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Nicu Brodsky+Pediatrix+NeoReview Questions > MFM > Flashcards

MFM Flashcards

(85 cards)

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1
Q

Side effects of indomethacin?

A

pulmonary hypertension, renal insufficiency, ileal perforation, or NEC

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2
Q

Does transient neonatal MG correlate with severity of maternal dz or level of mom’s titers?

A

no!

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3
Q

Is NAS severity withdrawal related to amount of opiate exposure?

A

no!

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4
Q

What additional drug can be used to treat NAS especially if additional cNS sx or if mom had poly-substance use

A

phenobarbital

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5
Q

symptoms of fetal alcohol syndrome

A

SHORT palpebral fissures, thin vermilion border, smooth philtrum. Can also cause cardiac (VSD, TOF+PS), CNS abnormalities

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6
Q

Incidence of choroid plexus cysts?

A

<1% of infants

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7
Q

What medications for GDM cannot be used in pregnancy bc they cross placenta?

A

metformin and glyburide

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8
Q

Maternal ITP, mom’s platelets are _____, most neonates are affected/unaffected. In Gestational thrombocytopenia, maternal Plt are _____ and most neonates are unaffected/affected

A

Maternal ITP: mom’s platelets < 70k, most neonates unaffected
Gestational: mom’s platelets > 70k, most neonates unaffected

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9
Q

Pregnant women with mumps or measles are at higher risk of spontaneous abortion?

A

mumps

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10
Q

What is the dominant thyroid hormone in fetal life?

A

RT3

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11
Q

In PKU, what improves fetal outcomes?

A

Low maternal phenylalanine concentrations BEFORE conception

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12
Q

2 vessel cord associations

A

cardiac and renal anomalies, IUGR, preterm birth. NO fetal demise

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13
Q

Quad screen for T21

A

Low / high / low / high
AFP / beta HCG, uE3, inhibit A

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14
Q

What is category III tracing?

A

absent FHR variability AND recurrent lates, recurrent variables, bradycardia, sinusoidal

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15
Q

Fetal alcohol syndrome leads to (growth and development wise)

A

persistent microcephaly, prenatal/postnatal growth restriction, MR

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16
Q

What is the most accurate measurement to predict fetal GA

A

fetal crown rump length measured b/w 7-10 weeks gestation

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17
Q

Amniocentesis performed early has increased risk of ______

A

talipes equinovarus (club foot)

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18
Q

Fetal weight is estimated from ______

A

abdominal girth, biparietal diameter, head circumference, femur length

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19
Q

Placentas of fetuses that exhibit abnormal doppler flow velocity ______

A

slender capillaries with decreased capillary loops in gas-exchanging terminal villi

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20
Q

What are components of biophysical profile?

A

5 categories, score of 2 or 0
NST: 2 accels within 20 mins associated with fetal movements
Fetal body movement: assess for at least 3 fetal movements in 30 min period
Breathing: assess for 30 seconds of continuous breathing during 30 min period
Tone: one extension/flexion cycle of a limb with rapid return to flexed position during 30 min period
Amniotic fluid volume: presence of single pocket > 2 cm

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21
Q

Interpretation of BPP score

A

10 - well fetus
8 w/ normal AFV: well fetus
8 with decreased AFV: some kind of asphyxia, deliver or recheck soon
6: labor induction if >36 weeks if favorable cervix and normal AFI. Repeat testing in 24 hrs if <36 weeks and cervix unfavorable. Deliver if <6.
4: labor induction if GA>32 weeks. Repeat same day if <32 weeks, deliver is <6
<2: labor induction

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22
Q

What happens when people PPROM between 28-34 weeks?

A

50% will progress to labor in 24 hrs and 80-90% will progress to labor within 1 week. Try to make it to 34 weeks

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23
Q

Amino acids require active / passive transport against concentration gradient (placenta)

A

active transport

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24
Q

Antiphospholipid syndrome

A

autoimmune disease associated with recurrent pregnancy loss, thrombophilia, fetal growth impairment, placental insufficiency, pre-E, and preterm birth.

10-48% of patients with APS also have pre-E. Heparin improves live birth rates but does NOT improve obstetric complications

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25
Disorders that cause oligohydramnios
fetal urinary tract anomalies, placental insufficiency, premature ROM, TTTS, maternal meds (indomethacin, ACE-inhibitors)
26
Polyhydramnios associated conditions
T18, T21, Turner, Beckwith Wiedemann
27
T18 quad screen
low / low / low / normal AFP / beta / estriol / inhibit A
28
T13 quad screen
trick question - quad screen not helpful
29
What is low ponderal index signify?
asymmetric growth Ponderal index = weight (g) x 100 / (crown - heel)^3
30
What happens to CBC, coags in pregnant women?
Increase in coagulation factors. Unchanged platelets, WBC increased, dilution anemia.
31
Is there increased maternal infection risk for twins?
no!
32
Teratogenic effects of maternal ACE inhibitor use
renal tubular dysgenesis, hypoplasia of skull, fetal compression syndrome with limb deformities, pulmonary hypoplasia in setting of oligohydramnios
33
Fetal effects of PHB, hydantoin, warfarin
PHB - fetal cleft lip/palate, cardiac abnormalities, GU anomalies Hydantoin - digit and nail hypoplasia, IUGR Warfarin - nasal hypoplasia and stippled bone epiphysis
34
Amnion nodosum
lesion of fetal membranes and placenta seen in pregnancies complicated by severe and long-standing oligo. PPROM, TTTS, severe IDM with placental vascular disease can cause
35
Larger twin in mono-chorionic pregnancies is at risk for ______
HOCM and neuro injury
36
Vanishing twin syndrome sequelae
higher incidence of preterm birth, lower BW, higher risk of double death, some evidence that Neuro developmental outcomes for surviving twin are most likely to be normal
37
Placenta produces large # of hormones. What layer and what hormones?
Syncytiotrophoblast - outer layer of blastcocyst. Produces HcG, human placental lactogen, leptin, progesterone, estrogens, insulin growth factor (but NOT insulin)
38
Maternal macronutrient deficiency increases risk for ______
T2DM, cardiovascular disease, HTN, dyslipidemia later in life
39
How does obesity affect gastroschisis frequency?
Obesity DECREASES incidence in gastroschisis
40
Oral glucocorticoids in pregnancy affects babies
higher rate of preterm birth and low BW
41
Side effects of maternal valproate use
NTD, cleft palate, hypospadias, craniosynostosis, polydactyly
42
Marfan syndrome on babies
highest risk for preterm delivery, cervical incompetence, premature ROM
43
What electrolyte reduces maternal blood lead levels
calcium
44
Side effects of epidural anesthesia?
maternal hypotension, fever, longer second stage of labor
45
What maternal condition causes 15-25% cases of polyhydramnios
maternal DM Fetal hyperglycemia --> increased osmotic diuresis --> fetal polyuria Therapeutic tx with indomethacin
46
What is next step for decreased fetal movements?
biophysical profile
47
IUFD in monochorionic twins -->what sequelae in surviving twin
multi cystic encephalomalacia and multiorgan damage in surviving twin (acute feto-fetal transfusion at time of demise, rapid blood loss from surviving twin to demised twin)
48
Management of IUFD in monochorionic twins in >24 and <24 weeks
>24 weeks: counseled about multi cystic encephalomalacia, no interventions available second trimester single IUFD before viability --> termination can be discussed
49
Gas exchange at placenta occurs at the ______
microvillus surface
50
What does sinusoidal tracing typically entail
severe anemia
51
Late preterm have higher risk of ____
congenital malformations. However less likely to have IUGR compared to term infants
52
Biggest sequelae of maternal chorio?
endometritis (30%)
53
Subnecrotizing funisits or chronic chorio = increased risk for ______ (in baby)
chronic lung disease
54
Leading risk factor for shoulder dystocia?
maternal DM
55
Risk for external cephalic version?
transplacental hemorrhage
56
What decreases risk of uterine rupture for TOLAC?
delivery following spontaneous labor
57
What to do if NST is bad?
BPP or contraction stress test
58
Next step if polyhydramnios? What AFI level?
AFI > 25. test for diabetes
59
Where is sugaleal bleed located?
below aponeurosis and above periosteum
60
In the placenta - maternal vs fetal blood
maternal blood bathes fetal vessels and gives up O2 to fetal blood
61
Transport across placenta favors lipids or water?
trophoblastic tissue favors lipid soluble
62
Placenta characteristics throughout pregnancy (thickness / microvilli)
thinner (10 --> 1.7 micro meters) and more villi (600-->1200 10^6) --> allows for better diffusion
63
How are carbs and amino acids transferred across placenta? NaCl?
Amino Acid - active transport Carbs - facilitated diffusion (GLUT receptors across concentration gradient) lipid transport mostly unknown, but probably transplacental NaCl - simple diffusion (Salt is simple) K regulated, Ca active transpo
64
Vasia previa is most likely to happen with
velamentous insertion
65
Different types of placenta previa
low lying: edge 0-2 cm from cervix Previa: edge overlapping 3.2 cm cervix complete - equal parts overlapping
66
when to deliver placenta accreta
34-36 weeks
67
what is circumvallate placenta
small chorionic plate with growth of extrachorial tissue - usually does not compromise fetomaternal exchange
68
velamentous cord insertion
normal pregnancies, the umbilical cord inserts into the middle of the placental mass and is completely encased by the amniotic sac. The vessels are hence normally protected by Wharton's jelly, which prevents rupture during pregnancy and labor. In velamentous cord insertion, the vessels of the umbilical cord are improperly inserted in the chorioamniotic membrane, and hence the vessels traverse between the amnion and the chorion towards the placenta.Without Wharton's jelly protecting the vessels, the exposed vessels are susceptible to compression and rupture
69
medically managed hypothyroidism in mother leads to _____. What to treat with?
euthyroid newborn that becomes hyperthyroid in first week must observe mother until PTU has metabolized (several days to 1 week) PTU first trimester (liver toxicity) MMI thereafter (facial, EA, aplasia cutis, choanal atresia)
70
Timing of twin gestation formation
Cleavage 1-3 days: Di/Di (morula) 4-8 days: Mono/di (blastocyst) 8-12 days: Mono/mono (implanted blastocyst) 13-15 days: conjoined (embryonic disc)
71
When to deliver mono-mono twins
32-34 weeks
72
etiologies for non-immune hydrops
Anemia (ex: parvovirus, feto-maternal hemorrhage, twin-to-twin transfusion) Cardiac Failure (ex: elevated RA pressure such as tricuspid atresia, heart block, tachyarrhythmia) Decrease osmotic pressure (ex: syphilis) Impaired lymphatic drainage (cystic hygroma, chromosomal abnormalities)
73
74
DDx of Very Low or Undectectable Maternal Serum Estriol Level
Placental sulfatase deficiency – Anencephaly – CAH –Molar pregnancy
75
what hormone does hcg mimic?
TSH (same alpha subunit)
76
How to screen for aneuploidy in 1st trimester?
GA 11-13 weeks Age plus NT plus serum markers – Pregnancy-associated plasma protein-A (PAPP-A) – Beta-hCG
77
How to screen for aneuploidy in 2nd trimester?
* 15-20 weeks; “quadruple screen” * Age plus serum markers – Alpha fetoprotein (AFP) – Human chorionic gonadotropin (hCG) – Unconjugated estriol (UE3) – Inhibin-A
78
When can you do cell-free DNA?
after 10 weeks Fetal DNA in maternal serum
79
what type of placenta can identical (monozygotic twins have)
all of the above Dizygotic is ALWAYS di/di
80
Describe FHR
* Category I – Baseline 110-160 – Moderate variability – No late or variable decelerations * Category III – Absent variability and any of: * Recurrent late or variable decelerations * Bradycardia Cat II is everything else
81
What Is a reactive NST
2 or more accels in a 20 min window
82
describe a BPP (performed over 30 mins)
0 or 2 points NST reactive Breathing >= 30 seconds Movement >= 3 torso/limbs Tone >= 1 flex/extend Fluid >=2 cm 8 or 10 is good
83
teratogenic effects of warfarin and phenytoin
microcephaly, midface hypoplasia
84
Categories of drug labeling (2015)
Pregnancy, lactation, females + males of reproductive potential
85
What US findings concerning for CMV
FGR, VM, echogenic bowel, hepatic/intracranial calcifications, hydrops

Nicu Brodsky+Pediatrix+NeoReview Questions (14 decks)

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