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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
Physiologic hydroureter of pregnancy due to?
Estrogen: stimulates hypertrophy and muscle elongation Progesterone: relaxation, generalized atony of urinary tract
25
Number 1 surgical emergency in pregnancy?
Acute appendicitis
26
Ptyalism?
Excessive flow of saliva
27
Effect of progesterone on gallbladder function
Progesterone inhibits CCK - causes GB stasis --> inc incidence of gall stones
28
All coagulation factors are increased in pregnancy except?
Factor 11 and 13
29
Pituitary enlargement in pregnancy is secondary to?
Hypertrophy of lactotrophs --> increased susceptibility to hypoxia
30
Effect of pregnancy to thyroid gland
Hyperplasia of thyroid gland --> because HCG and TSH have similar alpha units
31
T helper cells in pregnancy - increase or decrease?
Decrease - to accommodate 'foreign' baby
32
Hormone that impairs neutrophil activation
Relaxin - depressed PMN chemotaxis and adherence
33
WBCs in pregnancy?
Increased numbers of leukocytes
34
IOP in pregnancy?
Decreases Increased vitreous outflow
35
Corneal changes in pregnancy?
Increased corneal thickness due to edema Decreased corneal sensitivity - slight BOV
36
Average weight gain in pregnancy?
27.5 lbs
37
Treatment for asymptomatic bacteriuria?
Nitrofurantoin 100mg BID for 3 days Or Amoxicillin, First gen cephalosporin
38
What hormone is responsible for morning sickness?
HCG - nausea, vomiting
39
Unsafe vaccines in pregnancy
``` MMR Polio Varicella zoster Yellow fever Small pox ```
40
Vitamin A dose not acceptable during pregnancy
> 100,000 IU/ day Vitamin A is teratogenic
41
Effect of pregnancy on GI motility
Decreased gastric emptying time | Greater water absorption in intestines --> constipation
42
Patient presents with pica. What will you request?
CBC with retic count Pica is associated with IDA - make sure you cure the IDA
43
Why is there increased complain of headaches in pregnancy?
Due to effect of estrogen | Make sure you rule out pre-eclampsia as cause of headache
44
Prenatal visit scheduling
Every 4 weeks up to 28 weeks Every 2 weeks until 36 weeks Weekly thereafter
45
Leukorrhea in pregnancy - pathologic or physiogic?
Can be physiologic due to increased vaginal discharge c/o estrogen
46
Pathologic causes of leukorrhea in pregnancy
Bacterial vaginosis - give metronidazole 500mg BID x 7 days Trichomoniasis - Metronidazole Candidiasis - Miconazole, clotrimazole, nystatin
47
At 20 weeks, uterus expected at what level?
Umbilicus
48
At 12 weeks, uterus expected at what level?
Pubic symphysis
49
Uterus palpable at level of umbilicus - corresponds to -- weeks AOG?
20 weeks
50
Uterus palpable at level in between umbilicus and public symphysis - corresponds to -- weeks AOG?
16 weeks AOG
51
Uterus palpable at level of pubic symphysis - corresponds to -- weeks AOG?
12 weeks AOG
52
Discrepancy in fundal size is a difference of -- between expected AOG and measurement?
3 cm larger or smaller
53
Most common cause of false discrepancy in measurement of fundal size
Measurement error
54
Causes of false discrepancy
Measurement error | Gestational age calculation error
55
When to do GBS Screening?
35-37 weeks AOG
56
When to administer Rhogam?
If mom is Rh-, give Rhogam at 24-28 weeks AOG
57
When to screen for NTDs and other chromosomal anomalies?
16-18 weeks AOG (before 20 weeks)
58
When to do repeat Hgb and Hct?
28-32 weeks Blood volume is highest at this point Hct is diluted
59
When to give intrapartum GBS prophylaxis?
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
Intrapartum prophylaxis for GBS
Pen G IV until after delivery Or ampicillin If allergic, Erythromycin, Clindamycin
61
Most common reasons for antepartum testing
``` Decreased fetal movements DM Post term pregnancy Hypertension IUGR ```
62
Normal fetal movements
8-10 kicks every 2 hours (recorded by mother or by tocodynamometer)
63
MC fetal testing method
Nonstress testing (NST)
64
Test of fetal condition
Nonstress test (NST)
65
Test of uteroplacental function
Contraction stress test
66
Reactive Nonstress test
2 or more accelerations within 20 minutes that peak 15bpm or more above baseline, each lasting 16 seconds or more
67
MCC of non reactive nonstress test?
Non-hypoxic - Sleeping baby
68
What to do if Nonreactive nonstress test?
Do vibroacoustic stimulation If still non-reactive, do contraction stress test or biophysical profile
69
Interpretation of negative CST
No late decelerations --> reassuring fetal well being
70
Interpretation of positive CST
Repetitive late decelerations in the presence of 3 uterine contractions in 10 minute period
71
Components of fetal well being assessed in BPP?
``` Breathing Movement Muscle tone Amniotic fluid volume Heart rate acceleration - NST ```
72
What to do if there's a presence of Absent or reversed end diastolic flow in umbilical Doppler velocimetry?
Deliver! You don't want to see ARED Indicates uteroplacental insufficiency
73
MC used measurement in umbilical artery Doppler velocimetry
Umbilical artery systolic-diastolic (SD) ratio
74
MCC of fetal tachycardia
Maternal fever secondary to chorioamnionitis
75
MCC of fetal bradycardia
Use of local anesthetics
76
Minimal variability
<= 5 beats/minute from baselinw
77
Moderate variability
6-25 beats/ minute from baseline Normal!
78
Marked variability
>25 beats/minute from baseline
79
Gradual decrease in FHR below baseline beginning and ending with uterine contractions
Early decelerations Etiology: Head compression Benign
80
Abrupt decrease in FHR below baseline of at least 15 bpm with onset to nadir of LESS THAN 30 secs
Variable decelerations Etiology: umbilical cord compression Mild to moderate: benign Severe: reassuring --> fetus may be acidotic
81
Gradual decrease in FHR below baseline with onset to nadir of at least MORE THAN 30 secs
Late decelerations Etiology: uteroplacental Insufficiency Always worrisome!
82
MC isolated structural defects detected during prenatal diagnosis
Congenital heart defects
83
Secons MC isolated structural defects detected during prenatal diagnosis
Neural tube defects
84
When is maternal serum AFP screening done?
14-22 weeks AOG
85
Results of MSAFP screening?
Reported as multiple of median (MoM) | > 3.5 MoM clearly indicates fetal risk
86
MCC of increased MSAFP?
AOG dating error
87
Next step if with increased MSAFP?
Confirm age of gestation
88
Five cranial signs of NTD
Small BPD Ventriculomegaly Lemon sign - frontal bone scalloping Banana sign - elongation and downward displacement of cerebellum Effacement/ obliteration of cisterna magnus
89
Banana sign?
Elongation and downward displacement of cerebellum
90
Lemon sign?
Frontal bone scalloping
91
Screening for trisomy 21 during first trimester
Maternal serum B-HCG Pregnancy-associated plasma protein A (PAPP-A) UTZ: nuchal translucency
92
Screening for trisomy 21 during second trimester
``` ACE-I AFP: low Chorionic gonadotropin: high Estriol: low Inhibin: high ```

OB-Gyn (12 decks)

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