Class 20: Maternal Disease Flashcards
what can cross the placental barrier than can cause abnormalities in the fetus? (3)
infection, antibodies, drugs
what 3 factors of maternal infections affect the fetus?
- virulence
- transmission route
- gestational age at time of infection
when is the fetus most susceptible to infections?
during the 1st tri
what are 5 viral infections that can affect the fetus?
- cytomegalovirus
- herpes simplex
- varicella zoster
- rubella
- HIV
what is the most common cause of congenital infections?
cytomegalovirus (CMV)
CMV is a type of __
herpes
how can CMV be transmitted?
transplacental & upward through cervix
S&S of CMV include __, __, __
fever, fatigue, tiredness
what antiviral meds can help reduce transmission of CMV?
cytovene
if herpes simplex is transmitted to the fetus at ___ weeks, it can lead to stillbirth or spontaneous abortion
20 weeks
when is a C-section indicated with herpes simplex?
if it is present in the genital tract at the time of delivery
varicella is a danger to the fetus if exposed between ___ to ___ weeks
8-12 weeks
another name for rubella
german measles
the following are associated with which viral infection?
blindness, deafness, heart defects, microcephaly, hydrocephaly, cephalocele
german measles
when does transmission of HIV occur?
near time of birth
3 factors relating to transmission of HIV
- placental barrier effectiveness
- immunologic factors
- # of HIV particles present
3 types of bacterial infections that can spread to the fetus
- syphilis
- gonorrhea
- UTI
2 types of parasitic infections that can spread to the fetus
- toxoplasmosis
- malaria
what parasite spreads toxoplasmosis?
toxoplasma gondii
how can one contract toxoplasmosis? (2)
- eating raw meat
- cat feces
when is toxoplasmosis more transmittable?
3rd tri
consequence of toxoplasmosis?
repeated miscarriage
treatment for toxoplasmosis?
antibiotics
what type of mosquito spreads malaria?
female anophales mosquitos
what are the effects on the placenta with malaria?
placental insufficiency
5 types of endocrine & metabolic maternal diseases
- diabetes mellitus
- gestational diabetes
- hyperthyroidism
- hypothyroidism
- hyperparathyroidism
which type of diabetes is known as juvenile onset?
type 1
which type of diabetes is insulin dependent?
type 1
which type of diabetes is the more common type of diabetes mellitus?
type 2
faulty ____ metabolism is related to decreased insulin
carbohydrate
frequency of abnormalities with diabetic mothers
3-6%
why is there such a broad spectrum of associated fetal effects with mothers with diabetes mellitus?
diabetes mellitus affects organogenesis
diabetes mellitus is associated with macrosomia. T/F?
true
what is a macrosomic baby?
> 4000 g (90th percentile at birth)
most common trisomy associated with diabetes mellitus?
trisomy 21
what can happen to the placenta with a mother with diabetes mellitus?
thickened placenta (>6cm)
how many pregnancies are affected by gestational diabetes?
25/1000 (4%)
gestational diabetes is early onset. T/F?
false – late onset
what is the most common type of hyperthyroidism?
grave’s disease
lab values for hyperthyroidism?
elevated thyroxine
what does increased thyroxine lead to?
abnormal cell development –> FGR
hydatidiform mole can lead to hypothyroidism. T/F?
false – hyperthyroidism
hypothyroidism can lead to decreased fertility. T/F?
true
what can cause hyperparathyroidism?
parathyroid adenoma
3 types of maternal hematologic disorders?
- sickle cell anemia
- thalessemia
- toxemia of pregnancy
what happens to RBCs in patients with sickle cell anemia?
RBC’s are abnormally shaped & can get stuck in blood vessels –> slows down blood flow –> anemia
which population is affected by sickle cell anemia?
black population
which population is affected by thalassemia?
mediterranean descent
what is thalassemia?
form of anemia with decreased RBC production
what is the cause of toxemia of pregnancy?
unclear
2 stages of toxemia of pregnancy?
- preeclampsia
- eclampsia
toxemia of pregnancy can lead to increased placental volume & decreased placental maturation. T/F?
false – DECREASED placental volume & INCREASED placental maturation
what is fetal alcohol syndrome?
when alcohol crosses placental barrier, leading to cell death or inhibiting fetal growth
diagnosis criteria of FAS depends on ___
severity
what is fetal growth restriction?
when fetus is less than 10% of the predicted fetal weight for its gestational age
how many infants born <2500 g (5lb 8oz) have true IUGR?
1/3
what types of metabolic conditions can IUGR infants have later in life? (2)
- abdominal obesity
- type 2 DM
the cause of IUGR is ___ 50% of the time
idiopathic
2 fetal factors that can lead to FGR?
- genetic/chromosomal ABNL
- chronic fetal infx
6 maternal factors that can lead to IUGR?
- drug use
- poor nutrition
- poor pregnancy weight
- multiple gestation
- maternal disease
- placental insufficiency
2 environmental factors that can lead to IUGR?
- irradiation
- high altitude
2 types of IUGR?
- symmetric
- asymmetric/head sparing
most common type of IUGR?
head sparing
which trimester is affected with the fetus with symmetric IUGR
1st tri
what is asymmetric IUGR?
head & long bones are normal measurements but abdomen & organs are small
which trimester is affected with the fetus with head sparing IUGR?
2nd tri
the HC/AC ratio will be ___ in a fetus with head sparing IUGR
increased
why is the brain not spared with symmetric FGR?
because it occurs in early pregnancy (long duration)
symmetric IUGR leads to a ___ in cell number & size
decreased
symmetric IUGR is caused by __ & ___ factors
fetal & environmental
asymmetric IUGR is caused by ___ factors
maternal
head sparing IUGR occurs in the last ___ to ___ weeks of pregnancy
8-10 weeks
there is normal cell numbers in head sparing IUGR. T/F?
true
there is normal cell size in head sparing IUGR. T/F?
false – decreased cell size
pulse wave of which arteries may help diagnose FGR?
UTA & umbilical artery
normally, in early pregnancy, flow in UTA & UA is ___ resistance
higher
normally, as pregnancy progresses, flow in UTA & UA is ___ resistance
lower
as pregnancy progresses, the systolic/diastolic ratio ___
decreases
in 80% of cases with FGR, the systolic/diastolic ratio ___ & the UTA & UA exhibit ___ resistance
increases; higher
if a grade __ placenta is seen <35-36 weeks with an EFW of less than ___ grams, this can indicated FGR
grade 3; 2700 (5lb 14 oz)
