Chp. 32: Fetal Environment and Maternal Complications
causes of nonimmune hydrops
1. Chorioangioma 2. Cystic adenomatoid malformation 3. Diaphragmatic hernia 4. Fetal (nonimmune) anemia 5. Fetal infections 6. Idiopathic 7. Structural anomalies of the cardiac and lymphatic systems 8. Trisomy 13 9. Trisomy 18 10. Trisomy 21 11. Turner syndrome
Thin placental causes
1. Diabetes mellitus (long-standing) 2. IUGR 3. Placental insufficiency 4. polyhydramnios 5. preeclampsia 6. small-for-dates fetus
Thick placenta causes
1. diabetes mellitus 2. maternal anemia 3. infection 4. fetal hydrops 5. Rh isoimmunization 6. multiple gestation
functions of the placenta
1. gas transfer 2. excretory function 3. water balance 4. pH maintenance 5. hormone production 6. defensive barrier
S/D ratio
Assesses the vascular resistance in the placenta by taking a sample of the umbilical artery. decreases with advancing age. Absence or reversal of diastolic flow in the umbilical artery is considered irregular and is associated with an increased incidence of IUGR and oligohydramnios. An elevated S/D ratio is associated with increased placental resistance and an increase in the risk of perinatal mortality and morbidity.
death
Because both the patient and the fetus have an increased risk of ___ with placenta previa, a C section is the preferred method of delivery.
maternal diabetes
Either pregestational or gestational. Pregestational diabetes, the mother already has a history of diabetes. Gestational diabetes, which is the most common type of diabetes during pregnancy, is pregnancy induced. screened for this around 26 weeks' gestation. major risk is macrosomia.
20
Fetuses with a 2VC have an approximate ___% chance of having additional abnormalities, and thus a thorough examination of the fetus for other findings is warranted.
placenta increta
Invasion of the placenta within the myometrium. sono: Loss of normal hypoechoic interface between the placenta and myometrium with invasion into the myometrium.
fetal alcohol syndrome (FAS)
Most common cause of intellectual disability in the US. Alcohol, which is a teratogen, crosses the placenta and can cause CNS damage. Children exposed to alcohol in utero have been shown to have an increase risk for growth restriction, mental impairment, physical abnormalities, and immune dysfunction. sono: 1. Microcephaly 2. Dysgenesis of the corpus callosum 3. Long round philtrum 4. Malformed ears 5. Microphthalmia 6. Cleft palate 7. Heart defects such as ventricular septal defects
pregestational diabetes
Mothers with ___ have a higher risk of miscarriage and toxemia, and the fetus has an increased risk of congenital anomalies, hypoglycemia, respiratory distress, perinatal mortality, and IUGR.
placenta percreta
Penetration of the placenta through the uterine serosa and possibly into adjacent pelvic organs. Loss of normal hypoechoic interface between the placenta and the myometrium with penetration beyond the serosa.
myometrium
Placenta accrete denotes the abnormal attachment of the placenta to the ___.
marginal placenta previa
Placenta lies at the edge of the internal os
Low-lying placenta previa
Placental edge extends into the lower uterine segment but ends more than 2 cm away from the internal os
Umbilical cord
The ___ has TWO ARTERIES and ONE VEIN.
retained products of conception (RPOC)
The normal postpartum uterus returns to its nongravid size 6 to 8 weeks after delivery. When additional placental tissue remains within the uterus after the bulk of the placenta has been delivered. clinical findings: 1. postpartum vaginal bleeding. sono: 1. Echogenic intracavitary mass that may contain some calcifications 2. Color Doppler signals within the retained placental tissue
90
The obese fetus is defined as a fetus that has an EFW of greater than the ___th percentile.
placental abruption
The premature separation of the placenta from the uterine wall before the birth of the fetus, thus causing hemorrhage. Maternal conditions that are linked to the development of ___ include HTN, preeclampsia, cocaine use, cigarette smoking, poor nutrition, and trauma.
placenta
Weighs btwn 450 and 550 grams. Has a diameter of 16-20 cm. Produces hCG in first tri, and progesterone and estrogen in 2nd and 3rd tri. Consists of 3 parts: 1. chorionic plate (closest to fetus) 2. placental substance 3. basal layer or basal plate. Thickness should not exceed 4 cm.
middle cerebral artery
When comparing the two Doppler signals, the ___ should generate a higher resistance flow pattern than the umbilical artery. has been shown effective at evaluating for hypoxia in a fetus that is measuring small for dates.
leiomyoma
Which of the following would be least likely associated with immune hydrops?
diethylstilbestrol
a drug administered to pregnant women from the 1940s to the 1970s to treat threatened abortions and premature labor that has been linked with uterine malformation in the exposed fetus
multicystic dysplastic kidney disease
a fetal renal disease thought to be caused by an early renal obstruction; leads to the development of multiple noncommunicating cysts of varying sizes in the renal fossa
intrauterine growth restriction
a fetus that is below the 10th percentile for gestational age (small for gestational age) and whose growth is impeded for some reason
cystic adenomatoid malformation
a mass consisting of abnormal bronchial and lung tissue that develops within the fetal chest
mirror syndrome
a rare disorder in which the mother suffers from edema and fluid buildup similar to her hydropic fetus
marginal cord insertion
abnormal cord insertion at the edge of the placenta. aka BATTLEDORE placenta.
fetal hydrops
accumulation of fluid within at least two fetal body cavities. sono: 1. Fluid accumulation within at least two fetal body cavities (pleural effusion, ascites, skin edema, pericardial effusion) 2. Fetal hepatosplenomegaly 3. Polyhydramnios
TORCH
acronym that stands for toxoplasmosis, other infections, rubella, cytomegalovirus, and herpes simplex virus. Can cross the placenta and influence the fetus. Cytomegalovirus is listed as the most common congenital infection. sono: 1. Intracranial calcifications 2. Microcephaly 3. Microphthalmia 4. Ventriculomegaly 5. Hepatosplenomegaly
uterine synechia(e)
aka amniotic sheets. Linear bands of scar tissue within the uterus. ___ are the result of intrauterine adhesions, as seen with Asherman syndrome. Associated with premature rupture of membranes, premature delivery, and placental abruption. Associated with fetal anomalies. sono: 1. Linear, echogenic band of tissue traversing the uterine cavity 2. The band does not involve fetal parts, and the normal fetus appears to move freely
marginal placental abruption
aka subchorionic hemorrhage. most common placental hemorrhage identified with sono.
uterine artery
an abnormal flow pattern will yield high resistance within the ___ when IUGR is present.
circumvallate placenta
an abnormally shaped placenta caused by the membranes inserting inward from the edge of the placenta, producing a curled-up placental shape
succenturiate lobe
an accessory lobe of the placenta
macrosomia
an estimated fetal weight of greater than the 90th percentile or the neonate that measures more than 4,500 in nondiabetic mothers and 4,000 g in diabetic mothers. Mothers who are prone to havethis type of fetus are those who suffer from diabetes, whether pregestational or gestational.
infantile polycystic kidney disease
an inherited renal disease that results in bilateral enlargement of the fetal kidneys and microscopic renal cysts; also referred to as autosomal recessive polycystic kidney disease
two-vessel cord
an umbilical cord with one artery and one vein; could possibly be associated with other fetal abnormalities and intrauterine growth restriction
eclampsia
clinical findings: 1. Long-standing, uncontrolled preeclampsia 2. Headaches 3. Seizures sono: 1. Oligohydramnios 2. IUGR 3. Gestational trophoblastic disease 4. Placental abruption 5. Elevated S/D ratio
placenta accreta, increta, and percreta
clinical findings: 1. Previous C section or uterine surgery 2. Painless vaginal bleeding if placenta previa is present 3. Possibly asymptomatic sono: 1. Placenta previa (frequent associated finding) 2. Loss of the normal hypoechoic interface between the placenta and the myometrium
bladder flap hematoma
clinical findings: 1. recent c section sono: 1. Anechoic or complex mass located between the lower uterine segment and the posterior bladder wall
erythroblastosis fetalis
condition in which there is an incompatibility between the fetal and maternal red blood cells
nuchal cord
condition of having the umbilical cord wrapped completely around the fetal neck
allantoic cyst
cyst found within the umbilical cord. most often found near fetal abd. May be associated with omphalocele and aneuploidy. sono: 1. Cystic mass within the umbilical cord 2. Most often noted close to the fetal abdomen
IUGR
defined as estimated fetal weight (EFW) that is below the 10th percentile at a given gestational age. The fetus is at risk if the mother suffers from chronic disease, drinks alcohol, smokes cigarettes, has poor nutrition, is younger than 17 or older than 35 years, or has a history of previous pregnancies that were considered growth restricted.
gestational diabetes
diabetes acquired as a result of pregnancy
anasarca
diffuse edema
immune hydrops
fetal hydrops caused by Rh incompatibility. is caused by the absence of a detectable circulating fetal antibody against the red blood cells in the mother. Is associated with erythroblastosis fetalis and Rh isoimmunization.
nonimmune hydrops
fetal hydrops caused by congenital fetal anomalies and infections
oligohydramnios
fetal malformations/ complications associated with ___: 1. Bilateral multicystic dysplastic kidney disease 2.Bilateral renal agenesis 3. Infantile polycystic kidney disease 4. IUGR 5. Posterior urethral valves 6. Premature rupture of membranes (PROM)
polyhydramnios
fetal malformations/ complications associated with ___: 1. Cardiac and/or chest abnormalities 2.Chromosomal abnormalities 3.Duodenal atresia 4.Esophageal atresia 5.Gastroschisis 6. Neural tube defects 7. Omphalocele 8. Rh incompatibility 9. Twin-twin transfusion syndrome
vasa previa
fetal vessels resting over the internal os of the cervix. these vessels are prone to rupture as the cervix dilates. sono: identification of vessels over the internal os of the cervix with the use of color doppler 2. valementous cord insertion
umbilical vein varix
focal dilatation of the intra-abdominal portion of the umbilical vein. May be associated with fetal aneuploidy, growth restriction, hydrops, and demise.
Wharton jelly
gelatinous material that is located within the umbilical cord around the umbilical vessels
cotyledons
groups or lobes of chorionic villi
posterior urethral valves
irregular thin membranes of tissue located within the male posterior urethra that does not allow urine to exit the urethra
biophysical profile
method of fetal monitoring with sonography to produce a numerical scoring system that predicts fetal well-being
chorioangioma
most common benign placental tumor. most common location fo the mass is adjacent to the umbilical cord insertion site at the placenta. When large, they can be associated with IUGR, polyhydramnios, and fetal hydrops. clinical findings: 1. possible elevation in MSAFP. sono: 1. solid, hypoechoic or hyperechoic mass within the placenta
Hemangioma of the umbilical cord
most common tumor of the umbilical cord, although rare. sono: 1. Solid hyperechoic mass within the umbilical cord2. Most often noted close to the cord insertion into the placenta
complete placental abruption
most severe abruption. results int he development of retroplacental hematoma, located btwn placenta and myometrium.
partial placental abruption
only a few cm of separation
complete (total) placenta previa
placenta covers the internal os completely
partial placenta previa
placenta partially covers the internal os
bilobed placenta
placenta that consists of two separate discs of equal size
abruptio placentae
placental abruption
venous lakes
pools of maternal blood within the placental substance. aka maternal lakes or placental lakes.
preeclampsia
pregnancy-induced maternal high blood pressure and proteinuria after 20 weeks' gestation clinical findings: 1. Maternal hypertension 2. Maternal edema 3. Maternal proteinuria sono: 1. Oligohydramnios 2. IUGR 3. Gestational trophoblastic disease 4. Placental abruption 5. Elevated S/D ratio
vernix
protective fetal skin covering
twin-twin transfusion syndrome
shunting of venous or arterial blood from one twin to another through placental circulation
Leiomyoma
sono: 1. Hypoechoic mass within the uterus 2. Posterior shadowing from mass 3. Degenerating fibroids may have calcifications or cystic components 4. Multiple fibroids appear as an enlarged, irregularly shaped, diffusely heterogeneous uterus
Grade 0 placenta
sono: Uninterrupted chorionic plate and homogeneous placental substance
Grade 2 placenta
sono: moderate indentations in the chorionic plate with "comma-like" calcification in the placental substance.
Grade 3 placenta
sono: prominent indentation in the chorionic plate that extends to the basal layer with diffuse echogenic and anechoic areas noted within the placental substance.
Grade 1 placenta
sono: subtle indentations on the chorionic plate, with some small calcifications within the placental substance.
placenta accreta
the abnormal Adherence of the placenta to the myometrium. sono: Loss of normal hypoechoic interface between the placenta and the myometrium
velamentous cord insertion
the abnormal insertion of the umbilical cord into the membranes beyond the placental edge. Often associated with vasa previa.
amniotic fluid index
the amount of amniotic fluid surrounding the fetus; the sum of four quadrant measurements of amniotic fluid. The AFI is measured using the anteroposterior dimensions obtained from the four quadrants of the amniotic sac and adding them together. The measurements should not include fetal parts or umbilical cord.
decidua basalis
the endometrial tissue at the implantation site, and the maternal contribution of the placenta. the endometrium beneath the developing placenta.
estimated fetal weight
the fetal weight based on sonographic measurements
neonatal period
the first 28 days of life
diaphragmatic hernia
the herniation of the abdominal contents into the chest cavity through a defect in the diaphragm
cervical length measurement
the length measurement taken from the internal os to the external os. Should measure at least 3 cm.
cervical incompetence
the painless dilation of the cervix in the second or early third trimester. clinical findings: 1. Painless dilation of the cervix 2. Premature rupture of membranes 3. Vaginal bleeding sono: 1. Cervical length of less than 3 cm 2. Funneling of the cervix (can produce a "U" or "V" shape)
chorion frondosum
the part of the chorion, covered by chorionic villi, that is the fetal contribution of the placenta. derived from the blastocyst and contains the chorionic villi.
cerclage
the placement of sutures within the cervix to keep it closed
funneling (cervical)
the result of the premature opening of the internal os and the subsequent bulging of the membranes into the dilated cervix. An early sign of an incompetent cervix. May take on a U shape or V shape.
premature rupture of membranes
the rupture of the amniotic sac prior to the onset of labor
blastocyst
the stage of the conceptus that implants within the decidualized endometrium
vitelline duct
the structure that connects the developing embryo to the secondary yolk sac
lower uterine segment
the term used for the isthmus during pregnancy
philtrum
the vertical groove seen between the upper lip and the nasal septum
umbilical vein
the vessel of the umbilical cord that carries oxygenated blood from the placenta to the fetus proceeds cephalad to connect to the left portal vein within the liver.
postpartum
time directly after giving birth and extending to about 6 weeks
exsanguination
total blood loss; to bleed out
umbilical arteries
two vessels of the umbilical cord that carry deoxygenated blood from the fetus to the placenta. once they enter the abdomen, they proceed caudal around the bladder to connect to the fetal internal iliac arteries.
symmetric IUGR
when the entire fetus is small. suspected causes: 1. Genetic disorders 2. Fetal infections 3. Congenital malformations 4. Syndromes
placenta previa
when the placenta covers or nearly covers the internal os of the cervix. Located in the lower uterine segment. A common cause of painless vaginal bleeding in the 2nd and 3rd trimesters. The placenta should be evaluated for ___ after 20 weeks with an empty bladder using a TA approach. clinical findings: 1. previous c section or uterine surgery 2. painless vaginal bleeding 3. possibly asymptomatic
shoulder dystocia
when the shoulder of the fetus cannot pass through the birth canal during pregnancy
asymmetric IUGR
wherein the femur length typically is normal while all other measurements are small for gestation. suspected causes: 1. Nutritional deficiency 2.Oxygen deficiency