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OB/GYN > OB/GYN > Flashcards

OB/GYN Flashcards

1
Q

What is gravidity

A

the number of times a woman has been pregnant

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2
Q

What is parity

A

The number of pregnancies that led to a birth beyond 20 weeks gestational age OR an infant weight > 500g

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3
Q

What is P####

A 
(TPAL)
the number of term deliveries,
the number of preterm deliveries
the number of abortuses
the number of living children
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4
Q

What is the developmental age

A

the number of weeks and days since fertilization; usually unknown

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5
Q

What is gestational age

A

the number of weeks and days measured from the first day of the last menstrual period (LMP)

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6
Q

When is CRL considered

A

Crown Rump Length

6-12 weeks

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7
Q

When is BPD considered

A

Biparietal Diameter

After 13 weeks

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8
Q

What trimester is ultrasound measurement considered most accurate

A

1st

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9
Q

What is the standard of diagnosis for pregnancy

A

b-hCG

range of 1000-1500 IU/mL

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10
Q

Discuss b-hCG

A

Produced by the placenta
Peaks at 100,000 mIU/mL by 10 weeks GA
Decreases throughout the 2nd trimester, levels off during the 3rd

hCG levels double every 48 hours during early pregnancy

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11
Q

When is the gestational sac visible by ultrasound?

A

5 weeks GA

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12
Q

What happens to renal flow during the pregnancy

A

Increases 25-50%.

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13
Q

What happens to GFR during pregnancy

A

Increases early, then plateaus

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14
Q

What happens to uterine weight during pregnancy

A

Increases from about 60-70g to about 900-1200g

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15
Q

What is the average amount of weight gain for mothers during pregnancy

A

25 pounds (11-kg)

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16
Q

What happens to HR during pregnancy

A

increases gradually by 20%

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17
Q

What happens to BP during pregnancy

A

gradually decreases by 10% by 34 weeks, then increases to pregnancy values

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18
Q

What happens to stroke volume during pregnancy

A

Increases to a maximum at 19 weeks, then plateaus.

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19
Q

What happens to cardiac output during pregnancy

A

Rises rapidly by 20%, then gradually increases an additional 10% by 28 weeks

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20
Q

What happens with peripheral venous distention during pregnancy

A

Progressive increase to term

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21
Q

What happens to Peripheral vascular resistance during pregnancy

A

progressive decrease to term

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22
Q

What happens to respiratory rate during pregnancy

A

unchanged

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23
Q

What happens to tidal volume during pregnancy

A

increases by 30-40%

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24
Q

What happens to the expiratory reserve during pregnancy

A

gradual decrease

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25
Q

What happens to vital capacity during pregnancy

A

Unchanged

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26
Q

What happens to respiratory minute volume

A

Increases by 40%

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27
Q

What happens to blood during pregnancy

A

Increases by 50% in second trimester

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28
Q

What happens to hematocrit during pregnancy

A

decreases slightly

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29
Q

What happens to fibrinogen during pregnancy

A

increases

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30
Q

What happens to Electrolytes during pregnancy

A

unchanged

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31
Q

What happens to sphincter tone during pregnancy

A

decreases

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32
Q

What happens to gastric emptying time during pregnancy

A

Increases

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33
Q

What does the quad screen consist of

A

MSAFP (maternal serum a-Fetoprotein)
Inhibin A
Estriol
B-hCG

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34
Q

What is the unit MoM stand for

A

multiple of median

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35
Q

What is an elevated MSAFP (>2.5 MoM) associated with

A 
Open neural tube defects
Abdominal wall defects
Multiple gestation
Incorrect gestational dating
Fetal death
Placental abnormalities
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36
Q

What is reduced MSAFP (<0.5 MoM) associated with

A

Trisomy 21 and 18
Fetal demise
Inaccurate gestational dating

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37
Q

What is PAPP-A

A

Pregnancy associated plasma protein

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38
Q

What tests are needed to detect down syndrome

A

PAPP-A
Nuchal transparency
Free B-hCG

When conducted together can determine 91% of down’s and 95% of Trisomy 18

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39
Q

Using a quad screen what differentiates trisomy 21 from trisomy 18

A

Trisomy 18: all are decreased

Trisomy 21: MSAFP and Estriol are decreased while Inhibin A and B-hCG are increased

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40
Q

When is an amniocentesis indicated

A
  1. women >35 at time of delivery
  2. conjunction with abnormal quad screen
  3. Rh-sensitized pregnancy to obtain fetal blood type or to detect fetal hemolysis
  4. Evaluate fetal lung maturity
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41
Q

How do you evaluate fetal lung maturity using amniocentesis

A

lecithin-to-sphingomyelin ratio >2.5 or to detect the presence of phosphatidylglycerol

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42
Q

What is the teratogenic defect associated with ACE I

A 
fetal renal tubular dysplasia 
neonatal renal failure
oligohydramnios
intrauterine growth restriction (IUGR)
Lack of cranial ossification
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43
Q

What is the teratogenic defect associated with Alcohol

A

Fetal alcohol syndrome

>6 drinks per day has 40% risk

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44
Q

What are the deficits with fetal alcohol syndrome

A 
growth restriction before and after birth
metal retardation
midfacial hypoplasia
renal defect
cardiac defects
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45
Q

What is the teratogenic defect associated with androgens

A

virilization of females

advanced genital development in males

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46
Q

What is the teratogenic defect associated with carbamazepine

A 
neural tube defects
fingernail hypoplasia
microcephaly
developmental delay
IUGR
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47
Q

What is the teratogenic defect associated with cocaine

A 
bowel atresias
congentital malformation of the heart limbs, face, and GU
Microcephaly
IUGR
Cerebral infarcts
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48
Q

What is the teratogenic defect associated with Diethylstilbestrol (DES)

A

Clear cell adenocarcinoma of the vagina ro cervix, vaginal adenosis, abnormalities of the cervix and uterus or testes, possible infertility

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49
Q

What is the teratogenic defect associated with Lead

A

increased spontaneous abortion (SAB) rate

stillbirths

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50
Q

What is the teratogenic defect associated with Lithium

A

Congenital heart disease (Ebsteins anomaly)

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51
Q

What is the teratogenic defect associated with methotrexate

A

Increased SAB

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52
Q

What is the teratogenic defect associated with organic mercury

A 
Cerebral atrophy
microcephaly
mental retardation
spasticity
seizures
blindness
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53
Q

What is the teratogenic defect associated with phenytoin

A 
IUGR
Mental retardation
microcephaly
dysmorphic craniofacial features
cardiac defects
fingernail hypoplasia
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54
Q

What is the teratogenic defect associated with radiation

A

microcephaly
mental retardation

medical diagnostic radiation delivering < 0.05 Gy to the fetus has no teratogenic risk

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55
Q

What is the teratogenic defect associated with Streptomycin and kanamycin

A

hearing loss

CN VIII damage

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56
Q

What is the teratogenic defect associated with tetracycline

A

permanent yellow brown discoloration of deciduous teeth

hypoplasia of tooth enamel

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57
Q

What is the teratogenic defect associated with Thalidomide

A

bilateral limb deficiencies
anotia and microtia
cardiac and GI abnormalities

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58
Q

What is the teratogenic defect associated with trimethadione and paramethadione

A

cleft lip or cleft palate
cardiac defects
microcephaly
mental retardation

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59
Q

What is the teratogenic defect associated with Valproic acid

A

neural tube defects

minor craniofacial defects

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60
Q

What is the teratogenic defect associated with vitamin A and derivatives

A 
Increased SAB
mircotia
thymic agenesis
cardiovascular defects
craniofacial dysmorphism
microphthalmia
cleft lip or cleft palate
mental retardation
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61
Q

What is the teratogenic defect associated with Warfarin

A

Nasal hypoplasia and stippled bone epiphyses
developmental delay
IUGR
ophthalmologic abnormalities

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62
Q

When does a fetus’s endocrine structures begin to function

A

as early as the 11th week of pregnancy

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63
Q

What are the effects of an increased amount of circulating estrogens

A
  1. increase the maternal hepatic procution of binding proteins such as thyroid binding globulin (TBG) and cortisol binding globulin (CBG)
  2. Inhibit maternal pituitary gonadotropin synthesis and release
  3. Enjance placental production of 11B-hydroxysteroid dehydrogenase
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64
Q

What forms hCG

A

alpha and beta subunits non covalently linked

alpha is similar to alpha subunit in the pituitary gonadotropins (FSH, LH, TSH)

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65
Q

Where is hCG produced

A

exclusively the product of the trophoblast, specifically the syncytiotrophoblast

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66
Q

When will hCG begin to be produced

A

as early as 6-8 days post conception

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67
Q

what is the significance of abnormally low levels of hCG

A

miscarriage

ectopic pregnancy: (value exceeds 2000 mIU/mL and intrauterine pregnancy not visual on ultrasound.

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68
Q

What is the time difference for sensitivity for detecting hCG in the blood versuses serum

A

blood is 6-8 days of ovulation
urine is 14 days of ovulation

ONLY after implantation

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69
Q

how long after a pregnancy can hCG be detected

A

4 weeks for normal pregnancy

10 weeks for first trimester abortion or elective early termination

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70
Q

What are the biologic functions of hCG

A
  1. maintain the corpus luteum and continue progesterone production
  2. regulate fetal testicular testosterone production
  3. TSH like properties
  4. Clinical uses
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71
Q

When is hPL formed

A

as early as 3 weeks post conception and secreted from the synctiotrophoblast

Detectable in maternal serum after 6 weeks

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72
Q

What is the biologic function of hPL

A
  1. induces lipolysis and increases maternal free fatty acids, ketones, and glycerol, which provide energy for the mother
  2. increased insulin levels
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73
Q

What are the 3 potential sources of prolactin

A
  1. anterior lobe of the maternal pituitary gland
  2. anterior lobe of the fetal pituitary gland
  3. decidual tissue of the uterous
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74
Q

What is the biologic function of prolactin

A
  1. preparing the mammary glands for lactation
    a. stimulates growth of mammilary tissue
    b. lactation does not occur during pregnancy because estrogen inhibits the action of prolactin on the breast
  2. Decidual prolactin regulates fluid and electrolytes of the amniotic fluid
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75
Q

Where is progesterone produced in the pregnant state

A
  1. corpus luteum until the 7th week

2. Placenta after the 8th week

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76
Q

What is the biologic function of progesterone

A
  1. prepares the endometrium for implantation of the embryo
  2. relaxes the myometrium
  3. prevents rejection of the fetus by the maternal immune system
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77
Q

What is a progesterone receptor antagonist

A

mifepristone

used as as an abortifacient in the first trimester

78
Q

What are the 3 estrogens and what is the production ratio

A
  1. estrone (14%) - 1 OH
  2. estradiol (5%) - 2 OH
  3. Estriol (81%) - 3 OH

later in the pregnancy estriol is produced almost exclusively by the placenta

79
Q

Can estrogens be produced in the placenta

A

NO

due to a lack of the enzyme necessary to confer pregnenolone to androgen precursors

80
Q

What is do low levels of estrogen signify

A
  1. fetal demise
  2. anencephaly
  3. Maternal ingestion of corticosteroids
  4. placental sulfatase deficiency
81
Q

What are the biologic activities of estrogen

A
  1. stimulate receptor mediated LDL uptake by the placenta
  2. Increases blood flow to the uterous
  3. Regulates end-of-gestation events

Estrogen stimulates epithelial cell proliferation in human breast tissue. However, milk release is delayed until estrogen levels decrease after delivery

82
Q

What increases myometrial gap formation

A

Estriol

83
Q

What suppresses maternal lympohocyte activity

A

Progesterone

84
Q

What is necessary fro development of male external genitalia

A

hCG

85
Q

What is the most sensitive marker for abnormal karyotype

A

hCG

86
Q

What elevates ketone levels

A

hPL

87
Q

What hormone is produced by the uterus

A

prolactin

88
Q

What inhibits lactation during pregnancy

A

Estriol

89
Q

Lack of this hormone can cause spontaneous abortion in the first trimester

A

Progesterone

90
Q

Lack of this hormone is associated with an enzyme deficiency in the placenta

A

Estriol

91
Q

Elevated levels of this hormone are associated with twin pregnancy

A

hCG

92
Q

Anencephaly causes ack of production of this hormone

A

Estriol

93
Q

Where are gases and nutrients exchanged between mother and fetus

A

The villi of the placenta

94
Q

What is the function of the placenta

A
  1. Mother to fetus transfer of nutrients
  2. Gas exchange
  3. Secretion of proteins and steroids
    a. Progesterone is produced by the placenta from maternal cholesterol
    b. Estrogen is converted from circulating fetal androgens produced in the fetal adrenal glands
95
Q

How does the placenta immunologically protect itself from the mother

A

Invadinging placental cells express a unique antigen, HLA-G which is not recognized as a “foreign” antigen by the mother

96
Q

What forms the umbilical cord

A

Two umbilical arteries originate from the fetal aorta

one umbilical vein returns nutrient rich, oxygen rich blood to the fetus

97
Q

What are the amniotic membranes

A

Amnion: a single layer of epithelial cells surrounding the fetus and containing the amniotic fluids

Chorion: lies adjacent to the uterine endometrium, is exterior and fused to the amnion

98
Q

Where is amniotic fluid derived

A

primarily from the fetal urine. It is important for the successful development of the bronchial tree

99
Q

What are the requirements for fetal metabolism

A
  1. oxygen
  2. glucose
  3. amino acids
100
Q

What is the rate of fetal oxygen metabolism

A

8 ml/kg/min

normal adult is 3 ml/kg/min

101
Q

Where does the umbilical vein give branches

A

to the liver and becomes the ductus venosus

102
Q

What is the function of the ductus venosus

A

mixes maternal oxygenated blood with fetal deoxygenated blood and flows into the IVC

103
Q

What is the foramen ovale

A

a right to left intracardiac (atrial) shunt

104
Q

What promotes closure of a PDA

A

prostaglandin inhibitors

105
Q

What is the function of the ductus arteriosus

A

connects the left pulmonary artery to the arch of the aorta

106
Q

What maintains the patency of the ductus arteriosus

A

Prostaglandin E

107
Q

What does the fetal umbilical vein become in the neonate

A

ligamentum teres

108
Q

The intra abdominal portion of the umbilical arteries of the fetus become what in a neonate

A

lateral umbilical ligaments

109
Q

What is the normal fetal HR

A

120-160

110
Q

What is the cardiac output of a normal fetal heart

A

200 mL/kg/min

normal adult is 70 mL/kg/min

111
Q

when do fetal lungs begin to produce surfactant

A

34 weeks

from type II pneumocytes

112
Q

What is the function of surfactant

A

lowers the surface tension in the alveoli and prevents collapse

113
Q

How is fetal hepatic conjugation of bilirubin

A

deficient, and a mild hyperbilirubinemia may be seen for the first few days of life

114
Q

Where does hematopoiesis occur

A

2 weeks: yolk sac
5 weeks: spleen and liver
11 weeks: bone marrow

115
Q

What composes fetal hemoglobin

A

Fetus: 2 alpha and 2 gamma
Adult: 2 alpha and 2 beta

At term about 70% hemoglobin is fetal

116
Q

What is the function of the thyroid in fetal development

A

important for normal neurological development

117
Q

What is the most common immunoglobulin found in the fetus

A

IgG

Only IgG can cross the placenta

118
Q

What are some presumptive symptoms of pregnancy

A
  1. amenorrhea
  2. breast changes
  3. Nausea (morning sickness)
  4. Disturbances in urination
  5. Fatigue
  6. Sensation of fetal movement
119
Q

What is quickening

A

the sensation of fetal movement. Usually between the 16th and 20th week

120
Q

What is hegar’s sign

A

Softening between the cervix and the uterine fundus causes a sensation of separateness between these two structures

121
Q

what is chadwicks sign

A

the vaginal mucosa has a bluish color within the first 6-8 weeks of pregnancy

122
Q

How is pregnancy confirmed

A

Only two ways

  1. Identification of fetal heart beat (120-160)
  2. Ultrasonographic representation of a fetus
123
Q

How is EDC (estimated date of confinement) determined

A

9 calendar months plus 7 days from FDLMP
or
counting back 3 calendar months and adding 7 days to the FDLMP

124
Q

What is the viability of life if birth occurs in the end of the second trimester

A

80-90%

125
Q

What is lightening regarding pregnancy

A

the descent of the fetal head to or even through the pelvic inlet due to the development of a well formed lower uterine segment and a reduction in the volume of amniotic fluid

126
Q

Regarding pregnancy what is a bloody show

A

a discharge of a combination of blood and mucus caused by thinning and stretching of the cervix, is a sure sign of the approach of labor

127
Q

What is placenta previa

A

The placenta developing in the lower uterine segment an completely or partially covering the internal os.

Usually painLESS heavy bleeding

128
Q

What is abruptio placenta

A

premature separation of the normal implanted placenta.

usually painful bleeding

129
Q

What is normal fetus weight at 26, 36, and 40 weeks respectively

A

1000g (more than lbs)
2500g (5.5 lbs)
3300g (7-7.5 lbs)

130
Q

What are good indications of fetal lung maturation with reduced risk of RDS

A

Leithin-to-sphingomyelin (L/S) Ratio of or greater than 2:1

A greater indicator is presence of phosphatidylglycerol

131
Q

What accelerates fetal lung maturation

A

Glucocorticoids.

Stress will increase fetal cortisol production.
Administration of maternal glucocorticoids

132
Q

What are the types of fetal presentation

A
  1. Cephalic
    a. Vertex (chin in) (95%)
    b. Face (Neck extended)
    c. Brow (slightly extended but will convert to a vertex or a face during labor)
  2. Breech presentation
    a. Complete
    b. Incomplete
    c. Frank
133
Q

What is a complete breech presentation

A

both the legs and the hips are flexed

134
Q

What is an incomplete breech presentation

A

one hip is not flexed, and on foot or knee lies below the breech

135
Q

What is a frank breech

A

the hips are flexed and the legs are extended

136
Q

What is puerperium

A

period of 4-6 weeks and starts immediately after delivery and ends when the reproductive tract has returned to its nonpregnant condition

137
Q

How does breast feeding accelerate involution of the uterus

A

stimulation of the nipples releases oxytocin from the neurohypophysis; the resulting contractions of the myometrium facilitate the involution of the uterus

138
Q

What is lochia

A

uterine discharge that follows delivery and last for 3-4 weeks. Foul smelling lochia suggests:

  1. lochia rubra: blood stained fluid last for the first 3-4 days
  2. lochia serosa: discharge appears 3-4 days after delivery. It is paler than lochia rubra because it is admixed with serum
  3. Lochia alba: after the 10 day, because of admixture with leukocytes, the lochia assumes a white or yellow-white color
139
Q

What kind of contraception can lactating mothers use

A

Progesterone only oral contraceptions as soon as their milk supply is established.

Progesterone only contraceptives do not appear to have adverse effects on lactation.

140
Q

What is the most common cause of postpartum hemorrhage

A
  1. Uterine atony (most common)
    a. general anesthesia
    b. multiple fetuses
    c. prolonged labor
    d. rapid labor
    e. high parity
    f. vigorously stimulated with oxytocin
  2. Retention of of placental tissue
141
Q

What are some uterine contracting agents

A

Oxytocin
methylergonovine
Prostaglandin F(2a)

142
Q

What is a puerperal infection

A

infection of the GU tract during the puerperium accompanied by a temperature of 100.4 or higher that occurs for at least of the first 10 days after postpartum EXCLUSIVE of the first 24 hours

143
Q

How is milk production stimulated

A

Prolactin which is released from the anterior pituitary gland

Continuous production is controlled by a stimulus of the breast that curtails the release of prolactin-inhibiting factor from the hypothalamus

144
Q

What is responsible for milk let down

A

Oxytocin released from the posterior pituitary

145
Q

What kind of drugs or excreted in high concentrations in breast milk

A

lipid soluble drugs

146
Q

What are the two phases of the menstrual cycle and how do they differ in duration

A

Follicular is the 1st half and is variable in length.

Secretory phase is the second half and is fixed at 12-16 days

147
Q

How is EDC determined

A

EDC is determined by using naegele’s rule.

When FDLMP is uncertain, ultrasound can be used.

Use LMP unless

  1. Ultrasound dating in 1st trimester differs by more than 7-10 days
  2. Ultrasound dating in 2nd trimester differs by more than 14 days
  3. Ultrasound dating in 3rd trimester differs by more than 21 days.
148
Q

Foamy white vaginal liquid with a strawberry discoloration of the cervix is suggestive of what

A

Trichomonas

149
Q

White curdy vaginal discharge is suggestive of what

A

candida

150
Q

Foul-smelling, gray discharge may indicate what

A

bacterial vaginosis

151
Q

What is the diagonal conjugate

A

measured from the sacral promontory to the anterior inferior pubic symphysis. can be measured on on pelvic examination

152
Q

what is the obstetric conjugate

A

the length from the sacral promontory to the posterior pubic symphysis. Measurement is determined by subtracting 1.5 to 2 cm from the diagonal conjugate.

The obstetric conjugate is the shortest anterior posterior diameter through which the fetal head must pass.

153
Q

What are the for pelvic types

A

Android
gynecoid
platypelloid
anthropoid

154
Q

Describe the gynecoid pelvis

A 
Most common type (50%)
Overall shape is round 
posterior sagittal diameter of the inlet is only slightly shorter than the anterior sagittal diameter.
Ishial spines are not prominent
Wide pubic arch
155
Q

Describe the android pelvis

A

overall shape is heart like
posterior sagittal diameter of the inlet is much shorter than anterior sagittal, limiting the space for the fetal head
ischial spines are prominent
Narrow pubic arch

156
Q

Describe the anthropoid pelvis

A

Overall shape is long and oval
Anteriorposterior diameter is greater than the transverse
prominent ischial spines
narrow pubic arch

157
Q

Describe the platypelloid pelvis

A

Least frequent

flattened shaped with short anterioposterior diameter and wide transverse diameter

158
Q

What women should be offered genetic testing

A

All women.

Women over the age of 35 should be offered genetic testing through chorionic villous sampling or amniocentesis

159
Q

When is the quad screening performed

A

15-21 weeks

160
Q

What is the difference between integrated and sequential screening

A

sequential screening: the results of the first trimester screenings are released to the patient and the provider

Integrated screening: the result of the first trimester test is withheld and incorporated into a final overall risk assessment

161
Q

What is the frequent of prenatal visits

A

every 4 weeks until 24-28 weeks
every 2 weeks until 36 weeks
weekly until delivery

162
Q

What amount of weight should be gained during pregnancy

A

Normal BMI: 25-35 lbs
less than 19 BMI: 28-40 lbs
more than 29 BMI: 15 lbs

163
Q

How many calories should be taken in during pregnancy

A

2500

164
Q

What food items should be avoided during pregnancy

A

unpasteurized cheeses
raw shellfish
fish that have high mercury levels

165
Q

What is the effects of caffeine during pregnancy

A

greater than 5 cups per day has been associated with an increased risk of spontaneous abortion

166
Q

Are whites or black mothers a greater risk during pregnancy

A

Blacks:
4X higher maternal mortality
2X perinatal mortality

167
Q

What is the perinatal period

A

20 weeks gestation - 28 days after birth

168
Q

What are some items that increase risk in pregnant patients

A 
Low socioeconomic status
Maternal age Less than 20
Maternal age greater than 35
Substance abuse
Domestic Violence
169
Q

How is a short cervical discovered and what are the associated complications

A

Cervical length less than 2.5 cm
Determined by ultrasound at 20-24 weeks.
associated with risk of preterm birth

170
Q

What are the contraindications for a vaginal birth after cesarean

A

Classical uterine incision
Active herpes infection
Myomectomy
Placenta previa

171
Q

What is eisenmengers syndrome

A

he process in which a left-to-right shunt caused by a congenital heart defect causes increased flow through the pulmonary vasculature, causing pulmonary hypertension,[1][2] which in turn causes increased pressures in the right side of the heart and reversal of the shunt into a right-to-left shunt.
In adults, the most common causes of cyanotic congenital heart disease are Eisenmenger syndrome and tetralogy of Fallot. Eisenmenger’s syndrome specifically refers to the combination of systemic-to-pulmonary communication, pulmonary vascular disease, and cyanosis.

172
Q

What happens to clotting factors during pregnancy

A

Increased production of clotting factors by the liver.

Increases the risk of thromboembolic events

173
Q

What congenital abnormality in the fetus is associated with maternal Rho and La antibodies

A

associated with greater risk of congenital hear blocks

174
Q

What is consanguinity

A

marriage between close relatives

175
Q

What effect may the use of Paxil (paroxetine) have on fetal development

A

greater risk for fetal cardiac malformations

176
Q

When is a gestational diabetes screen completed

A

24-28 weeks with a 1 hour 50g glucose test

177
Q

What can be used to reduce incidence of neural tube defects

A

0.4 mg folic acid daily reduces incidence in the general population by 50%

4 mg daily in patients with previous NTD pregnancies will reduce risk by 70%

178
Q

What is the most common cause of inherited mental retardation

A

Fragile X

179
Q

What is the inherritance pattern of fragile x

A

X linked recessive

180
Q

When are serum markers drawn during pregnancy

A 
First trimester ( 10weeks 4 days - 13 weeks 6 days)
Included are:
MSAFP
B-hCG
PAPP-A
Second trimester (15-22 weeks)
Included are:
MSAFP
B-hCG
Estriol
Inhibin A
181
Q

What invasive testing is done in the first trimester

A

CVS (Chorionic Villus Sampling)

done in weeks 10-12

Risk of fetal loss is 1%

Rh negative women who are not sensitized receive Rho(D) immune globulin after the procedure

182
Q

What invasive testing is done in the second trimester

A

Amniocentesis

Risk of loss is 0.25 - 0.5%

If conducted in the 3rd trimester, the risk of preterm delivery is 1-2%

Rh negative women who are not sensitized receive Rho(D) immune globulin after the procedure

183
Q

An increase in NT (nuchal translucency) is suggest what

A

Trisomy 18 or Trisomy 21

Estriol is increased with 18
Estriol is decreased with 21

184
Q

What is the most common inherited disorder in caucasions

A

Cystic fibrosis

Carrier rate is 1 in 25

185
Q

What is the most common mutation associated with CF

A

Delta F508

There are 23 mutations that are tested in genetic screens which accounts for 80% of cases

It is an autosomal recessive trait

186
Q

What are the 3 types of normal hemoglobin

A

Hemoglobin A: 2 alpha and 2 Beta chains (95%)
Hemoglobin A2: 2 Alpha and 2 delta
Hemoglobin F: 2 alpha and 2 Gama

187
Q

What is the most common inherited trait in african americans

A

Sickle Cell
Frequency of trait is 1 in 12
Autosomal recessive inheritance

188
Q

What is Tay Sachs disease

A

the congenital absence of the enzyme hexosaminidase A, which results in an over accumulation of GM2 gangliosides, leading to severe progressive neurologic disease causing death in early childhood

Carrier rate in Ashkenazi Jews is 1 in 30

Autosomal recessive inheritance

189
Q

What is an ultrasound

A

low energy high frequency sound wave

Frequencies between 3.5 and 5 MHz

190
Q

What are the determining factors for amniotic fluid on ultrasound

A

Measurement of the deepest single pocket of amniotic fluid

8cm polyhydramnios

191
Q

How is fetal well being measured during a 3rd trimester ultrasound

A

Biophysical profile

  1. Amniotic Fluid
  2. Fetal Tone
  3. Fetal Movements
  4. Fetal breathing
  5. Nonstress test

score of 2 is normal 0 is abnormal for each section. Total score of 8-10 is normal

192
Q

When is fetal echocardiography indicated

A 
Risk factors for CHD (congenital heart disease)
suspected CHD's on ultrasound
suspected fetal arrhythmia
other congenital abnormality
nonimmune hydrops fetalis

OB/GYN (4 decks)

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