High Risk Pregnancy ✔️ Flashcards Preview

Fall 2014 - OB II > High Risk Pregnancy ✔️ > Flashcards

Flashcards in High Risk Pregnancy ✔️ Deck (73):
0

maternal high risk factors

advanced maternal age - AMA
abn maternal lab values
vaginal bleeding
insulin dependent diabetes mellitus
HTN
preeclampsia
maternal systemic disease

1

describe 1st trimester testing

looks for pattern of biochemical markers associated with plasma protein A (PAPP-A)

2

describe 2nd trimester screening

performed with maternal serum quad screen lab value and targeted US exam

3

quad screen looks at following serum markers:

AFP
HCG
uE3
inhibin-A

4

define hydrops fetalis

condition in which excessive fluid accumulates within fetal body cavities

5

2 classifications of fetal hydrops

immune hydrops

non-immune hydrops

6

what is hydrops fetalis associated with

anasarca - massive edema
ascites
pericardial effusion
pleural effusion
placental edema
polyhydramnios

7

describe immune hydrops

results from fetomaternal blood group incompatibility

blood group isoimmunization

Rh isoimmunization

indicated by presence of maternal serum antibody acting again fetal RBC antigen - sensitization

8

immune hydrops (IHF) Rh sensitization:

Rh- mom

Rh+ fetus

9

describe Rh sensitization

antibodies attack RBC's
fetal hemolysis
hemolytic anemia
cardiac output > eventually leads to hydrops & erythroblastosis fetalis

10

what may be needed if Rh sensitization is present

blood transfusion in utero

O- blood transfusedd into umbilical vein

11

immune hydrops - perinatal death rate for Rh-sensitized pregnancies is _____% to _____% before intrauterine transfusions performed

25-35

**perinatal death rate has decreased significantly with modern treatment and care

12

an Rh ______ father and an Rh ______ mother my conceive an Rh positive baby

positive father

negative mother

13

immune hydrops sonographically

scalp edema
pleural effusion
pericardial effusion
ascites
polyhydramnios
thickened placental > 5 cm

14

what does the indirect coomb's test check for

maternal Rh antibodies

15

immune hydrops - potential of fetal anemia can be determined by

US surveillance - doppler of MCA

amniocentesis

cordocentesis

16

immune hydrops is rare today dut to ______

RhoGam

17

describe alloimmune thrombocytopenia

rare

mother may develop immune response to fetal platelets in manner similar to that of RBC's

18

describe nonimmune hydrops

not a result of fetomaternal blood group incompatibility

disorders - cardio, chromo, hematologic, urinary, pulmonary, twin pregnancies, infectious diseases

19

to make a diagnosis of NIH (nonimmune hydrops), isoimmunization ruled out with _______ _______

antibody screening

20

nonimmune hydrops statistics

1 in 1500 to 1 in 3800 pregnancies

accounts for 90% of all hydrops cases

accounts for 3% of fetal mortality


21

nonimmune hydrops sonographically

scalp edema
pleural effusion
percardial effusion
ascites
cardiac abn's

22

bleeding in the 2nd and 3rd trimesters can be associated with what placental anomalies

placenta previa

placenta abruption

23

_______ _______ is the main cause for 3rd trimester bleeding

placenta previa

24

describe placenta previa

placenta covers internal cervical os and prohibits vaginal delivery of fetus

25

______ ______ is a rare condition in which umbilical cord is presenting part

vasa previa

26

_______ ________ is used to evaluate any structures in front of the cervical os to see if vascular

color doppler

27

________ ________ may cause vaginal bleeding during pregnancy

placental abruption

28

describe placental abruption

hypoechoic and 1-2 cm thick

thicker than 1-2 cm may be due to abruption or contraction

contraction should resolve within 20-30 minutes - use color doppler

29

retroplacental area will look __________ due to large number of blood vessels present

hydoechoic

**blood clots from abruption will not ehibit color flow

30

when sweeping with color doppler retroplacentally looking for flow void, if flow void is ________, be suspicious of abruption

present

31

2 categories of maternal diabetes

overt

gestational

32

describe overt diabetes

prior to pregnancy (IDDM or NIDDM)

33

describe gestational diabetes

manifests during pregnancy (GDM)

34

anomalies in IDM's (infants of diabetic moms)

**CARDIAC - most common in occurance - transposition of great vessels and VSD

single umbilical artery

polyhydramnios

IUGR - due to UPI secondary to vasc insufficiency

thin placenta

**Caudal Regression Syndrome - most exclusive anomaly of a diabetic mother

35

describe caudal regression syndrome

broad spectrum of findings:
sacral agenesis**
bowel
renal
bladder
msk

36

gestational diabetes sono findings

macrosomia - > 4,000 g (> 9 lbs)

increased plcental thickness - > 5 cm

polyhydramnios

37

3 stages of hypertension

PIH - pregnancy induced HTN - younder moms

chronic HTN (essential) HTN - older moms

chronic HTN aggrevated by pregnancy

38

hypertension is associated with

small placentas

preeclampsia - high HTN, proteinuria, edema
severe preeclampsia - deliver immediately
eclampsia - preeclampsia + seizures/coma = death

39

PIH (pregnancy induced hypertension) involves what 3 things...

preeclampsia

severe preeclampsia

eclampsia

40

describe supine hypotension syndrome

IVC is compressed > hypotension > mother feels nausated, dizzy, sweaty

41

describe systemic lupus erythematosus

chronic autoimmune disorder
inflammatory responses in the placental vessels
> incidence of spontaneous abortion & fetal death
monitor fetus to r/o congential heart block & pericardial effusion
incidence of spontaneous abortion and fetal death is 22%-49%

42

describe HELLP syndrome

Hemolysis
Elevated Liver Enzymes
Low Platelets
Pre-eclampsia findings

multisystemic ideopathic disorder > may lead to serious fetal compromise

43

describe hyperemesis gravidarum

vomiting - dehydration and electrolyte imbalance

hospitalization with IV

associated with H-mole and twin pregnancy

44

name 2 urinary tract diseases

pyelonephritis with flank pain

hydronephrosis

45

example of an adnexal cysts

physiologic ovarian cysts

46

uterine fibroids can cause _______ and _______ _______

pain and premature labor

47

premature labor can be caused by

maternal illness
epidemiologic factors
class
age
weight/height
smoking
cervial injury
coitus
bleeding
PROM
infections
multiple pregnancy

48

US assessment of preterm labor patient should include

amniotic fluid assesssment
cervical assessment
fetal number
placental assessment
targeted US

49

intrauterine fetal death accounts for roughtly ______ of all perinatal mortality

1/2

50

US findings associated with fetal death are

absent heart beat
absent fetal movement
overlap of skull bones (spalding's sign)
exaggerated curvature of fetal spine; gas in fetal abd

51

multiple gestation pregnancy basics

fetus closest to internal os is A
in 1st tri, if side by side, position may change
document membrane separating the fetus - diamniotic
gender is important
cord doppler

52

what should be documented during an exam for multiple gestations

number of sacs
number and location of placenta
gender of fetuses
biometry
presence of anomalies

53

increased incidence and risk of multifetal pregnancy

incidence:
due to older age of childbearing
assisted reproductive technologies

risk:
IUGR, incompetent cx, premature delivery

54

clincal findings of multiple gestations

LGA
abn quad screen
2 heart beats
palpate 2 heads
unsuspected

55

multiple gestation growth measurements

predictors of discordant growth

EFW difference > 20%
BPD difference of 6 mm
AC difference of 20 mm
FL difference of 5 mm

56

2 types of twinning

**dizygotic - 2 ova fertilized

monozygotic - 1 ovum fertilized

57

describe dizygotic twins (fraternal)

2 separately fertilized ova
each ovum implants separately
2 placentas - may be fused
2 chorion/2 amnion
NOT genetically identical
diamniotic, dichorionic

58

describe monozygotic twins

single fertilized ovum divides
genetically identical fetuses - game gender

59

early division monozygotic twins

0-4 days

2 chorion and 2 amnion (DC/DA)

60

divison of monozygotic twins days 4-8

MOST COMMON

1 chorion and 2 amnion (MC/DA)

61

division of monozygotic twins after 8 days

1 chorion and 1 amnion (MC/MA)

62

division of monozygotic twins after 13 days

incomplete - conjoined twins (MC/MA)

63

2 placentas are called

dichorionic

64

1 placentas is called

monochorionic

65

Chorionicity/Amnionicity in relation to:

twin peak sign or lambda
thick membrane
thinner membrane
absence of membrane

twin peak sign or lambda - DC/DA
thick membrane - DC/DA
thinner membrane - MC/DA
absence of membrane - MC/MA

66

describe twin to twin transfusion (TTS)

typically MC/DA

due to A-V communication within the placenta

67

twin to twin transfusion donor and recipient

donor:
severe IUGR
oligohydramnios
"stuck twin"

recipient:
polyhydramnios
hydrops fetalis

68

describe poly-oli sequence (stuck twin)

poly in one sac (recipient) and oligo in the other sace (donor)

16-26 weeks gestation

MC/DA

69

describe conjoined twins

incomplete division of the embryo after 13 days

70

types of conjoined twins

thoracopagus - thoras
omphalopagus - anterior wall
craniopagus - cranium
pygopagus - ischial
ischiopagus - buttocks

71

describe twin reversed arterial perfusion (trap)

must be monochorionic pregnancy
vein to vein and artery to artery anastamosis
one twin is acardiac and nonviable
other twin normally formed twin is "pump" twin

72

describe fetus papyraceous

a fetus which dies in the 2nd trimester of pregnancy and becomes compressed and parchment-like