Second and Third Trimester Complications - Cruz Flashcards Preview

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Flashcards in Second and Third Trimester Complications - Cruz Deck (32):
1

Define:

  • First trimester
  • Second trimester
  • Third trimester

  • First: last missed menses to 13 weeks
  • Second: 13-25 weeks
  • Third: 26 weeks to estimated due date

2

Name the diseases that make up TORCH

  • Toxoplasmosis
  • 'Other' (syphilis and Parvovirus B19)
  • Rubella
  • CMV
  • HSV

3

What organism is impicated in toxoplasmosis?

What is the essential reservoir for this disease? Why is this important for pregnant women?

toxoplasma gondii (coccidian parasite)

Cats. Pregnant women should not handle cat feces (fecal->oral->transplacental transmission)

4

Describe the effects of toxoplasmosis in:

  • First trimester
  • Second trimester
  • Third trimester

How is this diagnosed?

  • First: often results in death
  • Second: hydrocephalus (ventriculomegaly), intracranial calcifications, chorioretinitis
  • Third: often asymptomatic at birth

Dx: maternal +IgM and +IgG, fetal amniotic fluid PCR

5

6

Treponema pallidum causes what disease?

Describe its morphology and gram-staining

Syphilis

G(-) spirochete

7

When does congenital syphilis have the greatest chance of causing spontaneous abortion?

Give some other clinical manifestations

First trimester

  • Stillbirth
  • non-immune hydrops
  • preterm birth
  • hepatomegaly
  • ascites
  • anemia, thrombocytopenia

8

What screening tests are used to detect syphilis?

What confirmatory tests are used?

Screening: RPR and VDRL

Confirm dx: FTA-ABS, MHA, dark-field microscopy, DFA

9

Name the TORCH organism that is most closely associated with hemolysis and transient aplastic crisis

How is it transmitted?

Give some (fetal) clinical manifestations

Diagnostic tests?

Parvovirus B19

Tx: respiratory droplets with transplacental transfer

  • anemia
  • acute myocarditis
  • edema/hydrops
  • intrauterine fetal demise

Dx: maternal +IgM and +IgG, PCR of amniotic fluid

10

Increased blood flow velocity in the fetal brain is worrisome for which TORCH bug?

Parvovirus B19

11

What family of viruses does Rubella belong to?

How is it transmitted to the fetus?

Why (theoretically) should we be less concerned about this virus these days?

Togaviridae family of RNA viruses

Tx: respiratory droplets and transplacental transfer

Vaccine available

12

What congenital defects are associated with Rubella?

How is it diagnosed?

  • Deafness
  • Eye defects (cataracts and retinopathy)
  • CNS defects
  • Cardiac malformations
  • microcephaly, mental retardation, pneumonia, growth restriction, hepatosplenomegaly, hemolytic anemia, thrombocytopenia

Dx: increased IgM and IgG titers and PCR of amniotic fluid

13

Give (3) possible transmission modes for CMV to the fetus/infant

  1. Transplacental
  2. Perinatal (inoculation in vagina or breast milk)
  3. Bodily fluid contact (Don't kiss the baby, grandma)

14

Periventricular calcifications are a common finding with which TORCH bug?

Describe the characteristic histologic finding seen?

CMV

"Owl's Eye" = enlarged (cytomegalic) cells with large basophilic nuclear inclusions

15

Is transplacental infection common with HSV?

Give some other transmission modes

No. Transplacental infection is rare.

Other modes:

  • Perinatal (contact with vagina)
  • Contact after membrane rupture
  • Direct contact with other affected areas

16

Describe the clinical manifestation of fetal HSV infections

Microcephaly

ventriculomegaly

spasticity, echogenic bowel, hepatosplenomegaly, flexed extremities

17

What organism is identified with a Tzanck Smear?

What other diagnostic tools might be used in the identification of this organism?

HSV

Others: culture, PCR, serology

18

Define cervical insufficiency

Give some risk factors

painless cervical shortening or dilation leading to pregnancy loss

Risk factors:

  • collagen abnormalities
  • uterine abnormalities
  • prior obstetric trauma
  • mechanical dilation
  • prior 2nd trimester loss

19

What is cervical cerclage?

A suture technique used to reinforce closure of the cervix in cases of cervical insiffiency

20

How are gross fetal anomalies usually identified?

fetal ultrasound

21

What is Preterm Premature Rupture of Membranes (PPROM)?

What are its risk factors?

How is it diagnosed?

chorioamniotic membrane rupture before the onset of labor in pregnancies at less than 37 weeks of gestation

Risk factors: preterm labor, short cervix, advanced cervical dilation

Diagnosis: direct visualization of fluid with ferning on microscopy

22

Define preterm labor

Labor/birth between 20 weeks and <37 weeks

23

What is the #1 cause of perinatal morbidity and mortality in developed countries?

Give some risk factors

preterm labor/birth

Risk factors:

  • premature activation of the maternal or fetal HPA axis
  • exaggerated inflammatory response or infection
  • placental abruption
  • pathological uterine distension

24

What is placenta previa?

Is it painful?

  • Placenta located near (marginal) or over (complete) the internal cervical os
  • Painless with no contractions

25

Give some risk factors for placenta previa

  • Smoking
  • Advanced maternal age
  • Multiple gestation
  • Uterine anomalies
  • Scarring from previous pregnancies

26

Define placenta accreta

Why is this a problem?

Implantation extends into the basal zone of the endometrium

It increases difficulty in removing the entire placenta during delivery, leading to higher risk of hemorrhage and hysterectomy following delivery

27

What is placenta percreta?

What are its risk factors?

implantation that extends into the uterine serosa and/or adjacent organs

Risk factors:

  • multiple cesarean sections
  • placentra previa

28

What is placenta increta?

Implantation that extends into the myometrium

29

What is placental abruption?

Give some sumptoms/clinical features

Give some key risk factors

Placental separation due to hemorrhage into the decidual basalis before birth

  • Vaginal bleeding
  • uterine tenderness
  • May or may not show uterine heart tones

Risk factors:

  • prior abruption
  • trauma
  • PPROM
  • HTN
  • Smoking and cocaine abuse

30

What is velamentous cord insertion?

The umbilical cord attaches to the chorion and amnion rather than the placenta. The umbilical vessels continue on to the placenta between these two membranes. This arrangement makes the umbilical vessels prone to tearing.

Serious fetal blood loss may occur

31

Define macrosomia

Define intrauterine growth restriction

Estimated fetal weight >4500 grams (~9.9 lbs)

Estimated (via ultrasound) fetal weight <10th percentile

32

Which maternal anatomical measrement should be a part of a normal 20wks gestation ultrasound scan?

Cervical length (screen for cervical insufficiency)

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