2nd and 3rd trimester complication Flashcards by Meghan May

Placenta’s role: transport of nutrients and waste products to and from developing fetus; “fetomaternal organ”

• Fusion between fetal (____) and maternal (____) tissue for physiological exchange

chorion

endometrial

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r =weeks 13 through 25 weeks and 6 days of gestation

=26 weeks of gestation through the estimated due date

Second trimester

• Third trimester

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Second Trimester Complications

• Fetal Infections-TORCH infections –

-Toxoplasmosis
– Other (Syphilis, Parvovirus B19)
– Rubella

– Cytomegalovirus
– Herpes Simplex Virus

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a coccidian parasite

Essential reservoir-felines
Acute infection–>devastating effects; risk of fetal infection ↑ with gestational age, but severity ↓ with gestational age

Toxoplasmosis

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Transmission of Toxoplasmosis

o transplacental

o fecal-oral route

o risk of fetal infection increases with gestational age
o severity of fetal infection decreases with gestational age

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You’re performing ultrasound on women during 2nd trimester and notice baby ahs intracranial calcifications, hydrocephalus and choretinitis, DX

Toxoplasmosis:

triad seen in 2nd semseter = hydrocephalus, intracranial calcifications, and chorioretinitis

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Clincal manifestations of Toxoplasmosis during:

1st

2nd

3rd trimester

o First trimester-often results in death
o Second trimester-classic triad of hydrocephalus, intracranial calcifications, and chorioretinitis
o Third trimester-often asymptomatic at birth

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How do you Dx Toxoplasmosis in mom and baby

mom: +IgM and IgG titers

fetal PCR of amniotic fluic

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a Gram-neg spirochete

• Transmission: – transplacental – sexual activity

Fetal Infections-Syphilis
• Treponema pallidum

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Clincal manifestation of congentital syphillis

Clinical Manifestations-Congenital syphilis – spontaneous abortion (first trimester)
– Stillbirth
– non-immune hydrops (CV fail)

– preterm birth
– Hepatomegaly
– ascites
– anemia, thrombocytopenia

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you are doing an ultrasound on mom that is almost in her 2nd trimetser of pregnancy. You note abnormalities on ultrasound: ascites and hepatometagly. What is the mom at risk for or have?

at risk for still birthr or preterm baby:

has congenital syphillis

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Dx for Syphillis

– Screening: RPR and VDRL

– FTA-ABS and microhemagglutination (MHA) test to confirm dx

– Dark-field microscopy and direct fluorescent- antibody testing

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-a single-stranded DNA virus; see infection & lysis of erythroid progenitor cells–> hemolysis & transient aplastic crisis

• Parvovirus B19

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Transmission of B19

Dx of B19

• Transmission
– Respiratory droplets
– Transplacental transfer

Diagnosis
– +IgM and IgG
– Viral DNA by PCR (amniotic fluid)

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Clicnal manifestation of ParvoB19

anemia, acute myocarditis, edema/hydrops, intrauterine fetal demise

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Togavirus - a RNA virus
Since licensure of an effective vaccine, frequency has ↓

• Transmission
– Transplacental
– Respiratory droplets

Rubella

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Baby with: Deafness/ Eye defects (cataracts or retinopathy)/ CNS defects/ Cardiac malformations

– Other anomalies: microcephaly, mental retardation, pneumonia, fetal growth restriction, hepatosplenomegaly, hemolytic anemia, and thrombocytopenia

Caused by Rubella

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Effects eyes, ears and heart

think rubella

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Dx of Rubella

Diagnosis
– ↑ IgM & IgG titers
– PCR of amniotic fluid

see lemon shaped skull

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double-stranded DNA virus of the herpes family

• Transmission: Transplacental: Perinatal (contact with vagina during delivery or breast milk after delivery): Contact with bodily fluids **(urine/saliva) **

Cytomegalovirus

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SEe Periventricular calcifications for new born:

Congenital CMV

periventricular calcifications, intrauterine growth restriction, developmental delay, microcephaly, sensorineural hearing loss, retinitis, jaundice, hepatosplenomegaly, thrombocytopenia, hypotonia

CMV

Histologically: presence of enlarged (cytomegalic) cells that have dense “owl’s eye” basophilic inclusion within the nucleus

CMV

Dx of Congenital CMV

presence of CMV in the infant’s urine during the first week of life

Transmission of HSV to baby

– **_Perinatal (contact with vagina during delivery)_** – Contact after rupture of membranes – Direct contact with affected areas – **Transplacental infection is rare **

Clincal manifestations of congenital HSV 1 and 2 are rare:

microcephaly, **ventriculomegaly**, spasticity, echogenic bowel, hepatosplenomegaly, and _flexed extremities _

special dx of newborn with congenital HSV

HSV antibodies a**ppear during the first weeks** after infection and persist for life or Tzanck smear : multinucleated giant cells and viral inclusions

Definition: painless cervical shortening or dilation leading to pregnancy loss how to tx it:

Cervical Insufficiency tx: Cervical Cerclage

Risk factors of cervical insufficiency

– collagen abnormalities – uterine anomalies – prior obstetric trauma – mechanical dilation – prior 2nd trimester loss

Defects of organs or body parts due to an **intrinsically abnormal** developmental process where a structure is not formed, partially formed, or formed in an abnormal fashion

Fetal Anomalies risk: – Chromosomal – genetic abnormalities – exposure to teratogens

Dx of fetal anomalies of seen during:

etal ultrasound during second trimester tx varies depending on anomalie; some tx after birth, in utero or not compatible with life

chorioamniotic membrane rupture before the onset of labor in pregnancies at less than 37 weeks of gestation

Preterm Premature Rupture of Membranes (PPROM)

Risk factors for PPROM

Risk factors – preterm labor – short cervix – advanced cervical dilation

Dx of PPROM

Diagnosis: direct visualization of fluid and ferning on microscopy

Preterm Premature Rupture of Membranes (PPROM) Preterm Labor Hemorrhage Secondary to Placental Abnormalities Intrauterine Fetal Demise Intrauterine Growth Restriction Macrosomia

all thrid trimester cause of preterm labor

* Labor/Birth between 20 weeks and 36 6/7 weeks * #1 cause of perinatal morbidity and mortality in developed countries

preterm labor

Risk factors for preterm labor

– premature activation of the maternal or fetal hypothalamic-pituitary-adrenal axis – exaggerated inflammatory response/infection – abruption – pathological uterine distension

– Placenta Previa – Placenta Accreta – Placenta Abruption – Velamentous Cord Insertion

Hemorrhage Secondary to Placental Abnormalities Third trimester complications

* Placenta **located over or near internal cervical os** * Painless – No contractions present * Caused by implantation within the **uterus too near the cervix **

Placenta Previa

Risk factors Placenta previa

– Smoking – Advanced maternal age – Multiple gestation – Uterine anomalies – Scarring from previous pregnancies

– Implantation **extends into the basal zone** of the endometrium, ↑ difficulty of removing the entire placenta during delivery – Risk for hemorrhage and hysterectomy after delivery

Placenta Accreta

-implantation extends into myometrium

Placenta Increta

implantation extends **into uterine serosa or adjacent organs** – Risk Factors: multiple cesarean sections, placenta previa

Placenta Percreta

Placental separation due to hemorrhage into the decidual basalis before birth: Vaginal bleeding, uterine tenderness, and contractions, **with or without non-reassuring fetal heart tones **

Placenta Abruption

DX and risk factors for Placental abruption

* Diagnosis of exclusion * Risk Factors: prior abruption, trauma, PPROM, HTN, smoking and cocaine use

* Umbilical cord attaches **to the chorion and amnion** rather than the placenta * Umbilical vessels **continue onto the placenta** between the two membranes * Umbilical vessels *may easily be torn* causing serious blood loss

Velamentous Cord Insertion

-estimated fetal weight**\>4500grams** – Risk Factors: incorrect dates, maternal diabetes, excessive weight gain, maternal obesity Macrosomia

Cervical insufficiency/short cervix can affect a low risk population, and therefore cervical length evaluation should be part of the routine anatomy scan ~

20 weeks gestation.

Preterm premature rupture of membranes, preterm labor , IUGR, and macrosomia have \_\_\_\_and is a serious problem in high risk populations.

multiple etiologies