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Neo Board Review MAP > MFM > Flashcards

MFM Flashcards

1
Q

Ace inhibitors

A

Renal dysplasia

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2
Q

Amniocentesis

A

Greater than 15 weeks gestation
Fetal loss <1/500
Tests amniotic fluid skin cells

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3
Q

Amniotic band syndrome

A

Constriction or amputation of digits/limbs

31% associated with club foot deformity (20% bilateral)

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4
Q

Antenatal steroids decrease risk of ___

A

RDS
NEC
IVH
Neonatal death

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5
Q

Biophysical profile (BPP)

A

In a 30 minute window

  • breathing for >30 seconds
  • > 3 movements of torso/limbs
  • > 1 flex and extend
  • > 2 cm fluid pocket
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6
Q

Blood volume in pregnancy increases by?

A

45%

Max volume at 32 weeks

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7
Q

Placental carbon dioxide transport

A

Very lipid soluble, rapidly transported

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8
Q

Category I FHR

A

Baseline 110 to 160
Moderate variability
No late or variable decels

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9
Q

Category II FHR

A

Everything not category I or III

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10
Q

Category III FHR

A

Absent variability and either:
Recurrent late or variable decels
Bradycardia

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11
Q

Causes of hydrops fetalis

A

Anemia (parvovirus, FMH, TTTS)
Cardiac failure (elevated RA pressure)
Decreased osmotic pressure (syphilis, CMV)
Impaired lymphatic drainage (cystic hygroma, chromosomal anomalies)

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12
Q

Cell free DNA

A

After 10 weeks
Detects fetal DNA in maternal serum
Very accurate for T21, T18, T13

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13
Q

Chorionic villus sampling

A

11 to 13 weeks gestation

Fetal loss 1/200-300

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14
Q

Circumvallate placenta

A

Membranes are on opposite side of placenta

Painless bleeding in 1/2 cases

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15
Q

Risk of death or neurologic injury with twin demise

A

20% (MC) vs 1% (DC)

More likely if triplets vs twins
Immediate delivery will not help, the cause is hypotension


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16
Q

DES

A

Vaginal adenocarcinoma and adenosis

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17
Q

Diffusion calculation

A

Rate of diffusion = Permeability x Surface area x Concentration difference (Cm-Cf)

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18
Q

Estimated fetal weight

A

Within 15% of actual weight 95% of the time

Less accurate at higher gestational ages

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19
Q

HCG

A

TSH like effects (alpha subunit the same)

Causes nausea and vomiting in pregnancy

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20
Q

Human chorionic somatomammotropin (HCS)

A

Previously known as human placental lactogen (HPL)
Anti-insulin affects (GDM)
Stimulates fetal somatic growth

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21
Q

Hemochorial placenta

A

Humans
Maternal blood in direct contact with trophoblastic tissue
More permeable to lipid soluble molecules

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22
Q

Hemodynamic changes in pregnancy

A

Cardiac output increases by 43% (HR and SV)
SVR decreases by 21%
Colloid pressure decreases by 14%

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23
Q

Causes of high maternal AFP

A 
Open NTD
Twins
Fetal maternal hemorrhage
Abdominal wall defects
Lowe Syndrome
Congenital nephrotic syndrome
Fetal death
If unexplained, increased risk of growth restriction or death of fetus
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24
Q

IGG transfer

A

Via endocytosis

Uses a vesicle to protect from proteolysis

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25
Q

IGM transfer

A

No passage across placenta

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26
Q

Intervillous space

A

Confined space

Increased blood goes across villi to fetus

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27
Q

Late decelerations

A

Occur after every contraction

Caused by utero placental insufficiency

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28
Q

Latency antibiotics

A

Broad-spectrum abx x 7-10 days

Reduces risk of RDS, NEC, neonatal/maternal infxn

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29
Q

Lipid insoluble molecules

A

Unless a transporter present - cross through paratrophoblastic routes
Size dependent, small pathways, low permeability

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30
Q

Lipid soluble molecules

A

Diffuse across entire trophoblast surface
Permeability is large
Dependent on concentration gradient

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31
Q

Lithium

A

Ebstein’s anomaly

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32
Q

What causes maternal serum estrogen to be low?

A

Placental sulfatase deficiency
Anencephaly
CAH
Molar pregnancy

33
Q

Maternal oxygen administration

A

Increases O2 carrying capacity in the mother

Leads to a larger increase in fetal oxygen content

34
Q

Maternal thyroid in pregnancy

A

TBG increased
Total T4 increased
Early pregnancy HCG mimics TSH, so TSH levels are low and free T4 levels are high

35
Q

MCA Doppler

A

Best non-invasive test to assess for fetal anemia

36
Q

Methotrexate

A

FGR

Developmental delay

37
Q

Non-stress test (NST)

A

Reactive = 2 or more accelerations in a 20 minute window
HR increase by 15 BPM for at least 15 seconds
MCC of non-reactive NST is fetal sleep

38
Q

NSAIDs in pregnancy

A

Oligohydramnios

Narrowing or closure of PA in utero (PPHN after delivery)

39
Q

Oligohydramnios

A

Single verticle pocket (SVP) <2 cm
AFI <5 cm
SVP is better predictor

40
Q

Placental oxygen transport

A

Determined by oxyhemoglobin disassociation curve

Fetal temp higher, more acidotic, fetal Hgb

41
Q

Phenytoin

A

FGR
Microcephaly
Midface hypoplasia
Hypertelorism

42
Q

Placenta Accreta

A

Leads to massive maternal hemorrhage

  • Accreta invades the endometrium
  • Increta invades the myometrium
  • Percreta goes through the myometrium, can involve the bladder
43
Q

Amino acid transport

A

Active transport, requires energy

Fetal concentration greater than maternal

44
Q

Carbohydrate transport

A

Facilitated diffusion, no energy required
Requires GLUT receptors
Follows a concentration gradient
Placenta consumes glucose to maintain gradient

45
Q

Placenta previa

A

Placenta covering the cervical os
Leads to maternal hemorrhage and preterm labor
Three types: marginal, complete, low lying

46
Q

Placental abruption

A

Placenta breaks away from endometrium
Most of blood loss is maternal blood (intervillous space)
Clinical diagnosis - painful bleeding

47
Q

Calcium transport in pregnancy

A

Facilitated diffusion from mother to placenta
Protein binding in placenta to maintain concentration gradient
Active transport from placenta to fetus

48
Q

Potassium transport in pregnancy

A

Tightly regulated through K pumps

Fetal levels greater than maternal levels

49
Q

Lipid transport in pregnancy

A

Dependent on trans placental concentration gradient

50
Q

Sodium transport in pregnancy

A

Simple diffusion across a concentration gradient

Similar levels in mother and fetus

51
Q

Vitamin transport In pregnancy

A

Fat soluble: simple diffusion, deficiencies rare, toxicity possible
Water soluble: active transport
Iron: active transport using transferrin

52
Q

Polyhydramnios

A

SVP >8 cm
AFI > 25 cm
AFI better predictor

53
Q

RBCs in pregnancy

A 
20-30% increase
Dilutional anemia (blood volume increases by 45%)
54
Q

Respiratory changes in pregnancy

A

Tidal volume increases by 35%
Minute ventilation increases by 40%
FRC decreases by 20% (uterus pushes up diaphragm)

55
Q

SSRIs during pregnancy

A

Neonatal adaptation syndrome

Pulmonary hypertension

56
Q

Succenturate lobe

A

Accessory lobe of the placenta
Blood vessels exposed and may rupture during labor
Set up for vasa previa

57
Q

Timing of twin separation

A

Di-di: days 1-3
Mono-di: days 4-7
Mono-mono: days 8-12
Conjoined: days 13-15

58
Q

Transtrophoblastic channels

A 
Very small (20 nm)
Carry water soluble molecules
Channels can dilate and close (mechanism for water balance)
59
Q

EBM treatments for preterm birth

A

Antenatal corticosteroids
Transfer to tertiary center before delivery
Administration of antibiotics for GBS
Magnesium for neuroprotection

60
Q

Twin twin transfusion syndrome (TTTS)

A

Both twins can develop hydrops
Recipient twin: increased blood volume, potential for heart failure, polycythemia, polyhydramnios
Donor twin: poor growth, oligohydramnios, anemia

61
Q

Umbilical artery Doppler

A

Helps manage fetal growth restriction

Absent or reversed diastolic flow means high risk of morbidity and mortality

62
Q

Valproic acid

A

NTD

Developmental delay

63
Q

Variable decelerations

A

Variable relationship to contractions

Caused by umbilical cord compression

64
Q

Vasa previa

A

Fetal vessels exposed in front of cervix

At risk for tearing during the labor process, leading to fetal exsanguination

65
Q

Velamentous insertion

A

Vessels are freely on the placental surface
Increased risk for:
- growth restriction
- preterm birth
- fetal bleeding during labor (fetal mortality rate is 75%)

66
Q

Warfarin

A

Midface hypoplasia
FGR
Microcephaly

67
Q

What kind of blood flow does human placenta have?

A

Concurrent flow between maternal and fetal blood

68
Q

Do not cross the placenta

A 
TSH
Biliverdin
Heparin
Insulin
Glucagon
Growth hormone
IgM
Complement
69
Q

Quad screen T21

A

Low AFP
Low E3
High HCG
High inhibin

70
Q

What is a category 1 FHR predict?

A

Normal fetal acid base balance

71
Q

Carbamazepine during pregnancy

A

Growth restriction
Finger nail hypoplasia
Craniofacial defects
Neural tube defects

72
Q

What crosses the placenta via simple diffusion?

A

Respiratory gases
Lipids
Fat-soluble vitamins
Sodium

73
Q

What crosses the placenta via facilitated diffusion?

A

Glucose

Some glucocorticoids

74
Q

What crosses the placenta via channels?

A

Water

Some ions

75
Q

What crosses the placenta via active transport?

A

Amino acids
Proteins
Potassium

76
Q

What crosses the placenta via receptor mediated endocytosis?

A

Immunoglobulin G
LDLs
Iron

77
Q

What creatinine level is a relative contraindication to pregnancy?

A

> 2.5

78
Q

What is associated with amnion nodosum?

A

Anything associated with oligohydramnios

Neo Board Review MAP (18 decks)

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