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NICU Board Review > MFM > Flashcards

MFM Flashcards

1
Q

MCC of infant death in 🇺🇸

A

Congenital anomalies/ chromosomal (21%)
Disorders related to Prematurity (17%)
SIDS (6.5%)

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2
Q

MC presentation of acute chorio

A

Absent clinical manifestation
*Placental pathology is required to confirm
Associated with preterm birth

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3
Q

Primary marker for detection of fetal aneuploidy

A

Nuchal translucency
> 3mm - has 1 out of 6 risk for aneuploidy
Obtained between 10-15 weeks

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4
Q

Term IUGR - what is MC neurodevelopmental deficit?

A

ADHD is higher in term IUGR infants

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5
Q

MC perinatal complications in late preemies compared to term

A

Jaundice is the MC complication (50%)

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6
Q

Wedge shaped mass in lung with systemic arterial supply on fetal MRI. Dx?

A

Bronchopulmonary sequestration (doesn’t communicate w tracheobronchial tree)

CPAM can be macrocystic (MC) or microcystic and located anywhere in lung. Communicates w tracheobronchial tree w pulmonary circulation

CLE hyper inflated lung tissue w predisposition for upper lobes. Can appear similar to microcystic CPAM

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7
Q

Which plasma protein is associated with thrombotic features of antiphospholid syndrome?

A

Beta 2 glycoprotein 1

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8
Q

In TTTS which twin has chorionic magistral blood vessel pattern?

A

Donor twin (large size vessels w minimal branching extending from cord insertion to placental periphery)

They are more at risk of anemia, hypovolemia, to be wrapped in cord, and “stuck twin syndrome” bc oligohydramnios

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9
Q

What is the goal Hct during PUBS?

A

Transfusion volume goal is high hematocrit to minimize fluid overload (O negative hct 75-80%)

= hgb goal- hgb fetal/hgb donor-hgb goal (fetal placental blood volume 90-120ml/kg)

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10
Q 
How does the following change in pregnant women? 
HR
Blood volume 
CO/SV 
SVR
A

HR increases 10-20%
Blood volume increases 30% (ie relative anemia)
CO increases 30-50%
SVR decreases by 20%

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11
Q

Which enzyme correlates best with serum bile acid levels in a pregnant woman w Intrahepatic cholestasis of pregnancy?

A

Gluthathione S transferase alpha

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12
Q

Clinical finding most commonly seen in neonate born to mother with intrahepatic cholestasis of pregnancy?

A

Surfactant deficiency

They too will have elevated bile acids
Increased risk bile acid pneumonia and mec aspiration syndrome

No risk for cholestasis rash hepatitis or sepsis

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13
Q

Women with intrahepatic cholestasis of pregnancy are deficient in which trace element?

A

Selenium

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14
Q

Characteristics of placentas of obese women

A
  1. Hyper mature with increased # of terminal villi or accelerated villose maturation
  2. Acute inflammation -with > oxidative stress
  3. Larger than avg
  4. Decreased perfusion - infarction risk
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15
Q

Role of progesterone

A

Progesterone maintains uterus in relaxed state (down regulating gap junctions, decreasing oxytocin receptors, inc the threshold of contractions and inhibiting cervical ripening)

Highest levels at the end of pregnancy

IOL requires withdrawal of progesterone receptor function (functional suppression) despite the levels being high

Decline in steroid receptor coaactivator (SRC)

Progesterone Receptor A (PR-A) increases during labor which impairs receptor responsiveness

Estrogen contributes to labor by increasing uterine contraction
(Allowed by functional suppression of progesterone)

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16
Q

The greatest risk of congenital malformations in a diabetic mother occur with poor glucose control ____ of pregnancy

A

Prior to conception and 1st trimester

Fetal malformations are 2-4x higher in 🤰🏽 with diabetes compared to population

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17
Q

Risk of congenital anomalies with diabetes

A

If 👩🏽 achieves glycemic control PRIOR to pregnancy- risk of fetal anomalies is 2.5%

If 👩🏽 achieves glycemic control AFTER becoming pregnant, risk of fetal anomalies is 7.8%

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18
Q

How do you diagnose antiphospholipid syndrome?

A

Elevated IgM or IgG anticardiolipin Ab, anti-B2 glycoprotein 1 or lupus anticoagulant on 2 ocassion 12 weeks apart.

If all 3 elevated, higher risk of thrombotic events and pregnancy related morbidity

Preferential transport capacity for IgG1

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19
Q

Most common congenital anomaly with gestational diabetes

A

Caudal regression syndrome

impaired development of lower half of body

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20
Q

Maternal risk factor with Highest likelihood ratio for the development of preeclampsia

A

Chronic hypertension

Then APS

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21
Q

What are lacunae on ultrasound used to diagnose

A

The presence of Lacunae lakes is used to diagnose abnormalities in placental implantation (ie - placental accreta)

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22
Q

What is the greatest risk factor for demise of recipient twin in TTTS?

A

Evidence of cardiomyopathy

Cardiac function of recipient twin

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23
Q

Which factors are associated with worse maternal fetal outcomes in preeclampsia ?

A

Elevated ratio of fms-like tyrosine kinase 1 (Flt-1) [antiangiogenic] to
placental growth factor (PIGF, angiogenic)

(A low ratio between 24-37 weeks gestation can predict absence of preeclampsia within one week)

Remember Other antiangionenic factors are endoglin which is also increased and angiogenic like VEGF is decreased

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24
Q

What are the risk factors for late preterm birth ?

A 
AMA
Multiple gestations
Obesity
Prior preterm delivery (OR 7.5)
Short (<12 months) interpregnancy 🤰🏽 interval (OR 4)
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25
Describe changes in immunity during pregnancy relating to helper T cells
Downregulation of maternal immunity | Switch from TH1 cellular immunity to TH2 antibody mediated immunity
26
How is glucose and cephalexin transplacentally transferred?
Facilitated diffusion
27
How are lipids and fat soluble vitamins transplacentally transferred?
Simple diffusion Similar to O2 CO2 Na Cl and most meds
28
How are amino acids and H2O-soluble vitamins transferred?
Active transport Similar to Ca Ph Mg Iron and Iodide
29
How is water and dissolved electrolytes transplacentally transferred?
Bulk flow
30
How are immunoglobulin G antibodies transferred?
Pinocytosis Similar to other proteins
31
Marfan syndrome characteristics
AD Gêne: fibrillin 15q21.1 Dilated aortic root, MVP Lens subluxation (upward)
32
Highest risk to the fetus with IVF
Multiple gestation
33
What are non thrombotic complications of anti phospholipid syndrome (APS)
♥️ valvular disease Hemolytic anemia Livedo reticularis Thrombocytopenia
34
Risk factors for abnormal placentation (accreta, increta, percreta)
MCC Uterine surgery (includes C/S) Fibroids Multiparity AMA Accreta - implantation of the placenta that is deeper into the uterus than usual Increta -Invades Percreta - pénétrâtes
35
What are Hofbauer cells?
Stromae histiocytes found in placental villi of a normal placenta
36
Describe Quintero stages of TTTS
Stage I- oligo/polyhydramnios, visible donor bladder Stage 2- oligo/poly, non-visible donor bladder Stage 3-oligo/poly, abnl umbilical artery flow Stage 4-oligo/poly, hydrops Stage 5- oligo/poly, impending or actual demise in 1 or both twins
37
Which growth pattern puts babies at risk for CAD in adulthood? Remember metabolic syndrome….
Low BW Slow growth in infancy Excessive growth in childhood
38
Risks with gestational diabetes
Poor control preconception and in 1st trimester = increase risk for congenital anomalies Poor control in pregnancy= increase risk for Neonatal morbidities
39
Common Neonatal findings in baby’s born to preeclamptic mothers
Thrombocytopenia Neutropenia *Usually seen with growth restricted
40
MC valvular problem in pregnancy
Mitral stenosis Most of acquired valvular disease is 2/2 rheumatic fever
41
What imaging modality is best for early detection of gastrointestinal obstruction?
Fetal MRI
42
Describe findings of placentas of GDM mother
``` Large Chorangiosis (vascular change from low grade hypoxia-seen in DM, IUGR and gestational HTN) ```
43
What is the MCC of chronic infectious villositis (hint: intranuclear/cytoplasmic inclusion)?
CMV | Treponema pallidum
44
What is the MCC of fetal overgrowth in pregnancies with diabetes
Fetal hyperinsulinemia
45
Neonates born to mothers with APS are at high risk of?
Preterm birth SGA Autism/NDI with persistent APS-associated antibodies Anticardiolipin and antibB 2 glycoprotein abs may persist for 6 mo
46
Difference between pre gestational DM placenta (Type 1) and gestational diabetes placenta?
Pre gestational dm placentas have: immature chorionic villi Increased proliferation index Villose necrosis
47
MC complication associated with PUBS | Precutaneous villous sampling
Risk of fetal bradycardia (7-52%) Spontaneously resolves Severe in 3-4% of cases
48
Magnesium sulfate in preeclampsia reduces which maternal morbidities?
Progression to eclampsia 60% | May decrease risk placental abruption
49
Relative risk of morbidities in late preterm V’s term
Cerebral palsy (RR 2.7) Cognitive deficits (RR 1.6) Disorders of psychological development, behavior + emotional issues Impaired work capacity
50
MC reason for preterm delivery with preeclampsia
``` Stillbirth (15-20%) HELLP (6-10%) Abruption Pulmonary edema (2-4%) Eclampsia (1-2%) ```
51
MC pregnancy specific complication of APS?
Preeclampsia (50%) preterm birth (30%) IUGR (30%)
52
What is a long term neonatal adverse outcome for Fetal thrombotic vasculopathy ?
* Neurologic stroke Encephalopathy CP
53
Teratogen exposure during which period is most likely to lead to deleterious effects?
0-12 weeks during organogenesis
54
Mother with Maculopapular rash starting in face, posterior auricular lymphadenopathy and prodromal symptoms. What is the neonate affected with and clinical features?
Rubella Neonate clinical features: Cataracts PDA, Peropheral pulmonary artery stenosis Microcephaly Highest risk in first 12 weeks (most develop cardiac defects) Sensorineural hearing loss
55
Common neonatal presentation of Cosackieviruses
``` Maculopapular rash (viral exanthem) Myocarditis ``` Type B associated with cardiac issues
56
Which torch infection can lead to hypertrophic cardiomyopathy?
Parvovirus B19 Viremia (fever, flu like symptoms) Althralgia/rash (immune mediated) Suppression of erythropoiesis leading to anemia and hydrops if severe In some fetuses it can lead to hypertrophic cardiomyopathy Highest risk for hydrops is 1st trimester
57
Highest sensitivity of maternal serum AFP occurs at what gestational age?
Greatest sensitivity between 16-18 weeks Fetal AFP: peaks at ~13 weeks' gestation ``` Maternal serum AFP (MSAFP): detected after 12 weeks' gestation; peaks ~32 weeks' gestation usually check level between 15 and 22 weeks' gestation greatest sensitivity between 16 and 18 weeks' gestation ``` Amniotic fluid AFP: peaks at ~13 weeks' gestation correlates with fetal serum AFP
58
Complications of nifedipine as a tocolytic?
Fetal hypotension
59
What are the characteristics of amniotic fluid (AF)?
Osmolality decreases with increasing gestational age (2nd trimester - due to increased fetal urine production) AF volume + AFI (index) with bell shaped curve
60
What are the sources of AFV Production and Clearance During the 3rd Trimester?
- majority of AFV production is from fetal urine. - small amount of fetal lung fluid exits the lungs. - majority of AFV clearance is due to fetal swallowing - 2nd most important clearance mechanism is direct absorption of AF from the amniotic sac into fetal blood vessels within the placenta (i.e., intramembranous).
61
Types of Decelerations of FHR
Early —-> head compression Variable —-> umbilical cord compression (u, v, w pattern) Late —-> utero placental insufficiency Sinusoïdal pattern —-> ominous assocd with severe anemia
62
What is associated with fetal tachycardia ?
Fetal anemia Maternal anemia Maternal fever Terbutaline treatment (Magnesium is NOT associated)
63
What are predictors of preterm labor
Fibronectin > 50 (produced by amniocytes + cytotrophoblast) IL- > 400 Cervical length <30 mm
64
Role of hPL
Promotes fetal growth
65
How does CO, SVR and BP change in pregnant woman?
``` Increased CO (30% CO goes to uterus) Decreased SVR and 3rd trimester BP decrease to maximize blood flow to uterus and placenta ```
66
How does red cell mass, pro and anticoagulants change in pregnancy?
Increase in red cell mass 30% Increase in procoagulant and decrease in anticoagulant Increase in vascular stasis Increase risk for thromboembolic disease (likely so she doesn’t bleed to death at delivery lol)
67
How does minute ventilation, RR and FRC?
Increase in minute ventilation Deeper breaths not change in RR Fall in FRC
68
Maternal TSH can change in early pregnancy, why does this happen?
Cross reaction with hcg making it low TSH but no actual change in hormone levels
69
What treatment should u avoid in mothers with hypothyroidism
Radioactive iodide (can concentrate and damage fetal thyroid)
70
TTTS
10-15% of monochorionic diamniotic twins 80-100% mortality if untreated Large placental AV anastomoses result in uneven blood flow Donor and recipient twin - Donor with decreased blood volume, growth restricted, poor urine output (oligohydramnios); recipient is hypervolemic, polyhydramnios and hydrops Stages 1-5 (2-4 are candidates for treatment with laser ablation)
71
Which twins get affected by TRAP?
Twin reversed arterial perfusion Seen in mono mono twins Normally formed donor (pump) twin and a cardiac recipient twin Treat by cord occlusion of a cardiac twin
72
At what GA do you screen for gestational diabetes?
24-28 weeks
73
Gestational diabetes in mother is associated w increased congenital anomalies (T/F)
False
74
Neonates born to mothers with GDM are at risk for what?
Metabolic syndrome in the future Serial and ♥️ hypertrophy - resolves in a few months - treat poor cardiac output with b blockers (NOT pressors)
75
What is the most significant factor that affects risk of fetal malformations in mothers w gestational diabetes?
Preconceptual HgbA1c If elevated cardiac dx, caudal regression syndrome, small left colon
76
Name some Neonatal metabolic derangements seen with maternal diabetes
• Polycythemia-(due to insulin increasing metabolic rate and increased oxygen demand) Hypocalcemia-inadequate (PTH, excess calcitonin) Hypoglycemia • Hyperbilirubinemia • Increased thrombotic events due to hyperviscosity • Neonatal RDS • Fetal hyperinsulinemia also retards production of surfactant Prematurity • Fetal death
77
Fetal and Neonatal Risk factors of maternal diabetes
Polyhydramnions 2/2 osmotic diuresis w fetal hyperglycemia ``` Polycythemia hypoCa Hyperbili Thrombotic events for hyperviscosity Neonatal RDS ```
78
Diagnosis of Gestational Hypertension?
Elevated BP >140 systolic or 90 diastolic in a previously normotensive mother
79
How does preeclampsia lead to placental insufficiency
Inadequate remodeling of maternal spiral arteries | Maternal systemic vascular dysfunction->multi organ involvement
80
Fetal and Neonatal effects of preeclampsia are
• 12%-25% of fetal growth restriction and SGA infants, as well as 15%-20% of all preterm births • These preterm births are generally indicated, because the only known cure for preeclampsia is delivery of the fetus and placenta!
81
Fetal impact of maternal hypertension
``` Preterm birth SGA / IUGR Hypoglycemia Thrombocytopenia Neutropenia Polycythemia HypoCa from mag sulfate ```
82
What is the MCC hypothyroidism in pregnancy
Chronic autoimmune (Hashimoto)
83
Fetal manifestations of Graves’ disease
* Fetal tachycardia * Growth restriction * Fetal hydrops * Fetal goiter
84
MCC of neonatal Graves’ disease?
Transplacentally transfer of stimulating TSH receptor antibodies P/w fetal tachycardia IUGR fetal hydrops fetal goiter. Neonatal: irritability, tremor, exophtalmos, goiter If severe thyrotoxicosis-hyperthermia, arrhythmia, High output cardiac failure, death Self limited, antibodies get cleared 3-12 weeks Tx anti thyroid drugs and propanolol
85
Mothers with lupus are at higher risk of which prenatal complication?
Preeclampsia
86
How does neonatal lupus cause heart block?
Proposed that heart block results from binding of anti- Ro/SSA and/or anti-La/SSB antibodies to fetal cardiac cells that have undergone physiologic apoptosis during remodeling, leading to autoimmune injury and secondary fibrosis of the atrioventricular (AV) node and its surrounding tissue • Autoantibodies may also act by inhibiting calcium currents mediated by cardiac L and T type calcium channels
87
What is condition is responsible for 80-95% of all cases of congenital complete heart block (<5% present after birth)?
•Neonatal Lupus
88
What are the effects of SSRI on pregnancy
Paroxetine (Paxil), sertraline (Zoloft), fluoxetin (Prozac), citalopram (Celexa) • Early onset of symptoms * In baby: * Seizures, irritability, abnormal crying, tremor * Pulmonary Hypertension * NEC?
89
What is the triad of clinical features of Fetal Alcohol Syndrome?
``` 1. Impaired pre- and postnatal growth (lUGR) 2. Abnormal facies 3. Abnormalities of CNS or subsequent neurodevelopment ```
90
How to differentiate type of twins
``` T= monochorionicity Lambda= dichorionicity ```
91
TTTS vs TAP vs TRAP
Risk of TTS is not the same in all monochorionic twins. - highest in mono-di twins (as opposed to mono-mono). -Mono chorionic mono amniotic - less likely TTTS (they have a-a, v-a, v-v anastomoses; not so much a-v) Twin anemia polycythemia sequence (TAPS), no amniotic fluid difference, usually superficial as opposed to deep AV anastomoses Twin reverse arterial perfusion sequence (TRAP), the cardiac system of one twin does the work of supplying blood for both twins leading to "pump twin" and ´acardic twin" TTS- larger a-v vessel anastomoses (has fluid shifts) TAPS - smaller a-v vessel anastomoses (doesn’t have the fluid disturbance)
92
Which is the most common conjoined twin type?
Thoracopagus
93
When does fetal breathing begin?
10 weeks
94
What is considered oligohydramnios?
AFI<5cm or MVP<2cm
95
Polyhydramnios
AFI>24cm (severe>34) | MVP>8cm
96
Low estriol levels
Smith Lemli Opitz | Placental sulfatase deficiency
97
What makes up the BPP?
``` NST Fetal body movement Breathing Fetal Tone Amniotic Fluid Volume ```
98
What to look at closely with fetal monitoring?
Baseline (110-160 HR) Variability present (moderate 6-25 bpm - normal) Accelerations (normal - indicates a normally oxygenated fetus) Decelerations ?
99
What are NORMAL umbilical (fetal) arterial and venous blood gases?
- Arterial 7.27/55/-3 - Venous 7.35/40/-3 Metabolic: accumulation of lactic acid - Hypotension, poor tissue perfusion with dysfunction Respiratory: accumulation of COz - Respiratory not associated with poor outcomes
100
B methasone for pts <32 weeks decreases risk of CP from 4% to 2% True or False
True
101
When is delivery by C/S indicated in a fetus w abdominal wall defect?
Omphalocele with liver exposed
102
Effect of maternal marijuana use on neonate
Impairment in neurodevelopment, working memory and school performance
103
Warfarin effects on baby
Stippled epiphysis | Nasal bone abnormalities

NICU Board Review (19 decks)

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