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All about the glands
Double Trouble
Balloon Popped
Don't Rx this
Ease the pain
100
The recommended first line medical treatment for A2GDM.
What is Insulin? -Meformin is second line
100
A triangular projection of tissue that extends between layers of the intertwin membrane from a fused dichorionic placenta
What is a twin peak or lambda sign? -this is best seen between 10-14 weeks with an accuracy of ~95-98% to determine chorionicity -"T" sign indicates a monochorionic/diamniotic placenta
100
A fetus born with pulmonary hypoplasia, altered positioning of hands and feet, clubbed feet, hip dislocation and flattened facies, likely suffers from this syndrome.
What is Potters sequence or syndrome? -Prolonged oligohydramnios can result in Potter sequence -The reported frequency of skeletal deformations varies widely (1.5–38%) but many of these resolve with postnatal growth and physical therapy -Pulmonary hypoplasia after PROM before 24 weeks occurs in the range of 10–20%
100

Exposure to folic acid antagonists up until this many days/weeks after conception may inhibit neural tube closure.

What is 28 days/4 weeks? e.g. Carbamazepine, valproic acid, and methotrexate

100

This is the mechanism underlying maternal hypotension in the setting of regional anesthesia.

What is sympathetic blockade? -It occurs after about 10% of spinal or epidural blocks given during labor -result of the effects of local anesthetic agents on sympathetic fibers, which normally maintain blood vessel tone. -Vasodilation results in decreased venous return of blood to the right side of the heart, with subsequent decreased cardiac output and hypotension

200
The fetal thyroid gland begins concentrating iodine and synthesizing thyroid hormone at this gestation.
What is 12 weeks?
200
The Institute of Medicine recommends this range of pregnancy weight gain for obese patients with twins
What is 25 to 42 lbs? -essentially double the recommended weight gain for an obese patient with a singleton (11-20 lbs)
200
This percentage of patients will deliver within 7 days of the diagnosis of PPROM.
What is 50% -~ 25% within 48 hours -~ 75% within 14 days
200

This is the upper limit of radiation exposure recommended during pregnancy.

What is 5 rads? -exposure less than 8 weeks results in the “all or none effect”, with an increased risk of an SAB and no increased -exposure between ~8-15 weeks presents the highest risk of anomalies (e.g. microcephaly, cognitive delay, and IUGR) -this is based on data from pregnant women who survived the Nagasaki and Hiroshima attacks that showed ~ 50 rads or more of exposure resulted in the greatest increased risk

200
Regional anesthesia up to this dermatomal level is required for cesarean delivery.
What is T4? -the incision is usually around T12 dermatome -anesthesia is required up to T4 to completely block peritoneal discomfort, especially during uterine exteriorization -Anesthesia for a vaginal delivery would be up to T10
300
Ms. Jones' history is notable for hyperthyroidism. She presents to the office with complaints of fever and sore throat. Of note, she was recently started on propylthiouracil (PTU) 2 days ago. Her provider immediately stops her PTU due to concern for this development.
What is agranulocytosis? -Occurs in <1% of patients on thioamide drugs -Methimazole: concern for embryopathy (aplasia cutis) -PTU: concern for hepatotoxicity 0.1%
300
A pair of mono di twins were scanned at 23 weeks -twin A had an MVP of 1 cm and bladder could not be seen -twin B had an MVP of 10 cm -Dopplers in both twins were normal.
What is stage II twin to twin transfusion syndrome? Stage I – Oligohydramnios and polyhydramnios sequence, the bladder of the donor twin is visible. Stage II – Oligohydramnios and polyhydramnios sequence, but the bladder of the donor is not visualized. Stage III – Oligohydramnios and polyhydramnios sequence, nonvisualized bladder, and abnormal Dopplers. There is absent/reversed end-diastolic velocity in the umbilical artery, reversed flow in a-wave of the ductus venosus, or pulsatile flow in the umbilical vein in either fetus. Stage IV – One or both fetuses show signs of hydrops. Stage V – One or both fetuses have died.
300
This is the most common microbe that causes intramniotic infection.
What is Ureaplasma urealyticum? -2nd: any gram negative anaerobe (e.g. Bacteroides) -3rd: Mycoplasma hominis Other important ones: Gardnerella, GBS, Peptostreptococcus, E Coli, Enterococci
300
A small for gestational age neonate was born with nasal hypoplasia, stippled epiphyses on x-ray, hydrocephalus and cataracts. This was likely due to in utero exposure to this medication.
What is Coumadin? -the risk is greatest with exposure between 6-12 weeks with an incidence of 10-30%. -the risk is dose dependent with the risk increased with daily doses >5 mg
300
A patient with severe preeclampsia with severe features undergoes epidural anesthesia. Following anesthesia induction she complains of numbness and weakness in her fingers bilaterally. This is likely caused by.
What is a high epidural? -Numbness and weakness of the fingers and hands indicates that the level of anesthesia has reached the cervical level (C6-C8)
400
An increase in this accounts for the rise in total thyroid hormone level in pregnancy
What is thyroxine-binding globulin (TBG)?
400
These twins are formed by the division of the zygote 8-12 days after fertilization.
What are monoamniotic twins? Day 1 to 3: diamniotic, dichorionic placentation Day 4 to 8: diamniotic, monochorionic placentation Day 8-12: monoamniotic monochorionic placentation After day 13: conjoined twins
400
This tocolytic is recommended for the management of PPROM.
What is none? Best available evidence has shown that tocolysis in the setting of PPROM is associated: -lower risk of delivery within 48 hours -higher risk of chorioamnionitis -no significant improvement in neonatal outcomes
400

The following pattern of anomalies: oral cleft, growth restriction, microcephaly, hypoplasia of digits and nails, short nasal bone, and urogenital anomalies is associated with prenatal exposure to this medication.

What is Phenytoin? -up to 10% of infants prenatally exposed to Phenytoin will demonstrate fetal hydantoin sydrome

400
This is the recommended duration of time to withhold regional anesthesia after a therapeutic dose of Lovenox.
What is 24 hours? -12 hours is the recommended weight time after a prophylactic dose
500
This class of medications is used to treat prolactinomas.
What are Dopamine agonists? -Bromocriptine and Cabergoline
500
Women with uncomplicated mono-di twins can undergo delivery during this period.
What is between 34 to 37 6/7 weeks? Uncomplicated di-di twins: 38 weeks Uncomplicated mono-mono twins: 32–34 weeks
500
Induction of labor at 34 weeks in the setting of PPROM has been shown to reduce this ____ but may not reduce this ____.
What is chorioamnionitis but not neonatal sepsis Two randomized controlled trials evaluated delivery versus expectant management between 34 weeks and 37 weeks show that induction at 34 weeks: -did significantly reduce the risk of chorioamnionitis (1.6% at 34 wks vs. 5.3% at 37 wks -did not produce a statistically significant reduction in the rate of neonatal sepsis (2.7% at 34 wks vs. 4.1% at 37 wks; but the studies were under powered for this outcome
500
Exposure to this class of medication during the 2nd and 3rd trimester will likely cause fetal renal failure and oligohydramnios.
What are ACE inhibitors?
500
Puncture of this may result in a persistent headache after regional anesthesia.
What is the dura? -puncture of the dura results in spinal fluid leakage (i.e., a “wet tap”) -overall incidence is 1-3% among cases with a wet tap, up to 70% of patients will have a spinal headache