Preconception & Fetal Mortality

Question 1

This is defined as 28 days gestation up until the first 7 days after birth?

Answer 1

Perinatal period

Question 2

This time period is described as starting at birth and ending at year one?

Answer 2

Infant

Question 3

Birth to 28 days old describes what period?

Answer 3

Neonatal

Question 4

This is an infection of the placenta and amniotic fluid and can cause fetal death?

Answer 4

chorioamnionitis

Question 5

Placental development begins ____ days after conception?

Answer 5

7

Question 6

What is Baker Hypothesis?

Answer 6

That poor placental development is linked to:
-preeclampsia
-low birth weight
-preterm birth
-growth restriction in utero

This causes the fetus to have future chronic medical conditions

Question 7

Why is the optimal time of birth (or removal from uterus) at a max of 42 weeks?

Answer 7

Because at 42 weeks the placental support of the fetus decreases and the fetus is better off outside the uterus

Question 8

What are the three causes of fetal or perinatal mortality?

Answer 8

1. Fetal issues like low birth weight or congenital abnormalities
2. Placental issue like infection or cord damage
3. Maternal cause like DM, CVD, or extreme age

Question 9

Neonatal mortality is defined as death before the ___ day of life?

Answer 9

28th

Question 10

Neonatal death is usually caused by what 2 major etiologies?

Answer 10

1. Preterm birth issues
2. congenital malformations

Question 11

Most post neonatal deaths are caused by _____?

Answer 11

SIDS

Question 12

What fraction of infant deaths occur in the neonatal period?

Answer 12

2/3

Question 13

What is the most important way to prevent perinatal mortality?

Answer 13

Get pregnant person to stop smoking or reduce drastically for better outcome

Question 14

What are the two categories that describe causes for maternal deaths?

Answer 14

1. Direct: hemorrhage in birth or preeclampsia
2. Indirect: exacerbation of current condition like DM ,CVD

Question 15

Black, Alaskan native, and American Indian patients are _______ times more likely to die from pregnancy than a white person?

Answer 15

2-3

Question 16

If a patient with asthma is pregnant what drugs should they avoid for this condition and what can they take?

Answer 16

Avoid oral corticosteroids
Use inhaled corticosteroids

Question 17

In what case could a pregnant person take oral corticosteroids for asthma?

Answer 17

If there asthma is severe and uncontrolled because this poses a bigger risk to mom and fetus than the effects of the drug

Question 18

What drugs are contraindicated in pregnancy when treating hypertension and what is their impact on the fetus?

Answer 18

ACE inhibitors, ARB’s
- cause renal abnormalities and death to fetus

Question 19

What anticoagulant is a teratogenic drug?

Answer 19

Warfarin

Question 20

Can seizure medications be taken safely in pregnancy?

Answer 20

NO

Question 21

This substance found in the blood has a teratogenic effect on the fetus if too high, and is the most dangerous in the first trimester?

Answer 21

Glucose

Question 22

Pregnant people should have an A1C of ____% or lower?

Answer 22

7%

Question 23

If the pregnant person has this condition the fetus is at increased risk for higher rates of preterm birth, placental abruption, intrauterine growth restriction, preeclampsia, and fetal death?

Answer 23

hypertension

Question 24

If a pregnant person has this condition, its severity is directly related to worse fetal outcomes (worse case of disease =worse fetal outcome)?

Answer 24

Hypertension

Question 25

BMI between ____ & ____ is recommended during pregnancy?

Answer 25

18-24

Question 26

Low risk pregnant patients should take how many milligrams of folic acid daily?

Answer 26

0.4mg

Question 27

Low risk PT should take folic acid starting ____ up until the ______?

Answer 27

from 4 weeks gestation to the 3rd trimester

Question 28

High risk pregnant patients should take _____mg of folic acid daily?

Answer 28

4.0mg

Question 29

When should high risk pregnant PT begin folic acid regimine?

Answer 29

3 months prior to conception

Question 30

If infertility is suspected to be male related, what is the first evaluation?

Answer 30

Semen analysis

Question 31

What is the first step is assessing female driven infertility and what tests are indicated in this step?

Answer 31

Check ovarian function
-TSH
-Prolactin
-Mid-luteal progesterone
-Urinary LH surge

Question 32

What is the second step in assessing female driven infertility and how is this accessed?

Answer 32

Check the ovarian reserve
- if over 35y/o check egg quantity and quality
-use vaginal ultrasound or hysterosalpingogram to count follicles

Question 33

What is the pharmacological treatment for anovulation (2 drugs + a bonus drug)?

Answer 33

1. Clomid - ovulatory stimulant
2. Letrozole - ovulatory stimulant
   Bonus: metformin

Question 34

If a patient is over 35 years of age, when are they considered infertile?

Answer 34

After trying for 6 months - do work up then

Question 35

History of LEEP or CONE procedure, congenital abnormalities, recurrent cervicitis, and hypoestrogenic states can cause what type of infertility?

Answer 35

Cervical cause

Question 36

An abnormal shaped uterus, polyps, fibroids, and Asherman’s can cause what type of infertility?

Answer 36

Uterine

Question 37

Chlamydia infection scarring, toxic fluid filled cysts, or scaring from surgery cause what type of infertility?

Answer 37

Tubal

Question 38

This is the most common type of infertility and is caused by PCOS, hormone dysfunction, and anovulation?

Answer 38

Ovarian

Question 39

The ______ vaccination should be giver between 27-36 weeks gestation to avoid risk of neonatal infection of _______?

Answer 39

TDAP; pertussis