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Neo Board Review > MFM > Flashcards

MFM Flashcards

1
Q

First pregnancy hormone to increase

A

HCG, increases shortly after fertilization.. levels off in 2nd trimester.
Stimulates estrogen and progesterone production until placenta is formed

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2
Q

Role of progesterone in pregnancy

A

Maintains uterine quiescence, vasodilation

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3
Q

Which hormone is main driver of fetal growth during pregnancy?

A

Human placental lactogen

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4
Q

Gestational HTN BP levels?

A

SBP >140, DBP >90

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5
Q

Most common cause of neonatal hyperthyroid?

A

Maternal Graves

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6
Q

Most characteristic cardiac manifestation of neonatal lupus?

A

AV heart block

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7
Q

When do cardiac manifestations of maternal lupus occur in the fetus?

A

18-25 weeks gestation

Advanced forms present as fetal bradycardia

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8
Q

Which antibodies are responsible for the neonatal cardiac manifestations in maternal SLE?

A

Anti- Ro and Anti La

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9
Q

Location of mets for choriocarcinoma?

A

Lungs and vagina

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10
Q

What substances are transferred across the placenta be facilitated diffusion?

A

Glucose. Transported along the concentration gradient

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11
Q

What substances are transferred across the placenta by active transport?

A

Calcium, mag, phos, amino acids, water soluble vitamins. Transported against the concentration gradient

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12
Q

What is single umbilical artery associated with?

A

Urogenital tract, GI tract or cardiac anomalies

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13
Q

Source of blood loss in vasa previa?

A

Fetal

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14
Q

What is associated with the greatest risk for fetal heart block in maternal lupus?

A

Presence of anti-Ro and anti-La antibodies

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15
Q

What are the antibodies against in maternal myasthenia gravis?

A

IgG antibodies against acetylcholine receptors (neuromuscular junction)

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16
Q

Risk of congenital anomalies in maternal diabetes is dependent on?

A

Degree of uncontrolled diabetes and elevated glycosylated hemoglobin levels.
Greater risk if there is suboptimal glucose control prior to conception

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17
Q

Where is AFP formed and when does it peak in amniotic fluid and maternal serum?

A

AFP formed initially in the yolk sac, then fetal liver and GI tract
Peak in fetal serum at 13 weeks, amniotic fluid soon after
Peaks in maternal serum around 32 weeks

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18
Q

What is tested in first trimester screening?

A

PAPP-A and B-hCG

PAPP-A is not as elevated in T21 or T18

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19
Q

When is nuchal translucency tested?

A

1st trimester, between 10-14 weeks

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20
Q

What is absent nasal bone associated with?

A

Trisomy 21

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21
Q

Most sensitive thing tested for T21?

A

Beta hCG

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22
Q

Components of quad screen?

A

AFP
unconjugated estriol
inhibin A
Beta hCG

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23
Q

Where is unconjugated estriol produced?

A

Produced by placenta, uses precursors from fetal adrenal and liver

24
Q

Where is inhibin A produced?

A

Placenta and ovaries

25
Q

Gold standard test for fetal karyotype?

A

CVS or amnio

26
Q

When can cffDNA be tested?

A

After 9 weeks

27
Q

Causes of low amounts of cffDNA

A

Early GA
Suboptimal collection
Maternal obesity
Abnormal fetal karyotype

28
Q

Embryologic pathogenesis causing duodenal vs ileal/jejunal atresia

A

Duodenal atresia is due to failure of recanalization of solid cord
Ileal/jejunal atresia is due to an ischemic injury, vascular accident

29
Q

What syndromes is an omphalocele associated with?

A

Beckwith Wiedemann
T13
T18
Cloacal exstrophy

30
Q

When does the greatest % increase of fetal growth occur?

A

1st trimester

31
Q

Complications of fetal demise in monochorionic twins w/ vascular anastamoses

A
  1. Risk of DIC in surviving twin
  2. Risk of anemia in surviving twin (demised twin can have vasodilation)
  3. Risk of cerebral injury in surviving twin
32
Q

What kind of twins does TOPS occur in?

A

Monochorionic, diamniotic.

Does not occur in mo/mo because they share amniotic sacs

33
Q

What is tested in a non-stress test

A

FHR and reactivity (accelerations and beat-beat variability) in response to fetal movement

34
Q

What is a reactive positive non stress test?

A

> =2 accelerations within 20 minutes, associated with fetal movements
Increase in 15bpm, lasting >= 15 seconds

35
Q

What must be ruled out in a nonreactive non stress test?

A

Fetal sleep or effects from maternal sedatives

36
Q

What is a positive contraction stress test?

A

Late decels with 50% of contractions
Needs prompt intervention. Deliver if term.
If preterm, and there is FHR reactivity then give steroids, monitor and frequently test

37
Q

Categories of BPP

A 
NST
Fetal body movement
Breathing
Fetal tone
Amniotic fluid volume
38
Q

Cause of early decels?

A

Head compression. This leads to changes in cerebral blood flow, vagal decels in HR

39
Q

Cause of variable decels?

A

Umbilical cord compression -> baro or chemo receptor response
Most common pattern during labor. The decrease in FHR is much lower than that in early decels. Waveform resembles U, V or W

40
Q

Cause of late decels?

A

Uteroplacental insufficiency -> chemoreceptor response

Lags 10-30 seconds after the contraction

41
Q

Cause of absent or reverse UA end diastolic velocity

A

Increased placental vascular resistance

Increased risk of perinatal mortality

42
Q

When do neonatal myasthenia gravis symptoms resolve by?

A

2 months
10-20% of infants will have symptoms, usually present around 72 hours of age
Symptoms are not dependent on severity of maternal disease or level of maternal titers

43
Q

Neonatal findings with in utero warfarin exposure?

A 
Depressed nasal bridge
Nail hypoplasia
Stippled bone epiphysis
LBW
Seizures
cognitive impairment
44
Q

When does pre-eclampsia develop?

A

After 20 weeks, HTN and proteinuria

Severe pre-E also has headaches/oliguria/pulmonary edema/vision changes

Seizures happen in eclampsia

45
Q

Most common complication of pregnancy?

A

Pre-eclampsia

46
Q

TTTS occurs most commonly in which type of twin?

A

Monochorionic, diamniotic
Division between days 3-8
Increased risk of growth discordance

47
Q

What is the pH of amniotic fluid?

A

7-7.5

In cases of ROM, test pH of vaginal fluid: should be >6,5

48
Q

Which drug is safe to use during pregnancy for diabetes?

A

Insulin

Metformin crosses the placenta

49
Q

Most common type of monozygotic twin?

A

Monochorionic, diamniotic

50
Q

In which type of monozygotic twin is there an increased risk of cord entanglement?

A

Mono/mono
Division happens between days 8-13
Increase risk of acardia

51
Q

Most accurate method of determining fetal gestational age?

A

Crown rump length between 7-10 weeks (accurate to 3 days)

52
Q

At what gestational age is an amnio recommended?

A

After 14 weeks

53
Q

Fetal weight is estimated from which 4 measurements?

A

Abdominal circumference, femur length, BPD, head circumference

54
Q

Measurement used for asymmetric growth restriction?

A

Low ponderal index

55
Q

One of the best prognostic factors in growth restriction of twins?

A

Presence of positive diastolic flow in the umbilical artery of the smaller twin

56
Q

Sheehan syndrome

A

Pituitary ischemia and necrosis as a result of obstetrical blood loss
Hypotension, tachycardia, hypoglycemia and failure of lactation

57
Q

Most common presenting symptom of massive fetomaternal hemorrhage

A

Maternal complaint of decreased or absent fetal movements

Neo Board Review (16 decks)

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