Q

When performing the four-quadrant amniotic fluid volume calculation, it is important to hold the transducer in which position?

A

in longitudinal plane perpendicular to the examination table

80
Q

The fetus is obscuring the lower edge of the placenta being visualized in the second trimester. What can the sonographer do to improve visualization?

A

place the woman in the Trendelenberg position

81
Q

This occurs when the fetal membranes insert along the fetal surface, leaving an area of placenta free of membranes, and the placenta may separate and bleed:

A

circumvallate placenta

82
Q

Complications of placenta previa include an increased risk of (3)

A

premature delivery, post partum hemorrhage, IUGR

83
Q

In the ___________, you will record the position of the fetal head, spine, and stomach position.

A

transverse fetal lie

84
Q

pyopagus

A

conjoined twins fused at the sacral region

85
Q

omphalopagus

A

conjoined twins fuseed at the umbilicus

86
Q

IUGR may be symmetric or asymmetric. A symmetric growth restriction fetus is one that:

A

is globally small in all biometric measurements, usually due to first trimester factors

87
Q

Premature labor is the onset of labor before how many weeks’ gestation?

A

37 weeks

88
Q

The cervical width does what with increasing gestational age?

A

increases

89
Q

PROM increased risk

A

-pulmonary hypoplasia

90
Q

the normal umbilical artery looks like what waveform

A

ICA

OBGYN Abnormal BOARDS (9 decks)

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