Lecture 44 - Perinatal Pathology

Question 1

Premature birth is considered delivery at < ____ weeks, while Post-term birth is considered delivery at > _____ weeks.

Answer 1

< 38

> 42

Question 2

Small for gestational age (SGA) and Large for gestational age (LGA) are considered Below the ____ percentile and Above the ____ percentile respectively.

Answer 2

10th

90th

Question 3

Apgar score is used as a measure of neonatal health.

0-1 –> ____% chance of mortality

4 –> ____% chance f mortality

7+ –> Almost 0%

Answer 3

0-1 –> 50%

4 –> 20%

Question 4

The Ballard classification allows for determining ______ age via observance of particular anatomical features present at certain stages of growth/maturity.

Answer 4

Gestational age

Question 5

What’s the difference between a Malformation and a Deformation?

Answer 5

Malformations result from abnormal growth/maturation while Deformations result from an external stressor (not part of the inherent growth process).

Question 6

What’s the difference between a Syndrome and a Sequence?

Answer 6

Syndrome –> constellation of defects occurring together but NOT explained by a single initiating malformation.

Sequence –> cascade of defects arising from a single malformation.

Question 7

_______ sequence (aka Potter’s sequence) refers to Defects that arise from a deficiency in Amniotic fluid –> this can result in formation of Amniotic nodules, Potter’s facies (squished face of the fetus), Hand and Foot clubbing, and ______ hypoplasia (“no flow, no grow”).

Answer 7

Oligohydramnios (remember fetal kidneys are responsible for maintaining adequate Amniotic fluid)

Lung hypoplasia

Question 8

Trisomy 18 fetuses have characteristic “_____ _____” feet and overlapping ______.

Answer 8

“Rocker bottom”

Fingers

Question 9

Trisomy 13 is associated with a _____ defect. In severe cases, it can cause _________ (one brain hemisphere instead of the normal 2 - left and right).

_____ lips are common in these babies.

Answer 9

Midline defect

Holoprosencephaly

Cleft lips

Question 10

Klinefelter’s syndrome arises from what chromosomal composition?

How about Turner syndrome?

Which of the two is more common?

Answer 10

Klinefelter’s –> 47 XXY

Turner –> 45 XO

Turner is more common, but we see it less bc it causes more miscarriages (most that survive will be mosaics).

Question 11

One of the characteristic findings of Turner syndrome is ______ of the aorta (narrowing of the lumen, sort of like it was pinched).

Answer 11

Coartation of the aorta

Question 12

Amniocentesis is conducted in the _______ trimester, while Chorionic villous sampling is done during the ______ trimester.

Answer 12

1st

2nd

Question 13

_____ period refers to the period of time when an organ is being formed and is susceptible to Major damage by teratogens.

______ period refers to the period of time when an organ is fully formed, so its formation can no longer be perturbed (malformation is not possible at this point, only Deformation).

Answer 13

Critical period

Termination period

Question 14

Provide the following weeks during gestation in which the organs form:

CNS: Weeks ____-____

Heart: Weeks ___-___

Limbs: Weeks ___-___

Eyes: Weeks ___-___

Genitals: Weeks ___-___

Answer 14

CNS: 2-4

Heart: 3-6

Limbs: 4-6

Eyes: 4-6

Genitals: 6-8

Question 15

TORCH Complex is an acronym that describes a group of causative agents which result in very similar fetal malformations including _____ (eyes), ______ (ears), and Cardiac lesions.

The risk period is shortly before conception to about _____ weeks gestation.

Answer 15

TORCH (Toxoplasmosis, Other, Rubella, CMV, HSV)

Cataracts

Deafness

16 weeks

Question 16

Hydrops fetalis (largely swollen fetus) used to be caused by _____ disease (maternal immunity against fetal blood), but nowadays that’s pretty well treated. It’s typically more a result of Cardiac, Chromosomal, or Fetal Anemia issues.

Answer 16

Rh disease

Question 17

One of the causes of Hydrop fetalis in the 2nd trimester is ______. On histology, look for “cherry red” intracellular inclusions and immature _____ cells.

Answer 17

Parvovirus

Immature red cells

Question 18

The most common cause of miscarriage in the:

1st trimester is _______ abnormalities.

2nd trimester is ______ or Incompetent ______.

3rd trimester is _____, an____, bleeding, or _____ problems.

Answer 18

1st –> Chromosomal

2nd –> Infection or Incompetent Cervix

3rd –> Infection, Anoxia, bleeding, or Placental problems

Question 19

Bronchopulmonary Dysplasia (BPD) of the neonate results from BOTH ____ ____ syndrome (insufficient or lack of surfactant) and/or the treatment for it, creating scarring and fibrosis in the lung.

Answer 19

Respiratory Distress Syndrome (RDS)

Question 20

Necrotic Enterocolitis is another complication of ______ (pre or post-term birth?). Look for characteristic colonic ______ (air in the colon).

Answer 20

Preterm

Pneumatosis

Question 21

Post-term babies are at higher risk for ______ fractures (bc they’re too large to pass through the vagina) and resulting nerve injury. They are also at higher risk of ______ aspiration in utero, which if ingested below the vocal cords can cause chemical _______.

Answer 21

Clavicular fracture

Meconium aspiration

Chemical pneumonitis