MFM Flashcards
1
Q
How much does blood volume increase during pregnancy and when?
A
Increases by 30-50%
Starts to increase 1st trimester
Largest increase 2nd trimester
Rise slows during 3rd trimester
2
Q
Why does maternal blood volume increase during pregnancy?
A
Increases preload to:
- Protect from impaired venous return
- Meet increased demand from growing uterus
- Protect against delivery blood loss
3
Q
How does BP change during pregnancy?
A
Decreases during 1st trimester
Lowest during 2nd trimester
Widened pulse pressure
4
Q
How does cardiac output change during pregnancy?
A
Increases 30-50%
Greatest in lateral recumbent position due to improved venous return
5
Q
What respiratory changes occur during pregnancy?
A
Rate remains stable
Tidal volume and minute ventilation increase significantly
Residual volume decreases
Progesterone–> chronic hyperventilation/v PaCO2
6
Q
How do the kidneys adapt to pregnancy?
A
Hypertrophy: calyces and ureters dilate
Increased GFR and renal blood flow (^50%)
Decreased renal bicarb threshold–>Increased protein filtration
Increased ADH, renin, angiotensis II, aldosterone
7
Q
How do RBC’s change during pregnancy?
A
Total number increase by 30%
Production increases due to increased iron demand
Increased cell volume
Plasma» RBC increase–> dilutional anemia
8
Q
What changes are seen in WBC’s during pregnancy?
A
Increased estrogen-> leukocytosis
Decreased leukocyte function
9
Q
What changes are seen in platelets during pregnancy?
A
Counts remain stable
Width and volume increase (due to rapid consumption and replacement)
10
Q
How do hemoglobin and hematocrit change during pregnancy?
A
Dilutional anemia + increased erythropoiesis –>
slightly decreased Hgb/Hct
11
Q
Why is there a greater risk of thromboembolic disease and pregnancy?
A
Increased coagulation factors
Fibrinogen increases 30 to 50% due to estrogen
Decreased fibrinolysis
12
Q
What are the changes to the GI tract during pregnancy?
A
Displaced stomach and intestines
Decreased gastric emptying time, altered stomach position, decreased lower esophageal sphincter tone
Hemorrhoids, increased venous pressure
Impaired gallbladder contraction
13
Q
What alters endocrine function during pregnancy?
A
Pituitary gland enlargement by 135%, increased prolactin
Increased thyroxine binding globulin, increased total t4, decreased TSH
Increase in PTH related hormone, increased calcitriol and maternal absorption of calcium for transfer to fetus
Estrogen increases pancreatic cell stimulation, increase in insulin, increased lipogenesis / fat storage
14
Q
What produces HCG?
A
Synctiotrophoblasts
15
Q
When do HCG levels peak
A
First trimester
16
Q
Human placental lactogen __________ with increasing gestational age
A
Increases
17
Q
Human placental lactogen is involved in
A
Lipolysis and anti-insulin effects
18
Q
In labor, progesterone
A
Maintains a stable level but decreases functionally through decreased receptor and co activator numbers
19
Q
Progesterone’s immune functions in pregnancy include:
A
Anti inflammatory
Immunosuppressive to prevent fetal rejection
20
Q
Estrogen pregnancy functions include
A
Fetal organ maturation
Uterine endometrium proliferation
Strengthens uterine contractions
21
Q
From uterine wall to amniotic fluid, the layers of the placenta structure are
A
Myometrium Decidua basalis Chorion Cotelydon/villi Endometrial arteries Intervillous space Villus Chorionic plate Amnion Umbilical cord
22
Q
Placenta previa increases the risk of _______ by x _______ factor
A
Fetal anomalies
2.5 times
23
Q
Risk of placenta previa is increased by what maternal lifestyle factor?
A
Maternal smoking
24
Q
What GU mass increases the risk of placental abruption?
A
Uterine leiomyoma
25
What blood marker will be increased in the setting of abnormal placental adherence including placenta accreta increta and percreta?
Serum alpha feto protein
26
Complete molar pregnancy is characterized by
Larger than gestational age uterus
No fetus
46 XX of paternal origin
27
Partial molar pregnancy is characterized by
Smaller than gestational age uterus
Non-viable fetus
69 XXX, XXY, XYY
28
Choriocarcinoma is characterized by
Malignant trophoblastic growth
Hemorrhage or necrosis
Metastasis to lungs or vagina
Elevated beta HCG
29
True or false chorioangioma is a benign placental tumor?
True
30
Placental metastases can originate from
```
Melanoma
Leukemia
Lymphoma
Breast cancer
Lung cancer (carcinoma or sarcoma)
```
31
The average length of an umbilical cord is
30-100 cm
32
An umbilical cord length of _____ is associated with poor outcome
< 30cm
33
Single umbilical artery occurs in _____ percent of infants and is more common in ______
0.5-1%
| Twins
34
Mortality rate of vasa previa is _______
50-90%
35
Serum markers of maternal lupus include
Anticoagulant antibodies
| anticardiolipin antibodies
36
Maternal ribonucleoprotein antibodies associated with lupus are
Anti-rRo, SSA
| anti-La, SSB
37
Maternal lupus can often present with
Fetal heart block
38
In maternal lupus, presence of _____ increase risk of fetal heart block
Anti-Ro and anti-La antibodies
39
Antibodies present with the diagnosis of myasthenia gravis are
90% antibodies to acetylcholine receptors
40
Myasthenia gravis may exacerbate the maternal disease of
Lupus
41
Fetal anomalies that may be associated with myasthenia gravis
Arthrogryposis
42
Transient neonatal myasthenia gravis typically presents by _____ and resolves by _____
```
12-48h
15 weeks (avg duration 18 days)
```
43
If needed neonatal myasthenia gravis can be treated with
Anti-cholinesteraces
44
Maternal ITP typically has platelet counts of ______ and does / does not affect the fetus
<70k
Does not
Can cause neonatal autoimmune thrombocytopenia
45
The risk to the fetus in the setting of maternal ITP is increased
Intraventricular hemorrhage
46
Advanced maternal age has an increased risk of what four syndromes?
Trisomy 13
Trisomy 18
trisomy 21
Klinefelter syndrome
47
Gestational hypertension is defined as
Hypertension without proteinuria after 20 weeks gestation and return to baseline blood pressure by 12 weeks postpartum
48
Preeclampsia is defined as
Hypertension and proteinuria during pregnancy
49
Chronic hypertension is
blood pressure increases noted prior to pregnancy and persisting beyond 12 weeks postpartum
50
Preeclampsia is differentiated from chronic hypertension
New onset proteinuria during pregnancy
| Will occur in approximately 25% of women with chronic hypertension
51
Preeclampsia effects ____ percent of all pregnancy and recurs in up to _____ percent
5-10%
| 65%
52
Risk factors for a preeclampsia
```
First pregnancy
Multiple gestation
Measure uterine anomalies
Chronic hypertension
Chronic renal disease
Prior episode of preeclampsia
```
53
What is the cause of preeclampsia
Decreased trophoblastic invasion with less dilated spiral arteries
Decreased uterine placental blood flow leading to placental ischemia
Cytokine release
Increased blood pressure and fibrin deposition
Inhibited angiogenic activity due to increased soluble FLT1
54
HELLP syndrome is defined as
Hemolysis
Elevated liver enzymes (AST >70, LDH >600, TB >1.2)
Low platelets (plt <100k)
55
Glomerulonephulosis is/ is not reversible postpartum
Is
56
Early in gestation AFP is produced by the
Yolk sac
57
Later in gestation AFP is produced by
Fetal liver and GI tract
58
Fetal AFP peaks at ____ weeks
13
59
Maternal AFP peaks at ____ weeks
32
60
Greatest sensitivity for AFP screening is at ____-_____ weeks
16-18
61
AFP is elevated in these 4 situations:
Neuro (NTD)
GI: (obstruction, omphalocele, gastroschisis)
Renal: (polycystic kidneys, renal aplasia, nephrotic syndrome, cloacal exstrophy, obstruction)
Masses: (pilonidal cyst, cystic hygroma, sacrococcygeal teratoma)
Also: low birth/maternal weight, oligohydramnios, multiples, incorrect GA, osteogenesis imperfecta, placental chorioangioma
62
Decreased AFP is concerning for
Trisomies
| Gestational trophoblastic disease
63
After finding an elevated AFP the next step is
Ultrasound
64
An abnormal nuchal translucency measurement is
>3 mm
65
Sensitivity of PAPP-A screening is
60-65%
at 10-13 weeks
Must know maternal age
66
Nuchal translucency is most commonly a marker of
Cardiac anomalies
67
Nuchal translucency and PAPP-A screening are ____% sensitive for trisomy 18 and ____% for trisomy 21
91%
78-89%
68
Trisomy 21 quad screening shows
Increased beta HCG and inhibin A
Decreased uE3, AFP
69
Trisomy 18 quad screening shows
Decreased B-HCG, uE3, AFP
Inhibin-a minimally impacted
70
Trisomy 13 quad screening shows
equivocal results
71
Trisomy detection rates with PAPP-A, nuchal translucency and quad screen are
PAPP-A: 60-65%
QUAD: 75%
NT: 68%
COMBINED: 90-95%
72
QUAD screening with low uE3 and slightly decreased AFP, and HCG is concerning for
Smith lemli opitz
| Compare with trisomy 18
73
Turner syndrome quad screening appears similar to
Trisomy 21
74
Reverse or absent doppler flow in IUGR fetus develops from
Villous arteriole medial hypertrophy, increased fetal SVR, ventricular dilation/hypertrophy and increased HR
75
Double bubble on fetal US is associated with
Duodenal Atresia
Annular pancreas
Malrotation
Duodenal stenosis/web
76
Echogenic bowel is most often
Normal
Can be chromosomal, CMV, CF, meconium peritonitis, GI anomalies, swallowed maternal blood
77
Ileal/jejunal atresia occur most often
Proximal jejunum, distal ileum
| Most sure to intravascular accidents
78
Meconium peritonitis can be a sign of
CF or intestinal obstruction that causes perforation
| Appears as calcifications
79
Omphalocele should receive additional workup for
Beckwith-Wiedemann
Trisomy 13
Trisomy 18
Cloacal exstrophy
80
Severe micromelia and lack of vertebral ossification is
Achondrogenesis
81
The most common skeletal dysplasia is _______ with _____ findings
Achondroplasia
```
21-27 weeks:
Rhizomelia
Large head
Bossing
Protuberant abdomen
Trident-shaped head
```
82
Skeletal dysplasia with pulmonary hypoplasia is
Thanataphoric dysplasia
```
Severe micromelia
Curved femurs
Short, broad ribs
Pulmonary hypoplasia
Hypoplastic vertebral bodies
```
83
In utero fractures are usually the result of
Osteogenesis imperfecta type 2
84
Dandy Walker malformation is defined as
Cystic dilation of the fourth ventricle
enlarged posterior fossa
obstructive hydrocephalus
cerebellar vermis aplasia
85
Dandy Walker variant is defined as
Direct communication from fourth ventricle to the cisterna magna without enlargement of the posterior fossa
Can be seen in chromosomal abnormalities like trisomy 13
86
A mass with an associated school defect is called an
Encephalocele
87
Encephaloceles occur in what location most commonly?
75% occipital
88
Encephaloceles are commonly associated with what other system disease
Renal cystic disease
89
Explain of the posterior ossification centers of the spinal bones that may have a fluid filled sac over the skin is a
Meningomyelocele
90
Meningitis with an elongated cerebellum will demonstrate a _______ on imaging
Banana sign: crescent shape around brainstem
91
Meningoidal seal with abnormal concave frontal bones has a _____ sign on imaging
Lemon sign
| Seen between 18-24w
92
Other intracranial findings associated with meningococcal are
Microcephaly
| Ventriculomegaly
93
A large posterior spinal mass that is often cystic and solid is a
Sacrococcygeal teratoma
94
Sacrococcygeal teratomas are often associated with
Polyhydramnios
95
What severity of ventriculomegaly is associated with higher risk of mortality and morbidity?
All degrees of severity
96
Unilateral hydronephrosis is most likely
Unilateral ureteropelvic junction obstruction
97
Bilateral hydronephrosis is typically due to
Lower urinary tract obstruction I.e. posterior urethral valves
or
bilateral ureteropelvic junction obstruction
98
Severe hydronephrosis is defined as
Greater than 10 mm dilation in second trimester
or
greater than 15 mm dilation in third trimester
99
The definition of hydronephrosis begins at ______ dilation in the second trimester or ______ dilation in the third trimester
>5mm
| >7mm
100
Non-communicating cyst in the kidneys of different size are
Multi cystic dysplastic kidney
101
40% of multi-systic dysplastic kidneys will be associated with
Contralateral renal anomalies
102
Bilateral multiple renal cysts with normal renal tissue is
Polycystic kidney disease
103
Findings of distended bladder with thickened wall and hydronephrosis and oligohydramnios is concerning for
Posterior urethral valves
104
Non-visible kidney and bladder with severe oligohydramnios is concerning for
Bilateral renal agenesis
105
Cystic hygromas are most commonly seen in
Noonan syndrome
| Turner syndrome
106
A septated cystic mass or lymphangioma in the neck or occiput is a
Cystic hygroma
107
Cystic hygromas made less commonly evound in these four syndromes
Deletion 13Q
Trisomy 13
Trisomy 18
Trisomy 21
108
Amniocentesis is performed at
15 to 20 weeks
109
Amniocentesis samples
```
20 to 30 ml amniotic fluid for
AFP
acetylcholinesterase
fetal lung maturity
bilirubin
Infection
```
110
CVS is performed at
10 to 13 weeks
111
What does can be utilized to determine if a PUBS sample is maternal or fetal?
Clean our bed key test
112
What testing or therapies can be performed using pubs?
Chromosome analysis
Hemoglobin, IgM/ IGG, bacterial and viral cultures Hydrops evaluation
Transfusion
Fetal drug therapy
113
What is the rate of fetal loss with amniocentesis?
One in 200, higher if earlier
114
How long does it take to receive amniocentesis results?
1 to 2 weeks
115
What is the rate of fetal loss with chorionic villus sampling?
3 in 200, higher if transcervical
116
Which fetal genetic testing methods require rhogam for Rh sensitization?
Amniocentesis
| CVS
117
What is the rate of fetal loss for pubs?
1.4%
118
What is the highest risk associated with pubs?
Fetal maternal hemorrhage, 66%
119
A reassuring NST or contraction stress test indicates
High likelihood of intrauterine survival for 7 days
120
Components of a BPP include
```
NST
Fetal body movement
Breathing
Fetal tone
Amniotic fluid volume
```
121
A BPP score of_______ requires further intervention
8 with low AFV
| <6
122
A BPP score of ____ requires immediate delivery
0-2
123
Concerning fetal monitoring patterns are
```
Late decelerations without variability
Variable decelerations without variability
Prolonged severe bradycardia
Sinusoidal pattern
Overall lack of variability
```
124
What causes saltatory variability and what defines it?
>25 bpm swings
| Caused by acute hypoxia or compression of umbilical cord
125
What causes variable decelerations?
Umbilical cord compression:
- > hypertension in fetus
- >baroreceptor response
- > vagal deceleration
OR
- >fetal hypoxemia
- > chemoreceptor response/myocardial depression
- > deceleration of HR
126
Late decelerations are caused by
Uteroplacental insufficiency
127
Uteroplacental insufficiency leads to
Fetal hypoxemia
- > chemoreceptor response
- > enhanced alpha-adrenergic activity
- > fetal hypertension
- > baroreceptor response
- > parasympathetic response
- > late decelerations
OR
- > myocardial depression
- > late decelerations
128
AFI is influenced by maternal hormones ____ and _____
Prolactin- decreased amnion permeability
| Vasopressin- increases AF osmolality
129
Polyhydramnios is defined as
AFI >24cm
130
Severe oligohydramnios is associated with an increased mortality risk to
187/1000
131
Initial fetal growth is marked by the _______ stage which occurs the first _____ weeks gestation
Hyperplastic
| 16
132
The hyperplastic fetal growth stage is marked by an increase in
Cell number
| DNA
133
Impaired hyperplastic growth stage results in
Symmetric IUGR
134
The second phase of fetal growth is marked by the ________ stage which occurs between ______ weeks gestation
Hyperplastic and hypertrophic
| 16 to 32
135
The hyperplastic and hypertrophic stage of fetal growth is marked by increase in blank
Cell number
| Cell size
136
Impaired second stage fetal growth results in
Asymmetric or symmetric IUGR
137
The third stage of fetal growth is the ______ stage which occurs after _____ weeks gestation
Hypertrophic
| 32
138
The hypertrophic stage of fetal growth is marked by increase in
Cellular size
Protein and RNA
Fetal fat and glycogen are deposited
139
Impaired hypertrophic fetal growth stage results in
Asymmetric IUGR
140
Greatest PERCENT increase in fetal growth occurs in the ______ trimester
First
141
Greatest grams per day fetal growth occurs
With increasing gestational age
142
Hormones that regulate fetal growth are
Insulin
Insulin like growth factor I & II
Epidermal growth factor
143
How does growth hormone impact fetal growth?
No involvement of fetal or maternal growth hormone
| Fetal tissues do not have growth hormone receptors until late gestation
144
A growth curve showing consistently less than 10% growth throughout pregnancy is most consistent with
Genetic abnormality or familial SGA
145
A growth curve showing third trimester decrease in growth is concerning for
Preeclampsia
| May also be seen in twin and triplets
146
A growth curve showing normal growth until the second or third trimester at which point growth slows but still remains within normal percentiles demonstrates
Growth restriction due to failure to reach full growth potential
147
What is the difference between IUGR and SGA?
IUGR is a failure to grow to the genetic potential of a fetus and is always pathologic. Fetus maybe normal growth percentage or small.
SGA is growing at a smaller than expected size and may or may not be pathologic. Fetus is always small compared to population growth curve.
148
During which stage of fetal growth does maternal nutrition play a role in fetal weight gain?
Third trimester
149
Hypoglycemia is a bigger risk in babies with symmetric or asymmetric IUGR?
Asymmetric
150
Fundal height correctly identifies what percentage of IUGR fetuses?
40%
151
Ponderal index equals
Weight (grams)* 100 / (length (cm))^3
152
A low ponderal index is suggestive of
Asymmetric growth
153
Neonatal effects of SGA/IUGR
```
Depressed immune function
Hyperglycemia
Hypocalcemia
Hypoglycemia
Hypothermia
Perinatal deprepression
Polycythemia
```
154
Immunodepression associated with SGA/IUGR are due to
Decreased lymphocyte number in function and decrease immunoglobulins
May persist into later life
155
Increased catecholamines in SGA/IUGR infants can cause
Hyperglycemia
156
SGA/IUGR status increases mortality risk by
5-20x
157
Non-immune fetal hydrops is defined as
Fluid accumulation in at least two fetal compartments
158
Sites of possible fluid accumulation in non-immune fetal hydrops include
```
Skin
Ascites
Pleural effusion
Pericardial effusion
Cystic hygroma
Placenta
```
159
Incidence of non-immune fetal hydrops
1/1500-4000
160
Most common causes of non-immune fetal hydrops
```
Cardiac, 25%
Unknown, 16%
Aneuploidy, 16%
Genetic syndrome, 11%
Twin to twin transfusion syndrome, 10%
Pulmonary, 8%
Infection, 4%
```
161
Not immune fetal hydrops is most commonly identified through further evaluation of
Polyhydramnios
Hypertension
Maternal anemia
Fetal tachycardia
162
85% of fetuses with hydrops will have the following finding
Ascites, 85%
163
Evaluation of fetuses with non-immune fetal hydrops should include
Additional ultrasound for abnormalities including Doppler and cardiac views
Blood typing
torch evaluation
hemoglobin electrophoresis
Can consider amniocentesis or pubs
164
Perinatal mortality of infants with non-immune fetal hydrops is
40 to 90%, worse if oligo or cardiac disease
165
The most common perinatal complication of non-immune hydrops is
Preterm delivery, 90%
166
When does division occur in dichorionic diamniotic monozygotic twins?
Prior to day three
167
When does division occur in monochorionic diamniotic twins?
Between 3-8 days
168
When does division occur in monochorionic monoamniotic twins?
8 to 13 days
169
When does division occur in twins who are conjoined?
13 to 15 days
170
What is the most common chorionicity/amnioticity of monozygotic twins?
Monochorionic diamniotic 70-75%
171
What type of monozygotic twins are at highest risk for twin to twin transfusion syndrome?
Monochorionic diamniotic
172
In what percentage of twin pregnancy does single fetal demise occur?
5%
173
What are the three possible outcomes to the surviving twin if vascular anastomosis are present?
Disseminated intravascular coagulation
Anemia due to vasodilation in demised twin
Cerebral injury to surviving twin as a result of the above
174
Twin to twin transfusion occurs in ____ percent of _______ twins
5 to 15%
| Monochorionic diamniotic
175
Twin fetus who presents with anemia hypovolemia oligohydramnios and appears to be stuck against the uterine wall with decreased urine output and lower birth weight is concerning for
Donor twin, twin to twin transfusion
176
Twin fetus who presents with polycythemia hypervolemia polyhydramnios cardiac hypertrophy possibly hydrops and increased birth weight is concerning for
Recipient twin, twin to twin transfusion
177
Before what gestational age is twinted when transfusion associated with an especially poor outcome?
24 weeks
178
Hormone changes that occur during labor include
Stable progesterone with decreased function due to receptor decrease
Increased estrogen to strengthen contractions
Corticotropin releasing hormone produced by placenta to induce cortisol release 4 feet of long maturation and alteration in myometrial receptor expression
Prostaglandins E&F synchronize uterine contractions and ripen cervix, increase sensitization to oxytocin
179
What is the concentration and dosing of IV epinephrine?
1: 10,000
| 0. 1 to 0.3 ml/kg
180
What is the concentration and dosing of endotracheal epinephrine?
1: 10,000
| 0. 3-1ml/kg
181
What is the most significant risk factor for premature birth?
Previous pre-term delivery, 17 to 40%
182
Significant risk factors for preterm delivery include
```
Previous preterm delivery
Uterine malformations, 3 to 16%
Maternal history of DES exposure, 15 to 28%
Chorioamnionitis, 30%
Multiple gestation, 30 to 50%
```
183
What serum marker is most useful for predicting preterm delivery?
Fetal fibronectin
184
The mechanism of action of tributylene is
```
Beta 2 agonist
Activates adrenal cyclase
ATP converted to CAMP
Decreased intracellular calcium
Decreased uterine contractility
```
185
What is the mechanism of action of magnesium sulfate for tocolysis?
Decreased acetylcholine released
Calcium antagonist
Decreased uterine contractility
186
What is a mechanism of action of indomethacin for tocolysis?
Prostaglandin synthase inhibitor
187
What is the mechanism of action of calcium channel blockers for tocolysis?
Inhibits transmembrane calcium and flux
| Decreased uterine contractility
188
Miscarriage occurs in _____ percent of women less than 20 years of age and ____ percent of women greater than 40 years of age
12%
26%
189
Premature rupture of membranes occurs in _____ percent of all pregnancies
3-18%
190
PROM that occurs from 28 to 34 weeks gestation will result in
50% patients progressing to labor in 24 hours
80 to 90% progressing to labor within one week
191
PROM diagnosed by
pH >= 6.5
| Positive ferning
192
Chorioamnionitis will result in neonatal sepsis for _____ percent of newborns
10%
193
Postterm delivery is most commonly associated with
Anencephaly
| Placental sulfatase deficiency
194
Category B medications are defined as those
Animal studies with no fetal risks, no human studies
Adverse fetal effects in animal studies, not well controlled in human studies
195
Category C medications are defined as those
Inadequate animal or human studies
Adverse fetal effects in animal studies, no human studies available
196
Category D medications
Demonstrate fetal adverse risk but may have benefits that outweigh risks
197
Exam findings of a fetus exposed to ace inhibitors include
Skull hypoplasia
Fetal compression syndrome with limb deformations
Pulmonary hypoplasia
Renal tubular dysgenesis
198
The most common fetal tratogenic exposure is
Alcohol
199
Fetal alcohol syndrome is homemarked by abnormalities in
Physical exam
Growth
Neurodevelopment
200
The cardiac defect associated with fetal alcohol syndrome is
VSD
201
The anti epileptic within increased risk of hemorrhagic disease of the newborn is
Carbamazepine
Phenytoin
Phenobarbital
202
Presence of craniofacial defects fingernail hypoplasia growth restriction and neural tube defects in a newborn may indicate in utero exposure to
Carbamazepine
203
Besides still birth and placental overruption, cocaine fetal exposure may also cause
```
Cutis aplasia
Porencephaly
Illeal atresia
Cardiac anomalies
Visceral infarction
Urinary tract abnormalities
```
204
Cyclophosphamide exposure in utero may cause
```
Missing digits
Cleft palate
Imperforate anus
Microcephaly
Growth restriction
```
205
Vaginal adenocarcinoma may suggest in utero exposure to
Diethylstilbestrol (DES)
206
Facial effects of in utero phenytoin exposure include
Cleft lip/palate
Short nose
Depressed nasal bridge
Mild hypertelorism
207
Major increased risks of retinoic acid during pregnancy include
Spontaneous abortions/stillbirth
Significant cardiac anomalies including transposition, truncus arteriosus, TOF
Hydrocephalus
208
Epstein's anomaly is a sushi with what maternal medication?
Lithium
209
Methotrexate taken at _____ weeks of gestation can cause
6-8 weeks
```
Cranial dysplasia
Broad nasal bridge
Low set ears
Microcephaly
Craniosynostosis
```
210
Cardiac abnormalities and cleft lip and palate maybe associated with maternal medication
Phenobarbital
211
Premature PDA closure and pulmonary hypertension maybe associated with maternal medication
Salicylates
212
Phocomelia is associated with which maternal medication
Thalidomide
213
The maternal medication most likely to cause neural tube defects is
Valproic acid
214
Stippled bone epiphysis, nail hypoplasia, seizures, microcephaly, depressed nasal bridge are all contributable to which medication?
Warfarin
215
Warfarin administration between _______ weeks gestation is highest risk for development of fetal anomalies?
6-12, 25%
216
In pregnancy arsenic can cause
Spontaneous abortion
| Lupus weight
217
Ethylene oxide, inorganic mercury, benzene, formaldehyde can cause
Spontaneous abortion
