Maternal

Question 1

How long is a term pregnancy

Answer 1

280 days long, 40 weeks

Question 2

Maternal Diabetes Mellitus

Answer 2

Type 1 + 2

can cause spontaneous abortions and congenital malformations

goal is to establish glycemic control to decrese rate of hyperglycemia and ketosis

Question 3

type 1

Answer 3

autoimmune disease. Can cause decrease BF to the kidneys + pelvic vesesels reducing uterine bloof flow causing IUGR
- moms high change of experiencing hypoglycemia and SKA

Question 4

Type 2

Answer 4

hyperglycemia caused by increased insulin resistance, hepatic glucose production, abnormal insulin secretion

Question 5

gestational diabetes

Answer 5

moms have been having higher insulin resistance before conception

increased risk for obese women, previous GDM hx

dx with 1 hour glucose challenge @24-28 weeks if fails will do 3 hour challenge

Question 6

effect on infant with diabetes mom

Answer 6

• increase fetal hyperglycemia + insulin production

s/sx macrosomia, SGA,

neural tube defects, CV malformation

respiratory distress due to inhibition of phospholipid production and decerased synthesis of surfacrtant

infant can present with hypocalcemia due to dimished parathyropid response and polycythemia due to chronic hypoxic state in the fetus

Question 7

maternal hypertension

Answer 7

• causes uteroplacental ischemia, decreased blood flow

s/sx htn, proteinuria (poor renal perf), edema, bp >140/90, headahce, hyperreflex with clonus, visual changes, epigastric pain
&raquo_space; eclampsia: seizures, coma, HELLP sundrome

mange BP, corticosteroids, monitor baby, IV mag + labetalol or hydralazine

give infant betamethasone to increase lung maturity, x2 Q24

Question 8

reduced uteroplacental ischemia

Answer 8

ischemic lesion on the vascular bed of the placenta causing fetal growth restriction and prematurity

Question 9

neonate + mom HTN

Answer 9

• placenta insuff, IGUR, hypoglycemia, maladaption, hypoxia, low blood count,

Question 10

labetalol + mag sulfacte SE for infant

Answer 10

Mag - resp dep, poor feed, lethagy, hypotonia

labetalol- hypoglycemia, hypotension, bradycardia, resp depression, transient tachypnea

Question 11

hyperthyroidism maternal

thyroid hormones

Answer 11

• T3 + T4 hormones cross placenta, TSH does not
• maternal T4 important for fetal brain devlopment in first trimester
• drugs tx thyoid effect the fetal thyroid

Question 12

hypothyroidism

infant effects

Answer 12

• hashimoto’s thyroidutus
  if left untreated can cause neur delays

tx is replacemtn hormones during preg. L-thyroxine

infant - neurodevelopment delays, cong goiter, low iodine levels
tx thyroxine therapy

Question 13

hyperthyroidism

Answer 13

• graves disease

untreated can place mom at risk for thyroid storm (excess t4) putting them at risk for htn, HF, and minimal cardiac reserve, hydrops

sx of thyrotoxicosis start presenting by the 2nd week of life.

infant risk for IUGR, cardiac, goiter, CHF, hyperthroidism, neuro delay

Question 14

congenital goiters neonate

Answer 14

both hypo + hyperthyroidism

autoimmune antibodies can cause congenital goiters if large enough can cause tracheal obstruction or CF

tx propranolol

Question 15

ABO incompatibility

Answer 15

screen O type moms
most common
less severe

IgG pass the placenta to the fetus causes hemolysis increase bili levels

Question 16

RH incompatibility/ isoimmune hemolytic anemia

Answer 16

Fetus with RH + and Mom with no antigen

• mom produces immune response to produce antibodies against baby’s antigen. Moms antibodies enter fetal circulation and destroys fetals RBCs
• infants RBCs destroyes causing hemolysis

ssx: anemia from hemolysis, hypoxia, acidosis, CHF, hydrops, hypoglycemia, + Direct commbs test

prevent by gicing anti d immune globulin which will destroy fetak RBC in maternal circulation which blocks maternal antibody production(guve at 28 weeks, after delivery, and after amniocentesis

Question 17

Direct vs Indirect Coombs testq

Answer 17

Direct Coombs positive: indicates maternal IgG antibodies are attached to the surface of infants blood

positive indirect indicates maternal antibodies against the infant are present in maternal serum

Question 18

Maternal Systemic Lupus

+ neonates effects

Answer 18

Autoimmune disease
mom’sx ssx:htn, thrombotic events, spont abortion, preterm delivery. Time pregnancy during disease remission

antibodies transfer to the placenta
neonate: lupus like rash thrombocytopenia, hemolysis

maternal antibodies to anti-Ro/SSa and anti La/SS-B antigens = risk for congenital heart block Need pacemaker,

Question 19

Cocaine

Answer 19

CNS stimulant crosses the placenta + blood brain barrier

vasoconstrictive effects decrease blood to placenta, NAS will occur on 2-3 day

Question 20

amphetamines + methamphetamine

Answer 20

CNS stimulant

fetus: growth restriction, brain lesion (cause brain hemorrhage), cleft lip/palate
neonate: neuro, hypoglycemia, poor feeds, seizures, SIDS

Question 21

alcohol

Answer 21

Fetal alcohol spectrum disorder.

Question 22

opioids

Answer 22

ex. morphine, heorin, codein, fentanyl, methadone
neonate: LBW, neuro, withdrawal

NAS - withdrawal 2-4 days

Question 23

NAS

Answer 23

neuro: high pitched crym tremors, increased wakefulness
GI: vomiting, fever, sweating
metabolic, vaso, respiratory: fever, sneezing, tachypnea, sweating

Question 24

SSRI

Answer 24

antidepressant
Neonate s/sx: crying, irritable, tremors, fever, hypertonia, poor feeds, resp distress
NOT WITHDRAWAL - drug toxicity

Question 25

non stress test

Answer 25

• evaluates fetal anutonomic nervous system
• fetal movement + fetal heart accels which is predictive of absence of fetal metabolic acidemia

Reactive NST ; increase FHR 15BPM for 15 secs above basline HR x2 in 20minutes
Nonreactive NST: lack of FHR accel during 40 minute

Question 26

contraction stress test

Answer 26

• evaluates uterine contractions (causes interruption of uteroplacental perfusion) and transiet fetal hypoxemia
• min 3 contractions of 40 secs in 10 min period

Negative CST- no FHR decel
Positive CST: late decel associated with hypoxia and acidosis admited for induction

Question 27

BPP

Answer 27

biophysical profile = NST + US
ASsess: fetal breathing, body movements, fetal tone, amniotic fluid vol, NSTover 30 minutes. Total of 10
8-10 = normal
if lower will be induced

Question 28

Head Compression in labor

Answer 28

• causes a vagal response and reflow slowing FHR

early + late decels (occur after the contraction has started. Indicates interruption in fetal O2)

Question 29

Cord Compressiong

Answer 29

umb is lopped around body with oligohydraminos + ROM

Variable decels - abrupt descent. Usually HR recovers quick but if it doesnt it is an indication of diminshed O2 and hypoxia

can cause prlonged decels which resolves with intrauterine resucitation or delivery

Question 30

cord prolapse

Answer 30

• when the cord slips below the presenting part and UC is compressed by the present part
• tracing will show abrupt occurence of persistent severe variable decels or bradycardia

Question 31

placental previa

Answer 31

placenta implants low in the uterus near cev os
- episodic, painless, mat bleediing
- as gestation progresses, placenta can move from the cerv os
need c/s

Question 32

placental abruption

Answer 32

placenta suddenly separates from uterus
s/sx dark or bright red bleeding, abd or lower back pain, board like and tender abd, uterine irritability

Stillborn, anemia hypovolemia, premie, hypoxemia

Question 33

antenatal steroids

Answer 33

• given to reduce respiratory distress and IVH

Question 34

Magnesium sulfate + neonate

Answer 34

reduce occurenc of CP