CH. 52

• pappa a and bhcg
• used with nt 11-14 wks

maternal serum quad screening

• afp
• hcg
• unconjugated estriol
• inhibin-a
• 18-20 weeks

• 35 yrs +
• downs 1 in 385

at age 45= 1 in 45

• excessive fluid in the fetal body
• anasarca- entire body

maternal sertum immunoglobin G IgG antibody attacks fetal redblood cells

today we give RhoGAM

• scalp edema
• pleural effusion
• pericardial effusion
• ascites
• polyhydraminos
• thick placenta

• amniocentesis
• take 20ccs of fluid 15-18 weeks
• look at amount of bilirubin- light absorbing (spectrophotometric analysis)
• low- term, mid- preterm, or high- treatment or death

needle into fetal umbilical cord for blood sample

• indicates fetal transfusion need
• 1- needle into peritoneum slowly absorbed
• 2- into cord perferred

• mothers immune response to fetal platelets
• develops antibodies
• fetus results with low platelets
• fetus at risk for intracerebral hemorrage and bleeding
• cordocentesis to check platelets
• hemorrage common at adrenal glands

• not from fetomaternal blood group incompatibility
• can be from fetus mom or placenta
• 1 in 2500- 1 in 3500
• Cardiovascular lesions frequent cause
• hernia, CCAM, umb vein thromb
• vascular tumor acting as avshunt
• severe anemia

• one twin uses other waste
• both die IUGR

placenta previa or abruption

no o2 or blood to fetus

tv

2 cm

• umb chord or vessles cross os
• color doppler
• assoc with succenterate lobe and valemanous insertion

abruption or uterine contraction

• early and late trimester loss
• congenital anomolies
• considered high risk
• macrosomia or IUGR (vascular)

• glucose control
• infections- pyelonephritis
• problems swtih delivery

• macrosomic fetus (4000g +) 8lbs 3 oz
• cant fit though pelvis

• shoulders dont fit after head is delivered
• brachial plexus nerve injury

premature rupture of membranes

• lack of development of caudal spine and cord
• diabetic mothers

small placenta- IUGR

• 1- preeclampsia, severe, and eclampsia
• 2- chronic htn (before 20wks)

• high blood pressure with protienuria or edema
• pt can have seizures

seizures and coma after preeclampsia

• chronic autoimmune disorder
• effects all organ systems
• can have spont abort or fetal death (22-49%)

• excessive vomiting
• become dehydrated and electrolyte imbalance
• IV hydration

gallstones, trphoblastic dis (ruled out by iup), ulcers

asymptomatic bacteria that turns to pyelonephrosis

preg usually associated with mild hydro

usually has flank pain, increased wbc in urine

• cyst can be 8-10 cm- pelvic pain
• if doesnt resolve may be endometrioma or dermoid cyst
• can have torsion if over 5cm

• should gain 20lbs with pregnancy
• obesity linked to neurotube defects
• likely to have chronic hypertension
• incresed risk for severe eclampsia
• increased multiple births and uti

• stimulated by horomones- estrogen
• can outgrow blood supply and necrosis
• premature labor
• note size and location to watch for problems with delivery or poor placental profusion
• can cause IUGR

• before 37 weeks
• 15-20% pregnancies
• increased risk for repiratory problems, hemorhage, bowel immatuity, and feeding problems
• PROM
• infection, bleeding, poly, mutiple gest, iugr, maternal illness, incompetent cervix, uterine abn

• under 1500g
• inceased propensity for intracranial bleeding

• half from infection-prom
• chrom anom
• preeclampsia
• placental abruption
• iugr
• isoimmunization

• 15-20%
• 80% in 1st timester

• 45X 14.6%
• 20% triploidies
• half are trisomies

16-20 weeks on a daily basis

• no hearbeat
• no movement
• overlap of skull bones (spaldings sign)
• exagerated curve of spine
• gas in fetal abdomen

• diabetic mothers
• big abd circumfrence- compared to head and legnth

• not good outcome
• chrom anom
• intrauterine infection
• genetics
• placental insufficency

symmetric or asymmetric

• placental insufficency
• normal head but small body
• early delivered 34-35weeks have better chance of catching up to peers in 2 yers than if delivered at term

iugr can be diagnosed at 22-24 weeks

• preeclampmsia
• bleeding thrid trimester
• prolapse cord
• premature delivery
• congenital anomolies
• 5xs greater chance of death

• best
• two seperate fertilized ova
• each has its own placenta, chorion, amnion
• placentas may be in two locations or next to each other anf fuse (blood circulation is seperate)

• identica
• single fertilized egg that divides with two genetically identical fetus
• placenta, chorion, amnion depend on when division occurs

• 2 amnions
• 2 chorions
• (dichor diamn)

• 1 chorion
• 2 amnions
• monocho diamni

• 1 chorion
• 1 amnion
• monocho monoamni

• conjoined twins
• head thorax abd or pelvis
• most sucessful seperation when not sharing heart or lung

entangle umbilical cords and cut blood supply

• monozygotic twins share placenta
• av shunt in placenta
• arterial blood pumped into venous of the other
• donor is iugr and oligo
• reciepient gets too much blood- normal or large
• toomuch flow caused poly
• heart failure-hydroptic
• both risk dying

• serial amniocentisis
• selective feticide
• umbilical cord ligation
• laser occulsion of anatomosing placental vessle

singleton- disapearing twin

early loss and baby is reabsorbed

one twin dies and is too big to be reasbored and is flattened

• measured early and cant detect twins
• or operator does find second sac

• diamniotic pregnancy- usually monochorionic
• poly in one and oligo in the other
• 16-26 weeks
• poly sac compresses other normal blood flow creating oligo, placental insufficiency, twin to twin transfusion synd and appears stuck

• monochorionic twins
• one develops without a heart/ upper half of body
• artery to artery connection in placenta
• reverse flow alters ability for form normal heart
• acardiac twin missing head thorax or limbs

• after 13 days divison
• 5 types
• monochorionic monoamniotic joined fetus

joined at the thorax

joined at anterior wall

joined at the cranium, syncephalus- one head)

joined at ischial region

joined at butt

• number of sacs
• number and locations of placenta
• gender of fetuses
• biometric data
• presence of anomolies

A is closest to os or cervix

• dizygotic
• diamniotic
• dichorionic

• monozygotic
• monochorionic
• monoamnionic

dolicephaly- big front to back- compression

• bpd/ofd x 100
• less than 75% is doli

• 20% weight difference
• 5mm bpd difference
• 20mm ac difference
• 5mm fl difference

cant exist with boy and girl but can with same sexes