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Neonatology Boards > Brodsky and Martin- MFM > Flashcards

Brodsky and Martin- MFM Flashcards

1
Q

What happens to maternal HR in pregnancy?

A

Increased 10-15 bpm

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2
Q

What happens to maternal blood volume in pregnancy?

A

Increases 30-50% due to an increase in both plasma volume and RBCs

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3
Q

When does blood volume increase the most in pregnancy?

A

Second trimester (begins to increase during 1st, increases rapidly during 2nd, rises more slowly during 3rd)

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4
Q

Why does blood volume increase in pregnancy?

A

Leads to increased preload and : 1. Protects from impaired venous return when supine and erect, 2. Meets the demand of an extremely vascular uterus, 3. Protects the pregnant woman against large blood loss during delivery

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5
Q

What happens to blood pressure in pregnancy?

A

Decreases, lowest in 2nd trimester, also has a widened pulse pressure (because diastolic BP decreases more than systolic), decrease is due to decreased SVR

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6
Q

What happens to cardiac output during pregnancy?

A

Increases 30-50% with majority output to uterus and kidneys

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7
Q

In late pregnancy, in what position is cardiac output the greatest?

A

Lateral recumbent position (because supine impedes venous return- supine hypotensive syndrome)

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8
Q

How does pulmonary system change in pregnancy?

A
  1. Significant increase in TV with associated increase in minute ventilation
  2. Decreased residual volume
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9
Q

What acid/base status do pregnant women have and why?

A

Respiratory alkalosis with metabolic compensation (because increased progesterone induces a chronic hyperventilated state with a decrease in paCO2)

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10
Q

What happens to renal system in pregnancy?

A
  1. Renal hypertrophy, dilated calyces and ureters
  2. Increased GFR and blood flow (decreased BUN and creatinine)
  3. Decreased renal bicarbonate threshold, increased protein filtration
  4. Increased ADH, renin, angiotensisn II, and aldosterone secretion–> increased fluid volume and sodium retention
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11
Q

Do RBCs or plasma increase more in pregnancy?

A

Plasma, which leads to a dilutional anemia (but both plasma and RBCs are increasing, plasma is just increasing more)

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12
Q

What happens to WBCs in pregnancy?

A

Estrogen-mediated leukocytosis (greatest during labor), but despite high numbers there is decreased leukocyte function

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13
Q

What happens to platelets in pregnancy?

A

Minimal change in count but increased width and volume

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14
Q

What happens to coagulation in pregnancy?

A

Increased pro-coagulation factors and decrease anti-coagulation factors so a PRO-coagulation state, fibrinogen increases 30-50% because of estrogen effect

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15
Q

What puts a pregnant woman at risk for reflux?

A

Decreased gastric empting time, altered stomach position, and decreased lower esophageal sphincter tone

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16
Q

What puts a pregnant woman at risk for gallstones?

A

Impaired gallbladder contraction

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17
Q

What happens to pituitary in pregnancy?

A

Enlargement by 135% with increased prolactin production

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18
Q

What happens to thyroid hormones in pregnancy?

A

Increased thyroxine-binding globulin, increased total T4 with compensatory decrease in TSH. Woman remains euthyroid

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19
Q

What happens to PTH in pregnancy?

A

Significant increase in PTH-related hormone, which increases calcitriol production and leads to increased maternal intestinal absorption of calcium. Thus placental transfer of maternal calcium can occur while maternal serum calcium levels remain normal

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20
Q

Why do pregnant women have increased lipogenesis/fat storage?

A

Because estrogen stimulates pancreatic cells with associated increase in insulin

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21
Q

What produces hCG and what does it do?

A

Syncytiotrophoblasts. Prevent corpus luteum involution, suppresses maternal immune function, TSH-like effect

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22
Q

When is hCG most detected?

A

1st trimester

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23
Q

What is hPL, when is it most detected, and what does it do?

A

Human placental lactogen, increases with increased gestational age, increases lipid utilication, has anti-insulin effect

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24
Q

What does progesterone do during pregnancy?

A

Maintains uterus in a related state (smooth muscle relaxation); also has anti-inflammatory and immunosuppressive functions so it protects the fetus from immunological rejection by the pregnant woman

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25
Q

What happens to progesterone during labor

A

Requires a withdrawal of progesterone but concentrations stay the same so a functional suppression occurs dues to decreases in progesterone receptor and progesterone receptor co-activators as labor begins

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26
Q

Effect of estrogen during pregnancy

A

Regulates progesterone, assists with maturation of fetal organs and proliferation of uterine endometrium, contributes to labor by increasing strength of uterine contractions

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27
Q

What is the maternal portion of the placenta? How does it work?

A

Decidua basalis, divided into 10-38 lobes or cotyledons; oxygenated maternal blood from the endometrial arteries enters the intervillous space of the placenta in funnel-shaped spurts

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28
Q

What is the fetal portion of the placenta and how does it work?

A

Villous and chorion; contains numerous villi that are suspecded in the intervillous space

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29
Q

Type of transplacental transfer for: O2, CO2

A

Simple diffusion

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30
Q

Type of transplacental tranfer for: H2O

A

Simple diffusion

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31
Q

Type of transplacental transfer for: Na, Cl

A

Simple diffusion

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32
Q

Type of transplacental transfer for: Lipids

A

Simple diffusion

33
Q

Type of transplacental transfer for: Fat-soluble vitamins

A

Simple diffusion

34
Q

Type of transplacental transfer for: most medications

A

Simple diffusion

35
Q

Type of transplacental transfer for: Glucose

A

Facilitated diffusion

36
Q

Type of transplacental transfer for: Cephalexin

A

Facilitated diffusion

37
Q

How does facilitated diffusion work?

A

Transfer is mediated by a carrier that moves compounds along the concentration gradient, no energy required for passage of compounds

38
Q

Type of transplacental transfer for: Amino acids

A

Active transport

39
Q

Type of transplacental transfer for: Calcium, phosphate, magnesium, iron, and iodide

A

Active transport

40
Q

Type of transplacental transfer for: H2O-soluble vitamins

A

Active tranport

41
Q

Type of transplacental transfer for: H2O, dissolved electrolytes

A

Bulk flow (transfer by hydrostatic or osmotic gradient)

42
Q

Type of transplacental transfer for: Immunoglobulin G antibodies

A

Pinocytosis (compounds are engulfed, packaged and transferred across cell to opposite side)

43
Q

When do maternal IgGs get transferred?

A

Begins early in 2nd trimester with MOST antibodies being transferred during the 3rd trimester

44
Q

Type of transplacental transfer for: maternal or fetal cells

A

Breaks in the placental membrane

45
Q

Can the following cross the placenta: Bilirubin

A

Yes

46
Q

Can the following cross the placenta: aspirin

A

Yes

47
Q

Can the following cross the placenta: Coumadin

A

Yes

48
Q

Can the following cross the placenta: Dilantin

A

Yes

49
Q

Can the following cross the placenta: Valproate

A

Yes

50
Q

Can the following cross the placenta: Alcohol

A

Yes

51
Q

Can the following cross the placenta: Maternal IgG

A

Yes

52
Q

Can the following cross the placenta: TRH and iodine

A

Yes

53
Q

Can the following cross the placenta: T4 and T3

A

Yes (small amount)

54
Q

Can the following cross the placenta: Biliverdin

A

No

55
Q

Can the following cross the placenta: Heparin

A

No

56
Q

Can the following cross the placenta: Glucagon

A

No

57
Q

Can the following cross the placenta: human growth hormone

A

No

58
Q

Can the following cross the placenta: Insulin

A

No

59
Q

Can the following cross the placenta: propylthiouracil

A

No (only small amounts cross)

60
Q

Can the following cross the placenta: TSH

A

No

61
Q

Can the following cross the placenta: Maternal IgM

A

No

62
Q

Degrees of Placental Previa

A
  1. Complete- placental covers internal os completely
  2. Partial- placenta partially covers os
  3. Marginal- placenta just reaches os but does not cover it
  4. Low-lying- placenta implanted in lower uterine segment near os
63
Q

Prevalence of placenta previa?

A

1 in 200 deliveries

64
Q

Risk factors for placenta previa?

A

AMA, increased parity, previous c-section, maternal smoking, history of abortion

65
Q

Clinical features of placenta previa?

A

Increased risk of preterm delivery, greater risk of fetal anomalies (increased by 2.5x, unclear reason), acute onset of painless vaginal bleeding (typically after late 2nd trimester), initial bleeding usually ceases spontaneously and often recurrs

66
Q

Management of placenta previa with: severe bleeding

A

Deliver

67
Q

Management of placenta previa with: preterm and no active bleeding

A

Close inpatient monitoring, antepartum steroids

68
Q

Management of placenta previa with: mature

A

Deliver by c-section

69
Q

Risk factors for placental abruption

A

Maternal hypertension, history of prior abruption, AMA, increased parity, cigarette smoking, cocaine use, increased thrombotic maternal state, external trauma, uterine leiomyoma

70
Q

When do the majority of placental abruptions occur

A

Prior to labor

71
Q

Maternal hemorrhage may lead to:

A

Maternal shock, severe anemia, consumptive coagulopathy, and/or renal failure

72
Q

Risk factors for abnormal placental adherence

A

Co-existing placenta previa, history of curettage, increased parity, gravida 6 or more, implantation in lower uterine segment, or prior uterine surgery

73
Q

What is a hydatidiform mole?

A

Molar pregnancy, abnormal chorionic villi with trophblastic proliferation and villous edema that is typically contained within uterine cavity

74
Q

Types of hydatidiform mole

A
  1. Complete (majority 46 XX with mostly paternal origin, no feturs or amnion present, uterus large for GA, ~20% develop trophoblastic tumors)
  2. Partial (majority with 69 XXX, XXY, or XYY; nonviable fetus and amnion often present, uterus usually small for GA, less likely to develop trophoblastic tumors, rare to have medical complications)
75
Q

Management of hydatidiform mole:

A

Immediately suction and evacuate mole, possible hysterectomy, assess for metastatic disease, follow closely for persistent trophoblastic proliferation or malignant changes by following beta-hCG levels

76
Q

What is a chorioangioma?

A

A benign placental tumor

77
Q

Can placental metastases occur?

A

Yes but rare. Have been seen with malignant melanoma, leukemia, lymphoma, breast cancer, lung carcinoma or sarcoma

78
Q

Types of gestational trophoblastic disease

A
  1. Invasive mole (excessive growth with severe invasion, typically does not metastasize)
  2. Choriocarcinoma (very malignant trophoblastic tumor, rapidly growing invading uterine muscle and blood vessels, can lead to hemorrhage and/or necrosis, metastasis to lungs and vagina is common)

Neonatology Boards (2 decks)

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