Chapter 32 - Fetal Environment and Maternal Complications Flashcards by Gabriella Santangelo

Placental abruption

Abruption placentae

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Cyst found within the umbilical cord

Allanotic cyst

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The amount of amniotic fluid surrounding the fetus; the sum of four quadrant measurements of amniotic fluid

Amniotic Fluid index

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Diffuse edema

Anasarca

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Placenta that consists of two equal discs of equal size

Bilobed placenta

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Method of fetal monitoring with sonography to produce a numerical scoring system that predicts fetal well-being

Biophysical profile

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The stage of the conceptus that implants within the decidualized endometrium

Blastocyst

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The placement of sutures within the cervix to keep it closed

Cerclage

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The painless dilation of the cervix in the second or early third trimester

Cervical incompetence

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A benign placental tumor

Chorionagioma

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The part of the chorion, covered by chorionic villi, that is the fetal contribution of the placenta

Chorion Frondosum

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Fingerlike projections of gestational tissue that attach to the decidualized endometrium and allow the transfer of nutrients from the mother to the fetus

Chorionic Villi

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An abnormally shaped placenta caused by the membranes inserting inward from the edge of the placenta, producing a curled-up placental shape

Circumvallate placenta

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Groups or lobes of chorionic villi

Cotyledons

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A mass consisting of abnormal bronchial and lung tissue that develops within the fetal chest

Cystic adenomatoid malformation

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The endometrial tissue at the implantation site, and the maternal contribution of the placenta

Decidua basillis

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Condition in which there is an incompatibility between the fetal an maternal red blood cells

Erythroblastosis Fetalis

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The fetal weight based on sonographic measurements

Estimated fetal weight r

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Total blood loss; to bleed out

Exsanguination

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The result of the premature opening of the internal os and the subsequent bulging of the membranes into the dilated cervix

Funneling (cervical)

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Fetal hydrops caused by Rh incompatibility

Immune hydros

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Term used for isthmus during pregnancy

Lower uterine segment

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A fetus that is below the 10th percentile for gestational age (small for gestational age) and whose growth is impeded for some reason

Intrauterine growth restriction

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An estimated fetal weight of greater than the 90th percentile or the neonate that measures more than 4,500g

Macrosomia

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Abnormal cord insertion at the edge of the placenta

Marginal Cord insertion

Fetal stool that is composed of fetal skin, hair, amniotic fluid, and bile

Meconium

A rare disorder in which the mother suffers from edema and fluid buildup similar to her hyrdropic fetus

mirror syndrome

First 28 days of life

Neonatal period

A group of developmental abnormalities that involve the brain and spine

Neural tube defects

Fetal hydrops caused by congenital fetal anomalies and infections

Nonimmune hydros

Condition of having the umbilical cord wrapped completely around the fetal neck

Nuchal cord

The vertical groove seen between the upper lip and the nasal septum

Philtrum

The abnormal adherence of the placenta to the myometrium in an area where the decidua is either absent or minimal

Placenta Accrete

Invasion of the placenta within the myometrium

Placenta Increta

Penetration of the placenta through the uterine serosa and possibly into adjacent pelvic organs

Placenta Percreta

When the placenta covers or nearly covers the internal os of the cervix

Placenta Previa

Enlargement of the placenta

Placentamegaly

A lower-than-normal amount of amniotic fluid or the gestational age

Oligohydroamnios

40 An excessive amount of amniotic fluid for the gestational ag

Polyhydroamnios

Time directly after giving birth and extending to about 6 weeks

postpartum

Pregnancy-induced maternal high blood pressure and excess protein in the urine after 20 weeks gestation

Preeclampsia

The rupture of the amniotic sac prior to the onset of labor

Premature rupture of membranes (PROM)

When additional placental tissue remains within the uterus after the bulk of the placenta has been delivere

Retained products of conception

When the shoulder of the fetus cannot pass through the birth canal during pregnancy

Shoulder Dystocia

An accessory lobe of the placenta

Succenturiate lobe

Acronym that stands for toxoplasmosis, other infections, rubella, cytomegalovirus, and herpes simplex virus

TORCH

Shunting of venous or arterial blood flow from one twin to another through placental circulation

TWIN-TWIN TRANSFUSION SYNDROME

An umbilical cord with one artery and one vein; could possibly be associated with other fetal abnormalities and intrauterine growth restriction

TWO-VESSEL CORD

Two vessels of the umbilical cord that carry deoxygenated blood from the fetus to the placenta

UMBILICAL ARTERIES

The vessel of the umbilical cord that carries oxygenated blood from the placenta to the fetus

Umbilical Vein

Focal dilation of the intra-abdominal portion of the umbilical vein

UMBILICAL VEIN VARIX

Fetal vessels resting over the internal os of the cervix

VASA PREVIA

The abnormal insertion of the umbilical cord into the membranes beyond the placenta edge

VELAMENTOUS CORD INSERTION

Pools of maternal blood within the placental substance

VENOUS LAKES

Protective fetal skin covering

vernix

The structure that connects the developing embryo to the secondary yolk sac

vitellijne duct

Gelatinous material that is located within the umbilical cord around the umbilical vessels

Wharton jelly

the ___________, the maternal contribution of the placenta, is the endometrium beneath the developing placenta

decidua basassi

the _____________, the portion derived from the blastocyst and containing the chorionic villi, is the fetal contribution to the placenta

chorion frondsum

the placenta consist approximately 10 to 30 _____, which are groups or lobes of chorionic villi

cotyledons

the placenta produces _____, which maintains the corpus luteum of the ovary

hcG

later in pregnancy, the placenta also produces ________ and ______ taking over the function from the corpus luteum

estrogen and progesterone

the placenta consist of three parts:

-chorionc plate placental substance basal layer or basal platw

functions of the placenta:

gas transfer excretory function water balance pH maintenance hormone production defensive barrier

________ also referred to as maternal lakes or placental lakes, are pools of maternal blood within the placental substance

venous lakes

a _______ placenta consists of two separate discs of equal size

bilobed

an accessory lobe or a ______________ lobe of the placenta, which are additional smaller lobes located separate from the main segment of the placenta

succenturiate

a __________ placenta is abnormally shaped placenta caused by the membranes inserting inward from the edge of the placenta, producing a curled-up placental contou

circumvallate

a circumvallate placenta may lead to:

vaginal bleeding and placental abruption

4cm

both a thick or large placenta (termed placentomgely) and a thin placenta are associated with:

maternal/ and or fetal abnormalities

sonographic finding of a grade 0 placenta:

uninterrupted chorionic plate and homogenous placental substance

sonographic finding of a grade I placenta:

subtle indentations on the chorionic plate, with some small calcifications within the placental substance

sonographic findings of a grade II placenta:

moderate indentations in the chorionic plate with "comma-like" calcification in the placental substance

sonographic findings of a grade III placenta:

prominent indentation in the chorionic plate that extends to the basal layer with diffuse echogenic and anechoic areas noted within the placental substance

implantation of the placenta may occur within the lower uterine segment. this will often lead to ___________ which is evident when the placenta covers the internal os of the cervix

placenta previa

placenta previa is discovered more often in women with:

a history of multiparity, advanced maternal age, previous abortion, and c-section

possible causes of a thick placenta: (6)

*Diabetes mellitus *Maternal anemia *Infection *Fetal hydrops *Rh isoimmunization *Multiple gestation

possible causes of a thin placenta: (6)

Diabetes mellitus (long standing) *IUGR *Placental insufficiency *Polyhydramnios *Pre-eclampsia *Small for dates fetus

placenta previa is a common cause of _______________ in the second and third trismesters

painless vaginal bleeding

placenta covers the internal os completely:

complete (total) previa

placenta partially covers the internal os:

partial previa

placenta lies at the edge of the internal os:

marginal previa

placental edge extends into the lower uterine segment but ends more than 2 cm away from the internal os:

low-lying prevue

clinical findings of placenta previa: (3)

1. Previous C section or uterine surgery 2. Painless vaginal bleeding 3. Possibly asymptomatic

the complication of fetal vessels resting over the internal os of the cervix is referred to as:

vasa previa

vasa previa can lead to _________ of the fetus

exsanguination (severe loss of blood)

vasa previa is often associated with:

velamentous cord insertion (when a fetus' umbilical cord abnormally inserts on the edge of the placenta along the chorioamniotic membranes, causing fetal blood vessels to travel unprotected from the placenta until they come together and reach the protection of the umbilical cord)

sonographic findings of vasa previa: (2)

1. identification of vessels over the internal os of the cervix with the use of color doppler 2. velamentous cord insertion

____________ is the premature separation of the placenta from the uterine wall before the birth of the fetus, causing hemorrhage

placental abruption (aka abruptio placentae)

maternal conditions that are linked to the development of placental abruption include: (6)

hypertension, preeclampsia, cocaine use, cigarette smoking, poor nutrition, and trauma

clinical findings of placental abruption: (4)

1. abdominal pain 2. possible vaginal bleeding 3. uterine contraction 4. uterine tenderness

sonographic findings of placental abruption:

1. hematoma located either at the edge of the placenta or between the placenta and the mypmetrium

____________ the condition that is defined as the abnormal adherence of the placenta to the myometrium in an area where the decidua is either absent or minimal

placenta accrete

adherence of the placenta to the myometrium loss of normal hypoechoic interface between the placenta and the myometrium:

placenta accrete

invasion of the placenta within the myometrium loss of normal hypoechoic interface between the placenta and myometrium with invasion into the myometrium:

placenta increta

penetration of the placenta through the serosa and possibly into adjacent organs loss of normal hypoechoic interface between the placenta and the myometrium with penetration beyond the serosa:

placenta percreta

clinical findings of placenta accreta, increta, and percreta: (3)

1. previous C section or uterine surgery 2. painless vaginal bleeding if placenta previa is present 3. possibly asymptomatic

sonographic findings of placenta accreta, increta, and percreta: (2)

1. placenta previa (frequent associated finding) 2. loss of normal hypoechoic interface between the placenta and the myometrium

the most common placental tumor- located adjacent to the umbilical cord insertion site at the placenta:

chorioangioma

larger chorioangioma have been associated with: (3)

polyhydramnios, intrauterine growth restrictions (IUGR), and fetal hydrops

clinical findings of a chorioangioma: (1)

1. possible elevation in maternal serum alpha-fetoprotein

sonographic findings of a chorioangioma: (1)

1. Solid hypoechoic or hyperechoic mass within the placenta

linear bands of scar tissue within the uterus- result of intrauterine adhesions, as seen with asherman syndrome:

uterine synechia(e) (aka amniotic sheets)

sonographic findings of uterine synechia(e): (2)

1. linear, echogenic band of tissue traversing the uterine cavity 2. the band does not involve fetal parts, and the normal fetus appears to move freely

the umbilical cord is surrounded by what material:

Wharton jelly

the cord develops from the fusion of the _______ and the _____

yolk stalk and vitelline duct

the _________ carries oxygenated blood from the placenta to the fetus, enters the fetal abdomen and proceeds cephalad to connect to the left portal vein

umbilical vein

the arteries, once they enter the abdomen, proceed caudal around the bladder to connect to the fetal internal iliac arteries. therefore color doppler can establish that there is a:

three vessel cord (3vc)

fetuses with a ______ have an approximate 20% chance of having additional abnormalities, and a thorough examination of the fetus for other findings is warrante

two-vessel cord

the umbilical cord normally inserts into the _______ portion of the placenta

central

abnormal cord insertion sites are described as either ___________ or ____________

marginal or velamentous

__________ cord insertion is at the edge of the placenta

marginal

___________ cord insertion denotes the insertion of the umbilical cord into the membranes beyond the placental edge

velamentous

umbilical cord encircling the fetal neck is termed:

nuchal cod

allantoic cysts are often found near:

the fetal abdomen

allantoic cysts have been seen in connection with:

omphalocele and aneuploidy

another cystic-appearing mass that may be noted within the abdomen if the fetus, appearing to be adjacent to the umbilical cord, is an:

umbilical vein varix

umbilical vein varix has been associated with: (4)

-fetal aneuploidy (the presence of one or more extra chromosomes or the absence of one or more chromosomes) -growth restriction -hydrops -demise

the most common tumor of the umbilical cord although rare:

hemangiomas of the umbilical cord

sonographic findings of allantoic cysts: (2)

1. cystic mass within the umbilical cord 2. most often noted close to the fetal abdomen

sonographic findings of hemangiomas of the umbilical cord: (2)

1. solid hyperechoic mass within the umbilical cord 2. most often noted close to the cord insertion into the placenta

S/D ratio will decrease with advancing gestations... an elevated S/D ratio is associated with:

ncreased placental resistance and an increase in the risk if perinatal mortality and morbidity

absence or reversal of diastolic flow in the umbilical artery is considered irregular and is associated with

an increases incidence of IUGR and oligohydramnios

amniotic fluid functions:

protecting the fetus from trauma, temperature regulation, musculoskeletal maturity, and normal lung and gastrointestinal development

the fetal ____ and ____ produce the majority of amniotic fluid, with ______being the greatest contributor

kidneys lungs urine

AFI should measure at least _____ with a normal range between:

2cm-2-8 cm

for measurement of AFI, transducer MUST be be placed:

perpendicular to the floor

an excessive amount of amniotic fluid is termed: where as a decent amount is termed:

polyhydramnios oligohydramnios

when oligohydramnios is observed, abnormalities of the _________ should be suspected

urinary system

when polyhydramnios is present, abnormalities of the fetal ______ should be suspected

gastrointestinal

a group of infections that can cross the placenta and influence the development of the fetus:

torch

What does TORCH stand for?

Toxoplasmosis Other infections Rubella Cytomegalovirus Herpes

fetal malformation and complications associated with oligohydramnios: (6)

-bilateral multicystic dysplastic kidney disease (MCKD) -bilateral renal agenesis -infantile polycystic kidney disease -intrauterine growth restriction -posterior urethral valves -premature rupture of membranes (PROM)

fetal malformations and complications associated with polyhydramnios: (8)

-cardiac and/or chest abnormalities -duodenal atresia -esophageal atresia -gastroschisis -neural tube defects -omphalocele -Rh incompatibility -twin-twin transfusion syndrome

__________ is listed as the most common congential infection

cytomegalovirus

common sonographic finding of fetal infections (cytomegalovirus), is the presence of:

intracranial calcifications (heart abnormalities, microphthalmia, microcephaly, ventriculomegaly, and hepatosplenomegaly may be noted as well)

______ virus has also been linked with microcephaly, decreased brain tissue, and limb abnormalities such as club foot

zika

sonographic findings of TORCH: (5)

1. Intracranial calcifications 2. Microcephaly 3. Ventriculomegaly 4. Hepatosplenomegaly 5. microphthalmia-(small eyes)

the most common cause of intellectual disability in the US:

fetal alcohol syndrome (FAS)

fetuses exposed to alcohol in utero have been shown to have an increase risk for:

growth restriction, mental impairment, physical abnormalities, and immune dysfuction

sonographic findings of fetal alcohol syndrome: (7)

1. microcephaly 2. dysgenesis of the corpus callosum 3. long round philtrum (groove between the base of the nose and the border of the upper lip) 4. malformed ears 5. microphthalmia 6. cleft palate 7. heart defects such as ventricular septal defects

suspected causes of symmetric intrauterine growth restriction: (4)

genetic disorders fetal infections congenital malformations syndromes

suspected causes of asymmetric intrauterine growth restriction:

nutritional deficiency oxygen deficiency

painless dilation of the cervix in the second or early third trimester:

cervical incompetence

_____ of the cervix is a result of the premature opening of the internal os and the subsequent bulging of the membranes into the dilated cervix

funneling

the cervical length should at least measure:

3cm

clinical findings of a cervical incompetence: (3)

. painless dilation of the cervix 2. premature rupture of membranes 3. vaginal bleeding

clinical findings of cervical incompetence: (2)

1. cervical leg 2. premature rupture of membranes 3. vaginal bleedin

sonographic findings of cervical incompetence: (2)

1. cervical length of less than 3 cm 2. funneling of the cervix

immune hydrops is associated with _________ and _______________

erythroblastosis fetalis and Rh isoimmunization

Occurs when when the mother has Rh-negative blood and the fetus has Rh-positive blood:

maternal Rh sensitization (aka Rh isoimmunization)

these antibodies cross the placenta and begin to destroy the fetal RBCs, resulting in:

tal anemia, enlargement of the fetal liver and spleen, and the accumulation of fluid within the fetal body cavities

the prevention of immune hydrops caused by Rh sensitization is the administration of

RhoGAM (aka Rh immune globulin)

a rare disorder in which the mother suffers from edema and fluid buildup similar to her hydropic fetus:

maternal mirror syndrome

sonographic findings of fetal hydrops: (4)

1. fluid accumulation within at least two fetal body cavities 2. fetal hepatosplenomegaly 3. polyhydramnios 4. thickened placenta

causes of nonimmune hydrops: (11)

*Chorioangioma *Cystic adenomatoid malformation *Diaphragmatic hernia *Fetal (nonimmune) anemia *Fetal infections *Idiopathic *Structure anomalies of cardiac & lymphatic systems *Trisomy 13 *Trisomy 18 *Trisomy 21 *Turner syndrome

hose with an increased risk of preeclampsia include

advanced maternal age, diabetic patients, and those who have gestational trophoblastic diseas

clinical findings of preeclampsia: (3)

1. Maternal hypertension 2. Maternal edema 3. Maternal proteinuria

clinical findings of eclampsia: (3)

1. long standing, uncontrolled preeclampsia 2. headaches 3. seizures

sonographic findings of preeclampsia and eclampsia: (5)

1. oligohydramnios 2. IUGR 3. gestational trophoblastic disease 4. placental abruption 5. elevated S/D ratio

the major risk for the fetus of a mother with gestational diabetes is _______

macrosomia

the major risk for the fetus of a mother with gestational diabetes is _______

placentomegaly (>4cm), polyhydramnios, and AC measures larger than other measurements

mothers with pregestational diabetes have a higher risk of miscarriage and _________

toxemia

with pregestational diabetes, the fetus is at risk of: (5)

congenital anomalies, hypoglycemia, respiratory distress, perinatal mortality, and IUGR

the congenital anomalies most often encountered with pregestational diabetes include:

cardiac defects, neural tube defects, caudal regression syndrome, sirenomelia, and renal anomalies

a bladder flap hematoma may result from a ________

c-section

clinical findings of bladder flap hematoma: (1)

1. recent c section

sonographic findings of bladder flap hematoma: (1)

1.Anechoic or complex mass located between the lower uterine segment and posterior bladder wall

commonly referred to as a fibroid, is a common benign smooth muscle uterine tumor. asymptomatic during pregnancy:

leiomyoma

sonographic findings of a leiomyoma: (4)

1. Hypoechoic mass 2. Posterior shadowing 3. Calcifications or cystic components (degenerating) 4. Enlarged, irregularly shaped, diffuse lay heterogenous uterus

excessive and sustained postpartum vaginal bleeding may be the result of:

retained products of conception (RPOC) (refers to placental and/or fetal tissue that remains in the uterus)

RPOC is typically treated with:

dilatation and curettage (D&C)

clinical findings of retained products of conception: (1)

1. postpartum vaginal bleeding

sonographic findings of retained products of conception: (2)

1. echogenic intracavitary mass that may contain some calcifications 2. color doppler signals within the retained placental tissue

nonimmune hydrops is associated with all of the following except: a. RH isoimmunization b. pleural effusion c. turner syndrome d. fetal infections

the maternal contribution to the placenta is the: a. chorionic vera b. decidua vera c. decidua basalis d. chorion frondosum

the placenta releases _________ to maintain the corpus luteum a. human chorionic gonadotropin b. follicle-stimulating hormone c. luteinizing hormone d. gonadotropin-stimulating hormone

An anechoic mass is noted within the umbilical cord during a routine sonographic examination. What is the most likely diagnosis? a. Hemangioma b. Vasa previa c. Chorioangioma d. Allantoic cyst

with Rh isoimmunization, the maternal antibodies cross the placenta and destroy the fetal: a. spleen b. RBCs c. liver d. WBCs

mothers with pregestational diabetes, as opposed to gestational diabetes, have an increased risk of a fetus with: a. neural tube defects b. proteinuria c. TORCH d. diethylstilbestrol

a succenturiate of the placenta refers to a: a. bilobed placental lobe b. circumvallate placental lobe c. accessory lobe d. circummarginate placental lobe

Pools of maternal blood noted within the placental substance are referred to as: a. Accessory lobes b. Decidual casts c. Chorioangiomas d. Maternal lakes

the fetal contribution of the placenta is the: a. chorionic vera b. decidua casts c. decidua basalis d. chorion frondosum

which of the following would be least likely associated with immune hydrops? a. fetal hepatomegaly b. fetal splenomegaly c. anasarca d. leiomyoma

the placenta is considered too thick when it measures: a. >4mm b. >4cm c. >8mm d. >3.5cm

all of the following are associated with a thin placenta except: a. preeclampsia b. IUGR c. fetal hydrops d. long-standing diabetes

what would be most likely confused for a uterine leiomyoma? a. placental infarct b. chorioangioma c. myometrial contraction d. placenta previa

when the placenta completely covers the internal os, it is referred to as: a. low-lying previa b. marginal previa c. partial previa d. total previa

one of the most common causes of painless vaginal bleeding in the second and third trimesters is: a. spontaneous abortion b. abruptio placentae c. placenta previa d. placenta accrete

all of the following are associated with a thick placenta except: a. fetal infections b. Rh isoimmunization c. placental insufficiency d. multiple gestations

placenta accrete denotes: a. the abnormal attachment of the placenta to the myometrium b. the premature separation of the placenta from the uterine wall c. the invasion of the placenta into the myometrium d. the condition of having the fetal vessels rest over the internal os

doppler sonography reveals vascular structures coursing over the internal os of the cervix. this findings is indicative of: a. vasa previa b. placenta previa c. placenta increta d. abruptio placentae

all of the following are clinical features of placental abruption except: a. vaginal bleeding b. uterine tenderness c. abdominal pain d. funneling of the cervix

penetration of the placenta beyond the uterine wall would be referred to as: a. placenta accrete b. placenta increta c. placenta previa d. placenta percreta

all of the following are associated with oligohydramnios except: a. bilateral renal agenesis b. infantile polycystic kidney disease c. premature rupture of membranes d. duodenal atresia

the most common placental tumor is the: a. choriocarcinoma b. maternal lake c. chorioangioma d. allantoic cyst

pregnancy-induced maternal high blood pressure and excess protein in the urine after 20 weeks gestation is termed: a. preeclampsia b. gestational diabetes c. eclampsia d. gestational trophoblastic disease

the normal umbilical cord has: a. one vein and one artery b. two veins and two arteries c. two veins and one artery d. two arteries and one vein

insertion of the umbilical cord at the edge of the placenta is referred to as: a. velamentous cord insertion b. partial cord insertion c. marginal cord insertion d. nuchal cord insertion

increased S/D ratio is associated with all of the following except: a. IUGR b. placental insufficiency c. allantoic cysts d. perinatal mortality

a velamentous cord insertion is associated with which of the following? a. placenta increta b. placental abruption c. vasa previa d. circumvallate placenta

the normal umbilical cord insertion point into the placenta is: a. central b. superior margin c. inferior margin d. laternal margin

normally, the S/D ratio: a. increases with advancing gestation b. decreases with advancing gestation c. reverses occasionally during a normal pregnancy d. has an absent diastolic component

Fetal TORCH is frequently associated with: a. maternal hypertension b. twin-twin transfusion c. intracranial calcifications d. renal cystic disease

Evidence of polyhydramnios should warrant a careful investigation of the fetal: a. genitourinary system b. gastrointestinal system c. extremities d. cerebrovascular system

IUGR is evident when the EFW is: a. above the 90th percentile b. below the 90th percentile c. above the 10th percentile d. below the 10th percentile

the cervix should measure at least _____ in length a. 4 cm b. 5 cm c. 3 cm d. 8 mm

the abnormal insertion of the umbilical cord into the membranes beyond the placental edge is termed: a. placenta previa b. placental abruption c. marginal insertion d. velamentous insertion

the measurement that should be carefully scrutinized in cases of IUGR is the: a. AC b. femur length c. biparietal diameter d. head circumference

Doppler assessment of the middle cerebral artery: a. helps to determine whether fetal anorexia is occurring b. is valuable in diagnosing the extent of ventriculomegly c. can evaluate the fetus for hypoxia d. is important to determine whether TORCH complications are present

mother will gestational diabetes run the risk of having fetuses that are considered: a. nutritionally deficient b. acromegalic c. microsomic d. macrosomic

which of the following is described as the situation in which the placental edge extends into the lower uterine segment but ends more than 2 cm away from the internal os? a. low lying placenta b. marginal previa c. partial previa d. total previa

which of the following would increase the likelihood of developing placenta previa? a. vaginal bleeding b. previous cesarean section c. corpus albicans d. chorioangioma

Chapter 32 - Fetal Environment and Maternal Complications Flashcards

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