MFM

Question 1

Low estriol can signify what?

Answer 1

Most common: placental sulfatase deficiency (XR ichthyosis)

less common: CAH, anencephaly, molar pregnancy

Question 2

Estriol results in inc/dec TBG?

Answer 2

increase in TBG

Question 3

Increase in minute ventilation is from what?

Answer 3

Increased tidal volume
No change in RR, FEV1/FVC
Decrease in FRC

*respiratory alkalosis with metabolic compensation

Question 4

Maternal hydronephrosis on what side?

Answer 4

R>L due to uterine dextrorotation (same side as neonatal adrenal hemorrhage)

Question 5

Maternal myasthenia

• what percentage of fetuses get TNMG?
• symptoms?
• when does it present and resolve?

Answer 5

• 10-20%
• poor suck, facial diplegia, DTR’s present; can be worsened with some meds (vanc, gent)
• present ~3 days, recover by 2 months

Question 6

Maternal hyperthyroidism

• what percentage of fetuses get hyperthyroid?
• what do you measure?
• symptoms?
• when does it present and resolve?
• treatment?

Answer 6

• 1-5%
• tachycardia, IUGR, preterm, craniosynostosis
• TRAb in cord blood
• presents at 1 week (after antithyroid meds have worn off), recover at ~1 month
• “SIMBA down:” steroids, iodine, MMA, b-blocker

Question 7

What is the first trimester screen?

Answer 7

nuchal translucency (>3 mm), hcg, PAPP-A

Question 8

5 components of NST?

Answer 8

• 1 episode of extension/flexion
• 2 HR accelerations (10 bpm if <31, 15 bpm if >32)
• 3 discrete movements
• 30 seconds of fetal breathing
• Amniotic Fluid (MVP 2-7 cm or AFI 6-24 cm)

Question 9

• Smoking during pregnancy causes?

- Second-hand smoke causes?

Answer 9

• asthma, SIDS

- ADHD, fire-related death

Question 10

Placenta can remove which:

• conjugated bilirubin
• unconjugated bilirubin
• biliverdin

Answer 10

Unconjugated bilirubin

Question 11

MCC for symmetric and asymmetric IUGR

Answer 11

symmetric: maternal sickle cell
asymmetric: UPI

Question 12

Antiphospholipid antibody syndrome - what to give mom?

Answer 12

Heparin improves live birth rate, but doesn’t decrease associated complications (pre-E, IUGR, preterm birth)

Question 13

hormones secreted by synctiotrophoblast?

Answer 13

estrogen, progesterone, hcg, hPL, IGF, leptin

Question 14

Maternal hyperthermia increases risk of what 2 things?

Answer 14

neural tube defects and miscarriage

Question 15

KBT equation?

Answer 15

(fetal cells/maternal cells) x100 x50

aka: every % counts for 50 mls

Question 16

A mother is being treated with radioactive iodine for Graves - after what week should she stop?

Answer 16

12 weeks

Question 17

Difference between complete and partial molar pregnancies?

Answer 17

Complete mole - 46 XX of paternal origin; there is NO fetus or amnion
Partial mole - 69 X_/_; there is a nonviable fetus

Question 18

Medication contraindications to breastfeeding?

Answer 18

Lithium, radioactive agents, methotrexate (lose radioactive milk)

Question 19

Infectious contraindications to breastfeeding?

Answer 19

active TB, HIV, HSV on breast, active breast abscess, VLBW infant AND mother with CMV or HSV

Question 20

Peak fetal AFP production at what gestational age?

Peak maternal AFP concentration when?

Answer 20

peak fetal production at 13 weeks, then decreases; continues to be excreted into urine/amniotic fluid; absorbed by maternal concentration and peak is at 32 weeks