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OB-Gyn > Fetal Development, Maternal adaptation > Flashcards

Fetal Development, Maternal adaptation Flashcards

0
Q

Lifespan of fetal RBCs?

A

90 days

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1
Q

First site of embryonic hematopoeisis?

A

Yolk sac - 3-8 weeks

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2
Q

Kleihauer-Betke test

A

To test presence of fetal blood cells in maternal circulation

Test to determine presence of fetal hemorrhage - to know how much rhogam to give

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3
Q

At how many weeks AOG is surfactant present?

A

Starts to appear in amniotic fluid at 28-32 weeks

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4
Q

Most active component of surfactant

A

Dipalmitoylphosphatidylcholine (DPPC)

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5
Q

Full lung development is achieved at?

A

8 years of age!

Alveolar development begins just before birth, until 8 yrs old

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6
Q

Peak of HCG?

A

8-10 weeks AOG

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7
Q

Aka “Pregnancy Hormone”

A

HCG (Human Chorionic Gonadotropin)

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8
Q

Best known function of HCG

A

Rescue and maintenance of corpus luteum in early pregnancy until the placenta can take over at 6-8 weeks AOG

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9
Q

Maintains corpus luteum in early pregnancy

A

HCG

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10
Q

Hormone responsible for formation of male external genitalia?

A

DHT

In androgen insensitivity, there is a problem with the receptors for DHT so there is no development of external male genitalia

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11
Q

Hormone responsible for development of male internal genitalia?

A

Testosterone

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12
Q

Other names for HPL?

A

Other names:

Human Placental Lactogen
Chorionic Growth hormone
Chorionic Somatomammotropin

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13
Q

AOG where HPL is highest? Relevance?

A

24-28 weeks

HPL is thought to increase maternal insulin resistance that occurs as pregnancy progresses - peak at 24-28 weeks

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14
Q

Hormone with GH-like activity, with anti-insulin action

A

HPL - “diabetogenic”

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15
Q

Source of progesterone in first 6-7 weeks

A

Corpus luteum

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16
Q

Where is estriol produced?

A

Produced almost exclusively by the placental syncitotrophoblast

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17
Q

Most potent estrogen?

A

Estradiol

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18
Q

What hormone causes the formation of linea nigra?

A

Melanocyte stimulating factor (MSH)

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19
Q

Black line from above the umbilicus to pubis that may be seen at later part of gestation

A

Linea nigra

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20
Q

Mask of pregnancy

A

Chloasma or Melasma gravidarum

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21
Q

BP changes in pregnancy?

A

No change in systolic BP
Decrease in diastolic BP

  • Increased pulse pressure
  • Deceased TPR

*Increased CO

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22
Q

GFR in pregnancy? Increase or decrease?

A

Increases by 50%

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23
Q

Physiologic hydroureter of pregnancy more common in which side?

A

Right > Left

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24
Q

Physiologic hydroureter of pregnancy due to?

A

Estrogen: stimulates hypertrophy and muscle elongation

Progesterone: relaxation, generalized atony of urinary tract

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25
Q

Number 1 surgical emergency in pregnancy?

A

Acute appendicitis

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26
Q

Ptyalism?

A

Excessive flow of saliva

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27
Q

Effect of progesterone on gallbladder function

A

Progesterone inhibits CCK - causes GB stasis –> inc incidence of gall stones

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28
Q

All coagulation factors are increased in pregnancy except?

A

Factor 11 and 13

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29
Q

Pituitary enlargement in pregnancy is secondary to?

A

Hypertrophy of lactotrophs –> increased susceptibility to hypoxia

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30
Q

Effect of pregnancy to thyroid gland

A

Hyperplasia of thyroid gland –> because HCG and TSH have similar alpha units

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31
Q

T helper cells in pregnancy - increase or decrease?

A

Decrease - to accommodate ‘foreign’ baby

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32
Q

Hormone that impairs neutrophil activation

A

Relaxin - depressed PMN chemotaxis and adherence

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33
Q

WBCs in pregnancy?

A

Increased numbers of leukocytes

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34
Q

IOP in pregnancy?

A

Decreases

Increased vitreous outflow

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35
Q

Corneal changes in pregnancy?

A

Increased corneal thickness due to edema

Decreased corneal sensitivity - slight BOV

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36
Q

Average weight gain in pregnancy?

A

27.5 lbs

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37
Q

Treatment for asymptomatic bacteriuria?

A

Nitrofurantoin 100mg BID for 3 days

Or Amoxicillin, First gen cephalosporin

38
Q

What hormone is responsible for morning sickness?

A

HCG - nausea, vomiting

39
Q

Unsafe vaccines in pregnancy

A 
MMR
Polio
Varicella zoster
Yellow fever
Small pox
40
Q

Vitamin A dose not acceptable during pregnancy

A

> 100,000 IU/ day

Vitamin A is teratogenic

41
Q

Effect of pregnancy on GI motility

A

Decreased gastric emptying time

Greater water absorption in intestines –> constipation

42
Q

Patient presents with pica. What will you request?

A

CBC with retic count

Pica is associated with IDA - make sure you cure the IDA

43
Q

Why is there increased complain of headaches in pregnancy?

A

Due to effect of estrogen

Make sure you rule out pre-eclampsia as cause of headache

44
Q

Prenatal visit scheduling

A

Every 4 weeks up to 28 weeks
Every 2 weeks until 36 weeks
Weekly thereafter

45
Q

Leukorrhea in pregnancy - pathologic or physiogic?

A

Can be physiologic due to increased vaginal discharge c/o estrogen

46
Q

Pathologic causes of leukorrhea in pregnancy

A

Bacterial vaginosis - give metronidazole 500mg BID x 7 days

Trichomoniasis - Metronidazole

Candidiasis - Miconazole, clotrimazole, nystatin

47
Q

At 20 weeks, uterus expected at what level?

A

Umbilicus

48
Q

At 12 weeks, uterus expected at what level?

A

Pubic symphysis

49
Q

Uterus palpable at level of umbilicus - corresponds to – weeks AOG?

A

20 weeks

50
Q

Uterus palpable at level in between umbilicus and public symphysis - corresponds to – weeks AOG?

A

16 weeks AOG

51
Q

Uterus palpable at level of pubic symphysis - corresponds to – weeks AOG?

A

12 weeks AOG

52
Q

Discrepancy in fundal size is a difference of – between expected AOG and measurement?

A

3 cm larger or smaller

53
Q

Most common cause of false discrepancy in measurement of fundal size

A

Measurement error

54
Q

Causes of false discrepancy

A

Measurement error

Gestational age calculation error

55
Q

When to do GBS Screening?

A

35-37 weeks AOG

56
Q

When to administer Rhogam?

A

If mom is Rh-, give Rhogam at 24-28 weeks AOG

57
Q

When to screen for NTDs and other chromosomal anomalies?

A

16-18 weeks AOG (before 20 weeks)

58
Q

When to do repeat Hgb and Hct?

A

28-32 weeks
Blood volume is highest at this point
Hct is diluted

59
Q

When to give intrapartum GBS prophylaxis?

A

Previous infant with invasive GBS infection
GBS bacteriuria
Positive GBS screening test (unless CS and no ROM)
Delivery < 37 weeks AOG
Membrane rupture > 18 hrs
Intrapartum temp > 38 C

60
Q

Intrapartum prophylaxis for GBS

A

Pen G IV until after delivery

Or ampicillin
If allergic, Erythromycin, Clindamycin

61
Q

Most common reasons for antepartum testing

A 
Decreased fetal movements
DM
Post term pregnancy 
Hypertension 
IUGR
62
Q

Normal fetal movements

A

8-10 kicks every 2 hours (recorded by mother or by tocodynamometer)

63
Q

MC fetal testing method

A

Nonstress testing (NST)

64
Q

Test of fetal condition

A

Nonstress test (NST)

65
Q

Test of uteroplacental function

A

Contraction stress test

66
Q

Reactive Nonstress test

A

2 or more accelerations within 20 minutes that peak 15bpm or more above baseline, each lasting 16 seconds or more

67
Q

MCC of non reactive nonstress test?

A

Non-hypoxic - Sleeping baby

68
Q

What to do if Nonreactive nonstress test?

A

Do vibroacoustic stimulation

If still non-reactive, do contraction stress test or biophysical profile

69
Q

Interpretation of negative CST

A

No late decelerations –> reassuring fetal well being

70
Q

Interpretation of positive CST

A

Repetitive late decelerations in the presence of 3 uterine contractions in 10 minute period

71
Q

Components of fetal well being assessed in BPP?

A 
Breathing
Movement 
Muscle tone 
Amniotic fluid volume 
Heart rate acceleration - NST
72
Q

What to do if there’s a presence of Absent or reversed end diastolic flow in umbilical Doppler velocimetry?

A

Deliver!

You don’t want to see ARED
Indicates uteroplacental insufficiency

73
Q

MC used measurement in umbilical artery Doppler velocimetry

A

Umbilical artery systolic-diastolic (SD) ratio

74
Q

MCC of fetal tachycardia

A

Maternal fever secondary to chorioamnionitis

75
Q

MCC of fetal bradycardia

A

Use of local anesthetics

76
Q

Minimal variability

A

<= 5 beats/minute from baselinw

77
Q

Moderate variability

A

6-25 beats/ minute from baseline

Normal!

78
Q

Marked variability

A

> 25 beats/minute from baseline

79
Q

Gradual decrease in FHR below baseline beginning and ending with uterine contractions

A

Early decelerations
Etiology: Head compression
Benign

80
Q

Abrupt decrease in FHR below baseline of at least 15 bpm with onset to nadir of LESS THAN 30 secs

A

Variable decelerations

Etiology: umbilical cord compression
Mild to moderate: benign
Severe: reassuring –> fetus may be acidotic

81
Q

Gradual decrease in FHR below baseline with onset to nadir of at least MORE THAN 30 secs

A

Late decelerations

Etiology: uteroplacental Insufficiency
Always worrisome!

82
Q

MC isolated structural defects detected during prenatal diagnosis

A

Congenital heart defects

83
Q

Secons MC isolated structural defects detected during prenatal diagnosis

A

Neural tube defects

84
Q

When is maternal serum AFP screening done?

A

14-22 weeks AOG

85
Q

Results of MSAFP screening?

A

Reported as multiple of median (MoM)

> 3.5 MoM clearly indicates fetal risk

86
Q

MCC of increased MSAFP?

A

AOG dating error

87
Q

Next step if with increased MSAFP?

A

Confirm age of gestation

88
Q

Five cranial signs of NTD

A

Small BPD
Ventriculomegaly
Lemon sign - frontal bone scalloping
Banana sign - elongation and downward displacement of cerebellum
Effacement/ obliteration of cisterna magnus

89
Q

Banana sign?

A

Elongation and downward displacement of cerebellum

90
Q

Lemon sign?

A

Frontal bone scalloping

91
Q

Screening for trisomy 21 during first trimester

A

Maternal serum B-HCG
Pregnancy-associated plasma protein A (PAPP-A)

UTZ: nuchal translucency

92
Q

Screening for trisomy 21 during second trimester

A 
ACE-I
AFP: low
Chorionic gonadotropin: high
Estriol: low
Inhibin: high

OB-Gyn (12 decks)

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