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AMNIOCENTESIS
- Eval amniotic fl levels
- Performed: around 16 wks of gestation
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Reasons to perform AMNIOCENTESIS
- To assess fetal lung maturity (@ 37weeks)
- Elevated AFP
- 35+y/o
- Chromosomal abnormalities
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BPP
- BioPhysical Profile
- Designed to detect fetal health and well being of baby
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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
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Trisomy 18 markers
Decreased: MS-AFP, HCG, UE3, INHIBIN-A
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Trisomy 21
everything same as 18 except Incr HCG & Inhibin A
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What is CVS?
- Chorionic Villus Sampling-Needle stick
- Determines Chromosomal Abnormalities
- Performed bet 9-12 wks gestation
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What is MSAFP?
- Maternal Serum Alpha Feto Protein
- Detection of open neural tube defects
- Trisomy 18 & 21
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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
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Maternal Bl tests in 1st trimester
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Maternal Bl tests in 2nd trimester
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NUCHAL TRANSLUCENCY
- Measures fl filled area @ back of fetal neck
- Performed: 11-13.5 wks (CRL: 45-84 mm)
- <3mm
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NUCHAL FOLD
- Measures fold of skin behind baby's skull @ level of PF (post fossa)
- Performed: 16-22 wks
- <6mm
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FETAL CIRCULATION
- Ductus Venosus
- Ductus Arteriosis
- Foramen Ovale
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DUCTUS VENOSUS
Shunts bl away from liver to send oxygen-rich bl to the rt atrium
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DUCTUS ARTERIOSIS
Shunts oxygen-rich bl fr Pulmonary art to AO arch
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FORAMEN OVALE
Shunts some of the RT atrium bl dir -> LT atrium by passing the lungs
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PREECLAMPSIA
- Hypertension
- Inc Protein in urine
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PLACENTAL ABRUPTION
Premature separation fr the myometrium
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HYDROPS
- Abnormal accumulation of fl in fetal body cavities
- Pl effusion, pericardial eff, ascites
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FETUS PAPYRACEOUS
- Fetal demise after 20 wks
- Fetus is flattened
- Hyperechoic & flat
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AMNIOTIC BAND
- Disruption of the amnion early in the pregnancy
- Harmful to fetus
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AMNIOTIC SHEET
- aka Amniotic Pillars
- Amnion does NOT completely fuse w/ chorion
- NO harm to fetus
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OLIGOHYDRAMNIOS
Not enough amniotic fl
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POLYHYDRAMNIOS
Too much amniotic fl
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AFI
- Amniotic Fl Index
- Amt of Amniotic Fl measured during U/S assessment
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CHORIONIC VILLI
Finger-like projections that anchor the placenta
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VASA PREVIA
Cord presenting @ CX first
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MACROSOMIA
- Excessive birth weight
- 95th percentile 4000g->8.8 lbs
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ROBERT'S SIGN
Echogenic Foci (gas) in pulmonary vessels or abdomen (Fetal demise)
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SPAULDING SIGN
- Overlapping skull bones
- (Fetal Demise)
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DEUEL'S SIGN
- Halo effect secondary to subcutaneous scalp edema
- (Fetal demise)
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4 Functions of the placenta
- Conversion of fetal steroids -> estrogen
- Secretes progesterone/HCG
- Exchange of oxygen, waste prod & nutrients bet fetus & mom
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Placenta (Mother/Fetal portion)
- Mom: Decidua Basalis
- Fetal: Chorion Frondosum
- Max thickness: 5 cm A/P
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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
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Small placenta may be caused by:
- <1.5 cm AP
- Pre-eclampsia
- IUGR
- Diabetes mellitus
- Intrauterine infection
- Polyhydramnios
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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
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U/S survey of placenta includes
- Homogeneous
- Location & measurement
- Make sure tip of Placenta doest NOT cover CX
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Possible locations of Pl
- A/P
- RT/LT
- FUNDUS
- LOWER UT SEGMENT
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When do Amnion & Chorion fuse?
Weeks 12-16
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PLACENTA PREVIA
Placental tissue covering the Cervical Os
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Different kinds of Placenta Previa
- Complete/Total (Central Previa)
- Partial
- Marginal
- Low-lying (2 cm or less away fr CX)
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Clinical presentation of Placenta Previa
Painless, vaginal bleeding in 2nd & 3rd trimester
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CHORIOANGIOMA
- Most common tumor of placenta
- Hypoechoic, well defined mass
- Possible near cord insert
- Vascularity in/around mass
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What causes delayed & advanced maturation of placenta
- Gestational diabetes->big & puffy (delayed)
- Smoking, substance abuse, IUGR (advanced)
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Abnormal placental attachments
- UT scarring (higher risk)
- Placenta Accreta, Increta, Percreta
- Difficult to diagnose in U/S
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Succenturiate Placenta
Accessory Pl
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UMBILICAL CORD
- 2 Umbilical ART transport deoxygenated materials/waste
- Umbilical Vein delivers oxygenated bl & nutrients
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VELAMENTOUS INSERTION
- Attachment of Cord -> membranes rather than placenta
- NOT in Center
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BATTLEDORE INSERTION
- aka Marginal Insert
- Cord insert close to edge
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WHARTON'S JELLY
Found in umbilical cord surrounding the Vessels
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NUCHAL CORD
Cord wrapped around baby's neck
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Best way to demonstrate 3 vessel cord
TRV on fetal UB and turn on color doppler
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GASTROSCHISIS
- Protrusion of intestines (bowel) into amniotic cavity
- Usually on RT side
- Incr AFP
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USA OF GASTROSCHISIS
- Bowel floating in amniotic fl
- Cord not involved
- No membrane/sac covering hernia
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OMPHALOCELE
- Failure of intestines to return to abd cavity in 2nd trimester
- Mid Line base @ umbilical cord
- Contained in a membrane of amnion
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USA OF OMPHALOCELE
- Abd mass containing bowel, liver or combo
- Mass @ base of fetal cord insert
- Membrane/sac covers herniated organs
- Incr AFP
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Chance of Chromosomal abnormalities if mass includes:
- Incr risk -> some bowel
- Lower risk -> some liver
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BLADDER EXTROPHY
Bl outside of body -> Mid-line defect
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LBW (Limb Body Wall syndrome) is caused by?
Amniotic Band Syndrome
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When are fetal lungs considered mature? What is the test for it?
37 weeks -> L/S ratio (Lecithin/Sphingomyelin) performed thru Amniocentesis
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AMNIOTIC FLUID
Produced by Fetal kidneys, tissues, skin & fetal membrane
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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
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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
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CAUSES OF OLIGOHYDRAMNIOS
- DRIPPPC
- Distress (Fetal) Demise
- Renal abnormalities
- IUGR
- Post dates
- PROM
- Pre-eclampsia
- Chromosomal Abnormalities
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CAUSES OF POLYHYDRAMNIOS
- Gest. Diab
- Rh incompatibility
- GI Abnormalities
- Facial cleft mass
- Fetal hydrops
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USA OF HYDROPS
- Scalp edema
- Ascites
- Pl Effusion
- Pericardial Eff (earliest sign)
- Polyhydramnios
- Hepatosplenomegaly
- Thickened placenta
- Skin edema
- Hydrocephaly
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Rh Sensitization
- Rh incompatibility
- Mom Rh(-)/Dad Rh(+)/Baby Rh(-)
- Mom's bl attacks fetal bl
- Rhogam shot given to Mom & baby
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IUGR
- Intrauterine Growth Restriction
- Infant weighing <10th percentile
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2 kinds of IUGR
- Symmetric -> before 26 weeks
- Asymmetric -> after 26 weeks (Brain sparing) AC/HC
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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
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Placental Causes of IUGR
- Infarcts/Hemangiomas
- Small placenta
- 2 vessel cord
- Pl abrupto
- Pl insufficiency
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Fetal Causes of IUGR
- Genetic or chromosomal defects
- Intra UT infection
- Microcephaly
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