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DUTEC 180 > Test 1 > Flashcards

Test 1 Flashcards

(135 cards)

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1
Q

who is high risk?

A

patients with increased risk for adversed outcome

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2
Q

things to consider as high risk (8)

A 
AMA
weight (obesity)
smoker
DM
hypo/hyperthyroidism
maternal disease
previous pregnancy outcomes
family history
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3
Q

difference between screening and diagnostic tests

A

screening - offered to low risk population

diagnostic tests - for peope that are high risk

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4
Q

types of screening tests (2)

A

1st trimester - bloodwork + 11-14 week US

2nd trimester - quad screen + targeted US

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5
Q

what is part of 1st trimester screen (5)

A 
PAPP-A
free BhCG
NT
AMA
2nd blood draw at 16 weeks for AFP
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6
Q

what is part of 2nd trimester screen? (5)

A 
AFP
hCG
unconjugated estriol
inhibin A
US between 18-22
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7
Q

tests for cell free fetal DNA (2)

A

harmony

materniT21

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8
Q

what is cell free DNA test?

A

screening test for gender, trisomy 21, 18 and 13 and Turner’s

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9
Q

AMA

A

35 by date of delivery

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10
Q

downsides for genetic testing (5)

A 
invasive
risk of infection
fetal death
rupture of membranes
preterm delivery
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11
Q

when is CVS performed

A

11-14 weeks

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12
Q

when is amnio performed

A

16 weeks on

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13
Q

types of hypertension

A

chronic vs pregnancy induced

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14
Q

presentation of hypertension during pregnancy (2)

A

small placenta

small fetal size

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15
Q

Presentation fo pre-eclampsia/eclampsia (8)

A 
HTN + proteinuria
headaches
swelling/edema
seizures
stroke
coma
death
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16
Q

how is eclampsia cured?

A

delivery

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17
Q

what should be evaluated in hypertensive mother? (4)

A

growth
AFI
Doppler
BPP

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18
Q

what does lupus do?

A

complex deposits and inflammatory responses in placental vessels

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19
Q

complications of lupus (4)

A

stillbirth
IUGR
fetal heart block
pericardial effusions

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20
Q

hyperemesis gravidarum

A

excessive morning sickness

dehydration and electrolyte imbalance

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21
Q

urinary tract disease

A

bacteriuria leading to pyelonephritis leading to preterm labor
flank pain

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22
Q

what can happen to large cysts

A

painful
torsion
require surgery

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23
Q

when is surgery of minimal risk

A

between 14-22 weeks

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24
Q

common pregnancy complications (6)

A 
hyperemesis gravidarym
urinary tract disease 
adnexal/ovarian disease
obesity 
fibroids
preterm labor
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25
obesity increases risk for ______ (6)
``` neural tube defect chronic hypertension pregnancy induced hypertension pre-eclampsia UTI ```
26
complications of preterm labor (5)
``` RDS intracranial hemorrhage bowel immaturity feeding problems death ```
27
risk factors for PTL/PTD (9)
``` PPROM IUGR bleeding fetal anomalies polyhydramnios multiples maternal illness (DM, HTN, kidney infection) incompetent cervix uterine anomalies ```
28
epidemiological factors for pregnancy complications (7)
``` socioeconomic class maternal age weight and height late prenatal care smoking cervical injury/surgery poor OB history ```
29
vaginal bleeding in 2nd and 3rd trimester (3)
placenta previa vasa previa placental abruption
30
marginal placenta is considered when within _____ cm of cervix
2
31
known causes of fetal death (6)
``` infection congenital/chromosomal abnormalities placental abruption DM IUGR Rh sensitivity ```
32
sonographic findings of fetal death (5)
``` absent heart beat absent movement spalding sight - overlapping bones exaggerated curvature of spine gas in fetal abdomen ```
33
what measurements should you take in fetal demise and why
HC, AC, FL, HL | to know hot to get the baby out
34
IUGR is associated with (3)
aneuploidy infection placental insufficiency
35
symmetric IUGR cause
chromosomal abnormalities
36
Asymmetric IUGR
placental insufficiency
37
how often are major congenital anomalies found vs how many have minor defects
3/100 - major | 10-15% - minor
38
how often are chromosomal abnormalities found
1/180 live births
39
what is offered in diagnosis of chromosomal abnormality or suspected infection
CVS
40
CVS can diagnose (4)
genetic abnormalities biochemical/metabolic disorders thalassemia sickle cell disease
41
how soon are CVS results available
1 week
42
what is given to Rh negative unsensitized women
RhoGAM
43
early uses of amnio (3)
relieve polyhydramnios predict Rh isoimmunization fetal lung maturity
44
when are amnio results available
1-3 weeks
45
FISH
fluorescence in situ hybridization
46
FISH tests for (4)
T21 T13 T18 X/Y
47
Common indicator for amnio
AMA
48
what should you ALWAYS do with amnio
confirm heart rate before and after
49
AFP is produced by
yolk sac and later liver
50
where is AFP found (4)
fetal spine GI tract liver kidneys
51
how is AFP measured (2)
maternal serum or amniotic fluid
52
high AFP indicates
neural tube defects | abdominal wall defects
53
when does AFP peak
15-18 weeks
54
what is considered to be high AFP
2.5 MoM
55
high AFP is associated with (7)
``` twins kidney lesions PCKD placental lesions maternal liver disease fetal death oligohydramnios ```
56
low AFP is associated with
GI tract obstruction
57
where does inhibin A come from
maternal ovary
58
where does unconjugated estriol come from
placenta
59
lab values with Down's
high hCG low AFP low estriol
60
lab values for Edward's (tri 18)
Low hCG, AFP and estriol
61
PAPP-A _________ in aneuploidy
increases
62
what is hydrops fetalis
excessive fluid within cavities | requires 2 or more locations
63
possible locations of fluid to be hydrops (6)
``` anasarca placental edema ascites pericardial effusion pleural effusion polyhydramnios ```
64
velocity of ______ in MCA indicates anemia
1.5 MoM
65
what are two types of hydrops
immune and nonimmune
66
what is a normal thickness of placenta
age in weeks = placenta in mm
67
how do you check for immune hydrops
amnio - Rh testing and bilirubin level | Cordocentesis - blood type, hematocrit, hemoglobin
68
causes of non immune hydrops (5)
``` cardiovascular lesions dusrhythmias of heart structural cardiac anomalies pulmonary disease obstructive heart problems ```
69
role of ultrasound in hydrops (4)
monitor fluid levels, hydrops, mother, do BPP
70
mother has increased risk of ______ (3) in multiple
pre-ecplamsia vaginal bleeding prolapsed cord
71
fetus has increased risk of ____ (9) in multiples
``` PTD/PTL fetal demise SGA/IUGR structural anomalies congenital anomalies succenturiate placenta vasa previa abnormal cord origins abnormal presentation ```
72
how do you name the twins
Closest to the cervix = A and go down the alphabet
73
biggest risk to survival in twins
prematurity
74
maternal serum screening is _______ with multiples
less reliable
75
caring for dichorionic twins (4)
cervical length growth assessment AFI dopplers
76
2 yolk sacs = ____
mono/di twins
77
1 yolk sac = ______
mono/di or mono/mono
78
presentation of monochorionic twins in 2nd tri (4)
single placenta no twin peak sign thin membrane same gender
79
Di-Di twins split within _____
3 days of fetrilization
80
Mono-Di twins split between _____
4-8 days
81
mono-mono twins split between ____
8-13 days
82
conjoined twins split ____
after 13 days
83
monozygotic risks (4)
TTTS TRAP cord entanglement twin embolization syndrome
84
discordant twin growth
one normal, one
85
PAPP-A ______ as pregnancy progresses
increases
86
Classic T21 presentation
increased NT, increased PAPP-A increased hCG?
87
what is aneuploidy
abnormality of the number of chromosomes
88
most common aneuploidy
t21
89
cause of trisomies
nondisjunction
90
dominant disorder
single defective gene inherited from affected parent
91
recessive disorder
pair of defective genes from two carrier parents
92
who do boys inherit x-linked disorders from
mom
93
translocation is caused by _______
rearrangement of parts between chromosomes
94
antibody involved in Rh isoimmunization
IgG
95
mechanism of immune hydrops (7)
``` presence of IgG antibodies sensitization hemolysis fetal anemia CHF hydrops death ```
96
how many pregnancies are effected by NIH
1/2500-1/3500
97
what percentage of fetal mortality is caused by NIH
3%
98
twins have _______ greater chance of perinatal death than singleton
5x
99
MC twins are ______ more likely than DC twins to have a twin demise
3-4x
100
heartbeat seen when CRL ______
2mm
101
TTTS
twin to twin transfusion sundrome
102
TRAP
twin reversed arterial perfusion
103
what percentage of mo-mo twins are lost in 1st tri
68%
104
one twin's demise in mo-mo increases the other twin's risk for ____
brain and renal hypoxic injury
105
when should mo-mo twins be delivered
32-34 weeks
106
major complication/risk with mo-mo twins
cord entanglement
107
discordant birthweight can be predicted by ______
CRL disparity in 1st tri
108
risk factor for discordant birth weight
velamentous cord (13x)
109
SD of MCA should be ______ than SD of cord
>
110
high SD (absent or reversed diastolic) in cord indicates _____
IUGR
111
doppler findings in IUGR (4)
High SD in cord pulsatile UV (impending heart failure) low MCA reversal of A wave in ductus venosus (impending heart failure)
112
best diagnostic clue for TTTS
twins with asymmetric fluid distribution
113
1st tri findings in TTTS (3)
discordant CRL asymmetric NT's (1 normal, 1 enlarged) abnormal DV flow
114
2nd and 3rd tri TTTS findings (5)
``` Poly/Oli growth discordance cord size difference bladder (small or absent in donor, large in recipient) echogenic bowel/hypoxiz in donor ```
115
Recipient in TTTS is likely to acquire ______ (8)
``` cardiomyopathy cardiomegaly tricuspid regurg impaired ventricular function biventricular hypertrophy RVOT obstruction pulmonary atresia/stenosis structural heart defects ```
116
how can TTTS be ruled our immediately
DC twins
117
differentials for TTTS (2)
PPROM | anomalous twin
118
TTTS staging
``` 1 - poly/oli 2 - absent bladder in donor 3 - abnormal doppler 4 - hydrops 5 - death of 1 or both twins ```
119
different staging systems for TTTS and the difference
Quintero vs cincinnati | Cincinnati uses cardiovascular disease in grading
120
treatment for TTTS
laser coagulation of placental vessels (LCPV)
121
survival rate after LCPV
66% overall 70% recipient 60% donor 13% neurologic handicap
122
what is TRAP also known as
acardia monster
123
what happens in TRAP
acardia twin is perfused via blood from UA from pump twin
124
TRAP intervention and when is it offered
radiofrequency ablation | offered when theres cardiac failure in pump twin
125
thoracopagus
fused twins at chest
126
ophalopagus
fused xiphoid to umbilicus
127
thoracoophalopagus
extensive chest and abdomen fusion
128
pygopagus
fused buttocks
129
ischiopagus
fused hips
130
craniopagus
fused head
131
dicephalus
conglomerate mass with 2 heads
132
disprisopus/janiceps
one skull, 2 faces and variable extremities
133
US findings with conjoined (5)
``` mo/mo hyperextension of spines unusual limb position fused cords (2-7) vessels poly ```
134
common complication of high order pregnancies
``` hyperemesis gravidarum 1st tri bleeding ovary hyperstimulation sundrom ovarian torsion PreE Gestation DM anemia malnutrition PTL/PTD ```
135
birth weight of trips
1/2 of singleton

DUTEC 180 (6 decks)

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