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Repro > 04a: Abnormal Pregnancy > Flashcards

04a: Abnormal Pregnancy Flashcards

1
Q

There’s been a(n) (increase/decrease) in multifetal pregnancies, most likely due to:

A

Increase;

Women having pregnancies later in life (more likely to fertilize more than one egg)

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2
Q

The key major risk for multifetal pregnancy is:

A

Premature delivery (and the consequences tied to that)

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3
Q

T/F: Woman’s risk of aneuploidy doubles if she has twins.

A

True - esp if woman is at advanced age

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4
Q

Monoamniotic, monochorionic pregnancy: (1/2) fetuses, (1/2) placenta(s).

A

2 fetuses sharing same amniotic sac and same (1) placenta

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5
Q

High rates of stillbirth in (mono/di)-amniotic, (mono/di)-chorionic pregnancies. Why?

A

Mono; mono

Sharing amniotic sac causes umbilical cords to get tangled/compressed

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6
Q

(Earlier/later) split of zygote will increase chances that twins share amniotic sac/placenta.

A

Later

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7
Q

Notably high risk of poor growth/pre-term labor in (mono/di)-amniotic, (mono/di)-chorionic pregnancies. Why?

A

Di-di

Not enough room

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8
Q

Notably high risk of congenital malformations in (mono/di)-amniotic, (mono/di)-chorionic pregnancies. Why?

A

Di-mono and mono-mono (occur with shared placenta!)

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9
Q

Spontaneous abortion defined as loss of pregnancy before (X) weeks.

A

X = 20 (after that, “stillbirth”)

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10
Q

T/F: 80% of spont abortions occur in first trimester.

A

True

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11
Q

Trend of (X) hormone in pregnancy can be predictive of spontaneous abortion due to its chaotic ranges in the first few weeks.

A

X = hCG (normally doubles each day in early pregnancy, but all over the place/falls off in pts with spont abortion)

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12
Q

Recurrent abortion definition: (X) consecutive losses.

A

X = 2 in nulliparous woman; 3 in parous woman

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13
Q

Most, (X)%, of ectopic pregnancies are located in (Y)

A 
X = 94
Y = fallopian tubes
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14
Q

Two main mechanisms of ectopic pregnancy:

A
  1. Delayed/prevented passage of zygote into uterine cavity (tubal pathology)
  2. Inherent embryo factors that cause early implantation (not karyotype)
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15
Q

Pre-term birth rates have (increased/decreased) and are defined as under (X) weeks gestation.

A

Decreased (all-time high in ‘06);

X = 37

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16
Q

Pt with pre-eclampsia at 36 weeks gestation. The physician decides to induce labor. Does this meet criteria for spont preterm birth?

A

No - SPB excludes “indicated” preterm birth

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17
Q

All RFs for spontaneous preterm birth are likely related to:

A

Glucocorticoids (placental CRH drives process)

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18
Q

History of which procedures put patient at risk for spont preterm birth?

A

Ones that dilate cervix:

  1. 2nd trimester abortion
  2. Cervical surg
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19
Q

36 week gestation pregnant patient presents with sudden onset severe abdominal pain and contractions. The thought is (X) until proven otherwise

A

X = abruptio placenta (without visible bleeding)

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20
Q

Placenta previa refers to situation in which:

A

Placenta attaches right over cervix

21
Q

T/F: Patient with placenta previa must have C-section.

A

True - otherwise placenta will come out first and baby can’t breathe during delivery

22
Q

Placenta accreta refers to situation in which:

A

Placenta attached abnormally (myometrial invasion)

23
Q

How is placenta accreta managed?

A

Take out baby, don’t even try to take out placenta; then hysterectomy

24
Q

(X) placental complication has high risk of maternal hemorrhaging and death post-partum.

A

X = placenta accreta

25
Q

Placenta increta:

A

Abnormal placenta attachment where placenta invades more than 50% of myometrium

26
Q

Placenta percreta:

A

Abnormal placenta attachment where placenta invades past uterine wall (ex: into bladder)

27
Q

T/F: Switching from cigarette smoke to vaping will decrease risk of spont pre-term birth.

A

False - nicotine is the issue

28
Q

Term labor timing is dependent on (X), unlike pre-term labor which is initiated by (Y).

A 
X = placenta (fetus ready for birth)
Y = mother (high cortisol)
29
Q

Tocolysis:

A

Inhibition of uterine contractions

30
Q

Tocodnamometer:

A

Instrument for measuring uterine contractions

31
Q

List some agents used for tocolysis.

A
  1. CCB, Mg sulfate
  2. Beta agonists (interrupt myosin phosphorylation)
  3. COX inhibitors (decrease PGEs)
  4. Oxytocin antagonists
32
Q

Fetal growth restriction is pathologic when which criteria are met?

A

Under 10th percentile for gestational age PLUS

  1. Decreased amniotic fluid OR
  2. Falling off growth curve OR
  3. Abnormal intrauterine blood flow
33
Q

Maternal diabetes puts baby at risk of (hyper/hypo)-glycemia at birth.

A

Hypoglycemia (due to fetal hyperinsulinemia)

34
Q

Notably high risk of twin-twin transfusion syndrome in (mono/di)-amniotic, (mono/di)-chorionic pregnancies. Why?

A

Di-mono (a-v malformations in shared placenta; one baby has much higher V of amniotic fluid than another; both die)

35
Q

Infectious cause of fetal growth restrction

A

TORCHES (esp think of CMV, rubella, varicella, HIV)

36
Q

Pre-eclampsia cured by:

A

Delivery of baby

37
Q

Definition/diagnosis of pre-eclampsia:

A
  1. HT

2. Proteinuria

38
Q

Which clinical/lab findings (aside from HT, proteinuria) may point toward pre-eclampsia diagnosis?

A
  1. Edema (ascites, pulm)
  2. HELLP (hemolysis, elevated liver enzymes, low platelets)
  3. Abdominal pain
  4. Oliguria/anuria
39
Q

Sx of pre-eclampsia patient that suggests incoming seizure

A

HA, vision changes

40
Q

T/F: Mulitparity is a RF for pre-eclampsia.

A

False - nulliparity is (never exposed to pregnancy/paternal Ag before)

41
Q

T/F: Insulin resistance is RF for pre-eclampsia

A

True

42
Q

RFs for pre-eclampsia are similar in their ability to:

A

Impact activation state of endothelium (ex: vascular disease, thrombophilias)

43
Q

Placental ischemia: decrease in which molecules/factors?

A
  1. Prostacyclin

2. NO

44
Q

Placental ischemia: increase in which molecules/factors?

A
  1. Thromboxane
  2. TNF-alpha
  3. IL1
45
Q

Pre-eclampsia workup: after labs, (X) should be done.

A

X = ultrasound (fetal weight and amniotic fluid)

46
Q

Pre-eclampsia workup: what are the indications to induce delivery?

A
  1. Term pregnancy

2. Severe disease

47
Q

Pre-eclampsia: Rx for seizure prophylaxis

A

Mg Sulfate

48
Q

Women with pre-eclampsia have later-life risk of which disease?

A

CV (equivalent to 2pack/d smoker!) - so monitor yearly BP, lipids, blood glucose

Repro (8 decks)

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