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MFM Flashcards

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1
Q

MCC of infant death in 🇺🇸

A

Congenital anomalies/ chromosomal (21%)
Disorders related to Prematurity (17%)
SIDS (6.5%)

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2
Q

MC presentation of acute chorio

A

Absent clinical manifestation
*Placental pathology is required to confirm
Associated with preterm birth

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3
Q

Primary marker for detection of fetal aneuploidy

A

Nuchal translucency
> 3mm - has 1 out of 6 risk for aneuploidy
Obtained between 10-15 weeks

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4
Q

MC perinatal complications in late preemies compared to term

A

Jaundice is the MC complication (50%)

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5
Q

Wedge shaped mass in lung with systemic arterial supply on fetal MRI. Dx?

A

Bronchopulmonary sequestration (doesn’t communicate w tracheobronchial tree)

CPAM can be macrocystic (MC) or microcystic and located anywhere in lung. Communicates w tracheobronchial tree w pulmonary circulation

CLE hyper inflated lung tissue w predisposition for upper lobes. Can appear similar to microcystic CPAM

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6
Q

Antiphospholipid antibodies associated with pro coagulant state

A

Lupus anticoagulant
Anticardiolipin Abs
Anti Beta 2 glycoprotein Abs

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7
Q 
How does the following change in pregnant women? 
HR
Blood volume 
CO/SV 
SVR
A

HR increases 10-20%
Blood volume increases 30% (ie relative anemia)
CO increases 30-50%
SVR decreases by 20%

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8
Q

Role of progesterone

A

Maintains uterus in relaxed state
Anti-inflammatory and immunosuppressive- protects fetus from rejection by pregnant woman
Highest levels at the end of pregnancy

IOL requires withdrawal of progesterone receptor function–> mediated by decrease in progesterone receptors.

Estrogen contributes to labor by increasing uterine contraction
(Allowed by functional suppression of progesterone)

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9
Q

The greatest risk of congenital malformations in a diabetic mother occur with poor glucose control ____ of pregnancy

A

Prior to conception and 1st trimester

Fetal malformations are 2-4x higher in 🤰🏽 with diabetes compared to population

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10
Q

Risk of congenital anomalies with diabetes

A

If 👩🏽 achieves glycemic control PRIOR to pregnancy- risk of fetal anomalies is 2.5%

If 👩🏽 achieves glycemic control AFTER becoming pregnant, risk of fetal anomalies is 7.8%

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11
Q

Most common congenital anomaly with gestational diabetes

A

Caudal regression syndrome

impaired development of lower half of body

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12
Q

Maternal risk factor with Highest likelihood ratio for the development of preeclampsia

A

Chronic hypertension

Then APS

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13
Q

What are lacunae on ultrasound used to diagnose

A

The presence of Lacunae lakes is used to diagnose abnormalities in placental implantation (ie - placental accreta)

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14
Q

What is the greatest risk factor for demise of recipient twin in TTTS?

A

Evidence of cardiomyopathy

Cardiac function of recipient twin

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15
Q

What is the most significant risk factor for preterm birth?

A

Prior preterm delivery
Other risks: young or AMA, Multiple gestations, chorio, etc.

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16
Q

Describe changes in immunity during pregnancy relating to helper T cells

A

Downregulation of maternal immunity

Switch from TH1 cellular immunity to TH2 antibody mediated immunity

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17
Q

How is glucose and cephalexin transplacentally transferred?

A

Facilitated diffusion

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18
Q

How are lipids and fat soluble vitamins transplacentally transferred?

A

Simple diffusion

Similar to O2 CO2 Na Cl and most meds

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19
Q

How are amino acids and H2O-soluble vitamins transferred?

A

Active transport

Similar to Ca Ph Mg Iron and Iodide

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20
Q

How are immunoglobulin G antibodies transferred?

A

Pinocytosis

Similar to other proteins

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21
Q

Marfan syndrome characteristics

A

AD
Gene: fibrillin 15q21.1
Dilated aortic root, MVP
Lens subluxation (upward)

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22
Q

Highest risk to the fetus with IVF

A

Multiple gestation

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23
Q

Risk factors for abnormal placentation (accreta, increta, percreta)

A

co-existing previa, MCC Uterine surgery (includes C/S), Multiparity

Accreta - implantation of the placenta that is deeper into the uterus than usual

Increta -Invades myometrium

Percreta - Penetrates, invades other organs

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24
Q

Common Neonatal findings in baby’s born to preeclamptic mothers

A

Thrombocytopenia
Neutropenia

*Usually seen with growth restricted

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25
What is the MCC of chronic infectious villositis (hint: intranuclear/cytoplasmic inclusion)?
CMV
26
What is the MCC of fetal overgrowth in pregnancies with diabetes
Fetal hyperinsulinemia
27
Neonates born to mothers with APS are at high risk of?
Preterm birth SGA
28
Magnesium sulfate in preeclampsia reduces which maternal morbidities?
Progression to eclampsia 60% | May decrease risk placental abruption
29
MC pregnancy specific complication of APS?
Preeclampsia (50%) preterm birth (30%) IUGR (30%)
30
What is a long term neonatal adverse outcome for Fetal thrombotic vasculopathy ?
Neurologic stroke Encephalopathy CP
31
Teratogen exposure during which period is most likely to lead to deleterious effects?
0-12 weeks during organogenesis
32
Mother with Maculopapular rash starting in face, posterior auricular lymphadenopathy and prodromal symptoms. What is the neonate affected with and clinical features?
Rubella Neonate clinical features: Cataracts PDA, Peripheral pulmonary artery stenosis Microcephaly Highest risk in first 12 weeks (most develop cardiac defects) Sensorineural hearing loss
33
Common neonatal presentation of Cosackieviruses
``` Maculopapular rash (viral exanthem) Myocarditis ``` Type B associated with cardiac issues
34
Which torch infection can lead to hypertrophic cardiomyopathy?
Parvovirus B19 Viremia (fever, flu like symptoms) Althralgia/rash (immune mediated) Suppression of erythropoiesis leading to anemia and hydrops if severe In some fetuses it can lead to hypertrophic cardiomyopathy Highest risk for hydrops is 1st trimester
35
Highest sensitivity of maternal serum AFP occurs at what gestational age?
Greatest sensitivity between 16-18 weeks Fetal AFP: peaks at ~13 weeks gestation correlates with fetal serum AFP
36
Complications of nifedipine as a tocolytic?
Fetal hypotension
37
What are the characteristics of amniotic fluid (AF)?
Osmolality decreases with increasing gestational age (2nd trimester - due to increased fetal urine production) AF volume + AFI (index) with bell shaped curve
38
What are the sources of AFV Production and Clearance During the 3rd Trimester?
- majority of AFV production is from fetal urine. - small amount of fetal lung fluid exits the lungs. - majority of AFV clearance is due to fetal swallowing - 2nd most important clearance mechanism is direct absorption of AF from the amniotic sac into fetal blood vessels within the placenta (i.e., intramembranous).
39
Types of Decelerations of FHR
Early —-> head compression Variable —-> umbilical cord compression (u, v, w pattern) Late —-> utero placental insufficiency Sinusoïdal pattern —-> ominous assocd with severe anemia
40
What is associated with fetal tachycardia ?
Fetal anemia Maternal anemia Maternal fever Terbutaline treatment (Magnesium is NOT associated)
41
What are predictors of preterm labor
Fibronectin > 50 (produced by amniocytes + cytotrophoblast) IL- > 400 Cervical length <30 mm
42
Role of hPL or human chorionic somatommamotropin (hCS)
Promotes fetal growth
43
How does CO, SVR and BP change in pregnant woman?
Increased CO (30% CO goes to uterus) Decreased SVR and 3rd trimester BP decrease to maximize blood flow to uterus and placenta
44
How does red cell mass, pro and anticoagulants change in pregnancy?
Increase in red cell mass 30% Increase in procoagulant and decrease in anticoagulant Increase in vascular stasis Increase risk for thromboembolic disease (likely so she doesn’t bleed to death at delivery lol)
45
How does minute ventilation, RR and FRC change in pregnancy
Increase in minute ventilation Deeper breaths not change in RR Fall in FRC
46
Maternal TSH can change in early pregnancy, why does this happen?
Cross reaction with hcg making it low TSH but no actual change in hormone levels
47
What treatment should u avoid in mothers with hypothyroidism
Radioactive iodide (can concentrate and damage fetal thyroid)
48
TTTS
10-15% of monochorionic diamniotic twins 80-100% mortality if untreated Large placental AV anastomoses result in uneven blood flow Donor and recipient twin - Donor with decreased blood volume, growth restricted, poor urine output (oligohydramnios) - Recipient is hypervolemic, polyhydramnios and hydrops Stages 1-5 (2-4 are candidates for treatment with laser ablation)
49
At what GA do you screen for gestational diabetes?
24-28 weeks
50
Neonates born to mothers with GDM are at risk for what?
Metabolic syndrome in the future Serial and ♥️ hypertrophy - resolves in a few months - treat poor cardiac output with b blockers (NOT pressors)
51
What is the most significant factor that affects risk of fetal malformations in mothers w gestational diabetes?
Preconceptual HgbA1c If elevated, cardiac dx, caudal regression syndrome, small left colon
52
Name some Neonatal metabolic derangements seen with maternal diabetes
- Polycythemia-(due to insulin increasing metabolic rate and increased oxygen demand) - Hypocalcemia-inadequate (PTH, excess calcitonin) - Hypoglycemia - Hyperbilirubinemia - Increased thrombotic events due to hyperviscosity - Neonatal RDS - Fetal hyperinsulinemia also retards production of surfactant Prematurity - Fetal death
53
Fetal and Neonatal Risk factors of maternal diabetes
Polyhydramnions 2/2 osmotic diuresis w fetal hyperglycemia Polycythemia hypoCa Hyperbili Thrombotic events for hyperviscosity Neonatal RDS
54
Diagnosis of Gestational Hypertension?
Elevated BP >140 systolic or 90 diastolic in a previously normotensive mother
55
How does preeclampsia lead to placental insufficiency
Inadequate remodeling of maternal spiral arteries | Maternal systemic vascular dysfunction->multi organ involvement
56
Fetal and Neonatal effects of preeclampsia are
Growth restriction, SGA, preterm births Only known cure for preeclampsia is delivery of the fetus and placenta!
57
Fetal impact of maternal hypertension
``` Preterm birth SGA / IUGR Hypoglycemia Thrombocytopenia Neutropenia Polycythemia HypoCa from mag sulfate ```
58
What is the MCC hypothyroidism in pregnancy
Chronic autoimmune (Hashimoto)
59
Fetal manifestations of Graves’ disease
* Fetal tachycardia * Growth restriction * Fetal hydrops * Fetal goiter
60
MCC of neonatal Graves’ disease?
Transplacentally transfer of stimulating TSH receptor antibodies P/w fetal tachycardia IUGR fetal hydrops fetal goiter. Neonatal: irritability, tremor, exophtalmos, goiter If severe thyrotoxicosis-hyperthermia, arrhythmia, High output cardiac failure, death Self limited, antibodies get cleared 3-12 weeks Tx anti thyroid drugs and propanolol
61
Mothers with lupus are at higher risk of which prenatal complication?
Preeclampsia
62
How does neonatal lupus cause heart block?
Binding of anti-Ro/SSA/anti-La/SSB antibodies to fetal cardiac cells that have undergone physiologic apoptosis during remodeling, leading to autoimmune injury and secondary fibrosis of the atrioventricular (AV) node and its surrounding tissue Autoantibodies may also act by inhibiting calcium currents mediated by cardiac L and T type calcium channels
63
What is condition is responsible for 80-95% of all cases of congenital complete heart block (<5% present after birth)?
Neonatal Lupus
64
What is the triad of clinical features of Fetal Alcohol Syndrome?
1. Impaired pre- and postnatal growth (lUGR) 2. Abnormal facies, microcephaly 3. Developmental delay
65
TOPS, TAPS, TRAP
Risk of TTS highest in mono-di twins TOPS: Twin oligo-polyhydramnios sequence- difference in AF volumes and fetal hematocrits TAPS: Twin anemia polycythemia sequence- difference in fetal hct, no volume difference TRAP- Twin reverse arterial perfusion sequence: the cardiac system of one twin does the work of supplying blood for both twins leading to "pump twin" and ´acardic twin"
66
Which is the most common conjoined twin type?
Thoracopagus
67
When does fetal breathing begin?
10 weeks
68
What is considered oligohydramnios?
AFI<5cm or MVP<2cm
69
Polyhydramnios
AFI>24cm (severe>34) | MVP>8cm
70
Low estriol levels
Smith Lemli Opitz | Placental sulfatase deficiency
71
What makes up the BPP?
``` NST Fetal body movement Breathing Fetal Tone Amniotic Fluid Volume ```
72
What to look at closely with fetal monitoring?
Baseline (110-160 HR) Variability present (moderate 6-25 bpm - normal) Accelerations (normal - indicates a normally oxygenated fetus)
73
What are NORMAL umbilical (fetal) arterial and venous blood gases?
- Arterial 7.27/55/-3 - Venous 7.35/40/-3
74
B methasone for pts <32 weeks decreases risk of CP from 4% to 2% True or False
True
75
When is delivery by C/S indicated in a fetus w abdominal wall defect?
Omphalocele with liver exposed
76
Effect of maternal marijuana use on neonate
Impairment in neurodevelopment, working memory and school performance
77
Renal physiology paramater changes for pregnant woman (up or down) Renal plasma flow GFR Creat clearance BUN serum creatinine
Up Up Up Down Down
78
Ureters dilate during pregnancy T/F Which side dilates more?
True R>L Mild Hydronephrosis is a normal finding
79
What causes urinary stasis and increased risk of Pyelonephritis during pregnancy?
Progesterone- causes smooth muscle relaxation Enlarging uterus compresses distal ureters R>L Urinary stasis--> UTI
80
Tobacco- adverse effects
Abruption FGR
81
Cocaine- adverse effects
Abruption FGR ?Gastroschisis
82
Teratogen- NSAID- fetal effect
Oligohydramnios narrowing of PDA
83
ACE inhibitors Teratogen- fetal effect
Renal dysplasia
84
Valproic Acid- fetal effet
NTD Developmental delay
85
Phenytoin- fetal effect
FGR Digit/nail hypoplasia
86
Warfarin- fetal effect
Nasal hypoplasia Stippled epiphyses
87
Marfan syndrome- common complication
Preterm delivery due to cervical incompetence and PROM
88
Supplementation with what decreases lead levels in moms
Cacium
89
Epidurals associated with:
Maternal hypotension maternal fever longer 2nd stage of labor
90
Neonatal myasthenia gravis
10-20% neonates affected neonatal disease DOES NOT depend on severity of maternal disease Symptomatic within 72 hours, resolve within 2 months
91
Prenatal testing: when is CVS and amnios performed
CVS (trophoblastic tissue from placenta): After 9 weeks gestation, can be placental mosaicism Amnio: after 14 weeks
92
What are risks for early amnio
Increased risk club foot Pregnancy loss Failure to culture fetal cells
93
4 components of fetal measurement
Abdominal girth BPD HC Femur length
94
What is amnion nodosum
Observed in pregnancies c/b severe long standing oligohydramnios
95
When are the anueploidy screens and what are they?
10-13 weeks: PAPP-A, bHCG, nuchal translucency, fetal nasal bone 14-20 weeks: bHCG, Inhibin, estriol, AFP
96
Quad screen for Trisomy 13, 18, and 21
Not helpful for T13 Low AFP, estriol, AFP for T18 (inhibin unaffected) bHCG and Inhibin high, AFP and estriol low for T21 (BI is HI)
97
MC fetal anomaly
SUA (1% of all infants), higher incidence with twins Increased risk of cardiac, IUGR, renal, preterm birth
98
Fetal measurements
Crown rump 7-10 weeks, assess GA +/- 3-5 days BPD 14-20 weeks, assess GA +/- 7 days
99
Code dose epi
1:10,000 (0.1 mg/ml) IV: 0.1-0.3 ml/kg ETT: 0.5-1 ml/kg
100
What is sheehan syndrome
Abrupt blood loss--> pituitary ischemia/necrosis After delivery- persistent low BP, low BG, high HR, failure of lactation
101
MC infectious complication after C-section
Endometritis
102
Leading RF for shoulder dystocia
Maternal DM
103
Normal and high folate supplementation
0.4 mg (contained in MV) Hx of NTD: 4 mg/day
104
Carbohydrate transfer across placenta how
Facilitated diffusion- GLUT receptor
105
Which Ig is NOT transferred across placenta
IgM
106
Monozygotic splitting and results
Early split 0-3 days: di/di 3-8 days: mono/di 8-13 days: Mono/mono >14 days: conjoined
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