MFM

Question 1

First pregnancy hormone to increase

Answer 1

HCG, increases shortly after fertilization.. levels off in 2nd trimester.
Stimulates estrogen and progesterone production until placenta is formed

Question 2

Role of progesterone in pregnancy

Answer 2

Maintains uterine quiescence, vasodilation

Question 3

Which hormone is main driver of fetal growth during pregnancy?

Answer 3

Human placental lactogen

Question 4

Gestational HTN BP levels?

Answer 4

SBP >140, DBP >90

Question 5

Most common cause of neonatal hyperthyroid?

Answer 5

Maternal Graves

Question 6

Most characteristic cardiac manifestation of neonatal lupus?

Answer 6

AV heart block

Question 7

When do cardiac manifestations of maternal lupus occur in the fetus?

Answer 7

18-25 weeks gestation

Advanced forms present as fetal bradycardia

Question 8

Which antibodies are responsible for the neonatal cardiac manifestations in maternal SLE?

Answer 8

Anti- Ro and Anti La

Question 9

Location of mets for choriocarcinoma?

Answer 9

Lungs and vagina

Question 10

What substances are transferred across the placenta be facilitated diffusion?

Answer 10

Glucose. Transported along the concentration gradient

Question 11

What substances are transferred across the placenta by active transport?

Answer 11

Calcium, mag, phos, amino acids, water soluble vitamins. Transported against the concentration gradient

Question 12

What is single umbilical artery associated with?

Answer 12

Urogenital tract, GI tract or cardiac anomalies

Question 13

Source of blood loss in vasa previa?

Answer 13

Fetal

Question 14

What is associated with the greatest risk for fetal heart block in maternal lupus?

Answer 14

Presence of anti-Ro and anti-La antibodies

Question 15

What are the antibodies against in maternal myasthenia gravis?

Answer 15

IgG antibodies against acetylcholine receptors (neuromuscular junction)

Question 16

Risk of congenital anomalies in maternal diabetes is dependent on?

Answer 16

Degree of uncontrolled diabetes and elevated glycosylated hemoglobin levels.
Greater risk if there is suboptimal glucose control prior to conception

Question 17

Where is AFP formed and when does it peak in amniotic fluid and maternal serum?

Answer 17

AFP formed initially in the yolk sac, then fetal liver and GI tract
Peak in fetal serum at 13 weeks, amniotic fluid soon after
Peaks in maternal serum around 32 weeks

Question 18

What is tested in first trimester screening?

Answer 18

PAPP-A and B-hCG

PAPP-A is not as elevated in T21 or T18

Question 19

When is nuchal translucency tested?

Answer 19

1st trimester, between 10-14 weeks

Question 20

What is absent nasal bone associated with?

Answer 20

Trisomy 21

Question 21

Most sensitive thing tested for T21?

Answer 21

Beta hCG

Question 22

Components of quad screen?

Answer 22

AFP
unconjugated estriol
inhibin A
Beta hCG

Question 23

Where is unconjugated estriol produced?

Answer 23

Produced by placenta, uses precursors from fetal adrenal and liver

Question 24

Where is inhibin A produced?

Answer 24

Placenta and ovaries

Question 25

Gold standard test for fetal karyotype?

Answer 25

CVS or amnio

Question 26

When can cffDNA be tested?

Answer 26

After 9 weeks

Question 27

Causes of low amounts of cffDNA

Answer 27

Early GA Suboptimal collection Maternal obesity Abnormal fetal karyotype

Question 28

Embryologic pathogenesis causing duodenal vs ileal/jejunal atresia

Answer 28

Duodenal atresia is due to failure of recanalization of solid cord Ileal/jejunal atresia is due to an ischemic injury, vascular accident

Question 29

What syndromes is an omphalocele associated with?

Answer 29

Beckwith Wiedemann T13 T18 Cloacal exstrophy

Question 30

When does the greatest % increase of fetal growth occur?

Answer 30

1st trimester

Question 31

Complications of fetal demise in monochorionic twins w/ vascular anastamoses

Answer 31

1. Risk of DIC in surviving twin 2. Risk of anemia in surviving twin (demised twin can have vasodilation) 3. Risk of cerebral injury in surviving twin

Question 32

What kind of twins does TOPS occur in?

Answer 32

Monochorionic, diamniotic. | Does not occur in mo/mo because they share amniotic sacs

Question 33

What is tested in a non-stress test

Answer 33

FHR and reactivity (accelerations and beat-beat variability) in response to fetal movement

Question 34

What is a reactive positive non stress test?

Answer 34

>=2 accelerations within 20 minutes, associated with fetal movements Increase in 15bpm, lasting >= 15 seconds

Question 35

What must be ruled out in a nonreactive non stress test?

Answer 35

Fetal sleep or effects from maternal sedatives

Question 36

What is a positive contraction stress test?

Answer 36

Late decels with 50% of contractions Needs prompt intervention. Deliver if term. If preterm, and there is FHR reactivity then give steroids, monitor and frequently test

Question 37

Categories of BPP

Answer 37

``` NST Fetal body movement Breathing Fetal tone Amniotic fluid volume ```

Question 38

Cause of early decels?

Answer 38

Head compression. This leads to changes in cerebral blood flow, vagal decels in HR

Question 39

Cause of variable decels?

Answer 39

Umbilical cord compression -> baro or chemo receptor response Most common pattern during labor. The decrease in FHR is much lower than that in early decels. Waveform resembles U, V or W

Question 40

Cause of late decels?

Answer 40

Uteroplacental insufficiency -> chemoreceptor response | Lags 10-30 seconds after the contraction

Question 41

Cause of absent or reverse UA end diastolic velocity

Answer 41

Increased placental vascular resistance | Increased risk of perinatal mortality

Question 42

When do neonatal myasthenia gravis symptoms resolve by?

Answer 42

2 months 10-20% of infants will have symptoms, usually present around 72 hours of age Symptoms are not dependent on severity of maternal disease or level of maternal titers

Question 43

Neonatal findings with in utero warfarin exposure?

Answer 43

``` Depressed nasal bridge Nail hypoplasia Stippled bone epiphysis LBW Seizures cognitive impairment ```

Question 44

When does pre-eclampsia develop?

Answer 44

After 20 weeks, HTN and proteinuria Severe pre-E also has headaches/oliguria/pulmonary edema/vision changes Seizures happen in eclampsia

Question 45

Most common complication of pregnancy?

Answer 45

Pre-eclampsia

Question 46

TTTS occurs most commonly in which type of twin?

Answer 46

Monochorionic, diamniotic Division between days 3-8 Increased risk of growth discordance

Question 47

What is the pH of amniotic fluid?

Answer 47

7-7.5 | In cases of ROM, test pH of vaginal fluid: should be >6,5

Question 48

Which drug is safe to use during pregnancy for diabetes?

Answer 48

Insulin Metformin crosses the placenta

Question 49

Most common type of monozygotic twin?

Answer 49

Monochorionic, diamniotic

Question 50

In which type of monozygotic twin is there an increased risk of cord entanglement?

Answer 50

Mono/mono Division happens between days 8-13 Increase risk of acardia

Question 51

Most accurate method of determining fetal gestational age?

Answer 51

Crown rump length between 7-10 weeks (accurate to 3 days)

Question 52

At what gestational age is an amnio recommended?

Answer 52

After 14 weeks

Question 53

Fetal weight is estimated from which 4 measurements?

Answer 53

Abdominal circumference, femur length, BPD, head circumference

Question 54

Measurement used for asymmetric growth restriction?

Answer 54

Low ponderal index

Question 55

One of the best prognostic factors in growth restriction of twins?

Answer 55

Presence of positive diastolic flow in the umbilical artery of the smaller twin

Question 56

Sheehan syndrome

Answer 56

Pituitary ischemia and necrosis as a result of obstetrical blood loss Hypotension, tachycardia, hypoglycemia and failure of lactation

Question 57

Most common presenting symptom of massive fetomaternal hemorrhage

Answer 57

Maternal complaint of decreased or absent fetal movements