MFM Flashcards
First pregnancy hormone to increase
HCG, increases shortly after fertilization.. levels off in 2nd trimester.
Stimulates estrogen and progesterone production until placenta is formed
Role of progesterone in pregnancy
Maintains uterine quiescence, vasodilation
Which hormone is main driver of fetal growth during pregnancy?
Human placental lactogen
Gestational HTN BP levels?
SBP >140, DBP >90
Most common cause of neonatal hyperthyroid?
Maternal Graves
Most characteristic cardiac manifestation of neonatal lupus?
AV heart block
When do cardiac manifestations of maternal lupus occur in the fetus?
18-25 weeks gestation
Advanced forms present as fetal bradycardia
Which antibodies are responsible for the neonatal cardiac manifestations in maternal SLE?
Anti- Ro and Anti La
Location of mets for choriocarcinoma?
Lungs and vagina
What substances are transferred across the placenta be facilitated diffusion?
Glucose. Transported along the concentration gradient
What substances are transferred across the placenta by active transport?
Calcium, mag, phos, amino acids, water soluble vitamins. Transported against the concentration gradient
What is single umbilical artery associated with?
Urogenital tract, GI tract or cardiac anomalies
Source of blood loss in vasa previa?
Fetal
What is associated with the greatest risk for fetal heart block in maternal lupus?
Presence of anti-Ro and anti-La antibodies
What are the antibodies against in maternal myasthenia gravis?
IgG antibodies against acetylcholine receptors (neuromuscular junction)
Risk of congenital anomalies in maternal diabetes is dependent on?
Degree of uncontrolled diabetes and elevated glycosylated hemoglobin levels.
Greater risk if there is suboptimal glucose control prior to conception
Where is AFP formed and when does it peak in amniotic fluid and maternal serum?
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
What is tested in first trimester screening?
PAPP-A and B-hCG
PAPP-A is not as elevated in T21 or T18
When is nuchal translucency tested?
1st trimester, between 10-14 weeks
What is absent nasal bone associated with?
Trisomy 21
Most sensitive thing tested for T21?
Beta hCG
Components of quad screen?
AFP
unconjugated estriol
inhibin A
Beta hCG
Where is unconjugated estriol produced?
Produced by placenta, uses precursors from fetal adrenal and liver
Where is inhibin A produced?
Placenta and ovaries
Gold standard test for fetal karyotype?
CVS or amnio
When can cffDNA be tested?
After 9 weeks
Causes of low amounts of cffDNA
Early GA
Suboptimal collection
Maternal obesity
Abnormal fetal karyotype
Embryologic pathogenesis causing duodenal vs ileal/jejunal atresia
Duodenal atresia is due to failure of recanalization of solid cord
Ileal/jejunal atresia is due to an ischemic injury, vascular accident
What syndromes is an omphalocele associated with?
Beckwith Wiedemann
T13
T18
Cloacal exstrophy
When does the greatest % increase of fetal growth occur?
1st trimester
Complications of fetal demise in monochorionic twins w/ vascular anastamoses
- Risk of DIC in surviving twin
- Risk of anemia in surviving twin (demised twin can have vasodilation)
- Risk of cerebral injury in surviving twin
What kind of twins does TOPS occur in?
Monochorionic, diamniotic.
Does not occur in mo/mo because they share amniotic sacs
What is tested in a non-stress test
FHR and reactivity (accelerations and beat-beat variability) in response to fetal movement
What is a reactive positive non stress test?
> =2 accelerations within 20 minutes, associated with fetal movements
Increase in 15bpm, lasting >= 15 seconds
What must be ruled out in a nonreactive non stress test?
Fetal sleep or effects from maternal sedatives
What is a positive contraction stress test?
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
Categories of BPP
NST Fetal body movement Breathing Fetal tone Amniotic fluid volume
Cause of early decels?
Head compression. This leads to changes in cerebral blood flow, vagal decels in HR
Cause of variable decels?
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
Cause of late decels?
Uteroplacental insufficiency -> chemoreceptor response
Lags 10-30 seconds after the contraction
Cause of absent or reverse UA end diastolic velocity
Increased placental vascular resistance
Increased risk of perinatal mortality
When do neonatal myasthenia gravis symptoms resolve by?
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
Neonatal findings with in utero warfarin exposure?
Depressed nasal bridge Nail hypoplasia Stippled bone epiphysis LBW Seizures cognitive impairment
When does pre-eclampsia develop?
After 20 weeks, HTN and proteinuria
Severe pre-E also has headaches/oliguria/pulmonary edema/vision changes
Seizures happen in eclampsia
Most common complication of pregnancy?
Pre-eclampsia
TTTS occurs most commonly in which type of twin?
Monochorionic, diamniotic
Division between days 3-8
Increased risk of growth discordance
What is the pH of amniotic fluid?
7-7.5
In cases of ROM, test pH of vaginal fluid: should be >6,5
Which drug is safe to use during pregnancy for diabetes?
Insulin
Metformin crosses the placenta
Most common type of monozygotic twin?
Monochorionic, diamniotic
In which type of monozygotic twin is there an increased risk of cord entanglement?
Mono/mono
Division happens between days 8-13
Increase risk of acardia
Most accurate method of determining fetal gestational age?
Crown rump length between 7-10 weeks (accurate to 3 days)
At what gestational age is an amnio recommended?
After 14 weeks
Fetal weight is estimated from which 4 measurements?
Abdominal circumference, femur length, BPD, head circumference
Measurement used for asymmetric growth restriction?
Low ponderal index
One of the best prognostic factors in growth restriction of twins?
Presence of positive diastolic flow in the umbilical artery of the smaller twin
Sheehan syndrome
Pituitary ischemia and necrosis as a result of obstetrical blood loss
Hypotension, tachycardia, hypoglycemia and failure of lactation
Most common presenting symptom of massive fetomaternal hemorrhage
Maternal complaint of decreased or absent fetal movements
