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Neonatal-Perinatal Boards Review > Maternal/Fetus/Transition > Flashcards

Maternal/Fetus/Transition Flashcards

1
Q

Type of twins most at-risk for twin-twin transfusion syndrome (TTTS)

A

Monochorionic–most commonly mono-di, rarely in mono-mono

By sharing chorion can have multiple placental anastamoses so blood flow can become imbalanced

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2
Q

Signs (by escalating level of severity) of twin-twin transfusion syndrome (TTTS)

A

I: poly/oligo-hydramnios

II: absent bladder (donor)–this and anything more warrants laser occlusion/ablation

III: abnormal doppler flows (signifying insufficient delivery to donor)

IV: hydrops (recipient)

V: demise

(Quintero staging)

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3
Q

Risks to donor in twin-twin transfusion syndrome (TTTS)

A

Growth restriction

Anemia

“Stuck” (adhering to membranes 2-2 severe olighydramnios)

Death (higher risk to donor>recipient)

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4
Q

Risks to recipient in twin-twin transfusion syndrome (TTTS)

A

Hypervolemia/hydrops

Polycythemia

High-output heart failure/hypertrophic cardiomyopathy

Disseminated intravascular coagulopathy and thromboembolic events

Demise (higher risk in donor)

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5
Q

If one twin dies in-utero from twin-twin transfusion syndrome, the other has ____% risk of demise

A

>30%

(Often within hours; sudden shift in blood flow from pressure-drop in dead twin’s system steals from survivor–severe hypoperfusion)

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6
Q

Definition of preeclampsia and severe preeclampsia

A
  1. SBP>140 or DBP>90 plus proteinuria
  2. SBP>160 or DBP>110 plus proteinuria
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7
Q

Quad screen findings for Trisomy 21

A

Low AFP, high bHCG, low estradiol, high inhibin

Put in alphabetical order and then alternates low-high-low-high (remember it “starts” with low because only open defects cause high AFP)

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8
Q

What do late decelerations indicate?

A

Fetal hypoxemia

Most classic term is “uteroplacental insufficiency”

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9
Q

Teratogenic effects of Isotretinoin

A

dTGA

Macrocephaly, triangular faces

_T_retinoin = _T_GA and _T_riangular _T_oo big head

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10
Q

What is the most identifiable common cause of non-immune hydrops

A

Cardiac abnormalities (arryhthmias [which are often associated with CHD])

Account for 25% of non-immune hydrops

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11
Q

What three organs are prioritized for oxygen delivery/blood flow

A

Adrenals

Brain

Coronaries (heart)

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12
Q

Umbilical vein blood has a pO2 of ____

A

30mmHg (half the lower-limit of normal ex-utero)

About 1/3 of this oxygenated blood bypasses to the aorta through the foramen ovale (since it’s ejected pre-DA, it goes to most oxygen-needy coronaries and head)

A THIRD of this THIRTY mmHg blood goes to the THIRSTY heart and brain

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13
Q

How IgG transplacentally transferred

A

Pinocytosis

Really only molecule tested that’s transferred this way

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14
Q

The treatments mothers with a prior infant with Neonatal Alloimmune Thrombocytopenia (NAIT) receive

A

Steroids and weekly IVIG

Start at 12 weeks if prior infant had intracranial hemorrhage (ICH) (20 weeks if no prior ICH)

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15
Q

Most common cause of mild thrombocytopenia in a well-appearing newborn

A

Placental insufficiency

(Most common cause of severe thrombocytopenia is NAIT)

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16
Q

What do the umbilical arteries branch off of

A

Umbilical arteries come off the internal iliac arteries

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17
Q

Which ventricle provides majority of fetal cardiac output

A

Right (66% of CO)

Why it’s relatively hypertrophied at birth

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18
Q

What are the PO2/oxygen saturations in the:

1) Umbilical vein
2) Left ventricle
3) Right ventricle
4) IVC/SVC

A

1) UV: PO2 40 / SaO2 80% (DV SaO2 70% per Brodsky)
2) LV: PO2 30 / SaO2 65%
3) RV: SaO2 55%
4) SVC/IVC: PO2 15 / SaO2 30%
* (Some variation in quoted numbers in literature, these picked as representative and easy to remember)*

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19
Q

The right-heart pressure is _____ the left-heart because of ________

A
  1. EQUAL TO
  2. Large shunts (foramen ovale and ductus arteriosus)
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20
Q

In-utero, prostaglandins come from ______ and ex-utero, they’re metabolized _________

A

The placenta

In the lung vasculature

Increased PBF→faster metabolism→closure of PDA→more PBF (PBF=pulmonary blood flow)

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21
Q

What two arteries constrict with increasing PaO2

A

Umbilical arteries

Ductus arteriosus

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22
Q

Most heart defects occur by ___ weeks of gestation

A

8

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23
Q

The earliest sign of placental insufficiency

A

Small abdominal circumference 2-2 decreased liver size

Decreased placental flow/O2→dilated ductus venosus to “spare” brain→decreased portal sinus shunting→smaller abd organs

24
Q

Maternal use of what two classes of medications could result in Potters sequence

A

ACEI and ARBs (angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers)

Primary driver of nephrogenesis is renin-angiotensin system (reason to not use these in babies PMA<36 weeks when nephrogenesis is still happening!)

25
Q
  1. How long it takes for one alcoholic drink to be processed
  2. When the peak concentration’s in breastmilk (related to the timing of consumption)
A
  1. 2 hours
  2. 30-60 minutes after consumption
    * Alcohol IN breastmilk metabolized as well, so if mothers wait >2h per drink before feeding/pumping, may be safe*
26
Q

Most common cause of severe thrombocytopenia in well-appearing newborns

A

Neonatal Alloimmune Thrombocytopenia (NAIT)

Severe is <50 K/uL

27
Q

What does the umbilical vein join

A

Umbilical vein joins the inferior vena cava (via the ductus venosus)

The portal sinus is what a UVC crosses and gets “stuck” with an acute right turn into the portal system

28
Q

Ambiguous genitalia occur/develop by ____ weeks of gestation

A

12

29
Q

Which is NOT a neonatal sequelae of maternal diabetes:

A. Stillbirth

B. Neural tube defect

C. Hypercalcemia

D. Hypertrophic cardiomyopathy

E. Hypoglycemia

A

C. Hypercalcemia

Hypocalcemia as a result of functional hypoparathyroidism (see hypomagnesemia in these babies as well)

30
Q

Of the three stages of labor, only the first is subdivided–define latent and active phases of the first stage

A

Latent: Starts when uterine contractions AND cervix changes slowly (ends when dilation speeds up, which varies).

Active: Rate of cervix dilation more rapid (≥1cm/h), for most starts between 3-6cm. Ends when fully dilated.

(Classic Friedman definition was active phase started at 3cm but newer data suggests may be later)

31
Q

Define the second and third stages of labor

A

Second: From full cervical dilation to delivery

Thid: From birth to placenta delivers

32
Q

What’s defined as a prolonged latent phase of the first stage of labor

A

Nulliparous: >20h

Multiparous: >14h

33
Q

Name teratogen associated with:

Microcephaly

Nasal hypoplasia with a depressed bridge

Nail hypoplasia

Stippled epiphyses

A

Warfarin

  • Stippled epiphyses (chondrodysplasia punctata) classic for warfarin, alcohol, hypothyroid)*
    (radiopaedia. org)
34
Q

Name the teratogen associated with:

IUGR

Digit and nail hypoplasia

Umbilical and inguinal hernias

A

Phenytoin (AKA hydantoin)

  • Think IUGR and digit hypoplasia*
  • One of only antiepileptics (AED) where predominant defect isn’t a neural tube defect (NTD)*
35
Q

What is the technical term for “flippers” and the drug associated with it

A

Phocomelia

Thalidomide

36
Q

What is the main cancer treatment that’s teratogenic, and its effects

A

Methotrexate

Cranial dysplasia

Broad nasal bridge

Low-set ears

37
Q

The main teratogenic effect of valproate

A

Neural tube defects

Also midface hypoplasia, long philtrum, cardiac defects (especially of aorta/aortic valve) and arachnodactyly

38
Q

What do early decelerations indicate?

A

Fetal head compression (and a vagal response)

39
Q

What are variable decelerations associated with?

A

Umbilical cord compression

Can just be a vagal response, if severe or prolonged start to worry for hypoxemia or myocardial depression

40
Q

The average timeframe in which transient neonatal myasthenia gravis will present, and the timeframe in which 90% will resolve

A

72 hours

2 months

Hypotonia, poor feeding are most classic signs–comes from transplacental passage of anti-Ach receptor IgG

41
Q

Fetal calcitonin is ____ in the third trimester

A

High

Inhibits fetal bone resorption

42
Q

The pH of amniotic fluid

A

7

Remember it’s neutral whereas the vagina’s normally acidic, so when checking for rupture they’re testing for 6.5+

43
Q

Immunizations contraindicated in pregnancy

A

MMR and varicella

Same as those that wait until children are 12+ months

44
Q

Two diabetes medications that should be avoided in pregnancy

A

Metformin and glyburide

Both shown to cross the placenta

45
Q

The HbA1c level that confers about 25% chance of congenital malformations

A

10

Remember, PRE-concenption control (since teratogenic effects happen most the first 8-10 weeks) matters most

46
Q

Gestational age for gestational diabetes screening

A

24-28 weeks

If glucose 140-200 requires confirmatory test; if >200 already diagnostic

47
Q

Which confers a greater risk to a fetus, measles or mumps?

A

Mumps

Both caused by paramyxovirus and acquired same way; mumps has risk of first-trimester miscarriage (only risk re: measles is preterm labor)

48
Q

What is the highest fetal thyroid hormone

A

Reverse tririodothyronine (rT3)

Maternal T4 can cross placenta, inactivated [to rT3] by deiodinase

49
Q

The three ways to diagnose hemolysis as part of HELLP

A

Hemolysis on smear

LDH > 600

Total bilirubin > 1.2

Need to demonstrate hemolysis, elevated liver enzyme (AST >70) and thrombocytopenia (<100,000)

50
Q

The most common fetal anomaly

A

Single umbilical artery

In addition to cardiac anomalies, renal anomalies it is associated with IUGR and preterm birth

51
Q

The sensitivity of a 4-chamber only fetal echo vs. 4-chamber+ RVOT/LVOT views

A

60 vs. 90%

52
Q

Three things women with gestational diabetes (GDM) are at-risk for [themselves]

A

Diabetes Type 2 (>50%)

Pregancy-induced hypertension

Cardiovascular disease

53
Q

How glucose crosses the placenta

A

Facilitated diffusion

GLUT3 most important transporter on placenta, GLUT1 on fetal tissues

54
Q

How lipids cross the placenta

A

Simple diffusion

55
Q

How proteins (i.e. amino acids) cross the placenta

A

Active transport

The only energy source that needs energy spent to cross!

56
Q

How IgG crosses the placenta

A

Pinocytosis

Other intact proteins also cross this way

Neonatal-Perinatal Boards Review (11 decks)

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