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Urogenital System > 7. Obstetrics: Complications of The Antenatal Period > Flashcards

7. Obstetrics: Complications of The Antenatal Period Flashcards

1
Q

List six common antenatal complications

A 
Amniotic fluid disorders
Intrauterine growth restriction
Cervical insufficiency
Multiple gestation
Fetal demise in utero (IUFD)
Post term pregnancy
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2
Q

What can cause reduced or absent amniotic fluid

A

Premature rupture of membranes

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3
Q

True or False
Abnormal amniotic fluid disorders AFV may suggest fetal congenital anomalies, chromosomal abnormalities or fetal growth restriction

A

True

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4
Q

Describe what the qualitative assessment in ultrasound estimation of amniotic fluid volume includes

A

It is a subjective interpretation without sonographic measurements

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5
Q

What is the role of the sonographer doing qualitative assessment of amniotic fluid volume

A

They scan the uterine contents then report the amniotic fluid volume as oligohydramnios, normal or polyhydramnios based on his or her clinical expertise

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6
Q

List three semi quantitative methods for ultrasound estimation of amniotic fluid volume

A

Single deepest pockets/maximum vertical pockets/largest vertical pocket
Amniotic fluid index AFI
2 x 1cm/ 2 x 2cm pocket technique

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7
Q

Describe the single deepest pockets semi quantitive methods of estimation of amniotic fluid volume

A

The vertical dimension in centimeters of the largest pockets of amniotic fluid not persistently containing umbilical cord or fetal extremities

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8
Q

Which semi quantitative method of estimation of amniotic fluid volume is described as
The vertical dimension in centimeters of the largest pockets of amniotic fluid not persistently containing umbilical cord or fetal extremities

A

Single deepest pockets/maximum vertical pockets/largest vertical pocket

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9
Q

In the single deepest pockets semi quantitive methods of estimation of amniotic fluid volume the horizontal component of the vertical dimension must be at least what measurements

A

1cm

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10
Q

In single deepest pocket semi quantitive methods for estimation of amniotic fluid volume which depth is considered Oligohydramnios

A

Depth <2cm

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11
Q

In single deepest pocket semi quantitive methods for estimation of amniotic fluid volume which depth is considered normal

A

Depth >/= 2cm and <8cm

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12
Q

In single deepest pocket semi quantitive methods for estimation of amniotic fluid volume which depth is considered polyhydramnios

A

Depth>/= 8cm

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13
Q

How is amniotic fluid index calculated

A

It is calculated by dividing the uterus into four quadrants using the linea nigra for the right and left divisions and umbilicus for the upper and lower quadrant

Then the maximal vertical amniotic fluid pocket dial me to in each quadrant not containing cord or fetal extremities is summed

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14
Q

Which semi quantitive methods for estimation of amniotic fluid volume is calculated by dividing the uterus into four quadrants using the linea nigra for the right and left divisions and umbilicus for the upper and lower quadrant

Then the maximal vertical amniotic fluid pocket diameter in each quadrant not containing cord or fetal extremities is summed

A

Amniotic fluid index (AFI)

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15
Q

Which amniotic fluid index is considered oligohydramnios

A

AFI = 5cm

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16
Q

An AFI of less than or equal to 5 cm is considered oligohydramnios, normal or polyhydramnios

A

Oligohydramnios

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17
Q

Which amniotic fluid index is considered normal

A

AFI >5cm and <24cm

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18
Q

Which amniotic fluid index is considered polyhydramnios

A

AFI >/=24cm

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19
Q

An AFI of >/=5cm and <24cm is considered oligohydramnios, normal or polyhydramnios

A

Normal

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20
Q

An AFI of >/= 24cm is considered oligohydramnios, normal or polyhydramnios

A

Polyhydramnios

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21
Q

Describe the semi quantitive methods 2 x 1 cm or 2 x 2 cm pocket technique

A

Identification of at least one package of amniotic fluid with a minimum dimensions of 2 x 1 cm or 2 x 2 cm measured vertically and horizontally (or horizontally and vertically) not containing umbilical cord or fetal extremities

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22
Q

Which semi quantitative method is defined as the Identification of at least one package of amniotic fluid with a minimum dimensions of 2 x 1 cm or 2 x 2 cm measured vertically and horizontally (or horizontally and vertically) not containing umbilical cord or fetal extremities

A

2 x 1 cm or 2 x 2 cm pocket technique

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23
Q

Define oligohydramnios

A

It is amniotic fluid volume that is less than expected for the gestational age

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24
Q

Why is an adequate volume of amniotic fluid critical

A

To allow normal fetal movement and growth and to cushion the fetus and umbilical cord

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25
Q

List nine causes of polyhydramnios

A 
Gestational diabetes
Idiopathic
Macrosomia (new born with excessive birth weight)
Hydrops ( severe swelling in fetus)
Twin to twin transfusion syndrome
Fetal bowel obstruction
Arthrogryposis, akinesia syndrome
Congenital pulmonary malformation
Placental chorioangioma
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26
Q

What is the term used to describe severe swelling of the fetus

A

Hydrops

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27
Q

What is a term used to describe a newborn with an excessive birthweight

A

Macrosomia

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28
Q

Define macrosomia

A

This is a new born with an excessive birth weights

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29
Q

What is twin to twin transfusion syndrome (TTTS)

A

This is a prenatal condition in which twins share on equal amounts of the placenta is blood supply resulting in the two fetus is growing at different rates

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30
Q

This is a prenatal condition in which twins share on equal amounts of the placenta is blood supply resulting in the two fetus is growing at different rates

A

Twin to twin transfusion syndrome (TTTS)

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31
Q

Intrauterine growth restriction can be detected by which type of examination

A

Ultrasound examination

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32
Q

List five important steps in prenatal care for a patient with intrauterine growth restriction

A

Confirming the suspected diagnosis
Determining the cause and the severity of fetal growth restriction
Counseling the parents
Closely monitoring fetal growth and well-being
Determining the optimal time for and a route of delivery

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33
Q

List some intrinsic fetal factors that can cause fetal growth restriction

A

Aneuploidy
Congenital malformations
Infection

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34
Q

Can fetal growth restriction resulting from intrinsic fetal factors be improved by any intervention

A

Nope

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35
Q

Which has a better prognosis fetal growth restriction from intrinsic fetal factors or those related to Utero placental insufficiency

A

Those Related to Utero placental insufficiency

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36
Q

Define intrauterine growth restriction

A

It is defined as less than 10th percentile weight for gestational age and this establishes the diagnosis as being small for gestational age

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37
Q

What are the three steps in management of intrauterine growth restriction

A
  • Complete history and physical examination
  • To assess for maternal disorders that have been associated with restricted fetal growth
  • obstetrical imaging and laboratory evaluation’s are performed to look for fetal and Placental etiologies
  • Fetal survey
  • Fetal echocardiogram
  • Fetal genetic studies
  • Work up for infection
  • Amniotic fluid DNA testing
38
Q

Why is a fetal survey done when testing for intrauterine growth restriction

A

A detailed fetal anatomic survey should be performed in all cases since approximately 10% of fetal growth restriction accompanied by congenital anomalies

39
Q

List for anomalies associated with intrauterine growth restriction

A

Omphalocele
Diaphragmatic hernia
Skeletal dysplasia
Some congenital heart defects

40
Q

In the serial ultrasound evaluation for antepartum on management of intrauterine growth restriction which aspects are monitored

A

Fetal growth,
fetal behavior and
impedance to blood flow in fetal vessels

41
Q

What is the name of the process that uses ultrasound to check blood flow in the umbilical cord or between the uterus and placenta

A

Doppler Velocimetry

42
Q

What is the Doppler velocimetry

A

It is a process that uses ultrasound to check blood flow in the umbilical cord or between the uterus and placenta

43
Q

What does the frequency of antepartum management for intrauterine growth restriction depend on

A

The severity of findings and whether the examinations are being done to monitor fetal well-being or fetal growth

44
Q

In antepartum management of intrauterine growth restriction if the examinations are being done to monitor fetal well-being how often are these examinations done

A

1 to 7 times per week

45
Q

In antepartum management for introduce you to in growth restriction if the examination is done to monitor fetal growth, how often is this examination done?

A

Every 1 to 4 weeks

46
Q

Define cervical insufficiency

A

The term is used to describe painless cervical dilation leading to recurrent second trimester pregnancy losses/births of otherwise normal pregnancies

Also applied to women with one or two losses/births or at a risk for second trimester pregnancy loss/birth

47
Q

Most second trimester los Reyes/berts. are caused by other disorders such as

A

Decidual inflammation/infection
Hemorrhage
Uterine overdistention

48
Q

List three cervical insufficiency risk factors

A

Congenital cervical abnormalities
Acquired cervical abnormalities
Cervical trauma that may occur during labor or delivery

49
Q

Which clinical findings would you have when taking the past obstetrical history for cervical insufficiency

A

Second trimester pregnancy losses/deliveries, often associated with short labor
Progressively earlier deliveries in successive pregnancies

50
Q

What are some mild symptoms of cervical insufficiency

A

Pelvic pressure
Pre-menstrual like cramping or backache
Change in volume colour and consistency of vaginal discharge

51
Q

Symptoms of cervical insufficiency may begin between which weeks of gestation

A

Weeks 14 and 20

52
Q

List too late clinical presentations are cervical insufficiency

A

Advanced dilation and effacement, spotting, unprovoked grossly prolapse the membranes or ruptured membranes
Contractions that seem in adequate to explain the advanced effacement and dilation

53
Q

After imaging has been done list three clinical findings Of cervical insufficiency

A

The cervix may be short (below the 10th percentile which is 25 mm)
The fetal membranes may be separated and debris (sludge) may be seen in the amniotic fluid
A rapid rate of decrease in cervical length overtime and cervical shortening before 20 weeks may be noted

54
Q

What is the function of Cervicovaginal fetal fibronectin test

A

Cervicovaginal fetal fibronectin provides moderate to minimal prediction of preterm birth in women with multiple pregnancies

55
Q

True or false a combination of a short cervix on ultrasound examination and a positive, fFN (cervicovaginal fetal fibronectin) result is predictive of an increased risk of preterm delivery

A

True

56
Q

Which hormone supplement Tatian is administered for women with a history of spontaneous preterm birth

A

Progesterone supplementation

57
Q

Define dizygotic twins

A

Fraternal twins occur from ovulation and fertilization of two oocytes

58
Q

Define monozygotic twins

A

Identical twins and result from ovulation and fertilization of a single oocyte with subsequent division of the zygote

59
Q

Describe the placentas in monozygotic twins

A

May have two separate placentas or one placenta that is monochorionic/ monoamniotic or monochorionic/diamniotic

60
Q

What percent of dichorionic placentas are associated with dizygotic twins?

A

80%

61
Q

What percentage of dichorionic placentas are associated with monozygotic twins

A

20 %

62
Q

All monochorionic placentas are associated with monozygotic twins with which rare exception

A

Pregnancies conceived by Assisted reproductive technology ART

63
Q

Twin pregnancies resulting in two placentas, two amnions, two Chorions which produce monozygotic twins is as a result of cleavage of the zygote during which period of time after fertilization

NB// this presentation usually results in dizygotic twins

A

During first three days after fertilization

64
Q

Twin pregnancies resulting in one placentas, two amnions, one Chorions which produce monozygotic twins is as a result of cleavage of the zygote during which period of time after fertilization

A

4th to 8th day after fertilization

65
Q

Twin pregnancies resulting in one placentas, one amnions, one Chorions which produce monozygotic twins is as a result of cleavage of the zygote during which period of time after fertilization

A

8th to 12th day

66
Q

Describe the placenta and membranes in twin pregnancies where the cleavage of the monozygotic twins occurred during the first 3 days after fertilization

A

Two placentas, two amnions, two chorion

67
Q

Describe the placenta and membranes in twin pregnancies where the cleavage of the monozygotic twins occurred from the fourth to eighth day after fertilization.

A

One placenta, one chorion, two amnion

68
Q

Describe the placenta and membranes in twin pregnancies where the cleavage of the monozygotic twins occurred from 8th to 12th day after fertilization

A

One placenta, one chorion, one amnion

69
Q

List eight maternal risks and complications of multiple gestation

A 
Gestational hypertension and preeclampsia
Gestational diabetes
Acute Fatty Liver
Pruritic urticarial papules and plaques of pregnancy (PUPPP)
Intrahepatic cholestasis of pregnancy 
Iron deficiency anemia
Hyperemesis gravidarum
Thromboembolism
70
Q

Define preeclampsia

A

A pregnancy complication characterized by high blood pressure and signs of damage to another organ system

71
Q

A pregnancy complication characterized by high blood pressure and signs of damage to another organ system

A

Preeclampsia

72
Q

What is Pruritic urticarial papules and plaques of pregnancy (PUPPP)

A

It is an itchy rash that appears in stretch marks of the stomach during late pregnancy

73
Q

What is the name of the itchy rash that appears in stretch marks of the stomach during late pregnancy

A

Pruritic urticarial papules and plaques of pregnancy (PUPPP)

74
Q

List 9 monochorionic Complications

A 
Twin to twin transfusion Syndrome (TTTS)
Twin anemia polycythemia sequence (TAPS)
Selective fetal growth restriction (sFGR)
Twin reversed arterial perfusion (TRAP)
Monoamniotic twins (MA)
Conjoined twins
Discordant anomalies 
High-order monochorionic multiples
Death of one twin
75
Q

Twins is not a diagnosis what are the two correct terms

A

Dichorionic or monochorionic

76
Q

When is the anatomic survey for a mono chorionic twin taken

A

At 18 to 22 weeks

77
Q

When is the echocardiogram for a monochorionic twin taken

A

At 18 to 22 weeks

78
Q

Which three tests are performedIn both monochorionic and dichorionic twin pregnancies between 11 and 14 weeks

A

Screening for trisomy 21
Chorionicity
Dating, labelling

79
Q

Which three tests are done at 16 to 18 weeks for a monochorionic twin pregnancy

A

Fetal growth, deep vein pulse DVP

UA-PI (umbilical arterial pulsality index) UA-PI

80
Q

Which four tests are done at 20 to 22 weeks in a dichorionic twin pregnancy

A

Detailed and not to me
Biometry
Amniotic fluid volume
Cervical length

81
Q

What are some benefits of early detection of monochorionic complications

A

Allows for time the referral to treatment center

Allows the patient the opportunity to educate her self

82
Q

What is the most common and potentially most serious monochorionic complication

A

Twin to twin transfusion syndrome TTTS

83
Q

What percentage of all monochorionic gestation is affected by twin to twin transfusion syndrome TTTS

A

Approximately 10%

84
Q

Which complication accounts for approximately half of all the deaths in monochorionic gestations

A

Twin to twin transfusion syndrome TTTS

85
Q

What is the loss rate for a monochorionic gestation with twin to twin transfusion syndrome TTTS

A

Approximately 70 to 100%

86
Q

Define twin to twin transfusion syndrome

A

It is a prenatal condition in which twins share an equal amounts of the placenta is blood supply resulting in the true fetus is growing at different rates

87
Q

It is a prenatal condition in which twins share an equal amounts of the placenta is blood supply resulting in the true fetus is growing at different rates

A

Twin to twin transfusion Syndrome

88
Q

What is the principal basis of twin to twin transfusion syndrome

A

There is a donor twin that transfers volume to the recipient twin

89
Q

What happens to the donor twin in twin to twin transfusion syndrome

A

The donor twin becomes oliguric or Oligohydramnios and hypovolemic

90
Q

What happens to the recipient twin in twin to twin transfusion syndrome

A

Recipient becomes polyuric or polyhydramnios and hypervolemic

91
Q

What is the goal of intervention of twin to twin transfusion syndrome management

A

To restore more equitable blood flow Between the twins and thus halt or reverse cardiac decompensation in the recipient twin

Urogenital System (17 decks)

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