04a: Abnormal Pregnancy

Question 1

There’s been a(n) (increase/decrease) in multifetal pregnancies, most likely due to:

Answer 1

Increase;

Women having pregnancies later in life (more likely to fertilize more than one egg)

Question 2

The key major risk for multifetal pregnancy is:

Answer 2

Premature delivery (and the consequences tied to that)

Question 3

T/F: Woman’s risk of aneuploidy doubles if she has twins.

Answer 3

True - esp if woman is at advanced age

Question 4

Monoamniotic, monochorionic pregnancy: (1/2) fetuses, (1/2) placenta(s).

Answer 4

2 fetuses sharing same amniotic sac and same (1) placenta

Question 5

High rates of stillbirth in (mono/di)-amniotic, (mono/di)-chorionic pregnancies. Why?

Answer 5

Mono; mono

Sharing amniotic sac causes umbilical cords to get tangled/compressed

Question 6

(Earlier/later) split of zygote will increase chances that twins share amniotic sac/placenta.

Answer 6

Later

Question 7

Notably high risk of poor growth/pre-term labor in (mono/di)-amniotic, (mono/di)-chorionic pregnancies. Why?

Answer 7

Di-di

Not enough room

Question 8

Notably high risk of congenital malformations in (mono/di)-amniotic, (mono/di)-chorionic pregnancies. Why?

Answer 8

Di-mono and mono-mono (occur with shared placenta!)

Question 9

Spontaneous abortion defined as loss of pregnancy before (X) weeks.

Answer 9

X = 20 (after that, “stillbirth”)

Question 10

T/F: 80% of spont abortions occur in first trimester.

Answer 10

True

Question 11

Trend of (X) hormone in pregnancy can be predictive of spontaneous abortion due to its chaotic ranges in the first few weeks.

Answer 11

X = hCG (normally doubles each day in early pregnancy, but all over the place/falls off in pts with spont abortion)

Question 12

Recurrent abortion definition: (X) consecutive losses.

Answer 12

X = 2 in nulliparous woman; 3 in parous woman

Question 13

Most, (X)%, of ectopic pregnancies are located in (Y)

Answer 13

X = 94
Y = fallopian tubes

Question 14

Two main mechanisms of ectopic pregnancy:

Answer 14

1. Delayed/prevented passage of zygote into uterine cavity (tubal pathology)
2. Inherent embryo factors that cause early implantation (not karyotype)

Question 15

Pre-term birth rates have (increased/decreased) and are defined as under (X) weeks gestation.

Answer 15

Decreased (all-time high in ‘06);

X = 37

Question 16

Pt with pre-eclampsia at 36 weeks gestation. The physician decides to induce labor. Does this meet criteria for spont preterm birth?

Answer 16

No - SPB excludes “indicated” preterm birth

Question 17

All RFs for spontaneous preterm birth are likely related to:

Answer 17

Glucocorticoids (placental CRH drives process)

Question 18

History of which procedures put patient at risk for spont preterm birth?

Answer 18

Ones that dilate cervix:

1. 2nd trimester abortion
2. Cervical surg

Question 19

36 week gestation pregnant patient presents with sudden onset severe abdominal pain and contractions. The thought is (X) until proven otherwise

Answer 19

X = abruptio placenta (without visible bleeding)

Question 20

Placenta previa refers to situation in which:

Answer 20

Placenta attaches right over cervix

Question 21

T/F: Patient with placenta previa must have C-section.

Answer 21

True - otherwise placenta will come out first and baby can’t breathe during delivery

Question 22

Placenta accreta refers to situation in which:

Answer 22

Placenta attached abnormally (myometrial invasion)

Question 23

How is placenta accreta managed?

Answer 23

Take out baby, don’t even try to take out placenta; then hysterectomy

Question 24

(X) placental complication has high risk of maternal hemorrhaging and death post-partum.

Answer 24

X = placenta accreta

Question 25

Placenta increta:

Answer 25

Abnormal placenta attachment where placenta invades more than 50% of myometrium

Question 26

Placenta percreta:

Answer 26

Abnormal placenta attachment where placenta invades past uterine wall (ex: into bladder)

Question 27

T/F: Switching from cigarette smoke to vaping will decrease risk of spont pre-term birth.

Answer 27

False - nicotine is the issue

Question 28

Term labor timing is dependent on (X), unlike pre-term labor which is initiated by (Y).

Answer 28

``` X = placenta (fetus ready for birth) Y = mother (high cortisol) ```

Question 29

Tocolysis:

Answer 29

Inhibition of uterine contractions

Question 30

Tocodnamometer:

Answer 30

Instrument for measuring uterine contractions

Question 31

List some agents used for tocolysis.

Answer 31

1. CCB, Mg sulfate 2. Beta agonists (interrupt myosin phosphorylation) 3. COX inhibitors (decrease PGEs) 4. Oxytocin antagonists

Question 32

Fetal growth restriction is pathologic when which criteria are met?

Answer 32

Under 10th percentile for gestational age PLUS 1. Decreased amniotic fluid OR 2. Falling off growth curve OR 3. Abnormal intrauterine blood flow

Question 33

Maternal diabetes puts baby at risk of (hyper/hypo)-glycemia at birth.

Answer 33

Hypoglycemia (due to fetal hyperinsulinemia)

Question 34

Notably high risk of twin-twin transfusion syndrome in (mono/di)-amniotic, (mono/di)-chorionic pregnancies. Why?

Answer 34

Di-mono (a-v malformations in shared placenta; one baby has much higher V of amniotic fluid than another; both die)

Question 35

Infectious cause of fetal growth restrction

Answer 35

TORCHES (esp think of CMV, rubella, varicella, HIV)

Question 36

Pre-eclampsia cured by:

Answer 36

Delivery of baby

Question 37

Definition/diagnosis of pre-eclampsia:

Answer 37

1. HT | 2. Proteinuria

Question 38

Which clinical/lab findings (aside from HT, proteinuria) may point toward pre-eclampsia diagnosis?

Answer 38

1. Edema (ascites, pulm) 2. HELLP (hemolysis, elevated liver enzymes, low platelets) 3. Abdominal pain 4. Oliguria/anuria

Question 39

Sx of pre-eclampsia patient that suggests incoming seizure

Answer 39

HA, vision changes

Question 40

T/F: Mulitparity is a RF for pre-eclampsia.

Answer 40

False - nulliparity is (never exposed to pregnancy/paternal Ag before)

Question 41

T/F: Insulin resistance is RF for pre-eclampsia

Answer 41

True

Question 42

RFs for pre-eclampsia are similar in their ability to:

Answer 42

Impact activation state of endothelium (ex: vascular disease, thrombophilias)

Question 43

Placental ischemia: decrease in which molecules/factors?

Answer 43

1. Prostacyclin | 2. NO

Question 44

Placental ischemia: increase in which molecules/factors?

Answer 44

1. Thromboxane 2. TNF-alpha 3. IL1

Question 45

Pre-eclampsia workup: after labs, (X) should be done.

Answer 45

X = ultrasound (fetal weight and amniotic fluid)

Question 46

Pre-eclampsia workup: what are the indications to induce delivery?

Answer 46

1. Term pregnancy | 2. Severe disease

Question 47

Pre-eclampsia: Rx for seizure prophylaxis

Answer 47

Mg Sulfate

Question 48

Women with pre-eclampsia have later-life risk of which disease?

Answer 48

CV (equivalent to 2pack/d smoker!) - so monitor yearly BP, lipids, blood glucose