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Flashcards in OB/GYN Deck (192):
1

What is gravidity

the number of times a woman has been pregnant

2

What is parity

The number of pregnancies that led to a birth beyond 20 weeks gestational age OR an infant weight > 500g

3

What is P####

(TPAL)
the number of term deliveries,
the number of preterm deliveries
the number of abortuses
the number of living children

4

What is the developmental age

the number of weeks and days since fertilization; usually unknown

5

What is gestational age

the number of weeks and days measured from the first day of the last menstrual period (LMP)

6

When is CRL considered

Crown Rump Length
6-12 weeks

7

When is BPD considered

Biparietal Diameter
After 13 weeks

8

What trimester is ultrasound measurement considered most accurate

1st

9

What is the standard of diagnosis for pregnancy

b-hCG
range of 1000-1500 IU/mL

10

Discuss b-hCG

Produced by the placenta
Peaks at 100,000 mIU/mL by 10 weeks GA
Decreases throughout the 2nd trimester, levels off during the 3rd

hCG levels double every 48 hours during early pregnancy

11

When is the gestational sac visible by ultrasound?

5 weeks GA

12

What happens to renal flow during the pregnancy

Increases 25-50%.

13

What happens to GFR during pregnancy

Increases early, then plateaus

14

What happens to uterine weight during pregnancy

Increases from about 60-70g to about 900-1200g

15

What is the average amount of weight gain for mothers during pregnancy

25 pounds (11-kg)

16

What happens to HR during pregnancy

increases gradually by 20%

17

What happens to BP during pregnancy

gradually decreases by 10% by 34 weeks, then increases to pregnancy values

18

What happens to stroke volume during pregnancy

Increases to a maximum at 19 weeks, then plateaus.

19

What happens to cardiac output during pregnancy

Rises rapidly by 20%, then gradually increases an additional 10% by 28 weeks

20

What happens with peripheral venous distention during pregnancy

Progressive increase to term

21

What happens to Peripheral vascular resistance during pregnancy

progressive decrease to term

22

What happens to respiratory rate during pregnancy

unchanged

23

What happens to tidal volume during pregnancy

increases by 30-40%

24

What happens to the expiratory reserve during pregnancy

gradual decrease

25

What happens to vital capacity during pregnancy

Unchanged

26

What happens to respiratory minute volume

Increases by 40%

27

What happens to blood during pregnancy

Increases by 50% in second trimester

28

What happens to hematocrit during pregnancy

decreases slightly

29

What happens to fibrinogen during pregnancy

increases

30

What happens to Electrolytes during pregnancy

unchanged

31

What happens to sphincter tone during pregnancy

decreases

32

What happens to gastric emptying time during pregnancy

Increases

33

What does the quad screen consist of

MSAFP (maternal serum a-Fetoprotein)
Inhibin A
Estriol
B-hCG

34

What is the unit MoM stand for

multiple of median

35

What is an elevated MSAFP (>2.5 MoM) associated with

Open neural tube defects
Abdominal wall defects
Multiple gestation
Incorrect gestational dating
Fetal death
Placental abnormalities

36

What is reduced MSAFP (<0.5 MoM) associated with

Trisomy 21 and 18
Fetal demise
Inaccurate gestational dating

37

What is PAPP-A

Pregnancy associated plasma protein

38

What tests are needed to detect down syndrome

PAPP-A
Nuchal transparency
Free B-hCG

When conducted together can determine 91% of down's and 95% of Trisomy 18

39

Using a quad screen what differentiates trisomy 21 from trisomy 18

Trisomy 18: all are decreased

Trisomy 21: MSAFP and Estriol are decreased while Inhibin A and B-hCG are increased

40

When is an amniocentesis indicated

1. women >35 at time of delivery
2. conjunction with abnormal quad screen
3. Rh-sensitized pregnancy to obtain fetal blood type or to detect fetal hemolysis
4. Evaluate fetal lung maturity

41

How do you evaluate fetal lung maturity using amniocentesis

lecithin-to-sphingomyelin ratio >2.5 or to detect the presence of phosphatidylglycerol

42

What is the teratogenic defect associated with ACE I

fetal renal tubular dysplasia
neonatal renal failure
oligohydramnios
intrauterine growth restriction (IUGR)
Lack of cranial ossification

43

What is the teratogenic defect associated with Alcohol

Fetal alcohol syndrome
>6 drinks per day has 40% risk

44

What are the deficits with fetal alcohol syndrome

growth restriction before and after birth
metal retardation
midfacial hypoplasia
renal defect
cardiac defects

45

What is the teratogenic defect associated with androgens

virilization of females
advanced genital development in males

46

What is the teratogenic defect associated with carbamazepine

neural tube defects
fingernail hypoplasia
microcephaly
developmental delay
IUGR

47

What is the teratogenic defect associated with cocaine

bowel atresias
congentital malformation of the heart limbs, face, and GU
Microcephaly
IUGR
Cerebral infarcts

48

What is the teratogenic defect associated with Diethylstilbestrol (DES)

Clear cell adenocarcinoma of the vagina ro cervix, vaginal adenosis, abnormalities of the cervix and uterus or testes, possible infertility

49

What is the teratogenic defect associated with Lead

increased spontaneous abortion (SAB) rate
stillbirths

50

What is the teratogenic defect associated with Lithium

Congenital heart disease (Ebsteins anomaly)

51

What is the teratogenic defect associated with methotrexate

Increased SAB

52

What is the teratogenic defect associated with organic mercury

Cerebral atrophy
microcephaly
mental retardation
spasticity
seizures
blindness

53

What is the teratogenic defect associated with phenytoin

IUGR
Mental retardation
microcephaly
dysmorphic craniofacial features
cardiac defects
fingernail hypoplasia

54

What is the teratogenic defect associated with radiation

microcephaly
mental retardation

medical diagnostic radiation delivering < 0.05 Gy to the fetus has no teratogenic risk

55

What is the teratogenic defect associated with Streptomycin and kanamycin

hearing loss
CN VIII damage

56

What is the teratogenic defect associated with tetracycline

permanent yellow brown discoloration of deciduous teeth
hypoplasia of tooth enamel

57

What is the teratogenic defect associated with Thalidomide

bilateral limb deficiencies
anotia and microtia
cardiac and GI abnormalities

58

What is the teratogenic defect associated with trimethadione and paramethadione

cleft lip or cleft palate
cardiac defects
microcephaly
mental retardation

59

What is the teratogenic defect associated with Valproic acid

neural tube defects
minor craniofacial defects

60

What is the teratogenic defect associated with vitamin A and derivatives

Increased SAB
mircotia
thymic agenesis
cardiovascular defects
craniofacial dysmorphism
microphthalmia
cleft lip or cleft palate
mental retardation

61

What is the teratogenic defect associated with Warfarin

Nasal hypoplasia and stippled bone epiphyses
developmental delay
IUGR
ophthalmologic abnormalities

62

When does a fetus's endocrine structures begin to function

as early as the 11th week of pregnancy

63

What are the effects of an increased amount of circulating estrogens

1. increase the maternal hepatic procution of binding proteins such as thyroid binding globulin (TBG) and cortisol binding globulin (CBG)
2. Inhibit maternal pituitary gonadotropin synthesis and release
3. Enjance placental production of 11B-hydroxysteroid dehydrogenase

64

What forms hCG

alpha and beta subunits non covalently linked

alpha is similar to alpha subunit in the pituitary gonadotropins (FSH, LH, TSH)

65

Where is hCG produced

exclusively the product of the trophoblast, specifically the syncytiotrophoblast

66

When will hCG begin to be produced

as early as 6-8 days post conception

67

what is the significance of abnormally low levels of hCG

miscarriage

ectopic pregnancy: (value exceeds 2000 mIU/mL and intrauterine pregnancy not visual on ultrasound.

68

What is the time difference for sensitivity for detecting hCG in the blood versuses serum

blood is 6-8 days of ovulation
urine is 14 days of ovulation

ONLY after implantation

69

how long after a pregnancy can hCG be detected

4 weeks for normal pregnancy

10 weeks for first trimester abortion or elective early termination

70

What are the biologic functions of hCG

1. maintain the corpus luteum and continue progesterone production
2. regulate fetal testicular testosterone production
3. TSH like properties
4. Clinical uses

71

When is hPL formed

as early as 3 weeks post conception and secreted from the synctiotrophoblast

Detectable in maternal serum after 6 weeks

72

What is the biologic function of hPL

1. induces lipolysis and increases maternal free fatty acids, ketones, and glycerol, which provide energy for the mother
2. increased insulin levels

73

What are the 3 potential sources of prolactin

1. anterior lobe of the maternal pituitary gland
2. anterior lobe of the fetal pituitary gland
3. decidual tissue of the uterous

74

What is the biologic function of prolactin

1. preparing the mammary glands for lactation
a. stimulates growth of mammilary tissue
b. lactation does not occur during pregnancy because estrogen inhibits the action of prolactin on the breast

2. Decidual prolactin regulates fluid and electrolytes of the amniotic fluid

75

Where is progesterone produced in the pregnant state

1. corpus luteum until the 7th week
2. Placenta after the 8th week

76

What is the biologic function of progesterone

1. prepares the endometrium for implantation of the embryo
2. relaxes the myometrium
3. prevents rejection of the fetus by the maternal immune system

77

What is a progesterone receptor antagonist

mifepristone

used as as an abortifacient in the first trimester

78

What are the 3 estrogens and what is the production ratio

1. estrone (14%) - 1 OH
2. estradiol (5%) - 2 OH
3. Estriol (81%) - 3 OH

later in the pregnancy estriol is produced almost exclusively by the placenta

79

Can estrogens be produced in the placenta

NO

due to a lack of the enzyme necessary to confer pregnenolone to androgen precursors

80

What is do low levels of estrogen signify

1. fetal demise
2. anencephaly
3. Maternal ingestion of corticosteroids
4. placental sulfatase deficiency

81

What are the biologic activities of estrogen

1. stimulate receptor mediated LDL uptake by the placenta
2. Increases blood flow to the uterous
3. Regulates end-of-gestation events

Estrogen stimulates epithelial cell proliferation in human breast tissue. However, milk release is delayed until estrogen levels decrease after delivery

82

What increases myometrial gap formation

Estriol

83

What suppresses maternal lympohocyte activity

Progesterone

84

What is necessary fro development of male external genitalia

hCG

85

What is the most sensitive marker for abnormal karyotype

hCG

86

What elevates ketone levels

hPL

87

What hormone is produced by the uterus

prolactin

88

What inhibits lactation during pregnancy

Estriol

89

Lack of this hormone can cause spontaneous abortion in the first trimester

Progesterone

90

Lack of this hormone is associated with an enzyme deficiency in the placenta

Estriol

91

Elevated levels of this hormone are associated with twin pregnancy

hCG

92

Anencephaly causes ack of production of this hormone

Estriol

93

Where are gases and nutrients exchanged between mother and fetus

The villi of the placenta

94

What is the function of the placenta

1. Mother to fetus transfer of nutrients
2. Gas exchange
3. Secretion of proteins and steroids
a. Progesterone is produced by the placenta from maternal cholesterol
b. Estrogen is converted from circulating fetal androgens produced in the fetal adrenal glands

95

How does the placenta immunologically protect itself from the mother

Invadinging placental cells express a unique antigen, HLA-G which is not recognized as a "foreign" antigen by the mother

96

What forms the umbilical cord

Two umbilical arteries originate from the fetal aorta

one umbilical vein returns nutrient rich, oxygen rich blood to the fetus

97

What are the amniotic membranes

Amnion: a single layer of epithelial cells surrounding the fetus and containing the amniotic fluids

Chorion: lies adjacent to the uterine endometrium, is exterior and fused to the amnion

98

Where is amniotic fluid derived

primarily from the fetal urine. It is important for the successful development of the bronchial tree

99

What are the requirements for fetal metabolism

1. oxygen
2. glucose
3. amino acids

100

What is the rate of fetal oxygen metabolism

8 ml/kg/min

normal adult is 3 ml/kg/min

101

Where does the umbilical vein give branches

to the liver and becomes the ductus venosus

102

What is the function of the ductus venosus

mixes maternal oxygenated blood with fetal deoxygenated blood and flows into the IVC

103

What is the foramen ovale

a right to left intracardiac (atrial) shunt

104

What promotes closure of a PDA

prostaglandin inhibitors

105

What is the function of the ductus arteriosus

connects the left pulmonary artery to the arch of the aorta

106

What maintains the patency of the ductus arteriosus

Prostaglandin E

107

What does the fetal umbilical vein become in the neonate

ligamentum teres

108

The intra abdominal portion of the umbilical arteries of the fetus become what in a neonate

lateral umbilical ligaments

109

What is the normal fetal HR

120-160

110

What is the cardiac output of a normal fetal heart

200 mL/kg/min

normal adult is 70 mL/kg/min

111

when do fetal lungs begin to produce surfactant

34 weeks

from type II pneumocytes

112

What is the function of surfactant

lowers the surface tension in the alveoli and prevents collapse

113

How is fetal hepatic conjugation of bilirubin

deficient, and a mild hyperbilirubinemia may be seen for the first few days of life

114

Where does hematopoiesis occur

2 weeks: yolk sac
5 weeks: spleen and liver
11 weeks: bone marrow

115

What composes fetal hemoglobin

Fetus: 2 alpha and 2 gamma
Adult: 2 alpha and 2 beta

At term about 70% hemoglobin is fetal

116

What is the function of the thyroid in fetal development

important for normal neurological development

117

What is the most common immunoglobulin found in the fetus

IgG

Only IgG can cross the placenta

118

What are some presumptive symptoms of pregnancy

1. amenorrhea
2. breast changes
3. Nausea (morning sickness)
4. Disturbances in urination
5. Fatigue
6. Sensation of fetal movement

119

What is quickening

the sensation of fetal movement. Usually between the 16th and 20th week

120

What is hegar's sign

Softening between the cervix and the uterine fundus causes a sensation of separateness between these two structures

121

what is chadwicks sign

the vaginal mucosa has a bluish color within the first 6-8 weeks of pregnancy

122

How is pregnancy confirmed

Only two ways
1. Identification of fetal heart beat (120-160)
2. Ultrasonographic representation of a fetus

123

How is EDC (estimated date of confinement) determined

9 calendar months plus 7 days from FDLMP
or
counting back 3 calendar months and adding 7 days to the FDLMP

124

What is the viability of life if birth occurs in the end of the second trimester

80-90%

125

What is lightening regarding pregnancy

the descent of the fetal head to or even through the pelvic inlet due to the development of a well formed lower uterine segment and a reduction in the volume of amniotic fluid

126

Regarding pregnancy what is a bloody show

a discharge of a combination of blood and mucus caused by thinning and stretching of the cervix, is a sure sign of the approach of labor

127

What is placenta previa

The placenta developing in the lower uterine segment an completely or partially covering the internal os.

Usually painLESS heavy bleeding

128

What is abruptio placenta

premature separation of the normal implanted placenta.

usually painful bleeding

129

What is normal fetus weight at 26, 36, and 40 weeks respectively

1000g (more than lbs)
2500g (5.5 lbs)
3300g (7-7.5 lbs)

130

What are good indications of fetal lung maturation with reduced risk of RDS

Leithin-to-sphingomyelin (L/S) Ratio of or greater than 2:1

A greater indicator is presence of phosphatidylglycerol

131

What accelerates fetal lung maturation

Glucocorticoids.

Stress will increase fetal cortisol production.
Administration of maternal glucocorticoids

132

What are the types of fetal presentation

1. Cephalic
a. Vertex (chin in) (95%)
b. Face (Neck extended)
c. Brow (slightly extended but will convert to a vertex or a face during labor)

2. Breech presentation
a. Complete
b. Incomplete
c. Frank

133

What is a complete breech presentation

both the legs and the hips are flexed

134

What is an incomplete breech presentation

one hip is not flexed, and on foot or knee lies below the breech

135

What is a frank breech

the hips are flexed and the legs are extended

136

What is puerperium

period of 4-6 weeks and starts immediately after delivery and ends when the reproductive tract has returned to its nonpregnant condition

137

How does breast feeding accelerate involution of the uterus

stimulation of the nipples releases oxytocin from the neurohypophysis; the resulting contractions of the myometrium facilitate the involution of the uterus

138

What is lochia

uterine discharge that follows delivery and last for 3-4 weeks. Foul smelling lochia suggests:
1. lochia rubra: blood stained fluid last for the first 3-4 days
2. lochia serosa: discharge appears 3-4 days after delivery. It is paler than lochia rubra because it is admixed with serum
3. Lochia alba: after the 10 day, because of admixture with leukocytes, the lochia assumes a white or yellow-white color

139

What kind of contraception can lactating mothers use

Progesterone only oral contraceptions as soon as their milk supply is established.

Progesterone only contraceptives do not appear to have adverse effects on lactation.

140

What is the most common cause of postpartum hemorrhage

1. Uterine atony (most common)
a. general anesthesia
b. multiple fetuses
c. prolonged labor
d. rapid labor
e. high parity
f. vigorously stimulated with oxytocin
2. Retention of of placental tissue

141

What are some uterine contracting agents

Oxytocin
methylergonovine
Prostaglandin F(2a)

142

What is a puerperal infection

infection of the GU tract during the puerperium accompanied by a temperature of 100.4 or higher that occurs for at least of the first 10 days after postpartum EXCLUSIVE of the first 24 hours

143

How is milk production stimulated

Prolactin which is released from the anterior pituitary gland

Continuous production is controlled by a stimulus of the breast that curtails the release of prolactin-inhibiting factor from the hypothalamus

144

What is responsible for milk let down

Oxytocin released from the posterior pituitary

145

What kind of drugs or excreted in high concentrations in breast milk

lipid soluble drugs

146

What are the two phases of the menstrual cycle and how do they differ in duration

Follicular is the 1st half and is variable in length.

Secretory phase is the second half and is fixed at 12-16 days

147

How is EDC determined

EDC is determined by using naegele's rule.

When FDLMP is uncertain, ultrasound can be used.

Use LMP unless
1. Ultrasound dating in 1st trimester differs by more than 7-10 days
2. Ultrasound dating in 2nd trimester differs by more than 14 days
3. Ultrasound dating in 3rd trimester differs by more than 21 days.

148

Foamy white vaginal liquid with a strawberry discoloration of the cervix is suggestive of what

Trichomonas

149

White curdy vaginal discharge is suggestive of what

candida

150

Foul-smelling, gray discharge may indicate what

bacterial vaginosis

151

What is the diagonal conjugate

measured from the sacral promontory to the anterior inferior pubic symphysis. can be measured on on pelvic examination

152

what is the obstetric conjugate

the length from the sacral promontory to the posterior pubic symphysis. Measurement is determined by subtracting 1.5 to 2 cm from the diagonal conjugate.

The obstetric conjugate is the shortest anterior posterior diameter through which the fetal head must pass.

153

What are the for pelvic types

Android
gynecoid
platypelloid
anthropoid

154

Describe the gynecoid pelvis

Most common type (50%)
Overall shape is round
posterior sagittal diameter of the inlet is only slightly shorter than the anterior sagittal diameter.
Ishial spines are not prominent
Wide pubic arch

155

Describe the android pelvis

overall shape is heart like
posterior sagittal diameter of the inlet is much shorter than anterior sagittal, limiting the space for the fetal head
ischial spines are prominent
Narrow pubic arch

156

Describe the anthropoid pelvis

Overall shape is long and oval
Anteriorposterior diameter is greater than the transverse
prominent ischial spines
narrow pubic arch

157

Describe the platypelloid pelvis

Least frequent
flattened shaped with short anterioposterior diameter and wide transverse diameter

158

What women should be offered genetic testing

All women.

Women over the age of 35 should be offered genetic testing through chorionic villous sampling or amniocentesis

159

When is the quad screening performed

15-21 weeks

160

What is the difference between integrated and sequential screening

sequential screening: the results of the first trimester screenings are released to the patient and the provider

Integrated screening: the result of the first trimester test is withheld and incorporated into a final overall risk assessment

161

What is the frequent of prenatal visits

every 4 weeks until 24-28 weeks
every 2 weeks until 36 weeks
weekly until delivery

162

What amount of weight should be gained during pregnancy

Normal BMI: 25-35 lbs
less than 19 BMI: 28-40 lbs
more than 29 BMI: 15 lbs

163

How many calories should be taken in during pregnancy

2500

164

What food items should be avoided during pregnancy

unpasteurized cheeses
raw shellfish
fish that have high mercury levels

165

What is the effects of caffeine during pregnancy

greater than 5 cups per day has been associated with an increased risk of spontaneous abortion

166

Are whites or black mothers a greater risk during pregnancy

Blacks:
4X higher maternal mortality
2X perinatal mortality

167

What is the perinatal period

20 weeks gestation - 28 days after birth

168

What are some items that increase risk in pregnant patients

Low socioeconomic status
Maternal age Less than 20
Maternal age greater than 35
Substance abuse
Domestic Violence

169

How is a short cervical discovered and what are the associated complications

Cervical length less than 2.5 cm
Determined by ultrasound at 20-24 weeks.
associated with risk of preterm birth

170

What are the contraindications for a vaginal birth after cesarean

Classical uterine incision
Active herpes infection
Myomectomy
Placenta previa

171

What is eisenmengers syndrome

he process in which a left-to-right shunt caused by a congenital heart defect causes increased flow through the pulmonary vasculature, causing pulmonary hypertension,[1][2] which in turn causes increased pressures in the right side of the heart and reversal of the shunt into a right-to-left shunt.
In adults, the most common causes of cyanotic congenital heart disease are Eisenmenger syndrome and tetralogy of Fallot. Eisenmenger's syndrome specifically refers to the combination of systemic-to-pulmonary communication, pulmonary vascular disease, and cyanosis.

172

What happens to clotting factors during pregnancy

Increased production of clotting factors by the liver.

Increases the risk of thromboembolic events

173

What congenital abnormality in the fetus is associated with maternal Rho and La antibodies

associated with greater risk of congenital hear blocks

174

What is consanguinity

marriage between close relatives

175

What effect may the use of Paxil (paroxetine) have on fetal development

greater risk for fetal cardiac malformations

176

When is a gestational diabetes screen completed

24-28 weeks with a 1 hour 50g glucose test

177

What can be used to reduce incidence of neural tube defects

0.4 mg folic acid daily reduces incidence in the general population by 50%

4 mg daily in patients with previous NTD pregnancies will reduce risk by 70%

178

What is the most common cause of inherited mental retardation

Fragile X

179

What is the inherritance pattern of fragile x

X linked recessive

180

When are serum markers drawn during pregnancy

First trimester ( 10weeks 4 days - 13 weeks 6 days)
Included are:
MSAFP
B-hCG
PAPP-A

Second trimester (15-22 weeks)
Included are:
MSAFP
B-hCG
Estriol
Inhibin A

181

What invasive testing is done in the first trimester

CVS (Chorionic Villus Sampling)

done in weeks 10-12

Risk of fetal loss is 1%


Rh negative women who are not sensitized receive Rho(D) immune globulin after the procedure

182

What invasive testing is done in the second trimester

Amniocentesis

Risk of loss is 0.25 - 0.5%

If conducted in the 3rd trimester, the risk of preterm delivery is 1-2%

Rh negative women who are not sensitized receive Rho(D) immune globulin after the procedure

183

An increase in NT (nuchal translucency) is suggest what

Trisomy 18 or Trisomy 21

Estriol is increased with 18
Estriol is decreased with 21

184

What is the most common inherited disorder in caucasions

Cystic fibrosis
Carrier rate is 1 in 25

185

What is the most common mutation associated with CF

Delta F508

There are 23 mutations that are tested in genetic screens which accounts for 80% of cases

It is an autosomal recessive trait

186

What are the 3 types of normal hemoglobin

Hemoglobin A: 2 alpha and 2 Beta chains (95%)
Hemoglobin A2: 2 Alpha and 2 delta
Hemoglobin F: 2 alpha and 2 Gama

187

What is the most common inherited trait in african americans

Sickle Cell
Frequency of trait is 1 in 12
Autosomal recessive inheritance

188

What is Tay Sachs disease

the congenital absence of the enzyme hexosaminidase A, which results in an over accumulation of GM2 gangliosides, leading to severe progressive neurologic disease causing death in early childhood

Carrier rate in Ashkenazi Jews is 1 in 30

Autosomal recessive inheritance

189

What is an ultrasound

low energy high frequency sound wave
Frequencies between 3.5 and 5 MHz

190

What are the determining factors for amniotic fluid on ultrasound

Measurement of the deepest single pocket of amniotic fluid
8cm polyhydramnios

191

How is fetal well being measured during a 3rd trimester ultrasound

Biophysical profile

1. Amniotic Fluid
2. Fetal Tone
3. Fetal Movements
4. Fetal breathing
5. Nonstress test

score of 2 is normal 0 is abnormal for each section. Total score of 8-10 is normal

192

When is fetal echocardiography indicated

Risk factors for CHD (congenital heart disease)
suspected CHD's on ultrasound
suspected fetal arrhythmia
other congenital abnormality
nonimmune hydrops fetalis