CH. 52

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Author:
rbeacr
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150789
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CH. 52
Updated:
2012-04-28 21:42:32
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Sonography High Risk Preg
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Sonography and High Risk Preg
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  1. biochemical markers in 1st trimester
    • pappa a and bhcg
    • used with nt 11-14 wks
  2. second trimester screening
    maternal serum quad screening
  3. maternal serum quad markers are
    • afp
    • hcg
    • unconjugated estriol
    • inhibin-a
    • 18-20 weeks
  4. advanced maternal age
    • 35 yrs +
    • downs 1 in 385

    at age 45= 1 in 45
  5. hydrops fetalis
    • excessive fluid in the fetal body
    • anasarca- entire body
  6. immune hydrops
    maternal sertum immunoglobin G IgG antibody attacks fetal redblood cells

    today we give RhoGAM

    • scalp edema
    • pleural effusion
    • pericardial effusion
    • ascites
    • polyhydraminos
    • thick placenta
  7. immune hydrops test
    • amniocentesis
    • take 20ccs of fluid 15-18 weeks
    • look at amount of bilirubin- light absorbing (spectrophotometric analysis)
    • low- term, mid- preterm, or high- treatment or death
  8. cordocentesis for rh
    needle into fetal umbilical cord for blood sample

    • indicates fetal transfusion need
    • 1- needle into peritoneum slowly absorbed
    • 2- into cord perferred
  9. alloimmune thrombocytopenia
    • mothers immune response to fetal platelets
    • develops antibodies
    • fetus results with low platelets
    • fetus at risk for intracerebral hemorrage and bleeding
    • cordocentesis to check platelets
    • hemorrage common at adrenal glands
  10. nonimmune hydrops
    • not from fetomaternal blood group incompatibility
    • can be from fetus mom or placenta
    • 1 in 2500- 1 in 3500
    • Cardiovascular lesions frequent cause
    • hernia, CCAM, umb vein thromb
    • vascular tumor acting as avshunt
    • severe anemia
  11. twin to twin transfusion
    • one twin uses other waste
    • both die IUGR
  12. vaginal bleeding in 2nd to 3rd trimester
    placenta previa or abruption
  13. if placenta detaches in labor
    no o2 or blood to fetus
  14. best way to evaluate placenta and os
    tv
  15. marginal or partial previa less than ___ from os
    2 cm
  16. vasa previa
    • umb chord or vessles cross os
    • color doppler
    • assoc with succenterate lobe and valemanous insertion
  17. normal 1-2 cm hypoechoic area behind placenta thicker means
    abruption or uterine contraction
  18. insulin dependant diabetic mothers (type 1) are at risk for
    • early and late trimester loss
    • congenital anomolies
    • considered high risk
    • macrosomia or IUGR (vascular)
  19. iddm mothers hospitalized for
    • glucose control
    • infections- pyelonephritis
    • problems swtih delivery
  20. high glucose in diabetic mothers can cause
    • macrosomic fetus (4000g +) 8lbs 3 oz
    • cant fit though pelvis
  21. shoulder dystocia
    • shoulders dont fit after head is delivered
    • brachial plexus nerve injury
  22. prom
    premature rupture of membranes
  23. caudal regression syndrome
    • lack of development of caudal spine and cord
    • diabetic mothers
  24. hypertension in mother
    small placenta- IUGR

    • 1- preeclampsia, severe, and eclampsia
    • 2- chronic htn (before 20wks)
  25. preeclampsia
    • high blood pressure with protienuria or edema
    • pt can have seizures
  26. eclampsia
    seizures and coma after preeclampsia
  27. systemic lupus erythematosus
    • chronic autoimmune disorder
    • effects all organ systems
    • can have spont abort or fetal death (22-49%)
  28. hyperemesis gravidarum
    • excessive vomiting
    • become dehydrated and electrolyte imbalance
    • IV hydration

    gallstones, trphoblastic dis (ruled out by iup), ulcers
  29. Urinary tract disease
    asymptomatic bacteria that turns to pyelonephrosis

    preg usually associated with mild hydro

    usually has flank pain, increased wbc in urine
  30. adnexal cysts
    • cyst can be 8-10 cm- pelvic pain
    • if doesnt resolve may be endometrioma or dermoid cyst
    • can have torsion if over 5cm
  31. obesity
    • should gain 20lbs with pregnancy
    • obesity linked to neurotube defects
    • likely to have chronic hypertension
    • incresed risk for severe eclampsia
    • increased multiple births and uti
  32. uterine fibroids
    • stimulated by horomones- estrogen
    • can outgrow blood supply and necrosis
    • premature labor
    • note size and location to watch for problems with delivery or poor placental profusion
    • can cause IUGR
  33. preterm labor
    • before 37 weeks
    • 15-20% pregnancies
    • increased risk for repiratory problems, hemorhage, bowel immatuity, and feeding problems
    • PROM
    • infection, bleeding, poly, mutiple gest, iugr, maternal illness, incompetent cervix, uterine abn
  34. premature size
    • under 1500g
    • inceased propensity for intracranial bleeding
  35. fetal death
    • half from infection-prom
    • chrom anom
    • preeclampsia
    • placental abruption
    • iugr
    • isoimmunization
  36. how many preg result in miscarriage
    • 15-20%
    • 80% in 1st timester
  37. most common single chrom anomoly
    • 45X 14.6%
    • 20% triploidies
    • half are trisomies
  38. fetal movements felt
    16-20 weeks on a daily basis
  39. sonographic findings of fetal demise
    • no hearbeat
    • no movement
    • overlap of skull bones (spaldings sign)
    • exagerated curve of spine
    • gas in fetal abdomen
  40. asymetric macrosomia
    • diabetic mothers
    • big abd circumfrence- compared to head and legnth
  41. small for gest age
    • not good outcome
    • chrom anom
    • intrauterine infection
    • genetics
    • placental insufficency

    symmetric or asymmetric
  42. asymetric
    • placental insufficency
    • normal head but small body
    • early delivered 34-35weeks have better chance of catching up to peers in 2 yers than if delivered at term

    iugr can be diagnosed at 22-24 weeks
  43. multiple gestations at greater risk for
    • preeclampmsia
    • bleeding thrid trimester
    • prolapse cord
    • premature delivery
    • congenital anomolies
    • 5xs greater chance of death
  44. dizigotic twins
    • best
    • two seperate fertilized ova
    • each has its own placenta, chorion, amnion
    • placentas may be in two locations or next to each other anf fuse (blood circulation is seperate)
  45. Monozygotic
    • identica
    • single fertilized egg that divides with two genetically identical fetus
    • placenta, chorion, amnion depend on when division occurs
  46. monozygotic division 0-4 days
    • 2 amnions
    • 2 chorions
    • (dichor diamn)
  47. monozygotic division 4-8 days
    • 1 chorion
    • 2 amnions
    • monocho diamni
  48. monozygotic division after 8 days
    • 1 chorion
    • 1 amnion
    • monocho monoamni
  49. monozygotic division after 13 days
    • conjoined twins
    • head thorax abd or pelvis
    • most sucessful seperation when not sharing heart or lung
  50. one amnion problems
    entangle umbilical cords and cut blood supply
  51. twin to twin transfusion
    • monozygotic twins share placenta
    • av shunt in placenta
    • arterial blood pumped into venous of the other
    • donor is iugr and oligo
    • reciepient gets too much blood- normal or large
    • toomuch flow caused poly
    • heart failure-hydroptic
    • both risk dying

    • serial amniocentisis
    • selective feticide
    • umbilical cord ligation
    • laser occulsion of anatomosing placental vessle
  52. 70 % of twins end with
    singleton- disapearing twin
  53. vasnishing twin
    early loss and baby is reabsorbed
  54. fetus papyraceous
    one twin dies and is too big to be reasbored and is flattened
  55. appearing twin
    • measured early and cant detect twins
    • or operator does find second sac
  56. poly oligo sequence
    stuck twin
    • diamniotic pregnancy- usually monochorionic
    • poly in one and oligo in the other
    • 16-26 weeks
    • poly sac compresses other normal blood flow creating oligo, placental insufficiency, twin to twin transfusion synd and appears stuck
  57. acardiac anomaly
    • monochorionic twins
    • one develops without a heart/ upper half of body
    • artery to artery connection in placenta
    • reverse flow alters ability for form normal heart
    • acardiac twin missing head thorax or limbs
  58. conjoined twins
    • after 13 days divison
    • 5 types
    • monochorionic monoamniotic joined fetus
  59. thoracopagus
    joined at the thorax
  60. omphalopagus
    joined at anterior wall
  61. craniopagus
    joined at the cranium, syncephalus- one head)
  62. pyopagus
    joined at ischial region
  63. ischiopagus
    joined at butt
  64. scanning multiples look for
    • number of sacs
    • number and locations of placenta
    • gender of fetuses
    • biometric data
    • presence of anomolies

    A is closest to os or cervix
  65. male and female twins means
    • dizygotic
    • diamniotic
    • dichorionic
  66. intertwined umb chord
    conjoined twins
    or more than 3 vessle cord means
    • monozygotic
    • monochorionic
    • monoamnionic
  67. crowding may cause twin
    dolicephaly- big front to back- compression
  68. ci=
    • bpd/ofd x 100
    • less than 75% is doli
  69. growth restriction in fetuses
    • 20% weight difference
    • 5mm bpd difference
    • 20mm ac difference
    • 5mm fl difference
  70. IUGR and twin to twin transfusion
    cant exist with boy and girl but can with same sexes

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