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CP2 OBGYN > ANC - P4 > Flashcards

ANC - P4 Flashcards

1
Q

Cause of CMV (cytomegalovirus)

A

Herpes virus 5

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2
Q

What is the most common virus to be transmitted to the fetus during pregnancy?

A

CMV

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3
Q

What % of pregnant women are infected by CMV during pregnancy

A

1%

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4
Q

What % of those infected w/ CMV pass on to fetus

A

1/3

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5
Q

Of fetuses infected, what % will be caused damaged by CMV

A

5%

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6
Q

When is the highest risk to fetus for CMV?

A

1st trimester

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7
Q

PS CMV (3)

A

Asymp usually
Flu like illness
Or glandular fever type illness - fever, splenomeg, imp LFT

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8
Q

Ix CMV

A

Viral serology - CMV IgM + G

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9
Q

Mx CMV (3)

A

Rx to fetal medicine specialist
No Tx for mother
TOP

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10
Q

Features of congenital CMV (6)

A 
IUGR
HSmegaly 
TTP 
Jaundice 
Microencephaly 
Chorioretinitis
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11
Q

% mortality congenital CMV

A

20-30%

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12
Q

What % of pregnant F have GBS commensally

A

25%

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13
Q

RF GBS infection (6)

A 
GBS infection in previous baby
Prematurity
ROM >24hrs before delivery 
Pyrexia during labour 
\+ve test GBS in mother 
Mother diagnosed w/ UTI
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14
Q

CF GBS mother (4)

A

UTI
Chorioamnionitis
TachyC
Endometritis

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15
Q

CF GBS neonate (5)

A 
Neonatal pyrexia
Cyanosis 
difficulty breathing 
Difficulty feeding 
FLoppiness
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16
Q

Ix GBS

A

Swabs (culture on enriched culture medium)

Urine cultures??

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17
Q

Preventing GBS (2)

A

High dose IV BEN PEN throughout labour

If ROM >37w - induce to reduce amount of time fetus is exposed

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18
Q

Transmission of Parovirus B19

A

Respiratory droplets

Blood

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19
Q

What % of women become infected w/ parovirus in pregnancy

A

1/400

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20
Q

Often those infected, what % of pregnant women pass parovirus on to their fetus

A

33%

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21
Q

Oft those infected w/ parovirus, what is the outcome for 9% of fetuses

A

Spontaneous miscarriage

Or intrauterine death

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22
Q

CF parovirus in mother

A

Asymp

Or symmetrical arthralgia

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23
Q

CF parovirus in baby (5)

A 
URTI 
Malaise 
Headaches
Low grade fever
Slapped cheek syndrome
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24
Q

Ix parovirus

A

Viral serology
IgM = recent infeection
IgG = past infection (immunity)

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25
Q

Mx parovirus in pregnancy (3)

A

Rx
Mum = self limiting
Fetus - main risk = fetal hydrops –> Rx 3’ centre for intrauterine erythrocyte transfusion

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26
Q

Why is rubella no longer screened for antenatally

A

Due to success of MMR vaccine

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27
Q

Maternal features rubella (6)

A 
Asymp 
Or non specific: 
Malaise
Headache 
COryza
Lymphadenopathy 
Fine maculopapular rash
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28
Q

Ix rubella

A

ELISA - IgG +M

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29
Q

Mx rubella if <12w

A

Rx fetal medicine specialist

due to 90% risk vert transmission –> multiple defects –> TOP

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30
Q

Mx rubella if >20w

A

Despite 45% risk vert transmission –> no additional risk to fetus :)

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31
Q

Congenital rubella syndrome - features present at birth: (6)

A 
SNHL
Cardiac defects (PS/PDA/VSD)
Retinopathy/Congenital cataracts
LD
Microencephaly 
Thrombocytopenia, blueberry muffin appearance
32
Q

Congenital rubella syndrome - features present later on (4)

A

DM
Thyroiditis
GH abnormalities
Behavioural disorders

33
Q

CF chickenpox in mothers (6)

A 
Pneumonia
Hepaitis 
Encephalitis 
Fever
Malaise
Pruritic maculopapular rash
34
Q

Ix chicken pox in preg

A

Typically clinical

if in any doubt - immunofluorescence or PCR

35
Q

Maternal Mx chicken pox (5)

A

Test for immunity
If not immune - VZIG within 10 days contact + before rash appears
If with rash - aciclovir within 24hrs rash onset
USS - check fetal abnorm
Vaccine pre-preg or postpartum

36
Q

When does varicella of the newborn occur

A

If chicken pox is within the last 4 weeks of pregnancy

37
Q

Sx varicella of the newborn

A

Often asymp

38
Q

Tx varicella of the new born

A

VZIG

Aciclovir

39
Q

What is fetal varicella syndrome

A

Subsequent reactivation of the virus in utero

40
Q

PS fetal varicella syndrome

A

Skin scarring
Eye defects
Hypoplasia of limbs
Neurological defects

41
Q

Neurological defects in fetal varicella syndrome (4)

A

Microcephaly
Cortical/spinal atrophy
Seizures
Horners syndrome

42
Q

Eye defects in fetal varicella syndrome (4)

A

Microophthalmia
Chorioretinitis
Cataracts
Optic atrophy

43
Q

PS GAS (group A strep) in pregnancy

A

Chorioamnionitis

Or Sepsis

44
Q

Tx GAS in pregnancyt

A

Abx

45
Q

Impact of syphillis in pregnancy

A

Miscarriage/stillbirth

Or –> congenital sypphillis

46
Q

Tx HSV during pregnancy

A

Aciclovir

Deliver w/ CSC if within 6w 1st attack or genital lesions @ time delivery

47
Q

Impact of herpes zoster <20w pregnant

A

Rarely teratogenic

48
Q

Impact of herpes zoster at time of delivery

A

Severe neonatal infection

49
Q

Mx herpes zoster

A

IgG to neonate

50
Q

Mx chlamydia in pregnancy

A

ABx - azithro/erythro

51
Q

What is the leading cause of maternal mortality

A

VTE

52
Q

Why does risk of VTE increase greeatly in pregnacy (2)

A

Due. tochangesin. the clotting cascade
Incr fibrinogen
Decr protein S

53
Q

What period of pregnancy has the highest risk of VTE

A

Post partum

54
Q

Why is the L leg most commonly affected by DVT in pregnancy

A

Due to compression of uterus on L iliac vv

55
Q

Ix VTE

A

raised D dimer is norm in preg

FBC/U+E/LFT/Coag screen

56
Q

Extra Ux DVT (2)

A

Compression duplex uSS

Venograms

57
Q

Extra Ix PE (2)

A

ECG/CXR

CPTA V/Q scan

58
Q

Mx VTE (3)

A

LMWH until 6-12w post partum
Compression stockings
Mobilisation + hydration

59
Q

VTE prophylaxis in pt who has had CSC

A

10 day course LMWH

60
Q

Obesity in pregnancy - risks to mum (7)

A 
Higher risk VTE 
Pre-eclampsia 
Diabetes 
CSC wound infections 
More difficult CSC
PPH
Death
61
Q

Obesity in pregnancy - risk to fetus (4)

A

Congen abnorms (NTDs)
Diabetes
Incr mortality
USS less acurate

62
Q

Mx of obesity during pregnancy

A

W advice
5mg preconceptual folic acid
+ Vit D
Maintain weight throughout pregnancy as losing weight during pregnancy isnt a good idea

63
Q

Mx pregnancy BMI >35

A

Screen for GDM

BP surveillance

64
Q

Mx Pregnancy BMI >40

A

Formal anaesthetic risk assessment

Antenatal thromboprophylaxis recommended

65
Q

E.g.s of high risk thrombophilias (4)

A

APLS
Protein S/C deficiency
Activated protein C resistance
Antithrombin III deficiency

66
Q

E.g.s of lower risk thrombophilias (4)

A

Factor V Leiden
Prothrombin gene variant
Hyperhomocysteinaemia
Antiphospholipid Ab with no syndrome

67
Q

Complications of thrombophilias in pregnancy (6)

A 
VTE
Miscarriage
Preterm 
Pre-eclampsia 
IUGR
Placental abruption
68
Q

Mx of thrombophilias in pregnancy (4)

A

Incr maternal + fetal surveillance
Aspirin
LMWH postnatally +/- antenatally
ANtenatal LMWH if prev preg lol

69
Q

PS APLS in pregnancy (4)

A 
placental thrombosis --> 
Rec miscarriage 
IUGR
Early pre-eclampsia 
Foetal loss
70
Q

Mx APLS

A

USS + elective induction

Post natal anti-coag - prevent VTE

71
Q

Conseq hyperchromocysteinaemia in pregnancy

A

Pregnancy loss

Pre-eclampsia

72
Q

Tx hyperchromocysteinaemia in pregnancy

A

High dose folic acid

73
Q

Mx of pre-existing cardiac disease in pregnancy (7)

A 
Swap out 'bad' meds 
Acei --> B-blockers/nifedipine
Warfarin --> LMWH 
Echo 
Regular anaemia checks 
Avoid epidural and forceps 
ABx in labour to prevent against endocarditis in high risk pt
74
Q

Mx of epilepsy in pregnancy (4)

A

Preconceptual assessment
Use as few anti-E drugs as poss + 5mg folic acid
Avoid Na valporate
From 36w - 10mg vit K PO

75
Q

Which anti-epileptic meds are safest in pregnancy (2)

A

Carbamazepine

Lamotrigine

CP2 OBGYN (21 decks)

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