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NICU Board Review Cards > MFM > Flashcards

MFM Flashcards

1
Q

What are the teratogen findings for coumadin (warfarin)

A

nasal hypoplasia
skeletal abnormalities
stippled calcification of multiple epiphyses.

  • due to inhibition of the formation of gamma-carboxyl residues from glutamyl residues, reducing protein binding with calcium.
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2
Q

What are the finding of fetal phenytoin syndrome

A

growth deficiency
intellectual disability
epicanthal folds
hypertelorism
a short nose with anteverted nostrils

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3
Q

what test should be done to pregnant women in 3rd trimester exposed to hepatitis A

A

Anti-HAV IgM

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4
Q

what are gestational complications of Hepatitis A in 2nd and 3rd TM

A

Premature contractions
Placental separation
PROM

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5
Q

what should be given to mom-baby dyad with exposure to hepatitis A close to delivery?

A

hepatitis A immunoglobulin to mother and the neonate within 48 hours of delivery
- due to concern for nosocomial outbreak

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6
Q

What is the teratogen finding in thalidomide?

A

Phocomelia- usually 1 limb commonly left sided upper extremity (hand directly attached to the trunk)

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7
Q

Vials of Rhogam for feto-maternal hemorrhage

A

Number of vials of anti-RhD IgG

=(volume of fetal blood [mL])/(30 mL)

  • fetal blood based on KB
    • Percentage of fetal cells x 50
  • Average blood volume = Patient weight (kg) * (Average blood volume in mL/kg)
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8
Q

Pregnancy management based on BPP

A

BPP

  • 8 or 10: continued routine surveillance and expectant obstetrical management of the pregnancy.
  • 6:
    • At term gestation, prompt delivery.
    • Preterm, a BPP of 6 or less supports repeat testing in 6 to 24 hours
  • 4 or less: delivery of the fetus.
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9
Q

When to administer Rhogam

A
  1. 28 weeks
  2. Within 72 hours of birth, if infant is Rh D positive and patient is not sensitized
  3. All invasive diagnostic procedures such as CVS and amniocentesis if fetus may be Rh D positive
  4. Any concern for fetal-maternal hemorrhage (consider check KB)
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10
Q

What passes by simple diffusion

A

O2, CO2, H2O, Na, Cl, lipids, fat sol vit, most med

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11
Q

What passes placenta by facilitated diffusion

A

Glucose

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12
Q

What passes placenta by active transport

A

-against a gradient

AA, Ca, phos, Mg, Fe, Io, water sol vit

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13
Q

what passes placenta by bulk flow

A

hydrostatic/ osmotic gradient

H2O dissolved electrolyte

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14
Q

What passes placenta by pinocytosis

A
  • IgG
    • start 2nd TM, most 3rd TM
  • engulfed, packed or transferred across the cell
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15
Q

Compounds that cross placenta

A
  • bilirubin
  • ASA, coumadin
  • Dilantin, valproate
  • Alcohol
  • T3, T4 small amt
  • TRH, Io
  • Maternal IgG
  • Maternal steroids:L beta and dexamethasone
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16
Q

Ca that has placental metz

A

melanoma, leukemia, lymphoma, Breast Ca,Lung Ca, sarcoma

  • rarely fetal metz
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17
Q

where does choriocarcinoma metz to

A

lungs

vagina

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18
Q

What are the short-term complications of growth-restricted fetuses occur soon after birth.

A
  • respiratory distress
  • meconium aspiration syndrome
  • hypoglycemia
  • polycythemia, hyperviscosity
  • non-physiological hyperbilirubinemia
  • sepsis
  • hypocalcemia
  • poor thermoregulation
  • immunological incompetence.
19
Q

Associated with absent fetal nasal bone

A

trisomy 21

20
Q

Condition associated with cystic hygroma

A

50% fetal aneuploidy (T21, T18, turners)

Euploid- structural heart disease, skeletal dysplasia

  • need fetal echo and offer CVS
21
Q

Interpretation quad screen

A
22
Q

Cell source for fetal cell free DNA

A
  • from apoptosis of placental syncytiotrophoblasts
  • still screening test
  • collected anytime after 9 weeks
23
Q

gold standard for fetal karyotype

A

amniocentesis or CVS

24
Q

Indication for cell free DNA (4)

A
  • inc aneuploidy risk
  • Rh-D neg mom with RhD heterozygote partner
  • Sex identification of X linked genetic d/o
  • risk for CAH (nonclassic CAH- one of the most common autosomal recessive disorders)
25
Q

Measurement findings in IUGR

A
  1. Dec AC
  2. low ponderal index (dec fetal weight but preserved length)
  3. dec femur length
  4. dec AFV (dec UO fr hypoxemia or dec renal bld flow)
  5. dec diastolic flow (inc S/D ratio)
26
Q

Incidence of outcome of GDM is related to the following factors: (3)

A
  1. onset of glucose intolerance
  2. duration of glucose intolerance
  3. severity of maternal diabetes
27
Q

The most common CHD associated in IDM

A
  1. atrioventicular septal defect
  2. double outlet RV
  3. truncus arteriosus
28
Q

What is main teratogenic factor in maternal DM

A

Hyperglycemia

  • from formation of reactive oxygen species
29
Q

Risk factors for LGA and macrosomia

A
  1. maternal obesity
  2. poor glycemic control
  3. excessive gestational weight gain (>40 lbs)
30
Q

Pathology of maternal DM and LGA/macrosomia

A

fetal hyperinsulinemia from maternal hyperglycemia

⇓

growth of insulin sensitive tissue

(adipose tissue)

normal head, adipose in intrascapular ands shoulder area

31
Q

complications of shoulder dystocia

A
  • brachial plexus injury
  • facial never injury
  • cephalhematoma
32
Q

Findings of caudal regression syndrome

A
  • flattening of buttocks
  • loss of gluteal cleft
  • widely spaced buttock dimples
  • palpable sacral defect or groove

Important: if with findings additional imaging abdominal and spinal MRI

33
Q

Long term complication of maternal DM

A
  • higher rate of obesity/greater BMI
  • higher BP
  • Overall declining trend in pancreatic beta cell func
  • AbN glucose tolerance
34
Q

what are the finding of fetal valporoate syndrome

A
  • limb abnormalities
  • lip/cleft palate
  • urinary tract defects

Valproate also:

  • cardiac anomalies
  • neural tube defects, dominantly spina bifida,
  • developmental delay
35
Q

Diagnostic criteria of fetal alcohol syndrome

A
  1. Cardinal features: smooth philtrum, thin vermillion border, small palpebral fissures
  2. Growth deficit- weight, length, HC
  3. CNS AbN- small head, unprovoked seizures, MRI AbN

Confirmed Hx of prental alcohol exposure

36
Q

It is a placental abnormality due to failure of fetal extravillous trophoblast to adequately invade the uterus and remodel the spiral arteries

A

maternal vascular malperfusion

Associated with pre-eclampsia, pregestational diabetes, chronic maternal renal disease, low early-pregnancy–associated concentration of plasma protein A, oligohydramnios, decreased biophysical scores, and decreased fetal growth.

37
Q

Placental abnormality that presents with compromised umbilical cord blood flow

A

fetal vascular malperfusion (FVM)

Associated with: decreased fetal movement, category 3 fetal heart rate tracings, and prolonged fetal meconium exposure

38
Q

Placental abnormality with maternal and fetal neutrophils congregate in the chorion and amnion in response to chemotactic signals

A

acute chorioamnionitis (ACA)

In preterm: strongly associated with invasive bacterial infection after PPROM or PTL
In term infants: debated whether associated with infection vs physiologic triggering of normal labor

39
Q

It is a placental abnormality with maternal T-cell–mediated immune response to antigens in the fetal villous stroma

A

villitis of unknown etiology (VUE)

Predisposing conditions: congenital viral infections, ovum donation, maternal autoimmune disease, and substance use

40
Q

What is the relationship of gestational, chronologic, postmenstrual, conceptional and corrected age

A
  1. Gestional age- age from LMP (for IVF add 2 weeks), stops when baby is born
  2. Chronologic age- age from birth
  3. Post menstrual- gestational plus chronologic
  4. Corrected age: chronologic age- EDC
41
Q

What are the benefits of antenatal steroids

Drug: Dexamethasone/Betamethasone

A
  1. Accelarate fetal lung- surfactant production
  2. Prevent infant lung disease- reduce RDS, improved surfactant production
  3. dec mortality
  4. dec IVH
  5. dec NEC

  • also role in CPAM, NAIT
42
Q

Side effect of antenatal steroids in late preterm infants

A

Neonatal hypoglycemia

43
Q

Most common cardiac defect associated with TTTS

A
  • Pulmonic stenosis
  • VSD
  • ASD

From most prevalent to least in mono-di twin with TTTS vs without
* attributed to vascular disruption and cardiovascular changes

44
Q

What component of breastmilk considered as bacteriostatic against numerous bacteria

A

Lactoferrin

Oligosaccharide- prebiotic component of breastmilk

NICU Board Review Cards (19 decks)

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