Old Exams Flashcards
5 contraindications to external cephalic version
- Uterine anomalies
- Third-trimester bleeding
- Multiple gestation
- Oligohydramnios
- Evidence of uteroplacental insufficiency
- A nuchal cord identified by US
- Previous cesarean delivery or other significant uterine surgery
- Obvious Cephalopelvic disproportion (CPD)
Source: Creasy & Resnik’s, Chapter 43
Why irradiate blood before intrauterine transfusion?
To prevent graft-versus-host reaction
Source: Creasy & Resnik’s, Chapter 38, p. 639
What is the Barker Hypothesis?
This hypothesis proposes that early-life environment has long-term effects on the latter life
Name 3-4 differential diagnoses for a fetal anterior neck
- Goiter
- Cervical teratoma
- Anterior lymphangioma
- Cystic hygroma
- Thyroglossal duct cyst
- Branchial cleft cyst
- Soft tissue tumors (All rare : hemangioma, fibromatosis, myofibromatosis, fibrosarcoma, rhabdomyosarcoma, neuroblastoma)
Name 3-4 differential diagnoses for a fetal sacral mass
- Sacrococcygeal teratoma
- Myelomeningocele
- Terminal Myelocystocele
- Lipoma
- Vestigial tail
- Sirenomelia
- Other solid tumors (sarcoma)
One neonatal contraindication to give Naloxone
Opioid-dependent mother /Neonatal abstinence syndrome
“during neonatal resuscitation, naloxone should not be administered to a newborn of an opioid-dependent mother because of the risk of precipitating acute withdrawal and seizures.”
Name the effects of Magnesium Sulphate
Act on cell membranes to
- slow or block neuromuscular and cardiac conducting system transmission
- decrease smooth muscle contractility (decrease uterine contractility)
- depress CNS irritability (desired anticonvulsant effect)
Name the potential adverse effects associated with MgSO4 toxicity?
- Loss of deep tendon reflexes
- Respiratory depression/paralysis
- Electrocardiographic changes
- Cardiac arrest
In case of respiratory failure due to Mg toxicity, Name the antidote and the dose needed
Calcium gluconate 10ml of 10% solution injected IV over 3 minutes
In case of cardiac arrest due to Mg toxicity, Name the antidote and the dose needed
Calcium gluconate 15-30ml of 10% solution injected IV over 3 minutes (1500-3000mg)
What does level I-A evidence mean?
Strong recommendation, high quality of evidence, can apply to most patients in most circumstances without reservation
5 differential diagnoses of postpartum headaches.
- Postnatal headache/Migraine
- Tension headache
- Cluster headache
- Postpartum Preeclampsia
- Post dural puncture headache
- Cerebral venous sinus thrombosis
screening tools for PTB with good NPV
- Transvaginal ultrasound (TVU) measurement of cervical length
- Testing for fetal fibronectin in cervico-vaginal fluid
Patient with Hepatitis C wants invasive testing? Which method of invasive testing has the most evidence in order to counsel this patient?
Amniocentesis
“In women with chronic hepatitis C infection, amniocentesis is recommended over chorionic villus sampling due to the limited data available on chorionic villus sampling (conditional, low).”
“Amniocentesis in women with a chronic hepatitis C infection does not appear to significantly increase the risk of vertical transmission of the virus; however, there is limited published cohort data, and this information should be shared with the patient during the informed consent process (conditional, low). “
What is a unique complication of early CVS?
Limb-reduction defects
Oromandibular-limb hypogenesis syndrome
3 conditions to screen for in Ashkenazi Jewish couple
- Tay-Sachs disease
- Canavan disease
- Familial dysautonomia
- Cystic fibrosis
Patient with AFLP – what is the neonatal condition you have to test for?
Fatty acid oxidation defect - LCHAD deficiency
3 fetal complications associated with maternal dialysis in pregnancy
- IUGR/low birth weight
- Fetal demise
- Preterm delivery
Indications for EXIT (Ex utero intrapartum treatment) Procedure
1- Disorders with potential to cause congenital airway obstruction
- Congenital high airway obstruction syndrome (CHAOS)
- Large head
- Neck tumors
2- Upper airway problems that might cause difficult intubation
- Micrognathia
3- Need for fetal cardiopulmonary support during surgery (EXIT-to-ECMO)
Patient is 11 weeks pregnant. Her brother has Hemophilia A, and she is a carrier. NIPT showed that the fetus is a male. She wants diagnostic testing because she will consider TOP if her fetus is affected. Which invasive testing will you offer her? And why? Name 2 advantages.
CVS
- results will be available earlier
- reducing anxiety
- allowing earlier & safer TOP if results are abnormal
Epileptic patient at 13 weeks. Stable on Keppra x 1 years. Admitted for hyperemesis gravidarum. You are called because she just had a seizure. Name 3 reasons to explain the decreased threshold for seizures.
- Reduced gastric motility secondary to No/Vo
- Decreased serum levels of Keppra without appropriate - dose adjustment to maintain plasma levels at prepregnancy value
- Fatigue & sleep deprivation
- Reduced absorption of anticonvulsant drug secondary to use of antacids
Name 1 pituitary hormone that accelerate fetal lung maturity.
ACTH
Most common enzyme deficiency in CAH?
21-hydroxylase deficiency
What do you recommend for management of maternal PKU to optimize fetal outcomes?
- Maternal dietary treatment (dietary restriction of phenylalanine intake)
- Monitoring of phenylalanine concentrations before conception and at least biweekly throughout pregnancy to maintain levels between 120-360𝜇mol/L
