EXAM 2-fetal/maternal factors & fetal doppler/twins

fetal doppler

can differentiate between SGA/IUGR, identify fetal anemia and high risk for adverse outcomes with uterine artery doppler

factors affecting doppler waveforms

pt position, fetal/maternal breathing, fetal cardiac arrythmias, meds taken by mom

uterine artery doppler helps predict _____ and is sampled where it crosses over _____

hypertensive disorders, internal iliac

uterine artery flow during 1st trimester/non-gravid

high resistance

uterine artery during 2nd/3rd trimester

low resistance

the normal diastolic notch in ______ can be seen up to _____

uterine artery, 26 weeks

a notch in doppler seen after 26 weeks, could indicate _____ or ______

IUGR, placental insufficiency

a uterine artery ratio of greater than _____ could indicate _____ to uterus

2.6, decreased flow

umbilical vein sampling location

free-floating cord

umbilical vein flow should be constant, and non-pulsatile after

20 weeks

abnormal umbilical vein waveform could indicate

fetus with growth restriction, non-immune hydrops, fetal compromise

umbilical artery sampling location

fetal CI, placenta CI, mid uterine artery

umbilical artery is always a ______ vessel and _____ is an ominous sign

low resistance, flow reversal

umbilical artery normal s/d ratio

<3 after 30 weeks

abnormal umbilical artery waveform could indicate

early delivery, IUGR, death or other complications

MCA doppler can be used if ______ or ______ are suspected

fetal anemia, IUGR

MCA doppler sampling location

below BPD, ant to thalamus, at circle of willis, close to ICA

if MCA doppler waveform is _____, it could indicate increased flow to preserve brain, “______”

low resistance, brain sparing

ductus venosus can be evaluated

11-13w6d or 2nd/3rd trimester

ductus venosus is useful for suspected _____ or ______

down syndrome, cardiac defects

normal ductus venosus waveform

triphasic, with positive atrial contraction

absent ____ in ductus venosus waveform, indicates that baby should be ______

a-wave, delivered asap

multiple pregnancy mom is at risk for

hypertension, pre-term labor, placenta abruption, pre-eclampsia

multiple pregnancy fetus is at risk for

umbilical cord problems, congenital abnormalities, IUGR, twin-to-twin transfusion

fetal sac A location

above internal OS

ideal time to identify amnionicity/chorionicity

10-14 weeks

day 4

chorion forms

day 9

amnion forms

chorion=

placenta=

amniotic sac=

yolk sac=

dizygotic twins types

di-di

di-di twins are ____ fertilized by _____

two ova, two sperm

dizygotic di-di twins

most common type of twinning with the least amount of complications

on US, di-di twins can only be identified if

2 different genders

lambda sign AKA

delta, twin sign AKA

monozygotic twin types

di-di, mo-di, mo-mo

monozygotic di-di twins days

one zygote decides during days 0-4

mo-di twins days

one zygote divides during days 4-8

mo-di sign

T-sign

mo-di twins

most common monozygotic twinning

mo-di twins major complication

twin-to-twin transfusion

mo-mo twins days

one zygote divides during days 8-12

mo-mo twins complications

twin-to-twin transfusion, umbilical cord problems

conjoined twins

occurs if zygote divides after 13 days

most common site for conjoined twins

thorax/thoracopagus

head

craniopagus

thorax

thoracopagus

abdomen

oomphalopagus

pelvis

pyopagus

fetus papyraceous

twin dies later in pregnancy and is markedly flattened from loss of fluid and most soft tissue

twin-to-twin transfusion AKA

poly-oli syndrome/stuck twin syndrome AKA

stuck twin syndrome occurs in _______ pregnancies

only monochorionic

poly-oli syndrome treatments

serial amniocentesis, selective feticide, laser of placental vessels

donor twin in t-t-t

IUGR and oli

recipient twin in t-t-t

poly and normal/LGA

recipient twin in t-t-t can get _____ 25% of the time, increasing the risk of _____

hydrops, heart failure

acardiac anomaly

rare anomaly occurring in mo-mo twins

in acardiac anomaly one twin develops without

heart and often upper half of body

in acardiac anomaly, pump twin is usually normal except for ______ and _____

cardiomegaly, hydrops

arcuate uterus

concave indentation with obtuse angle

subseptate

central point of septum at acute angle

high risk pregnancy considers

family hx, abnormal blood work, vaginal bleeding, and cervical incompetence

maternal factors

AMA, diabetes mellitus, hypertension, maternal infections

maternal diabetes

most common maternal disorder that increases risk for complications, including early and late trimester pregnancy loss and congenital anomalies

glucose

primary fuel for fetal growth

if glucose is _____ then the fetus may become _____, greater than 90th percentile

too high, macrosomic

us findings for fetus born to diabetic

macrosomic fetus, polyhydramnios, thick placenta

gestational diabetes usually resolves but slightly ____ the risk for _____

increases, type II

Type II diabetes

more commonly occurring in obese patients where the pancreas don’t produce enough insulin or body’s cells become resistant

Type II AKA

non-insulin dependent AKA

pregestational diabetes AKA

maternal diabetes mellitus AKA

bloodwork for diabetes

A1C

poorly controlled diabetes can be associated with

fetal anatomic abnormalities

CCNGGSS

cardiovascular malformations, caudal regression syndrome, neural tube defects, GI/GU defects, skeletal defects, SUA

caudal regression syndrome

rare congenital anomaly, lower part doesn’t develop properly, and can be associated with VACTRL

VACTERL

vertebral atresia, anal atresia, cardiac defects, trachea-esophageal issues, renal abnormalities, limb abnormalities

3 of these ______ abnormalities have to be present to be considered _____

VACTRL, caudal regression syndrome

hypertension placenta

thin and prematurely mature with an increased risk of abruption

hypertension is associated with

oligohydramnios, IUGR

fetus with hypertensive mother has increased risk for

fetal distress and fetal death in utero

toximia

term used for hypertensive disorders

pregnancy induced hypertension

gestational hypertension diagnosed after 20 weeks

pre-eclampsia

gestational hypertension plus protein in urine and where patients commonly have edema with rapid weight gain

eclampsia

onset of seizures that can result in coma or death of mom

_____ of women diagnosed with pre-eclampsia will develop ____

4-12%, HELLP

HELLP

Hemolysis, elevated liver function tests, low platelet count

low platelet count AKA

thrombocytopenia AKA

HELLP symptoms

headaches, nausea, vomiting, RUQ pain, fatigue, edema, hypertension

TORCH

Toxoplasmosis, other, rubella, cytomegalovirus, herpes

_____ are the most common maternal infections seen with ______

TORCH, fetal congenital abnormalities

O in TORCH

syphillis, varicella, parvovirus

maternal infection sono findings

calcification in fetus especially liver/brain

toxoplasmosis

transmitted through undercooked spoiled meat or infected cat litter

toxoplasmosis sono findings

intracranial calcs, IUGR, microcephaly

syphillis can increase risk

stillbirth, low birth weight, and neonatal death

varicella

can cause multiple hyperechoic foci in abdomen

parvovirus

common, check for hydrops, and MCA doppler for anemia

rubella AKA

german measles AKA

_____ can result in ______, particularly VSDs and Tetralogy of Fallot

rubella, cardiac defects

cytomegalovirus

most common in pregnancy and can cause fetal death if contracted in first trimester