NBME 10. 33Q prenatal screening 02-13 (1)

Question 1

Antepartum intrauterine fetal demise commonly presents with?2

Answer 1

decreased fetal movement and
lack of fetal heart tones on examination.

Question 2

what confirms demise?

Answer 2

Ultrasonography confirms the lack of fetal cardiac activity and intrauterine fetal demise

Question 3

Cause of stillbirth (ie loss after 20 weeks) in high-income countries?3

Answer 3

chromosomal abnormalities, uteroplacental insufficiency, and maternal medical disease

Question 4

Cause of stillbirth (ie loss after 20 weeks) in low-income countries?3

Answer 4

maternal infection, preeclampsia, or obstructed labor in low-income countries.

Question 5

other causes of stillbirth mentioned? 5

Answer 5

Other causes include hydrops fetalis,
placental abruption,
fetal arrhythmia,
umbilical cord compression, and
fetomaternal hemorrhage.

Question 6

Common evaluation at the time of fetal demise includes? although this varies based on the patient and health care system.

Answer 6

fetal autopsy
placental examination, complete blood count, fasting blood glucose,
urine drug screen, a type and screen, Kleihauer-Betke test, and genetic testing

Question 7

risk factors for demise?

Answer 7

Risk factors include a previous fetal demise, African American race, extremes of reproductive age, multiple gestations, and assisted reproduction.

Question 8

Patients with previous antepartum fetal demise must be carefully monitored during their pregnancy to prevent recurrence.

Answer 8

.

Question 9

patients that are at risk for demise, what testing should undergo during pregnancy?

Answer 9

They should receive two to three ultrasounds across the gestation to determine age, congenital anomalies, and amniotic fluid volume, along with routine monitoring of fetal growth

Question 10

Additionally to UG 2-3 times (metioned before), women with an unexplained late-term stillbirth at greater than 32 weeks’ gestation, should undergo??

Answer 10

weekly nonstress testing in the third trimester starting at 32 weeks’ gestation.

Question 11

Fetal doppler ultrasonography at 36 weeks’ gestation (Choice C) may provide information about the fetal growth and amniotic fluid volume. However, ultrasonography for that purpose is recommended to occur at 24 to 30 weeks’ gestation, rather than at 36 weeks, as it will allow earlier detection of abnormal fetal growth patterns.

Answer 11

.

Question 12

Amniocentesis for karyotype analysis (Choice D) may be warranted but is not recommended until 15 to 18 weeks’ gestation.

Answer 12

performing the procedure earlier is associated with an increased risk for fetal loss

Question 13

Amniocentesis used as confirmation…?

Answer 13

confirmatory test following an abnormal quad screen for fetal abnormalities rather than as an initial diagnostic test.

Question 14

case was 14 week, now all good, but previously demise was at 38 weeks.

Answer 14

option was: Cesarean delivery at 37 weeks’ gestation (Choice E) - is not warranted. Delivery should not occur prior to 39 weeks’ gestation for patients with a previous unexplained stillbirth and a current uncomplicated pregnancy.

Question 15

when delivery in pts with previously demise? what weeks

Answer 15

Delivery should not occur prior to 39 weeks’ gestation for patients with a previous unexplained stillbirth