additional Flashcards
what is PUB’s blood
O - washed, CMV neg, leukoreduced, irradiated, concentrated <7 day old
how quickly does hydrops resolve
24-48 hr
threshold for transfusion
hct <30
goal hct for transfusion
35-50
prior to 24 weeks consider 25 adequte
- in this situation repeat in 48 hours and than repeat again in 7-10 days
hct decline per day after transfusion
1%
repeat transfusions
emperic 10 days after 1st
2 weeks after 2nd
3 weeks after 3rd
expected decline in fetal hemoglobin of 0.4 g/dL/day, 0.3 g/dL/day, and 0.2 g/dL/day after the first, second, and third transfusion,
MCA threshold after 1 IUT
1.69
Nait - what is affected but not severe
prior affected child with no ICH
Treatment for NAIT non-severe
20 wks: IVIG 2 gm /kg/wk
30 wks- add prednisone .5 mg /kg/day
CD at 37-38 weeks
Treatment of NAIT with a history of ICH
12 wks 1 gm/ kg/wk
20 wk 2 gm/kg/wk
28 wk add prednisone 0.5 mg/kg/day
CD 37-38 wks
early onset FGR at what week
32 weeks gestation
Do we use BPP in FGR
No
Where do you take your umbilical artery?
at the umbilicus
what is the cut off for umbilical artery dopplers?
> 95% RI, PI or S/d
What do you do with a fetus that has abnormal dopplers and FGR
weekly uad
nst 1-2 x week
EFW up to q2 weeks
deliver at 37
what do you do with a fetus that is <3rd with normal dopplers
weekly uad
weekly nst
consider efw q2
deliver at 37
what to do with >3rd and normal dopplers
uad q 1-2 weeks than q 2-4 if stable
weekly nst
ew q3-4
deliver 38-39
absent end diasolic flow
admission (?) UAD 2-3 x per week corticosteroids NST 2x weekly (if outpt) EFW q2 weeks deliv 33-34
reversed end diastolic flow
admission steroids NST 1-2x day EFW q2 week Deliver 30-32 weeks
Recurrace risk for heart block in a fetus
16-18%
who should be screened with ssa levels?
lupus sjogrens RA mixed CTD prior child with neonatal lupus or congential heart block
highest risk for heart block
18-24 weeks
rare after 30
- antibodies distroy av conduction
mode of delivery for fetal heart block
CD - can’t interpret the EFM
definition of prolonged PR
> 150 msec
Where to put the doppler for PR interval
accoss MV and LVOT
A wave- atrial contracting
PR- beginning of atrial contraction to beginning of ventricular contraction (how well is the AV node working )
Why I don’t screen PR intervals
arrythmia noted with doppler
acultate weekly
1st degree does not always progress
2nd degree often progresses but may revert
complete heart block is permanent and not reversible
steroids have some risks and benefit is unclear
what is 2nd degree heart block
prolonged PR and occasional dropped beats
how do you monitor complete heart block
weekly hydrops checks and twice weekly bpp
talk through a cervical length
empty bladder clean probe insert towards anterior fornix saggital view remove until blurred and than reinsert cervix should be 2/3 of the screen internal and external os should be visualized take 3 measurements and use the best shortest
when to send a FFN
PTL with a CL 20-30 mm 22-35 weeks
- consider ffn for PPROM
preterm labor lab eval
wet mount GC swab GBS UDS UA
window for GBS testing
36-38
high risk for penicillin allergy what gbs ppx
clinda if it’s sensitive
- consider penicillin allergy testing
If rapid GBS testing is negative do you need gbs ppx
yes if there are risk factors for GBS sepsis (preterm , prolonged rom, fever)
what is a mild penicilin allergy
non-uticarial rash
symptoms that are not consistent with an allergy
puritis without rash
reports history of allergy but unsure what happened
gbs regimen standard low risk allergy high risk allergy high risk allergy clinda resistant
penicillin 5 m and 3 mil every 4 hours
ancef 2 gm than 1 gm every 8 hr
clinda 900 mg every 8 hours
vanco 30 mg/kg q 8 hours with max 2 gm
IF you discontinued mag and need to restart. How long does it need to be to repeat the bolus
6 hr
nitrozine test
vaginal 3.8-4.2
amniotic fluid 7
amnisure looks for what
alpha microglobulin-1
(false positive up to 30%
whats the dose of indigo
1 ml in 9 ml
- remove tampon 30 minutes later.
vit K in last month of pregnancy with which medications
phenobarbital carbamazepine phenytoin topiramate oxycarbazepine
fetal hydantoin syndrome
Phenytoin
iugr, microcephaly, cardiac defect, hypoplastic nails, craniofacial abnormalities
- 30 affected, full syndrome in 15%
screening for drug use
4 p's parents use drugs partner use drug prior difficultly with drugs present drug use
iv drug use lab
STD evaluation
echocardiogram
lovenox
ppx
theraputic
ppx- one prior unprovoked VTE, high risk thrombophilia
theraputic- high risk thrombophilia with one prior VTE or 2 prior VTE
neonatal concerns with protein C or S
if homozygote neonatal purpur fulminans- requires life long anticoagulation
spinal cord lesion above t10
SVE regularly at 26 wks
Inpatient at 32 weeks
use non-absorbable sutures and remove
spinal cord lesion above T6
ptb
autonomic dysreflexia
- hypertension/bradycardia/headache/ congestion/rubor/sweating
treat with atropine/clonidine
prevent with epidural
myasthenia gravis
abnormal t cell regulation - antibodies to acetylcholine receptor
- no mag
- neonatal myasthenia - resolves in 6 weeks
benefits of delayed cord clamping
preterm- decreased need for blood transfusion/anemia, decreased NEC and IVH
Why did you check MCA dopplers
Honestly, since the most recent FGR recommendations which stratifies FGR further into severe and non-severe and clearly reviewed the current MCA literature, we have stopped doing MCA Doppler’s. However, prior to the most recent FGR document we were using CPR to risk stratify FGR due to a number of poor outcomes we had seen in term FGR fetuses at altitude. We had decided to use CPR to help with risk stratification as there had been a growing body of literature on CPR’s in the 2000’s, some of which indicated that it might correlate with adverse outcomes better than just the uterine artery Doppler alone. We were simply trying to risk stratify, which we now do as per the subsequent recommendations.
phe508 del
pro750 leu
CFTR mutations
8q22.2 microdeletion
- this deletion was smaller so unclear if this phenotype would occur.
8q22. 1 Deletion. The phenotype of this deletion issimilar to that of the Nablus mask syndrome, symptoms in-clude ID, speech disorder and typical dysmorphic features.The deletion is approximately 1.6 Mb
6q25 deletion
microcephaly, developmental delay, dysmorphic features and hearing loss, whereas two of them had agenesis of the corpus callosum. Dysmorphic features include midface hypoplasia, hypertelorism, broad nasal root and posteriorly rotated ears.
20 q 13.2-13.33 duplication
moderate developmental delay, abnormal craniofacial features and ventricular septal defect
Urinary tract dilation
A1 <28 week 4-7 mm
>28 weeks 7-10 mm
A2-3 <28 weeks >7mm
>28 weeks >10 mm
- upgraded due to peripheral calyceal dilation or abnormal echogenic renal parenchyma
> 15 does not have it’s own name but has worse prognosis
Mild hydronephrosis – Surgical intervention performed 10 percent
•Moderate hydronephrosis – Surgical intervention performed in 24 percent
•Severe hydronephrosis – Surgical intervention performed 63 percent
At 20 months hydronephrosis persisted in 10, 25, and 72 percent of patients with mild, moderate, and severe fetal hydronephrosis, respectively
Society of Fetal Urology- 4 levels ( same as above with 2/3 based on the number of calyces and 4 being cortical thinning
