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Flashcards in fetal / neonatal Deck (71)
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1

Complications in the fetus from indomethacin in pregnancy include:

a. renal insufficiency
b. oligohydramnios
c. premature closure of the ductus arteriosus
d. all of the above
e. none of the above

d. all of the above

Its an NSAID

2

Cardiovascular changes at birth

A - the brain is the organ that receives the most dramatic increase in blood flow
B - pulmonary vascular resistance and pulmonary blood flow decrease
C - foramen ovale is a flap valve that becomes functionally closed when L atrial pressure exceeds R atrial pressure
D - prostaglandins have a minor role in physiological closure of ductus arteriosus

C - foramen ovale is a flap valve that becomes functionally closed when L atrial pressure exceeds R atrial pressure

Occurs in the first few minutes of life

DUCTUS ARTERIOSUS - closes over course of a few hours
Pulmonary artery goes from high pressure to low pressure
Fall in prostaglandin (from placenta being removed) --> closure of ductus arteriosus
Also get constriction of smooth muscle in ductus arteriosus from high oxygen levels

3

What is the blood volume of a newborn baby weighing 3500gm?

A. 150 ml
B. 250 ml
C. 300 ml
D. 350 ml
E. 400 ml

D. 350 ml

Another set on answers say 300ml

BV of a child is around 85-105 ml/kg (WHO)

4

An ultrasound examination reveals that your patient has a fetus with gastroschisis. You advise her that:

A - The fetus has >30% chance of an associated chromosomal abnormality
B - Surgical repair is successful in <20% of cases
C - It is uncertain whether LUSCS confers any advantages over NVD
D - The infant is likely to have severe mental retardation

C - It is uncertain whether LUSCS confers any advantages over NVD

Surgical repair is often successful
Neonatal mortality low (5-10%)
Increased risk of FGR and PTB
Neonatal bowel complications
The opening is near the umbilicus but towards to right and not directly over it
- no increase in incidence of chromosomal abnormalities
- only contains small bowel usually
- a/w oligo

Omphalocele - membrane covered herniation, inserts into the apex of the sac (of cord insertion)
- high incidence with associated abnormalities / genetic syndromes / chromosomal abnormalities (T13, 18)
- Can contain stomach, liver, spleen
- a/w poly

5

What is the fetal PaO2 at term?

A - 22 mmHg
B - 32 mmHg
C - 42 mmHg
D - 52 mmHg
E - 62 mmHg

B - 32 mmHg


32-35mmHg in the fetal umbilical vein

Compared to 90-100mmHg in mum

6

What is the cord pH at term immediately after a normal labour and delivery?

A - Vein 7.3, artery 7.27
B - Vein 7.27, artery 7.3
c - Vein 7.5, artery 7.2
d - Vein 7.2, artery 7.5

A - Vein 7.3, artery 7.27

Median artery pH - 7.27
Median vein pH - 7.35

7

Which of these crosses the placenta the least?

A - TSH
B - T4
C - TRH
D - Propylthiouracil

A - TSH

Don't cross
- TSH

Does cross
- TRH

8

Which of the following drugs will affect the fetus adversely if used during pregnancy?

A - Flagyl
B - Heparin
C - Thiazide diuretics
D - Azothiaprine

C - Thiazide diuretics

Increase risk of malformations, fetal/neonatal electrolyte abnormalities, jaundice and thrombocytopenia

9

The most common cause of term infant mortality is:

A - congenital abnormalities
B - infection
C - NEC
D - Bronchopulmonary dysplasia
E - IVH

B - infection

10

You see a patient with bipolar disease on Lithium 900mg /day. The risks to the fetus include:

A - CNS abnormalities
B - Cardiac abnormalities
C - Renal anomalies
D- Postmaturity

B - Cardiac abnormalities

Ebstein's anomaly - septal and posterior leaflets of tricuspid valve are displaced towards the apex of the right ventricle --> tricuspid regurgitation --> RA dilatation
Foramen ovale doesn't close sometimes
Rx: valve replacement and closure of the foramen ovale

11

Phenytoin is associated with all of the following except:

A - IUGR
B - Mental retardation
C - Spina bifida
D - Cardiac anomalies
D - Cleft palate

C - Spina bifida

"Fetal dilantin syndrome"
Growth deficiency
Developmental delay
Characteristic facies
GU abnormalities
Cleft palate

12

Neonatal thyroid function which are true:

a - increase in thyroxine after birth in preterm but not term infants
b - neonatal rise in T4 due to TSH increase
c - thyroxine is involved in shivering but not non-shivering thermogenesis

b - neonatal rise in T4 due to TSH increase

Serum TSH concentrations rise abruptly
A/w exposure to cold
Initial surge in TSH --> stimulates T4 secretion
T4 peaks 24-36h of life
Serum T3 also rises at same time


serum TSH levels rise rapidly in the first minutes after birth and peak at 30 minutes of postnatal life

13

A woman with bipolar affective disorder on lithium presents at 11/40. Serum lithium is 1.0 (0.9-1.4). She should be told:

a - lithium is suspected of causing heart defect
b - to cease lithium now will reduce risk to the baby
c - to reduce dose will reduce risk to baby
d - she should have CVS
e - should have amniocentesis at 16/40

a - lithium is suspected of causing heart defect

14

Which drug should not be used in lactation

a - Amiodarone
b - Warfarin
c - Digoxin
d - Propylthiouracil

a - Amiodarone

Secreted in high amounts in breastmilk
Contraindicated in breastfeeding
Rare cases of hypothyroidism in baby

PTU - safe 1st trimester, later in pregnancy risk of maternal liver disease, safe in breastfeeding

Warfarin - avoid in 1st trimester, 2nd and 3rd can give, safe in breastfeeding

Digoxin - minimal amounts in breastmilk, in pregnancy crosses placenta but not known to be harmful - lacking data

15

Which of the following is the most common cause of neonatal hyperthyroidism?

a - previous thyroidectomy on thyroxine
b - Graves disease treated with PTU
c - Maternal exposure to Iodine 131 during pregnancy
d - Iodine deficiency goitre
e - Maternal Hashimoto’s thyroiditis

b - Graves disease treated with PTU

TSH receptor stimulating antibodies (TSI)
PTU doesn't reduce TSI
TSI can cross the placenta

16

Most likely cause of perinatal mortality with diabetes?

a - fetal hypoglycaemia
b - congenital abnormality
c - APH
d - Fetal hyperinsulinaemia
e - PIH

d - Fetal hyperinsulinaemia

PEDERSON HYPOTHESIS
Maternal high glucose --> fetal hyperinsulinaemia --> high rates of fetal growth and subcut fat and glycogen deposition in liver --> increased fetal metabolic rate which can provoke fetal hypoxia

Congenital abnormality - 2-4 fold increased risk
- T1DM 2.9-7.5%
- T2DM 2.1-12.3%

17

Management in suspected fetal hypothyroidism?

a - give mother thyroxine
b - intraamniotic thyroxine
c - do nothing in utero but give thyroxine to neonate
d - none of the above

c - do nothing in utero but give thyroxine to neonate

Usually due to TSH receptor blocking antibodies crossing the placenta
- More common in women with atrophic thyroiditis rather than Hashimoto's
2% of congenital hypothyroidism

Refer MFM for serial USS

18

To pick up most no. of causes of neonatal hypothyroidism

a - TSH only
b - TSH first and if elevated do T4
c - Both TSH and T4
d - T3

b - TSH first and if elevated do T4

TSH on guthrie card
Screening for congenital hypothyroidism

19

Primip with no antenatal care delivers 1000 gm baby at 28/40. What is most likely cause of death?

A - sepsis
B - temp instability
C - intracranial haemorrhage
D - RDS

D - RDS

(as per Lancet article)

20

What features are suggestive of neonatal hypothyroidism – except?

a - hypotonia
b - atypical facies
c - open posterior fontanelle
d - slow heart rate in labour

b - atypical facies

swollen eyes, but no other atypical facies

21

Which one crosses the placenta

a - heparin only
b - warfarin only
c - heparin and warfarin
d - none of the above

B - warfarin only

22

Which one causes stipling of the epiphysis?

a - heparin only
b - warfarin only
c - heparin and warfarin
d - none of the above

b - warfarin only

stipling = pattern of focal bone calcification
- caused by warfarin, hypothyroidism, alcohol

23

What is the risk of congenital heart block with anti Ro + La antibodies?

A - 5%
B - 10%
C - 20%

A - 5%

24

most likely to be assoc with oligohydramnios:

A - VSD- isolated
B - posterior urethral valves
C - PUJO – unilateral
D - duodenal atresia

B - posterior urethral valves

Keyhole sign on USS - distended bladder, oligo

PUJO = pelvic ureteric junction obstruction

25

most likely to be assoc with abnormal karyotype

A - VSD- isolated
B - posterior urethral valves
C - PUJO – unilateral
D - duodenal atresia

D - duodenal atresia

30% of duodenal atresia with have T21
3% of those with T21 will have duodenal atresia

Vactryl association

26

Which of the following cannot be detected on routine US scanning?

a - hydrocephalus
b - exomphalos
c - cystic fibrosis
d - cleft palate

c - cystic fibrosis

27

A previously healthy 4 day old infant becomes hypotensive and dehydrated, low Na and high K. Which definitive Ix likely to be positive next?

raised 17-OH progesterone (>200)

CAH
- salt-wasting crisis

28

Predominant Hb type in neonate?

a - HbA
b - HbA2
c - HbF
d - HbH

c - HbF

29

US (picture given) at 17/40 shows ‘frog’s eyes’ and maternal serum AFP 4 times above normal range. Following options in counselling parents?

a - defect unclear as not often seen at 17/40
b - neonatal survival is poor (<48hrs)
c - prompt termination required to avoid serious maternal complications
d - fetus will survive, but with significant morbidity

b - neonatal survival is poor (<48hrs)

frog eyes = anencephaly

30

What has the least effect on the fetus when given to the mother?

a - TSH
b - TRH
c - Thyroxine

a - TSH

Doesn't cross