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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
PET maternal complications
-placental abruption -HELLP syndrome -pulmonary edema -acute renal failure -eclampsia -liver failure -stroke -death -long term cardiovascular morbidity
26
PET fetal complications
-preterm delivery -IUGR -hypoxia -perinatal death
27
PET symptoms after 20weeks
-hypertension -proteinuria -edema -vision disturbances -ruq pain /epigastric -severe frontal headache -oliguria (low urine output)
28
eclampsia
-seizures -coma or cva (cerebral vascular accident) -abnormal liver function -thrombocytopenia (platelet deficiency) -renal failure
29
HELLP syndrome
H -hemolytic E - elevated L - liver enzymes L - low P - platelet develop in the 3rd trimester or after delivery.
30
HELLP risk factors
-multiparous white women >25
31
HELLP complications
-placental abruption -acute renal failure -liver infarcts/hematoma -vascular collapse -shock and death
32
HELLP US management
-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
HELLP US management
-assess fetal well being -fetal weight estimate in view of premature delivery -assess for PET when both conditions coexist
34
gestational diabetes
gestational diabetes is a disease of carbohydrate intolerance
35
gestational diabetes signs
-maternal obesity -glucosuria -fetal macrosomia
36
gestational diabetes maternal risks
-miscarriage -preeclampsia -preterm labor
37
gestational diabetes fetal complications
-stillbirths -congenital malformations -macrosomia -perinatal mortality -polyhydramnios shoulder dystocia
38
congenital malformations in pregestational diabetes
-cardiac defects -neural tube defects -caudal regression syndrome -renal malformations
39
gestational diabetes US management
-umbilical artery dopplers -AFI assessment -subcutaneous measurements -early dating scan -growth scans -detailed anomaly scan
40
hydrops fetalis
- 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
immune hydrops
underlying condition is due to fetal anemia developing from maternal red blood cell alloimmunization
42
alloimmunization
an immune response to foreign antigens after exposure to genetically different cells or tissues
43
immune hydrops US
transfusion is based on relationship between MCA PSV to GA
44
non-immune hydrops
caused by other conditions. - cardiovascular conditions (common) - >50% no underlying cause - aneuploidy, turner syndrome, trisomy 21
45
trisomy 13 and 18
common presentation is growth restriction
46
RH incompatibility (isoimmunization)
RH (-) mother carries an RH (+) fetus mother develops an immune response during labor
47
complications of isoimmunization
fetus can develop -anemia -hydrops fetalis -congestive cardiac failure

OBSTETRIC ULTRASOUND (5 decks)

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