Pregnancy

Question 1

What are risk associated with multi-fetal pregnancies?

Answer 1

Both maternal and fetal risks!! Miscarriage, cervical insufficiency, PPROM, PTL, prematurity, cerebral palsy, growth restriction, GDM, HDP, PPH, need for cesarean

Question 2

What is difference between multifetal pregnancy reduction vs. selective reduction

Answer 2

Multifetal: reduce fetuses based on technical consideration (i.e location of fetus)
Selective reduction: decision about which fetus is based on health status of the fetus.

Question 3

What is risk of spontaneous pregnancy loss (entire preg) for twins, triplets, quads?

Answer 3

Risk increases w/ increasing number of fetuses. Twins 8%, triplets 15%, Quads 20%.

Question 4

How do you measure CRL and how accurate is it?

Answer 4

If up to 8w6d: +/- 5d.
If up to 13w6d, +/- 7d
3 discrete measurements and take the average of the 3: mid-sagittal plane (genital tubercle and fetal spine in view), from crown to rump

How can we limit number of multifetal pregnancies from ART? Implant 1 embryo. For ovulation induction, choosing letrozole over clomid.

Question 5

What are benefits and any risks to exercise in pregnancy?

Answer 5

Benefits: decr risk GDM, cesarean delivery, operative vaginal delivery, postpartum cesarean recovery. Prevents postpartum depression. Risks of low activity: bone demineralization psychosocial.

Avoid Scuba diving, surfing, gymnastics, Downhill skiing, water skiing. Contact sports: soccer, basketball (maybe avoid).

Contraindications to aerobic exercise during pregnancy? Placenta previa, preterm labor, ruptured membranes, severe anemia. Significant heart and lung disease.

Question 6

Most common indications for primary cesarean delivery?

Answer 6

1. abnormal labor (failed IOL/arrest of descent)
2. Non-reassuring fetal heart rate
3. malpresentation.

30% CS rate in US.

Question 7

Mono-di twin pregnancies: How would you counsel on complications?

Answer 7

Start with complications with all twins and then specific to mono-di
Risk of miscarriage, structural anomalies, HDP, GDM, fetal anomalies, PTL/Prematurity
Counsel on shared placenta and associated risks: TTTS, TAPS, selective FGR.
Refer to MFM
Serial CL, monthly growth US, genetic screening

bASA
Delivery at 36-37wks. Later discuss mode of delivery

Question 8

What is TTTS?

Answer 8

5 stages: oligo/polyhydramnios, absent bladder in donor twin, abnormal dopplers, hydrops, fetal death.
What are pre-requisites: monochorionic diamniotic twin pregnancy

Question 9

How should EC be used?

Answer 9

• no office exam or hcg. see if menses >7d late, AUB or pain develops.

WITHIN 3 DAYS
- combined estrogen/progestin pill (100ug estrogen and 0.5mg levonorgestrel) x 2 doses 12hr apart
- Plan B (OTC): Progestin only 1.5mg levonorgestrel single dose. 3% failure rate.

WITHIN 5D
- Copper iUD (99% effective) - good for obese women
- 52mg LNG IUD (97% effective)
- Ulipristal (Ella) 30mg single dose - selective progesterone modulator. inhibits ovulation. 99% elective.

Follow-up: if no period in 3 weeks, do hcg and counsel on contraception.

Question 10

What are risk factors for preterm delivery?

Answer 10

prior PTD, infection, placental abruption, pre-eclampsia multiple gestation, short cervix, younger age <18, black race, PPROM, bleeding in pregnancy

Question 10

What is likelihood of delivery at term for pt in PTL?

Answer 10

50%

Question 11

What are contraindications to tocolytics?

Answer 11

PTL, vaginal bleeding, evidence of infection, GA>34wks, IUFD, fetus w/ lethal anomaly, non-reassuring fetal status. PEC-SF or eclampsia.

Question 12

At what Mag level do you have loss of reflexes?
Respiratory paralysis?
Cardiac arrest?

Answer 12

loss of reflexes (>9)
respiratory paralysis (>12)
cardiac arrest (>30).

Question 13

When is aspirin indicated?

Answer 13

1+ moderate risk factor or 1 high-risk factor

High: hx cHTN, PEC, pre-gestational DM, renal disease, autoimmune (SLE, APLS), multifetal gestation

Low: nullip, fam hx PEC, black race, low income, Ama, IVF

Question 14

What are modifiable and non-modifiable RF for PTB?

Answer 14

Modifiable:
- low maternal pre-pre weight
- smoking/substance abuse
- short interpret interval (<18 months)

Non-modifiable
- prior PTB
- UTI and infections (BV)
- vaginal bleeding
- multiple gestation (60% PTB w/ twins)
- short cervix
- race

Question 15

how do you manage a pregnancy w/ IUD?
What are incr risk of pregnancy complications?

Answer 15

Perform TVUS to confirm IUP. If IUD is inferior to gestational sac, could attempt removal at IUD. 20% risk miscarriage w/ IUD removal.

Incr risk miscarriage, PTL, septic AB. bleeding

Question 16

What are contraindications to breastfeeding?

Answer 16

HIV pos, untreated TB, untreated varicella, herpes on breast, substance abuse

Question 17

How would you evaluate a patient with positive antibody screen in pregnancy?

Answer 17

See if antibody is associated with hemolytic disease of the newborn. If it does, determine paternal antigen and zygosity status.
If antigen neg, fetus not at risk
If antigen pos and heterozygtote or paternity uncertain, determine fetal antigen status by amnio.
If antigen pos and homozygote, fetus is at risk for HDFN.
Get serial maternal titers q2-4weeks. If titers >16, start MCAD at 24w.
Or if previous alloimmunized pregnancy, start MCAD at 24w.
If MCAD >1.5 mOm do PUBS, determine fetal hct. If > 35 weeks, deliver.
Delivery at 37-38w if MCA normal. MCA not as useful after 35w.
Concern for alloimmunization.
What diagnostic tests would you order?
How would you manage the patient throughout the pregnancy?
Why do some antibodies not cause problems in a pregnancy?
IgG crosses the placenta, IgM do not cross placenta

Question 18

What is differential for postpartum w/ pulse 160, agitated and sweating?
How would you evaluate?

Answer 18

hemorrhage, substance use, supraventricular tachycardia, other cardiac disease, thyroid storm, infection, sepsis

H&P, EKG, CBC, TSH, assess for drug intoxication

Question 19

How do you evaluate pt w/ hx epilepsy who desires fertility?

Answer 19

H&P, routine prenatal labs, optimize management of med probs. which meds she’s on,. If weaned from aeds, do 6-12 mo before conceiving. Neuro consult

Question 20

How would you counsel pt with epilepsy in pregnancy and how would you manage during pregnancy?

Answer 20

At risk for PEC, PTD, PPH, FGR, IUFD, maternal mortality and CS.
AED can lead to NTD. on monotherapy, lowest dose. Lamictal and keppra best. Then phenytoin. valproate=NOT GOOD. Folic acid 1mg daily prior to conception and then 0.4mg daily if on ANY AED.

Monitor AED level. Lamictal and keppra can cause changes in clearance. Epilepsy doesn’t incr risk of aneuploidy. Monitor growth.
Continue AED doses in labor and postpartum. Proper sleep hygiene.

Question 21

Most common surgical problem in pregnancy?

Differential diagnosis for RLQ pain in pregnancy?

Answer 21

Appendicitis. CBC, T&S, lactate if ill-appearing, abdominal US. sx of n/V, anorexia, guarding, rebound, fever.

The McBurney point is the most common site of maximum tenderness in acute appendicitis. one-third of the distance from the anterior superior iliac spine to the umbilicus

Appendicitis, pyelonephritis, nephrolithiasis, uterine rupture, abruption, degenerating fibroid, ruptured ovarian cyst, PTL, GI (constipation, viral gastroenteritis), MSK/muscle strain

How would you manage appendicitis? Consult gen surg. If surgery, would counsel them on fetal monitoring pre and post procedure, proper positioning (LLDB), mechanical VTE prophylaxis.

Question 22

What foods are at high risk of listeria?
What are symptoms of listeria?

Answer 22

Soft cheese, deli meats, smoked seafood, unwashed produce

N/V, abdominal upset, myalgias, diarrhea

Question 23

What are fetal effects of listeria?
How do you diagnose?
How do you manage?

Answer 23

Can cause fetal infection, fetal loss, neonatal sepsis and death

DDx w/ Blood culture. Report to health department.

Just monitor for fever. If exposure and fever, IV ampicillin x 14d. If allergic, bactrim.

Question 24

What is a contraction stress test?

Answer 24

assess fetal wellbeing. -oxygenation decr during uterine contractions and late decals will occur.
- requires 3 contractions lasting 40 sec over 10 min period (achieve w/ labor, nipple stem or IV pit)
- pt in lateral recumbent position

Neg: no decels
Pos: Late decels w/ 50% or more contractions
Suspicious: intermittent late or significant variables
Equivocal: decals following contractions where contractions are q2min and last >90 sec
Unsatisfactory: fewer than 3 contractions in 10min period

Question 25

What is a BPP?

Answer 25

Comprises 5 components:
- NST
- Breathing (1 fetal breathing movement at least 30sec)
- Tone: 1 flexion/extension movement (Extremity or hand)
- Movement: 3 or more distinct body movements
- AFI with greatest vertical pocket 2cm or greater

8 or 10=normal
6=equivocal
4=abnormal

Question 26

What would you expect umbilical cord gases to reveal if BPP was 6/8 with occasional variables?

Answer 26

Pathologic fetal anemia: pH <7.0, base deficit linear relationship w/ lactate acid and correlates w/ neonatal neurologic morbidity. Base excess >12 predicts newborn complications. BE 12-16=incr newborn mortality and encephalopathy.

Question 27

What is a category 3 tracing?

Answer 27

Absent variability, recurrent lates and variables. recurrent=decelerations occur with at least 50% contractions in 20 min period.
What causes a sinusoidal pattern? Fetal anemia and maternal narcotics

Question 28

What is differential diagnosis for an obtunded pregnant patient?
What is initial workup?

Answer 28

Miscarriage w/ acute hemorrhage, acute drug intoxication, seizure, DKA.
- Order ABG, CBC, BMP, TSH, lactate, UA.
Look for elevated anion gap>20 and elevated hydroxybutyrate. Eval for cause of DKA (infection).

Question 29

What is management of DKA?

Answer 29

Order beta-hydroxybutyrate, q2hr CBC/BMP, IVF/NS (replace 4-5 L), regular insulin (can decrease once glucose <200), and electrolyte replacement. Consult medicine and endocrinology.
If K<3.3, give KCL and HOLD insulin.

Question 30

What is differential for rash in pregnancy?
What is diagnosis and management of maternal varicella?

Answer 30

Scarlet fever, roseola, varicella, parvo, toxoplasmosis, allergic reaction, contact dermatitis

Vesicular lesions on erythematous base.
Prodrome of fever, malaise, myalgia 1-3 d before rash
PCR testing of scraping from skin vesicles.
Tx=oral acyclovir 800mg 5x/day for 7d. Delay delivery for 1 week to allow for IgG and passive transfer to neonate.

Varicella pneumonia - mortality 40%. IV acyclovir.

If someone exposed to chickenpox, what is management?
Prophylaxis within 10d exposure. Varicella-zoster immune globulin if not vaccinated. If become infected, tx w/ acyclovir. Vaccinate postpartum.

Question 31

If postpartum fever not improving with antibiotics, what would you do?

Answer 31

Consider abscess or Consider septic pelvic thrombophlebitis. Diagnosis of exclusion if pt not improving.

• Ddx: palpable cord-like mass on exam or thrombosis on imaging. tx=anticoagulation 1mg/kg of LVX q12hr and continue abx.

Endometritis: gent 5mg/kg q24 for gram neg, clinda for anaerobes, 900mg q8h.

Question 32

What is differential diagnosis for SOB in pregnancy w/ hx cHTN and obesity?

Answer 32

PEC-SF, pneumonia, asthma, PE, URI, pulmonary edema
What tests? CBC, CMP, upc, BNP, troponin, CXR.

Question 33

How does the maternal cardiovascular system change in pregnancy?

Answer 33

Incr in LV volumes, LV mass, total blood volume, dilutional anemia, incr in CO.

Question 34

What is peripartum cardiomyopathy and what is the management?

Answer 34

Development of cardiac failure in last month of pregnancy or within 5 months of delivery.
LV systolic dysfunction (EF <45%)

RF: african american, multiple gestation, PEC, pp HTN, maternal cocaine abuse.

Goals of tx: sx relief, decr in pulmonary congestion, preload/afterload optimization.
loop/thiazine diuretic, inotrope (digoxin) for improved contractions, consider anticoagulation.

What is risk of recurrence in subsequent pregnancy?
>50%. AVOID pregnancy if EF <50%.

Question 35

List common maternal infections associated with severe fetal complications when acquired congenitally?

Answer 35

HSV, CMV, varicella, parvo, toxo, syphilis

Question 36

If pt’s child is diagnosed with parvo, how would you manage?

Answer 36

IgG and IgM to assess her immunity to parvo. Assess for sx. Counsel on risks. Risk of acquiring infection is 50% from your own child.

How is fetal parvovirus diagnosed?
How is fetal parvo managed? US looking for markers: fetal anemia and hydrops. Monitor with weekly MCAD for 10wks after maternal seroconversion and if anemia, could consider PUBS and IUT.

If initial screen is IgG and IgM negative, repeat serologies in 4 weeks to see if she acquires the infection.
How would you classify fetal hydrops 2/2 parvo: non-immune

What type of blood do you give with PUBS/IUT? CMV-neg, irradiated leukocyte poor blood. Do pUBS to confirm bc MCAD are screening tests.

Fetal risks of Parvo: fGR, hearing loss, HSM, thrombocytopenia

Question 37

What is incidence of stillbirth?

What are risk factors?

What workup would you recommend?

Answer 37

< 1%.

Maternal: african race, nulliparity, T2DM, HDP, AMA, substance use
Fetal: FGR, congenital anomalies, cord accidents

CBC (infection), coags (Abruption), APLS, Placental pathology, visual inspection of fetus, autopsy. Microarray.
Placenta + autopsy will give answer in majority of cases.

Question 38

What is ICP? incidence, risk factors, when it occurs?

Answer 38

Elevation of bile acids. Transport of bile acids from gallbladder is disrupted. Can cause fetal arrhythmia which leads to IUFD.

1%

RF: Prior cholestasis, baseline liver disease, hispanic ethnicity, multiple gestation, IVF pregnancy, AMA, hep C

• Increases risk for PEC, GDM, PTD, RDS.

3rd trimester. Pt complains of itching of palms/soles, may have rash. Dark urine, pale stool.

What is workup: bile acids (>10=abnormal), CMP

When do you deliver? BA>100 delivery at 36wks. BA>40, deliver by 37w due to increased risk of stillbirth

Question 39

What is management of ICP?

What is postpartum management? How would you counsel them?

Answer 39

Meds: ursudiol 300mg TID

Antenatal testing: NST and BPP.

Incr risk of developing again (90% recurrence risk). Avoid OCPs for contraception bc of liver dysfunction.
Check bile acids at PP visit

Question 40

What is incidence of twins and higher-order multiple births?

What are risks of multi-fetal pregnancies?

Answer 40

Twins: 34/1000 and 1/1000 higher order.

Fetal risks: anomalies, PTD, FGR, SAB
Maternal risks: GDM, HDP, PPH

Question 41

What primary prevention strategies can limit # multifetal pregnancies that result from ART?

Answer 41

Single embryo transfer for IVF
Low dose for ovulation induction meds. If suspicion for multiple ovulation event, cancelling a cycle.
Using IVF instead of gonadotropins.

Question 42

How do you counsel patient on an elective primary CS?

Answer 42

History to understand reasons for request, discuss risks of CS, let her know that elective CS is a possibility (not prior to 39w), discuss family planning desires (if desire multiple children, increased risk).

Cesarean delivery: incr risk PPH, injury to surrounding structures, infection, prolonged hospitalization, VTE, longer recovery

Vaginal delivery: risk of lacerations. Shorter recovery, less pain, decr risk hemorrhage.

Question 43

How would you manage pt at 12wks w/ factor v leiden?

Answer 43

History to determine personal/fam hx of factor V or VTE.
Find out why she got tested
Workup: heterozygote or homozygote, other thrombophilia testing.
Management: prophylactic anticoagulation (lovenox or UFH). Hold 24hr prior to IOL/CS.

What is the risk of fetus having Factor v leiden? what kind of mutation/inheritance??

Question 44

What is difference between vasa previa and velamentous cord insertion?
What is a vasa previa?

Answer 44

Unprotected umbilical vessels run through amniotic membranes and pass over cervix

Type 1: velamentous cord insertion - fetal vessels run freely within membranes overlying cervix or in close proximity (2cm from os)
Type 2: bilobed or succenturiate lobe and fetal vessels connecting both lobes course over or in proximity to cervix (2cm from os).

What is a funic presentation? How do you distinguish from vasa previa?
Usually transient. Do color doppler interrogation. Would have NORMAL placental cord insertion.

How would you counsel the patient?
Complications: fetal hemorrhage or fetal death

How would you manage the patient?
BMZ between 28-32wks. Consider hospitalization at 30-34wks, delivery at 34-37wks. “I admit my patients at 30 weeks, give BMZ and deliver between 34-37wks” plan may be altered by pt’s symptoms or proximity to hospital.

Question 45

How do you manage severe range BP at 31wks?

Answer 45

IV access, PEC labs, H&P (any cHTN, gHTN, PEC, meds, PEC sx), repeat BP in 15 min. Counsel pt on management. Fetal monitoring. IF persistent SRBP, start Mag, give BMZ, consult MFM/NICU. Start PO dose.

Management of SRBP is obstetrical emergency so I would require collaboration and coordination from multiple team members including nursing, MFM, anesthesia, NIUC. Notify nurse of severe range BP and make sure we have adequate personnel.

Admit and do growth US

When would you deliver prior to 34wks?
Worsening labs (LFTs>2x ULN, Cr>1.1 or 2x baseline, Plts<100), pulmonary edema, stroke, MI, persistent sx, inability to control her BP, nonreassuring fetal status.
Contraindication to expectant management: lethal anomaly or nonreassuring fetal tracing.

Question 46

For obese patient, If needs CS for arrest of labor, would would you do for BMI pre-op, intra-op and post-op

Answer 46

Pre-op: 3g ancef if >120kg, Azithro 500mg IV, chlorhex prep

Intra-op: assistance w/ retraction and exposure. Fascia using PDS because increases strength of closure.

Post-op: counsel on incr risk wound infections and VTE.

Question 47

What is your pre-conception counseling if BMI 32 w/ negative infertility workup?

Answer 47

Check male factor infertility. Review prior workup. Discuss prenatal vitamin, check immunization/titers, optimize medical problems. Discuss idiopathic infertility.
Discuss ovulation induction to start. Refer to REI for IVF if fails.
Discuss ovulation induction protocol: Letrozole (live birth rate 20%). Clomid (live birth rate 10%). inhibits estrogen neg feedback, causes increase in FSH/LH.
Can begin day 3 of cycle: 5d. Once ovulation occurs, use same dose for 4-6 cycles. Sex every other day for 1 week starting 5 days after last dose. LH surge 5-12d after clomid.
Clomid dosing: 50mg, 100mg or 150mg.
Letrozole dosing: 2.5mg, 5mg, or 7.5mg.
How to evaluate if she’s ovulating? Check progesterone, basal body temp, LH surge.
How do you counsel about timed intercourse?
When would you refer to REI? After 3 cycles of OI if haven’t conceived.
How do you manage progesterone withdrawal bleeding? Look up!

Question 48

What are cerclage indications?

Answer 48

1. History indicated
   Prior preg w/ cerclage
   2nd trim loss w/ painless dilation
2. Ultrasound indicated
   CL <2.5cm and prior PTB
3. Exam indicated
   < 24 wks noted to have cervical dilation on the exam

How do you perform a cerclage?
McDonald’s.
Indications for abdominal cerclage?
Failed TVC
No cervical tissue available for TVC (prior LEEP).

Question 49

What are recommended vaccines in pregnancy?

What are other vaccines that are safe but not given to all pregnant women?

What is counseling on RSV vaccine in pregnancy?

Answer 49

flu/covid, Tdap (27-36w), RSV.

• Any adults around the neonate should get Tdap if not previously vaccinated. At least 2 weeks before seeing infant.

Hepatitis A, pneumonia, certain types of meningitis.

Recommended between 32w and 36w. RSV season Sep-Jan
Option of maternal RSV vaccine or monoclonal Ab for infants under 8 months.
Nirsevimab=monoclonal Ab
Benefit of maternal RSV vaccine: reduces # vaccines infant receives at birth, newborn has immediate protection if vaccination occurs 2 weeks before birth. Ab from maternal vaccination may be more resistant to virus mutation.
Monoclonal Ab benefits: may last longer than maternal vaccination. Ab development directly to newborn vs passive transfer from maternal vaccination.

Question 50

What are causes of echogenic bowel:

What is the workup for echogenic bowel?

Do you need to test mom for CF?

What is autosomal recessive condition?

Answer 50

T21, intra-amniotic bleeding, CF, CMV

detailed anatomy, GC. Offer CMV, CF and aneploidy testing. Consider follow up for growth bc risk of FGR.

Carrier screen for mom. If neg, doesn’t eliminate risk but reduces it dramatically.

Need allele from mom and dad to have disease.

Question 51

Pt is G2P1 at IPV, found to be A neg with +Anti-D Ab.. What would you ask?

Current rhogam recommendations from ACOG??
Any additional labs?

Answer 51

Did she receive rhogam in 1st preg> Any blood transfusion? Any vaginal bleeding in this pregnancy and did she receive Rhogam? Any complications in 1st preg? Does she know FOB blood type?

CBC, Titers, paternal antigen status.

If Rhogam positive antibody, titer usually 1:4 or less. It’s pooled Anti-D, will give positive antibody screen. Expect Rhogam to be in system for up to 3 weeks. Should repeat T&S in 4 weeks and see if still positive. See if rhogam effect vs true desensitization.

Question 52

When should you give Rhogam?

Answer 52

Anything that increases chance of fetal cells entering maternal circulation.

Early pregnancy bleeding
CVS/amnio/ECV
3rd trimester bleeding
Routine at 28w

ECV
Molar pregnancy
1st trim SAB
D&C
Termination of pregnancy
Ectopic
Antenatal hemorrhage >20 weeks gestation
Abdominal trauma
Fetal death in the 2nd or 3rd trimester

Question 53

How do you assess maternal-fetal hemorrhage volume?

Answer 53

SCREENING
Rosette fetal red blood cell assay to detect greater than 2 mL of fetal whole blood in maternal circulation

QUANTIFICATION TEST are appropriate if rosette test is positive
- Kleihauer-Betke (inexpensive, but lacks standardization and precision). Acid-dilution. Hgb F is more resistant. Put acid, Hgb F will NOT lyse. Normal Hgb lyse.

–Volume of fetal bleed: % fetal cells x maternal blood volume
Maternal blood volume: 70 mL/kg x weight (kg) (assume 5,000 mL if maternal information is unknown)
- Flow cytometry (more accurate, but limited by cost and availability)

Question 54

What is rhogam dosing?

Answer 54

Standard 300-microgram dose of anti-D immune globulin covers 30 mL of Rh D-positive fetal whole blood (or 15 mL of fetal red blood cells)

1. Exposures to <30 mL of Rh D-positive fetal whole blood
   - 28 weeks: 300 micrograms
   - After birth (within 72 hours): 300 micrograms
2. Exposures to >30 mL of Rh D-positive fetal whole blood
   - Assess volume of fetal-maternal hemorrhage to guide dosing
   Can use up to eight full vials at one time
   IM: Separate sites every 12 hours until the desired dosage has been reached
   IV: Rh immune globulin is also available

Question 55

How would you manage the following situation? G2P1 with IPV at 22wks. Labs positive for KID Ab, Blood type is A neg.

Answer 55

Obtain History: prior pregnancy, any prior blood transfusions. FOB testing for Antigen.

FOB tested and is homozygous positive for KID Antigen.

“ I will check reference charts to see the degree of severity of the antibody. I will see if it’s associated with hemolytic disease of the fetus and newborn”

If mom has antibody, she DOES NOT have antigen (bc antibody formed because she didn’t have antigen). If FOB doesn’t have antigen, the fetus cannot have it either. If father DOES have antigen and is homozygous, he will definitely pass to fetus.

What is next step in management if FOB is negative for KID Ab?
Wont’ change management. Expect that to be case since he has antigen.
What is next step in management if FOB is negative for KID antigen?
Reassure pt that fetus not at risk if paternity is assured.
IF pt’s Kid (JKA) Ab titer is 1:2, how would you manage? Rpt in 4wks.
Continue until 1:8 and then start MCAD looking at peak systolic velocity.

Question 56

What is management of titers of 1:64 for Fya Duffy Ab in mom?

Answer 56

MCAD w/ peak systolic velocity to evaluate for hydrops. Concern w/ alloimmunization and HDFN.

If you can’t do PSV, is there an alternative test? Amniocentesis to check for bilirubin in baby’s blood.

If PSV is 1.6MoM, what is management? PUBS w/ IUT. concerning for alloimmunization.

What type of blood to give the baby? O-neg, CMV neg, irradiated leukocyte poor blood.

Describe how to perform a PSV? Identify the MCA. Circle of willis. Interrogate artery at its origin site. No fetal movement/breathing. Zero angle of approach. Take 3 measurements and use the highest.

Question 57

What makes a KB test falsely positive?

Answer 57

Anything that increases maternal Hgb F like maternal sickle cell or thalassemia. Can then do Hgb electrophoresis.