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MFM Flashcards

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1
Q

Prevalence of single umbilical artery (2 vessel cord)

A

</= 1%

3-4x more likely in twins
may be associated with urogenital or cardiac anomalies

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2
Q

SEVERE Pre-Eclampsia definition

A

Hypertension and proteinuria + one or more:

  • BP >/= 160/110
  • Proteinuria >/= 5g in 24hrs or >/=3+ protein x2 samples
  • Vision changes
  • HA
  • Oliguria
  • Any HELLP symptoms (Hemolysis, Elevated Liver enzymes, Low Platelets)
  • Pulmonary edema
  • FGR
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3
Q

Preeclampsia definition

A

Hypertension (SBP >=140 OR DBP >=90 more that 2x)
- after 20 weeks
- a/w with proteinuria (?)

*severe 160/110

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4
Q

Pre-E prevalence

A

5-10% of pregnant women
(most common complication of pregnancy)

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5
Q

Increases risk of Pre-E

A

Primaparity
Twin gestation
cHTN
Diabetes
Obesity

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6
Q

FAS prevalence

A

0.5-2 per 1000 live births in the US

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7
Q

TTS prevalence

A

*most common in Mono/Di

5-15% of mono/di; fewer in mono/mono
(even though 85% have vascular anastomoses)

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8
Q

Calcium acretion amount/timeline

A

80% between 25-40 wks

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9
Q

Antenatal steroids reduce:

A
  • mortality
  • IVH (severe?)
  • RDS (but not chronic lung disease)
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10
Q

Choroid plexus cysts (fetal US) %

A

< 1% (0.5% of fetuses)

usually detected as early as 11 wks; usually disappear by 26 wks

*small number may have Tri 18 (but usually nothing)

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11
Q

pH of:
normal vaginal fluid
amniotic fluid
what is suggestive of ROM

A

normal vaginal fluid: pH 4.5-5.5
amniotic fluid: 7-7.5
ROM suspected: >/= 6.5

*Nitrazine yellow–>blue in ROM
*false positives can occur with blood, semen, BV

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12
Q

Vaccination (for mother if needed)

A

recommended vaccines: tetanus, diphtheria, inactivated flu

ok, but give in 2nd or 3rd trimester if needed: pneumococcal, meningococcal, hepB, inactivated polio

*no live vaccines (eg MMR)

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13
Q

Risk of congenital malformation when HbA1C ~10 prior to conception

A

20-25%

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14
Q

Most common type of twin

A

Di-zygotic (2/3 of all twins)
(so two eggs/two sperms; fraternal; di/di)

monozygotic twins 1 per 250 (higher with ART)

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15
Q

Monozygotic twin type + timing of split

A

Days:

0-3 - mono/mono (~25%)
3-8 - mono/di (~75%)
8-13 - mono/mono (~1%)

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16
Q

Timing of maternal diabetes screening0

A

24-28 wks

50g load
–> glu >130-140 –> retest with 3hr/100g
—> glu >200 = GDM (no 3hr test)

100g load; 3 checks 1 hr apart
–> GDM if at least 2 abnormal

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17
Q

Maternal ITP vs gestational thrombocytopenia platelet counts

A

ITP <70,000
gestational thromobocypenia >70,000 (usually)

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18
Q

Maternal ITP –> significant thrombocytopenia in neonate (<50k) how often?

A

<10%

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19
Q

Maternal mumps vs measles (paramyxovirus)

A

Transmission:
Mumps - saliva transmission
Measles - transplacental (hematogenous)
Both- respiratory droplets, fomites

Incubation
Mumps: 12-25d
Measles: 8-12d (info from onset of sx to 3d post rash)

Pregnancy
Mumps: increased risk of FIRST trimester abortions
Measles: increased risk of prematurity, NO increased risk of abortion, NO teratogenic effects
Both: no increased severity of symptoms

Congenital infections:
Mumps: very rare, most w/ mild sx
Measles: if sx <10 d of life, increased mortality

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20
Q

Predominant fetal thyroid hormone

A

rT3

(D3 inactivates most of maternal T4; T3 persevered in brain)

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21
Q

Associations with 2 vessel cord (single umbilical artery)

A

cardiac anomalies
IUGR
renal anomalies
preterm birth

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22
Q

Quad screen profiles

A

Tri 13 - quad screen not helpful

Tri 18
Low AFP, Low b-hCG, Low uE3, nml inhibin
(60% risk)

Tri 21
Low AFP, High b-hCG, Low uE3, High inhibin
(75% risk)

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23
Q

Estimation of fetal gestation

A

Crown-rump length (CRL) at 7-10 weeks
(predicts GA within 3 days)

Bipariatal distance (BPD) at 14-20 weeks
(predicts GA w/in 7 days)

US biometric measurements most accurate prior to 20 weeks

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24
Q

Partial vs Complete Molar pregnancy

A

Molar pregnancies: abnormal chorionic villi w/ trophoblastic proliferation and villous edema w/in uterine cavity

Partial:
- 2 sperm enter 1 egg (usually)
- Karyotype 69 XXX,XXY, or XYY
- nonviable fetus and amnion often present

Complete:
- mostly 46XX of PATERNAL origin (empty egg)
- No fetus of amnion present
- ~20% develop into trophoblastic tumors

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25
Chorioangiomas vs Choriocarcinomas
ChorioANGIOMAS - benign placental tumors ChorioCARCINOMAS - malignant trophoblastic tumors - rapid growth -can invade uterine muscle and blood vessels - can met to lungs and vagina
26
Radiation risk to fetus
risk to fetus >20 rad procedure <5 rad not expected to cause harm *should still discuss with mother (barium enema 4 rad; abd CT 3.5 rad; chest or head CT 1 rad)
27
Anatomy scan sensitivity
18-20wks 90% of congenital anomalies w/o risk factors CNS - 88% Urinary tract - 85% Digestive system - 52% TEF - 7.4%
28
Fetal lung maturity testing
Used after 32 weeks (tests on amniotic fluid) Fluorescent polarization - probe binds to albumin and surfactant; measures albumin:surfactant ration Lecithin/sphingomyelin ration: lecithin increases with increasing gestation; sphingomyelin stays the same; uses thin layer chromatography to get ratio; at least 2 = adeq surf stores Phosphatidylglycerol: commonest of surfactant detected later than lecithin (indicates more mature) Lamellar bodies: "high number" = maturity
29
High maternal AFP
Neurological (open neural tube defect) GI (e.g. liver necrosis, obits, omph, gastrosch( Renal Masses Low BW, low Maternal weight, oligo, multiple test, underset of GA, osteogenesis imperfect, placental chorioangioma *if unexplained - increased risk of IUGR or fetal death)
30
CVS vs amnio
CVS can be done after 9 weeks gestation but may have both normal and abnormal karyotype (2% of the time) and require repeat amnio later Amnio - after 14 wks (increased risk of talipes equinovarus, pregnancy loss, and failure to culture fetal cells if done earlier)
31
BPP scoring
Fetal movement - 3 in 30 mins Breathing - 30s continuous breathing in 30 mins Fetal tone: 1 extension/flexion cycle w/ rapid return to flexed position in 30 mins AFV: single vertical pocket >2cm +/- NST: 2 accelerations (15 bpm for >15s) within 20 minutes a/w fetal movement
32
BPP Score meaning
33
Definition of oligo/polyhydramnios
Normal AFI 8-18cm Oligo: AFI < 5 (0.5-8%) Poly: AFI >24 (0.1-3%) *poly is more associated with genetic syndromes (tri 18, tri 21, turner, BWS)
34
How to calculate Ponderal index
Ponderal index = [weight (g) x 100] / (crown-heel)^3
35
placenta with hemorrhage at the edge
likely 2/2 chorioamnionitis local hemorrhage caused by inflammation and destruction of decius and foraying membranes
36
Amnion nodosum
observed w/ severe and longstanding oligohydramnios (eg PPROM, TTTS, severe DM w/ placental vascular disease) raised, yellowing, ovoid nodules - squamous cells embedded in degenerative amorphous debris hypothesis: from degeneration of epithelial layer of amnion and rubbing of fetal skin against membranes results in deposition of vernix and skin cells into the focal defects
37
Vanishing twin risks and considerations
Higher risk of premature birth and low birth weight Chorionicity important prognostic factor (dichorionic LESS risk for double IUFD) Monochroinonic twins at higher risk for neurodeveolpmental injury after single IUFD --> some evidence earlier gestational age = less neurodevelopment injury in surviving twin Single IUFD (in mono and di chorionic) a/w preterm labor and delivery Monochorionic - single IUFD can result it muliticystic encephalomalacia and mutiorgan damage in surviving twin (rapid blood loss from surviving twin to demised twin --> hypotension --> ischemic damage) **No interventions available to reduce risk after single demise (can offer ligation of cord if pending demise) Survival rate of other twin(??): 8-16% if IUFD at 20-24wks 92-100% after 37wks Demised fetus may be incorporated into membranes and difficult to identify; occasionally flattened/compressed (fetus papyraceus)
38
Produced by the syncytiotrophoblast
(originates from outer cell layer of the blastocyst - layer of specialized epithelial cells, serves as a barrier b/w maternal and fetal circulation and and endocrine organ) hCG, HPL, leptin, progesterone, estrogens, Insulin-like growth factor (NOT insulin)
39
Inadequate maternal caloric intake increases the risk for ________ in adulthood (for the fetus)
Type 2 DM cardiovascular disease hypertension dyslipidemia
40
Albuterol
decreased risk of gestational HTN
41
Oral glucocorticoids
low birthweight *ORAL glucocorticoids do not cross the placental in significant amounts, so no effect on adrenal glands
42
Overall risk of congenital malformations
2-3%
43
How to reduce lead levels
Calcium
44
Epidural may prolong _____ stage of labor
2nd
45
Only acceptable response to concerns in pregnant women with decreased fetal movements
BPP
46
NRP epi doses (IV and ETT)
IV: 0.02 mg/kg/dose (0.2ml/kg) ETT: 0.1mg/kg (1ml/kg) *concentration 1:10,000 (0.1mg/ml)
47
SInusoidal pattern =
Severe anemia
48
Leading cause of mortality in late preterm
congenital malformations
49
More common/higher risk in late preterm (than term)
IUGR (higher mortality rate) Maternal complications (preE, HTN, DM) Respiratory distress apnea hypoglycemia temp instability feeding difficulties jaundice
50
SGA or LGA higher risk for MSF
SGA
51
Symptoms of Sheehans
*failure of lactation tachycardia persistent hypotension hypoglycemia
52
lymphocytic hypophysitis
lymphocytic infiltration and enlargement of the pituitary ---> destruction of pituitary cells cause unknown; occurs late in pregnancy or in postpartum *headache out of proportion to size of the lesion (+signs of hypo pit)
53
pituitary apoplexy
sudden hemorrhage in pituitary; often into an adenoma *dramatic presentation *acute onset of severe headache, diplopia (pressure on oculomotor nerves) and hypo pit
54
Most common infection post c/s
Endometritis (up to 30% of cases) >5% for wound infx, sepsis, pelvic abscess, thrombophlebitis
55
sign in chorioamniotits that infant is at increased risk for chronic lung diesease
Subnecrosing funisitis = chronic chorio
56
Histologic timeline for chorioamnionitis
< 6 hrs: mat neutrophils in fibrin below chorionic plate 6-24 hrs: neutrophils infiltrate entire chorionic plate and full thickness of membranes *fetal response occurs -->fetal neutrophil across fetal vessel walls --->chorionic vasculitis, umbilical phlebitis, umbilical arteritis >24 hrs: - pervasculitis (fetal PMNs infiltrate umbilical cord stroma - necrotizing chorioamnionitis (necrosis of the amnion) Chronic (days to weeks): subnectrotizing funisitis (perivascular umbilical arcs of calcific debris, glycoprotein, neovasculariazation)
57
how to minimize perinatal risk of macrosomia
C-section (but must be discussed)
58
Leading risk factor for shoulder dystocia
Maternal diabetes risk doubles across all birth weight categories; overall increases risk by 70% small risk from (increase of 2-8%): AMA >= 42wks Obesity, multiparty prev infant >4kg excessive weight gain (>= 20kg) short stature
59
Potential effects on fetus of abundant intrauterine glucose supply
- altered pancreatic development with decreased beta-cell mass - diabetes later in life - impaired insulin secretion/glucose intolerance - increased fetal growth
60
Reactive NST
(NST detects fetal heart rate, fetal movement, and uterine activity) reactive if at least: 2 accelerations (HR 15bpm above baseline for 15s) in 20 mins --> need to be a/w fetal movements *if fetus sleeping, may need to retest within 20 mins
61
Mechanism of indomethacin for tx of poly
prostaglandin synthetase inhibitor - decreases fetal urine production - enhances fluid absorption by the lungs - increases transmemiranous absorption
62
Blood vessels that break in subgaleal
emissary veins that connect the dural sinuses to the superficial veins of the scalp
63
Triple screen for Tri18 Tri 21
Tri18: low AFP, low B-hCG, low uE3 Tri21: low AFP, HIGH B-hCG, low uE3
64
approx ____% of fetal blood flow goes to the placenta via the umbilical arteries
45%

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