Perinatal Testing And History

Front 1

1.What tests done during the first trimester? 2.When? 3.What they indicate?

Back 1

1. Free beta-hCG and PAPP-A to calculate risk for tri 18 and 21. Also US
2. between 10 4/7 and 13 6/7 wks
3. beta hCG - elevated and PAPP-A - decreased for tri 21.

Front 2

What test done to confirm abnormal 1st trimester tests?

Back 2

Chorionic villus sampling.

Front 3

Tests for 2nd trimester screening? At what age?

Back 3

Quad screen (if no 1st trim. tests) - alpha fetoprotein, total hCG, unconjugated estriol, inhibin A.
between 15 and 21 wks.

Front 4

What indicate Quad abnormal results? How to confirm?

Back 4

MSAFP and unconjugated estriol - low, hCG and inhibn A - elevated for Down s., also for tri 13 and 18. Amniocentesis to confirm.

Front 5

If AFP level is elevated, what it is indicate?

Back 5

In maternal serum - open neural tube defects, in amniotic fluids - abdominal wall defects, congenital nephrosis, intestinal atresia.

Front 6

What is integrated screening?

Back 6

US measurement of the fetal NT, done btw 10 4/7 and 13 6/7 wks. PAPP-A in 1st tri., Quad screen - in 2nd.

Front 7

Sequential screening?

Back 7

NT, PAPP-A, free beta-hCG are measured in 1st, and Quad test in 2nd. Has high false-positive rate.

Front 8

Contingent sequential testing?

Back 8

NT, PAPP-A, free beta-hCG in 1st, Quad in 2nd when an elevated risk is noted.

Front 9

Calculation of gestational age.

Back 9

Measure crown-rump length between 6 and 14 wks. After the 1st tri., a combination of biparietal diametr, head circumference, abdominal circ., femur length is used.

Front 10

Definition of oligohydramnios? Maternal and fetal Causes?

Back 10

When amniotic fluid index <5 cm, or < 10% on a gestational age-depending scale. Spontaneous rupture of membranes - most common, other maternal - placental insufficiency, chr. hypertension, postdates. Fetal - renal agenesis, bladder outlet obstruction, karyotypic abnorm., cardiac defects.

Front 11

Polyhydramnios? Causes?

Back 11

AFI > 25 cm. Associated with fetal anomalies - anencephaly, NTD, duodenal atresia, multiple gest. with twin-twin transf., nonimmune hydrops. Maternal - DM.

Front 12

Biophysical profile?

Back 12

Fetal movements, fetal breathing, tone, amniotic fluid volume. Done often after nonreactive NST. Useful after 26-28 wks. Score 10 - normal, 4-6 - chr. asphyxia, 0-2 - hi mortality.

Front 13

Fetal well-being?

Back 13

the baseline heart rate is normal, there are periodic accelerations in the FHR.

Front 14

Reactive nonstress test (NST).

Back 14

in a 20-min period, at least 2 accelerations of the FHR peaking 15 b/m above baseline, each acceleration lasting at least 15 sec. In a fetus < 32 wks - accel. 10 beats for 10 sec.

Front 15

Nonreactive NST.

Back 15

FHR does not meet the established criteria for 1 hrs.

Front 16

Contraction stress test (CST).

Back 16

Assess fetus at risk for uteroplacental insuf., Adequate - 3 contractions, each for 40-60 secs w/in period of 10 min. Normally, the FHR is increased with contractions. Normal (negative) - no late decel., the baseline FHR is normal. Positive - late decel. with 2 of 3 contractions over 10 min period. Delivery warranted.

Front 17

The normal baseline FHR.

Back 17

110 - 160 beats/min.

Front 18

Fetal tachycardia. Causes.

Back 18

> 160. Maternal or fetal infection, fetal hypoxia, thyrotoxicosis, maternal use of cardiac drugs.

Front 19

Fetal bradycardia. Causes.

Back 19

< 110. Hypoxia, complete heart block, maternal use of beta-blockers.

Front 20

Variability. Indicate?
Causes of decreased or absent V.

Back 20

Rapid fluctuations in the baseline fhr. Indicates a functioning sypathetic-parasympathetic NS, the most sensitive for fetal well being.
Decreased V. - sev. hypoxia, anencephaly, other NTD, complete heart block, maternal narcotics or magnesium, normal fetal sleep.

Front 21

Late decelerations.

Back 21

Result of uteroplacental insufficiency with fetal hypoxia. Causes - mat. hypotension, supine position, regional anesthesia, mat. hypertension, postdates, preeclampsia.

Front 22

Variable decelerations. Causes.

Back 22

Slowing of the FHR with abrupt onset and return to the baseline, with preceded and followed by small accelerations of the FHR.
Abrupt compression of the umbilical cord, or cord stretch, rapid fetal descend, cord prolapse.

Front 23

Lecithin-sphingomyelin ratio.

Back 23

Measure in amniotic fluid to check lung maturation. Lecithin - active component of surfactant, secreted by type 2 alveolar cells. Gradually incr. after 28 wks. Sphingomyelin secreted in body tissues other than the lungs. level constant. L-S = or > 2 - mature, less immature.

Front 24

When lung maturation delayed?
Accelerated?

Back 24

Delayed - in DM, Rh isoimmunization.
Accelerated - SCD, narcotic addiction, PROM, chr. hypertension, IUGR, smoking.

Front 25

When is RhoGAM given?

Back 25

Rh neg. mother with vaginal bleeding e.g. abortion, abruption, ectopic, trauma. Fetal-maternal hemorrhage ->isoimmunization. RhoGAM given as a prophylaxis at 28 wks gestation and at discharge in absence of sensitization. Dose - 50 mcg if < 12 wks, 300 mcg - > 12 wks.

Front 26

Preeclampsia. Tx. Fetal effects.

Back 26

Around or after 20 wks. Main features - incrsd BP, proteinuria, edema, if seizures - eclampsia. Tx - initially - magnesium, with severe - delivery.
Fetal effects - asymmetric IUGR due to uteroplacental insufficiency.

Front 27

Preterm labor. Risk factors.

Back 27

Labor occur before 37th wk gestation. Risk factors - multiple birth, cocaine, abruptio, alcohol, smoking,

Front 28

Complicaitons of PROM.

Back 28

premature labor, prolapsed cord, infection.

Front 29

Drugs contraindicated in pregnancy.

Back 29

Thalidomide Androgens Progestins
Aspirin & indomethacin Phenytoin
Metronidazole Chloramphenicol Aminoglycoside Tetracycline
Live vaccines Warfarin Valproic ACE inhibitors

Front 30

Effect of maternal smoking on fetus.

Back 30

Reduced birth wt and lenght (asymmetric IUGR).Dose related.
Nicotine -> vasoconstriction ->reduced placental blood flow ->chr. hypoxia and icrsd carbon monoxide level.

Front 31

S/s of maternal Magnesium toxicity.

Back 31

Decreased deep tendon reflexes, respiratory depression.

Front 32

Fetal side effects of Indomethacin.

Back 32

Olygo-, ductul constriction, increased risk for NEC and IVH.

Front 33

Effect of maternal PIH on fetus.

Back 33

Asmmetric IUGR, perinatal asphyxia, polycythemia, prematurity, increassed risk of placental abruption.

Front 34

Complications of maternal cardiac d. on fetus.

Back 34

genetic factors,alterations in placental perfusion and exchange, the impact of maternal drugs.

Front 35

Fetal malformations due to maternal warfarin therapy.

Back 35

1st trimester - nasal hypoplasia, epiphyseal stippling, ASD, PDA, mental and growth retardation.
2nd - eyes and CNS abnormalities.

Front 36

Fetal response to acute blood loss?

Back 36

Hypoxemia and acidosis lead to bradycardia, vasospasm, initial shunt of blood to vital organs ->brain damage, demise.

Front 37

Effect of increased maternal glucose level on fetus.

Back 37

Early in pregnancy - congenital malformations, later - fetal hyperglycemia, increased fetal insulin production.

Front 38

Can insulin and glucose cross the placenta?
When the fetal pancreas produce insulin?
What trigger fetal growth?

Back 38

Glucose cross the placenta, insulin - does not.
20 wks.
The combination of elevated blood glucose and insulin level. Rapid organs growth combined with increased fat and glycogen stores.

Front 39

How fetus can acquire TB?

Back 39

Directly from mother's blood or swallowing amniotic fluids although most transmission occurs post-partum thru maternal contact.

Front 40

Can mother with TB breastfeed?

Back 40

Yes, if mother with inactive disease and taking meds.

Front 41

Maternal complications with low Hgb?

Back 41

At risk for infection, pre-eclampsia, postpartal hemorrhage. With severe low Hgb - mother at risk for cardiac failure. Fetus at risk for stillbirths, low BW, neonatal death.

Front 42

Is maternal iron-deficiency anemia affect fetus?

Back 42

Neonates are not deficient of iron at birth, but have low store and may develop iron deficiency.

Front 43

Maternal folic acid deficiency is associated with what fetal problems?

Back 43

Open neural tube defects.

Front 44

True or false.
Folic acid deficiency is associated with iron deficiency.

Back 44

True.

Front 45

How maternal hyperthyroidism affect the fetus?

Back 45

Thyroid-stimulating antibodies and drugs used for tx, cross the placenta and can increase fetal thyroid hormone production.

Front 46

S/s of Grave's d. in fetus and neonates.

Back 46

Tachycardia, growth retardation, goiter, CHF.

Front 47

Causes of fetal cretinism.

Back 47

Maternal iodine deficiency.

Front 48

How maternal PKU affect the offsprings?

Back 48

Microcephaly, mental retardation, growth retardation,cardiac disease.

Front 49

Tolerance of distress as relation to gestational age?

Back 49

The preterms tolerate longer periods of distress, than full terms, whereas the postterms may be in significant distress without displaying late decelerations.

Front 50

Rh sensitivity.

Back 50

Rh negative mother's blood contact blood of an Rh-positive fetus ->anti-D antibodies cross the placenta and attack the fetal Rh-positive RBCs, resulting in hemolysis. Problem during the 2nd and subsequent pregnancies.

Front 51

Why the fetus can develop erythroblastosis fetalis with hemolysis?

Back 51

Hemolysis triggers increased RBC production (erythroblastosis fetalis) which if left untreated results in severe /fatal edema (hydrops fetalis) that cause CHF.

Front 52

when ABO incompatibility will happen? Why?

Back 52

When mom is O and fetus is A or B.Anti-A or anti-B antibodies cross the placenta and hemolysis occur in fetus.

Front 53

The bigest problem when mom takes PCP(phenilcyclidine)?

Back 53

Mother may have overdose or psychotic response that can result in hypertension, hyperthermia and coma which will compromise the fetus.

Front 54

Effect of amphetamines on mother during the pregnancy?

Back 54

They are CNS stimulants. Use of these substances causes hypertension and tachycardia which can cause miscarriage, abruptio placentae, premature delivery.

Front 55

Effect of amphetamines on fetus?
Symptoms of neonatal withdrawal?

Back 55

Cross the placenta. Cause fetal hypertension, prenatal stroke. Symmetric SGA.
Abnormal sleep pattern (lethargy), poor feeding, tremor, diaphoresis, miosis, frantic fist sucking, hi-pitch cry, fever, yawning, hyperreflexia.

Front 56

Effect of heroin on mother?

Back 56

Heroin users are at increased risk of poor nutrition, iron deficiency anemia, pre-eclampsia-eclampsia.

Front 57

Neonatal withdrawal from heroin?

Back 57

Symptoms begin 48 to 72 hrs after delivery and include CNS and GI dysfunction, frequent yawning, sneezing, sweating, fever, tachycardia.

Front 58

Methadone.

Back 58

Used to treat heroin addiction. Exposure to methadone causes miscarriage, stillbirth, IUGR, fetal distress, low birth rate. Withdrawal symptoms the same as heroin.

Front 59

Effect of maternal smoking on fetus?

Back 59

Symmetric IUGR, increased rate of congenital birth defects (cleft lip/palate, limb reduction, urinary tract defects), placenta previa, placental abruption, preterm birth.

Front 60

Cocaine.

Back 60

Cross the placenta, act as vasoconstrictor. Causes fetal cardiac dysfunction. Increase risk of prematurity. Causes cerebral infarctions, nonduodenal intestinal atresia, anal atresia, NEC, GU defects, limb defects. Direct effect on neonatal CNS