MFM

Question 1

At discharge, a full term infant’s examination reveals that the infant has a weak cry, hypotonia, and poor oral feeding with difficulty swallowing. Because the infant’s mother has myasthenia gravis, there is a high probability that these symptoms are attitubable to transient neonatal myasthenia gravis. By what age is this infant expected to completely recover? By what do hours of age dosymptoms typically occur?

Answer 1

By 2 months of age. MG is a chronic autoimmune disease leading to progressive fatigure and weakness involving facial, pharyngeal, and respiratory muscles. 90% with MG has antibodies(IgG) to acetylcholine receptors. 10-20% of neonates born to women with MG will develop neonatal MG as a reults of transplacental transfer of maternal Ach receptor antibodies. Neonatal MG manifests as in the question. These symptoms tyically occur by 72 hours of age with a mean duraiton of 18 days, but may be as long as 15 weeks. There is excellent recovery with 90% by 2 months, the remaining 10% by 4 months. MFM Q1

Question 2

A neonate presetns with depressed nasal bridge, nail hypoplasia, seizures, and stippled bone epiphyses. These are findings are most likely a result from intrauterine exposure to which teratogen?

Answer 2

Warfarin. Intratuterine exposure during 6-12 weeks gestation leads to clinical manifestations in25% of neonates, as listed in the question. Infants may alos have low birthweight, seizure activity, and cognitive disabilities. If intrauterine exposure occurs after the 12th week, there is less of an impact on the fetus. MFM Q2

Question 3

A 34 year old mother has a an elevated serum alpha-fetoprotein (AFP) at 18 weeks. You counsel her that the next most appropriate step would be: A. Amniocentesis to measure AFP B. Amniocentesis to obtain a karyotype C.Fetal ultrasound D. Plasma protein A (PAPP-A) screening E. Repeat beta hCG serum testing

Answer 3

C. Fetal Ultrasound to determine gestationa age. If a pregnant woman has an elevated AFP, fetal ultrasound is recommended. If gestational age has been underestimated resulting in a normal AFP or multiple gestations are identified, routine care is suggested. IF the US confirms the gestational age and there is no fetal abnormalities a/w and elevated AFP, genetic counseling is recommended and amniocentesis may be considered to measure amniotic AFP and obtain a karyotype. If a fetal abnormality is detected by US, care is tailored to the specific finding. MFM Q3

Question 4

What is included in a quadruple screen and which of the 4 tests is the least sensitive?

Answer 4

While a quadruple screen is done at 14-20 weeks (16 weeks is optimal) and consists of AFP, maternal unconjugated estriol, and maternal beta- hCG and inhibin A, maternal AFP is the least sensitive of the 4 tests. If a pregnant woman has an elevated AFP, fetla ultrasound is recommended.

Question 5

You are called STAT to a C-section secondary to severe vaginal bleeding a/w placental abruption. The infant emerges vigorous, crying, and pink. As you review the maternal history, you find a history of substance abuse. Which of the drug of abuse is associated with placental abruption? What other problems can this drug of abuse cause in the fetus?

Answer 5

Cocaine. Intrapartum exposure to cocaine can increase the risk of stillbirths, placental abruption, skull abnormalities, cutis aplasia, porencephaly, ileal atresia, cardiac anomalies and urogenital anomalies. MFM Q 4

Question 6

Name the drug of abuse is a/w the following: increase the risk of stillbirths, placental abruption, skull abnormalities, cutis aplasia, porencephaly, ileal atresia, cardiac anomalies and urogenital anomalies.

Answer 6

cocaine MFM Q4

Question 7

You are called to a delivery due to late fetal heart rate decelerations. What is the most physiologic cause of this pattern? Head compression, placental compression, umbilical cord compression, or uteroplacental insufficiency?

Answer 7

uteroplacental insufficiency MFM Q 5

Question 8

What is the pathophysiology behind late decelerations?

Answer 8

uteroplacental insufficiency –>fetal hypoxia –>chemoreceptor response –>enchanced alpha adrenergic activity –> fetal hypertension –> baroreceptor response –> parasympathetic response –> late deceleration; uteroplacental insufficiency –> fetal hyppxemia –> myocardial depression –> late deceleration MFM Q5

Question 9

What is the mechanism behind early decelerations

Answer 9

fetal head compression –> pressure on the head –> changes in cerebral blood flow –> vagal decelerations –> early decelerations MFM Q5

Question 10

What is the mechanism behind variable decelerations

Answer 10

umbilical cord compression –> decrease in fetal heart rate by either a baroreceptor or chemoreceptor vagal response or fetal myocardial compression MFMQ5

Question 11

What is the prevalance of a single umbilical artery (2 vessel cord)?

Answer 11

< or = 1% MFM Q6

Question 12

This anomaly is 3-4x more common in twins compared with singletons and may be associated with urogenital tract or cardiac anomalies

Answer 12

single umbilical artery MFM Q6

Question 13

This medication is a prostaglandin synthase inhibitor that is adminitster to pregnant woman as a tocolytic. It can lead to presistent pulmonary HTN, renal insufficiency, ileal perforation, or necrotizing enterocolitis in the neonate and thus prolonged maternal use is not recommended.

Answer 13

Indomethicin MFM Q8

Question 14

This medication administered to pregnant women can increase the risk of congenital heart defects in the neonate. Case reports reveal other risks such as fetal goiter and premature birth, as well as neonatal hypotonia, arrythmias, seizures, and diabetes insipidus.

Answer 14

lithium MFM Q8

Question 15

This is a tocolytic medication that decreases uterine contractility by decreasing acetylcholine release from the neuromuscular junction and by acting as a calcium antagonist. Neonatal complications can include a decreased respiratory rate, decreased peristalsis, hypotension, and/or hypotonia

Answer 15

magnesium sulfate MGM Q8

Question 16

This is a calcium channel blocking agent used for tocolysis because it decreases uterine contractility as a result of transmembrane calcium influx. Prolonged use can lead to uteroplacental insufficiency.

Answer 16

Nifedipine MFM Q8

Question 17

This is a beta-2 agonist that binds to beta-2 receptors of the uterine myometrium, activating adrenyl cyclase, which converts ATP to cyclic adenosine monophosphate. This decreaes intracellular calcium with an associated decrease in uterine contractility. While fetal tachycardia can be associated with administration of this medication to the mother, it has minimal effects on the neonate.

Answer 17

Terbutaline MFM Q8

Question 18

This is one of the most common complications of pregnancy affecting 5-10% of pregnant women. It can occur in a women that is previously healthy or be superimposed on a woman with a chronic hypertensive disorder

Answer 18

pre-eclampsia MFM Q9

Question 19

Define pre-eclampsia

Answer 19

hypertension developing after 20 weeks gestation that is associated with proteinuria MFM Q9

Question 20

Name risk factors for Pre-E

Answer 20

primaparity, twin gestation, chronic HTN, diabetes, obesity MFM Q9

Question 21

Define severe pre-eclampsia

Answer 21

Hypertension developing after 20 weeks gestation that is associated with proteinuria and one or more of the following: BP > or = to 160/110, proteinuria > or = to 5 grams in 24 hours or > or = 3+ protein in two urine samples, changes in vision, headaches, oliguria, any manifestations of HELLP syndrome, pulmonary edema, fetal growth restriction MFM Q9

Question 22

Define HELLP

Answer 22

hemolysis (elevated LDH), elevated liver enyzmes, low platelets MFM Q9

Question 23

What are common symptoms of NAS?

Answer 23

CNS (tremors, agitation, hyperactive moro reflex, abnormal tone) GI (diarrhea, poor feeding, excessive sucking) and autonomic disturbances (temperature instability, sneezing, skin color changes) MFM Q 12

Question 24

What is the first line management of NAS?

Answer 24

morphine; if there are additional CNS symptoms or the mother had polysubstance abuse, phenobarbital may be useful MFM Q 12

Question 25

A baby is born with the following features: dysmorphic facies (short palpebral fissures, thin vermillion border of the upper lip, smooth philturm), microcephaly, and growth restriction. What substance did she consume during her pregnancy?

Answer 25

Alcohol. It affects cardiac (VSD, Tetralogy of Fallot with pulmonary stenosis) and CNS abnormalities. MFM Q 13

Question 26

What is the occurance of FAS?

Answer 26

0.5-2 per 1000 live birth in the US with disproportionately higher rates among African American and Native Americans MFM Q13

Question 27

What are possible mechanisms behind the teratogenesis of alcohol on the fetal brain?

Answer 27

1. an apoptotic effect via blockade of NMDA glutamate receptors and activation of gamma-aminobutyric acid (GABA) A receptors. 2. reduction in the fetus' ability to respond to free radical damage 3. direct inhibition of sonic hedgehog gene signaling MFM Q13

Question 28

A 45 year old womam had a successful in vitro fertilzation resulting in twin gestaion. In which of the following types of twin gestation is a twin to twin transfusion MOST LIKELY to occur? Dichorionic diamniotic, monochorionic diamniotic, monochorionic monoamniotic

Answer 28

Monochorionic diamniotic. Twin to twin transfusion occurs in only 5-15% of monochorionic diamniotic twins even though 85% of these twins have vascular anastomoses. Twin to twin can occur in monochorionic monoamniotic twins but occurs less frequently. Monozygotic twins that are dichorionic diamniotic are not a risk for twin to twin. MFM Q 14

Question 29

This occurs when there is placental vascular anastomoses (typically deep and ateriorvenous connections) leading to acute and chronic transfer of blood from one twin to another

Answer 29

twin to twin transfusion MFM Q 14

Question 30

Approximately 80% of fetal mineral accretion occurs between 25 and 40 weeks. Explain how this happens

Answer 30

Because placental syncytioblasts have a relatively low calcium concentration, facilitative diffusion fom the pregnant woman to the placenta can occur. Next an ATP dependent calcum pump tranfers calcium from the basal syncytial surface to the fetus. These processes enale to the fetus to be hypercalcemic relative to the mother, particularly in the thrid trimester. MFM Q 15

Question 31

\_\_\_\_\_ fetal calcitonin concentration inhibits fetal bone resorption

Answer 31

High MFM Q 15

Question 32

Does estrogen increase or decrease the fetal mineral accretion

Answer 32

increases MFM Q15

Question 33

A pregnant woman at 27 weeks is admitted with preterm labor and gets one course of antenatal steroids. When determining the risks and benefits of antenatal corticosteroids, there has been proven reduction in all the following except: infant mortality, PDA, respiratory distress, and severe IVH

Answer 33

PDA. Studies have shown reduction in infant mortality, respiratory distress, and and IVH. PDA has not been impacted. Studies have not consistently shown a reduction in NEC or CLD between those who received steroids and those who didn't. MFM Q 16

Question 34

A 28 yo woman has a fetal survey at 18 weeks gestation and fetal US demonstrates choroid plexus cysts. There are no other radiographic findings. What is the prevalance of choroid plexus cysts? \<1%, 5%, 10%, 20%, 30%

Answer 34

\<1%. Choroid plexus csyts are detected by fetal US in 0.5% of fetuses as early as 11 weeks gestation and usually disappear by 26 weeks. Ususally isolate but may be a/w trisomy 18. MFM Q17

Question 35

What is the cause of choroid plexus cysts?

Answer 35

neuroepithelial folds that are filled with CSF and debris. MFM Q 17

Question 36

What is the pH of amiontic fluid?

Answer 36

pH\> /= 6.5 (7-7.5) You can use nitrazine paper as an indicator. MFM Q18

Question 37

What is the normal pH of vaginal fluid?

Answer 37

4.5-5.5 False positives can occur with blood, semen, and BV while false negatives can occur if there is an inadequate amount of vaginal fluid. MFM Q 18

Question 38

A pregnant woman migrates from Botwana and does not have an vaccines. Which vaccines, if any, are contraindicated in pregnant women?

Answer 38

Measles, mumps, rubella, and varicella contain live viruses and therefore contraindicated in pregnancy unless there is a high probability of exposure and disease. MFM Q19

Question 39

What vaccines may be administered during pregnancy but preferably in the 2nd or 3rd trimester due to the risk of teratogenicity?

Answer 39

pneumococcal, meningococcal, hep B, and inactivated polio MFM Q19

Question 40

What vaccines are recommended for pregnant women?

Answer 40

tetanus, diptheria, and inactivted infuenza MFM Q19

Question 41

Are metformin and glyburide safe to use for gestational diabetes?

Answer 41

Yes. Insulin is first line but metformin and glybruide both cross the placenta but studies have shown no increase in congenital anomalies with the use of Metformin. The risk of neonatal hypoglycemia and macrosomia is higher with glyburide compared to insulin. MFM Q 20 (note- answer in book is wrong)

Question 42

True or false- women with type 1 and type 2 DM have significantly higher risk for congenital malformations compared to women with gestational diabetes

Answer 42

True. The risk of congenital malformations approaches 20-25% when HgbA1c values approach 10. MFM Q21

Question 43

Which of the following types of twins poses the greatest risk for cord entanglement? Dichorionic diamniotic, monochorionic diamniotic, monochorionic monoamniotic

Answer 43

Monochorionic monoamniotic MFM Q 22

Question 44

What is the incidence of dizygotic twins and how are these babies formed?

Answer 44

2/3 of all twins are dizygotic. Formed by fertilization of 2 eggs but 2 sperm leading to fraternal twins; dizygotic twins have 2 placentas but if implantations sites are near, the placentas may fuse MFM Q 22

Question 45

What is the incidene of monozygotic twins and how are these babies formed?

Answer 45

1 per 250 or 1/3 of all twins; 1 egg is fertilized by 1 sperm which splits during the first 2 weeks of development; 25-30% are dichorionic diamniotic, 70-75% are monochorionic diamniotic, and 1-2% are monochorionic monoamniotic MFM Q 22

Question 46

What are the 3 types of monozygotic twins and what is the timing of splitting of each of these types?

Answer 46

A. dichorionic diamniotic: early division before day 3; before the chorion is completely formed B. monochorionic diamniotic: division between 3-8 day; after the chorion is formed and before the amnion is completely formed. C. monochorionic monoamniotic: later division (between 8-13 days); after both the chorion and amnion have formed; if splitting day 13-15 (ie after the chorion, amnion, and embryonic plate formed) it may lead to conjoined twins MFM Q22

Question 47

What are the in utero risks for monochorionic diamniotic twins?

Answer 47

increased risk for twin-twin transfusion; greater chance of growth discordance MFM Q 22

Question 48

What are the in utero risks to monochorionic monoamniotic twins?

Answer 48

cord entanglement a/w a high mortality rate; greater chance of growth discordance; risk of acardia (rare complication where one twin has no heart or non-functioning rudimentary cardiac tissue; the twins survive because of placental vascular anastomoses; the pump twin is at risk of cardiac failure with 50% mortality) MFM Q 22

Question 49

When are pregnant mom's screened for gestational diabetes?

Answer 49

24-28 weeks MFM Q23

Question 50

What is the difference in platelet count and affect on the neonate between maternal ITP and gestational thrombocytopenia?

Answer 50

In both conditions, neonates are unaffected with maternal ITP., the maternal platelet count is usually \<70,000 and in gestationa thrombocytopenia and maternal platelet count is usually \> 70,000. MFM Q 24

Question 51

What is the pathophysiology behind maternal ITP?

Answer 51

ITP occurs in pregnant women when antibodies directed against maternal antigens on maternal platelets are cleard by the reticuloendothelial system, causing maternal thrombocytopenia (platelets \< 70,000). Neonates aren't affected. (MFM Q 24)

Question 52

Measlses and mumps are both paramyxoviruses. Which one increases the risk of first trimester spontaneous abortion?

Answer 52

Mumps. There is no increased risk of spontaneous abortions with measles. MFM Q25

Question 53

Which of the following is the dominant thyroid hormone during fetal life? Free thyrozine (T4), reverse triiodothryonine (rT3), and triiodothronine (T3)

Answer 53

rT3. The fetus converts throxine (T4) to rT3 bydeiodinase (D3), an enzyme that is present in placental and fetal tissues. D3 inactivates most of maternal T4. Thus rT3 is the dominant thyroid hormone during fetal life. Fortuntely, T4 concentrations in the fetal rain are presered because of local action of intracellular deiodinase (D2). MFM Q 26

Question 54

A pregnant woman with a twin pregnancy presents at 29 weeks with an acute increase in abdominal girth. Fetal US reveals hydrops in on twin and a twin-to-twin transfusion is suspected. Which twin is most likely to develop hydrops a/w twin-to-twin transfusion?

Answer 54

Recipeint twin. The recipient twin may develop polycythemia, hypervolemia, polyhydramnios, cardiac hypertrophy, and/or hydrops.The donor twin can develop anemia, hypovolemia, oligohydramnios, decreased urine output, and decreased growth. MFM Q 27

Question 55

What is the management of an HIV + mother?

Answer 55

IV zidovudine in all patients (started at admission until delivery if vaginal and 3 hours prior to surgery if C-section.) C-section indicated for viral load \> 1,000 copies/ mL or for usual fetal obstetric indictions (fetal malposition and or placenta previa).

Question 56

What are risk factors for placenal abruption?

Answer 56

previous history of abruption, hypertensive disorders, drug abuse, multplie gestations, premature rupture of membranes

Question 57

What are maternal complications of placenta abruption?

Answer 57

obstetic hemorrage, coagulopathy, renal failure, need for blood transfusion, hysterectomy, maternal death

Question 58

When is immediate delivery indicated in a woman with Pre-E

Answer 58

seizures/eclampsia, pulmonary edema, acute renal failure (Cr \> 1.5) or oliguria (\<500 mL urine in 24 hours,) neurologic deficits, placental abruption, DIC, non-reassuring fetal status, IUFD, previable gestation

Question 59

When is delivery after the completion of antenatal steroids indicated in a women with pre-E?

Answer 59

persistently severely elevated blood pressure despite the max treatment with 2 anti-hypertensive medications, HELLP, severe fetal growht restriction, persistent severe oligohydamnios, reversal of diastolic flow in umbilical artery dopplers with severe fetal growth restriction, thrombocytopenia (\<100,000), epigastric or RUQ pain with AST/ALT \> 2 times the upper limit of normal, labor or ROM, persistent severe symptoms

Question 60

When is delivery indicated in a women with stable severe Pre-Eclampsia?

Answer 60

34 weeks MFM Q33; Delivery at 34 weeks is recommended as long as there are no contraindications for expectant management

Question 61

What will the quad screen show for a fetus with a high risk of T21?

Answer 61

low AFP,high beta hCG, low unconjugated estriol, high inhibin A. The quad screen is done between 14 and 20 weeks

Question 62

What will the quad screen show for a fetus with a high risk of T18

Answer 62

low AFPP, low beta hCG, low unconjugated estriol, and normal inhibin A. The quad screen is not helpful for detecting T13

Question 63

What is a category I tracing?

Answer 63

baseline HR or 110-160, variability in the feta HR (6-25), no late or variable decelerations, early decels may be present or absent, early accels may be presnet or absent

Question 64

What is a category III tracing?

Answer 64

absent baseline HR variability and any of the folloing: recurrent late decels, recurrent variable decels, bradycardia,. Sinusoidal pattern may also be present

Question 65

What measurements are used to in the calculation of the estimated fetal weight?

Answer 65

abdominal girth, biparietal diameter, head circumference, femur length

Question 66

What are the substances that are transferred across the placenta using active transport?

Answer 66

calcium, phosphate, magnesium, iron, iodide, water-soluble vitamins, amino acds

Question 67

Name the substances that are transporteda across the placenta to the fetus via simple diffusion?

Answer 67

oxygen, carbon dioxide, water, sodium chloride, lipids, fat soluble vitamins, and most medications

Question 68

What are the potential impacts on the fetus from maternal use of alcohol?

Answer 68

Most common teratogenic exposure to the fetus. The earlier the period of exposure in utero, greater likelihood of classic features. Greater effect with exposure of large amounts infrequently compared to smaller chronic intake. FAS is the most preventable cause of mental insufficiency

Question 69

What is required to make the diagnosis of FAS?

Answer 69

Physical, growth, and neurodevelopment; Facial: long smooth philtrum, thin upper lip, short palpebral fissures, ptosis, strabismus, epicanthal folds, maxillary hypoplasia, short nose, flat nasal bridge; Cardiac: VSD, ASD, and tetralogy of Fallot with Pulm Stenosis; Neurological: often with irritability and tremulousness (self-limited, disappears within the first few months), mental insufficiency (IQ = 63), microcephaly, heterotopias , hyperactivity during childhood, fine motor dysfunction with poor hand-eye coordination, increased risk of behaviroal issues. Other: intrauterine growth restriction, short stature, abnormal palmar creases, limited joint mobility, small distal phalangrs, small 5th fingernails, renal abnormalities

Question 70

What are the potential impact on the fetus with maternal use of lithium?

Answer 70

Ebstein's anomaly, case reports of fetal goiter, hypotonia, arrhythmias, seizures, diabetes insipidus, premature birth

Question 71

What things cross the placenta by facilitated diffusion?

Answer 71

Glucose, Cephalexin; facilitated transport across the placenta is mediated by a carrier that moves compounds along the concentration gradient; no energy required

Question 72

Name the compounds that do NOT cross the placenta

Answer 72

Biliverdin, Heparin, glucagon, human growth hormone, insulin, propylthiouracil (PTU), TSH, maternal IgM, levothyroxne

Question 73

placental abruption is most commonly associated with what other maternal pathology?

Answer 73

maternal hypertension

Question 74

What is the S/D ratio in IUGR fetus?

Answer 74

increased; IUGR fetuses have decreased diastolic flow velocities and therefore increased S/D ratio

Question 75

Placental previa commonly occurs with what other placentation pathology?

Answer 75

placenta accreta; placenta previa is painless bleeding; risk for accreta increases with increasing # of C-sections, esp if previa present

Question 76

What is the most common cause of non-reactive NST?

Answer 76

fetal sleep

Question 77

fetal effects of valproate?

Answer 77

NTDs and developmental delay, long thin fingers, cardiac anomalies, facial- narrow bifrontal diameter

Question 78

fetal effects of maternal phenytoin?

Answer 78

digit and nail hypoplasia, IUGR, cleft lip/palate, midface hypoplasia and hypertelorism

Question 79

fetal effects of maternal isoretinoin?

Answer 79

cardiac anomalies, microtia, hydrocephalus, thymic and/or parathyroid abnormalities, limb abnormalities

Question 80

fetal effects of maternal SSRI use?

Answer 80

neonatal adaptation syndrome, pulmonry HTN

Question 81

fetal effects of maternal warfarin use?

Answer 81

midface hypoplsia, FGR. Microcephaly

Question 82

fetal effects of maternal ,methotrexate?

Answer 82

cranial dysplasia, broad nasal bridge, low set ears

Question 83

Maternal DES use causes what effects in the fetus?

Answer 83

vaginal adenocarcinoma, vaginal adenosis

Question 84

What is the most common teratogenic exposure to the fetus?

Answer 84

Alcohol. It affects cardiac (VSD, Tetralogy of Fallot with pulmonary stenosis) and CNS abnormalities. MFM Q 13

Question 85

Facial features of FAS?

Answer 85

long, smoother philtrum, thin upper lip, short palpebral fissures, strabismus, maxillary hypoplsia, short nose, flat nasal bridge

Question 86

What are the indications for GBS IAP?

Answer 86

colonized (urine or genital Cx), unknown colonization status and risk factors ( GA \< 37 weeks, ROM \> 18 hours, fever)

Question 87

What is a common cause of non-genetic congenital deafness?

Answer 87

CMV

Question 88

What is the most significant risk factor for preterm delivery?

Answer 88

previous preterm delivery

Question 89

T/F Chorioamnionitis has a high correlation with PTL?

Answer 89

True: about 30% of PTL due to chorio

Question 90

For twin gestation, what are the common risk factors for fetal demise of one twin?

Answer 90

monozygotic twins, same sex twins, pregnancy complicated by severe pre-eclampsia

Question 91

What is the most common cause of non-immune hydrops?

Answer 91

fetal CHF. Cardiac causes are 25% of cases and NIHF is specifically a/w increased preload or decreased cardiac output leading to greater stress on the RV; arrhythmia (SVT and heart block), CHD, cardiac mass, cardiomyopathy; other causes include anueploidy (16%) ,TTTS (10%), pulmonary (8%) like chlylothorax, CCAM, pulmonary sequestration

Question 92

What is the most common inherited form of non-immune hydrops?

Answer 92

aneuploidy

Question 93

What is the ponderal index?

Answer 93

[weight (grams) x 100] / (crown-heel) ^3; low ponderal index is a/w increased risk of adult coronary artery disease (in Finland), better predictor of this than birth weight

Question 94

What does a low ponderal index indicate?

Answer 94

asymmetric growth

Question 95

What is the most sensitive test for T21?

Answer 95

maternal B-hCG (elevated)

Question 96

What is the most common cause of infant death in the US?

Answer 96

disorders related to short gestation

Question 97

What is the most common presentation of acute chorio?

Answer 97

absent clinical manifestaions; therefore, need placental pathology to confirm the diagnosis

Question 98

The most common perinatal complication seen in late preterms compared to terms is what?

Answer 98

indirect hyperbilirubinemia. Occurs in \> 50% and last longer and have higher peak bilirubin levels compared to terms

Question 99

True or false: chronic TTTS is almost exclusively restricted to twins with monochorionic diamniotic placentation

Answer 99

True

Question 100

Neonates born to women with intrahepatic cholestasis of pregnancy are at increased risk of what?

Answer 100

RDS

Question 101

Women with intraheptic cholestasis of pregnancy are at increased risk of what nutritional deficiency?

Answer 101

selenium; commonly seen in women from Chile and Finland since their diets are low in selenium

Question 102

What is the greatest risk for demise in the recipient twin in TTTS?

Answer 102

echocardiographic evidence of cardiomyopathy is the greatest risk factor for intrauterine fetal demise of the recipient twin

Question 103

What is the most common cause of acquired valvular disease?

Answer 103

rheumatic fever

Question 104

What is the most common valvular issue that occurs in a pregnant women?

Answer 104

mitral stenosis

Question 105

What is the most common cause of of chronic infectious villositis in the US?

Answer 105

viral = CMV; parasitic= Trepnonema pallidum

Question 106

What is the most common reason for preterm delivery in a pregnancy complicated by severe pre-eclampsia?

Answer 106

Stillbirth;second most common reason is HEELP syndrome

Question 107

What is the most common pregnancy-specific complicaton related to anti-phopholipid antibodies?

Answer 107

pre-Eclampsia

Question 108

women with placental accreta, increta and percreta are at high risk of what?

Answer 108

hemorrhage at the time of delivery; therefore many require admission to the intensive care unit and remain intubated for the first day post-partum due to fljid shifts and frequent need for resus with crystalloid and blood products

Question 109

Describe catastrophic anti-phospholipid syndrome

Answer 109

subset of neonates with APS antibodies that have rapid presentation of thrombosis, arterial occulsion, or microthrombi in 3 or more organs. In general, neonates bom to women with APS are exposed to APS antibodies, but these antibodies are insufficient to lead to diseaase. Instead large vessel thrombosis is found in these neonates if the neonate has other prothromnbotic risk factors (cental vascular catheter, sepsis, perinatal depression, prematurity, inherited prothomboic disorder

Question 110

What is the most common perinatal complication of pre-E?

Answer 110

fetal growth restriction

Question 111

When is delivey recommended for women with GDM if there is poor in-hospital glycemic control?

Answer 111

between 34+0 and 36+6; need steroids if delivered during this time

Question 112

Which population in the US is at increased risk for late preterm delivery?

Answer 112

teens and women \>35 yo

Question 113

What is the most common licit substance of abuse?

Answer 113

tobacco;- placental blood flow is significantly reduced in women that use tobacco Note Etoh is the most common teratogenic substance of abuse

Question 114

oligo, renal failiure, lung hypoplasia, skull ossification defects- Name the maternal drug used

Answer 114

ACE inhibitors

Question 115

fetal bradycardia, hypoglycemia, possible FGR- name the maternal drug'

Answer 115

propranolol

Question 116

Neural tube defects, craniofacial defects, hemorrhagic disease of the newborn. Name the maternal drug

Answer 116

carbemazepine

Question 117

choanal atresia, esophageal atresia, hypothyroidism/goiter, cutis aplasia- name the maternal drug

Answer 117

methimazole

Question 118

slowed bone growth, enamel hypoplasia, pernamanet yellowiing of the teeth- Name the maternal drug used

Answer 118

tetracyclines

Question 119

Describe the two kinds of molar pregnancies

Answer 119

In both types Beta-hCG is higher than expected for GA. Occurs in 1 in 1000 pregnancies Partial molar: 69 XXX, XXY, or XYY; nonviable fetus and amnion present, uterus is usually small for gestation; lessl likelt to develop trophoblastic tumors; rare to have medical complications Complete molar: (majority 46XX with paternal origin); no fetus or amnion present; uterus usually large for GA; ~20% develope trophoblastic tumors and frequently have medical complications

Question 120

What hormone is thought to have a role in increasing the respiratory drive in the pregnant woman?

Answer 120

progesterone is thought to have a role in increasing the respiratory drive of the pregnant woman but does not impact fetal breathing

Question 121

What is the most common complication in mother's with HELLP syndrome?

Answer 121

placental abruption followed by DIC; placental abruption then leads to fetal intrauterine asphxia and infants are born pale, limp, apneic and bradycardic; NOTE: infants born to mothers with placental abruption have a 15 fold higher risk of perinatal mortality and may have increased morbidity such as IVH, PVL, and CP

Question 122

Women with untreated hypothyroidism are at risk for what pregnancy complications?

Answer 122

* miscarriage * pre-E * placental abruption * FGR * prematuriy * still birth

Question 123

If anti-D antibody is present, what titer level is significant and may result in fetal morbidity?

Question 124

In a mother who is in an MVA, what is the most common cause of fetal death?

Answer 124

placental abruption

Question 125

What is the most common reason for non-obstetrical surgical intervention in pregnancy?

Answer 125

acute appendicitis

Question 126

List the 3 most common causes of infant death in the US in order from most to least

Answer 126

1. Congenital malformations, deformations and chromosomal abnormalities (~21%) 2. disorders related to short gestation and low birth weight (17%) 3. SIDS (6.5%)

Question 127

Compared to term infants with normal weights, term infants with growth restriction are more likely to have deficits in what?

Answer 127

Deficits in attention with hyperactivity (ADHD has been found to be higher in terms with growth restriction) But they have similar rates of employment, years of completed education, and life satisfaction

Question 128

acute villositis with neutrophilic infiltration and microabsceses is pathognomonic for what infection?

Answer 128

listeria

Question 129

* hyoplasia or absent ears * conotruncal heart malformations * hydrocephalus and brain malformations * cognitive deficits Name the teratogen

Answer 129

isotretinoin

Question 130

Name the teratogen * craniosynostosis * hypertelorism * limb defects (ulnar digit deficiency, syndactylyl * CHD

Answer 130

methotrexate

Question 131

Name the teratogen * mild to moderate growth retardation * wide anterior fontanel * widely spaced eyes * hypoplasia of distal phalanges with small nails * borderline to mild cognitive impairment

Answer 131

phenytoin

Question 132

Name the teratogen * neural tube defects * CHD * hyperconvex nails * cleft lip