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MFM Flashcards

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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
what are the measures on ultrasound that estimate GA? when is the best time
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
26
stages of fetal growth
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
27
ponderal index =
(weight (g) x 100)/ (crown-heel)^3
28
timing of splitting of twins
DCDA: < 3d MCDA 4-7d MCMA 8-13 conjoined 13-15
29
cellphase at time of splitting of twins
DCDA: morula MCDA: blastocyst MCMA: implanted blastocyst
30
MC type of twin
MCDA
31
NST reactive -
>2 accelerations in 20 minutes with fetal movements and increased HR > 15 lasting >15 seconds
32
BPP parts
1. NST 2. fetal movement 3. breathing 4. tone 5. AFV
33
early deceleration
head compression --> cerebral blood flow --> vagal deceleration of HR
34
variable deceleration
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
late deceleration
uteroplacental insufficiency: 1. fetal chemoreceptors > alpha adrenergics > BP > baro > parasympathetics > late decel 2. myocardial depression
36
differences in paO2 by vessel
maternal uterine artery > maternal uterine vein > UV > UA
37
differences in paCO2 by vessel
UA> UV/uterine vein > uterine artery
38
differences in pH by vessel
uterine artery > UV/uterine vein > umbilical artery
39
MoA terbutaline
b2 agonist --> cAMP --> decrease intracellular Ca --> decrease uterine contractiliy
40
MoA Mg sulfate
decrease Ach release from NMJ (Ca antagonist) --> decrease uterine contractility
41
MoA indomethacin
Pg synthase inhibitor
42
MoA nifedipine
CCB --> decrease uterine contractility
43
teratogen effect of captopril/enalopril
potters syndrome 2nd/3rd trimester renal
44
teratogen effect of alcohol
facial VSD, ASD, ToF microcephaly, NDI/motor IUGR
45
teratogen effect of carbamazepine
finger hypoplasia FGR NTD NDI decreased vit K
46
teratogen effect of cocaine
still birth abruption skull/cutis aplasia/porencephaly ileal atresia, cardiac anomalies
47
teratogen effect of cyclophosphamide
limbs cleft single coronary imperforate anus FGR/microcephaly
48
teratogen effect of phenytoin
Hypoplasia digit/nail Hernias Hypospadius Heart: pulmonary or aortic valvar stenosis/VSD IUGR
49
teratogen effect of isoretinoin
TGA, TA, ToF, VSD, DORV, hypoplastic arch microtia hydrocephalus thymic/parathyroid
50
teratogen effect of warfarin
stippled bone epiphysis nasal hypoplasia MR
51
AFP timing of fetal and maternal peaks
fetal peaks 13 weeks maternal detected at 12 weeks then peaks at 32
52
GDM timing of screening
24-28 weeks
53
measles or mumps? increased risk of SAB in first trimester
mumps
54
fetal weight is estimated based on what 4 parameters
1. abdominal girth 2. biparietal diameter 3. head circumference 4. femur length
55
what is a specific measurement for asymmetric growth restriction?
ponderal index
56
amnion nodosum
small yellowish nodules in amion seen with oligohydramnios (maternal DM, TTTS, PPROM)
57
hormones produced by syncytiotrophoblast
human placental lactogen estrogen leptin progesterone | HELP
58
MC complication of pregnancy in women with Marfans
preterm delivery
59
what supplement helps reduce maternal lead level?
calcium
60
subnecrotizing funisitis is associated with what?
chronic lung disease
61
primary marker of fetal aneuploidy
nuchal translucency
62
IUGR infants MC neuro deficit
ADHD
63
MC complication in late preterm
jaundice
64
acute villositis with neutrophillic infiltration and microabscess formation
listeria
65
protein associated with thrombotic features of APS
B2 glycoprotein 1
66
neonatal complications associated with maternal intrahepatic cholestasis of pregnancy
- surfactant deficiency - meconium aspiration - bile acid pneumonia
67
what deficiency is associated with maternal intrahepatic cholestasis of pregnancy
selenium
68
Quintero stages
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
chronic infectious villositis
CMV
70
which ART is associated with highest risk of genomic imprinting?
intracytoplasmic sperm injection
71
hormones that are produced by mom acting on placenta and transferred to fetus
TH, oxytocin and estrogen
72
hormones produced by fetus, altered by placenta and transferred to mother
DHEA
73
hormones produced by placenta and transfered to mom? or fetus?
hcG IGF2
74
MC substance abused during pregnancy
tobacco
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