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Pregnancy HY Flashcards

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1
Q

Endometrial glands invades myometrium.
Symmetrical, soft large (globular), boggy uterus.
± Myometrial thickening on u/s
Dx/Tx & Definitive Tx?

A

Adenomyosis
Mirena IUD
(levonorgestrel-releasing intrauterine device)
Definitive tx: Hysterectomy

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2
Q

Irregularly enlarged uterus
Well-circumscribed masses in the myometrium on u/s
Dx?

A

Uterine leiomyoma - Fibroma

(Elevated risk of spontaneous abortion)

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3
Q

1 hour Oral Glucose Tolerance test done at

A

24w visit

(if abnormal do 3hr test)

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4
Q

When 1st dose of Rhogam if pt is Rh (–) & no antibodies

A

28w

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5
Q

when do all pregnant women get the Tdap vaccine?
Other recommended vaccines in pregnancy?

A

T-Dap (27w–)
HepB (if non-immune)
Flu vaccine (non-live)

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6
Q

1st Prenatal Visit (~10w) screening (5):

A

HIV, HBVsAg, Syphillis
UA/Ucx (Asymptomatic Bacteuria- test of cure)
Rh Status check (Indirect Coombs if blood type is Neg)

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7
Q

Anal Vaginal GBS swab indicated when

A

35-37w

(if premature labor, do it at that time)

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8
Q

Pre-Term Labor <32w
what is given

A

Magnesium
Betamethasone
Ampicillin/Amoxicillin
± Indomethacin (tocolytic)

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9
Q

Pre-Term Labor <34w
what is given

A

2 doses Betamethasone
Ampicillin/Amoxicillin
± Nifedipine (tocolytic )

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10
Q

Premature rupture of Membrane <34w
Mom or Fetus have compromise (like infection, bleed, etc)
NBSIM

A

Immediate Delivery

(Mg if <32w +Betamethasone + Ampicillin/Amoxicillin)

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11
Q

Premature Rupture of Membrane <34w
Mom & Fetus have no infection, bleeding, or distress
NBSIM?

A

Betamethasone
Ampicillin/Amoxicillin
Fetal Monitoring
Expectant management

<32w Magnesium

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12
Q

3 days post-partum what care does the mother receive?

A

2nd RhoGam dose (if no Abs)

(Baby should get 1st HBV vaccine and Vit K)

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13
Q

at 10w visit if mom is Rh (–) NBSIM?

NBSIM: If results (–) or (+)?

A

Indirect Coombs test
(check for ABs)

Negative ABs → RhoGAM at 28w (& again 3d PP)

Positive ABs → Check Father’s Rh status

FYI (out of test’s scope)
if father Rh + baby will need Doppler u/s of MCA for anemia

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14
Q

Polyhydraminos happens when baby pees a lot
or isn’t swallowing/drinking enough.
Causes (4)?

A

Twins
Diabetic Mother
Anencephaly (can’t swallow)
obstruction to swallowing (esophageal/intestinal atresias)

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15
Q

Oligohydraminos happens when baby can’t pee.
List 3 causes & feared complication?

A

Renal Agenesis
Urinary Obstruction (PUV/VUR)
Mom used ACE-I/ARBs (teratogens)

Urinary tract anomaly→olygohydraminos→Fetal Compression→ Potter Sequence:

Lung Hypoplasia/NRDS, Limb deformities, Face deformities

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16
Q

2 mcc of new born seizures:

A

Hypoglycemia → Diabetic mom, Beckwith Wiedemann
Hypocalcemia → Digeorge syndrome

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17
Q

Belly Size and Baby Age size discrepancy
NBSIM? Interpret outcome.

A

NST (Non-invasive Stress Test)
──
Reactive= 2 acceleration in 20 minutes → GOOD
Non-Reactive= get a BPP (or try waking baby up)

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18
Q

Non-Reactive Stress Test
NBSIM? Interpret Outcome.

A

Biophysical Profile (BPP)
──
Sore 0-2 = C-section now
Score 4,6 = Contraction Stress Test
──
(BPP Score will be given on test!!!)
(CST Results out of scope)

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19
Q

11 weeks gestation (< 20w)
Hyperemesis gravidarum
HTN
Heavy vaginal bleeding
Huge Size >Date discrepancy
± theca lutein cysts

Note: The NBME may mention these as speculum blue lesions indicating vaginal mets.

Dx?

A

Gestational trophoblastic Dz

(MolarPregnancy)

Theca lutein Cystic mass causing size discrepancy

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20
Q

30F at 35 weeks
2 day (ACUTE) history of N/V
RUQ Abd Pain + Jaundice
Hypoglycemia
Leukocytosis, Normal/↓PLTs
↑PT/PTT/Fibrin degradation
↑ ↑ AST/ALT ± ↑ GGT
Indirect Bilirubin > direct Bilirubin
↑ Creatinine
Dx/TX?

A

Acute fatty liver of pregnancy
(DIC like picture)

Tx: immediate delivery

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21
Q

30F at 35 weeks
2 week (chronic) history of Itchiness
RUQ Abd Pain/ Jaundice
Leukocytosis, Normal PLTs
↑ Total serum bile acid
↑ /nl Bilirubin
↑ AST/ALT
Dx/Tx?

A

Intrahepatic Cholestasis of Pregnancy
Tx: Ursodeoxycholic acid + Deliver at 36w
(or immediately if 37w)

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22
Q

Pre-eclampsia/Eclampsia patient with MAHA (schistocytes) with HTN, Anemia & low PLTs
↑AST/ALT
Evidence of hemolysis
(↑LDH, ↓ Haptoglobin, ↑Indirect Bilirubin)
Dx/Tx?

A

HELLP syndrome
Immediately Deliver
+ Magnesium (mom) + Hydralazine (for HTN)
─

Hemolysis (↓ Hb/Haptoglobin, ↑ LDH, ↑ Indirect Bili)
Elevated Liver enzymes (↑ AST/ALT)
Low Platelets

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23
Q

How to differentiate between HELLP syndrome and Acute Fatty Liver of Pregnancy?

A

AFLP → has hypoglycemia &↑ PT/PTT/ fibrin degradation product. (DIC like)

HELLP → Normal PT & PTT (no fibrin degradation)

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24
Q

(classic presentation)
Severe SOB, cough, hemoptysis, and weight-loss 3 weeks after an abortion.
Dx?

A

Choriocarcinoma

Hematogenous spread loves to go to the lungs!

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25
MC kind of vaginal malignancy: BRF for primary vaginal carcinoma: Treatment/Cx:
vaginal malignancy → **Squamous cell cancer** BRF → HPV 16/18/30s Tx: Surgery & Radiation (adhesions/ vaginal stenosis)
26
Glandular cell vaginal malignancy. Dx?
Clear Cell Adenocarcinoma of the Vagina (fetus exposed to DES = T-shaped uterus)
27
B-HCG cutoff to see a gestational sac on an ultrasound. bHCG > ____
> 2000
28
Pap-smear guidelines for pts after a Hysterectomy (s/t endometrial **hyperplasia/cancer**)
Keep doing pap-smears of **vaginal cuff** (only stop if hysterectomy was s/t benign reasons)
29
4ft tall female with amenorrhea. Dx? Classify the hypogonadism
Turner’s Syndrome Hypergonadotropic Hypogonadism Hypergonadotropic (↑ FSH/LH & ↑ GnRH) Hypogonadism (↓ Estrogen) s/t streak ovaries
30
18F with Tanner 5 breasts & pubic hair with Amenorrhea No uterus. Dx?
Mullein agenesis (MRKH syndrome) Breast present = Estrogen is okay Pubic hair present = Testosterone/Progesterone is okay
31
Supermodel having a BMI of 17 with amenorrhea. Classify the hypogonadism? GnRH FSH LH E2 levels?
Hypogonadotropic Hypogonadism HPG axis shut down= ↓ FSH/LH, ↓ GnRH (gonadotropins) & ↓ Estrogen (gonads)
32
1º Amenorrhea with severe lower abdominal pain at the end of the month. Bulge in vaginal vault on exam. Dx?
Imperforate hymen Transverse vaginal septum (rare, 2nd option) Tx: Surgery
33
Treatment for Primary Dysmennorhea? PE is normal
1st line: NSAIDs 2nd line: OCPs s/t prostaglandins causing violent uterine contraction
34
25F Infertile w/Painful menses, painful poop, painful sex. Dx/BRF/Temporary & Definitive Tx?
Endometriosis (+) Family history Temporary Tx: OCPs Definitive Tx: Hysterectomy Patho: Endometrial glands/stroma are outside the endometrium (mc in the ovaries chocolate cysts)
35
In Endometriosis where is one common attachment point affected? how is it definitively diagnosed & treated?
Can attach to **utero-sacral Ligament** (HY) Definitive dx → Laparoscopy Definitive tx → Hysterectomy
36
Heavy menstrual bleeding, **symmetrically soft/tender** uterus on bimanual exam. Dx: Tx: Definitive dx: Definitive tx:
Adenomyosis Tx: Mirena IUD Definitive tx: Hysterectomy Definitive dx: Laparoscopy (endometrial glands in myometrium)
37
Most effective emergency contraception.
Copper IUD
38
What kind of contraception should be avoided in a postpartum female?
Estrogen containing contraception
39
Contraception with the need for Vit D/Ca supplementation.
Depo-Provera Reversible decr in bone mineral density Delayed Return to fertility (progestin injectable q3m)
40
23F abdominal pain, vaginal bleeding + Positive B-HCG Dx/Tx?
Ectopic Pregnancy Tx: Methotrexate
41
MTX contraindications (2)
bHCG > 5000 Fetal cardiac activity present
42
If pregnancy is viable bHCG should
DOUBLE every 48hrs
43
PCOS patient desiring pregnancy.
**Clomiphene** Letrazole (Letrazole inhibits aromatase thus lowers E2)
44
PCOS criteria? Must meet **2** for dx Treatment of PCOS?
1. Hyperandrogenism 2. Irregular menses (Anovulation) 3. Polycyctic ovaries on U/S Tx: **Weight-loss + OCPs**
45
Mucopurulent vaginal discharge & Lower Abdominal/ Adnexal tenderness Dx/Tx? Now has RUQ pain → dx?
Pelvic inflammatory Disease CTX + Doxycycline (or Azithromycin) RUQ pain → spread to liver capsule (Fitz Hugh Curtis Syndrome)
46
19F persents with AMS, Sudden high fevers, Red skin, + palmar exfoliating rash; recent h/o menses Dx?
Toxic Shock Syndrome (fyi emperic abx → Vanco + Clindamycin)
47
30F presents with Fever & Unilateral swelling/fluctuant mass in inferior labia. Dx/Tx?
Bartholin Gland Abscess Incise & Drain + WORD catheter (for drainage & ↓recurrence)
48
Increased UTI risk in pregnant women s/t
High Progestin (relaxes smooth muscle in ureters →urinary stasis)
49
NBSIM of Asymptomatic bacteriuria in a pregnant pt?
Amoxicillin Cephalexin or Nitrofurantoin → Get urine Cx as **TEST of CURE**
50
Severe nausea, vomiting, and weight loss in a 23 yo F at 11 weeks gestation. Dx/Tx? If admitted, what is the tx?
Hyperemesis Gravidarum **Doxylamine + Vit. B6** Inpatient tx→ N Saline + **Thiamine** + Odansetron
51
Causes of increased MSAFP (2)
Incorrect Dating Neural Tube Defects
52
NBSIM if pt has ↑Maternal **AFP**? NBSIM if pt has (+) cell **Free DNA**?
For both 1st get an **Ultrasound** →Amniocentesis, After u/s
53
NRST with a normal FHR but no accels and the child is not moving. What is your NBSIM?
Vibro-acustic stimulation (fetus is sleeeping)
54
Teratogenic drugs causing fetal: Renal Anomalies/failure: Ashen gray newborn + cardio collapse: R sided heart/Tricuspid valve problems: Poor Bone development: Limb hypoplasia: Intracranial hemorrhage + IUGR: Aminoglycosides → Ototoxicity Valproate → neural tube/spine defects Phenytoin → cleft palate, phalanx/fingernail hypoplasia
Renal failure: ACE/ARBs Ashen gray newborn: Chloramphenicol R sided heart problems: Lithium Bone development: Tetracycline Limb hypoplasia: Thalidomide ICH + IUGR: Warfarin
55
BRF for preterm labor.
Prior h/o Pre-term labor
56
**Ultra HY** Obstetric complication associated with: **Bacterial vaginosis** **Asymptomatic bacteriuria** Ureaplasma infection
Pre-Term Labor Pre-Term Delivery
57
Woman with **Recurrent 2nd trimester (13-24w) pregnancy losses** Dx/ Risk Factor/ Emergent Tx/ Ppx?
**Cervical incompetence** H/o **Conization** or **LEEP** Emergent tx: Cervical **Cerclage** Ppx: **Vaginal Progestin Suppositories** –––– *memory device: second trimester = cervical cerclage*
58
Pregnant pt with h/o Eclampsia NBSIM?
Start Aspirin (stop at 32w)
59
Preventive measure to reduce risk of neonatal/fetal infection in women with **prolonged rupture of membranes**:
↓ # of digital vaginal exams
60
1. NBSIM of prolonged rupture of membranes at >37 weeks (full term)? 2. NBSIM if prolonged rupture of membranes > 18 hrs?
1. give **Oxytocin** 2. give **Ampicillin** or Amoxicillin (for GBS ppx)
61
Criteria for prophylactic C section in an Infant of DM?
if estimated fetal weight is > 4,500g > 9.15 lbs
62
Gestational HTN is diagnosed after ___ and at what BP?
≥ 20 weeks 140/90
63
Pre-Eclampsia vs Eclampsia
Preeclampsia = gestational HTN + Proteinuria Eclampsia = gestational HTN + Proteinuria + **Seizure**
64
Management of Eclamptic Seizure (2)?
IV Magnesium Immediate Delivery (after seizure is done)
65
Antihypertensives in pregnancy (4)
(Hypertensive moms love nifedipine) Hydralazine Methyl-dopa Labetalol Nifedipine
66
34F with AMS and decreased DTRs being treated for pre-eclampsia. Dx/Tx?
Hypermagnesemia (toxicity) **CALCIUM GLUCONATE** ( & **stop Mg**)
67
Gestational DM pathophysiology s/t ____ that causes **insulin resistance**
Human Placental Lactogen (placental hormone)
68
Drug of choice for tx of Gestational DM?
**Insulin** 2nd line: METFORMIN 3rd line: Glyburide (Sulfonylurea)
69
Newborn with Respiratory Distress born to mom with gestational diabetes. Explain Pathophysiology?
**Low** Surfactant (Baby has a lot of **insulin suppresses surfactant** synthesis)
70
Newborn with Small Brain (microcephaly) + Sensory Neural Hearing Loss + Periventricular Calcifications Dx?
CMV
71
Newborn with Macrocephaly (Hydrocephalus) + Chorioretinitis (eye-problems) + **diffuse** Intracranial Calcifications Dx?
Toxoplasmosis
72
pt w/ hx of Herpes NBSIM: If **visible genital lesions** during Labor? If **no** visible genital lesions?
(+) Lesions = C-Section No lesions = Vaginal delivery
73
NBSIM if Hep BSAg (+) mom is delivering a newborn?
Give baby: HepB vaccine + HepB Ig (active and passive immunity)
74
Biggest NBME RF for fetal tachycardia?
Maternal Fever (Nl: 110-160)
75
Baby’s anterior shoulder is stuck during delivery (Dystocia). NBSIM?
1. Apply **Suprapubic pressure** 2. If that doesn't work do McRoberts Maneuver Put woman **knee to chest position & apply suprapubic pressure**
76
Pregnant pt with High Fever + Fetal HR 190 Uterine tenderness, foul smelling vaginal d/c on exam Dx/Tx/NBSIM?
Chorioamnionitis Tx: Amp-Gentamicin Immediate Delivery
77
Preterm **labor** management <37w **Uncomplicated** NBSIM?
Betamethasone Ampicillin/Amoxicillin (<35w or GBS unk/+)
78
MCC of postpartum hemorrhage & treatment
Uterine Atony Oxytocin
79
3 days postpartum + uterine tenderness. Dx/Tx/BRF?
Endometritis Clindamycin + Gentamicin BRF → C-Section (gently clean the uterus)
80
When do you admit pt with Post Partum Depression (2)?
1. **PP Psychosis** (hearing voices, Seeing things; delusions) 2. **Physical evidence** of suicide or infanticide (bought a gun, Harmed baby on purpose)
81
Work up for pulmonary embolism in pregnant women? First dx test: 2nd dx test if 1st normal → 3rd dx test if 2nd test low risk →
1. **Ultrasound** compression (+DVT → Heparin) 2. **V/Q scan** (high probability → **Heparin**) 3. Low probability → **CT Angiography** chest
82
Algorithm on NBMEs for determining the cause of 3rd trimester (≥27w) vaginal bleeding. 1st Ask yourself → Painful or Painless 2nd Ask yourself → FHRT normal or abnormal 3rd Ask yourself → drugs, trauma or C-section?
**Painless** 1. vasa previa (Fetal HRT abnormalities present) 2. placenta previa (**No** Fetal HRT abnormalities) **Painful** 1. Placental abruption (cocaine or trauma) 2. Uterine Rupture (h/o C-section → Loss of fetal station or palpable fetal parts in abdomen) *loss of station = # becoming more + *fetal parts are felt as bumps on abdomen or uneven abdomen)
83
Contraindicated exams with vasa/placenta previa. What mode of evaluation is okay?
**Digital Vaginal Exam** Speculum Exam ---- Transvaginal ultrasound ---- Vasa Previa → C-section Placenta Previa → C-section if **low lying**
84
Mgt of **placenta previa** in **unstable** mom in active labor + FHRT **abnormalities** **versus** Mgt of **placenta previa** in an asymptomatic mom **not in labor**
Unstable → C-section immediately Stable → Pelvic Rest (no sex) /Supportive care
85
Management of vasa previa & uterine rupture
C-section (immediate)
86
31F at 29 weeks gestation presents with a 3 hr history of painful contractions that occur every 3-4 mins. **Consistent Contractions occurring at <37w is Pre-Term labor** Tocolysis for pts >32w Tocolysis for pts <32w 2 protective medications: Antibiotic:
Tocolysis >32w → Nifedipine Tocolysis <32w → Indomethacin Protective medications <32w: Magnesium (neuroprotective) <34w: Betamethasone Antibiotic: → Amoxicillin or Ampicillin (GBS ppx for anyone in pre-term labor)
87
1hr Glucose Tolerance test for GDM screening is recommended between what weeks?
24–28w
88
pt is 17w pregnant and has abnormal Quad Screen Results. NBSIM?
**Amniocentesis** for **Karyotype** Analysis (only if **15-18w**)
89
Pregnant pt with hx of 3rd Trimester IUFD. NBSIM?
Obtain NST in 3rd Trimester
90
Syndrome that presents with pheochromocytomas or medullary thyroid cancer
MEN 2A & 2B
91
____ is generally the first manifestation of MEN 2A
medullary thyroid carcinoma (Hypocalcemia)
92
FMH of neuroendocrine tumors ↑ Calcitonin ↓ Calcium Dx?
Medullary Thyroid Carcinoma (Men 2A >2B)
93
27M h/o **Ulcerative Colitis (on infliximab)** presents with severe **bloody diarrhea**, LLQ abdominal pain, and malaise. Colonoscopy: erythematous mucosa & superficial ulcers continuously from **rectum to proximal descending colon**. Biopsy: **Intracellular inclusion bodies**. Dx/Tx?
CMV Colitis Ganciclovir
94
Excessive vomiting causes metabolic _____ Excessive Diarrhea causes metabolic ____
vomiting = Hypokalemic, **Hypo**chloremic metabolic **alkalosis** Diarrhea = **Hyper**chloremic metabolic **acidosis** (non-anion gap)
95
Female s/p **abortion or miscarriage** presents with **rising bHCG levels** (± levels were initially decreasing) Dx/Tx?
**Gestational Trophoblastic dz (neoplasia)** Tx: **Resection + Chemo** vs Choriocarcinoma → presents with hemoptysis ± multiple theca cysts. Monitor hCG for 1 year ± Hysterectomy **FYI**: new-onset HTN, proteinuria, or end-organ dysfunction at **< 20 weeks** gestation suggests GTDz
96
Fever + diffuse maculopapular rash in hands and feet. Dx/Tx?
2º Syphilis Penicillin
97
Baby's born to mom's with SLE or Sjogrens at risk for what defect?
Complete AV Block
98
Gestational hypertension Pregnancy-induced hypertension (SBP ≥ 140 or DBP ≥ 90) **w/o proteinuria or end-organ dysfunction** Diagnosed at ____ weeks
≥ 20 weeks
99
**Preeclampsia** Gestational HTN (≥20w) + ____ or ____. **Eclampsia** Gestational HTN (≥20w) + new-onset **seizures**
end-organ dysfunction (i.e. lab abnormalities: LFTs etc) proteinuria ─ Occurrence of new-onset HTN, proteinuria, or end-organ dysfunction at **< 20 weeks** gestation is suggestive of **gestational trophoblastic disease**.
100
Fetal heart Rate Tracings Mnemonic VEAL CHOP
**V**ariable decels → **C**ord compression **E**arly decels → **H**ead compression **A**ccelerations → **O**kay **L**ate decels → **P**lacental insufficiency/ischemia
101
Fetal lung maturity by amniocentesis → Check ___:___ ratio Mature if > ___:___
Lecithin to Sphingomyelin >2:1
102
Contraindications to Estrogen HRT E2 Contraceptives (6)
≥35 F who **actively smokes** Severe HTN h/o VTE dz → DVT, PE, Stroke, MI h/o Breast Cancer h/o Migraines **with** Auras Hepatic Adenoma
103
Symmetric IUGR causes (3) (small Head & Body)
TORCH infections Chromosomal Abnormality Small/Skinny mother
104
Asymmetric IUGR causes (4) (normal Head + small Body)
HTN Diabetes SLE/APLS Pre-Eclampsia (s/t placental insufficiency or anomalies)
105
Fundal height from pubic symphysis to belly button = ___ weeks EGA
30 weeks
106
Order of reproductive development in girls:
TAM Thelarchy (boobs 8 yo) → Adrenarche (Pubes 9 yo) → Menarchy (10 yo)
107
Contraception associated with delayed return of fertility.
Depo-Provera
108
The 3 polymicrobial OBGYN infections:
Bartholin Gland Abscess Endometritis Chorioamnionitis
109
Female + breast mass just below the nipple. Is breast feeding or was breast feeding. END of STORY → Dx? Classic location?
Galactocele Subareolar mass
110
Breast mass with recent breast trauma: dx/tx?
Fat Necrosis no tx
111
Woman on OCPs gets pregnant while on * st. John’s Wort * griseofulvin (Tinea) * carbamazepine (seizures, Trigeminal neuralgia, BPD) * phenytoin (seizures) * barbiturates * rifampin Why is that?
Cyp-P450 inducers ↑ enzymes that break down OCPs so OCPs don’t work
112
Lynch syndrome (AD) aka Hereditary nonpolyposis colon cancer (HNPCC) Affected pts develop a few small adenomas that rapidly progress to **colorectal cancer** at an **early age**. Also at ↑ risk of _____ cancer (4) Individuals are asymptomatic until they present with symptoms of advanced cancer. Mutation in ______ gene.
Gastric, Endometrial, Colon, and Ovarian cancers (GECkO) DNA mismatch repair (MMR) gene
113
Arrest of Labor (no cervical changes) Protraction of Labor (inadequate rate of cervical change) **Management for both**
Are contractions adequate (q2-3m + MVU>200)? Yes → C-section No → Oxytocin → C-section (if, oxy doesn’t work)
114
Contractions are adequate, if both are true. Contractions every ___ min MVU > ___ ---- Calculating MVU
every 2-3 min MVU >200 ---- (Amplitude of contraction) x (# of contractions in 10 min) Example: 2 minutes = 1 contraction of 60mmHg 2 min x 5 = 10 min 60mmHg x 5 = 300 MVU → Adequate
115
**Respiratory distress in newborns** Preterm → NRDS tx(2)/cx (3) --- Term → Transient tachypnea of newborn cause/notable finding/tx --- Postterm (>42w) → dx/tx
Surfactant deficiency = small lung volumes Cx: Retinopathy, Broncho-dysplasia, ICH Tx: **oxygen + surfactant** --- fluid remains in lung fissures s/t C-section no hypoxia Tx: Supportive care --- **Meconium aspiration syndrome** Tx: **Supportive care**
116
Stages of labor stage 1 (cervical ripening) Latent ( ___ cm) Null: <20h Multi: <14h Active (___ cm) Null: ≥ __ cm/h Multi: ≥ __ cm/h stage 2 (fetal delivery) Null: <3h Multi: <2h stage 3 (placental delivery) Null + Multi: < **30min**
stage 1 (cervical ripening) Latent (0–6 cm) Null: <20h Multi: <14h Active (6–10cm) Null: ≥1.2cm/h Multi: ≥1.5cm/h stage 2 (fetal delivery) Null: <3h Multi: <2h stage 3 (placental delivery) Null + Multi: < 30min
117
ToF 4 findings
Pulmonary stenosis s/t Overriding aorta RV hypertrophy (drains R & L ventricle) s/t VSD

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