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FALL 2014 OB > High Risk Pregnancy > Flashcards

High Risk Pregnancy Flashcards

(74 cards)

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0
Q

What are the screening tests for high risk?

A

first trimester: looks for the pattern of biochemical markers assoc with plasma protein A (PAPP-A) and free beta-hCG3

Second trimester screening: performed with maternal serum quad screen lab value and targeted ultrasound exam

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1
Q

What are the factors for a high risk pregancy?

A

advanced maternal age (AMA)

abnormal maternal lab values

vaginal bleeding

insulin-dependent diabetes mellitus (IDDM)

hypertension

preeclampsia

maternal systemic disease

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2
Q

what is hydrops fetalis?

A

condition in which excessive fluid accumulates within fetal body cavities

Immune hydrops and non-immune hydrops

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3
Q

What is the Indirect combs test

A

checks for maternal antibodies

prevents antibody production

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4
Q

What is anasarca?

A

skin edema

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5
Q

What is the cutoff for pericardial effusion?

A

2-3 mm

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6
Q

what is VSD?

A

ventricular septum defect

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7
Q

What are the quad screen markers?

A

alpha-fetoprotein (AFP)

Human chorionic gonadotropin (HCG)

Unconjugated estriol (uE3)

inhibin A

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8
Q

What are the factors of hydrops fetalis?

A

anasarca (massive edema)

ascites

pericardial effusion

pleural effusion

placental edema

polyhydramninos

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9
Q

What causes immune hydrops?

A

fetomaternal blood group incompatibility

blood group isoimmunization

Rh isoimmunization

indicatd by presence of maternal serum antibody acting against fetal RBC antigen-sensitization

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10
Q

What happens with RH sensitization?

A

Antibodies attack RBC’s

fetal hemolysis

hemolytic anemia

cardiac output > eventually leads to generalized hydrops and erythroblastosis fetalis

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11
Q

How do you fix RH sensitization?

A

may need blood transfusion in utero

O-blood tranfused into umbilical vein

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12
Q

What is the sonographic appearance of immune hydrops?

A

scalp edema

pleural effusion

pericardial effusion

ascites

polyhydramnios

thickened placenta > 5cm

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13
Q

how can the potential of fetal anemia be determined?

A

ultrasound surveillance (doppler of middle cerebral artery ^ velocity)

amniocentesis

cordocentesis

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14
Q

What does an amniocentesis test for?

A

direct Rh testing of fetus

delta optical density measuring bilirubin in AF

sent for spectrophotometric analysis

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15
Q

how is a cordocentesis performed?

A

needle placed into fetal umbilical vein and blood sample obtained

transfusion if nessesary

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16
Q

Why is immune hydrops rare today?

A

the RhoGAM

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17
Q

What is alloimmune thrombocytopenia?

A

rare

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

she develops antibodies to fetal platelets

result can be fetus with dangerously low platelet count (thrombocytopenia)

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18
Q

What is caused by any thing other than blood incompatibility?

A

nonimmune hydrops

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19
Q

what disorders are found with nonimmune hydrops?

A

cardiovascular, chromosomal, hematologic, urinary, pulmonary

twin pregnancies

infectious disease

antibody screen needed to make diagnosis of NIH

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20
Q

What accounts for approx 90% of all hydrops cases?

A

nonimmune hydrops

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21
Q

What is the sonographic appearance of nonimmune hydrops?

A

scalp edema

pleural effusion

pericardial effusion

ascites

cardiac abnormalities

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22
Q

What is bleeding in the second and third trimester associated with?

A

placental anomalies

placenta previa

placenta abruption

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23
Q

What is the main cause for the third trimester bleeding?

A

placenta previa

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24
What is placenta previa?
placenta covers internal cervical os and prohibits vaginal delivery of fetus
25
What is vasa previa?
rare condition in which umbilical cord is presenting part
26
Why would you use color doppler in from of the cervical os?
to evaluate for structures in front of the os to see if its vascular
27
What are the reasons a placenta might be thicker than 1 to 2 cm other than abruption?
uterine contraction contractions should resolve in 20 to 30 minutes and typically have central blood flow
28
how do you determine placental abruption?
use color flow doppler blood clots from abruption will not exhibit color flow retroplacental area hypoechoic due to large number of blood vessels (mainly veins) sweep with color doppler retroplacentally lookinf for flow void; if flow void is present be suspicious of abruption
29
What are the two categories of maternal diabetes?
overt gestational
30
What is overt diabetes?
diabetes prior to pregnancy (IDDM)
31
What is IDDM?
insulin dependent diabetic mellitus NIDDM - non-insulin dependent diabetes mellitus
32
What is gestational diabetes?
manifests during pregnancy (GDM)
33
What anomalies are found in IDM's (infants of diabetic moms)?
cardiac - **most common occurrence*** **transposition of great vessels and VSD** single umbilical artery polyhydraminos IUGR - due to UPI secondary to vascular insufficiency thin placenta caudal regression syndrome
34
What is the most exclusive anomaly of a diabetic mother?
caudal regression syndrome
35
What is affected by caudal regression syndrome?
sacral agenesis*** bowel renal bladder musculoskeletal
36
What happens with gestational diabetes to the baby?
high blood glucose levels in mother bring extra glucose to baby causes baby to put on extra weight
37
What are the sonographic findings of gestational diabetes?
macrosomia (>4000 grams 9lbs) increased placental thickness >5cm polyhydramnios
38
What are the three stages of hypertension?
PIH Chronic HTN (essential HTN) Chronic HTN aggravated by pregnancy
39
What condition is associated with HTN?
small placentas
40
What issues does the mother have if she has preeclampsia:?
high blood pressure proteninuria edema
41
What is eclampsia?
pre-eclampsia + seizures severe preeclampsia = deliver immediately
42
which kind of hypertension causes abnormal cord dopplers?
PIH
43
What is supine HYPOtension syndrome?
IVC is compressed creating hypotension mother feels nauseated, dizzy, sweaty
44
What is systemic lupus erythematosus?
chronic autoimmune disorder inflammatory responses in the placental vessels incidence of spontaneous abortion and fetal death (22% to 49%)
45
If the mother has systemic lupus erythematosus what will you monitor in the fetus?
r/o congenital heart block and pericardial effusion
46
What is HELLP Syndrome?
Hemolysis Elevated L Enzymes Low Platelets pre-eclampsia findings multi-systemic idiopathic disorder > may lead to serious fetal compromise
47
What is hyperemesis graviarum?
vomiting - dehydration and electrolyte imbalance hospitalization with IV associate with H-mole and twin pregnancy
48
What are the urinary tract diseases with high risk pregnancy?
pyelonephritis with flank pain hydronephrosis
49
what kind of adnexal cysts might you find with pregnancy?
physiologic ovarian cysts
50
What uterine pathology might cause pain and premature labor?
uterine fibroid (leiomyoma)
51
What are some factors in premature labor?
maternal illness epidemiological factors class age weight/height smoking cervical injury coitus bleeding PROM infections multiple pregnancy
52
If you are assessing preterm labor what should your US study include?
amniotic fluid assessment cervical assessment fetal number placental assessment targeted ultrasound
53
What accounts for roughly half of all perinatal mortality?
intrauterine fetal death 50% of the time cause of death cannot be determined
54
What are known causes of intrauterine fetal death?
infection congenital or chromosomal abnormalities preeclampsia placental abruption diabetes growth restriction blood group isoimmunization
55
what are the sonographic findings of fetal death?
absent heart beat absent fetal movement overlap of skull bones (Spalding's sign) exaggerated curvature of fetal spine gas in fetal abdomen
56
Which multiple gestations which fetus is named "A"
fetus closest to internal os
57
What must you determine with multiple gestations?
number of sacs number and location of placenta gender of fetuses biometry presence of anomalies
58
What causes multifetal pregancy?
older age of childbearing assisted reproductive technologies (ART)
59
What are multifetal pregnancies at risk for?
IUGR incompetent cervix premature delivery
60
What are the predictors of discordant growth?
EFW difference > 20% BPD difference of 6 mm AC difference of 20mm FL difference of 5mm
61
What does dizygotic mean?
2 ova fertilized ***most common***
61
what does monozygotic mean?
1 ovum fertilized
62
What is the criteria for dizygotic twins (fraternal)?
two separately fertilized ova each ovum implants separately two placentas - may be fused two chorion/two amnion NOT genetically identical diamniotic, dichorionic
63
what is the criteria for monozygotic twins?
single fertilized ovum divides genetically identical fetuses - same gender early division - 0-4 days (2 chorion, 2 amnion DC/DA) Division - 4-8 days ***most common** (1 chorion, 2 amnion MC/DA) Division - after 8 days (1 chorion, 1 amnion MC/MA) Division 0 after 13 days (incomplete -conjoined twins MC/MA)
64
What does dichorionic mean?
two placentas
65
What does monochorionic mean?
single placenta
66
Describe the four different kinds of membranes
twin peak sign or Lambda - DC/DA thick membrane - DC/DA Thinner membrane - MC/DA Absence of Membrane - MC/MA
67
What is twin to twin transfusion (TTS)?
typically monochorionic/diamnionic due to arteriovenous communication within the placenta
68
What happens to the donor and the recipient with TTS?
Donor Recipient severe IUGR polyhydramnios oligohydramnios hydrops fetalis "stuck twin"
69
What is poly-oli sequence (stuck twin)?
poly in one sac (recipient) and oligo in the other sac (donor) 16-26 weeks gestation monochorionic/diamniotic
70
What are the five different types of conjoined twins?
thoracopagus - thorax ompalopagus - anterior wall craniopagus - cranium pygopagus - ischial ischiopagus - buttocks
71
What is TRAP?
twin reversed arterial perfusion must be monchorionic pregnancy vein to vein and artery to artery anastamosis one twin is acardiac and nonviable other one normally formed twin is "pump" twin
72
What is fetus papyraceous?
a fetus which dies in the second trimester of pregnancy and becomes compressed and parchment-like

FALL 2014 OB (4 decks)

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