MFM/Perinatology Flashcards
Recommended gestational age range and time-interval for antenatal steroid administration
Between 24.0 to 34.0 weeks gestational age in a woman that is at high risk for imminent preterm delivery within the next 7 days.
At gestational age 34 0/7w and beyond, benefit of antenatal steroids is unclear.
Benefits of antenatal steroids within appropriate gestational age range?
Age range indicated: between 24.0 to 34.0 weeks gestational age in a woman that is at high risk for imminent preterm delivery within the next 7 days.
Reduced perinatal mortality, decreased risk of IVH and respiratory distress syndrome.
General findings of antenatal steroids in late preterm infants (ALPS)
ALPS trial 2016 (Antenatal Late Preterm Steroids trial in 2016); multi-centered, double-blinded, 2800 deliveries
Results:
Significant decreased in primary outcome [respiratory composite of need for NIMV >2 hours (includes HFNC), FiO2 >30% for >4hrs, mechanical ventilation, or perinatal death] between beta vs placebo groups. Some decrease in TTN, need for surfactant, etc.
No impact on: need for mechanical ventilation, NICU admission, incidence of RDS.
Increase in rates of neonatal hypoglycemia (BG<40): (24% vs 15%).
Antenatal steroid impact on neurodevelopment at school age–data?
Antenatal Steroids for Term Elective C-section: antenatal steroids prior to elective C/s at term–> assessed school performance at school age (8-15 years).
Low rates of follow up (~50%), but beta exposed children more likely to be in the lowest quartile of academic ability (17% beta vs. 8.5%).
Marijuana effect on neurodevelopment?
Decrease in language and memory skills from age 4 to school age, later decreases in attention and school performance, worse functional memory as an adult. Animal studies show marijuana to affect dopaminergic pathways in the brain. Increased concerns for depression and marijuana/tobacco use as a teenager.
https://www.cdc.gov/cannabis/health-effects/pregnancy.html?CDC_AAref_Val=https://www.cdc.gov/marijuana/health-effects/pregnancy.html
Relationship between maternal BMI and success of VBAC?
Inverse relationship between maternal and success of VBAC; higher BMI is associated with decrease spontaneous delivery, increased need for IOL, failure of induction, increased rates of C-section and related complications.
Maternal obesity is linked with increased risk of metabolic disease later in life for the child, childhood obesity, CV disease, Type I DM and asthma.
Distinguish between intrauterine vs traumatic depressed skull fracture
Intrauterine- no history of traumatic or instrumentation during delivery; usually area of depression does not exceed >0.5cm in diameter; usually normal intracranial anatomy
Traumatic- birth trauma, generally >0.5cm of depressed fracture– can be associated with subdural hemorrhage (neurosurgical consult and head imaging warranted)
