Antepartum / intrapartum fetal evaluation, operative vaginal delivery, TOLAC, diabetes

Question 1

Effect of mild hypoglycemia on fetal movement

Answer 1

Increases

Question 2

Contractions required for CST

Answer 2

3 ctx in 10 min last 40-60 sec each

Question 3

CST outcomes

Answer 3

Neg = no late decels
Pos = recurrent lates (>50% of ctx)
Equivocal = intermittent late decels

Question 4

Time for NST

Answer 4

20 min

Question 5

BPP fetal breathing

Answer 5

30 sec or more within 30 min

Question 6

BPP fetal movement

Answer 6

Three or more discrete body / limb movements within 30 min

Question 7

BPP fetal tone

Answer 7

One or more episode of flexion / extension

Question 8

BPP AFV

Answer 8

One or more pocket 2 x 2 cm or greater

Question 9

BPP 6/10 preterm

Answer 9

Repeat BPP in 24 hrs

Question 10

BPP 4/10

Answer 10

Deliver

Question 11

Even with score 0 on BPP, false positive rate is…

Answer 11

20% (it is 75% for 6/10)

Question 12

Modified BPP

Answer 12

NST + AFI (>5 cm is normal)

Question 13

Percent of cerebral palsy cases that occur antepartum vs intrapartum

Answer 13

> 70% vs 4%

Question 14

Tachysystole

Answer 14

> 5 ctx in 10 min

Question 15

Common causes of fetal tachycardia

Answer 15

Maternal fever, scopolamine, atropine, hydroxyzine, terbutaline, ritodrine, epinephrine

Question 16

Rare causes of tachycardia

Answer 16

Fetal hyperthyroidism, anemia, HF, or arrhythmias

Question 17

Rare causes of fetal bradycardia

Answer 17

Heart block, hypothermia, hypoglycemia, beta blockers, Nubain

Question 18

Accelerations guarantee…

Answer 18

pH > 7.20

Question 19

Pathologic fetal acidemia cord blood values

Answer 19

pH < 7.00 and base deficit > 12

Question 20

Fetal contraindications to operative delivery

Answer 20

Osteogenesis imperfecta, thrombocytopenia, hemophilia

Question 21

Gestational age for vacuum

Answer 21

34 wga (can do below for forceps)

Question 22

Mid, low, outlet operative delivery

Answer 22

Mid > +2 station
Low > +2 station and not on pelvic floor
Outlet > +2 and scalp visile at introitus

Question 23

Late-term vs post-term

Answer 23

41.0 - 41.6 wga vs > 41.6 wga

Question 24

When to initiate antenatal testing in normal pregnancy

Answer 24

41.0 wga (“may begin testing”)

Question 25

Prevalence of GDM

Answer 25

7%

Question 26

Hormones involved in pathology of GDM

Answer 26

Human chorionic somatomammotropin (hPL), progesterone, prolactin, cortisol. placental insullinase (increased clearance)

Question 27

Lifetime risk of T2DM if GDM present

Answer 27

50%

Question 28

Criteria for early glucose screening

Answer 28

BMI > 25 + risk factor (inactivity, ethnicity, cHTN, PCOS, first degree relative, hyperlipidemia, hx of GDM, prior BW > 4000 g)

Question 29

Glucose screening

Answer 29

24-28 wga: 1 hr GTT (50 g glucose load)

Question 30

NNT to prevent 1 brachial plexus injury by doing C/S for EFW > 4500 g

Answer 30

588

Question 31

How/when to screen for DM postpartum

Answer 31

6-12 wks postpartum and q3yrs thereafter (prefer 75 g 2 hr GTT)

Question 32

Definition of diabetic nephropathy (DM-F)

Answer 32

> 400 mg protein in 24 hrs prior to 20 wga

Question 33

Risks of pregestational DM in the first trimester

Answer 33

SAB, 6-12% risk of congenital malformations (cardiac, skeletal, CNS, or caudal regression)
With HgbA1c = 10%, risk is 20-25%

Question 34

Risk of IUFD in third trimester with pregestational DM

Answer 34

1%

Question 35

Rule of 8’s

Answer 35

HgbA1c = 8% -> average BG 180 mg/dL

Each 1% change = +/- 30 mg/dL

Question 36

Effect of 1 u of short-acting insulin

Answer 36

Lowers BG by about 30 mg/DL and covers 10 g of carbohydrates

Question 37

Risk of shoulder dystocia with DM vs not

Answer 37

50% increased risk

Question 38

Fluid deficit in DKA

Answer 38

100 mL/kg