OB TEST #4

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Author:
marie78
ID:
263617
Filename:
OB TEST #4
Updated:
2014-02-26 01:11:50
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OB
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Description:
Placenta, amniotic fluid
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  1. AMNIOCENTESIS
    • Eval amniotic fl levels
    • Performed: around 16 wks of gestation
    •  
  2. Reasons to perform AMNIOCENTESIS
    • To assess fetal lung maturity (@ 37weeks)
    • Elevated AFP
    • 35+y/o
    • Chromosomal abnormalities
  3. BPP
    • BioPhysical Profile
    • Designed to detect fetal health and well being of baby
  4. How is BPP performed?
    • Non-Stress Test & U/S eval
    • NST: Attaching 1 belt to mom's abdomen measuring fetal heart rate & another belt measuring contractions
  5. How is BPP scored?
    • 0 or 2
    • 8-10 normal (max)
  6. Trisomy 18 markers
    Decreased: MS-AFP, HCG, UE3, INHIBIN-A
  7. Trisomy 21
    everything same as 18 except Incr HCG & Inhibin A
  8. What is CVS?
    • Chorionic Villus Sampling-Needle stick
    • Determines Chromosomal Abnormalities
    • Performed bet 9-12 wks gestation
  9. What is MSAFP?
    • Maternal Serum Alpha Feto Protein
    • Detection of open neural tube defects
    • Trisomy 18 & 21
  10. Causes of elevated MSAFP
    • Incorrect dates
    • Mult gest
    • Anything protruding out of fetus
    • Open neural tube defects
    • Abd wall defects
    • Sacrococcygeal teratoma
    • Placental chorioangioma
    • Maternal-fetal hemorrhage
  11. Maternal Bl tests in 1st trimester
    • HCG
    • PAP A
  12. Maternal Bl tests in 2nd trimester
    • Inhibin A
    • HCG
    • UE3
    • AFP
  13. NUCHAL TRANSLUCENCY
    • Measures fl filled area @ back of fetal neck
    • Performed: 11-13.5 wks (CRL: 45-84 mm)
    • <3mm
  14. NUCHAL FOLD
    • Measures fold of skin behind baby's skull @ level of PF (post fossa)
    • Performed: 16-22 wks
    • <6mm
  15. FETAL CIRCULATION
    • Ductus Venosus
    • Ductus Arteriosis
    • Foramen Ovale
  16. DUCTUS VENOSUS
    Shunts bl away from liver to send oxygen-rich bl to the rt atrium
  17. DUCTUS ARTERIOSIS
    Shunts oxygen-rich bl fr Pulmonary art to AO arch
  18. FORAMEN OVALE
    Shunts some of the RT atrium bl dir -> LT atrium by passing the lungs
  19. PREECLAMPSIA
    • Hypertension
    • Inc Protein in urine  
  20. PLACENTAL ABRUPTION
    Premature separation fr the myometrium
  21. HYDROPS
    • Abnormal accumulation of fl in fetal body cavities
    • Pl effusion, pericardial eff, ascites
    •  
  22. FETUS PAPYRACEOUS
    • Fetal demise after 20 wks
    • Fetus is flattened
    • Hyperechoic & flat
  23. AMNIOTIC BAND
    • Disruption of the amnion early in the pregnancy
    • Harmful to fetus
  24. AMNIOTIC SHEET
    • aka Amniotic Pillars
    • Amnion does NOT completely fuse w/ chorion
    • NO harm to fetus
  25. OLIGOHYDRAMNIOS
    Not enough amniotic fl
  26. POLYHYDRAMNIOS
    Too much amniotic fl
  27. AFI
    • Amniotic Fl Index
    • Amt of Amniotic Fl measured during U/S assessment
  28. CHORIONIC VILLI
    Finger-like projections that anchor the placenta
  29. VASA PREVIA
    Cord presenting @ CX first
  30. MACROSOMIA
    • Excessive birth weight 
    • 95th percentile 4000g->8.8 lbs
  31. ROBERT'S SIGN
    Echogenic Foci (gas) in pulmonary vessels or abdomen (Fetal demise)
  32. SPAULDING SIGN
    • Overlapping skull bones
    • (Fetal Demise)
  33. DEUEL'S SIGN
    • Halo effect secondary to subcutaneous scalp edema
    • (Fetal demise)
  34. 4 Functions of the placenta
    • Conversion of fetal steroids -> estrogen
    • Secretes progesterone/HCG
    • Exchange of oxygen, waste prod & nutrients bet fetus & mom
  35. Placenta (Mother/Fetal portion)
    • Mom: Decidua Basalis
    • Fetal: Chorion Frondosum
    • Max thickness: 5 cm A/P
  36. Large placenta may be caused by:
    • >5cm
    • Gest Diabetes
    • Rh isoimmunization
    • Maternal infections
    • Mult gest
    • chorioangioma
    • Hydrops fetalis
    • Maternal anemia
    • Sacrococcygeal teratoma
    • Partial mole
    • Chromosomal abnormalities
    • Abruption
  37. Small placenta may be caused by:
    • <1.5 cm AP
    • Pre-eclampsia
    • IUGR
    • Diabetes mellitus
    • Intrauterine infection
    • Polyhydramnios
  38. PLACENTAL GRADING
    • 0-3
    • 0: homogenous mid-gray, no Ca++
    • 1: mid-gray scattered w/ Ca++
    • 2: Basal layer Ca++ "comma-like" indentations
    • 3: Basilar Ca++, separation of cotyledons
    • Grade 3 Pl is only OK after 35 weeks
  39. U/S survey of placenta includes
    • Homogeneous
    • Location & measurement
    • Make sure tip of Placenta doest NOT cover CX
  40. Possible locations of Pl
    • A/P
    • RT/LT 
    • FUNDUS
    • LOWER UT SEGMENT
  41. When do Amnion & Chorion fuse?
    Weeks 12-16
  42. PLACENTA PREVIA
    Placental tissue covering the Cervical Os
  43. Different kinds of Placenta Previa
    • Complete/Total (Central Previa)
    • Partial
    • Marginal
    • Low-lying (2 cm or less away fr CX)
  44. Clinical presentation of Placenta Previa
    Painless, vaginal bleeding in 2nd & 3rd trimester
  45. CHORIOANGIOMA
    • Most common tumor of placenta
    • Hypoechoic, well defined mass
    • Possible near cord insert
    • Vascularity in/around mass
    •  
  46. What causes delayed & advanced maturation of placenta
    • Gestational diabetes->big & puffy (delayed)
    • Smoking, substance abuse, IUGR (advanced)
  47. Abnormal placental attachments
    • UT scarring (higher risk)
    • Placenta Accreta, Increta, Percreta
    • Difficult to diagnose in U/S
  48. Succenturiate Placenta
    Accessory Pl  
  49. UMBILICAL CORD
    • 2 Umbilical ART transport deoxygenated materials/waste
    • Umbilical Vein delivers oxygenated bl & nutrients
  50. VELAMENTOUS INSERTION
    • Attachment of Cord -> membranes rather than placenta
    • NOT in Center
  51. BATTLEDORE INSERTION
    • aka Marginal Insert
    • Cord insert close to edge
  52. WHARTON'S JELLY
    Found in umbilical cord surrounding the Vessels  
  53. NUCHAL CORD
    Cord wrapped around baby's neck
  54. Best way to demonstrate 3 vessel cord
    TRV on fetal UB and turn on color doppler
  55. GASTROSCHISIS
    • Protrusion of intestines (bowel) into amniotic cavity
    • Usually on RT side  
    • Incr AFP
  56. USA OF GASTROSCHISIS
    • Bowel floating in amniotic fl
    • Cord not involved 
    • No membrane/sac covering hernia
  57. OMPHALOCELE
    • Failure of intestines to return to abd cavity in 2nd trimester
    • Mid Line base @ umbilical cord
    • Contained in a membrane of amnion
  58. USA OF OMPHALOCELE
    • Abd mass containing bowel, liver or combo
    • Mass @ base of fetal cord insert
    • Membrane/sac covers herniated organs
    • Incr AFP
  59. Chance of Chromosomal abnormalities if mass includes:
    • Incr risk  -> some bowel
    • Lower risk -> some liver
  60. BLADDER EXTROPHY
    Bl outside of body -> Mid-line defect  
  61. LBW (Limb Body Wall syndrome) is caused by?
    Amniotic Band Syndrome
  62. When are fetal lungs considered mature? What is the test for it?
    37 weeks -> L/S ratio (Lecithin/Sphingomyelin) performed thru Amniocentesis
  63. AMNIOTIC FLUID
    Produced by Fetal kidneys, tissues, skin & fetal membrane
  64. How to measure AFI
    • Probe s/b on SAG
    • Calipers A/P Measure fl only.
    • NO Fetal parts or cord
    • 4 Quadrants added together to obtain AFI
    • Use the largest pocket of Amniotic Fl
    • Normal range: 5-22 cm/Single pocket 2-8 cm
  65. FUNCTIONS OF AMNIOTIC FLUID
    • Protective cushion
    • Equalizes Po & temp
    • Prevents adherence to memb
    • Rsvr for fetal metabolites
    • Allows for symmetric growth
    • Essential for fetal lung development
  66. CAUSES OF OLIGOHYDRAMNIOS
    • DRIPPPC
    • Distress (Fetal) Demise
    • Renal abnormalities
    • IUGR
    • Post dates
    • PROM
    • Pre-eclampsia
    • Chromosomal Abnormalities
  67. CAUSES OF POLYHYDRAMNIOS
    • Gest. Diab
    • Rh incompatibility
    • GI Abnormalities
    • Facial cleft mass
    • Fetal hydrops
  68. 2-types of HYDROPS
    • Non-Immune
    • Immune (Rh)
  69. USA OF HYDROPS
    • Scalp edema
    • Ascites
    • Pl Effusion
    • Pericardial Eff (earliest sign)
    • Polyhydramnios
    • Hepatosplenomegaly
    • Thickened placenta
    • Skin edema
    • Hydrocephaly
  70. Rh Sensitization
    • Rh incompatibility
    • Mom Rh(-)/Dad Rh(+)/Baby Rh(-)
    • Mom's bl attacks fetal bl
    • Rhogam shot given to Mom & baby
  71. IUGR
    • Intrauterine Growth Restriction
    • Infant weighing <10th percentile
  72. 2 kinds of IUGR
    • Symmetric -> before 26 weeks
    • Asymmetric -> after 26 weeks (Brain sparing) AC/HC
  73. Maternal Causes of IUGR
    • High Altitude
    • Poor nutrition
    • Smoking
    • Mult gest
    • Drug/alc abuse
    • TORCH infections
    • Severe anemia
    • Diabetes Mellitus
    • Chronic renal disease
    • Rh sensitization
    • Severe chronic asthma
    • <17 or >35 y/o
    • Heart disease
  74. Placental Causes of IUGR
    • Infarcts/Hemangiomas
    • Small placenta
    • 2 vessel cord
    • Pl abrupto
    • Pl insufficiency
  75. Fetal Causes of IUGR
    • Genetic or chromosomal defects
    • Intra UT infection
    • Microcephaly

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