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At Risk/Multiple Gestation Pregnancies Flashcards

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1
Q

What is the definition of preterm labor?

A

Labor before 37 weeks

Full term pregnancy is around 40 weeks.

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2
Q

What is Intrauterine Growth Restriction (IUGR)?

A

Fetal weight below the 10th percentile due to various physiologic conditions

Pathologic conditions prevent the fetus from growing properly.

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3
Q

What are common causes of IUGR?

A
  • Poor nutritional status
  • Smoking
  • Multiple Gestations
  • TORCH infections
  • Alcohol/substance abuse
  • Severe anemia
  • Diabetes
  • Chronic renal disease
  • Age less than or equal to 17 or more than or equal to 35
  • Heart disease
  • High altitude

Maternal factors are significant contributors to IUGR.

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4
Q

What are the categories of IUGR?

A
  • Symmetric IUGR
  • Asymmetric IUGR

Symmetric IUGR accounts for 10% of cases, while asymmetric IUGR happens in the last 8-10 weeks of pregnancy.

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5
Q

What is the hallmark sign of symmetric IUGR?

A

All measurements are less than 10%

This includes head, abdomen, and femur measurements.

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6
Q

What are some associated anomalies with symmetric IUGR?

A
  • Trisomy 18
  • Trisomy 21
  • Neural tube defects
  • Potter Sequence

These anomalies can be detected through sonographic findings.

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7
Q

What is the significance of the Doppler waveforms in IUGR?

A

Subtle changes in umbilical arterial Doppler waveforms indicate fetal compromise

This is only done for pregnancies of concern.

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8
Q

What are the Doppler flow patterns associated with umbilical artery (UA)?

A
  • UA-PEDF: Present end-diastolic flow
  • UA-AEDF: Absent end-diastolic flow
  • UA-REDF: Reversed end-diastolic flow

These patterns indicate varying degrees of fetal distress.

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9
Q

What does a decrease in middle cerebral artery (MCA) Doppler indicate?

A

Brain sparing effect due to compromised fetal circulation

Increased delivery of oxygenated blood to the brain at the expense of other organs.

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10
Q

What is the criteria for IUGR in terms of fetal weight?

A

Estimated fetal weight at or below the 10th percentile for gestational age

This can be assessed through biometric measurements.

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11
Q

What are the sonographic signs of fetal anemia?

A
  • Hydrops fetalis
  • Hepatosplenomegaly
  • Abnormal Doppler findings of MCA velocity

These findings indicate reduced RBC levels in fetal circulation.

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12
Q

What is fetal demise?

A

In utero death of the fetus at any stage of gestation

A death prior to 20 weeks is classified as a spontaneous abortion.

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13
Q

What maternal risk factors are associated with fetal complications?

A
  • Diabetes (poorly controlled)
  • Systemic lupus erythematosus
  • Infection
  • Hypertension (poorly controlled)
  • Pre-eclampsia
  • AMA
  • Rh isoimmunization
  • Uterine rupture
  • Maternal trauma

These factors can significantly impact fetal health.

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14
Q

Identify some risks associated with multiple gestations.

A
  • Multiple heart beats
  • Congenital abnormalities
  • Infections
  • Hydrops fetalis

These risks are higher in pregnancies with multiple fetuses.

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15
Q

What is the difference between dizygotic and monozygotic twins?

A
  • Dizygotic: Two zygotes from two ova
  • Monozygotic: One zygote (identical twins)

The formation of twins can depend on various factors including maternal age and assisted reproductive technologies.

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16
Q

What membrane configurations can occur in monozygotic twins?

A
  • Dichorionic/diamniotic (Di/Di)
  • Monochorionic/diamniotic (Mono/Di)
  • Monochorionic/monoamniotic (Mono/Mono)

These configurations depend on when the zygote divides after fertilization.

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17
Q

What is the significance of the Spalding sign?

A

Indicates fetal demise with overriding skull bones

This is a sonographic finding that can help diagnose fetal death.

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18
Q

Which of the following would NOT cause intracranial calcifications in a fetus? A. Zika virus B. Fetal anemia C. Toxoplasmosis D. CMV

A

B. Fetal anemia

Fetal anemia is not associated with causing intracranial calcifications.

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19
Q

What is the only way to determine if twins are not identical?

A

If we see 2 fetuses with opposite sex (M/F)

Otherwise, we cannot tell if they are identical.

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20
Q

What are the possible placental and amniotic sac configurations for twins?

A
  • 2 placentas, 2 amniotic sacs
  • 1 placenta, 2 amniotic sacs
  • 1 placenta, 1 sac

These configurations indicate different types of twinning.

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21
Q

What is the definition of monozygotic twins?

A

One egg splits into two!

This results in identical twins.

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22
Q

At what weeks is the determination of chorionicity and amnionicity most accurate?

A

7-10 weeks

This is crucial for assessing placental and sac configurations.

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23
Q

What does the presence of 2 gestational sacs indicate in early pregnancy?

A

Dichorionic/Diamniotic pregnancy

This indicates a lower risk for complications.

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24
Q

What indicates a monochorionic/monoamniotic pregnancy?

A

1 placenta, 1 sac

This configuration has the highest risk.

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25
What is the significance of the yolk sac in early gestation?
Helps in membrane determination ## Footnote Each amniotic sac must have a yolk sac.
26
What does the twin peak sign (lambda sign) indicate?
Dichorionic/Diamniotic twin gestation ## Footnote It shows placental tissue between 2 chorionic membranes.
27
What is the T-sign indicative of?
Monochorionic/Diamniotic pregnancy ## Footnote Indicates a shared placenta with two sacs.
28
What is the primary risk associated with monoamniotic twins?
Fetal cord entanglement ## Footnote This situation poses high mortality risk.
29
What is the incidence of birth defects in monoamniotic twins?
20% incidence of birth defects ## Footnote This is due to the higher risk factors involved.
30
What constitutes a vanishing twin?
20% of twin pregnancies result in singleton delivery due to in utero death of one twin ## Footnote This may occur due to spontaneous abortion or malformation.
31
What are the sonographic findings of Twin-to-Twin Transfusion Syndrome (TTTS)?
* Monochorionic placentation * AFI discrepancy * Donor twin DVP: < 2 cm * Recipient twin DVP: > 8 cm * Significant growth discordance (>20%) ## Footnote TTTS can lead to severe complications if untreated.
32
What is an acardiac twin?
An unusual variant of twin-twin transfusion syndrome with severely malformed donor twin ## Footnote The acardiac twin may have a rudimentary heart or be completely acardiac.
33
What does 'fetus papyraceus' refer to?
Death of one fetus preserved in utero, becoming compressed ## Footnote This results in a small fetus with loss of fluid.
34
What are conjoined twins?
Twins that share a body area ## Footnote They result from late monozygotic division after day 13.
35
What is the most common type of conjoined twins?
Thoracopagus ## Footnote This type represents about 75% of all cases.
36
What are the sonographic findings for conjoined twins?
* Lack of separating membrane * Inability to separate fetal bodies or heads * More than three vessel cord * Polyhydramnios ## Footnote These findings help in diagnosis.
37
What is the main cause of complications in monoamniotic twins?
Fetal cord entanglement ## Footnote This can lead to high mortality rates.
38
What is the standard assessment for twins during sonographic evaluation?
* Number of fetuses * Fetal lie * Number of placentas * Presence or absence of membranes * Standard biometry/anatomy * Qualitative assessment of amniotic fluid * Pulsed and/or color Doppler if indicated ## Footnote These assessments guide clinical management.
39
What are the two types of conjoined twins mentioned?
Thoracopagus and Omphalopagus ## Footnote Craniopagus is also mentioned as a type of conjoined twins.
40
Who were the Delaney twins and when were they separated?
The Delaney twins were separated on June 6, 2017, by a 30-member surgical team at Children's Hospital of Philadelphia.
41
What condition is characterized by a cervix that cannot support an intrauterine gestation to term?
Incompetent Cervix
42
What are some risk factors for Incompetent Cervix?
* Uterine anatomic anomalies * Prior cervical trauma or surgery * Recurrent spontaneous or elective abortions * Previous preterm deliveries * Multifetal pregnancy * Exposure to diethylstilbestrol (DES)
43
What is Diethylstilbestrol (DES) and when was it prescribed?
A synthetic form of the female hormone estrogen prescribed to pregnant women between 1940 and 1971.
44
What sono signs indicate an Incompetent Cervix?
* Cervical length less than 2.5 cm before 34 weeks * Cervical width greater than 2 cm in second trimester * Bulging cervical membranes * Dynamic cervix
45
What is a method of treating cervical incompetence?
Cervical Cerclage
46
What are the complications associated with Maternal Diabetes during pregnancy?
* Caudal regression * Inguinal hernias * Neural tube defects * Clubfoot * Cardiac anomalies * Single umbilical artery * Renal anomalies * Polydactyly * GI anomalies * Skeletal anomalies
47
What is defined as fetal weight greater than 4000-4500 grams?
Macrosomia
48
What are some maternal effects of diabetes during pregnancy?
* Pre-eclampsia * HELLP syndrome * Renal dysfunction * Diabetic retinopathy * Hypoglycemia * Peripheral vascular disease
49
What are the categories for sonographic findings in diabetic complications?
* Fetal anatomic abnormalities * Placental changes * Growth-related changes
50
What is the difference between preexisting hypertension and gestational hypertension?
* Preexisting: chronic elevation of blood pressure before pregnancy * Gestational: persistent elevation of BP after 20 weeks gestation that resolves postpartum
51
What is the triad of congenital rubella syndrome?
* Cataracts * Congenital heart disease * Deafness
52
What are the sono signs associated with cytomegalovirus during pregnancy?
* Increased periventricular echogenicity * Ventriculomegaly * Intracranial calcifications
53
What are the three ways herpes manifests in neonates?
* Skin, eyes, and mouth (SEM) herpes * CNS herpes * Disseminated herpes (DIS)
54
What are the complications of uterine rupture?
* Hemorrhage * Shock * Postoperative infection * Ureteral damage * Amniotic fluid embolism * Disseminated intravascular coagulopathies
55
What defines preterm delivery?
Spontaneous delivery before 37 weeks gestation
56
What is the puerperium?
The period after delivery that begins with the expulsion of the placenta and ends when maternal anatomy and physiology return to normal.
57
What sono findings indicate retained products of conception?
* Fluid filled uterine cavity in patients with active bleeding * Echogenic masses in the endometrial cavity * Increased vascularity with Doppler evidence
58
What is the definition of PROM?
Premature rupture of membranes occurring before the onset of labor before 37 weeks.
59
What is a risk factor for preterm labor?
* Previous uterine surgery * Uterine anomalies * Maternal stress * Heavy cigarette smoking * Multiple gestations * Polyhydramnios
60
What indicates fluid-filled uterine cavity in postpartum patients?
Active bleeding ## Footnote This condition may show echogenic masses in the endometrial cavity.
61
What is the significance of an endometrial diameter greater than 1.5 cm in postpartum patients?
Consistent with retained products of conception ## Footnote This measurement can be assessed using ultrasound.
62
What Doppler evidence suggests retained placental tissue?
Increased vascularity and feeding vessel ## Footnote These findings are critical in diagnosing retained products of conception.
63
What is suspected when a postpartum patient has a fever greater than 100.4 degrees on any two of the first 10 postpartum days?
Puerperal infection ## Footnote Accompanied by fever, high WBC, tachycardia, and uterine tenderness.
64
What can persist or not respond to antimicrobial therapy in postpartum infections?
Abscesses ## Footnote More common in patients who have undergone cesarean sections.
65
What sono signs indicate the presence of abscesses in postpartum patients?
Complex or anechoic fluid collections, presence of internal debris, acoustic shadowing when gas bubbles are present ## Footnote These findings help in the diagnosis of abscesses.
66
What is a cesarean section?
Delivery of the fetus, placenta, and membranes through an incision in the abdominal wall ## Footnote Indicated when vaginal delivery is not feasible or poses undue risk.
67
List common indications for a cesarean section.
* Placenta previa * Cephalopelvic disproportion * Uterine inertia * Premature separation of the placenta * Malpresentation * Preeclampsia/eclampsia * Fetal distress * Cord prolapse * Vasa previa * Maternal genital infection (herpes) ## Footnote These conditions often necessitate a cesarean delivery.
68
What does a cesarean scar niche refer to?
Myometrial defect and tethering of the endometrium in the region of the old cesarean scar ## Footnote Can cause dysfunctional uterine bleeding due to retained blood.
69
Where are hematomas most commonly located in relation to cesarean sections?
Anterior to the uterine incision and posterior to the bladder wall ## Footnote Result from failure to stop bleeding after the incision is closed.
70
What increases the risk of venous thrombosis during the postpartum state?
Vascular changes associated with pregnancy, labor, and delivery ## Footnote Risk increases substantially compared to nonpregnant women.
71
What is Virchow’s triad?
1. Hypercoagulability of blood 2. Venous stasis 3. Alterations of the venous endothelium ## Footnote These factors contribute to the increased risk of venous thrombosis.
72
What is the most common site for venous thrombosis in postpartum patients?
Lower extremity ## Footnote Ovarian veins are rare but very serious, often occurring on the right side.
73
What is cordocentesis?
An invasive method of obtaining a fetal blood sample using ultrasound guidance ## Footnote Also known as fetal blood sampling or percutaneous umbilical blood sampling (PUBS).
74
What is the treatment of choice for fetuses with severe hemolytic anemia?
Intravascular fetal transfusion ## Footnote This procedure is critical for managing severe cases.

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