GP PREFI EVALS PART 2

Play an AI-generated podcast conversation about this lesson

high incidence of spontaneous abortions, premature labor, placental abnormalities

low birth weight

prone to SIDS

Smoke-derived nicotine

o mutagenic, carcinogenic, teratogenic o cause malformations such as microcephaly, blindness, skull defects, spina bifida

Irradiations (1%)

result of inheritance of multiple genetic polymorphisms that confer a “susceptibility phenotype” -interaction with environment is required before the disorder becomes manifested

Multifactorial inheritance (20-25%)

decreased incidence of neural tube defects is by intake of

Folic acid Signup and view all the answers

Congenital dislocation of the hip genetic factor

Shallow acetabular socket Signup and view all the answers

Congenital dislocation of the hip environmental factor

Frank breech position in utero Signup and view all the answers

In this period, an injurious agent damages either enough cells to cause death and abortion or only a few cells, presumably allowing the embryo to recover without developing defects

early embryonic period Signup and view all the answers

the embryo is extremely susceptible to teratogenesis;

Third and ninth weeks Signup and view all the answers

During this period, organs are being crafted out of the germ cell layers

Fourth and fifth weeks Signup and view all the answers

The fetus is susceptible to growth restriction or injury to already formed organs. Thus a given agent may produce different anomalies if exposure occurs at different times of gestation.

Fetal period Signup and view all the answers

Mode of action of cyclopamine

Inhibits hedgehog signaling in the embryo Signup and view all the answers

mutations in hedgehog signaling cause

holoprosencephaly Signup and view all the answers

o an antiepileptic o recognized teratogen during pregnancy

Valproic acid Signup and view all the answers

Mode of action of valporic acid

disrupts expression of homeobox (HOX) proteins, which are implicated in the patterning of limbs, vertebrae, and craniofacial structures Signup and view all the answers

mutations in HOX cause same features in

valproic acid embryopathy Signup and view all the answers

o vitamin A (Retinol) derivative o absent during embryogenesis

malformations affecting multiple organ systems

essential for normal development and differentiation

All-trans-retinoic acid Signup and view all the answers

Mode of action of All-trans-retinoic acid

mediate deregulation of components of TGF-β signaling (involved in palatogenesis) Signup and view all the answers

mutations in Tgfb3 gene cause

Cleft palate Signup and view all the answers

➔ gestational age less than 37 weeks ➔ 2nd most common cause of neonatal mortality

Prematurity Signup and view all the answers

Appropriate for gestational age (AGA)

Birthweight between 10th and 90th percentile Signup and view all the answers

Small for gestational age (SGA)

Birthweight below 10th percentile Signup and view all the answers

Large for gestational age (LGA)

Birthweight above 90th percentile Signup and view all the answers

Preterm

Born before 37 weeks Signup and view all the answers

Post-term

Born after 42nd week Signup and view all the answers

refers to spontaneous ROM occurring BEFORE 37 weeks of gestation

PPROM Signup and view all the answers

refers to spontaneous ROM occurring AFTER 37 weeks of gestation

PROM Signup and view all the answers

the major cause of preterm labor with and without intact membranes o present in ~25% of all preterm births

Intrauterine infection Signup and view all the answers

inflammation of the placental membranes

Chorioamnionitis Signup and view all the answers

inflammation of the fetal umbilical cord

Funisitis Signup and view all the answers

Most common microoganisms in intrauterine infection

Ureaplasma urealyticum, Mycoplasma hominis, Gardnerella vaginalis (dominant organism in bacterial vaginosis), Trichomonas, Gonorrhea, Chlamydia Signup and view all the answers

Uterine, cervical, and placental structural abnormalities

Uterine distortion, cervical incompetence, placenta previa, abruptio placentae Signup and view all the answers

hyaline membrane disease

Neonatal respiratory disease syndrome Signup and view all the answers

Refer to some infants (1/3) who weigh less than 2500 gm despite being born at term

undergrown rather than immature

suffer from fetal growth restriction (aka intrauterine growth retardation)

Small-for-gestational-age (SGA) infants Signup and view all the answers

intrinsically reduce growth potential despite an adequate supply of nutrients

characterized by symmetric growth restriction (proportionate FGR)

Fetal Abnormalities Signup and view all the answers

Diseases under fetal abnormalities

Chromosomal disorders, fetal infections, congenital anomalies Signup and view all the answers

Most common microorganisms that cause fetal infections

TORCH (Toxoplasmosis, Rubella, Cytomegalovirus, Herpes) Signup and view all the answers

most common factor associated with SGA infants: maternal conditions that result in decreased blood flow

Maternal Abnormalities Signup and view all the answers

toxemia of pregnancy

preeclampsia Signup and view all the answers

Maternal abnormalities

Vascular diseases, maternal malnutrition, avoidable factors, drugs Signup and view all the answers

uteroplacental insufficiency

result in asymmetric or disproportionate growth retardation with relative sparing of the brain

viewed as downregulation of growth in late half of gestation d/t limited availability of nutrients and oxygen

Placenta abnormalities Signup and view all the answers

umbilical-placental vascular anomalies

single umbilical artery, abnormal cord insertion, placental hemangioma Signup and view all the answers

results from viable genetic mutations occurring AFTER zygote formation

Chromosomal mosaicism Signup and view all the answers

Most frequently documented chromosomal mosaicism

Trisomy 7 Signup and view all the answers

occur at the time of the 1st and 2nd postzygotic division

Generalized constitutional mosaicism Signup and view all the answers

occurs later and within dividing trophoblast or extraembryonic progenitor cells of the inner cell mass

limited to placenta

Confined placental mosaicism Signup and view all the answers

Strong associations of RDS

Infant is almost always preterm, male gender, maternal diabetes, delivery by cesarean section Signup and view all the answers

Within 30 minutes of RDS

Breathing becomes more difficult Signup and view all the answers

Within a few hours of RDS

cyanosis becomes evident in the untreated infant. Fine rales can then be heard over both lung fields. Signup and view all the answers

Within few hours of RDS, A chest radiograph at this time usually reveals uniform minute reticulogranular densities, producing a so-called

Ground glass picture Signup and view all the answers

The fundamental defect in RDS is

pulmonary immaturity and deficiency of surfactant Signup and view all the answers

hydrophobic surfactant proteins

SP-B and SP-C Signup and view all the answers

Surfactant proteins that play a role in pulmonary host defense (innate immunity)

SP-A and SP-D Signup and view all the answers

Surfactant proteins that are involved in reduction of surface tension at the air-liquid barrier

SP-B and SP-C Signup and view all the answers

Mutations in SFTPB and SFTBC results in

severe respiratory failure in neonates Signup and view all the answers

Cells that produce surfactant

type II alveolar cells Signup and view all the answers

Glucocorticoids play an important role because increased corticosteroid release (d/t intrauterine stress and FGR) will lead to

Lower risk of RDS Signup and view all the answers

Major thrust in the control of RDS focuses on prevention via

Delaying labor until the fetal lung reaches maturity and Inducing maturation of the lung in the fetus at risk Signup and view all the answers

expression of VEGF is markedly decreased

cause endothelial cell apoptosis

Retrolental fibroplasia Hyperoxic phase Signup and view all the answers

cause lesions in the retina

Retrolental fibroplasia hypoxic phase Signup and view all the answers

reversible impairment in development of septation at saccular stage

Bronchopulmonary dysplasia Signup and view all the answers

Cytokines released during Bronchopulmonary dysplasia

TNF, IL-1B, IL-6, IL-8 Signup and view all the answers

the presence of gas within the wall of the small or large intestine

Pneumatosis intestinalis Signup and view all the answers

Perinatal infections primary routes of infection

Transcervical or ascending, Transplacental or hematologic, Combination Signup and view all the answers

Most bacterial and few viral infections (e.g., herpes simplex II) are acquired by what route

cervicovaginal Signup and view all the answers

Causes erythema infectiousum or 5th disease of childhood

Has a particular tropism for erythroid cells

Parvovirus B19 Signup and view all the answers

Occurs within the first 7 days of life, Most common cause: Group B Streptococcus

Early-onset sepsis Signup and view all the answers

From 7 days to 3 months of life, Infections with Listeria and Candida

Late-onset sepsis Signup and view all the answers

Accumulation of edema fluid in the fetus during intrauterine growth

Fetal hydrops Signup and view all the answers

A hemolytic disease caused by blood group antigen incompatibility between mother and fetus

Immune hydrops Signup and view all the answers

What are the major antigens in immune hydrops?

Rh antigens, ABO blood groups Signup and view all the answers

Only major cause of Rh incompatibility

D antigen Signup and view all the answers

Hemolytic disease occurs almost exclusively in infants of

group A/B with group O mothers Signup and view all the answers

o Direct result of red cell loss o May result in hypoxic injury to the heart and liver

Anemia Signup and view all the answers

bilirubin blinds to lipids in the brain and can damage the CNS, causing

kernicterus Signup and view all the answers

Chromosomal anomalies associated with fetal hydrops

45,X karyotype (Turner syndrome) , trisomies 21 and 18 Signup and view all the answers

abnormalities of lymphatic drainage from the neck → lead to postnuchal fluid accumulation or cystic hygromas

Turner Syndrome (45,X) Signup and view all the answers

deletion of all four a-globin genes

most common cause of nonimmune hydrops

Homozygous a-thalassemia Signup and view all the answers

bilirubin level that can cause neural damage

<blockquote> 20 mg/dL </blockquote> Signup and view all the answers