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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
preterm mean pH and BE
7.28, -2.5
26
umbilical artery pH for pathologic fetal acidemia
<7.00
27
more negative base deficit
associated with metabolic component
28
fetal blood gas: metabolic
low pH, low bicarb (higher base deficit (or more negative excess)) - long term
29
fetal blood gas: respiratory
low pH, normal bicarb (no deficit) - acute
30
term mean pH and BE
7.27, -2.7
31
base deficit that predicts and increased risk of moderate or severe newborn complications
base deficit <12 (>2SD above mean)
32
very bad base deficit
12-16 mmol
32
what increases incidence of monozygotic twins
ovulation induction
33
Monozygotic (identical) MonoMono twins split at
8-12 days
33
incidence of monozygotic twins
4/1000 births
33
Monozygotic (identical) DiDi twins split at
0-4 days
34
Monozygotic (identical) Mono(c)Di(a) twins split at
4-8 days
35
Monozygotic (identical) Conjoined twins split at
>13d
36
most common type of monozygotic twins
Monochorionic Diamniotic (c/f TTTS)
37
incidence of DKA in preg
5-10% pregestational DM
38
DKA lab criteria
low arterial pH (<7.3), low serum bicarb (<15 mEq/L), elevated AG, positive serum ketones, fetal minimal var/late decels
39
Anti-TB regimen: active
isoniazid, rifampin, ethambutol for 2mo, followed by isoniazid and rifampin for 7mo (total 9mo) - check baseline LFTs first
40
Anti-Tb regimen: latent (without HIV)
start tx 2-3 mo after delivery - unless high risk (recent contact with untreated active TB, recent test conversion, or significant immunosuppression)
41
who to test for TB
- recent contact with pt with untreated active TB - pts with HIV - pts with other significant immunosuppression
42
Anti-Tb regimen: latent (with HIV)
- in low-transmission setting, wait until 2-3mo after (unless high risk) - in high-transmission setting, tx
43
EPDS requiring referral
>=11
44
CF inheritance
autosomal recessive
45
risk factors for post-term preg
nulliparity, poor dating, male fetuses, hx same, anencephaly, maternal obesity, AMA, fetal placental sulfatase deficiency
46
Level of maternal care: accredited birth center
advanced providers / midwives uncomplicated term singleton vertex fetus without complications
46
Level of maternal care: level 1
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
Level of maternal care: level 2
Specialty any pt Level 1+higher risk conditions ***
48
Level of maternal care: level 3
Some subspecialty care (icu support, blood bank) - moderate maternal cardiac dz ***
49
Level of maternal care: level 4
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
when is miso more efficient than oxytocin
<28w
51
PGE1 medication
misoprostol
52
PGE2 medication
cervidil
53
how often can you dose miso
q3-6hrs
54
>50% placental separation can cause
DICfi
55
fibrinogen level in placental abruption
=<200
56
placental abruption risk factors
trauma/accident cocaine or drug use polyhydramnios OB risks (cHTN PreE, HELLP, eclampsia, PROM, chorio, short cord, ***) Older maternal age ***
57
couvelaire uterus
- abrupted uterus extravasated with blood - atonic and prone to PPH - need to aggressively manage atony to prevent DIC, exsanguination (high risk hysto)
58
umbilical cord prolapse risk factors
nonvertex presentation multiple birth poly preterm birth multiparity
59
Abnormal SCr in pregnancy
>0.75 mg/dL (consider reganl insufficeicny)
60
renal values that increase in preg
GFR and renal blood flow (cause fall in SCr)
61
relaxin MOA
vasodilator
62
maternal acid-base status in pregnancy
respiratory alkalosis (renal-compensated)
63
important to avoid maternal hyperthermia in
first trimester (can lead to neural tube defects)
63
respiratory changes in preg
decreased functional resdiual capacity, serum bicarb, *** increased minute ventilation
63
renal changes in preg
***
64
cardiac changes in preg
increased HR, cardiac output decreased SVR, PVR no change ***
65
diagnostic criteria cushing syndrome
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
additional calories intake when breastfeeding
450-500 kcal per baby daily
67

CREOGS (12 decks)

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