Complications in Pregnancy

Question 1

turner syndrome

Answer 1

• 45 chromosomes, including a single X chromosome
• elevated AFP
• female fetus
• 1:5000
• cystic hygroma, cardiac defects, renal anomalies, cubitus valgus, short femur, general lymph edema
• differential: cephalocele, trisomy 13, hydrops fetalis

Question 2

beckwith-wiedemann

Answer 2

• classic triad of macrosomia, omphalocele, and macroglossia
• increases risk of developing wilms tumor, hemihypertrophy, renal anomalies,a nd hepatosplenomegaly
• hemihypertrophy, macroglossia, omphalocele
• differential: down syndrome

Question 3

sequence

Answer 3

refers to a pattern of multiple anomalies that results from a single anomaly or mechanical factor

Question 4

monochorionic/monoamniotic

Answer 4

• two or more fetuses
• single gestational sac
• no membrane
• zygote splits 10-14 days postfertilization
• differential: technical difficulty in locating membrane

Question 5

dichorionic/diamniotic

Answer 5

• zygote splits within 3-5 days of fertilization
• four-layered membrane
• two or more individual gestational sacs and placentas
• thick membrane with V shape called twin peak or lambda sign
• differential: mirror image artifact

Question 6

twin to twin transfusion syndrome

Answer 6

• same sex fetuses
• single placenta
• arterial blood of the donor twin pumps into the venous system of the recipient twin
• recipient twin ultimately receives too much blood
• donor twim may display IUGR and oligo
• receiving twin may aquire hydrops and poly
• differential: acardiac twin or poli-oli syndrome

Question 7

cubitus valgus

Answer 7

abnormal outward bending or twisting of the elbow

Question 8

exencephaly

Answer 8

a condition where the skull is defective causing exposure or extrusion of the brain

Question 9

disruption

Answer 9

is a defect of an organ resulting from the breakdown of previously normal tissue

Question 10

hydrops fetalis

Answer 10

• an abnormal interstitil accumulation of fluid in the body cavities and soft tissues
• fluid accumulation may results in anasarca, ascites, pericardial effusion, pleural effusion, placentomegaly, and polyhydramnios
• may result from antibodies in the maternal circualtion that destroythe fetal red blood cells or without evidence of clood group incompatibility
• sonography cannot differentiate immune from nonimmune hydrops

Question 11

multifetal gestations

Answer 11

• 70% of pregnancies beginning with twins will deliver a singleton pregnancy
• monozygotic twins results from a single fertilized ovum
• dizygotic twins results from two separate ova
• majority of pregnancies are dizgotic
• dizygotic pregnancies are always dichorionic/diamniotic
• twin A closet to the internal os
• IUGR most common causediscordant growth in a dichrionic multifetal gestation
• twin-twin transfusion syndrome is the most common cause of discordant growth in a monochrorionic multifetal gestation

Question 12

chorionic villi sampling

Answer 12

• performed between 10 and 12 gestational wks
• results after 1 wk
• identify masses
• assess fetus postprocedure

Question 13

limb body wall complex

Answer 13

• rare complex malformation caused by the failure of closure of the ventral body wall
• two or more defects
• ventral wall defect, cranial anomalies, marked scoliosis, limb defects, short umbilical cord, amniotic bands
• differential: amniotic band syndrome or trisomy 13

Question 14

conjoined twins

Answer 14

• monozygotic
• fusion of twin fetuses
• usually anterior and one body part
• inseparable fetal bodies and skin contours, no membrane
• differential: acardiac twin or normal twin pregnancy

Question 15

amniotic band syndrome

Answer 15

• ruptured amnion sticks and entangles fetal parts
• associated with fetal abnormalities and amputations
• thin hyperechoic linear structure floating within the amniotic cavity
• feta abnormalities
• differential: synechia, amniotic chorionic separation, limb-body wall complex, placetnal shelf

Question 16

fetus papyraceus

Answer 16

• demise of a twin that is too large to reabsorb

Question 17

clinodactyly

Answer 17

• inward curving of the fifth finger associated with Downs

Question 18

acardiac twin

Answer 18

• rare
• diamniotic/monochorionic
• twin reversed arterial perfusion
• blood shunted through a vein to vein and artery to artery
• places a large cardiovascular burden on the normal twin
• acardiac
  
  • poorly developed upper body, anencephaly, absent or poor heart, limbs may be present
• normal
  
  • hydrops, poly, cardiac failure

Question 19

immune hydrops

Answer 19

• rh sensitivity
• scalp edema, pleural effusion, poly, placentomegaly
• differential: nonimmune hydrops or pleural effusion

Question 20

eagle-barret syndrome

Answer 20

• prune belly syndrome
• hypotonic abdominal wall muscles
• associated with dialted fetal bladder, small thorax, and imperforate anus
• hydronephrosis, megaureter, oligo, small thorax, large abdomen, cryptorchidism, hip dislocation, scoliosis
• differential: urinary obstruction or urethral atresia

Question 21

deformation

Answer 21

refers to an abnormal form, shape, or position of a part caused by mechanical forces antenatally

Question 22

spalding sign

Answer 22

overlapping of the crainal bones associated with fetal demise

Question 23

meckel-gruber syndrome

Answer 23

• lethal condition
• occurs equally in males and females
• autosomal recessive
• encephalocele, infantile polycystic renals, oligo, bladder not visualized, polydactyly
• differential: trisomy 13 or infantile polycystic disease

Question 24

vanishing twin

Answer 24

• early fetal demise of one embryo
• twin pregnancy
• demised twin resolves
• becomes singleton pregnancy
• differential: succenturine placenta or subchorionic hemorrhage

Question 25

edward syndrome

Answer 25

* trisosmy 18 * 80% of cases display a clenched fist * decrease in AFP * overall poor prognosis * female prevalence * heart defects, choroid plexus cysts, clenched hands, micrognathia, renal anomlaies, cleft lip and palate, omphalocele, two vessel cord * differential: trisomy 13 or triploidy

Question 26

anasarca

Answer 26

severe generalized massive edema often seen with hydrops fetalis

Question 27

stuck twin

Answer 27

* poli-oli sequence * monochorionic/diamniotic * usuallyamnifests between 16 and 26 gestational weeks * one twin oligo, other twim poly * differential: acardiac twin, twin to twin

Question 28

triploidy

Answer 28

* three complete sets of chromosomes * most will abort spontaneously * 1:5000 * early onset IUGR, holoprosencephaly, hypertelorism, micrognathia, microphthalmia, ventriculomegaly, oligo, 2 vessel cord, cardiac anomalies, clubfeet, syndactyly * differential: trisomy 13 or 18

Question 29

embryoscopy

Answer 29

* permits direct viewing of the developing fetus * assess fetus after procedure

Question 30

malformation

Answer 30

refers to a defect of an organ that results from an intrinsically abnormal development process

Question 31

cordocentesis

Answer 31

* used to analyze fetal chromosomes * fetal blood is aspirated through the umbilical cord * assess fetus postprocedure

Question 32

amniocentesis

Answer 32

* used to analyze fetal chromosomes in early pregnancy * typically between 15-18 wks * can be preformed as early as 12 gestational wks * recheck fetal well being after procedure

Question 33

patau syndrome

Answer 33

* trisomy 13 * 90% of cases display cardiac defects * syndrome of midline defects * 1:25,000 * poor prognosis * holoprosencephaly, microcephaly, cystic hygroma, absent or small eyes, cardiac defects, omphalocele, polycystic kidneys, clubfoot, polydactyly, IUGR, poly, facial cleft

Question 34

sandal toe deformity

Answer 34

increased distance between the first and second toes associated with Downs

Question 35

eclampsia

Answer 35

gravest form of pregnancy induced maternal hypertension characterized by seiures, coma, proteinuria, and edema

Question 36

pentalogy of cantrell

Answer 36

* congenital disorder characterized by two out of the following major defects * cardiac, abdominal wall defect, diaphragmatic hernia, defect of diaphragmaric pericardium, ectopia cordis * pulsating mass outside of the chest, ophalocele, gastroschisis * differential: beckwith-wiedemann or acardiac twin

Question 37

syndactyly

Answer 37

congential anomaly characterized by the fusion of the finger and toes

Question 38

nonimmune hydrops

Answer 38

* large for dates * anasarca, edema, ascites, pleural effusion, pericardial effusion, poly, placentomegaly, fetal tachycardia, 200-240 bpm * differential: immune hydrops or pleural effusion

Question 39

down syndrome

Answer 39

* trisomy 21 * decrease in AFP * 1:800 live births * coexisting anomalies dicate overall prognosis * 30% of cases demonstrate duodenal atresia * nuchal fold \>6mm, cardiac folci, macroglossia, low set ears, short stature, brachycephaly * differential: beckwith-wiedemann syndrome

Question 40

monochorionic/diamniotic

Answer 40

* zygote splits 5-10 days after fertilization * three layer membrane * two or more individual gestational saces with shared placenta * membrane attachment of one chorion creates a T shape * moderately thick membrane * differential: mirror image artifact