MFM Flashcards
Cardiovascular adaption in pregnancy
- inc HR 10-15bpm
- inc blood volume 30-50%, especially 2nd trimester
- decreased SVR > decrease BP/pulse pressure
- inc CO especially to uterus and kidneys
Pulmonary adaption in pregnancy
no change RR
inc TV and MV
chronic hyperventilated state
renal adaption in pregnancy
renal hypertrophy and dilated calyces and ureters
increased GFR/RBF
lose more bicarb and protein; keep more sodium
hematologic adaption in pregnancy
dilutional anemia but both RBC and plasma increase
leukocytosis but decreased function
increased coagulation, but normal platelet count
gastrointestinal adaption to pregnancy
decreased gastric emptying time, increased reflux and hemorrhoids
impaired gallbladder contraction
endocrine adaption to pregnancy
- enlargement of pituitary increasing prolactin
- increased TBG, FT4, but decreased TSH –> euthyroid
- PTHrP increased –> calcitriol
- estrogen stimulates insulin release from pancreas –> increased lipogenesis and fat storage
where is hCG produced
syncytiotrophoblasts
when is hCG detected
blood and urine 8-9 days after ovulation
function of bHCG in pregnancy
- prevents corpus luteum involution
- suppresses maternal immune system
- TSH like effects
where is hPL produced
syncytiotrophoblasts
hPL levels over time in pregnancy
increases with GA
hPL effects in pregnancy
anti-insulin effect–>increases lipid utiliation
what is role of progesterone in pregnancy
- maintains uterus in relaxed state; withdrawal of function (but not concentration) leads to labor - possibly by decreased receptions
- antiinflammatory
- immunosuppressive
what is role of estrogen in pregnancy
- regulates progesterone fetal maturation
- proliferation of endometrium
- increases strength of contractions
compounds that do not cross placenta
biliverdin
heparin
glucagon
hcg
insulin
ptu
IgM
TSH
what is vasa previa
unprotected umbilical vessels are crossing the internal os and present prior to fetal head
not alway in velamentous cord insertion
types of urachal remnants
- complete patent urachus
- partial patent urachus at umbilical end = urachal sinus
- patent central part = urachal cyst
- patent urachus at bladder end - bladder diverticulum
- mucosal remnant at the umbilical end = umbilical polyp
pathophysiology of PEC based on timing
<34 weeks abnormal placental implantation
>34 weeks endothelial dysfunction
preventive strategies for PEC
Ca
aspirin
UF heparin and LMW (fair evidence)
Mg
where is AFP produced in pregnancy
fetal yolk sac early, then fetal liver and GI tract
absent fetal nasal bone
trisomy 21
quad test for trisomies
tri21: low AFP, high bHCG (most sensitive), low uE3, high inhibin A
tri18: low AFP, low bHCG, low uE3, normal inhibin A
tri 13: not helpful
prenatal testing for smith lemli opitz
low uE3, low AFP, low hCG
prenatal testing for turner
low AFP, high bHCG, low uE3 (like tri21)
high inhibin A if hydropic; low if non-hydropic
what are the measures on ultrasound that estimate GA? when is the best time
crown-rump length: 1st trimester/ GA +/- 3-5d
cephalo-biparietal diameter: GA +/- 7d if 14-20wk
abdominal circumference: GA +/- 3 week
femur length: GA +/- 3 week
stages of fetal growth
first 16 weeks: hyperplastic; increased cell number and DNA
16-32 weeks: hyperplastic and hypertrophic; increase in cell number and size
32+: increase in cell size, protein and rna; most fetal fat and glycogen deposition
ponderal index =
(weight (g) x 100)/ (crown-heel)^3
timing of splitting of twins
DCDA: < 3d
MCDA 4-7d
MCMA 8-13
conjoined 13-15
cellphase at time of splitting of twins
DCDA: morula
MCDA: blastocyst
MCMA: implanted blastocyst
MC type of twin
MCDA
NST reactive -
> 2 accelerations in 20 minutes with fetal movements and increased HR > 15 lasting >15 seconds
BPP parts
- NST
- fetal movement
- breathing
- tone
- AFV
early deceleration
head compression –> cerebral blood flow –> vagal deceleration of HR
variable deceleration
umbilical cord compression leading to:
1. BP fetus –> baroreceptor –> vagal deceleration of HR
2. fetal hypoxemia –> chemoreceptor –> vagal deceleration of HR
3. fetal hypoxemia –> myocardial depression –> vagal deceleration of HR
late deceleration
uteroplacental insufficiency:
1. fetal chemoreceptors > alpha adrenergics > BP > baro > parasympathetics > late decel
2. myocardial depression
differences in paO2 by vessel
maternal uterine artery > maternal uterine vein > UV > UA
differences in paCO2 by vessel
UA> UV/uterine vein > uterine artery
differences in pH by vessel
uterine artery > UV/uterine vein > umbilical artery
MoA terbutaline
b2 agonist –> cAMP –> decrease intracellular Ca –> decrease uterine contractiliy
MoA Mg sulfate
decrease Ach release from NMJ (Ca antagonist) –> decrease uterine contractility
MoA indomethacin
Pg synthase inhibitor
MoA nifedipine
CCB –> decrease uterine contractility
teratogen effect of captopril/enalopril
potters syndrome
2nd/3rd trimester
renal
teratogen effect of alcohol
facial
VSD, ASD, ToF
microcephaly, NDI/motor
IUGR
teratogen effect of carbamazepine
finger hypoplasia
FGR
NTD
NDI
decreased vit K
teratogen effect of cocaine
still birth
abruption
skull/cutis aplasia/porencephaly
ileal atresia, cardiac anomalies
teratogen effect of cyclophosphamide
limbs
cleft
single coronary
imperforate anus
FGR/microcephaly
teratogen effect of phenytoin
Hypoplasia digit/nail
Hernias
Hypospadius
Heart: pulmonary or aortic valvar stenosis/VSD
IUGR
teratogen effect of isoretinoin
TGA, TA, ToF, VSD, DORV, hypoplastic arch
microtia
hydrocephalus
thymic/parathyroid
teratogen effect of warfarin
stippled bone epiphysis
nasal hypoplasia
MR
AFP timing of fetal and maternal peaks
fetal peaks 13 weeks
maternal detected at 12 weeks then peaks at 32
GDM timing of screening
24-28 weeks
measles or mumps? increased risk of SAB in first trimester
mumps
fetal weight is estimated based on what 4 parameters
- abdominal girth
- biparietal diameter
- head circumference
- femur length
what is a specific measurement for asymmetric growth restriction?
ponderal index
amnion nodosum
small yellowish nodules in amion seen with oligohydramnios (maternal DM, TTTS, PPROM)
hormones produced by syncytiotrophoblast
human placental lactogen
estrogen
leptin
progesterone
HELP
MC complication of pregnancy in women with Marfans
preterm delivery
what supplement helps reduce maternal lead level?
calcium
subnecrotizing funisitis is associated with what?
chronic lung disease
primary marker of fetal aneuploidy
nuchal translucency
IUGR infants MC neuro deficit
ADHD
MC complication in late preterm
jaundice
acute villositis with neutrophillic infiltration and microabscess formation
listeria
protein associated with thrombotic features of APS
B2 glycoprotein 1
neonatal complications associated with maternal intrahepatic cholestasis of pregnancy
- surfactant deficiency
- meconium aspiration
- bile acid pneumonia
what deficiency is associated with maternal intrahepatic cholestasis of pregnancy
selenium
Quintero stages
- O/P, visible donor bladder
- O/P, donor bladder not visible
- O/P, abnormal doppler
- O/P, hydrops
- O/P, demise
chronic infectious villositis
CMV
which ART is associated with highest risk of genomic imprinting?
intracytoplasmic sperm injection
hormones that are produced by mom acting on placenta and transferred to fetus
TH, oxytocin and estrogen
hormones produced by fetus, altered by placenta and transferred to mother
DHEA
hormones produced by placenta and transfered to mom?
or fetus?
hcG
IGF2
MC substance abused during pregnancy
tobacco
