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Flashcards in fetal / neonatal Deck (71)
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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


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


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)


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


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


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


Which of these crosses the placenta the least?

B - T4
D - Propylthiouracil


Don't cross

Does cross


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


The most common cause of term infant mortality is:

A - congenital abnormalities
B - infection
D - Bronchopulmonary dysplasia

B - infection


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


Phenytoin is associated with all of the following except:

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


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


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


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


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


Most likely cause of perinatal mortality with diabetes?

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

d - Fetal hyperinsulinaemia

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%


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


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


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


(as per Lancet article)


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


Which one crosses the placenta

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

B - warfarin only


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


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

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

A - 5%


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


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


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

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

c - cystic fibrosis


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)

- salt-wasting crisis


Predominant Hb type in neonate?

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

c - HbF


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


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

a - TSH
b - TRH
c - Thyroxine

a - TSH

Doesn't cross