MFM Flashcards
Infant with weak cry, hypotonia, poor oral feeding
Transient neonatal myasthenia gravis (10-20% infants effected) -
The presence of disease does not depend on severity of maternal disease or level of titers
Due to transplacental transfer of maternal Ach receptor antibodies
Symptoms by 72 hours with mean duration 18 days
Recovery by 2 months (90%) or 4 months (10% babies)
Neural tube, facial, cardiac defects, hypospadias, poor cognition
Valproic acid exposure in utero
Depressed nasal bridge, nasal hypoplasia, stippled bone epiphyses, low BW, seizures, cognitive disability
Warfarin exposure in utero
- If exposure happens after 12 weeks, less of an impact
Next step after elevated AFP
Fetal ultrasound
AFP least sensitive marker in quadruple screen
Elevated AFP, normal ultrasound
If gestational age confirmed and no fetal abnormality associated with elev AFP, genetic counseling is recommended and amniocentesis may be considered for karyotype
Side effects of intrapartum cocaine exposure
Stillbirth, placental abruption, skull abnormalities, cutis aplasia, porencephaly, ileal atresia, cardiac and urogenital anomalies
Late decelerations caused by
Uteroplacental insufficiency
Variable decelerations caused by
umbilical cord compression
Early decelerations caused by
Fetal head compression
What percent of population is single umbilical artery found in?
More common in which population?
Associated with:
1) <1%
2) Twins
3) Urogenital tract or cardiac anomalies
Nadir of deceleration at same time as peak of contraction
Early deceleration
Abrupt decrease in FHR with abrupt resolution
Variable deceleration
Onset, nadir and recovery after beginning, peak and end of contraction
Late deceleration
Pulmonary hypertension, renal insufficiency, ileal perforation, NEC
Indomethacin usage (prostaglandin synthase inhibitor) - used as tocolytic
Congenital heart defects, fetal goiter, premature birth, neonatal hypotonia, arrhythmias, seizures, diabetes insipidus
Lithium administration
Ebstein’s anomaly
Lithium exposure
Decreased respiratory rate, decreased peristalsis, hypotension, hypotonia
Magnesium sulfate administration (decreases Ach release from NMJ and calcium antagonist)- tocolytic
Fetal effects of pregestational vs gestational DM
Pre: miscarriage, stillbirth, birth defects (especially heart and ONTD) * Highest risk when poor glycemic control BEFORE conception
Any DM: growth disorders (usually macrosomia but can be IUGR d/t small vessel dx), cardiomyopathy, birth injury, neonatal metabolic abnormalities, RDS
Is caesarean recommended for DM?
Only if >4500g EFW (twice risk of having shoulder dystocia as same weight without DM)
Is DM at risk of premature labor?
Yes, d/t poly (–> inc uterine distention, contractions, ROM)
(Unsure mechanism but thought d/t polyuria from inc glucose)
Short palpebral fissures, thin vermillion border, smooth philthrum
Fetal alcohol syndrome
Fetus is _calcemic to mother
HYPER
Most Ca transfer in 3rd trimester: Facilitative diffusion from mom to placenta and then active ATP pump from placenta to fetus.
Calcitonin in pregnancy
Inhibits fetal bone resorption
Resorption process by which osteoclasts break down bone to release calcium
Estrogen and calcium
Increases fetal mineral accretion
ANS reduces:
IVH, NEC, mortality and RDS
NOT shown to reduce PDA or CLD
Choroid plexus cysts are found in _% of fetuses
0.5%
Can be found as early as 11 weeks and usually disappear by 26 weeks
Some ass. with T18 but usually clinically insignificant
pH of PROM
> /= 6.5
(pH vaginal fluid 4-4.5 and pH amniotic fluid 7-7.5)
False + with semen, blood, BV
Diabetes medication allowed in pregnancy
Insulin
Metformin and Glyburide cross placenta
When GDM test performed ?
24-28 weeks
1) 50g load –> >130–> take 3 hour; >200–> GDM dx
2) 3 hour test (100g load) –> tests at 1,2,3 hours (if 2 or more abnormal–> GDM)
ITP vs gestational thrombocytopenia
ITP: maternal plts <70k; severe neonatal thrombocytopenia <10% babies
GT: maternal plts >70k; benign and no neonatal thrombocytopenia
Which risk of 1st trimester abortion? Measles vs Mumps?
Mumps
What is the dominant thyroid hormone during fetal life?
rT3 (reverse T3)
Fetus converts free T4 to rT3 by deiodinase (D3)- enzyme present in placental and fetal tissues
Symptoms in donor twin (TTTS):
anemia, hypovolemia, oligo, decreased UOP, decreased growth
Symptoms in recipient twin (TTTS):
polycythemia, hypervolemia, polyhydramnios, cardiac hypertrophy, hydrops
Maternal adaptations to pregnancy:
RBF _creases, GFR _creases, tidal volume _creases, residual lung volume_creases, minute ventilation _creases, blood pressure _creases, pulse pressure _creases, pituitary gland size _creases, plasma volume _creases, RBC mass _creases
RBF increases, GFR increases, tidal volume increases, residual lung volume decreases, minute ventilation increases, blood pressure decreases, pulse pressure increases (diastolic decreases more than systolic), pituitary gland size increases, plasma volume increases, RBC mass increases (but PV increases more so dilution anemia)
MCC fetal mortality associated with MVA
maternal shock - must ensure maternal hemodynamic stability!!
Most common reason for non obstetric surgical intervention in pregnancy
Appendicitis
Which has better safety profile? regional or general anesthesia?
Regional; General has 17 fold higher complication rate
What do inhalation agents for general anesthesia do to uterine tone?
Decrease it thus inhibiting labor during the operative procedure
Do anesthetics and muscle relaxants cross the placenta?
Anesthetics do and muscle relaxants do NOT
IUGR, fingernail hypoplasia, craniofacial defects, NTD
Carbamazepine
sim to phenytoin but no CHD
Cleft lip/palate, nail hypoplasia, IUGR, CHD
Phenytoin
sim to carbamazepine but no NTD
