MFM

Question 1

Infant with weak cry, hypotonia, poor oral feeding

Answer 1

Transient neonatal myasthenia gravis (10-20% infants effected) -
The presence of disease does not depend on severity of maternal disease or level of titers
Due to transplacental transfer of maternal Ach receptor antibodies
Symptoms by 72 hours with mean duration 18 days
Recovery by 2 months (90%) or 4 months (10% babies)

Question 2

Neural tube, facial, cardiac defects, hypospadias, poor cognition

Answer 2

Valproic acid exposure in utero

Question 3

Depressed nasal bridge, nasal hypoplasia, stippled bone epiphyses, low BW, seizures, cognitive disability

Answer 3

Warfarin exposure in utero

- If exposure happens after 12 weeks, less of an impact

Question 4

Next step after elevated AFP

Answer 4

Fetal ultrasound

AFP least sensitive marker in quadruple screen

Question 5

Elevated AFP, normal ultrasound

Answer 5

If gestational age confirmed and no fetal abnormality associated with elev AFP, genetic counseling is recommended and amniocentesis may be considered for karyotype

Question 6

Side effects of intrapartum cocaine exposure

Answer 6

Stillbirth, placental abruption, skull abnormalities, cutis aplasia, porencephaly, ileal atresia, cardiac and urogenital anomalies

Question 7

Late decelerations caused by

Answer 7

Uteroplacental insufficiency

Question 8

Variable decelerations caused by

Answer 8

umbilical cord compression

Question 9

Early decelerations caused by

Answer 9

Fetal head compression

Question 10

What percent of population is single umbilical artery found in?
More common in which population?
Associated with:

Answer 10

1) <1%
2) Twins
3) Urogenital tract or cardiac anomalies

Question 11

Nadir of deceleration at same time as peak of contraction

Answer 11

Early deceleration

Question 12

Abrupt decrease in FHR with abrupt resolution

Answer 12

Variable deceleration

Question 13

Onset, nadir and recovery after beginning, peak and end of contraction

Answer 13

Late deceleration

Question 14

Pulmonary hypertension, renal insufficiency, ileal perforation, NEC

Answer 14

Indomethacin usage (prostaglandin synthase inhibitor) - used as tocolytic

Question 15

Congenital heart defects, fetal goiter, premature birth, neonatal hypotonia, arrhythmias, seizures, diabetes insipidus

Answer 15

Lithium administration

Question 16

Ebstein’s anomaly

Answer 16

Lithium exposure

Question 17

Decreased respiratory rate, decreased peristalsis, hypotension, hypotonia

Answer 17

Magnesium sulfate administration (decreases Ach release from NMJ and calcium antagonist)- tocolytic

Question 18

Fetal effects of pregestational vs gestational DM

Answer 18

Pre: miscarriage, stillbirth, birth defects (especially heart and ONTD) * Highest risk when poor glycemic control BEFORE conception
Any DM: growth disorders (usually macrosomia but can be IUGR d/t small vessel dx), cardiomyopathy, birth injury, neonatal metabolic abnormalities, RDS

Question 19

Is caesarean recommended for DM?

Answer 19

Only if >4500g EFW (twice risk of having shoulder dystocia as same weight without DM)

Question 20

Is DM at risk of premature labor?

Answer 20

Yes, d/t poly (–> inc uterine distention, contractions, ROM)
(Unsure mechanism but thought d/t polyuria from inc glucose)

Question 21

Short palpebral fissures, thin vermillion border, smooth philthrum

Answer 21

Fetal alcohol syndrome

Question 22

Fetus is _calcemic to mother

Answer 22

HYPER
Most Ca transfer in 3rd trimester: Facilitative diffusion from mom to placenta and then active ATP pump from placenta to fetus.

Question 23

Calcitonin in pregnancy

Answer 23

Inhibits fetal bone resorption

Resorption process by which osteoclasts break down bone to release calcium

Question 24

Estrogen and calcium

Answer 24

Increases fetal mineral accretion

Question 25

ANS reduces:

Answer 25

IVH, NEC, mortality and RDS | NOT shown to reduce PDA or CLD

Question 26

Choroid plexus cysts are found in _% of fetuses

Answer 26

0.5% Can be found as early as 11 weeks and usually disappear by 26 weeks Some ass. with T18 but usually clinically insignificant

Question 27

pH of PROM

Answer 27

>/= 6.5 (pH vaginal fluid 4-4.5 and pH amniotic fluid 7-7.5) False + with semen, blood, BV

Question 28

Diabetes medication allowed in pregnancy

Answer 28

Insulin | Metformin and Glyburide cross placenta

Question 29

When GDM test performed ?

Answer 29

24-28 weeks 1) 50g load --> >130--> take 3 hour; >200--> GDM dx 2) 3 hour test (100g load) --> tests at 1,2,3 hours (if 2 or more abnormal--> GDM)

Question 30

ITP vs gestational thrombocytopenia

Answer 30

ITP: maternal plts <70k; severe neonatal thrombocytopenia <10% babies GT: maternal plts >70k; benign and no neonatal thrombocytopenia

Question 31

Which risk of 1st trimester abortion? Measles vs Mumps?

Answer 31

Mumps

Question 32

What is the dominant thyroid hormone during fetal life?

Answer 32

rT3 (reverse T3) | Fetus converts free T4 to rT3 by deiodinase (D3)- enzyme present in placental and fetal tissues

Question 33

Symptoms in donor twin (TTTS):

Answer 33

anemia, hypovolemia, oligo, decreased UOP, decreased growth

Question 34

Symptoms in recipient twin (TTTS):

Answer 34

polycythemia, hypervolemia, polyhydramnios, cardiac hypertrophy, hydrops

Question 35

Maternal adaptations to pregnancy: RBF _creases, GFR _creases, tidal volume _creases, residual lung volume_creases, minute ventilation _creases, blood pressure _creases, pulse pressure _creases, pituitary gland size _creases, plasma volume _creases, RBC mass _creases

Answer 35

RBF increases, GFR increases, tidal volume increases, residual lung volume decreases, minute ventilation increases, blood pressure decreases, pulse pressure increases (diastolic decreases more than systolic), pituitary gland size increases, plasma volume increases, RBC mass increases (but PV increases more so dilution anemia)

Question 36

MCC fetal mortality associated with MVA

Answer 36

maternal shock - must ensure maternal hemodynamic stability!!

Question 37

Most common reason for non obstetric surgical intervention in pregnancy

Answer 37

Appendicitis

Question 38

Which has better safety profile? regional or general anesthesia?

Answer 38

Regional; General has 17 fold higher complication rate

Question 39

What do inhalation agents for general anesthesia do to uterine tone?

Answer 39

Decrease it thus inhibiting labor during the operative procedure

Question 40

Do anesthetics and muscle relaxants cross the placenta?

Answer 40

Anesthetics do and muscle relaxants do NOT

Question 41

IUGR, fingernail hypoplasia, craniofacial defects, NTD

Answer 41

Carbamazepine | sim to phenytoin but no CHD

Question 42

Cleft lip/palate, nail hypoplasia, IUGR, CHD

Answer 42

Phenytoin | sim to carbamazepine but no NTD