Fetal Things Flashcards
What are facts about CMV?
MOST COMMON
- Fetus: congenital hearing loss from maternal re-activation
congenital CMV: jaundice, petechiae, thrombocytopenia, HSM, FGR, myocarditis, hydrops
- Primary maternal CMV: risk of transmission to fetus 30-40%
- highest transmission rate in 3rd trimester but MOST SEVERE if 1st trimester infection.
- Labs: avidity=0.6 or higher (acute infection)
- US findings: microcephaly, ventriculomegaly, ascites, hydrops, echogenic bowel, IUGR, oligo
What are facts about parvovirus?
MOST LETHAL
assoc w/ SAB, hydros, stillbirth
- hydrops is 2/2 aplastic anemia
- Labs: IgG, IgM, PCR. ONLY absence of all 3=non-exposure
What are facts about varicella zoster?
30% mortality with pneumonia
congenital varicella low.
- sx of congenital infection: skin scarring, limb hypoplasia, chorioretinitis, microcephaly
- high rate neonatal death
- tx=PO acyclovir for mom, immune globulin (VZIG) to infants and then IV acyclovir
What are facts about toxoplasmosis?
caused by intracellular parasite . 2/2 cysts in undercooked meat (#1), oocysts from cat poop (#2).
- sx=asymptomatic cervical LAD, fever, malaise, night sweats, myalgias.
- congenital toxo: chorioretinitis, hearing loss, rash, HSM, periventricular calcifications, ventriculomegaly
- IgM stays positive long time post exposure. If possible false pos IgM, collect 2nd sample 2 weeks later.
- Treat to decrease risk of fetal death!!
What is a lemon sign?
when sides of forehead are pulled in due to pull of cisterns magna from spina bifida that distorts intracranial contents
What is a banana sign?
associated with Arnold Chiari malformation
- herniation through cisterns magna
- also hydrocephalus
- - from OPEN neural tube defect!!
What is blueberry muffin sign?
associated with CMV-infected baby
What are signs of cerebral palsy?
low agars, low birth weight (500-1500g), hypoxia (pH<7), chorioamnionitis, periventricular leukomalacia
What is fetal circulation?
Placenta (oxygen rich) -> umbilical vein -> bypass fetal liver -> IVC -> RA -> foramen ovale -> LA -> LV-> aorta -> fetal brain. Oxygen poor blood from fetus returns to RA -> RV -> ductus arteriosus -> lower half of fetal body -> umbilical artery.
- Highest Co2 concentration is in fetal RV.
What is the appropriate ratio of chest compressions to breaths in term neonate?
3:1 compressions-to-breath per minute
- 90 compressions and 30 breaths
What are characteristic of mono mono twins on ultrasound?
T-sign
- less than 2mm membrane thickness
Gender concordant
One placenta
- 2 membrane layers
Which antigens related to hemolytic disease require fetal assessment?
Kell (k)
Kidd (JKa) - not jKb
Rh E
Rh C
Duffy (A) - not duffy B
M
What is path of fetal endocrinology?
Fetal pituitary -> ACTH -> fetal adrenal -> DHEAS -> fetal liver -> 17-OH DHEAS -> placenta -> unconjugated estriol -> maternal liver -> conjugated estriol sulfate -> estriol glucuronide -> maternal urine
hypoWhat is VACTERL?
vertebral defects, anal atresia, cardiac defects, tracheo-esophageal fistula, renal anomalies, and limb abnormalities. People diagnosed with VACTERL association typically have at least three of these characteristic features.
- can also have mullerian agenesis
What is the effect of tetracycline on the fetus?
hypoplasia and staining of fetal teeth
What is effect of Sulfa drugs on fetus?
Kernicterus of newborn
What is effect of streptomycin on fetus?
Fetal high tone hearing loss
What is effect of chloramphenicol on fetus?
gray baby syndrome
What is largest fetal head diameter at term
Supra-occipital mental
What is an increased nuchal translucency associated with?
> 3mm associated with fetal cardiac defects
- most common=septal defect
- then abdominal wall defect and diaphragmatic hernias
- can perform if CRL <84mm
What is risk of neurological compromise and fetal death for surviving twin after death of one twin?
Monochorionic: neurological injury 15%, death 18%
Dichorionic: neurological injury 1%, death 3%
What are fetal effects of tretinoin use?
external ear malformations, cleft palate, micrognathia, heart defects, brain malformations
What is the recommended daily intake of iodine in pregnancy?
220 mcg
