Simtics - fetal growth and high risk preg Flashcards
s/s may indicate presence of fetal/maternal disease (6)
- fetus large/small for dates
- maternal lower abdo pain
- vag bleed
- premature labour
- pre eclampsia
- maternal RF
what is pre-eclampsia. what does it present as (3)
a multisystem disorder linked to placental implantation.
- maternal hypertension (130/90)
- proteinuria
- edema
what may develop along with eclampsia? (2)
- fatal seizures
- HELLP syndrome (Hemolytic anemia, Elevated Liver enzymes, Low Platelet count)
pre-eclamsia is a significant cause of fetal what
fetal IUGR
in measuring amniotic fluid volume (single pocket assessment), polyhydraminos is when
MVP >8 cm
in measuring amniotic fluid volume (single pocket assessment), oligohydraminos is when
MPV <2 cm
in measuring amniotic fluid volume (amniotic fluid index), what is the normal range?
when Q1+Q2+Q3+Q4 = 5-20 cm
oligo <5 cm
poly >18-20 cm
Macrosomia
when estimated fetal weight ≥ 4000 g
large for gestational age
a fetal weight at or above the 10th percentile for gestational age
macrosomia risk factors
- gestational diabetes
- enlargement placenta
raised maternal AFP could mean (2)
- multiple pregnancy
- neural tube defects
twin peak sign occurs with
aka lambda sign
dichorionic-diamniotic
pathology assoc with multiple preg (4)
- poly-oli/stuck twin
- TTT syndrome
- conjoined twins
- acardiac anomaly
fetal risk for pump/donor twin and recipient twin
pump/donor: reduced o2 = less kidney blood flow thus output = oligohydramnios
recipient = poly and heart failure
most common conjoined twin
Thoracopagus: they are joined at the chest and have a cardiac connection.
IUGR
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.
risk factors for IUGR (7)
- previous IUGR pregnancy
- uterine anomaly
- multiple pregnancy
- significant placental hemorrhage
- maternal hypertension (with or without pre-eclampsia)
- maternal diabetes
- tobacco/drug/alch
IUGR babies have an increased risk of
antepartum death (death before birth) and neonatal morbidity
small for gestational age
a fetus with a weight below the 10th percentile, but with no known cause
EFW paramaters (4)
BPD
HC
AC
FL
what is more common : symmetric or asymmetric IUGR
asymmetric IUGR
causes of asymmetric IUGR
- uteroplacental insufficiency
- maternal diabetes
- pre-eclampsia -chronic hypertension
- smoking
- uterine anomaly
- placental hemorrhage.
asymmetric IUGR measures present as
small AC with normal BPD and HC
Early ultrasound markers of uteroplacental insufficiency include (4)
- decreased fetal biometry
- echogenic bowel
- mild cardiomegaly -abnormal uteroplacental/fetal Doppler studies
what is a major indicator (measurement) for IUGR or macrosomia?
AC - will be disproportionally small compared to HC and BPD in IUGR and
AC will be disproportionally large in macrosomia
BPD alone is not a reliable predictor of IUGR
true - fetal head may be dolichocephalic/brachycephalic due to its position in the uterus or to oligohydramnios. HC is more useful in this instance
dolichocephalic head seen in what positions
transverse or breech position
what is useful to differentiate symetric IUGR from asymmetric IUGR?
HC:AC ratio
in asymmetric IUGR how does the HC:AC ratio change?
the ratio increases (HC proportionally greater than AC) due to reduction in subcutaneous tissue and fat in the fetus with IUGR
how does the HC:AC ratio NORMALLY change as gestational age increases?
HC:AC ratio decreases as gestational age increases (HC smaller than AC)
most common cause of IUGR
uteroplacental insufficiency
normal ductus venosus waveform
saw-tooth
how does amniotic fluid volume increase with GA? until when?
increases proportionally with gestational age until approximately 34 weeks;
fetal causes of polyhydramnios (7)
- CNS disorders
- GI problems (including hydrops)
- skeletal disorders
- upper GI tract obstruction
- renal disorders
- fetal macrosomia
- rh isoimmunization
polyhydramn clinically presents as
uterus larger than expected for calculated dates
most common cause of polyhydramnios is
maternal diabetes
prolonged oligohydramnios associated with (2)
limb contractures such as talipes or club foot
fetal (4) & other (2) anomalies assoc with oligohydro include
- bilateral renal agenesis
- polycystic kidney
- multicystic dysplastic kidneys
- bladder outflow obstruction
- ureteroplacental insufficiency
- IUGR
grade I placenta
mid second, early third trimester
- subtle indentations chorionic plate
- random echogenic densities 2-4mm
grade II placenta
late third trimester
- “comma” indentations
- basal area has echogenic densities
grade II placenta
very late third trimester
- complete indentations
- hypoechoic densities
- large echogenic with shadowing
most women with placenta previa experience what
placental migration
complications placenta previa (4)
- premature delivery
- hemorrhage (maternal & post partum)
- placental accreta
- IUGR
placenta accreta grades
AIP
accreta: chorionic vili invades decidua basalis
increta: chorionic vili invade myometrium
percreta: chorionic vili penetrate uterine serosa
placental thickness > ? cm is abnormal
5 cm
Name of rare placental tumour, and when its ominous
chorioangioma, >5 cm
chorioangioma is associated with (4)
polyhydramnios
hydrops
IUGR
demise
extreme nausea and vomiting, vaginal bleed, large uterus for dates and pre-eclampsia may indicate
trophoblastic disease
swiss cheese or bunch of grapes indicates
hydatidiform mole
risk factors for accreta, increta and percreta (
- placenta previa
- previous C section
- prev curettage
- multiple preg
indication for total hysterectomy
placenta accreta
umbilical cord diameter greather than ____ cm is abnormal
6 cm
what is baddledore insertion
marginal insertion of umbilical cord into placenta
painless bleeding in 3rd trimester
placenta previa
low lying placenta is within ___ cm of the IO
2 cm
when the cord is inserted into the membranes before it enters the placenta
velamentous (membranous) insertion
5 aspects of biophysical profile
- breathing movements (BM)
- body/trunk movement (FM)
- fetal tone (FT)
- amniotic fluid volume
- cardiac non-stress test (NST)
2 points for breathing movements in biophysical profile
at least 30 seconds of continuous breathing
2 points for body/trunk movement
at least 3 unprovoked extremity or trunk movements - flexion of extremity, arching of back, twisting of the trunk
2 points for fetal tone
at least 1 episode of extension with immediate return of flexion of an extremity
2 points for AFV
0 points for AFV
2 points: AFI 5-22
0 points: < 5 cm
what is cardiac non-stress test
measures the spontaneous changes in fetal heart rate and maternal uterine activity
2 points for cardiac non-stress test
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
there is a ___ min time limit for which biophysical profile measures
30 minutes for FM, FM, FT, AFV
20-40 min for cardiac nonstress test
sonographic findings for hydrops (6)
hydrop if at least two of:
- scalp edema <5mm
- pleural effusion
- pericardial effusion
- ascites
- polyhydramnios
- placentomegaly
maternal diabetes risk on mother (2)
pre-eclampsia and eclampsia
maternal diabetes risk on fetus (4)
- macrosomia
- IUGR
- placental abruption & intrauterine demise
- anomalies (NTDs ie caudal regression syndrome, transposition great vessels, tetralogy of fallot)
what systems does pre-eclampsia include? (3)
what is it linked to?
- cardiovascular (hypertension)
- renal (proteinuria)
- hematological (edema)
poor implantation of placenta
what is eclampsia?
the occurrence of seizures or coma during pregnancy, or shortly after childbirth
what is chronic maternal hypertension?
what is the risk?
HTN present prior to pregnancy, or BEFORE 20 weeks’ gestation
placental abruption
if pre-eclampsia is neglected, what can develop?
eclampsia or HELLP syndrome
what is HELLP (3)
- hemolytic anemia
- elevated liver enzymes
- low platelet count (thrombocytopenia)
pre-eclampsia is a significant cause of
IUGR
another term for pre-eclampsia
toxemia
proteinuria lab values
> 300 Mg in 24 hr urine collect
what is gestational hypertension?
transient HTN of pregnancy.
HTN that develops after 20 weeks in pregnancy and goes away after delivery.
NO PROTEINURIA
funneling of internal os AKA
what is it?
early herniation of fetal membranes
- a protrusion of the amniotic membranes by 3 mm or more into internal os
cervical incompetence
painless cervical dilation and patients with recurrent second trimester pregnancy loss
When performing the four-quadrant amniotic fluid volume calculation, it is important to hold the transducer in which position?
in longitudinal plane perpendicular to the examination table
The fetus is obscuring the lower edge of the placenta being visualized in the second trimester. What can the sonographer do to improve visualization?
place the woman in the Trendelenberg position
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:
circumvallate placenta
Complications of placenta previa include an increased risk of (3)
premature delivery, post partum hemorrhage, IUGR
In the ___________, you will record the position of the fetal head, spine, and stomach position.
transverse fetal lie
pyopagus
conjoined twins fused at the sacral region
omphalopagus
conjoined twins fuseed at the umbilicus
IUGR may be symmetric or asymmetric. A symmetric growth restriction fetus is one that:
is globally small in all biometric measurements, usually due to first trimester factors
Premature labor is the onset of labor before how many weeks’ gestation?
37 weeks
The cervical width does what with increasing gestational age?
increases
PROM increased risk
-pulmonary hypoplasia
the normal umbilical artery looks like what waveform
ICA
