Definition of PEC.
Definition of SEVERE PEC?
SBP>140 or DBP>90 more than twice
severe: SBP>160 or DBP>90
definition of PEC
140/90 on 2 occasions
severe: 160/110
Early decels in a fetal tracing are due to what?
Head compression (changes cerebral blood flow -> vagal deceleration in HR)
Which leads to more hypoglycemia at birth? Symmetric or asymmetric IUGR?
What’s the etiology of both?
Asymmetric - more hypoglycemia
-uteroplacental insufficiency: diabetes, PEC, cHTN
Symmetric has relatively normal glycogen and fat stores
-etiology: chromosomal, congenital infections, some IEM, familial
Variable decels in fetal tracing are due to what?
Umbilical cord compression
Looks like letters U, V, W
Usually does not have a consistent relationship with contractions
Late decels in fetal tracing are due to what?
Uteroplacental insufficiency
-if loss of variability, ominous
-maternal hypotension
-uterine hyperstimulation
-placental dysfunction
-PEC, maternal diabetes
Definition of category III tracing?
Absent fetal FHR baseline variability with one of the following:
-bradycardia
-recurrent late decels
-recurrent variable decels
Or sinusoidal pattern (severe anemia, fetomaternal hemorrhage, asphyxia)
Umbilical arterial gas in comparison to umbilical venous gas has higher or lower of these?
pH
CO2
O2
Umbilical arterial gas ALWAYS has lower pH, lower O2, higher CO2
Air bubble will increase pH, decrease -CO2, increase po2
CRH role and concentration with increasing GA
-Levels increase with increasing GA
-peak at delivery
-also fetal lung maturation, potentiation of estrogen, prostaglandin, oxytocin effects
Prostaglandins E and F role in fetal life
Levels increase prior to labor onset to synchronize uterine contractions, ripen cervix, increase myometrial sensitivity to oxytocin
Benefits of antenatal steroids
-lower incidence RDS, NEC, IVH
Which maternal med causes these findings: CHD, microtia/anotia, anterolateral displacement of hair whorl, hjypertelorism, down slanting palpebral fissures, depressed nasal bridge, triangular fancies due to hypoplastic maxilla, cleft palate, facial nerve paralysis, narrow sloping forehead
Neuro- hydrocephalus, cerebellar hypoplasia, microcephaly, mental deficiency
Other-thymic and parathyroid issues, limb reduction
Isotretinoin
Which maternal med causes these findings: neural tube defects, hypospadias,
Face: narrow bifrontal diameter, high forehead, epicanthic folds, broad nasal bridge, short nose, anteverted nostrils, midface hypoplasia, long philtrum, small mouth
CHD
Long thin fingers and toes, hyper convex fingernails
Valproic acid
Which maternal med causes these findings:
Craniofacial defects, finger nail hypoplasia, growth restriction
Neural tube issues - esp meningomyelocele, developmental delay,
Decreased vit K placental transfer and thus increased risk of hemorrhagic disease of the newborn
Carbamazepine
Which placental hormone has TSH like effects?
hCG
Which placental hormone is diabetogenic causing GDM, anti-insulin type effects in mother to stimulate fetal growth
hPL aka human chorionic somatomammotropin (hCS)
How does bilirubin cross the placenta? Unbound vs bound?
Unbound: simple diffusion
Bound: cannot cross
Polydactyl, hypospadias, meningomycelocele, craniosynostosis. What medication was mother taking?
Valproate
Distal nail hypoplasia, IUGR, intellectual deficits, facial dysmorphisms. What medication was mother taking?
Phenytoin. This is fetal hydantoin syndrome
Phenytoin predominantly affects limbs (digital hypoplasia), facial features, and neurodevelopment, while isotretinoin causes more severe CNS malformations, ear abnormalities, and endocrine dysfunction
Antenatal steroids <37 weeks decrease risk of:
Perinatal death (average risk ratio [RR] 0.72, 95% confidence interval [CI] 0.58-0.89)
Neonatal death (average RR 0.69, 95% CI 0.59-0.81)
Respiratory distress syndrome (average RR 0.66, 95% CI 0.56-0.77)
Moderate/severe respiratory distress syndrome (average RR 0.59, 95% CI 0.38-0.91)
Need for mechanical ventilation (average RR 0.68, 95% CI 0.56-0.84)
Intraventricular hemorrhage (average RR 0.55, 95% CI 0.4-0.76)
Necrotizing enterocolitis (average RR 0.5, 95% CI 0.32-0.78)
Systemic infections in the first 48 hours after birth (average RR 0.6, 95% CI 0.41-0.88)
