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OBSTETRIC ULTRASOUND > THE HIGH RISK PREGNANCY > Flashcards

THE HIGH RISK PREGNANCY Flashcards

1
Q

High risk pregnancy

A

maternal or fetal factors which exist that may adversely affect the outcome of the pregnancy

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2
Q

maternal factors

A

1.alcohol/drug abuse
2.medication
3.hypertension
4.rhesus immunization
5.chronic maternal disease

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3
Q

fetal factors

A

1.genetic or incidental congenital malformations
2.IUGR
3.multiple gestations

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4
Q

other factors

A

1.PROM
2.Placenta
3.Incompetent cervix

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5
Q

alcohol abuse

A

alcohol is a patent teratogen, it reduces blood flow to the placenta and fetus

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6
Q

effects of alcohol on fetus

A
  1. CNS dysfunction
  2. Pre and postnatal growth restriction
    3.craniofacial abnormalities
    4.cardiac defects
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7
Q

major effects of alcohol by trimester

A

1st trim
-most developmental destructions occur
2nd trim
-increased risk of spontaneous abortion
3rd trim
- decreased fetal growth

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8
Q

FAS phenotype appearance

A

Head - small, head size

Forehead - Narrow, receding forehead

Nose - short, upturned nose, flattened nose bridge

Jaw - underdeveloped, receding chin, receding or flattened upper jaw

Eyes - drooping eyelids

Ears - uneven placement and size

Lips - Absence of groove in upper lips

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9
Q

FAS US management

A

-anatomy exam @ 20-23 weeks
-exclude defects, cleft palate, cardiac defects
-serial scans to monitor fetal growth scans
-HC:AC ratio to exclude MICROcephaly
-2nd trimester ass. with a small bdp and hc

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10
Q

smoking

A

nicotine interferes with fetal oxygen supply

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11
Q

smoking leads to

A
  1. increased risk to preterm labor
    2.infant mortality
    3.SIDS
    4.respiratory problems
    5.slowed fetal growth and low birth weight
    6.premature aging of the placenta
    7.oligohydramnios
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12
Q

smoking us management

A

1.US scan @ 20-23 weeks
2.serial scans, monitor fetal growth patterns
3.placental assessment for premature aging
4.amniotic fluid assessment

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13
Q

PROM

A

P -premature
R - rupture
O - of
M - membranes

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14
Q

PROM definition

A

the rupture of membranes prior to the onset of labor at or beyond 37 weeks gestation

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15
Q

PROM maternal risks

A

1.infection
2.inducing labor
3.endometriosis
4.sepsis
5.maternal death

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16
Q

PROM fetal risks

A

1.infection
2.placental abruption
3.sepsis
4.fetal distress
5.fetal restriction deformities
6.pulmonary hypoplasia
7.fetal/neonatal death

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17
Q

fetal Valproic acid syndrome

A

results from maternal valproic use during pregnancy

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18
Q

valproic acid

A

anti-seizure medication

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19
Q

fetal valproic acid syndrome US

A

-monthly growth scans
-fetal echocardiography
-3d US to assess more subtle facial and limb findings

20
Q

fetal warfarin syndrome

A
  • vitamin k (regulate blood calcium levels) antagonist
  • reduces blood clotting
21
Q

fetal warfarin syndrome US

A

1.severe nasal hyperplasia
2.rhizomelia
3.stippled epiphyses ,3rd trimester
4.postnatal radiography to confirm skeletal findings

22
Q

PET (PREECLAMPSIA)

A

high blood pressure after 20 weeks of gestation with proteinuria, renal and liver and hemotological abnormalities

23
Q

PREECLAMPSIA

A

placental disease which regresses on delivery and expulsion of the placenta

24
Q

PET maternal predisposition

A

-primigravida
-chronic hypertension
-obesity
-black patients

25
Q

PET maternal complications

A

-placental abruption
-HELLP syndrome
-pulmonary edema
-acute renal failure
-eclampsia
-liver failure
-stroke
-death
-long term cardiovascular morbidity

26
Q

PET fetal complications

A

-preterm delivery
-IUGR
-hypoxia
-perinatal death

27
Q

PET symptoms after 20weeks

A

-hypertension
-proteinuria
-edema
-vision disturbances
-ruq pain /epigastric
-severe frontal headache
-oliguria (low urine output)

28
Q

eclampsia

A

-seizures
-coma or cva (cerebral vascular accident)
-abnormal liver function
-thrombocytopenia (platelet deficiency)
-renal failure

29
Q

HELLP syndrome

A

H -hemolytic
E - elevated
L - liver enzymes
L - low
P - platelet
develop in the 3rd trimester or after delivery.

30
Q

HELLP risk factors

A

-multiparous white women >25

31
Q

HELLP complications

A

-placental abruption
-acute renal failure
-liver infarcts/hematoma
-vascular collapse
-shock and death

32
Q

HELLP US management

A

-32-34 weeks gestation treated with corticosteroids to mature fetal lungs

->34 weeks deliver fetus

-platelet or blood transfusion may be given

-patients BP >160/110 antihypertensive therapy should reduce the risk of maternal cerebral hemorrhage sezuires

33
Q

HELLP US management

A

-assess fetal well being
-fetal weight estimate in view of premature delivery
-assess for PET when both conditions coexist

34
Q

gestational diabetes

A

gestational diabetes is a disease of carbohydrate intolerance

35
Q

gestational diabetes signs

A

-maternal obesity
-glucosuria
-fetal macrosomia

36
Q

gestational diabetes maternal risks

A

-miscarriage
-preeclampsia
-preterm labor

37
Q

gestational diabetes fetal complications

A

-stillbirths
-congenital malformations
-macrosomia
-perinatal mortality
-polyhydramnios
shoulder dystocia

38
Q

congenital malformations in pregestational diabetes

A

-cardiac defects
-neural tube defects
-caudal regression syndrome
-renal malformations

39
Q

gestational diabetes US management

A

-umbilical artery dopplers
-AFI assessment
-subcutaneous measurements
-early dating scan
-growth scans
-detailed anomaly scan

40
Q

hydrops fetalis

A
  • 2 or more US findings:
  • scalp and body edema (skin thickness >5mm)
    -ascites
    -pleural effusion
    -pericardial effusion
    -polyhydramnios
    -placental thickening (>4 2nd trim, >6cm in 3rd trim)
    -90% non immune
    -10% immune
41
Q

immune hydrops

A

underlying condition is due to fetal anemia developing from maternal red blood cell alloimmunization

42
Q

alloimmunization

A

an immune response to foreign antigens after exposure to genetically different cells or tissues

43
Q

immune hydrops US

A

transfusion is based on relationship between MCA PSV to GA

44
Q

non-immune hydrops

A

caused by other conditions.
- cardiovascular conditions (common)
- >50% no underlying cause
- aneuploidy, turner syndrome, trisomy 21

45
Q

trisomy 13 and 18

A

common presentation is growth restriction

46
Q

RH incompatibility (isoimmunization)

A

RH (-) mother carries an RH (+) fetus
mother develops an immune response during labor

47
Q

complications of isoimmunization

A

fetus can develop
-anemia
-hydrops fetalis
-congestive cardiac failure

OBSTETRIC ULTRASOUND (5 decks)

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