Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Neo Boards > MFM > Flashcards

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How does BP change during pregnancy?

A

Decreases during 1st trimester
Lowest during 2nd trimester
Widened pulse pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How does cardiac output change during pregnancy?

A

Increases 30-50%

Greatest in lateral recumbent position due to improved venous return

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What changes are seen in WBC’s during pregnancy?

A

Increased estrogen-> leukocytosis

Decreased leukocyte function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What changes are seen in platelets during pregnancy?

A

Counts remain stable

Width and volume increase (due to rapid consumption and replacement)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How do hemoglobin and hematocrit change during pregnancy?

A

Dilutional anemia + increased erythropoiesis –>

slightly decreased Hgb/Hct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What produces HCG?

A

Synctiotrophoblasts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When do HCG levels peak

A

First trimester

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Human placental lactogen __________ with increasing gestational age

A

Increases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Human placental lactogen is involved in

A

Lipolysis and anti-insulin effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

In labor, progesterone

A

Maintains a stable level but decreases functionally through decreased receptor and co activator numbers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Progesterone’s immune functions in pregnancy include:

A

Anti inflammatory

Immunosuppressive to prevent fetal rejection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Estrogen pregnancy functions include

A

Fetal organ maturation
Uterine endometrium proliferation
Strengthens uterine contractions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Placenta previa increases the risk of _______ by x _______ factor

A

Fetal anomalies

2.5 times

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Risk of placenta previa is increased by what maternal lifestyle factor?

A

Maternal smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What GU mass increases the risk of placental abruption?

A

Uterine leiomyoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What blood marker will be increased in the setting of abnormal placental adherence including placenta accreta increta and percreta?

A

Serum alpha feto protein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Complete molar pregnancy is characterized by

A

Larger than gestational age uterus
No fetus
46 XX of paternal origin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Partial molar pregnancy is characterized by

A

Smaller than gestational age uterus
Non-viable fetus
69 XXX, XXY, XYY

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Choriocarcinoma is characterized by

A

Malignant trophoblastic growth
Hemorrhage or necrosis
Metastasis to lungs or vagina
Elevated beta HCG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

True or false chorioangioma is a benign placental tumor?

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Placental metastases can originate from

A 
Melanoma
Leukemia
Lymphoma
Breast cancer
Lung cancer (carcinoma or sarcoma)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

The average length of an umbilical cord is

A

30-100 cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

An umbilical cord length of _____ is associated with poor outcome

A

< 30cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Single umbilical artery occurs in _____ percent of infants and is more common in ______

A

0.5-1%

Twins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Mortality rate of vasa previa is _______

A

50-90%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Serum markers of maternal lupus include

A

Anticoagulant antibodies

anticardiolipin antibodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Maternal ribonucleoprotein antibodies associated with lupus are

A

Anti-rRo, SSA

anti-La, SSB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Maternal lupus can often present with

A

Fetal heart block

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

In maternal lupus, presence of _____ increase risk of fetal heart block

A

Anti-Ro and anti-La antibodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Antibodies present with the diagnosis of myasthenia gravis are

A

90% antibodies to acetylcholine receptors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Myasthenia gravis may exacerbate the maternal disease of

A

Lupus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Fetal anomalies that may be associated with myasthenia gravis

A

Arthrogryposis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Transient neonatal myasthenia gravis typically presents by _____ and resolves by _____

A 
12-48h
15 weeks (avg duration 18 days)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

If needed neonatal myasthenia gravis can be treated with

A

Anti-cholinesteraces

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Maternal ITP typically has platelet counts of ______ and does / does not affect the fetus

A

<70k
Does not
Can cause neonatal autoimmune thrombocytopenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

The risk to the fetus in the setting of maternal ITP is increased

A

Intraventricular hemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Advanced maternal age has an increased risk of what four syndromes?

A

Trisomy 13
Trisomy 18
trisomy 21
Klinefelter syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Gestational hypertension is defined as

A

Hypertension without proteinuria after 20 weeks gestation and return to baseline blood pressure by 12 weeks postpartum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Preeclampsia is defined as

A

Hypertension and proteinuria during pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Chronic hypertension is

A

blood pressure increases noted prior to pregnancy and persisting beyond 12 weeks postpartum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Preeclampsia is differentiated from chronic hypertension

A

New onset proteinuria during pregnancy

Will occur in approximately 25% of women with chronic hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Preeclampsia effects ____ percent of all pregnancy and recurs in up to _____ percent

A

5-10%

65%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Risk factors for a preeclampsia

A 
First pregnancy
Multiple gestation
Measure uterine anomalies
Chronic hypertension
Chronic renal disease
Prior episode of preeclampsia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What is the cause of preeclampsia

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

HELLP syndrome is defined as

A

Hemolysis
Elevated liver enzymes (AST >70, LDH >600, TB >1.2)
Low platelets (plt <100k)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Glomerulonephulosis is/ is not reversible postpartum

A

Is

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Early in gestation AFP is produced by the

A

Yolk sac

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Later in gestation AFP is produced by

A

Fetal liver and GI tract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Fetal AFP peaks at ____ weeks

A

13

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Maternal AFP peaks at ____ weeks

A

32

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Greatest sensitivity for AFP screening is at ____-_____ weeks

A

16-18

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

AFP is elevated in these 4 situations:

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Decreased AFP is concerning for

A

Trisomies

Gestational trophoblastic disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

After finding an elevated AFP the next step is

A

Ultrasound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

An abnormal nuchal translucency measurement is

A

> 3 mm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Sensitivity of PAPP-A screening is

A

60-65%
at 10-13 weeks
Must know maternal age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Nuchal translucency is most commonly a marker of

A

Cardiac anomalies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Nuchal translucency and PAPP-A screening are ____% sensitive for trisomy 18 and ____% for trisomy 21

A

91%

78-89%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Trisomy 21 quad screening shows

A

Increased beta HCG and inhibin A

Decreased uE3, AFP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Trisomy 18 quad screening shows

A

Decreased B-HCG, uE3, AFP

Inhibin-a minimally impacted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Trisomy 13 quad screening shows

A

equivocal results

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Trisomy detection rates with PAPP-A, nuchal translucency and quad screen are

A

PAPP-A: 60-65%

QUAD: 75%

NT: 68%

COMBINED: 90-95%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

QUAD screening with low uE3 and slightly decreased AFP, and HCG is concerning for

A

Smith lemli opitz

Compare with trisomy 18

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Turner syndrome quad screening appears similar to

A

Trisomy 21

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Reverse or absent doppler flow in IUGR fetus develops from

A

Villous arteriole medial hypertrophy, increased fetal SVR, ventricular dilation/hypertrophy and increased HR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Double bubble on fetal US is associated with

A

Duodenal Atresia
Annular pancreas
Malrotation
Duodenal stenosis/web

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Echogenic bowel is most often

A

Normal

Can be chromosomal, CMV, CF, meconium peritonitis, GI anomalies, swallowed maternal blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Ileal/jejunal atresia occur most often

A

Proximal jejunum, distal ileum

Most sure to intravascular accidents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Meconium peritonitis can be a sign of

A

CF or intestinal obstruction that causes perforation

Appears as calcifications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Omphalocele should receive additional workup for

A

Beckwith-Wiedemann
Trisomy 13
Trisomy 18
Cloacal exstrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Severe micromelia and lack of vertebral ossification is

A

Achondrogenesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

The most common skeletal dysplasia is _______ with _____ findings

A

Achondroplasia

21-27 weeks: 
Rhizomelia
Large head
Bossing
Protuberant abdomen
Trident-shaped head
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Skeletal dysplasia with pulmonary hypoplasia is

A

Thanataphoric dysplasia

Severe micromelia
Curved femurs
Short, broad ribs
Pulmonary hypoplasia
Hypoplastic vertebral bodies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

In utero fractures are usually the result of

A

Osteogenesis imperfecta type 2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Dandy Walker malformation is defined as

A

Cystic dilation of the fourth ventricle
enlarged posterior fossa
obstructive hydrocephalus
cerebellar vermis aplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Dandy Walker variant is defined as

A

Direct communication from fourth ventricle to the cisterna magna without enlargement of the posterior fossa
Can be seen in chromosomal abnormalities like trisomy 13

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

A mass with an associated school defect is called an

A

Encephalocele

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Encephaloceles occur in what location most commonly?

A

75% occipital

88
Q

Encephaloceles are commonly associated with what other system disease

A

Renal cystic disease

89
Q

Explain of the posterior ossification centers of the spinal bones that may have a fluid filled sac over the skin is a

A

Meningomyelocele

90
Q

Meningitis with an elongated cerebellum will demonstrate a _______ on imaging

A

Banana sign: crescent shape around brainstem

91
Q

Meningoidal seal with abnormal concave frontal bones has a _____ sign on imaging

A

Lemon sign

Seen between 18-24w

92
Q

Other intracranial findings associated with meningococcal are

A

Microcephaly

Ventriculomegaly

93
Q

A large posterior spinal mass that is often cystic and solid is a

A

Sacrococcygeal teratoma

94
Q

Sacrococcygeal teratomas are often associated with

A

Polyhydramnios

95
Q

What severity of ventriculomegaly is associated with higher risk of mortality and morbidity?

A

All degrees of severity

96
Q

Unilateral hydronephrosis is most likely

A

Unilateral ureteropelvic junction obstruction

97
Q

Bilateral hydronephrosis is typically due to

A

Lower urinary tract obstruction I.e. posterior urethral valves
or
bilateral ureteropelvic junction obstruction

98
Q

Severe hydronephrosis is defined as

A

Greater than 10 mm dilation in second trimester
or
greater than 15 mm dilation in third trimester

99
Q

The definition of hydronephrosis begins at ______ dilation in the second trimester or ______ dilation in the third trimester

A

> 5mm

>7mm

100
Q

Non-communicating cyst in the kidneys of different size are

A

Multi cystic dysplastic kidney

101
Q

40% of multi-systic dysplastic kidneys will be associated with

A

Contralateral renal anomalies

102
Q

Bilateral multiple renal cysts with normal renal tissue is

A

Polycystic kidney disease

103
Q

Findings of distended bladder with thickened wall and hydronephrosis and oligohydramnios is concerning for

A

Posterior urethral valves

104
Q

Non-visible kidney and bladder with severe oligohydramnios is concerning for

A

Bilateral renal agenesis

105
Q

Cystic hygromas are most commonly seen in

A

Noonan syndrome

Turner syndrome

106
Q

A septated cystic mass or lymphangioma in the neck or occiput is a

A

Cystic hygroma

107
Q

Cystic hygromas made less commonly evound in these four syndromes

A

Deletion 13Q
Trisomy 13
Trisomy 18
Trisomy 21

108
Q

Amniocentesis is performed at

A

15 to 20 weeks

109
Q

Amniocentesis samples

A 
20 to 30 ml amniotic fluid for 
AFP 
acetylcholinesterase 
fetal lung maturity 
bilirubin 
Infection
110
Q

CVS is performed at

A

10 to 13 weeks

111
Q

What does can be utilized to determine if a PUBS sample is maternal or fetal?

A

Clean our bed key test

112
Q

What testing or therapies can be performed using pubs?

A

Chromosome analysis
Hemoglobin, IgM/ IGG, bacterial and viral cultures Hydrops evaluation
Transfusion
Fetal drug therapy

113
Q

What is the rate of fetal loss with amniocentesis?

A

One in 200, higher if earlier

114
Q

How long does it take to receive amniocentesis results?

A

1 to 2 weeks

115
Q

What is the rate of fetal loss with chorionic villus sampling?

A

3 in 200, higher if transcervical

116
Q

Which fetal genetic testing methods require rhogam for Rh sensitization?

A

Amniocentesis

CVS

117
Q

What is the rate of fetal loss for pubs?

A

1.4%

118
Q

What is the highest risk associated with pubs?

A

Fetal maternal hemorrhage, 66%

119
Q

A reassuring NST or contraction stress test indicates

A

High likelihood of intrauterine survival for 7 days

120
Q

Components of a BPP include

A 
NST
Fetal body movement
Breathing
Fetal tone
Amniotic fluid volume
121
Q

A BPP score of_______ requires further intervention

A

8 with low AFV

<6

122
Q

A BPP score of ____ requires immediate delivery

A

0-2

123
Q

Concerning fetal monitoring patterns are

A 
Late decelerations without variability
Variable decelerations without variability
Prolonged severe bradycardia
Sinusoidal pattern
Overall lack of variability
124
Q

What causes saltatory variability and what defines it?

A

> 25 bpm swings

Caused by acute hypoxia or compression of umbilical cord

125
Q

What causes variable decelerations?

A

Umbilical cord compression:

  • > hypertension in fetus
  • > baroreceptor response
  • > vagal deceleration

OR

  • > fetal hypoxemia
  • > chemoreceptor response/myocardial depression
  • > deceleration of HR
126
Q

Late decelerations are caused by

A

Uteroplacental insufficiency

127
Q

Uteroplacental insufficiency leads to

A

Fetal hypoxemia

  • > chemoreceptor response
  • > enhanced alpha-adrenergic activity
  • > fetal hypertension
  • > baroreceptor response
  • > parasympathetic response
  • > late decelerations

OR

  • > myocardial depression
  • > late decelerations
128
Q

AFI is influenced by maternal hormones ____ and _____

A

Prolactin- decreased amnion permeability

Vasopressin- increases AF osmolality

129
Q

Polyhydramnios is defined as

A

AFI >24cm

130
Q

Severe oligohydramnios is associated with an increased mortality risk to

A

187/1000

131
Q

Initial fetal growth is marked by the _______ stage which occurs the first _____ weeks gestation

A

Hyperplastic

16

132
Q

The hyperplastic fetal growth stage is marked by an increase in

A

Cell number

DNA

133
Q

Impaired hyperplastic growth stage results in

A

Symmetric IUGR

134
Q

The second phase of fetal growth is marked by the ________ stage which occurs between ______ weeks gestation

A

Hyperplastic and hypertrophic

16 to 32

135
Q

The hyperplastic and hypertrophic stage of fetal growth is marked by increase in blank

A

Cell number

Cell size

136
Q

Impaired second stage fetal growth results in

A

Asymmetric or symmetric IUGR

137
Q

The third stage of fetal growth is the ______ stage which occurs after _____ weeks gestation

A

Hypertrophic

32

138
Q

The hypertrophic stage of fetal growth is marked by increase in

A

Cellular size
Protein and RNA
Fetal fat and glycogen are deposited

139
Q

Impaired hypertrophic fetal growth stage results in

A

Asymmetric IUGR

140
Q

Greatest PERCENT increase in fetal growth occurs in the ______ trimester

A

First

141
Q

Greatest grams per day fetal growth occurs

A

With increasing gestational age

142
Q

Hormones that regulate fetal growth are

A

Insulin
Insulin like growth factor I & II
Epidermal growth factor

143
Q

How does growth hormone impact fetal growth?

A

No involvement of fetal or maternal growth hormone

Fetal tissues do not have growth hormone receptors until late gestation

144
Q

A growth curve showing consistently less than 10% growth throughout pregnancy is most consistent with

A

Genetic abnormality or familial SGA

145
Q

A growth curve showing third trimester decrease in growth is concerning for

A

Preeclampsia

May also be seen in twin and triplets

146
Q

A growth curve showing normal growth until the second or third trimester at which point growth slows but still remains within normal percentiles demonstrates

A

Growth restriction due to failure to reach full growth potential

147
Q

What is the difference between IUGR and SGA?

A

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
Q

During which stage of fetal growth does maternal nutrition play a role in fetal weight gain?

A

Third trimester

149
Q

Hypoglycemia is a bigger risk in babies with symmetric or asymmetric IUGR?

A

Asymmetric

150
Q

Fundal height correctly identifies what percentage of IUGR fetuses?

A

40%

151
Q

Ponderal index equals

A

Weight (grams)* 100 / (length (cm))^3

152
Q

A low ponderal index is suggestive of

A

Asymmetric growth

153
Q

Neonatal effects of SGA/IUGR

A 
Depressed immune function
Hyperglycemia
Hypocalcemia
Hypoglycemia
Hypothermia
Perinatal deprepression
Polycythemia
154
Q

Immunodepression associated with SGA/IUGR are due to

A

Decreased lymphocyte number in function and decrease immunoglobulins
May persist into later life

155
Q

Increased catecholamines in SGA/IUGR infants can cause

A

Hyperglycemia

156
Q

SGA/IUGR status increases mortality risk by

A

5-20x

157
Q

Non-immune fetal hydrops is defined as

A

Fluid accumulation in at least two fetal compartments

158
Q

Sites of possible fluid accumulation in non-immune fetal hydrops include

A 
Skin
Ascites
Pleural effusion
Pericardial effusion
Cystic hygroma
Placenta
159
Q

Incidence of non-immune fetal hydrops

A

1/1500-4000

160
Q

Most common causes of non-immune fetal hydrops

A 
Cardiac, 25%
Unknown, 16%
Aneuploidy, 16%
Genetic syndrome, 11%
Twin to twin transfusion syndrome, 10%
Pulmonary, 8%
Infection, 4%
161
Q

Not immune fetal hydrops is most commonly identified through further evaluation of

A

Polyhydramnios
Hypertension
Maternal anemia
Fetal tachycardia

162
Q

85% of fetuses with hydrops will have the following finding

A

Ascites, 85%

163
Q

Evaluation of fetuses with non-immune fetal hydrops should include

A

Additional ultrasound for abnormalities including Doppler and cardiac views
Blood typing
torch evaluation
hemoglobin electrophoresis

Can consider amniocentesis or pubs

164
Q

Perinatal mortality of infants with non-immune fetal hydrops is

A

40 to 90%, worse if oligo or cardiac disease

165
Q

The most common perinatal complication of non-immune hydrops is

A

Preterm delivery, 90%

166
Q

When does division occur in dichorionic diamniotic monozygotic twins?

A

Prior to day three

167
Q

When does division occur in monochorionic diamniotic twins?

A

Between 3-8 days

168
Q

When does division occur in monochorionic monoamniotic twins?

A

8 to 13 days

169
Q

When does division occur in twins who are conjoined?

A

13 to 15 days

170
Q

What is the most common chorionicity/amnioticity of monozygotic twins?

A

Monochorionic diamniotic 70-75%

171
Q

What type of monozygotic twins are at highest risk for twin to twin transfusion syndrome?

A

Monochorionic diamniotic

172
Q

In what percentage of twin pregnancy does single fetal demise occur?

A

5%

173
Q

What are the three possible outcomes to the surviving twin if vascular anastomosis are present?

A

Disseminated intravascular coagulation
Anemia due to vasodilation in demised twin
Cerebral injury to surviving twin as a result of the above

174
Q

Twin to twin transfusion occurs in ____ percent of _______ twins

A

5 to 15%

Monochorionic diamniotic

175
Q

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

A

Donor twin, twin to twin transfusion

176
Q

Twin fetus who presents with polycythemia hypervolemia polyhydramnios cardiac hypertrophy possibly hydrops and increased birth weight is concerning for

A

Recipient twin, twin to twin transfusion

177
Q

Before what gestational age is twinted when transfusion associated with an especially poor outcome?

A

24 weeks

178
Q

Hormone changes that occur during labor include

A

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
Q

What is the concentration and dosing of IV epinephrine?

A

1: 10,000

0. 1 to 0.3 ml/kg

180
Q

What is the concentration and dosing of endotracheal epinephrine?

A

1: 10,000

0. 3-1ml/kg

181
Q

What is the most significant risk factor for premature birth?

A

Previous pre-term delivery, 17 to 40%

182
Q

Significant risk factors for preterm delivery include

A 
Previous preterm delivery
Uterine malformations, 3 to 16%
Maternal history of DES exposure, 15 to 28%
Chorioamnionitis, 30%
Multiple gestation, 30 to 50%
183
Q

What serum marker is most useful for predicting preterm delivery?

A

Fetal fibronectin

184
Q

The mechanism of action of tributylene is

A 
Beta 2 agonist
Activates adrenal cyclase
ATP converted to CAMP
Decreased intracellular calcium
Decreased uterine contractility
185
Q

What is the mechanism of action of magnesium sulfate for tocolysis?

A

Decreased acetylcholine released
Calcium antagonist
Decreased uterine contractility

186
Q

What is a mechanism of action of indomethacin for tocolysis?

A

Prostaglandin synthase inhibitor

187
Q

What is the mechanism of action of calcium channel blockers for tocolysis?

A

Inhibits transmembrane calcium and flux

Decreased uterine contractility

188
Q

Miscarriage occurs in _____ percent of women less than 20 years of age and ____ percent of women greater than 40 years of age

A

12%

26%

189
Q

Premature rupture of membranes occurs in _____ percent of all pregnancies

A

3-18%

190
Q

PROM that occurs from 28 to 34 weeks gestation will result in

A

50% patients progressing to labor in 24 hours

80 to 90% progressing to labor within one week

191
Q

PROM diagnosed by

A

pH >= 6.5

Positive ferning

192
Q

Chorioamnionitis will result in neonatal sepsis for _____ percent of newborns

A

10%

193
Q

Postterm delivery is most commonly associated with

A

Anencephaly

Placental sulfatase deficiency

194
Q

Category B medications are defined as those

A

Animal studies with no fetal risks, no human studies

Adverse fetal effects in animal studies, not well controlled in human studies

195
Q

Category C medications are defined as those

A

Inadequate animal or human studies

Adverse fetal effects in animal studies, no human studies available

196
Q

Category D medications

A

Demonstrate fetal adverse risk but may have benefits that outweigh risks

197
Q

Exam findings of a fetus exposed to ace inhibitors include

A

Skull hypoplasia
Fetal compression syndrome with limb deformations
Pulmonary hypoplasia
Renal tubular dysgenesis

198
Q

The most common fetal tratogenic exposure is

A

Alcohol

199
Q

Fetal alcohol syndrome is homemarked by abnormalities in

A

Physical exam
Growth
Neurodevelopment

200
Q

The cardiac defect associated with fetal alcohol syndrome is

A

VSD

201
Q

The anti epileptic within increased risk of hemorrhagic disease of the newborn is

A

Carbamazepine
Phenytoin
Phenobarbital

202
Q

Presence of craniofacial defects fingernail hypoplasia growth restriction and neural tube defects in a newborn may indicate in utero exposure to

A

Carbamazepine

203
Q

Besides still birth and placental overruption, cocaine fetal exposure may also cause

A 
Cutis aplasia
Porencephaly
Illeal atresia
Cardiac anomalies
Visceral infarction
Urinary tract abnormalities
204
Q

Cyclophosphamide exposure in utero may cause

A 
Missing digits
Cleft palate
Imperforate anus
Microcephaly
Growth restriction
205
Q

Vaginal adenocarcinoma may suggest in utero exposure to

A

Diethylstilbestrol (DES)

206
Q

Facial effects of in utero phenytoin exposure include

A

Cleft lip/palate
Short nose
Depressed nasal bridge
Mild hypertelorism

207
Q

Major increased risks of retinoic acid during pregnancy include

A

Spontaneous abortions/stillbirth
Significant cardiac anomalies including transposition, truncus arteriosus, TOF
Hydrocephalus

208
Q

Epstein’s anomaly is a sushi with what maternal medication?

A

Lithium

209
Q

Methotrexate taken at _____ weeks of gestation can cause

A

6-8 weeks

Cranial dysplasia
Broad nasal bridge
Low set ears
Microcephaly
Craniosynostosis
210
Q

Cardiac abnormalities and cleft lip and palate maybe associated with maternal medication

A

Phenobarbital

211
Q

Premature PDA closure and pulmonary hypertension maybe associated with maternal medication

A

Salicylates

212
Q

Phocomelia is associated with which maternal medication

A

Thalidomide

213
Q

The maternal medication most likely to cause neural tube defects is

A

Valproic acid

214
Q

Stippled bone epiphysis, nail hypoplasia, seizures, microcephaly, depressed nasal bridge are all contributable to which medication?

A

Warfarin

215
Q

Warfarin administration between _______ weeks gestation is highest risk for development of fetal anomalies?

A

6-12, 25%

216
Q

In pregnancy arsenic can cause

A

Spontaneous abortion

Lupus weight

217
Q

Ethylene oxide, inorganic mercury, benzene, formaldehyde can cause

A

Spontaneous abortion

Neo Boards (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions