Complications in pregnancy

Complications in pregnancy

severe generalized massive edema often seen with hydrops fetalis.

inward curving of the fifth finger associated with Down syndrome.

abnormal outward bending or twisting of the elbow.

gravest form of pregnancy-induced maternal hypertension characterized by seizures, coma, proteinuria, and edema.

a condition in which the ventral wall of the chest fails to close and the heart develops outside of the chest.

a condition where the skull is defective, causing exposure or extrusion of the brain

fetus papyraceus

demise of a twin that is too large to reabsorb.

underdevelopment of the jaw, especially the mandible.

abnormal smallness of one or both eyes.

congenital anomaly characterized by the presence of more than the normal number of digits.

an abnormal condition characterized by the onset of acute hypertension after 24 weeks’ gestation. Classic triad includes maternal edema, proteinuria, and hypertension.

premature rupture of membranes (PROM)

early rupture of the gestational sac with leakage of part or all of the amniotic fluid.

onset of labor before 37 weeks’ gestation.

caused when the mother forms a corresponding antibody to the fetal blood, resulting in destruction of fetal red blood cells.

sandal toe deformity

Increased distance between the first and second toes associated with Down syndrome.

overlapping of the cranial bones associated with fetal demise.

congenital anomaly characterized by the fusion of the fingers or toes.

twin–twin transfusion syndrome (TTS)

the arterial blood of the donor twin pumps into the venous system of the receiving twin.

Chromosomal abnormalities

• Found in 1 of 180 live births.

Chromosomal Abnormalities

ANOMALY	INFORMATION	SONOGRAPHIC FINDINGS	DIFFERENTIAL CONSIDERATIONS
Edward syndrome	Trisomy 18 80% of cases display a clenched fist Decrease in AFP 1:8000 live births Overall poor prognosis 95% spontaneously abort Female prevalence	Heart defects Choroid plexus cysts Clenched hands Micrognathia Clubbed or rocker bottom feet Renal anomalies Cleft lip and palate Omphalocele Enlargement of the cisterna magna Microcephaly Small placenta Two-vessel cord Intrauterine growth restriction (IUGR)	Trisomy 13 Triploidy
Down syndrome	Trisomy 21 Decrease in alpha-fetoprotein (AFP) levels 1:800 live births Coexisting anomalies dictate overall prognosis Approximately 30% of cases demonstrate duodenal atresia	Subtle anomalies Nuchal fold ≥6 mm Ventricular septal defect Duodenal atresia Brachycephaly Hyperechoic cardiac focus Macroglossia Hyperechoic bowel Sandal toe deformity Clinodactyly Low-set ears Short stature	Beckwith-Wiedemann syndrome
Patau syndrome	Trisomy 13 90% of cases display cardiac defects Syndrome of midline defects 1:25,000 live births Overall poor prognosis Multiple anomalies, many involving the brain	Holoprosencephaly Microcephaly Cystic hygroma Absent or small eyes Facial clefts Cardiac defects Omphalocele Polycystic kidneys Clubfoot Polydactyly IUGR Polyhydramnios	Meckel-Gruber syndrome
Triploidy	Three complete sets of chromosomes Most will abort spontaneously 1:5000 live births	Early onset IUGR Holoprosencephaly Hypertelorism Micrognathia Microphthalmia Ventriculomegaly Oligohydramnios 2 vessel cord Cardiac abnormalities Clubfeet Syndactyly	Trisomy 13 Trisomy 18
Turner syndrome	45 chromosomes, including a single X chromosome Elevated AFP levels Female fetus 1:5000 live births	Cystic hygroma Cardiac defects Renal anomalies Cubitus valgus Short femurs General lymph edema	Cephalocele Trisomy 13 Hydrops fetalis

Fetal syndromes

• Demonstrate normal karyotype.

• Malformation refers to a defect of an organ that results from an intrinsically abnormal development process.

• Deformation refers to an abnormal form, shape, or position of a part caused by mechanical forces antenatally.

• Disruption is a defect of an organ resulting from the breakdown of previously normal tissue.

• Sequence refers to a pattern of multiple anomalies that result from a single anomaly or mechanical factor.

Fetal Syndromes

SYNDROME	INFORMATION	SONOGRAPHIC FINDINGS	DIFFERENTIAL CONSIDERATIONS
Amniotic band syndrome	Ruptured amnion sticks and entangles fetal parts Associated with fetal abnormalities and amputations	Thin hyperechoic linear structure floating within the amniotic cavity Fetal abnormalities	Synechia Amniotic chorionic separation Limb-body wall complex Placental shelf
Beckwith-Wiedemann syndrome	Classic triad of macrosomia, omphalocele, and macroglossia Normal karyotype Increases risk of developing Wilms’ tumor, hemihypertrophy, renal anomalies, and hepatosplenomegaly	Hemihypertrophy Macroglossia Omphalocele	Down syndrome
Eagle-Barrett syndrome	Prune belly syndrome Hypotonic abdominal wall muscles Associated with dilated fetal bladder, small thorax, and imperforate anus	Hydronephrosis Megaureter Oligohydramnios Small thorax Large abdomen Cryptorchidism Hip dislocation Scoliosis	Urinary obstruction Urethral atresia
Limb-body wall complex	Rare complex malformation caused by the failure of closure of the ventral body wall	Ventral wall defect Cranial anomalies Marked scoliosis Limb defects Short umbilical cord Amniotic bands	Amniotic band syndrome Trisomy 13
Limb-body wall complex	Two or more of the following Limb defects Lateral wall defects (esp. left) Encephalocele Exencephaly Facial defects Scoliosis		Amniotic band syndrome Trisomy 13
Meckel-Gruber syndrome	Lethal condition Occurs equally in males and females Autosomal recessive	Encephalocele Infantile polycystic renals Oligohydramnios Bladder not visualized Polydactyly	Trisomy 13 Infantile polycystic disease
Pentalogy of Cantrell	Congenital disorder characterized by two out of the following major defects 1. cardiac defect 2. abdominal wall defect 3. diaphragmatic hernia 4. Defect of diaphragmatic pericardium 5. ectopia cordis	Pulsating mass outside of the chest cavity Omphalocele Gastroschisis	Beckwith-Wiedemann syndrome Acardiac twin

Hydrops fetalis

• An abnormal interstitial accumulation of fluid in the body cavities and soft tissues.

• Fluid accumulation may result in anasarca, ascites, pericardial effusion, pleural effusion, placentomegaly, and polyhydramnios.

• Hydrops may result from antibodies in the maternal circulation that destroy the fetal red blood cells (immune) or without evidence of blood group incompatibility (nonimmune).

• Sonography cannot differentiate immune from nonimmune hydrops.

HYDROPS	CLINICAL FINDINGS	SONOGRAPHIC FINDINGS	DIFFERENTIAL CONSIDERATIONS
Immune	Rh sensitivity	Scalp edema Pleural effusion Pericardial effusion Polyhydramnios Placentomegaly	Nonimmune hydrops Pleural effusion
Nonimmune	Large for dates	Anasarca Edema or fluid accumulation in at least two fetal sites Ascites Scalp edema Pleural effusion Pericardial effusion Polyhydramnios Placentomegaly Fetal tachycardia 200-240 bpm	Immune hydrops Pleural effusion

Multifetal gestations

• Seventy percent of pregnancies beginning with twins will deliver a singleton pregnancy.

• Monozygotic twins result from a single fertilized ovum.

• Dizygotic twins result from two separate ova.

• Majority of pregnancies are dizygotic.

• Dizygotic pregnancies are always dichorionic/diamniotic.

• Label each fetus with Twin A closest to the internal os.

• IUGR is the most common cause of discordant growth in a dichorionic multifetal gestation.

• Twin–twin transfusion syndrome is the most common cause of discordant growth in a monochorionic multifetal gestation.

Sonographic evaluation

• Number of embryos.

• Presence or absence of dividing membrane(s).

• Biometric measurements.

• Fetal surveillance (same as singleton).

• Amniotic fluid volume.

Monozygotic Multifetal Gestations

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Tags: Abdomen, Obstetrics and Gynecolo, Sonography Exam Review Physics

Jun 15, 2016 | Posted by admin in GYNECOLOGY | Comments Off

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