Fetal Pathology

Question 1

The fetal period begins following the completion of the ___ week of development

Answer 1

eighth

Question 2

The perinatal period generally refers to the period around birth and variably regarded as:

Answer 2

3-5 months before birth, starting as early as 20 weeks gestation to as late as 28 weeks gestation. The perinatal period includes the first week following birth and thus overlaps with the neonatal period of the first four weeks of life.

Question 3

T/F Approximately 50% of cases of early pregnancy loss (≤ 20 weeks gestation ) are due to genetic defects with the most common being monosomy X, triploidy and trisomy 16

Answer 3

T

Question 4

most frequent aneuploid condition

Answer 4

trisomy 21

Question 5

most common chromosomal aberration in early pregnancy loss

Answer 5

turners 45x

Question 6

features of turners

Answer 6

small stature and gonadal dysgenesis resulting in adolescent presentation due to delayed menarche

Question 7

prenatal detection of 45x

Answer 7

cystic hygroma +/- hydrops (also, horseshoe kidney, bicuspid aortic valve and coarctation of the aorta)

Question 8

TORCH infections

Answer 8

toxoplasmosis, other (syphilis, parvo), rubella, cmv, herpes

Question 9

rubella fetal triad

Answer 9

cataracts, hearing loss and heart murmur

Question 10

highest risk to fetus from rubella occurs during weeks:

Answer 10

3-11 of gestation

Question 11

CMV fetal triad

Answer 11

chorioretinitis, cerebral calcfications and microcephaly

Question 12

TORCH infections are transmitted via ______ from the mother to the fetus

Answer 12

hematogenously (or transplacentally)

Question 13

echogenic bowel

Answer 13

Congenital CMV –> area of gross bowel wall thinning and dilatation with thick intraluminal material

Question 14

T/F Preterm infants have higher morbidity and mortality than full term infants.

Answer 14

T

Question 15

risk factors for preterm birth

Answer 15

preterm premature rupture of placental membranes (PPROM), intrauterine infection, uterine, cervical, placental structural abnormalities, and mulptile gestation

Question 16

Preterm delivery is classified as occurring at less than ___completed weeks of gestation

Answer 16

37

Question 17

T/F Preterm infants that are SGA have higher mortality than age-matched infants of appropriate weight

Answer 17

T –> also, full-term infants may not suffer from complications of functional immaturity but can have increased morbidity due to growth restriction.

Question 18

______ is the most common cause of early onset sepsis (within the first 7 days of life) and bacterial meningitis

Answer 18

Group B streptococcus

Question 19

Complications of prematurity

Answer 19

hyaline membrane disease/chronic neonatal lung disease, necrotizing enterocolitis, intraventricular hemorrhage, sepsis, developmental delay

Question 20

Most common cause of respiratory distress in

newborns

Answer 20

Hyaline Membrane Disease –> chest radiograph shows granular densities described as a “ground glass” appearance –> increased difficulty breathing beginning 30 minutes after birth progressing to cyanosis within hours

Question 21

Infants born prematurely have decreased

surface area and a functional deficit of ____ in alveolar space.

Answer 21

surfactant, a lipoprotein secreted by type II pneumocytes (alveolar epithelial cells) that reduces surface tension within the alveoli. This structural and functional immaturity results in respiratory distress.

Question 22

stages of alveolar development

Answer 22

pseudoglandular (6-16 weeks gestation), canalicular 16-28 weeks), saccular (28-36 weeks) and alveolar

Question 23

T/F Administration of exogenous surfactant has decreased the incidence of hyaline membrane disease.

Answer 23

T

Question 24

Pathophysiology of hyaline membrane disease/respiratory distress sydnrome

Answer 24

decreased alveolar surfactant –> increased alveolar surface tension –> hypoxemia and CO2 retention –> acidosis –> endothelial damage + vasoconstriction –> plasma leak into alveoli + necrosis –> increased diffusion gradient –> more hypoxemia and reduced surfactant production

Question 25

Necrotizing enterocolitis

Answer 25

intestinal immaturity, immune immaturity, ischemia/hypoxia, genetic, feeding practices –> feeding intolerance, distension, bloody stool

Question 26

T/F decreasing birthweight is associated with necrotizing enterocolitis

Answer 26

T

Question 27

Long-term complications of necrotizing enterocolitis (NEC)

Answer 27

neurodevelopmental delay, growth delay, chronic GI disease (strictures, short gut syndrome, abdominal adhesions)

Question 28

____ is a transient structure comprised of glial and neuronal cells with a dense venous network.

Answer 28

germinal matrix –> bleeding occurs in germinal matrix and spills into lateral ventricles –> hemorrhage typically occurs within hours of birth but can be delayed

Question 29

One known obstetric risk factor for germinal matrix/intraventricular hemorrhage

Answer 29

vaginal breech delivery

Question 30

T/F the older you are at birth, the lower the risk of germinal matrix hemorrhage

Answer 30

T –> germinal matrix disappears between 16-34 weeks so less of it is around at birth –> lower risk

Question 31

T/F Benign pediatric tumors are more common than malignant ones.

Answer 31

T