Twin-to-Twin Transfusion - ANSWER blood flows unevenly between babies (shared pla-
centa)
Donor twin in TTTS - ANSWER Receives decreased blood volume->smaller
Decreased perfusion = poor urinary output = low amniotic fluid
Appearance of donor twin in TTTS - ANSWER Anemic & pale
Recipient twin in TTTS - ANSWER Receives increased blood volume = strain on heart = po-
tential heart failure = high amniotic fluid
Appearance + s/s of Recipient twin in TTTS - ANSWER Red "ruddy" color, polycythemia,
high HCT and blood prone to clot
When does chronic twin to twin transfusion syndrome start? - ANSWER between 12-26
weeks
What are complications of chronic twin to twin transfusion syndrome? - ANSWER very
serious, can't be delivered due to immaturity; most do not survive and if they do = multiple
birth defects
Acute twin to twin transfusion syndrome - ANSWER Occurs suddenly when there is a
huge difference in blood flow between twins> Could be related to death or illness in one
twin (the donor) which floods the recipient twin with volume. Better prognosis with ATTS
Risks of folate deficiency - ANSWER High risk of neural tube defects
1
,Recommended daily folic acid intake - ANSWER folic acid 0.4-0.8mg which is 400-800
mcg
Maternal LUPUS (SLE) might lead to what in the neonate? - ANSWER High risk of heart
block in newborn
What is the pathophysiology of maternal lupus (SLE) effecting the neonate? - ANSWER
Collagen tissue overgrowth blocks electrical activity of the babies heart
Lupus mom taking steroids during pregnancy will need - ANSWER a stress dose of ster-
oids with labor which can lead to increase incidence of NEC (necrotizing enterocolitis) in in-
fant
What is the risk of a lupus mom receiving steroids? - ANSWER There is an increased inci-
dence of necrotizing enterocolitis (NEC) in infant and increased BP w/ long term use
What if a lupus mom doesn't get stress dose of steroids? - ANSWER There is a risk of Ad-
dison's disease, think SHOCK of the adrenals not having enough stress hormones = low BP
What is the immune response of hydros fetalis? - ANSWER Rh- mom attacks Rh+ fetus
What is the risk of maternal hyperthyroidism? - ANSWER Increase risk of preterm deliv-
ery (PTD)
What are complications of hypothyroidism (Hashimoto's disease)? - ANSWER Infertility
issues, increased risk of fetal brain & spinal cord problems, PTD
McBurney's point tenderness - ANSWER Appendix problem
2
, Avoid what pain medicine w/ drug addicts or methadone users? - ANSWER No
NUBAIN/STADOL, will cause immediate withdrawal
Ptyalism (excessive secretion of saliva) patients should avoid - ANSWER Avoid starchy
foods
When can amniocentesis be performed? - ANSWER around 14-20 weeks,
before 14 weeks risk of = clubfoot
15-16 weeks risk of = respiratory distress
What is the L:S ratio that indicates adequate surfactant production? - ANSWER > 2:1 =
Mature lungs
What is the desired L:S ratio in DM? - ANSWER 3:1
But contaminated amniotic fluid (blood or meconium) can give false ratios
What is the L:S ratio? - ANSWER lecithin/sphingomyelin ratio, a test to determine fetal
lung maturity in the amniotic fluid
Limitation of chorionic villus sampling (CVS) - ANSWER Can't diagnose NTD/Spina Bifida,
typically performed between 10-13 weeks
Early decelerations occur due to - ANSWER vagal response (increased ICP d/t head com-
pression)
NST Criteria for Reactivity - ANSWER NST reassuring x 24 hours
Reactivity
= 15 beats x 15 seconds >32 weeks or 10 beats x 10 seconds <32 weeks
3
centa)
Donor twin in TTTS - ANSWER Receives decreased blood volume->smaller
Decreased perfusion = poor urinary output = low amniotic fluid
Appearance of donor twin in TTTS - ANSWER Anemic & pale
Recipient twin in TTTS - ANSWER Receives increased blood volume = strain on heart = po-
tential heart failure = high amniotic fluid
Appearance + s/s of Recipient twin in TTTS - ANSWER Red "ruddy" color, polycythemia,
high HCT and blood prone to clot
When does chronic twin to twin transfusion syndrome start? - ANSWER between 12-26
weeks
What are complications of chronic twin to twin transfusion syndrome? - ANSWER very
serious, can't be delivered due to immaturity; most do not survive and if they do = multiple
birth defects
Acute twin to twin transfusion syndrome - ANSWER Occurs suddenly when there is a
huge difference in blood flow between twins> Could be related to death or illness in one
twin (the donor) which floods the recipient twin with volume. Better prognosis with ATTS
Risks of folate deficiency - ANSWER High risk of neural tube defects
1
,Recommended daily folic acid intake - ANSWER folic acid 0.4-0.8mg which is 400-800
mcg
Maternal LUPUS (SLE) might lead to what in the neonate? - ANSWER High risk of heart
block in newborn
What is the pathophysiology of maternal lupus (SLE) effecting the neonate? - ANSWER
Collagen tissue overgrowth blocks electrical activity of the babies heart
Lupus mom taking steroids during pregnancy will need - ANSWER a stress dose of ster-
oids with labor which can lead to increase incidence of NEC (necrotizing enterocolitis) in in-
fant
What is the risk of a lupus mom receiving steroids? - ANSWER There is an increased inci-
dence of necrotizing enterocolitis (NEC) in infant and increased BP w/ long term use
What if a lupus mom doesn't get stress dose of steroids? - ANSWER There is a risk of Ad-
dison's disease, think SHOCK of the adrenals not having enough stress hormones = low BP
What is the immune response of hydros fetalis? - ANSWER Rh- mom attacks Rh+ fetus
What is the risk of maternal hyperthyroidism? - ANSWER Increase risk of preterm deliv-
ery (PTD)
What are complications of hypothyroidism (Hashimoto's disease)? - ANSWER Infertility
issues, increased risk of fetal brain & spinal cord problems, PTD
McBurney's point tenderness - ANSWER Appendix problem
2
, Avoid what pain medicine w/ drug addicts or methadone users? - ANSWER No
NUBAIN/STADOL, will cause immediate withdrawal
Ptyalism (excessive secretion of saliva) patients should avoid - ANSWER Avoid starchy
foods
When can amniocentesis be performed? - ANSWER around 14-20 weeks,
before 14 weeks risk of = clubfoot
15-16 weeks risk of = respiratory distress
What is the L:S ratio that indicates adequate surfactant production? - ANSWER > 2:1 =
Mature lungs
What is the desired L:S ratio in DM? - ANSWER 3:1
But contaminated amniotic fluid (blood or meconium) can give false ratios
What is the L:S ratio? - ANSWER lecithin/sphingomyelin ratio, a test to determine fetal
lung maturity in the amniotic fluid
Limitation of chorionic villus sampling (CVS) - ANSWER Can't diagnose NTD/Spina Bifida,
typically performed between 10-13 weeks
Early decelerations occur due to - ANSWER vagal response (increased ICP d/t head com-
pression)
NST Criteria for Reactivity - ANSWER NST reassuring x 24 hours
Reactivity
= 15 beats x 15 seconds >32 weeks or 10 beats x 10 seconds <32 weeks
3
