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RC 2024-2025 > MFM > Flashcards

MFM Flashcards

1
Q

Marfan’s syndrome:
a) maternal risks
b) fetal risks

A

a) cervical insufficiency, aortic rupture, uterine rupture,
operative delivery, PPH, death
b) inheritance (AD), PTB, IUGR, IUFD

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2
Q

key features of herpes gestationis (aka pemphigoid)?

A
  • presents in T2/T3
  • papules/vesicles everywhere
  • C3 +/- IgG deposition in BM
  • 50-75% risk of recurrence

fetal risks: SGA, PTB, IUFD (30%), transient neonatal rash (5%)

Tx:
- increased FHS
- prednisone +/- IVIG
- delivery by 37wks

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3
Q

Causes of increased AFP on MSS? (7)

A

1) wrong dates
2) oNTD
3) abdo wall defect
4) twins
5) cystic hygroma
6) IUFD
7) non-OB (e.g. ovarian pathology)

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4
Q

Cardiac conditions where pregnancy is contraindicated? (10)

A

1) pulmonary arterial HTN
2) NYHA 3/4 or EF < 30%
3) severe (re)coarctation
4) severe aortic root dilation
a) Marfan’s: AR > 4.5cm
b) bicuspid AV or TOF: AR > 5cm
c) Turner’s ASI > 25mm/m2
5) Eisemenger’s syndrome
6) previous peripartum CM + current EF < 45%
7) vascular EDS
8) severe MS
9) severe symptomatic AS
10) Fontan circulation, with any complication

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5
Q

Derm conditions in pregnancy associated with increased fetal risks? (3)

A

1) pemphigoid (herpes gestationis)
2) pustular psoriasis (impetigo herpetiformis)
3) pruritis gravidarum (cholestasis)

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6
Q

Abnormal value for uterine artery Doppler?

A

PI > 2.5 (bilateral)

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7
Q

Indications for PPx for infectious endocarditis? (3)

A

1) prosthetic valve or material to repair valve
2) previous infectious endocarditis
3) structural valve regurgitation with prosthetic material, in the setting of …
- unrepaired/residual shunt
- cyanotic heart disease
- cardiac transplant

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8
Q

Risk factors for striae in pregnancy?

A
  • increased gestational weight gain
  • increased BMI
  • LGA
  • multiples
  • young maternal age
  • non-white ethnicity
  • FHx
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9
Q

US findings of oNTD? (5)

A

1) lemon head sign
2) banana cerebellum
3) ventriculomegaly
4) open defect along spine
5) talipes

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10
Q

When to deliver SGA + IUGR?

A

IUGR with abnormal Dopplers:
- absent/reversed DV a-wave: 26-30wks
- UA REDF: 30-32wks
- UA AEDF: 32-34wks
- at any GA, if maternal indication for delivery (e.g. abnormal NST, abruption, HELLP)

IUGR with normal Dopplers:
- by 37wks
- vs at 37wks for “uncomplicated”

SGA: 37-39wks

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11
Q

Hyperthyroidism:
a) maternal risks
b) fetal risks

A

a) maternal tachycardia, palpitations, sweating, heat intolerance, PET, CHF, thyroid storm, PP flare
b) hypothyroidism, goiter, fetal tachycardia, PTB, hydrops, IUFD

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12
Q

Triad of findings for congenital rubella syndrome?

A
  • sensorineural hearing loss
  • ocular defects
  • cardiac defects
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13
Q

Finding most associated with BPP score of 2?

A

persistent pulmonary HTN

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14
Q

Key features + fetal risks of pustular psoriasis in pregnancy (impetigo herpetiformis)?

A

features:
- pustules on erythematous plaques
- flexural surfaces
- onset in T3

fetal risks:
- PTB
- IUGR
- IUFD

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15
Q

facial features of FASD?

A
  • epicanthal folds
  • short palpebral fissures
  • small eyes
  • smooth philtrum
  • thin upper lip
  • absent maxilla
  • small head
  • CNS abnormalities
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16
Q

abnormal value for MCA Doppler for fetal anemia?

A

> 1.5 MoM

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17
Q

which acne Tx options are NOT safe in pregnancy?

A
  • retinoids
  • tetracyclines
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18
Q

which Tx options for psoriasis are SAFE in pregnancy?

A
  • steroids: topical or PO
  • UV light therapy
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19
Q

rash on extensor surfaces?

A

psoriasis

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20
Q

rash on flexor surfaces?

A

eczema

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21
Q

signs of MgSO4 toxicity?

A
  • decreased/absent reflexes
  • hypotension
  • low RR (<12/min)
  • low O2 sats (<94%)
  • low urine output (< 30cc/hr)
  • bradycardia
  • cardiac arrhythmias
  • muscle weakness
  • excessive drowsiness

antidote = calcium gluconate 10%, 10cc IV over 3 min

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22
Q

melasma in pregnancy:
a) incidence
b) Tx

A

a) 70%
b) avoid sun, use sunscreen, PP retinoic acid, consider laser if persistent (70% resolve PP)

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23
Q

normal derm changes in pregnancy?

A
  • increased pigmentation: linea nigra, new nevi
  • telangiectasias
  • brittle nails
  • nail bed coming off
  • transverse grooves in nails
  • PP hair loss
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24
Q

parvo B19 in pregnancy:
a) when does MOST hydrops occur following infection?
b) what GA would parvo infection be the worst?

A

a) 2-4 weeks
b) 13-16wks GA

25
Q

which thyroid molecule is LEAST likely to cross the placenta?

A

TSH

26
Q

LEAST teratogenic anticonvulsants? (2)

A
  • lamotrigine
  • levateracetam
27
Q

LRs for T21:
a) absent NB
b) increased NF

A

a) 6.6 if isolated, 23.3 in combination
b) 3.8 in isolation, 23.3 in combination

28
Q

enzyme deficiency in Tay-Sachs?

A

hexosaminidase

29
Q

when can you conceive following Zika infection?

A

3 months after last exposure or sxs

30
Q

RFs for oNTD:
a) moderate risk
b) high risk

A

a) moderate risk for NTDs:
- personal or FHx of FA-sensitive anomalies: NTDs, cardiac anoms, GU tract anoms, limb reduction defects, oral or facial clefting
- FHx of NTDs in first or second degree relatives
- DM: type 1 or 2
- use of teratogenic meds: antiepileptics, cholestyramine
- GI malabsorption conditions: IBD, celiac, prev gastric bypass Sx

b) high risk for NTDs: if the pregnant pt or partner have …
- personal Hx of NTD
- previous preg affected by NTD

31
Q

what are the benefits of IOL at 39-40wks for BMI > 30?

A
  • decreased LGA
  • decreased c-section
  • decreased neonatal morbidity
  • decreased neonatal mortality
32
Q

how long to wait to conceive after bariatric Sx?

A

24 months

33
Q

which fetal trisomy is associated with choriod plexus cysts?

A

T18

34
Q

which findings are associated with DECREASED risk of aneuploidy for fetal omphalocele? (2)

A
  • liver herniation
  • giant omphalocele

up to 40% of omphaloceles are associated with aneuploidy

35
Q

mode of delivery for fetal omphalocele?

A
  • vaginal delivery OK for smaller omphalocele
  • c-section may be needed for abnormal FHR in labor
  • c-section for large (>5cm) defect, especially if containing liver
36
Q

most likely cardiac defect with Eisenmenger syndrome?

A

VSD

37
Q

AS is a ____ dependent lesion: preload or afterload?

A

preload. avoid PPH + hypotension!

38
Q

fetal mortality rate in Canada?

A

4.5 per 1000 total births

39
Q

what is the ONLY type of antenatal fetal surveillance with level 1 evidence?

A

umbilical artery Doppler

40
Q

when are pregnant pts with T1DM at increased risk of hypoglycemia?

A

T1 and PP

41
Q

autonomic dysreflexia:
a) who
b) presentation
c) triggers
d) prevention

A

a) spinal cord injury at/above T6
b) HTN, pounding headache, vision changes, flushing, sweating, piloerection above level of injury + cold/pale skin below
c) ctx, PVEs, urinary retention, catheterization, blocked Foley, DRE, surgery
d) topical anesthetics for PVE + catheterization, early epidural

42
Q

which cardiac defects are NOT preload dependent?

A

AR
MR
MS

43
Q

investigations for hydrops fetalis? (10)

A
  • type + screen
  • CBC
  • kleihauer
  • karyotype or microarray
  • TSH
  • TORCH (including parvo B19)
  • PET BW (Mirror syndrome)
  • fetal anatomy scan
  • fetal Dopplers
  • fetal echocardiogram

+/- anti Ro/La, Hb electrophoresis, G6PD screen

44
Q

Dx criteria for peripartum cardiomyopathy? (4)

A
  • occurring within last 1 month of pregnancy to 5 months PP
  • LV dysfunction: EF < 45%
  • no Hx cardiac disease prior to onset
  • rule out other causes
45
Q

maternal CAH:
a) enzyme responsible
b) inheritance
c) prevention of virilization in female fetus

A

a) 21-hydroxylase deficiency
b) AR
c) dexamethasone 20mcg/kg/day until you confirm either male fetus, or unaffected female fetus

46
Q

stress dosing for steroids?

A

hydrocortisone 100mg IV q8hrs

47
Q

malignancies that can metastasize to the placenta? (3)

A
  • melanoma
  • leukemia
  • lymphoma
48
Q

gestational age for physiologic gut herniation in fetus?

A

9wks to 11+6

49
Q

why should blood glucose be kept at 4-7 mmol/L during labor?

A

decreases risk of neonatal hypoglycemia

50
Q

pre-existing DM:
a) target Hb A1C for preconception counselling
b) benefits of pre-conception DM optimization
c) anomalies associated with hyperglycemia

A

a) 6.5%, if safe to do so (< 7.0% associated with decreased progression to retinopathy)

b) decreased risk of
- congenital anomalies
- SAB
- PET
- progression of retinopathy

c) anomalies a/w hyperglycemia
- VSD: MC anomaly
- caudal regression (aka NTD from waist-down): this is pathognomonic
- sirenomelia

51
Q

associations with single umbilical artery? (5)

A
  • renal anomalies (#1)
  • IUGR
  • congenital heart defects
  • spinal defects
  • chromosome abnormalities (1%)

NOT associated with clefting

52
Q

management of pheochromocytoma in pregnancy?

A
  • alpha blockers FIRST, then beta blockers
  • alpha blocker = phenoxybenzamine
  • if Dx < 24wks consider Sx
  • if Dx > 24wks: medical Tx, delivery by c-section
53
Q

ventriculomegaly is associated with which aneuploidy?

A

T21

54
Q

which enzyme protects the fetus from maternal increases in cortisol?

A

placental 11-beta-hydroxysteroid dehydrogenas

55
Q

maternal complications of Cushings in pregnancy? (7)

A
  • HDPs
  • GDM
  • CHF
  • maternal mortality
  • pulmonary edema
  • sepsis
  • GI bleeding
56
Q

which conditions in pregnancy are associated with aplastic anemia?

A

parvo B19
sickle cell

57
Q

definition of growth discordance in twins?

A
  • EFW (bigger twin / smaller twin) of > 20%
  • difference of > 20mm in AC
58
Q

RhoGam: ___ mcg covers ____ mL of fetal RBCs + ___ mL of fetal blood

A

300 mcg
15 mL
30 mL

59
Q
A

RC 2024-2025 (5 decks)

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