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MFM Flashcards

1
Q

Cardiovascular adaption in pregnancy

A
  1. inc HR 10-15bpm
  2. inc blood volume 30-50%, especially 2nd trimester
  3. decreased SVR > decrease BP/pulse pressure
  4. inc CO especially to uterus and kidneys
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2
Q

Pulmonary adaption in pregnancy

A

no change RR
inc TV and MV
chronic hyperventilated state

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3
Q

renal adaption in pregnancy

A

renal hypertrophy and dilated calyces and ureters
increased GFR/RBF
lose more bicarb and protein; keep more sodium

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4
Q

hematologic adaption in pregnancy

A

dilutional anemia but both RBC and plasma increase
leukocytosis but decreased function
increased coagulation, but normal platelet count

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5
Q

gastrointestinal adaption to pregnancy

A

decreased gastric emptying time, increased reflux and hemorrhoids
impaired gallbladder contraction

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6
Q

endocrine adaption to pregnancy

A
  • enlargement of pituitary increasing prolactin
  • increased TBG, FT4, but decreased TSH –> euthyroid
  • PTHrP increased –> calcitriol
  • estrogen stimulates insulin release from pancreas –> increased lipogenesis and fat storage
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7
Q

where is hCG produced

A

syncytiotrophoblasts

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8
Q

when is hCG detected

A

blood and urine 8-9 days after ovulation

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9
Q

function of bHCG in pregnancy

A
  1. prevents corpus luteum involution
  2. suppresses maternal immune system
  3. TSH like effects
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10
Q

where is hPL produced

A

syncytiotrophoblasts

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11
Q

hPL levels over time in pregnancy

A

increases with GA

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12
Q

hPL effects in pregnancy

A

anti-insulin effect–>increases lipid utiliation

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13
Q

what is role of progesterone in pregnancy

A
  • maintains uterus in relaxed state; withdrawal of function (but not concentration) leads to labor - possibly by decreased receptions
  • antiinflammatory
  • immunosuppressive
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14
Q

what is role of estrogen in pregnancy

A
  • regulates progesterone fetal maturation
  • proliferation of endometrium
  • increases strength of contractions
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15
Q

compounds that do not cross placenta

A

biliverdin
heparin
glucagon
hcg
insulin
ptu
IgM
TSH

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16
Q

what is vasa previa

A

unprotected umbilical vessels are crossing the internal os and present prior to fetal head
not alway in velamentous cord insertion

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17
Q

types of urachal remnants

A
  1. complete patent urachus
  2. partial patent urachus at umbilical end = urachal sinus
  3. patent central part = urachal cyst
  4. patent urachus at bladder end - bladder diverticulum
  5. mucosal remnant at the umbilical end = umbilical polyp
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18
Q

pathophysiology of PEC based on timing

A

<34 weeks abnormal placental implantation
>34 weeks endothelial dysfunction

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19
Q

preventive strategies for PEC

A

Ca
aspirin
UF heparin and LMW (fair evidence)
Mg

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20
Q

where is AFP produced in pregnancy

A

fetal yolk sac early, then fetal liver and GI tract

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21
Q

absent fetal nasal bone

A

trisomy 21

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22
Q

quad test for trisomies

A

tri21: low AFP, high bHCG (most sensitive), low uE3, high inhibin A

tri18: low AFP, low bHCG, low uE3, normal inhibin A

tri 13: not helpful

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23
Q

prenatal testing for smith lemli opitz

A

low uE3, low AFP, low hCG

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24
Q

prenatal testing for turner

A

low AFP, high bHCG, low uE3 (like tri21)

high inhibin A if hydropic; low if non-hydropic

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25
Q

what are the measures on ultrasound that estimate GA? when is the best time

A

crown-rump length: 1st trimester/ GA +/- 3-5d
cephalo-biparietal diameter: GA +/- 7d if 14-20wk
abdominal circumference: GA +/- 3 week
femur length: GA +/- 3 week

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26
Q

stages of fetal growth

A

first 16 weeks: hyperplastic; increased cell number and DNA

16-32 weeks: hyperplastic and hypertrophic; increase in cell number and size

32+: increase in cell size, protein and rna; most fetal fat and glycogen deposition

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27
Q

ponderal index =

A

(weight (g) x 100)/ (crown-heel)^3

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28
Q

timing of splitting of twins

A

DCDA: < 3d
MCDA 4-7d
MCMA 8-13
conjoined 13-15

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29
Q

cellphase at time of splitting of twins

A

DCDA: morula
MCDA: blastocyst
MCMA: implanted blastocyst

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30
Q

MC type of twin

A

MCDA

31
Q

NST reactive -

A

> 2 accelerations in 20 minutes with fetal movements and increased HR > 15 lasting >15 seconds

32
Q

BPP parts

A
  1. NST
  2. fetal movement
  3. breathing
  4. tone
  5. AFV
33
Q

early deceleration

A

head compression –> cerebral blood flow –> vagal deceleration of HR

34
Q

variable deceleration

A

umbilical cord compression leading to:
1. BP fetus –> baroreceptor –> vagal deceleration of HR
2. fetal hypoxemia –> chemoreceptor –> vagal deceleration of HR
3. fetal hypoxemia –> myocardial depression –> vagal deceleration of HR

35
Q

late deceleration

A

uteroplacental insufficiency:
1. fetal chemoreceptors > alpha adrenergics > BP > baro > parasympathetics > late decel
2. myocardial depression

36
Q

differences in paO2 by vessel

A

maternal uterine artery > maternal uterine vein > UV > UA

37
Q

differences in paCO2 by vessel

A

UA> UV/uterine vein > uterine artery

38
Q

differences in pH by vessel

A

uterine artery > UV/uterine vein > umbilical artery

39
Q

MoA terbutaline

A

b2 agonist –> cAMP –> decrease intracellular Ca –> decrease uterine contractiliy

40
Q

MoA Mg sulfate

A

decrease Ach release from NMJ (Ca antagonist) –> decrease uterine contractility

41
Q

MoA indomethacin

A

Pg synthase inhibitor

42
Q

MoA nifedipine

A

CCB –> decrease uterine contractility

43
Q

teratogen effect of captopril/enalopril

A

potters syndrome
2nd/3rd trimester

renal

44
Q

teratogen effect of alcohol

A

facial
VSD, ASD, ToF
microcephaly, NDI/motor
IUGR

45
Q

teratogen effect of carbamazepine

A

finger hypoplasia
FGR
NTD
NDI
decreased vit K

46
Q

teratogen effect of cocaine

A

still birth
abruption
skull/cutis aplasia/porencephaly
ileal atresia, cardiac anomalies

47
Q

teratogen effect of cyclophosphamide

A

limbs
cleft
single coronary
imperforate anus
FGR/microcephaly

48
Q

teratogen effect of phenytoin

A

Hypoplasia digit/nail
Hernias
Hypospadius
Heart: pulmonary or aortic valvar stenosis/VSD
IUGR

49
Q

teratogen effect of isoretinoin

A

TGA, TA, ToF, VSD, DORV, hypoplastic arch
microtia
hydrocephalus
thymic/parathyroid

50
Q

teratogen effect of warfarin

A

stippled bone epiphysis
nasal hypoplasia
MR

51
Q

AFP timing of fetal and maternal peaks

A

fetal peaks 13 weeks
maternal detected at 12 weeks then peaks at 32

52
Q

GDM timing of screening

A

24-28 weeks

53
Q

measles or mumps? increased risk of SAB in first trimester

A

mumps

54
Q

fetal weight is estimated based on what 4 parameters

A
  1. abdominal girth
  2. biparietal diameter
  3. head circumference
  4. femur length
55
Q

what is a specific measurement for asymmetric growth restriction?

A

ponderal index

56
Q

amnion nodosum

A

small yellowish nodules in amion seen with oligohydramnios (maternal DM, TTTS, PPROM)

57
Q

hormones produced by syncytiotrophoblast

A

human placental lactogen
estrogen
leptin
progesterone

HELP

58
Q

MC complication of pregnancy in women with Marfans

A

preterm delivery

59
Q

what supplement helps reduce maternal lead level?

A

calcium

60
Q

subnecrotizing funisitis is associated with what?

A

chronic lung disease

61
Q

primary marker of fetal aneuploidy

A

nuchal translucency

62
Q

IUGR infants MC neuro deficit

A

ADHD

63
Q

MC complication in late preterm

A

jaundice

64
Q

acute villositis with neutrophillic infiltration and microabscess formation

A

listeria

65
Q

protein associated with thrombotic features of APS

A

B2 glycoprotein 1

66
Q

neonatal complications associated with maternal intrahepatic cholestasis of pregnancy

A
  • surfactant deficiency
  • meconium aspiration
  • bile acid pneumonia
67
Q

what deficiency is associated with maternal intrahepatic cholestasis of pregnancy

A

selenium

68
Q

Quintero stages

A
  1. O/P, visible donor bladder
  2. O/P, donor bladder not visible
  3. O/P, abnormal doppler
  4. O/P, hydrops
  5. O/P, demise
69
Q

chronic infectious villositis

A

CMV

70
Q

which ART is associated with highest risk of genomic imprinting?

A

intracytoplasmic sperm injection

71
Q

hormones that are produced by mom acting on placenta and transferred to fetus

A

TH, oxytocin and estrogen

72
Q

hormones produced by fetus, altered by placenta and transferred to mother

A

DHEA

73
Q

hormones produced by placenta and transfered to mom?
or fetus?

A

hcG

IGF2

74
Q

MC substance abused during pregnancy

A

tobacco

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