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MFM Flashcards

1
Q

Surveillance for monochorionic twins

A

Fetal echocardiogram indicated due to increased risk of congenital heart defects
Growth ultrasonography and fluid assessment should be performed every 4 weeks, and antenatal testing should commence at 32 weeks
Screening for twin-to-twin transfusion syndrome is initiated at 16 weeks then every 2 weeks thereafter

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2
Q

MOST commonly reported infectious cause of non-immune hydrops fetalis

A

Parvo

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3
Q

Hx indicated cerclage indications

A

History of ≥ 1 pregnancy loss in the second trimester related to painless cervical dilation without placental abruption or labor
Prior cerclage due to painless cervical dilation in the second trimester

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4
Q

Physical exam indicated cerclage criteria

A

Painless cervical dilation in the second trimester

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5
Q

US indicated cerclage criteria

A

Current singleton pregnancy
Prior spontaneous preterm birth < 34 weeks
Short cervical length < 25 mm prior to 24 weeks’ gestation

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6
Q

Characteristics of fetal alcohol syndrome

A

Growth restriction

Central nervous system abnormalities:
Abnormal reflexes and tone
Poor coordination and balance

Facial dysmorphisms:
Short palpebral fissures
Thin vermillion border
Smooth philtrum

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7
Q

How to dx antenatal fetal CMV infection

A

CMV DNA detection in amniotic fluid

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8
Q

risk factors for acute fatty liver

A
  • fetal lnog-chain 3-hydroxyacyl CoA dehydrogenase deficiency (20%)
  • hx AFLP
  • multiple gestation
  • preeclampsia or HELLP
  • male fetus
  • low BMI <20
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9
Q

when do you typically see acute fatty liver

A

3rd TM (rare PP)

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10
Q

lab findings of acute fatty liver: pathognomonic

A

low glucose

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11
Q

lab findings of acute fatty liver: elevated

A

bilirubin, SCr, WBC, ammonia, uric acid, PT INR, aPTT
- can have proteinuria

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12
Q

lab findings of acute fatty liver: LOW

A

glucose, coag inhibitors (ex/ antithrombin), Plt, fibrinogen

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13
Q

Swansea criteria is for

A

acute fatty liver

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14
Q

AFLP management

A

deliver within 24hrs
crit care support
treat hypoglycemia, coagulopathy

  • most resolve after delivery 7-10d
  • can have long term liver effects
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15
Q

vasa previa associated with *** placenta

A

abnormal placentation

> 90% previa, low-lying, bi-lobed, or succenturiate or PCI

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16
Q

What is the Apt test

A

test for fetal blood in maternal system
- looking for color change of blood when exposed to base (maternal dark, fetal minimally changed)
- fetal hemoglobin resistant to basic denaturation but adult is susceptible

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17
Q

diagnostic cervical CA procedures to do in preg

A

DO NOT doe endocervical curettage

DO:
Pap
Colpo
colpo with bx
Diagnostic conization indicated if confirmation of invasive dz will alter timing or mode of delivery
- if not, postpone until postpartum

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18
Q

cervical CA in preg management: pre-invasive CA

A

definitive tx PP

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19
Q

cervical CA in preg management: invasive CA + LN mets

A

immediate definitive tx, regardless of GA, including delivery

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20
Q

cervical CA in preg management: middle severity

A

depends on maternal preference and willingness to terminate pregnancy

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21
Q

cervical CA in preg management: microinvasive dz (stage 1A1)

A

diagnostic conization
- neg margins done
- pos margins, delivery by CD, repeat cone 6-8w

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22
Q

cervical CA in preg management: delivery mode - vaginal

A

Stage 1A1 and 1A2 with neg margins
- avoid epis

  • everyone else CS
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23
Q

normal umbilcal artery pH

A

7.25-7.45

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24
Q

normal umbilical vein pH

A
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25
Q

preterm mean pH and BE

A

7.28, -2.5

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26
Q

umbilical artery pH for pathologic fetal acidemia

A

<7.00

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27
Q

more negative base deficit

A

associated with metabolic component

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28
Q

fetal blood gas: metabolic

A

low pH, low bicarb (higher base deficit (or more negative excess))
- long term

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29
Q

fetal blood gas: respiratory

A

low pH, normal bicarb (no deficit)
- acute

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30
Q

term mean pH and BE

A

7.27, -2.7

31
Q

base deficit that predicts and increased risk of moderate or severe newborn complications

A

base deficit <12
(>2SD above mean)

32
Q

very bad base deficit

A

12-16 mmol

32
Q

what increases incidence of monozygotic twins

A

ovulation induction

33
Q

Monozygotic (identical) MonoMono twins split at

33
Q

incidence of monozygotic twins

A

4/1000 births

33
Q

Monozygotic (identical) DiDi twins split at

34
Q

Monozygotic (identical) Mono(c)Di(a) twins split at

35
Q

Monozygotic (identical) Conjoined twins split at

36
Q

most common type of monozygotic twins

A

Monochorionic
Diamniotic
(c/f TTTS)

37
Q

incidence of DKA in preg

A

5-10% pregestational DM

38
Q

DKA lab criteria

A

low arterial pH (<7.3),
low serum bicarb (<15 mEq/L),
elevated AG,
positive serum ketones,
fetal minimal var/late decels

39
Q

Anti-TB regimen: active

A

isoniazid, rifampin, ethambutol for 2mo, followed by isoniazid and rifampin for 7mo (total 9mo)
- check baseline LFTs first

40
Q

Anti-Tb regimen: latent (without HIV)

A

start tx 2-3 mo after delivery
- unless high risk (recent contact with untreated active TB, recent test conversion, or significant immunosuppression)

41
Q

who to test for TB

A
  • recent contact with pt with untreated active TB
  • pts with HIV
  • pts with other significant immunosuppression
42
Q

Anti-Tb regimen: latent (with HIV)

A
  • in low-transmission setting, wait until 2-3mo after (unless high risk)
  • in high-transmission setting, tx
43
Q

EPDS requiring referral

44
Q

CF inheritance

A

autosomal recessive

45
Q

risk factors for post-term preg

A

nulliparity, poor dating, male fetuses, hx same, anencephaly, maternal obesity, AMA, fetal placental sulfatase deficiency

46
Q

Level of maternal care: accredited birth center

A

advanced providers / midwives

uncomplicated term singleton vertex fetus without complications

46
Q

Level of maternal care: level 1

A

No specialty

low-risk women with uncomplicated pregnancies and women with higher-risk conditions (ex/ uncomplicated twins, TOLAC, uncomplicaed CS, PreE, well-controlled GDM)

47
Q

Level of maternal care: level 2

A

Specialty

any pt Level 1+higher risk conditions
***

48
Q

Level of maternal care: level 3

A

Some subspecialty care (icu support, blood bank)
- moderate maternal cardiac dz
***

49
Q

Level of maternal care: level 4

A

Cooper
regional perinatal health
severe ICU care

level 3+higher risk conditions or complications
- severe maternal cardiac conditions
- severe pulm HTN
- neurosurgery or cardiac surgery
- unstable condition, need of organ transplant

50
Q

when is miso more efficient than oxytocin

51
Q

PGE1 medication

A

misoprostol

52
Q

PGE2 medication

53
Q

how often can you dose miso

54
Q

> 50% placental separation can cause

55
Q

fibrinogen level in placental abruption

56
Q

placental abruption risk factors

A

trauma/accident
cocaine or drug use
polyhydramnios
OB risks (cHTN PreE, HELLP, eclampsia, PROM, chorio, short cord, **)
Older maternal age
**

57
Q

couvelaire uterus

A
  • abrupted uterus extravasated with blood
  • atonic and prone to PPH
  • need to aggressively manage atony to prevent DIC, exsanguination (high risk hysto)
58
Q

umbilical cord prolapse risk factors

A

nonvertex presentation
multiple birth
poly
preterm birth
multiparity

59
Q

Abnormal SCr in pregnancy

A

> 0.75 mg/dL (consider reganl insufficeicny)

60
Q

renal values that increase in preg

A

GFR and renal blood flow (cause fall in SCr)

61
Q

relaxin MOA

A

vasodilator

62
Q

maternal acid-base status in pregnancy

A

respiratory alkalosis (renal-compensated)

63
Q

important to avoid maternal hyperthermia in

A

first trimester
(can lead to neural tube defects)

63
Q

respiratory changes in preg

A

decreased functional resdiual capacity, serum bicarb, ***

increased minute ventilation

63
Q

renal changes in preg

64
Q

cardiac changes in preg

A

increased HR, cardiac output
decreased SVR, PVR
no change ***

65
Q

diagnostic criteria cushing syndrome

A

urinary free cortisol (UFC) >4x upper limit normal or salivary cortisol >3-4x upper limit of normal.
- If positive, have to do dexamethasone suppression test to find cause

66
Q

additional calories intake when breastfeeding

A

450-500 kcal per baby daily

CREOGS (12 decks)

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