Antenatal care Flashcards
When can you perform an amnio to detect prenatal fetal CMV?
7 weeks after infection and over 21/40
Chicken pox timeline - VZIG and aciclovir and infectious period?
- From contact until 10 days - can give VZIG
- If given VZIG - infectious period is 21 days, if not 28 days
- If present in first 24 hours of the rash - give aciclovir if 20/40 or more
- Lesions take around five days to crust (and then are non-infective)
Risk of early onset GBS
- overall risk
- positive vaginal swab
- Intrapartum pyrexia
- overall risk 0.5:1000
- positive vaginal swab - 2.3:1000
- intrapartum pyrexia - 5.3:1000
What percentage of IUDs have chromosomal abnormality?
6%
Indications for referral to fetal medicine specialist for HDFN?
history of previous HDFN
IUT
Titre of 1:32 or above
Rising titres as it indicates the risk of severe fetal anaemia
anti-D level over 4IU/ml
any anti-K level
anti-d - 4-15 moderate risk - referral needed. Over 15 - URGENT referral
What percentage of women with OC have a family history of it?
14%
Which drugs used in solid organ transplant are teratogenic?
ARB
ACEi
Mycophenolate
Warfarin
Which drug to treat IBD should be avoided in pregnancy?
Fluroquinolones
HUS vs TTP
HUS has defects in complement regulation
When should you reduce the dose of MgSO4 and by how much
Half the dose of MgSO4 when urine output falls below 20mls/hr
What is the only anti-TNF which crosses the placenta the least so is the safest in pregnancy?
Certolizumab
What liver lesion may grow in pregnancy?
Haemangiomas show accelerated growth with oestrogen
What percentage of monochorionic pregnancies does TTTS complicate?
15%
What percentage of monochorionic pregnancies who have laser ablation for TTTS result in TAPS?
13%
when should the anomaly scan for twins take place?
18 to 20+6
when should the NT scan for twins take place?
11 to 14+1
What is the stillbirth rate in the UK?
1:200
When is the lowest risk of stillbirth in the UK?
39/40
What did the TRUFFLE study show?
No difference in stillbirth when ductus venosus doppler measurement was used compared to CTG
What did the TIPPS study show?
No help with placenta-related complications or change in SB rate with LMWH
What are the key symptoms in the diagnosis of symphysis pubis dysfunction?
pubic bone pain
walking, turning in bed, lifting or parting legs
What are the key signs in the diagnosis of symphysis pubis dysfunction?
Positive trendelenburg sign (sagging of one bumcheek on one leg)
Pain over SI joint or SP
What are the risk factors for osteomyelitis of the pubis?
Gynaecological surgery, urogenital procedures and operative delivery
What are the symptoms and signs for osteomyelitis of the pubis?
low grade pyrexia pain at SP and pubic rami Pain on hip abduction NN anaemia inc WCC and CRP
What is osteitis pubis?
Symmetrical pubic pain
Especially on climbing stairs, kicking, pivoting on one leg
Normal bloods
Xray - erosions cytic changes of the pubis
What is pregnancy-induced osteomalacia?
cause?
Sx?
Ix?
Vit D deficiency
aches and pains
Looser zones
waddling gait - proximal myopathy
Low serum calcium and raised ALP
Low serum vit D
What is transient osteoporosis of pregnancy affecting the hip joint?
Usually left hip
Rare
Pain in the hip
NOT tender on the SP
Marginal rise in inflammatory markers
Xrays - osteopenia - localised and involves the femoral head and acetabulum
What is the incubation period for rubella?
14-21 days
what is the period of infectivity for rubella?
7 days before and after the rash
When is maternal infection most likely to cause congenital rubella?
First trimester
What are the signs of congenital rubella?
PDA, ocular defects, sensorineural deafness and mental retardation
Dose of anti D up to 20 weeks?
250IU
No Kleihauer required
Dose of anti D after 20 weeks? Additional testing and anti D?
500IU, and a kleihauer to test for FMH over 4mls - more would be required
What is the rate of spontaneous reversion after ECV?
5%
Why do we offer CS for footling breech presentations?
High risk of cord prolapse - 7%
What does an absence Duffy blood group antigen provide some protection against?
P. vivax
Who has significant protection against P. falciparum?
haemoglobinopathies (eg: SCD)
erythrocyte enzyme defects (G6PD def)
What is the mortality rate of congenital tuberculosis?
50%
When can peripartum cardiomyopathy present?
AN (late) or up to 6 months postpartum
Risk factors for peripartum cardiomyopathy?
Afro-Caribbean Older Multip Multiple pregnancy HTN PET
Treatment of peripartum cardiomyopathy?
beta-blockers
Diuretics
ACEi
What proportion of maternal deaths due to cardiac causes are due to cardiomyopathy?
25%
What proportion of women with peripartum cardiomyopathy with have a spontaenous recovery?
50%
When is pregnancy contraindicated in a woman with Marfans syndrome?
When the aortic root is over 4-4.5cm
What is the treatment for severe malaria?
IV artesunate
What is the treatment for non-severe P. falciparum?
Oral quinine 600mg 8H and oral clindamycin 450mg 8H 7/7
What is the treatment for non-falciparum malaria?
Oral chloroquine 600mg followed by 300mg 6 hours later, then 300mg day 2 and day 3
What is the incubation period of parvovirus
13-18 days
What is the management for a person neg for IgG parvovirus who is exposed?
2/40 USS until 30 weeks. If normal - discharge.
What is the dose of anti-D given per ml?
500u for up to the first four mls, then 125u after that for each ml.
What is the dose of lidocaine/kg
3mg//kg
Previous abruption means abruption how likely in next pregnancy?
4.4%
Risk of postnatal depression
8-15%
Risk of perpeural psychosis?
0.1-2%
Risk of suicide in postpartum psychosis?
Infanticide?
5%
5%
Bipolar - risk of PP psychosis
25%
Above what level of spinal cord injury is there a risk of autonomic dysreflexia?
T6
Above what level of spinal cord injury will a woman not feel labour?
T10
What is the risk of vertical transmission of CMV in a woman who has seroconverted during pregnancy?
1st and 2nd trimester - 40%
3rd - 65%
