Maternal Factors

Question 1

What does hCG do and when is it at its highest level in pregnancy?

Answer 1

HCG prevents corpus luteum involution and suppresses maternal immune function
Highest in 1st trimester

Question 2

What effect does progesterone have on uterus?

Answer 2

Smooth muscle relaxation — supposed in labor

Question 3

What effect does estrogen have on uterus?

Answer 3

Regulates progesterone, increases strength of contractions

Question 4

Fetal significance of placenta previa

Answer 4

Increased risk of preterm delivery, increase risk for fetal anomaly (2.5x)

Question 5

What are risk factors for placenta abruption?

Answer 5

Maternal hypertension, history of prior abruption, advance maternal age, multiparous, cigarette smoking, cocaine use, trauma, fibroids

Question 6

What are the types of molar pregnancy?

Answer 6

1. Complete: 46XX, mostly paternal origin, no fetus or amnion present, large uterus, 20% trophoblastic tumors, usually have medical complications.
2. Partial: 69 XXX/xxy/xyy. fetus is often present, small uterus, rare to have medical complications.

Question 7

What is the fetal significance of maternal lupus?

Answer 7

Increase incidents of first trimester abortion, intrauterine growth restriction, and fetal death.

Increased risk of congenital heart block, especially if anti-Ro and anti-La antibodies are detected

Question 8

What is the fetal significance of myasthenia gravis?

Answer 8

Limited fetal effects, usually only a small percentage of antibodies directed towards fetal acetylcholine receptors.

If fetus is affected, usually they present with fetal arthrogryposis.

10 to 20% of neonates have transient symptoms that present within 12 to 48 hours after birth and last anywhere from 18 days to 15 weeks. Presentation includes generalized weakness, weak respiratory muscles, facial weakness, difficulty, swallowing, or feeding, and ocular motor disturbance.

90% of infants with transient symptoms, recover by two months of age

Question 9

What are fetal effects of diabetes mellitus? (Overall, endocrine/electrolytes, pulmonary, cardiac, CNS, hematologic, GI, GU, and skeletal)

Answer 9

Overall: stillbirth, polyhydramnios, preterm birth, LGA, organomegaly
Endocrine/electorlytes: transient hyperinsulinism, early neonatal hypocalcemia
Pulmonary: surfactant deficiency
Cardiac: HCOM, VSD, TGA, ASD, HLHS, DORV, Truncus
CNS: neural tube defects
Hematologic: polycythemia
GI: duodenal atresia, imperforate anus, situs in versus, small colon
GU: renal agenesis, hydronephrosis, renal vein thrombosis
Skeletal: caudal regression syndrome

Question 10

Definition of Preeclampsia

Answer 10

Systolic >= 140
Diastolic >= 90

Question 11

What is HELLP syndrome

Answer 11

Hemolysis (elevated LDH or bilirubin)
Elevated Liver Enzymes
Low Platelets (less than 100K)