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OB- US and High Risk Pregnancy


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is a medical complication of pregnancy that occurs frequently in high-risk populations; places both mother and fetus at risk
hypertension may be associated with small ___ because of the effect of the hypertension on the blood vessels; if the placenta develops poorly, the blood supply to the fetus may be restricted and ___ may result
growth-restricted fetuses are at increased risk of fetal ___ and death in utero
there are various forms of hypertensive disease during pregnancy. in the past, the term ___ was used to describe hypertensive disorders because it was believed that a "toxin" in the mother's bloodstream caused hypertension (term no longer used)
a state that the mother was in before becoming pregnant; is diagnosed when high blood pressure is found prior to 20 weeks gestation; can result from primary essential htn or secondary htn (renal, endocrine, or neurologic causes)
chronic hypertension
three types of pregnancy induced hypertension (more severe than chronic and is life-threatening)
preeclampsia, eclampsia, severe eclampsia
___ is a pregnancy condition in which htn develops w/ proteinurea and edema. if the htn is neglected, the pt may develop life-threatening seizures. __ may develop in some cases and refers to the severity
preeclampsia severe eclampsia
generally indicates that a pt. must be delivered immediately ___ represents the occurence of seizures or coma in a preeclamptic patient
sono appearance is oligohydramnios, IUGR, fetal demise, increased incidence of abruptio placenta, placental maturity before time, and small placenta
pregnancy-induced htn
labor before 37 wks; causes are PROM, infection, bleeding, fetal anomalies, polyhydramnios, multiple pregnancy, IUGR, maternal illness such as diabetes or htn, incompetent cx, bicornuate ut or fibroid
premature labor
premature infants are at greater risk for having problems, such as respiratory ___, intracranial hemorrhage, bowel ___, and feeding problems
distress immaturity
epidemiologic factors such as socioeco status, maternal age, wt, and ht, late prenatal care, smoking, coitus, a hx of cx injury or surgery, poor previous OB hx, previous miscarriage, and flying above sea level are all predisposing to _
premature labor
sonographically for premature labor, sonographers should assess the amniotic fluid index assessment, cervical lenghth, fetal number, and placental ___
occurs in approx. 10% of pregnancies and characterized by spontaneous rupture of the amniotic sac prior to the onset of labor; if prior to 35 weeeks gestation it is assoc. with considerable neonatal morbididty and mortality
premature rupture of membranes
management of this may include induction of labor, corticosteroids, antibodies, and home/hospital care
premature rupture of membranes
risk factors include invasive procedures, cigarette smoking, cervical surgery during pregnancy, htn, diabetes, and multiple prior elective abortion infection
premature rupture of membranes
what is seen sonographically in PROM?
fetal death accounts for roughly _ of all perinatal mortality; the cause of death cant be determined in approx _ the cases. have been assoc w/ infection, congenital and chromo ___, preeclampsia, placenta abruptio, diabetes,IUGR, and blood grp _
1/2 1/2 anomalies isoimmunization (Rh incompatibility)
fetal death may occur at _ time during pregnancy. clinically, 1st tri loss may be diagnosed when the pt presents w/ vaginal ___, cramping, and passage of _. pt should feel fetal movements daily at _-_ wks
any bleeding tissue 16-20 weeks
sono findings are: absent heart beat, anascara, no fetal movement, overlap of skull bones, an exagerated curvature of fetal spine, gas in the fetal abdomen, and edematous soft tissue of the head
fetal death
edematous soft tissue of the head is ___ sign. overlap of skull bones is ___ sign. gas in the fetal abdomen is ___ sign
druel's sign spalding sign robert's sign
when there is fetal death, a brieft ultrasound exam of the fetus for structural anomalies should be performed and biometry obtained to determine ___ for delivery
U.S. extremly valuable in assess of multiple gestations. may be used to monitor growth of the fetuses and for guidance of diagnositic _ procedures. the mother with a multiple gestation is at inc risk for ob comp such as _,_,_
therapeutic preeclampsia, third trimester bleeding, prolapsed cord
twin fetuses are at increased risk or premature delivery and congenital anomalies. as a result, a twin has a ___ times greater chance of perinatal death than a singleton fetus
during 1st tri, multiple fetuses can be found by visualizing more than one _w/i the ut. in 2nd and 3rd tri, clinical findings may prompt an US exam. the _ may be large and ___screening which detects NTD may be high
gestational sac uterus maternal serum alpha-fetoprotein (msafp)
once a mult gest is identified, us should be done looking for fetal _. each mult gest.eval by us, the tech needs to eval ___. (are there 2 or 1?) to assess # chorions, amnions, time of division
anomalies placental type
"stuck twin usually manifests at _- _ wks w/ maj involving monochorionic twins. stuck twin sydrome may be caused by fetal anomaly in 1 GS resulting in polyhy, compressing the blood flow in the normal twin's ___ which results in oligo, plac insuf in 1 pla
*16 to 26 weeks *placenta *twin-to-twin transfusion (most common cause of TOPS)
twins are more closely related to ____
arise from two separately fertilized ova. each ovum implants separately in the UT and develops its own placenta, chorion, and amniotic sac (diamniotic, dichorionic). sometiems the placentas fuse making it look like one so look for membrane in between
dizygotic (fraternal) twins
in fraternal twins, the placentas may implant in different parts of the UT and may be distinctly separate or may implant adjacent to each other and ___. although the placentas may be fused, their blood circulations remain ___ and separate from each other
fuse distinct
arise from a single fertilized egg, which divides, resulting in two genetically identical fetuses. depending on whether the fertilized egg divides early or late, there may be one or two placentas, chorions, and amnion sacs
monozygotic (identical) twins
identical twins: division _ to _days,2 amnions and 2 chorions. __ to __, monochorionic, diamniotic. after __ days, two fetuses will be present but mono,mono. conjoined after _ days
0-4 4-8 8 13
present a very high risk situation, because besides being assocated with an increased incidence of fetal anomalies, if there is only one amniotic sac, the twins may entangle their umbilical cords and cutting off ___
blood supply (monochorionic, monoamniotic)
one of the problems seen with imaging monozygotic twins include the phenomenon of the __ and __ twin
vanishing appearing
one twin may die in utero and the other one continue to grow. if the demise is early, complete resorbtion of both embryo and gestational sace or early placental may occur. RPOC aren't seen on US
vanishing twin
study showed that _ % of preg that began with twins ended with one. many of these losses occur very ___ and are never detected. twin can be resorbed back into maternal body. others are detected early when the pt. has 2nd tri _
70% early bleeding (empty extra sac found)
if the fetus dies after reaching a size too large for resorption the fetus is markedly ___ from loss of fluid and most of the soft tissue.. this is termed ____.
flattened papyraceous
just as a twin may appear to vanish, one may also appear. the appearing twin is seen when ultrasound exams are performed very early in gestation (5-6 weeks) and ___ of GS happens
gestational sac
is characterized by a diamniotic pregnancy with polyhydramnios in one sac and severed oligohydramnios and a smaller twin in the other sac; one chorion and two amnions
poli-oli sequence aka stuck twin aka TOPS (twin polyohydramnios oligohydramnio syndrome)
when oligohydramnios exists in one sac and polydramnios in the other making the small twin appear stuck
polu-oli sequence (TOPS)
only occurs in monochorionic diamniotic twins; exists when there is an arteriovenous shunt within the placenta. the arterial blood of one twin is pumped into the venous system of the other twin
twin to twin transfusion
in twin to twin transfusion, the donor twin becomes ___ and growth restricted. this twin has less blood flow through its kidneys, urinates less, and develops ___. donor appears growth restricted resulting in lung immaturity and ___
anemic oligohydramnios starvation
in twin to twin transfusion, recipient gets too much blood flow and develops _. twin may be normal or _in size. excessive blood flows thru kidneys and urinates too much. twin may even go into _ and become hydropic. also has _ and ascites
polyhydramnios large heart failure organomegaly
in twin to twin transfusions, both twins are at risk of _ b/c its nutritional and oxygen rich blood supply is severely restricted and larger one b/c of heart failure. usually manifests at __ to __ weeks. the majority involve monochorionic
dying 16-26 weeks
a rare unique anomaly occurring in diamniotic monochorionic twins, in which one twin develops without a heart and often absence of the upper half of the body
twin-reversed arterial perfusion aka cardiac twin.
occurs because of an artery-to-artery connection in the placenta that leads to perfusion of the abnormal twin via co-twin. the reversed direction of blood flow in the abnormal twin alters the hemodynamic properties needed for normal cardiac formation
twin-reversed arterial perfusion aka cardiac twin
on ultrasound, one sees a monochorionic twin gestation with one normal fetus and one fetus with an absent heart
twin-reversed arterial perfusion aka cardiac twin
in TRAP the acardiac twin received poor oxy blood and is incompletely formed often missing the _ trunk, extremities, and head, and encased by massive skin _. organs are also absent in abd and thorax w/ poorly formed or absent limbs
upper edema
in twin-reversed arterial perfusion this twin may appear normal, but if the twin develops heart failure due to overproduction then it may hydrops and fetal demise, IUGR or organomegaly and polyhydramnios because it's overworking
pump twin
monochorionic, monoamniotic; occur from incomplete division of the embryo after 13 days from conception
conjoined twins
conjoined twins are always the same sex with ___ % being female
list the five types of conjoined twins
thoracopagus, omphalopagus, craniopagus, synecephalus, pygopagus, ischiopagus
conjoined twin types: __ means attached at the buttocks. ___ means joined at the ischial region. ___ means joined twins with one head. ___ means joined at the thorax. ____ means joined at the anterior wall
ischiopagus pygopagus syncephalus thoracopagus omphalopagus
on ultrasoudn,one will see a monochorionic monoamniotic gestation with two fetuses connected. this technique allows assessment of prognosis, surgical planning, and parental counseling bfore delivery
conjoined twins
are at an inc risk for pregnancy-related complications, like early and late tri fetal death and anomalies; may be complicated by hospitalization for glucose control, nephritis, delivery problems, hyperemesis
insulin-dependent diabetes mellitus mothers (IDDM)
diabetic moms need to be monitored frequently for adequate nutritional and fluid intake, especially if experiencing ___ in the first trimester. ___ is the primary fuel for fetal growth. if it is very high and uncontrolled the fetus may become ___.
hyperemesis glucose macrosomic
once delivered, the diabetic mother may experience problems with glucose control in the nursery, necessitating ___
intravenous glucose administration
there are multiple fetal anomalies associated with diabetes and increased risk for fetal demise. in diabetics who have vasculopathy, fetuses may be at risk for ____. what are the 8 complications?
IUGR congenital heart defects, neural tube defects, polyhydramnios, renal anomalies, IUGR or macrosomia, caudal regression syndrome, placentomegaly
a major congenital anomaly is found in every __ of 100 births and an additional __ to __ % of births are complicated by minor birth defects
3 10-15%
us has become the investigative tool for the ob/gyn to access the developing fetus. it is likely that the fetus with an anomaly will be subjected to ___ at some time during pregnancy. the role of the _ is to screen for unsuspected anomaly
ultrasound sonographer
the benefits of an ultrasound exam are greatest when the sonographer is adept at detecting congenital anomales and understand the cause, progression, and __ of the common congenital anomalies
when a fetal anomaly is found ___, a multidisciplinary team approach to managing the fetus, mother, and family is preferable because the fetus may need special monitoring (e.g. serial ultrasound), delivery, and postnatal care, as well as ___
antenatal surgery
fraternal twins are more common in mothers _ to _ yrs old, multiparity, of _ origin, and family _ and ovulation therapy
*35-39 *ethnic _origin
fetus whose wt is >than the 90% for GA. infant may be too big to fit thru pelvis, making c-section necessary. if delivery happens vag, however the dr. may have trouble delivering the shoulders(dyscotia)

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