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Neo Board Review MAP > MFM > Flashcards

MFM Flashcards

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1
Q

Ace inhibitors

A

Renal dysplasia

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2
Q

Amniocentesis

A

Greater than 15 weeks gestation
Fetal loss <1/500
Tests amniotic fluid skin cells

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3
Q

Amniotic band syndrome

A

Constriction or amputation of digits/limbs

31% associated with club foot deformity (20% bilateral)

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4
Q

Antenatal steroids decrease risk of ___

A

RDS
NEC
IVH
Neonatal death

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5
Q

Biophysical profile (BPP)

A

In a 30 minute window

  • breathing for >30 seconds
  • > 3 movements of torso/limbs
  • > 1 flex and extend
  • > 2 cm fluid pocket
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6
Q

Blood volume in pregnancy increases by?

A

45%

Max volume at 32 weeks

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7
Q

Placental carbon dioxide transport

A

Very lipid soluble, rapidly transported

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8
Q

Category I FHR

A

Baseline 110 to 160
Moderate variability
No late or variable decels

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9
Q

Category II FHR

A

Everything not category I or III

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10
Q

Category III FHR

A

Absent variability and either:
Recurrent late or variable decels
Bradycardia

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11
Q

Causes of hydrops fetalis

A

Anemia (parvovirus, FMH, TTTS)
Cardiac failure (elevated RA pressure)
Decreased osmotic pressure (syphilis, CMV)
Impaired lymphatic drainage (cystic hygroma, chromosomal anomalies)

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12
Q

Cell free DNA

A

After 10 weeks
Detects fetal DNA in maternal serum
Very accurate for T21, T18, T13

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13
Q

Chorionic villus sampling

A

11 to 13 weeks gestation

Fetal loss 1/200-300

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14
Q

Circumvallate placenta

A

Membranes are on opposite side of placenta

Painless bleeding in 1/2 cases

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15
Q

Risk of death or neurologic injury with twin demise

A

20% (MC) vs 1% (DC)

More likely if triplets vs twins
Immediate delivery will not help, the cause is hypotension


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16
Q

DES

A

Vaginal adenocarcinoma and adenosis

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17
Q

Diffusion calculation

A

Rate of diffusion = Permeability x Surface area x Concentration difference (Cm-Cf)

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18
Q

Estimated fetal weight

A

Within 15% of actual weight 95% of the time

Less accurate at higher gestational ages

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19
Q

HCG

A

TSH like effects (alpha subunit the same)

Causes nausea and vomiting in pregnancy

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20
Q

Human chorionic somatomammotropin (HCS)

A

Previously known as human placental lactogen (HPL)
Anti-insulin affects (GDM)
Stimulates fetal somatic growth

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21
Q

Hemochorial placenta

A

Humans
Maternal blood in direct contact with trophoblastic tissue
More permeable to lipid soluble molecules

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22
Q

Hemodynamic changes in pregnancy

A

Cardiac output increases by 43% (HR and SV)
SVR decreases by 21%
Colloid pressure decreases by 14%

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23
Q

Causes of high maternal AFP

A 
Open NTD
Twins
Fetal maternal hemorrhage
Abdominal wall defects
Lowe Syndrome
Congenital nephrotic syndrome
Fetal death
If unexplained, increased risk of growth restriction or death of fetus
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24
Q

IGG transfer

A

Via endocytosis

Uses a vesicle to protect from proteolysis

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25
IGM transfer
No passage across placenta
26
Intervillous space
Confined space | Increased blood goes across villi to fetus
27
Late decelerations
Occur after every contraction | Caused by utero placental insufficiency
28
Latency antibiotics
Broad-spectrum abx x 7-10 days | Reduces risk of RDS, NEC, neonatal/maternal infxn
29
Lipid insoluble molecules
Unless a transporter present - cross through paratrophoblastic routes Size dependent, small pathways, low permeability
30
Lipid soluble molecules
Diffuse across entire trophoblast surface Permeability is large Dependent on concentration gradient
31
Lithium
Ebstein’s anomaly
32
What causes maternal serum estrogen to be low?
Placental sulfatase deficiency Anencephaly CAH Molar pregnancy
33
Maternal oxygen administration
Increases O2 carrying capacity in the mother | Leads to a larger increase in fetal oxygen content
34
Maternal thyroid in pregnancy
TBG increased Total T4 increased Early pregnancy HCG mimics TSH, so TSH levels are low and free T4 levels are high
35
MCA Doppler
Best non-invasive test to assess for fetal anemia
36
Methotrexate
FGR | Developmental delay
37
Non-stress test (NST)
Reactive = 2 or more accelerations in a 20 minute window HR increase by 15 BPM for at least 15 seconds MCC of non-reactive NST is fetal sleep
38
NSAIDs in pregnancy
Oligohydramnios | Narrowing or closure of PA in utero (PPHN after delivery)
39
Oligohydramnios
Single verticle pocket (SVP) <2 cm AFI <5 cm SVP is better predictor
40
Placental oxygen transport
Determined by oxyhemoglobin disassociation curve Fetal temp higher, more acidotic, fetal Hgb
41
Phenytoin
FGR Microcephaly Midface hypoplasia Hypertelorism
42
Placenta Accreta
Leads to massive maternal hemorrhage - Accreta invades the endometrium - Increta invades the myometrium - Percreta goes through the myometrium, can involve the bladder
43
Amino acid transport
Active transport, requires energy | Fetal concentration greater than maternal
44
Carbohydrate transport
Facilitated diffusion, no energy required Requires GLUT receptors Follows a concentration gradient Placenta consumes glucose to maintain gradient
45
Placenta previa
Placenta covering the cervical os Leads to maternal hemorrhage and preterm labor Three types: marginal, complete, low lying
46
Placental abruption
Placenta breaks away from endometrium Most of blood loss is maternal blood (intervillous space) Clinical diagnosis - painful bleeding
47
Calcium transport in pregnancy
Facilitated diffusion from mother to placenta Protein binding in placenta to maintain concentration gradient Active transport from placenta to fetus
48
Potassium transport in pregnancy
Tightly regulated through K pumps | Fetal levels greater than maternal levels
49
Lipid transport in pregnancy
Dependent on trans placental concentration gradient
50
Sodium transport in pregnancy
Simple diffusion across a concentration gradient | Similar levels in mother and fetus
51
Vitamin transport In pregnancy
Fat soluble: simple diffusion, deficiencies rare, toxicity possible Water soluble: active transport Iron: active transport using transferrin
52
Polyhydramnios
SVP >8 cm AFI > 25 cm AFI better predictor
53
RBCs in pregnancy
``` 20-30% increase Dilutional anemia (blood volume increases by 45%) ```
54
Respiratory changes in pregnancy
Tidal volume increases by 35% Minute ventilation increases by 40% FRC decreases by 20% (uterus pushes up diaphragm)
55
SSRIs during pregnancy
Neonatal adaptation syndrome | Pulmonary hypertension
56
Succenturate lobe
Accessory lobe of the placenta Blood vessels exposed and may rupture during labor Set up for vasa previa
57
Timing of twin separation
Di-di: days 1-3 Mono-di: days 4-7 Mono-mono: days 8-12 Conjoined: days 13-15
58
Transtrophoblastic channels
``` Very small (20 nm) Carry water soluble molecules Channels can dilate and close (mechanism for water balance) ```
59
EBM treatments for preterm birth
Antenatal corticosteroids Transfer to tertiary center before delivery Administration of antibiotics for GBS Magnesium for neuroprotection
60
Twin twin transfusion syndrome (TTTS)
Both twins can develop hydrops Recipient twin: increased blood volume, potential for heart failure, polycythemia, polyhydramnios Donor twin: poor growth, oligohydramnios, anemia
61
Umbilical artery Doppler
Helps manage fetal growth restriction | Absent or reversed diastolic flow means high risk of morbidity and mortality
62
Valproic acid
NTD | Developmental delay
63
Variable decelerations
Variable relationship to contractions | Caused by umbilical cord compression
64
Vasa previa
Fetal vessels exposed in front of cervix | At risk for tearing during the labor process, leading to fetal exsanguination
65
Velamentous insertion
Vessels are freely on the placental surface Increased risk for: - growth restriction - preterm birth - fetal bleeding during labor (fetal mortality rate is 75%)
66
Warfarin
Midface hypoplasia FGR Microcephaly
67
What kind of blood flow does human placenta have?
Concurrent flow between maternal and fetal blood
68
Do not cross the placenta
``` TSH Biliverdin Heparin Insulin Glucagon Growth hormone IgM Complement ```
69
Quad screen T21
Low AFP Low E3 High HCG High inhibin
70
What is a category 1 FHR predict?
Normal fetal acid base balance
71
Carbamazepine during pregnancy
Growth restriction Finger nail hypoplasia Craniofacial defects Neural tube defects
72
What crosses the placenta via simple diffusion?
Respiratory gases Lipids Fat-soluble vitamins Sodium
73
What crosses the placenta via facilitated diffusion?
Glucose | Some glucocorticoids
74
What crosses the placenta via channels?
Water | Some ions
75
What crosses the placenta via active transport?
Amino acids Proteins Potassium
76
What crosses the placenta via receptor mediated endocytosis?
Immunoglobulin G LDLs Iron
77
What creatinine level is a relative contraindication to pregnancy?
>2.5
78
What is associated with amnion nodosum?
Anything associated with oligohydramnios

Neo Board Review MAP (18 decks)

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