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MIDS 187 > Ch 18 Effects of Maternal Disease on Pregnancy > Flashcards

Ch 18 Effects of Maternal Disease on Pregnancy Flashcards

1
Q

What does TORCH stand for?

A

Toxoplasmosis, others viruses, rubella, cytomegalovirus + herpes

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2
Q

What is TORCH?

A

-It is common maternal infections associated with fetal congenital anomalies
-These tests check for several different infections in a newborn

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3
Q

What is toxoplasmosis?

A

-Parasitic infection transmitted through undercooked/raw meat that is contaminated
-Pregnant pt should not handle cat litter b/c of risk of contracting the parasite by inhaling the dust

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4
Q

Does the obstetric pt typically experience symptoms with toxoplasmosis?

A

No, asymptomatic

(15-17% of maternal infection in 1st trimester can transfer to the placenta + fetus causing anomalies)

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5
Q

Severe toxoplasmosis infection can present as what 3 things in the fetus + neonate?

A

-CNS anomalies
-Ascites
-Hypatosplenomegaly

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6
Q

Is acquiring toxoplasmosis in early or late pregnancy more likely going to spread to the fetus?

A

Late - acquiring the infection during 3rd trimester will more likely affect fetus

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7
Q

What does “others” represent in TORCH?

A

-Syphilis
-Varicella-zoster
-Parvovirus B19 (5th disease)

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8
Q

Infections with syphilis in early pregnancy may result in what?

A

Spontaneous abortion

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9
Q

Fetal contamination with maternal chickenpox infection results in what?

A

Fetal varicella-zoster

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10
Q

The risk for fetal anomalies is highest in which trimesters?

A

1st + 2nd

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11
Q

List the sonographic evidence of varicella-zoster virus in the fetus that is displayed in the image on the lecture slide?

A

Echogenic hepatic foci + abdomen

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12
Q

What are the 2 fetal complications when exposed to acute parvovirus B19?

A

-Death
-Nonimmune hydrops

(these occur within 12 weeks following infection in pregnancy)

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13
Q

What are noninvasive ways to diagnose fetal anemia + nonimmune hydrops?

A

An anatomic survey + measurement of peak systolic flow of MCA

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14
Q

What infection was one of the 1st recognized maternal infections that resulted in fetal anomalies?

A

Rubella (aka German or 3 day measles)

(malformations occur with 1st trimester exposure)

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15
Q

How does gestational herpesvirus infections reach the embryo/fetus?

A

Through the placenta by ascending through the cervix OR through fetal contact with birth canal during vaginal delivery

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16
Q

What is the m/c known cause of congenital infections in humans?

A

CMV (cytomegalovirus virus)

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17
Q

Is there a high or low rate of transmission of the herpes simplex virus infection to the neonate?

A

High - associated with cranial malformations, microphthalmia + hepatosplenomegaly

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18
Q

The presence of the virus in the maternal genital tract at time of delivery indicates the need for what?

A

C-section - b/c of high neonatal infection rate with vaginal delivery

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19
Q

What is a typical finding when a maternal infection has crossed the placenta?

A

Polyhydramnios

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20
Q

CMV infection + toxoplasmosis m/c result in what?

A

Periventricular calcifications

21
Q

What is the m/c maternal disorder the OB sonographer encounters?

A

Diabetes mellitus

22
Q

What are the types of diabetes mellitus?

A

Type 1: insulin dependent (juvenile onset)
Type 2: noninsulin dependent (adult onset)

Secondary: pancreatic disease, hormones, drugs, chemicals, genetic syndromes

23
Q

Impaired glucose tolerance + gestational diabetes is a condition that only occurs when?

A

During pregnancy

24
Q

High blood sugar levels (hyperglycemia) in the mother results in the disruption of what?

A

Embryonic organogeneisis

25
Q

What pathology occurs in 6.4% of diabetic mothers?

A

SUA

(may also experience IUGR or macrosomia - due to hyperglycemia)

26
Q

What is fetal macrosomia?

A

-Newborn who is much larger than average
-Fetal weight over 4,500g (9 lb 9 oz) or above 90th percentile for gest age

27
Q

If a mother has diabetes, an anatomic survey b/w what weeks will allow for screening for malformations? When should follow up exams occur?

A

-B/w 18-22 weeks for anatomic survey
-Follow up exams done every 4-6 weeks for fetal growth + estimated weight

28
Q

What causes placental enlargement in fetus’s whose mother has diabetes?

A

Due to chronic hyperglycemia

29
Q

Gestational diabetes m/c begins during what month of pregnancy?

A

B/w month 5 or 6 (24-28 weeks) + disappears shortly after delivery

30
Q

What type of test is the preferred method to diagnose gestational diabetes?

A

Glucose tolerance test (done b/w weeks 24-28)

31
Q

What is the glucose tolerance test?

A

-Drinking glucose solution + checking glucose level after 1 hour
-A higher glucose level requires a 3 hour glucose tolerance test
-The diagnosis is made when 2 or more high glucose levels during the 3 hour test occur

32
Q

What is toxemia?

A

Preeclampsia - 3rd trimester disease characterized by maternal edema, hypertension, proteinuria + CNS irritability

33
Q

2 stages of toxemia?

A

1: Preeclampsia (hypertension with proteinuria and/or edema)

2: Eclampsia (when 1 or more convulsions occur, there is an increased maternal + fetal mortality)

34
Q

When preeclampsia develops before 26 weeks gestation, what happens?

A

A prenatal mortality rate as high as 20% has been reported

35
Q

Preeclampsia m/c occurs in what age?

A

Young primigravidas (preg for 1st time) + in older multiparas (preg multiple times)

36
Q

What 3 factors are associated with preeclampsia?

A

-Low birth weight
-Fetal distress
-Placental abruption

37
Q

What drugs can be prescribed to help control BP + seizures?

A

BP: antihypertensive drugs
Seizures: anticonvulsant medication

38
Q

If toxemia is present, will they deliver the fetus right away?

A

Yes! Immediately

39
Q

What is the HELLP syndrome?

A

Hemolysis, Elevated Liver enzymes, Low Platelets

40
Q

Are HELLP symptoms similar to preeclampsia findings?

A

Yes - often go together

41
Q

When does HELLP m/c occur in pregnancy?

A

3rd trimester - rarely occurs earlier

42
Q

What women m/c have HELLP?

A

-African descent
-Nulliparous white women with preeclampsia + family history

43
Q

We should be suspicious of placental abruption when the mother experiences what signs?

A

Abdominal pain in a women with chronic hypertension

44
Q

Can hypertension occur in pregnancy w/o the development of toxemia?

A

Yes

45
Q

What do serial S/D ratios detect?

A

The development of increased placental vascular resistance

46
Q

Does hypertension of any type pose a risk to the mother + fetus?

A

Yes

47
Q

Excessive consumption of alcohol (a teratogen) during pregnancy can result in what?

A

Fetal alcohol syndrome (FAS)

48
Q

What is the leading cause of mental retardation in the West?

A

FAS - results in cognitive + functional disabilities as well as structural + growth anomalies in the fetal period

MIDS 187 (19 decks)

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