Perinatal medicine Flashcards

1
Q

pregnancies are at increased risk of fetal abnormality include those in which:

A
  • the mother is older
  • previous congenital abnormality
  • family history of an inherited disorder
  • the parents are identified as carriers of an autosomal recessive disorder
  • a parent carries a chromosomal rearrangement
  • parents are close blood relatives (cosanguinity)
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2
Q

the fetus can sometimes be treated by giving medication to the mother, give examples:

A
  • Glucocorticoid therapy before preterm delivery accelerates lung maturity and surfactant production.
  • Digoxin or flecainide can be given to the mother to treat fetal supraventricular tachycardia.
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3
Q

What can be detected on antenatal blood sampling from mother?

A
  • Hep B, syphilis, rubella, HIV,
  • Neural tube defects (spina bifida or anencephaly),
  • Trisomies (combined with USG and confirmed with amniocentesisi or chorionic villous sampling).
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4
Q

What can be detected on ultrasound screening?

A
  • Gestational age
  • Multiple pregnancies
  • Structural malformation
  • Fetal growth
  • Amniotic fluid volume (oligohydramnios/polyhydramnios, potter syndrome)
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5
Q

What can we detect with amniocentesis?

A

chromosme/microarray and DNA analysis

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6
Q

What can we detect with fetal blood sampling?

A

fetal Hb for anemia, fetal infection serology and fetal blood transfusion

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7
Q

What can we detect with chorionic villus sampling?

A

chromosome/microarray and DNA analysis, fetal infection (PCR) and enzyme analysis of inborn error of metabolism.

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8
Q

What can we detect with Preimplantation genetic diagnosis (PGD)?

A

in vitro fertilization allows genetic analysis of cells from developing embryo before transfer to the uterus

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9
Q

What can we detect with fetoscopy?

A

minimal invasive surgery (laser photocoagulation of communicating vessels in twin-twin transfusion syndrome)

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10
Q

What can we detect with non-invasive prenatal testing (NIPT)– cell-free fetal DNA (cffDNA) from maternal blood?

A

identification of Down syndrome and other chromosomal disorders, fetal gender and rhesus status.

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11
Q

there are few conditions in which therapy can be given to fetus directly, which?

A
  • Rheus isoimmunization–> severely affected fetuses become anemic and may develop hydrops fetalis, with edema and ascites.
  • Perinatal isoimmune thrombocytopenia–> this condition is analogous to thesus isoimmunization but involves maternal antiplatelet antibodies crossing the placenta.
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12
Q

How can we detect placental insufficiency and IUGR?

A

monitor closesly: biophysical profile (amniotic fluid volume, fetal movement, fetal tone, fetal breathing movements and fetal heart activity) and doppler blood flow velocity (umbilical and middle cerebral arteries)

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13
Q

The management of preterm labour may involve:

A
  • antenatal corticosteroids
  • antibiotics reduce risk of amnionitis and neonatal infection.
  • tocolysis- suppress uterine contractions to try and suppress labour and allow completion of the course of antenatal steroids.
  • magnesium sulphate-reduces the incidence of cerebral palsy
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14
Q

The main problems for the infant associated with multiple births are:

A
  • Preterm labour
  • IUGR
  • Congenital abnormalities
  • Twin-twin transfusion syndrome in monochroionic twins
  • Complicated deliveries
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15
Q

Poorly controlled maternal diabetes is associated with:

A

polyhydramnios and preeclampsia, increased rate of early fetal loss, congenital malformations and late unexplained intrauterine death.

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16
Q

Fetal problems associated with maternal diabetes are:

A
  • Congenital malformations (cardiac malformations, sacral agenesis, and hypoplastic left colon)
  • IUGR
  • Macrosomia
17
Q

Neonatal problems associated with maternal diabetes are:

A
  • Hypoglycemia
  • Respiratory distress syndrome
  • Hypertrophic cardiomyopathy
  • Polycythemia (venous hematocrit>0.65): makes the infant look plethoric
18
Q

Can thyroid stimulating immunoglobulin (Hyperthyroidism) cross the placenta?

A

yes, and it can cause hyperthyroidism in the fetus

19
Q

How can we detect hyperthyroidism in the fetus?

A

fetal tachycardia of CTG (cardiotocography) trace, and fetal goitre may be evident on ultrasound.

20
Q

How can we detect hyperthyroidism in a neonate?

A

irritability, weight loss, tachycardia, heart failure, diarrhea and exophthalmos in the first 2 weeks of life

21
Q

How to treat hyperthyroidism in neonates?

A

anti-thyroid drugs until the condition resolves.

22
Q

SLE in mother is associated with what outcome?

A
  • recurrent miscarriage
  • IUGR
  • pre-eclampsia
  • placental abruption
23
Q

Can the SLE antibodies cross placenta and if so, which?

A

Ro (SS-A) or LA (SS-B)

There is also a sel-limiting rash

24
Q

Can autoimmune thrombocytopenic purpura in a pregnant women affect the fetus?

A

Yes, IgG can cross the placenta and damage fetal platelets.

25
Q

What can severe fetal thrombocytopenia cause in fetus?

A

intracranial hemorrhage following birth trauma

26
Q

What should be given to infants with severe thrombocytopenia or petechia?

A

IV immunoglobulin

27
Q

Maternal medication that may adversely affect the fetus is:

A
  • Anticonvulsant drugs
  • Cytotoxic drugs
  • Iodides/propylthiouracil
  • Lithium
  • SSRIs
  • Tetracycline
  • Thalidomide
  • Vit A and retinoids
  • Warfarin
28
Q

What is the clinical syndromes of fetal alcohol syndrome?

A
  • growth restriction
  • developmental delay and cardiac defects (70%)
  • face: saddle-shaped nose, maxillary hypoplasia, absent philtrum between the nose and upper lip, and short, thin upper lip, also a strawberry nevus
29
Q

maternal cigarette smoking is associated with increased risk of?

A
  • Misscariage and stillbirth

- Reduced birthweight and IUGR

30
Q

Drugs given during labor and their adverse effects:

A
  • Opioid agents: may suppress respiration at birth
  • Epidural: may cause maternal pyrexia during labour
  • Sedatives (diazepam): may cause sedation, hypothermia and hypotension
  • Oxytocin and prostaglandin F2: may cause hyperstimulation of the uterus leading to fetal hypoxia
  • IV fluids: may cause neonatal hyponatremia