Fetal-Maternal Medicine Flashcards
1
Q
What are the different membranes involved in placental and fetal development?
A
Chorion, Amnion, Yolk Sac, Allantois
These membranes originate from the developing embryo and play crucial roles in nutrient exchange and protection.
2
Q
What are the three regions of the decidua?
A
Decidua basalis, Decidua capsularis, Decidua parietalis
These regions are important for placental attachment and function.
3
Q
What is the function of chorionic villi during placental development?
A
Facilitates nutrient and gas exchange between mother and fetus
They develop into primary, secondary, and tertiary villi.
4
Q
What is placenta accreta?
A
Chorionic villi attach to the myometrium
This can lead to complications during delivery.
5
Q
What is the primary function of the placenta?
A
To provide oxygen and nutrients to the fetus and remove waste products
It acts as a lung, kidney, and liver for the fetus.
6
Q
What is the significance of the fetal endocrine system?
A
Regulates growth and development of the fetus
It interacts with maternal hormones for optimal fetal health.
7
Q
What are the two main types of trophoblasts?
A
Cytotrophoblasts, Syncytiotrophoblasts
These cells are crucial for implantation and placental development.
8
Q
Fill in the blank: The placenta is composed of _______.
A
Three organs: lung, kidneys, and liver
Each organ system performs essential functions for fetal health.
9
Q
What is preeclampsia?
A
New onset hypertension after 20 weeks of pregnancy with proteinuria
It can lead to serious complications for both mother and fetus.
10
Q
What is the difference between oligohydramnios and polyhydramnios?
A
Oligohydramnios: not enough amniotic fluid; Polyhydramnios: too much amniotic fluid
Both conditions can lead to complications during pregnancy.
11
Q
True or False: The placenta has an immunologic function.
A
True
It protects the fetus from maternal immune responses.
12
Q
What is the role of human chorionic gonadotropin (hCG)?
A
Maintains the corpus luteum and prevents menstruation
It is crucial for early pregnancy maintenance.
13
Q
What is eclampsia?
A
Onset of seizures in women with preeclampsia
It is a potentially life-threatening condition.
14
Q
What are the risk factors for abruptio placentae?
A
Trauma, smoking, hypertension, preeclampsia, cocaine abuse
This condition involves premature separation of the placenta.
15
Q
What is the function of the placenta regarding nutrient transfer?
A
Facilitated diffusion, active transport
It allows for the transfer of glucose, amino acids, and other essential nutrients.
16
Q
What happens during the rupture of membranes?
A
Breaking of the amniotic sac, indicating labor may have started
It can also increase the risk of infection.
17
Q
What is the incidence of placenta accreta in the 2000s?
A
1 in 533 pregnancies
This is a significant increase from the incidence in the 1960s.
18
Q
What is the role of the placenta in waste excretion?
A
Removes urea, creatinine, bilirubin, CO2
This is crucial for maintaining fetal health.
19
Q
Fill in the blank: Placental insufficiency leads to _______.
A
Poor growth, preterm birth, stillbirth
Insufficient blood flow to the placenta can have serious consequences.
20
Q
What is the significance of estriol levels during pregnancy?
A
Used to assess fetal well-being
It reflects fetal health and placental function.
21
Q
What is the primary function of decidual cells?
A
Support placental attachment and function
They are filled with glycogen and provide nutrients.
22
Q
What hormone levels are used to assess fetal well-being?
A
Estriol levels
Estriol is a form of estrogen produced by the placenta and fetus, and its levels can indicate fetal health.
23
Q
How does the placenta protect the fetus?
A
It acts as an immunologic barrier
The placenta expresses HLA-G and Fas ligand, which help protect the fetus from maternal immune responses.
24
Q
What is the significance of MHC I representation on syncytiotrophoblast?
A
There is no MHC I representation
This lack of MHC I helps prevent maternal immune detection of the fetus.
25
What immunoglobulin is transferred to the fetus via pinocytosis?
IgG
## Footnote
IgG is the only immunoglobulin that can cross the placenta and provides passive immunity to the fetus.
26
What is Rh Hemolytic Disease of the newborn caused by?
Rh- mother and Rh+ fetus
## Footnote
The condition arises when maternal antibodies attack fetal red blood cells in a subsequent pregnancy.
27
What test is used to prevent Rh Hemolytic Disease?
Rosette Test & Rhogam
## Footnote
The Rosette Test can help detect Rh incompatibility and guide the administration of RhoGAM.
28
What are the two classifications of amniotic fluid volume abnormalities?
Oligohydraminos and Polyhydraminos
## Footnote
Oligohydraminos is defined as less than 500ml, while polyhydraminos is greater than 2000ml.
29
List some causes of Oligohydraminos.
* Bilateral renal agenesis
* Preterm amnion rupture
* Uteroplacental insufficiency
* Maternal dehydration
30
What does the acronym TORCHES stand for?
* Toxoplasma gondii
* Other
* Rubella
* Cytomegalovirus (CMV)
* Herpes Simplex Virus (HSV1 and 2)
* HIV
* Syphilis
31
What are some teratogens that can affect fetal development?
* ACE inhibitors
* Some antibiotics
* Antiepileptic drugs
* Methimazole
* Warfarin
* Alcohol
* Cocaine
* Smoking
32
What is Intrauterine Growth Restriction (IUGR) associated with?
* Genetic abnormalities
* Maternal environment (malnutrition, substance abuse, etc.)
* Placental insufficiency and umbilical cord disorders
33
What is the role of human placental lactogen during pregnancy?
It increases insulin resistance
## Footnote
This occurs particularly in the 2nd and 3rd trimesters, leading to excess glucose being available to the fetus.
34
What are the two types of Gestational Diabetes?
* A1GDM (managed with diet changes)
* A2GDM (responsive only to medication)
35
What are maternal risk factors for Gestational Diabetes?
* Age
* Obesity
* Previous medical history
* Family history of diabetes
36
What complications can arise from Gestational Diabetes?
* Preeclampsia
* Polyhydramnios
* Fetal macrosomia
* Hyperbilirubinemia
* Neonatal respiratory distress syndrome
37
What is the most accurate statement concerning the treatment of a mother with RhoGAM?
It prevented hemolytic disease in her newborn son
## Footnote
RhoGAM is administered to Rh- mothers to prevent the development of antibodies against Rh+ fetal blood.
38
What is a possible diagnosis for a 32-year-old patient presenting with sudden severe abdominal pain and vaginal bleeding at 34 weeks gestation?
Placental abruption
## Footnote
The sudden pain and bleeding, alongside the patient's history of substance use, suggest this diagnosis.
39
why can't the surrounding tissues feed the embryo in an ectopic pregnancy
decidual cells are only found in the uterine lining
40
cytotrophoblast cells are important for what physiologic functions in the fetal-maternal relationship;?
these cells eventually differentiate into chorionic villi which are important for the development of fetal-maternal blood supply
41
allantois are derived from what embryologic membrane?
the yolk sac
42
what layer of the placenta is highly vascualarized?
the decidua parietalis
43
which layer of the mature placenta makes contact w/ the site of implantation?
decidua basalis
44
what placental layer separates the embryo from the uterine cavity?
decidua capsularis
45
T or F: chorion is derived from trophoblasts.
true
46
the amnion and yolk sac are derived from what part of the embryo?
inner cell mass
47
what are the most important roles of the allantois?
development of umbilical and placental blood vessels
48
what is placenta Increta
penetration of the villi into the myometrium
49
what is placenta Percreta?
villi perforate through the myometrium into the uterine serosa
50
what is the pathogenesis of abnormal placental attachments?
defective decidual layer
under normal circumstances, decidua cells express inhibitors that control and regulate MMPs created by syncytiotrophoblasts
51
T or F: the incidences of abnormal placental attachments is increasing
true
52
what is placenta previa?
when the placental attachment covers some or all of the cervix
53
what is a clinical hallmark of abruptio placentae?
abrupt, painful bleeding in 3rd trimester
54
T or F: for the first 8 weeks of pregnancy, fetal contribution is minimal
false
maternal contribution is minimal for the first 8 weeks
55
what is providing nutrients to the embryo for the 1st 8 weeks of pregnancy?
the decidum
56
starting at 9-10 weeks, fetal growth becomes more ....... and placenta growth becomes......
fetal growth > placental growth
57
compare and contrast the physiological conditions during the 1st 8 weeks of pregnancy compared to after?
first 8 weeks:
low O2 tension
hypoxic enviroment
increased VEGF
after the 1st 8 weeks:
O2 and glucose levels increase
VEGF goes down
58
what is the pathophysiology of pre-eclampsia?
incomplete remodeling of maternal spiral arteries
59
what are risk factors for pre-eclampsia
maternal age > 35
obesity
IVF
60
what is a clinical hallmark of ectopic pregnancy
shoulder pain
61
what are risk factors for ectopic pregnancy
PID
tobacco
infections
induced ovulation
tubal surgery
62
Placenta accreta increases the risk for what delivery complication?
bleeding if the placenta does not separate from the uterine wall
63
what is placenta marginatum?
placenta is in close proximity to the cervix but does not cover it
64
T or F placenta marginatum can develop into placenta previa later on and should therefore still be closely monitored
true
65
how is preterm birth clinically defined?
water breaks before 37 weeks gestation
66
fetus staying in the uterus post-rupture increases the risk for what?
infection
fetal distress syndrome
67
the placenta contains what type of glucose transporters?
GLUT1
68
hCG is produced by what embryonic cells?
syncytiotrophoblasts
69
T or F: fetal hormones are sulfated to reduce their activity
true
70
polyhydramnios is quantitatively defined as what?
amniotic fluid > 2000 mL
71
oligohydraminos is quantitatively defined as what?
amniotic fluid < 500 mL
72
what fetal defects are assoc. w/ polyhydraminos?
esophageal or duodenal atresia
anencephaly
73
gestational diabetes depends on the function of what maternal organ
the pancreas
74
Define pre-pregnancy care.
A set of interventions targeting any women of reproductive age, including biomedical, behavioral, and social risks.
75
What is the approximate percentage of pregnancies that are unplanned?
45-50%
76
What should be optimized before pregnancy?
Chronic medical conditions
77
What is the main goal of prepregnancy care?
To provide screening for risks, health promotion, and education.
78
What should be included in the history information for prepregnancy care?
* Medical, Surgical and Psychiatric history
* Reproductive/Family Planning
* Current Medications
* Family/Genetic history
* Immunizations
* Substance Abuse history
* Intimate Partner Violence
* Nutritional Status
* Exercise/Physical Activity
* Teratogen/Exposure
79
What is the recommended daily supplement for women in prepregnancy care?
Folic Acid: 400 micrograms; 4 milligrams if previous child with NTD or taking anticonvulsant medication.
80
What is the most accurate method to confirm pregnancy and establish gestational age?
Ultrasound of Crown-Rump-Length (CRL) prior to and including 13 6/7 weeks.
81
What hormone rises to a peak of 100,000 mIU/mL by 10 weeks gestation?
Human chorionic gonadotropin (HCG)
82
What are common signs and symptoms of pregnancy?
* Amenorrhea
* Nausea and vomiting
* Breast fullness and tenderness
* Fatigue
* Urinary frequency
83
What is hyperemesis gravidarum?
Persistent vomiting leading to acute starvation, weight loss, and electrolyte abnormalities.
84
What does the GPTPAL system stand for?
* G: Number of pregnancies
* P: Total number of deliveries after 20 weeks
* T: Term pregnancies
* P: Preterm pregnancies
* A: Abortions
* L: Living children
85
What is Naegele’s Rule used for?
To estimate the Expected Date of Delivery (EDD).
86
What physiological changes occur during pregnancy?
* Increase in blood volume
* Increase in cardiac output
* Decrease in systemic vascular resistance
87
What should the physical examination of the obstetrical patient include?
* Assessment of vitals
* General appearance
* Head/eyes/ears/nose/throat examination
* Observational assessment
88
True or False: A woman who makes healthy choices prior to conception is laying the foundation for a healthy pregnancy.
True
89
Fill in the blank: The Estimated Date of Confinement (EDC) is determined by the first day of _______.
last menstrual period (LMP)
90
What are some maternal concerns to assess during a prenatal visit?
* Was the pregnancy planned?
* How does she feel about the pregnancy?
* Does she have a support network?
91
What are common co-morbidities to consider in prepregnancy care?
* Hypertension
* Diabetes
* Thyroid disorders
* Asthma
* Depression
92
What is the significance of assessing family history in prepregnancy care?
To identify chronic illnesses and/or genetic disorders that may affect pregnancy.
93
What position should be avoided after 20 weeks of pregnancy?
Extended period in supine position
## Footnote
This is to prevent supine hypotension due to compression of the aorta and IVC.
94
What is melasma?
Patchy gray-brown or dark brown skin discoloration occurring on the face
## Footnote
Often referred to as 'the mask of pregnancy.'
95
What is the typical fetal heart rate in early pregnancy?
150 - 160 bpm
## Footnote
Slows to average 120 to 140 bpm near term.
96
What is the purpose of Leopold's maneuvers?
To determine fetal lie within the maternal abdomen
## Footnote
Most accurate after 36 weeks gestation.
97
What changes are associated with Chadwick's sign?
Dark blue to purplish-red congested appearance of the vaginal mucosa
98
What is the recommended caloric increase during the first trimester of pregnancy?
300 Kcal
99
Fill in the blank: Striae _______ are stretch marks of the abdomen that appear purplish.
gravidarum
100
What are the recommended vaccines for pregnant women according to ACOG and CDC-ACIP?
* Tdap (27 to 36 weeks GA)
* Influenza (inactivated)
* RSV (from 32 to 36 weeks GA)
* Covid (if eligible)
101
What is the recommended weight gain for a normal weight pregnant woman?
25 – 35 lb
## Footnote
This is according to the Institute of Medicine Weight Gain Recommendations.
102
What is the term for fetal movement awareness between 12 and 24 weeks gestational age?
Quickening
103
What dietary restrictions are recommended during pregnancy?
* Avoid unpasteurized milk and food products
* Avoid raw/undercooked meats, seafood, eggs
* Limit high mercury fish
104
What is the significance of measuring fundal height?
Height in centimeters should roughly equal weeks of gestation after 20 weeks
105
What is the normal range for fetal heart rate?
110-160 bpm
106
What physical examination findings may indicate pregnancy?
* Goodell’s sign
* Hegar’s sign
* Ladin’s sign
107
What is the recommended exercise for pregnant women?
* Walking
* Swimming
* Stationary cycling
* Low-impact aerobics
108
What is the normal contour and respiratory check for the chest/lungs during physical examination?
Check respiratory rate, contour, and breathing pattern
109
What is the recommendation for prenatal visits during the first trimester?
1 visit every 4 weeks
110
True or False: Pregnant women should avoid contact sports.
True
111
What is the role of the Edinburgh Postnatal Depression Scale (EPDS)?
To screen for depression in pregnant women
112
What should be documented during the concluding visit of a prenatal exam?
* Findings in chart
* Questions asked
* Importance of prenatal care
113
What is the significance of the cervix length during a bimanual exam?
Cervix is ~3 cm long, open at external os and closed at internal os prior to 34-36 weeks
114
What is the expected fundal height measurement for a pregnant woman at 28 weeks?
Approximately 28 cm
115
What should be assessed during the genitalia, anus, and rectum examination?
* Color of cervix
* Shape and healed lacerations
* Mucosal surface of cervix and os
116
What is diastasis recti?
A condition where the abdominal muscles separate during pregnancy
117
What is the significance of the 20-week mark in pregnancy examinations?
Change from finger breadth approximation to tape measure for fundal height
118
What is the recommended caloric increase during the second trimester?
400 Kcal
119
What is the normal response for fetal movements?
Maternal awareness of fetal movement or 'quickening'
120
What are some common concerns during pregnancy?
* Amenorrhea
* Nausea/Vomiting
* Breast Tenderness
* Fatigue
121
What is the purpose of a Pap smear during pregnancy?
To assess for cervical cancer and other infections if indicated
122
What is the ideal timing for Group B Streptococcus culture during pregnancy?
36 weeks
## Footnote
Testing for Group B Streptococcus is typically recommended at 36 weeks of gestation.
123
What blood tests should be repeated in high-risk populations during pregnancy?
CBC, RPR, HIV
## Footnote
These tests are important for monitoring the health of both the mother and the fetus.
124
After the examination of a pregnant patient, what should the clinician do?
Conclude exam, relay commitment, ask for questions, stress importance of prenatal care, discuss expectations and future visits, document findings, print educational material
## Footnote
These steps help ensure the patient understands their care and the importance of follow-up.
125
What should be included in each visit during pregnancy?
Specific bloodwork, vaccinations, education, counseling
## Footnote
Each visit should address the evolving needs of the pregnant patient.
126
Which organ system is focused on in the discipline of Reproductive Health?
Reproductive
## Footnote
This discipline addresses various aspects of reproductive health and normal pregnancy.
127
What is the title of the resource that discusses the effects of pregnancy on other organ systems?
Pregnancy Effects on Other Organ Systems
## Footnote
This resource provides insights into how pregnancy can affect different bodily systems.
128
What is the name of the book that includes 'Chapter 26: Pregnant Woman'?
Bates’ Guide to Physical Examination and History Taking, 13th ed
## Footnote
This book is a key reference for physical examination techniques.
129
What is the frequency and timing for in-person or virtual office hours?
Every Friday 11a-12p CST / 12-1p EST
## Footnote
This schedule allows for regular access to educational resources and support.
130
Fill in the blank: The examination of the pregnant patient should be an adapted exam to incorporate the _______.
changing female form and growing fetus
## Footnote
This adaptation is crucial for appropriate patient care.
131
What should clinicians stress the importance of during patient visits?
Prenatal care
## Footnote
Emphasizing prenatal care helps ensure the health of both mother and baby.
132
What type of feedback form is mentioned for lectures?
Lecture Feedback Form
## Footnote
This form allows students to provide their feedback on the lecture.
133
what is the definition of primagravida
a female who is pregnant for the first time
134
what is the definition of multigravida?
a female who has been pregnant more than once
135
how is term pregnancies quantitatively defined?
of deliveries after 37 weeks
136
how are pre-term pregnancies quantitatively defined?
of deliveries from 20-30 weeks
137
how is abortion quantitatively defined?
of deliveries less than 19 weeks
138
what SHx factors should be taken into consideration for prenatal care?
home & life support
exercise routines
tobacco, alcohol, & drug use
diet
139
how is EDD calculated?
FDLMP - 3 mo + 7 days + 1 year = EDD
*refer to ex. on slide 27 of the prenatal care ppt
140
T or F: on average, EDD is 280 days after FDLMP.
true
141
how does pregnancy affect pH?
increases it
142
T or F: GFR decreases during pregnancy
false
pregnancy is asso. w/ increase in GFR
143
HPL is assoc. w/ what?
gestational diabetes
144
what role does relaxin play in pregnancy
ligament laxity & pubic symphysis mobility
145
changes in progesterone during pregnancy have been linked to what symptoms of pregnancy?
SOB, GERD, & hydronephrosis
146
Changes in what hormone causes a hypercoagulable state during pregnancy?
estrogen
147
what hormone stimulates prolactin?
estrogen
148
head of the bed for a pregie should be elevated to a least how many degrees?
30 degrees
149
where on the chest can mammary souffle be heard?
2nd or 3rd ICS at the sternal border
150
palpation of apical impulse may present in which area of the chest and be higher
4th ICS
151
T or F: spider nevi is normal during pregnancy
true
152
T or F: tape measures are generally used to measure fundal height at < 20 weeks gestation
false
tape measures are used after 20 weeks gestation while finger breadth approximation is used for gestational periods before 20 weeks
153
T or F: uterine fundus measurement should be roughly equal to # of weeks gestation
true
154
fetal heart beat can be detected after how many weeks of gestation?
10-12 weeks
155
what doe leopold's maneuvers asses?
fetal position starting in 2nd trimester
156
leopold's maneuvers are most accurate after how many weeks of gestation?
36 weeks
157
what does the first leopold's maneuver assess?
upper fetal pole and contents of the fundus which should include the fetal buttocks
158
what does the 2nd leopold's maneuver asses?
evaluation of fetal back and extremities via physician hand placement on either side to the maternal abdomen
159
what does the 3rd leopold's maneuver assess?
lower fetal pole and descent into pelvis
physician palpates above the pubic symphysis
160
what does the 4th leopold's maneuver assess?
flexion of the fetal head as confirmation that the head is in the correct position for vaginal delivery
161
what is chadwick's sign
a dark blue-purplish-red congested appearance of the vaginal mucosa
162
what is hegar's sign?
softening of uterus at junction w/ the cervix (isthmus)
occurs during 1st trimester
163
what is Goodell's sign?
softening and cyanosis of the cervix after 4 weeks
164
what is ladin's sign?
softening of the uterus after 6 weeks
