The Fetus and Newborn

Question 0

What is an AGA baby?

Answer 0

> 10% and less than < 90% in birth weight

Question 1

What is meant by live birth?

Answer 1

Complete expulsion from mother, baby breathes or shows evidence of life

Question 2

What is preterm?

Answer 2

Infant born before the last day of the 37 week (259 day) of gestation

Question 3

What is low birth weight?

Answer 3

< 2,500 gm regardless of gestational age at birth

Question 4

What is meant by fetal death?

Answer 4

Death that occurs before the infant is fully expelled, not including abortion.

Question 5

What is infant death?

Answer 5

Death that occurs at any time between birth and 1 year of age.

Question 6

What is perinatal death?

Answer 6

Death from 28 weeks gestation to 28th day of life.

Question 7

What ethnic group has the highest mortality rates?

Answer 7

African-Americans followed by native Americans.

Question 8

Which specific group has the highest mortality rate?

Answer 8

Caucasian infants < 500 grams

Question 9

What maternal factors are associated with neonatal mortality?

Answer 9

Prenatal care delayed until first trimester, > 40 years of age who did complete high school, teen pregnancy, unmarried, smokers, and having underlying disease

Question 10

For premature infants what independent factors are associated with increased mortality?

Answer 10

Male, 5 min APGAR < 4, lack of antenatal steroids, bradycardia for 5 minutes, hypothermia, and IUGR.

Question 11

What is the leading cause of infant death in the US?

Answer 11

Congenital malformation, 25% of infant deaths.

Question 12

What is the most common umbilical abnormality?

Answer 12

Single artery, 40% have a major congenital abnormality, trisomy 18 is common.

Question 13

What is placental abrupt ion.

Answer 13

When a firm layer of blood forms after a retro placental hemorrhage

Question 14

What is the monochromic membrane found in what condition?

Answer 14

Seen in monozygotic twins when there is initially 1 ovum before division.

Question 15

What type of twins are dichotomies?

Answer 15

Associated with fraternal twins, but identical twin can also be dichorionic if twins separated early- before day 3.

Question 16

What are the guidelines for GBS prevention?

Answer 16

All pregnant women get vaginal/rectal GBS screening at 35-37 weeks and then prophylax if culture is positive unless she is going to have a C-section, has not had active labor and membranes are intact.

Question 17

What other conditions would GBS prophylax be required?

Answer 17

Previous baby with invasive GBS disease, unknown status-delivery of < 37 weeks, membrane rupture >18 hours and intraoaetum temp > 100.4

Question 18

What is the greatest risk factor for preterm delivery?

Answer 18

Previous preterm delivery

Question 19

What is the management of PROM in > 34 weeks gestation?

Answer 19

Evaluate mother via speculum exam, check fetus with fetal heart rate and look at fetal presentation.

Question 20

What is done for a fetus < 28 weeks and PROM?

Answer 20

Toxo lysis and steroid therapy.

Question 21

What is given for seizures to the mother if she has preeclampsia?

Answer 21

Magnesium sulfate

Question 22

In gestational diabetes, the incidence is most closely associated with what finding?

Answer 22

Degree of hyperglycemia prior to conception.

Question 23

What is the simplistic screening mention for IUGR?

Answer 23

Fundal height measurement- from the top of the uterine funds to the symphysis pubis.

Question 24

At what age should ultrasound be performed?

Answer 24

All fetuses grow at the same rate for the first 20 weeks. So ultrasound best at 18-20 weeks.

Question 25

Maternal fever in association with fetal tachycardia >180 bpm is associated with what?

Answer 25

Chorioamnionitis

Question 26

What defines fetal bradycardia?

Answer 26

Baseline heart rat of < 120 bpm

Question 27

What causes early de cels?

Answer 27

Fetal head compression during uterine contraction and creates vagal stimulation and slowing of the heart rate.

Question 28

What are late decels?

Answer 28

A fall in FHE either before or after peak of uterine contraction-all late decels are considered potentially ominous

Question 29

What does a heart rate of < 80 bpm?

Answer 29

If > 3 minutes considered ominous and indicates significant hypoxia.

Question 30

What are the common reasons for C-sections in the US?

Answer 30

Previous C-section, dystonia, fetal distress, malpresentation, “other”

Question 31

Which lobe of the liver has a higher oxygen level?

Answer 31

Left lobe of the liver as it get its blood supply from the umbilical vein

Question 32

At birth what happens to pulmonary pressures and flow?

Answer 32

Mean pulmonary artery pressure drops, mean pulmonary blood flow increases, and pulmonary vascular resistance drops.

Question 33

Does altitude alter patent ductus closure?

Answer 33

Infants born above 3,000 feet have an increased incidence.

Question 34

Under most conditions does the fetus synthesize glucose?

Answer 34

No, it gets all glucose from mother.

Question 35

What is the water content in a newborn?

Answer 35

75-80% water, 2/3rd ones cellular

Question 36

What are the APGAR scoring categories?

Answer 36

Heart rate, respiration, muscle tone, reflex irritability, and color.

Question 37

In infant resuscitation where should you keep PaO2?

Answer 37

At 50-70 mmHg, too much oxygen causes damage.

Question 38

What size endotracheal tube?

Answer 38

< 1.5 kg=2.5 mm
1.5-2.5 kg=3 mm
>2.2 kg=3.5 mm

Question 39

How does epinephrine work?

Answer 39

Alpha adrenergic
Enhances heart contractility
Constricts peripheral circulation
Beta adrenergic effects on heart-increases rate and effectiveness of cardiac contraction.

Question 40

What two medications can be given via endotracheal tube?

Answer 40

Epinephrine and atropine