maternal and fetal factors

A high-risk OB patient is one who is at an increased risk for an ________ pregnancy outcome.

Adverse

To identify the high-risk pregnancy, which two factors should be considered?

• Mother

• Fetus

Risks for a high-risk pregnancy include understanding (1)_______ and _______ factors as well as obtaining (2)______ history.

1. Maternal, Fetal

2. Family

List the 3 maternal risk factors previously discussed for a high-risk pregnancy.

• Blood work or procedure

• Vaginal bleeding

• Cervical incompetence

A maternal risk factor involving blood work/procedures will look at what 5 tests/procedures?

• 1st trimester blood work

• Quad screen

• Amniocentesis

• Chorionic villus sampling (CVS)

• Percutaneous cord blood sampling (PUBS)

1st trimester blood work involves what 3 hormones/measurements?

• PAPP-A

• hCG

• NT measurement

A quad screen test is used to indicate if more ________ should be considered.

Testing

What 4 hormones are involved in the quad screen test?

• AFP

• hCG

• Estriol

• Inhibin-A

1. An amniocentesis is when the _____________ is removed.

2. What are the 2 complications that could occur from an amniocentesis?

1. Amniotic fluid

2. Pregnancy loss, Infection

Some reasons for an amniocentesis procedure include…

1. Abnormal ______ testing

2. Assess fetal ____ maturity

3. Reduce the amount of _____________

1. Genetic

2. Lung

3. Amniotic fluid

What does ‘CVS’ stand for?

Chorionic villus sampling

CVS is the biopsy of the _____________.

Chorionic villus

Which two lab procedures are unable to detect neural tube defects?

• CVS

• PUBS

PUBS is another term for what?

Cordocentesis

What does ‘PUBS’ stand for?

Percutaneous cord blood sampling

A PUBS procedure is done by having a (1)_______ aspiration of the umbilical cord to analyze (2)_________.

1. Needle

2. Chromosomes

PUBS procedures detect…

1. ___________ abnormalities

2. Certain ______ disorders

1. Chromosomal

2. Blood

What is the most common reason for vaginal bleeding in the 1st trimester?

SCH (subchorionic hemorrhage)

What are three reasons for vaginal bleeding in the 3rd trimester?

• Placenta abruption

• Placenta previa

• Placenta accreta, increta, and percreta

What is the name of something they use to prevent cervical dilation?

Cervical cerclage (cervical stitch)

List the 4 maternal risk factors for a high-risk pregnancy.

• Advanced maternal age (AMA)

• Diabetes mellitus (DM)

• Hypertension (HTN)

• Maternal infections

AMA refers to a patient who will be ___ or older at the time of delivery.

35

1. In the US, which two treatments are offered to AMA patients?

2. Why is that?

1. Genetic counseling

   1. Invasive prenatal testing

2. Increased risk for genetic abnormalities

Certain syndromes and abnormalities have an increased risk if the patients are…

Advanced for maternal age (AMA)

What is the most common maternal disorder?

Maternal diabetes

Maternal diabetes includes which 3 diabetes?

• Type 1

• Type 2

• Gestational diabetes

Diabetes increases the risk for complications, which includes what two pathologies?

• Early and late trimester pregnancy loss

• Congenital anomalies

What is the primary fuel for fetal growth?

Glucose

If glucose levels are very high and uncontrolled, what could happen to the fetus?

Becomes macrosomic

A macrosomic fetus will be in the ___ percentile in weight.

90th

How is a macrosomic fetus normally delivered?

C-Section

Why is a macrosomic fetus delivered via C-Section?

At a greater risk for should dystocia if delivered vaginally

A macrosomic fetus’ shoulders cannot pass vaginally without…

Manipulation

1. With maternal diabetes, which diabetes type is more common?

2. What percentage will it account for?

1. Type 2

2. 90-95%

1. With maternal diabetes, which diabetes type is less common?

2. What percentage will it account for?

1. Type 1

2. 5-10%

Type 1 diabetes used to be called what?

Juvenile onset diabetes

Type 1 diabetes generally occurs at a ________ age.

Younger

With Type 1 diabetes…

1. More _______ is produced.

2. There is an _________ response where the body attacks the ________.

3. Making the ________ unable to secrete enough ______.

4. The patient will be ______ dependent.

1. Glucose

2. Auto-immune, Pancreas

3. Pancreas, Insulin

4. Insulin

Which diabetes type is more common in obese patients?

Type 2 diabetes

Type 2 diabetes used to be called what?

Non-insulin dependent diabetes

With Type 2 diabetes…

1. More _______ is produced.

2. The _______ has to create more ______.

3. Making the body ______ resistant.

4. The patient will need ______ shots to manage _______.

1. Glucose

2. Pancreas, Insulin

3. Insulin

4. Insulin, Glucose

With type 2 diabetes, the pancreas usually produces enough insulin, but not (1)_______. OR the body’s cells are (2)_________ to it.

Obese people have an insulin (3)__________.

1. Enough

2. Resistant

3. Resistance

Any type 1 or 2 diabetes that predates pregnancy will be termed…

Maternal diabetes mellitus (Pre-Gestational diabetes)

What is another term for maternal diabetes mellitus?

Pre-gestational diabetes

What is another term for pre-gestational diabetes?

Maternal diabetes mellitus

If a patient does not have diabetes, BUT develops it during pregnancy, what is that termed?

Gestational diabetes

Gestational diabetes will typically resolve itself after pregnancy, BUT it will still slightly increase the risk for what diabetes type?

Type 2 diabetes

List the 4 US findings for fetus’ born from a diabetic mother.

• Macrosomic fetus

• Polyhydramnios

• Thick placenta

• CCNGGSS

What does ‘CCNGGSS’ stand for?

• Cardiovascular malformation

• Caudal regression syndrome

• Neural tube defects

• GU anomalies

• GI anomalies

• Skeletal anomalies

• SUA

What does ‘GU’ stand for?

Genitourinary

What organs do GU anomalies affect?

• Kidneys

• Bladder

What does ‘SUA’ stand for?

Single umbilical artery

List the 5 possible congenital anomalies of the heart that could be seen in infants of diabetic mothers.

• Transposition of the great arteries w/ or w/o VSD

• VSD

• ASD

• Coarctation of the aorta w/ or w/o VSD

• Cardiomegaly

List the 3 possible congenital anomalies of the GI tract that could be seen in infants of diabetic mothers.

• Duodenal atresia

• Anorectal atresia

• Small left colon syndrome

List the 3 possible congenital anomalies of the renals that could be seen in infants of diabetic mothers.

• Hydronephrosis

• Renal agenesis

• Ureteral duplication

List the 4 possible congenital anomalies of the CNS that could be seen in infants of diabetic mothers.

• Caudal regression syndrome

• Neural tube defects

• Anencephaly

• Microcephaly

What does ‘CRS’ stand for?

Caudal regression syndrome

CRS is considered a rare ________ anomaly.

Congenital

1. Caudal regression syndrome is when the ______ part of the spine does not develop properly.

2. List some examples.

1. Lower

2. Absence of the sacrum

   1. Defects of the lower vertebral bodies.

CRS can be associated with what mnemonic of pathologies?

VACTERL

List the pathologies associated with the mnemonic ‘VACTERL’.

• Vertebral defects

• Anal atresia

• Cardiac defects

• Trachea-esophageal issues

• Renal anomalies

• Limb abnormalities

Trachea-esophageal issues can include ______ or _______.

• Atresia

• Fistula

Patients diagnosed with VACTERL typically have at least ___ of the pathologies.

3

Prognosis for caudal regression syndrome depends on the type of __________.

Abnormalities

This was found on the scan of a fetus with cardiac defects. What can be assumed here?

Caudal regression syndrome (CRS)

Vertebral defects of CRS present in __-__% of cases.

60-80%

Anal atresia of CRS present in __-__% of cases.

60-90%

Cardiac defects of CRS present in __-__% of cases.

40-80%

Trachea-esophageal fistula/atresia of CRS present in __-__% of cases.

50-80%

Renal anomalies of CRS present in __-__% of cases.

50-80%

Limb abnormalities of CRS present in __% of cases.

50%

Vertebral defects of CRS include the…

1. ____vertebrae

2. __________ vertebrae

3. _____ or missing vertebrae

4. Congenital ________

5. Spina _____

1. Hemi…

2. Hypoplastic

3. Extra

4. Scoliosis

5. Bifida

Vertebral defects of CRS can cause what pain later in life?

Back

Anal atresia in CRS will refer to the narrowing or lack of ______ of the anus.

Patency

Anal atresia of CRS may be accompanied by ____ anomalies.

GU

Anal atresia of CRS will have…

1. No passage of ________

2. Abdominal ________

3. ________

1. Meconium

2. Distension

3. Vomiting

Cardiac defects of CRS can have subtle to life threatening ______.

Defects

Common cardiac defects of CRS include:

1. _________ septal defect

2. _________ septal defect

3. Tetralogy of _____

4. Patent ductus ________

1. Ventricular

2. Atrial

3. Fallot

4. Arteriosus

What is the shorter form of ‘tracheo-esophageal fistula’?

TEF

What does ‘TEF’ stand for?

Tracheo-esophageal fistula

TEF of CRS is an abnormal connection between the _______ and the _________.

• Trachea

• Esophagus

What does ‘EA’ stand for?

Esophageal atresia

EA of CRS is a congenital condition characterized by the (1)_______ development of the (2)________.

1. Incomplete

2. Esophagus

TEFs are most often found in conjunction with…

EA (esophageal atresia)

TEF/EA of CRS may have patient presenting with…

1. Vomiting

2. Copious ____ secretions

3. Feed _________

4. Coughing

5. Cyanosis

6. Respiratory _______

3. Oral

4. Intolerance

6. Distress

Renal anomalies of CRS include these 4 pathologies:

1. Renal _______

2. Renal _______

3. Vesicouterine _____

4. _______ or ___-positioned kidneys

1. Aplasia

2. Dysplasia

3. Reflux

4. Displaced or mal-positioned

Renal anomalies of the CRS may not cause _______ immediately.

Problems

Renal anomalies of CRS may require a ________ or ________ consultation.

• Nephrology

• Urology

Limb abnormalities of CRS could present with radial aplasia. Define what that is.

Underdevelopment of the radius

Limb abnormalities of CRS include these 4 pathologies:

1. ________ (additional digits)

2. Missing ______

3. Lower limb ________

4. ________ (webbing)

1. Polydactyly

2. Digits

3. Hypoplasia

4. Syndactyly

What blood work is used to determine how controlled each case of diabetes is? (How well controlled someone’s glucose is)

Hemoglobin A1C

Poorly controlled diabetes (1)_______ the pregnancy or (2)_______ the pregnancy, can increase the risk for fetal anatomic anomalies.

1. Predating

2. During

A poorly controlled case of diabetes will have the hemoglobin A1C test measuring (1)_____ than (2)___.

1. More

2. 8

A mildly controlled case of diabetes will have the hemoglobin A1C test measuring (1)_____ than (2)___.

1. More

2. 7

A well controlled case of diabetes will have the hemoglobin A1C test measuring (1)_____ than (2)___.

1. Less

2. 7

Hypertension places both the _______ and _______ at a risk.

• Mother

• Fetus

What does ‘HTN’ stand for?

Hypertension

How does a placenta appear with HTN?

• Thin

• Prematurely mature

What is something mothers are at an increased risk for relating to the placenta if they have hypertension?

Placenta abruption

Hypertensive pregnancies may also be associated with which two pathologies?

• IUGR

• Oligohydramnios