MFM II

Question 1

what is vaginal pH vs amniotic fluid pH? how is this used in nitrazine test?

Answer 1

AF pH is alkalotic (>7) vs vaginal pH is acidotic (V is sharp)
Nitrazine test is used to test pH for ROM –> turns from yellow to blue

Question 2

what is a molar vs partial molar pregnancy?

Answer 2

molar: 46 XX (usually paternal) –> no fetus or amnion

partial molar: 69 xxy/xxx/xyy - usually two sperm one egg, usually some fetus and/or amnion

Question 3

how much radiation is okay to fetus?

Answer 3

<5 rad (1 rad = 10 milligray) is considered okay

Question 4

how is fetal weight estimated? which 4 components?

Answer 4

femur length, biparietal diameter, head circ and abdominal girth

Question 5

which system has least accuracy in 2nd trimester anatomy scan?

Answer 5

GI anomalies

Question 6

where does a spinal block go?

Answer 6

subarachnoid space (where CSF is). least maternal serum analgesia.

Question 7

maternal use of SSRI is associated with what?

Answer 7

ADHD in baby, and +/- autism

Question 8

PT neonate surface area:mass vs T in comparison to adult?

Answer 8

PT: 4x adult
T: 3x adult

Question 9

What is an abnormal s/d?

Answer 9

> 3.0 is bad
Bad in growth restricted, hypertrophy of colloid arterioles causes increased svr causes lower D bc decreased venous return

Question 10

What is perinatal Mortality vs early neonatal vs neonatal vs infant vs post neonatal?

Answer 10

Perinatal: 0-7d including stillbirth
Early neonatal: 0-7d
Neonatal: 0-1m
Infant: 0-1y
Postneonatal: 1m-1y

Question 11

what passes through placenta via pinocytosis?

Answer 11

Immunoglobulins, primarily IgG. IgM and IgA cannot

Question 12

what passes through placenta via facilitated diffusion?

Answer 12

glucose via primarily GLUT 1 receptor

Question 13

what passes through placenta via active transport?

Answer 13

active transport uses energy to have carrier-mediated transfer of compounds against concentration gradient.
the following are higher on fetal side, so need active transport: AA, Ca/Mg/Ph and water soluble vitamens

Question 14

what passes through placenta via simple diffusion?

Answer 14

• O2, CO2
• H2O, Na, Cl
• most maternal meds
• lipids, fat soluble vitamins

Question 15

what are Hofbauer cells?

Answer 15

stromal histiocytes typically found in placental villi

- lymphocytes and plasma cells indicate chronic inflammation

Question 16

how does CRH and progesterone effect pregnancy?

Answer 16

CRH: increased during onset of labor - rate of increase is most important, not absolute amount
progesterone: receptors and co-activators decreased to start labor and remove uterus from quiescent state

Question 17

what is the difference between infertility and subfertility?

Answer 17

subfertility is not being able to get pregnant for 6m, 50% still get pregnant in next 6m
infertility is not being able to get pregnant for 1y (or 2y by WHO definition)

Question 18

what is vanishing twin vs IUFD in twin pregnanices?

what is appropriate management and risk?

Answer 18

vanishing twin is if twin fetus dies in 1st trimester –> no increased risk to mother
considered IUFD if twin fetus dies in 2nd/3rd trimester –> increased risk of demise to other twin and hypotension at time of twin death, especially causing cycstic encephalomalacia
mgmt: if periviable and impending death, can do fetoscopic cord ligation

Question 19

what is appropriate ett and iv epi dosing?

Answer 19

always 1:10,000
ETT: 0.5 - 1ml/kg
IV: (1/10th of that) 0.01 ml/kg

Question 20

where is cf DNA derived from? higher or lower in early gestation?

Answer 20

comes from placenta, detectable by 4 weeks EGA. Increases with increasing EGA. It is shorter than maternal cfDNA and has half life of 15 minutes.

Question 21

what teratogenic effects does phenobarb have?

Answer 21

cleft, cardiac, decreased vit K absorption

Question 22

is preE more likely with first pregnancy or later?

Answer 22

more likely with first pregnancy

Question 23

whats the difference between pre E and severe preE

Answer 23

preE: pressure > 140/90 and 300mg proteinuria in 24 hours

severe preE: pressure >160/110 and 5 g proteinuria in 24 hours

Question 24

Kleinhauer betke test calcluation

Answer 24

fetal cells/maternal cells

for every 1% –> 50 ml of fetal blood lost