Ch. 34- Effects of Maternal Disease on Pregnancy

Overactive thyroid gland; pathologically excessive production of thyroid hormones or the condition resulting from excessive production of thyroid hormones

hyperthyroidism

Underactive thyroid gland; a glandular disorder resulting from insufficient production of thyroid hormones

hypothyroidism

Excessive secretion of parathyroid hormone resulting in abnormally high levels of calcium in the blood; can affect many system of the body (especially causing bone resorption and osteoporosis)

hyperparathyroidism

Genetic disorder of metabolism; lack of the enzyme needed to turn phenylalanine into tyrosine, which results in an accumulation of phenylalanine in the body fluids, which causes various degrees of mental deficiency

phenylketonuria

A mechanism by which cells ingest extracellular fluid contents

pinocytosis

Development of immunities to Rh-positive blood antigens from a fetus by a Rh-negative woman

Rh isoimmunization

Accumulation of fluid in fetal tissues in the form of ascites, pleural fluid, and skin edema resulting from factors other than a fetomaternal blood group incompatibility

nonimmune hydrops

Congenital form of anemia occurring mostly in black populations; characterized by crescent-shaped blood cells

sickle cell anemia

Inherited form of anemia caused by faulty synthesis of hemoglobin

thalassemia

Abnormal condition of pregnancy characterized by hypertension, edema, and protein in the urine

toxemia (aka preeclampsia)

Coma and seizures in second and third trimesters following preeclampsia

eclampsia

Maternal high blood pressure that was diagnosed prior to pregnancy

essential hypertension

Thrombophilia or hypercoagulability is the propensity to develop thrombosis (blood clots) because of a coagulation abnormality

thrombophilias

Inflammatory disease of connective tissue with variable features including fever, weakness, fatiguability, joint pains, and lesions on the face, neck, or arms

systemic lupus erythematous

Estimated fetal weight <10th percentile for the gestational age

intrauterine growth restriction (IUGR)

Chickenpox infection

varicella-zoster infection

Herpes virus that causes infectious mononucleosis

Epstein-Barr virus

Ovum or sperm (germ cells) that have genetic material that passes to offspring

germ line

Acute febrile highly contagious viral disease

influenza

Human immunodeficiency virus that progresses into AIDS

human immunodeficiency virus (HIV)

Parasitic infection transmitted to human from undercooked meat or contact with cat feces

toxoplasmosis

Includes toxoplasmosis, other viruses (syphilis, varicella-zoster, parvovirus B19), rubella, cytomegalovirus, and herpes infections

TORCH

Contagious viral disease that is a milder form of measles lasting 3 or 4 days

rubella (aka German measles)

Condition in which women without previously diagnosed diabetes exhibit high blood glucose levels during pregnancy

gestational diabetes

Any of a group of herpes viruses that enlarge epithelial cells and can cause birth defects; can affect humans with impaired immunologic systems

cytomegalovirus (CMV)

Erythema infectiosum or fifth disease; spreading via the upper respiratory tract, this virus affects children more strongly than adults

parvovirus B19

Mosquito-borne single-stranded RNA virus related to the dengue virus

Zika virus

An infectious disease caused by a newly discovered coronavirus

coronavirus (COVID-19)

Diabetes caused by a relative or absolute deficiency of insulin and characterized by polyuria

diabetes mellitus

Physiologic functions of the placenta include all except:

• exchange of nutrients

• exchange of waste

• exchange of solids

• exchange of gas

exchange of solids

Select the substance that requires “assistance” in order to cross the placental membrane.

• carbohydrates

• infectious agents

• drugs

• antibodies

carbohydrates

What type of imaging provides fetoplacental circulation information?

• TV

• EV

• TA

• Doppler

Doppler

PROM, toxemia, IUGR, sickle cell disease, and diabetes mellitus result in a ___________ indicating increased vascular resistance.

• low S/D ratio

• high S/D ratio

• low RI

• high RI

high S/D ratio

A maternal infection occurring before conception:

• may adversely affect a fetus

• always adversely affects a fetus

• never adversely affects a fetus

• will only affect a fetus if antibiotics are not prescribed

may adversely affect the fetus

Maternal infections passed to the fetus are usually via the:

• urinary and genital tract

• circulatory and respiratory systems

• genital tract and circulatory systems

• urinary and respiratory system

genital tract and circulatory systems

A rare viral infection that is linked to stillbirth, low infant birth weight, congenital heart anomalies, low microphthalmia is:

• HIV

• IUGR

• EBV

• varicella-zoster

EBV

Choose a bacterial infection that is seen during pregnancy and known to cause fetal prematurity, prolonged rupture of fetal membranes, sepsis, and IUGR.

• Epstein-Barr

• gonorrhea

• HIV

• malaria

gonorrhea

Select the infection that represents a very common medical complication of pregnancy. It causes premature delivery/ low birth weight and maternal cystitis.

• cholera

• CMV

• staphylococcus

• UTI

UTI

A maternal infectious disease that promotes placental insufficiency, causing IUGR, low birth weight, abortion, and stillbirth is:

• malaria

• strep throat

• common cold

• pneumonia

malaria

An infectious disease that can exacerbate during pregnancy, especially with patients having underlying medical conditions and those over 25 year of age, often requiring hospitalization:

• CMV

• covid

• common cold

• herpes

covid

The placental barrier that usually protects fetuses from toxoplasmosis is most effective:

• during early pregnancy

• mid pregnancy

• late pregnancy

• throughout the entire pregnancy

during early pregnancy

Fetal malformations occurring in the first trimester which consist of cataracts, cardiac defects, and deafness are caused by:

• mumps

• 3-day measles

• herpes virus

• pertussis

3-day measles

Periventricular echogenic calcifications visualized in the fetal cranium are commonly related to:

• hyperthyroidism and parathyroidism

• Rh isoimmunization

• chickenpox

• rubella and parvovirus B19

chickenpox

Select the type of diabetes that occur only during pregnancy and affects about 7% of all pregnant women.

• type 1

• type 2

• monogenic

• gestational

gestational

A glucose tolerance test:

• is usually performed between weeks 24 and 28

• checks the glucose level 2 hours after p.o. ingestion of a glucose solution

• that displays a 1 hour elevated level will require a 4 hour tolerance test

• is requested only if there is a family history of diabetes mellitus

is usually performed between weeks 24 and 28

Isoimmunized pregnancies can result in all except:

• erythroblastosis fetalis

• hepatosplenomegaly

• immune hydrops fetalis

• Rh factor

Rh factor

Maternal edema, hypertension, proteinuria, and nervous system irritability define:

• thrombophilia symptoms

• toxemia/hypertension symptoms

• maternal rubella symptoms

• maternal viral infection symptoms

toxemia/hypertension symptoms

The safest time for a female diagnosed with systemic lupus erythematosus to produce a pregnancy is:

• early in the childbearing years

• when disease activity is controlled by small doses of steroids and aspirin

• after multiple treatments of clomiphene

• following blood transfusion

when disease activity is controlled by small doses of steroids and aspirin

Select the maternal disease that is least likely to affect a fetus’s heart:

• influenza

• TORCH

• thalassemia

• EBV

thalassemia

The __________ plays a role as a barrier in preventing or facilitating the transmission of maternal disease to the fetus.

placenta

Substances and agents that move cross the placental barrier, harming the developing fetus are _____________ ________, ________, and antibodies.

infectious agents, drugs

Maternal hypertension ____________ uteroplacental blood flow.

decreases

Normally, as pregnancy progresses, diastolic flow _____________, representing ___________ resistance to flow.

increases; reduced

Toxemia (preeclampsia) of pregnancy is a ________-trimester disease characterized by maternal edema, hypertension, proteinuria, and central nervous system irritability.

third

Of the patients diagnosed with preeclampsia, 2-12% are affected by the __________ syndrome.

HELLP

Patients with UTIs during pregnancy should be treated with ____________ and monitored by frequent urine ____________.

antibiotics; cultures

Maternal malaria promotes placental ____________, causing IUGR, low birth weight, abortion, and stillbirth.

insufficiency

Fetal _________________, a diagnostic test, helps detect heart abnormalities in patients exposed to CMV and rubella.

echocardiography

If severe toxoplasmosis infection occurs, the outcome presents as central nervous system anomalies such as _____________, _____________, _______________ ______________, _____________, and mental retardation.

hydrocephalus; microcephaly; intracranial calcifications; seizures

Cyanotic heart disease results in premature birth, IUGR, and miscarriages, possibly owing to the lower __________ content in maternal circulation.

oxygen

If an obstetric patient is infected with parvovirus B19, US to image anatomy and measurement of the ______ _________ ______ of the middle cerebral artery are noninvasive procedures to diagnose fetal anemia and nonimmune hydrops.

peak systolic flow

Cesarean section delivery is indicated in the event of ________ __________ virus in the. maternal genital tract.

herpes simplex

Congenital malformations seen with diabetes are related to high blood sugar levels resulting in disruption of embryonic __________________.

organogenesis

The preferred predictor of neonatal weight in the third trimester is the ______________ _______________ measurement.

abdominal circumference

Hyperthyroidism produces thyroxine that causes a significant increase of _____-birth weight infants.

low

Phenylketonuria (PKU) control is by following a low-______________, low-protein diet.

phenylalanine; diet

Rh isoimmunization refers to the development of maternal ______________ to the surface antigens on fetal _____ blood cells.

antibodies; red

Rigid irregularly shaped blood cells that occur mostly in African Americans in the US is a curse of ________ ______ ____________ or ___________.

sickle cell disease or anemia

Ingestion of raw meat, contaminated water, and contact with feline feces is advised against for the obstetrical patient owing to the risk of acquiring ______________.

toxoplasmosis

What is the most common cause of congenital infections in humans?

• gestational herpes

• cytomegalovirus

• rubella

• varicella-zoster

cytomegalovirus

Which condition causes SUA?

• herpes

• covid

• diabetes mellitus

• varicella-zoster

diabetes mellitus

Which of the following is the most common TORCH infection?

• toxoplasmosis

• zika

• herpes simplex

• cytomegalovirus

cytomegalovirus

Which of the following is not associated with FAS?

• cleft palate

• microphthamia

• malformed ears

• macrocephaly

macrocephaly

A macrosomic fetus is predisposed to suffer from:

• IUGR

• TORCH infections

• shoulder dystocia

• eclampsia

shoulder dystocia

Which of the following is not included in HELLP syndrome?

• pyuria

• hemolysis

• elevated liver enzymes

• low platelet count

pyuria

Nonimmune hydrops is associated with all of the following except:

• Rh isoimmunization

• pleural effusion

• Turner syndrome

• fetal infections

Rh isoimmunization

Mothers with pre gestational diabetes, as opposed to gestational diabetes, have an increased risk of a fetus with:

• neural tube defects

• proteinuria

• TORCH

• diethylstilbestrol

neural tube defects

Which of the following would be least likely associated with immune hydrops?

• fetal hepatomegaly

• fetal splenomegaly

• anasarca

• leiomyoma

leiomyoma

All of the following are associated with a thin placenta except:

• preeclampsia

• IUGR

• fetal hydrops

• long-standing diabetes

fetal hydrops

All of the following are associated with a thick placenta except:

• fetal infections

• Rh isoimmunization

• placental insufficiency

• multiple gestations

placental insufficiency

All of the following are associated with oligohydramnios except:

• bilateral renal agenesis

• infantile polycystic kidney disease

• PROM

• duodenal atresia

duodenal atresia

Increased S/D ratio is associated with all of the following except:

• IUGR

• placental insufficiency

• allantoic cysts

• perinatal mortality

allantoic cysts

Normally, the S/D ratio:

• increases with advancing gestation

• decreases with advancing gestation

• reverses occasionally during a normal pregnancy

• has an absent diastolic component

decreases with advancing gestation

Fetal TORCH is frequently associated with:

• maternal hypertension

• twin-twin transfusion syndrome

• intracranial calcifications

• renal cystic disease

intracranial calcifications

Evidence of polyhydramnios should warrant a careful investigation of the fetal:

• genitourinary system

• gastrointestinal system

• extremities

• cardiovascular system

gastrointestinal system

All of the following are associated with polyhydramnios except:

• omphalocele

• gastroschisis

• esophageal atresia

• bilateral multicystic dysplastic kidney disease

bilateral multicystic dysplastic kidney disease

Mothers with gestational diabetes run the risk of having fetuses that are considered:

• nutritionally deficient

• acromegallic

• microsomic

• macrosomic

macrosomic

Doppler assessment of the middle cerebral artery:

• helps to determine whether fetal anorexia is occurring

• is valuable in diagnosing the extent of ventriculomegaly

• can evaluate the fetus for hypoxia

• is important to determine whether TORCH complications are present

can evaluate the fetus for hypoxia