What does hCG do and when is it at its highest level in pregnancy?
HCG prevents corpus luteum involution and suppresses maternal immune function
Highest in 1st trimester
What effect does progesterone have on uterus?
Smooth muscle relaxation — supposed in labor
What effect does estrogen have on uterus?
Regulates progesterone, increases strength of contractions
Fetal significance of placenta previa
Increased risk of preterm delivery, increase risk for fetal anomaly (2.5x)
What are risk factors for placenta abruption?
Maternal hypertension, history of prior abruption, advance maternal age, multiparous, cigarette smoking, cocaine use, trauma, fibroids
What are the types of molar pregnancy?
- Complete: 46XX, mostly paternal origin, no fetus or amnion present, large uterus, 20% trophoblastic tumors, usually have medical complications.
- Partial: 69 XXX/xxy/xyy. fetus is often present, small uterus, rare to have medical complications.
What is the fetal significance of maternal lupus?
Increase incidents of first trimester abortion, intrauterine growth restriction, and fetal death.
Increased risk of congenital heart block, especially if anti-Ro and anti-La antibodies are detected
What is the fetal significance of myasthenia gravis?
Limited fetal effects, usually only a small percentage of antibodies directed towards fetal acetylcholine receptors.
If fetus is affected, usually they present with fetal arthrogryposis.
10 to 20% of neonates have transient symptoms that present within 12 to 48 hours after birth and last anywhere from 18 days to 15 weeks. Presentation includes generalized weakness, weak respiratory muscles, facial weakness, difficulty, swallowing, or feeding, and ocular motor disturbance.
90% of infants with transient symptoms, recover by two months of age
What are fetal effects of diabetes mellitus? (Overall, endocrine/electrolytes, pulmonary, cardiac, CNS, hematologic, GI, GU, and skeletal)
Overall: stillbirth, polyhydramnios, preterm birth, LGA, organomegaly
Endocrine/electorlytes: transient hyperinsulinism, early neonatal hypocalcemia
Pulmonary: surfactant deficiency
Cardiac: HCOM, VSD, TGA, ASD, HLHS, DORV, Truncus
CNS: neural tube defects
Hematologic: polycythemia
GI: duodenal atresia, imperforate anus, situs in versus, small colon
GU: renal agenesis, hydronephrosis, renal vein thrombosis
Skeletal: caudal regression syndrome
Definition of Preeclampsia
Systolic >= 140
Diastolic >= 90
What is HELLP syndrome
Hemolysis (elevated LDH or bilirubin)
Elevated Liver Enzymes
Low Platelets (less than 100K)
What can be associated with a single umbilical artery?
Anomalies of the urogenital tract, gastrointestinal tract or cardiac system
Consider chromosomal anomalies
What is associated with velamentous insertion of the umbilical cord?
Occurs when the umbilical cord inserts outside of the placenta
Increase risk of intolerance of labor.
Increased risk, a prematurity and low birth weight
Occurs in almost all triplet gestations
What is associated with vasa previa?
Fetal blood loss due to rupture of the umbilical vessels.
Prenatal diagnosis should lead to planned cesarean section
What creates Alpha-Fetoprotein (AFP)?
Early vs Late
Early — fetal yolk sac
Late — fetal liver and GI tract
What is associated with elevated AFP (>2-2.5)?
Open neural tube defects
Omphalocele/gastroschisis
GI obstruction
Polycystic kidneys
Multiple gestation
Low birth weight
What is associated with low AFP (<0.6)?
Trisomies
Fetal death
When do you measure nuchal translucency? What is abnormal and what can it signify?
Measured between 10-14 weeks
>3mm is abnormal
Increase risk of aneuploidy (1 out of 6) or cardiac anomaly
When combined with maternal age risk, how is nuchal translucency detection of trisomy 21? Trisomy 18?
21: 78-89%
18: 91%
What is absent nasal bone associated with?
T21
What are the components of the quad screen?
Maternal AFP, Maternal estriol, Maternal B-hCG, and inhibin A
Low AFP, high B-hCG, low estriol, and high inhibin A
Trisomy 21
75-81% detection
Low AFP, low B-hCG, low estriol, normal inhibin A
T18
What trisomy can quad screen not detect?
T13
