Extras from Lectures Flashcards
Lecture notes
It causes up to 21% of all congenital hearing loss at birth and 10% of all cases of cerebral palsy
Refers to
CMV
VZV
Rubella
Parvovirus
Toxoplasmosis
Lecture notes
It causes up to 21% of all congenital hearing loss at birth and 10% of all cases of cerebral palsy
Refers to
CMV
VZV
Rubella
Parvovirus
Toxoplasmosis
Lecture
When is the greatest risk of transmission of CMV in pregnancy? [1]
When is the greatest risk of severe fetal infection? [1]
The risk of congenital infection appears to vary according to the point in gestation at which primary infection occurs, increasing from around 30% in the first trimester to 47% in the third trimester.
While the risk of viral transmission is lower in early pregnancy, the proportion of cases with a prenatal diagnosis of severe fetal infection is higher when infection occurs in the first compared with the third trimester of pregnancy.
Which of the following best describes CMV in pregnancy
- Infection is most likely in first trimester; biggest risk to baby in first trimester
- Infection is most likely in first trimester; biggest risk to baby in third trimester
- Infection is most likely in third trimester; biggest risk to baby in third trimester
- Infection is most likely in third trimester; biggest risk to baby in first trimester
- Infection is most likely in third trimester; biggest risk to baby in first trimester
Describe how you dx CMV in pregnancy [2]
The diagnosis of primary CMV infection in pregnancy can be made following either:
the appearance of CMV-specific IgG in a woman who was previously seronegative; or
detection of CMV IgM antibody and low IgG avidity
Lecture:
The main sequelae of congenital toxoplasma infection involve the CNS and eyes, and typically include [4]
The main sequelae of congenital toxoplasma infection involve the CNS and eyes, and typically include microcephaly, hydrocephalus, ventriculomegaly and chorioretinitis. These may lead to developmental delay, epilepsy and blindness.
How do you treat TG infection:
- to prevent vertical transmission after maternal infection [1]
- If vertical transmission is confirmed [4]
Spiramycin (until the end of the pregnancy, in the absence of confirmed vertical transmission) should be used to prevent vertical transmission after maternal toxoplasma infection during pregnancy
If vertical transmission is confirmed:
- fetal infection should be treated by spiramycin only for 1 week, followed by pyrimethamine plus sulfadiazine plus folinic acid throughout the pregnancy and the infant treated for 1further year.
Parvovirus
Fetal anaemia and fetal hydrops both visible on ultrasound. Anaemia can be assessed measuring at the how exactly? [1]
Fetal anaemia and fetal hydrops both visible on ultrasound. Anaemia can be assessed measuring at the Peak Systolic on Middle Cerebral artery (raised MCA-PSV).
Describe how herpes simplex can impact new born? [3]
Can cause localised to skin, eye and/or mouth lesionsor local central nervous system (CNS) disease (encephalitis)
How do you treat HSV infection in pregnancy? [2]
Treatment should not be delayed. Management of the woman should be in line with her clinical condition and will usually involve the use of oral (or intravenous for disseminated HSV) aciclovir in standard doses (400 mg three times daily, usually for 5 days). In the third trimester, treatment will usually continue with daily suppressive aciclovir 400 mg three times daily until delivery.
Caesarean section should be the recommended mode of delivery for all women developing first episode genital herpes in the third trimester, particularly those developing symptoms within 6 weeks of expected delivery, as the risk of neonatal transmission of HSV is very high at 41%
Describe how you would deliver a patient with polyhydramnios:
- moderate [1]
- severe [1]
- what would do for baby afterwards birth [1]
Delivery:
* Risk of malpresentation / cord prolapse/ pre term labour
* Aim delivery around 37 weeks for severe polyhydramnios
* 38-40 weeks for moderate polyhydramnios
* Nasogastric tube postnatally to ensure there is no blockage in oesophgus/ tracheoesophageal fistula
Women with a haemoglobinopathy will be managed jointly with a specialist haematologist.
They require high dose [drug, dose] close monitoring and transfusions when required.
Women with a haemoglobinopathy will be managed jointly with a specialist haematologist. They require high dose folic acid (5mg), close monitoring and transfusions when required.
Name two risks of IDA post-partum [2]
↑ post-partum depression
↑ risk of PPH: 60% if Hb < 8 5
Lecture:
How do determine if the baby is small because the placenta is not formed properly?
Check history and consider all risk factors for placental dysfunction
+
measure serum PAPP-A at 11-14 weeks: if < 0.4 placenta may not have formed properly
+
Doppler studies
Name 5 risk factors for baby being small because placenta hasn’t formed properly [5]
Describe the different dopplers you can do to determine if baby is small
Fetal investigations:
- Umbilical artery Dopplers
(UAD)
Maternal investigations:
- Uterine artery dopplers
Risk of fetal demise:
- ductus venosus
Fetal oxygenation:
- MCA
Describe the fetal response to hypoxia [3]
- Reduced PO 2
- Reduced glucose supply
- Reduced amino acid supply
Describe the the process of hypoxia causing stillbirth [4]
Describe how this would be detected on dopplers [4]
Hypoxia –> acidemia –> CNS damage –> stillbirth:
- Placental dysfunction would be indicated by abnormal uterine artery dopplers (UtA)
- Leads to abnormal umbilical artery
- Leads to brain sparing effect - causing an abnormal MCA Doppler
- Leads to reduced cardiac compliance and abnormal venous doppler
- Leads to fetal movements reduced and abnormal cCTG.
- Leads to still birth
Lecture
Difference between LGA and macrosomia? [1]
LGA= EFW>90th centile or EFW>4000g
Macrosomia= EFW>4.500g
Lecture
Name a genetic syndrome which might cause LGA/macrosomia [1]
What is the triad seen with it? [3]
Beckwith Wiedemann – macroglossia, exomphalos, organomegaly
NB: comes up a couple of times in lecture
Name two maternal factors that might cause LGA/macrosomia? [2]
GENETIC / SOCIAL
* Parental height
* Malnutrition
* High BMI
* Maternal
depression
There are several risk factors that increase the chances of a female developing fibroids.
Name 4 [4]
Early age of puberty
Increasing age
Obesity
Ethnicity (e.g. black females)
Describe the different types of myomectomy [3] as if to a patient
Abdominal Myomectomy
* In an abdominal myomectomy, an incision is made in the abdomen (which may be around 12 cm or less).
* This enables the doctor to reach the uterus so that the uterine fibroids can be removed from the wall of the womb (intramural) and the outer layer of the womb (subserous).
* Once the fibroids have been removed the uterus and abdomen are stitched up. You will be given a general anaesthetic for this procedure. You can expect to stay in hospital for 3-4 days.
Laparoscopic Myomectomy
* We can sometimes remove smaller fibroids using keyhole instruments passed through tiny cuts in your abdomen.
* This is called a laparoscopic myomectomy or laparoscopic resection.
* A laparoscope (a narrow tube with a fibre optic light) is inserted into the womb through a tiny cut in the abdomen.
* Other small cuts are made in the same area to insert instruments that can dissect and remove the fibroids. You will be given a general anaesthetic for this procedure. You can expect to stay in hospital for 1-2 days.
Hysteroscopic Myomectomy
* A hysteroscopic myomectomy (or hysteroscopic resection) is where a small hysteroscope is inserted through the vagina and the cervix, so that one or more fibroids can be removed.
* This procedure can only be done where there are small fibroids which are just underneath the uterine lining (submucous fibroids).
* You will be given a local or general anaesthetic and will probably be able to go home the same day.
Lecture
With regards to menorrhagia - how heavy is too heavy? [6]
- Flooding
- Clots - especially larger than 50p coin
- Changing pads 1-2hourly
- Double super pad and tampon
- Expelling tampons/coils
- Quality of life
Lecture
A patient wants to undertake uterine artery embolisation as their mangement.
What imaging would you use prior to this? [1]
MRI - fibroid mapping, suitability for Uterine Artery Embolisation
Lecture
What advise do you give post-myomectomy about getting pregnant? [1]
After myomectomy, usually advise avoiding pregnancy for 6 - 18 months
Describe the risk of fibroids in pregnancy:
during pregnancy [5]
during delivery [2]
During Pregnancy
* Increased rates of miscarriage and PTB
* Difficult to measure - growth scans
* Degeneration pain
* Malposition
* Growth restriction
Delivery and Post Partum
* If fibroid below presenting part of head, baby may not come vaginally
* Can make CS very difficult
* Risk of Post Partum Haemorrhage
What information do you need to give about fibroids and HRT [1]
In some women, HRT may moderately increase size of fibroids, which in turn may cause symptoms. Need to check fibroid symptoms at each clinical review, and refer where necessary
For a 30-year-old female, what is the most appropriate action if the latest smear shows sample is hrHPV +ve + cytologically normal? [1]
Repeat in 12 months
For a 30-year-old female, what is the most appropriate action if the latest smear shows sample is hrHPV +ve + cytologically abnormal?
Refer for colposcopy
In which instances would you test again at 12 months? [1]
This scan was for an anomaly scan.
What sign can be seen? [1]
What pathology does this indicate? [1]
Lemon sign - spina bifida
This scan was for an anomaly scan.
What sign can be seen? [1]
What pathology does this indicate? [1]
Banana sign - spina bifida
- banana sign describes the way the cerebellum is wrapped tightly around the brainstem as a result of spinal cord tethering and downward migration of the posterior fossa contents
What is the difference between anencephaly and acrania? [1]
What anomaly is seen in this US scan? [1]
An anamoly scan is given and they detect holoprosencephaly.
What is this? [1]
Holoprosencephaly:
- birth defect (congenital condition) that causes the fetal brain to not properly separate into the right and left hemispheres (halves).
What anomaly is seen in this US scan? [1]
Talipes
- Talipes, commonly known as clubfoot, is a congenital deformity of the foot and ankle where the foot is twisted out of its normal position. This condition can vary in severity and may affect one or both feet.
Lecture
Name two risks that increase risk of post-partum pyschosis [2]
- ↑risk: bipolar disorder, Hx of postpartum psychosis (note risk of relapse)
Lecture:
Describe the onset of post partum psychosis [2]
Severe episodes have a rapid onset
Immediate post partum period has the highesr risk
What does this image show? [1]
TVS of uterus – thickened endometrium
Which are the most common type of endometrial cancer? [1]
Adenocarcinomas:
- more than 75% are endometrioid
- also clear cell, uterine serous carcinomas
Where is the most common place for endometrial cancer to occur? [1]
How do you treat? [+]
Vault
Lecture:
Describe the bimodal development of vulval cancers and how this is clinically significant [+]
Important to note - he said in lecture
Bimodal developmental pathway: HPV dependent and HPV independent
HPV dependent:
- younger age group and radiosensitive, better prognosis
- HPV dependent associated with anal, vaginal and cervical tumours
- Associated with VIN
HPV Independent
- Older women; from lichen sclerosus
- Worse prognosis
You suspect endometriosis in a patient.
What examinations would you perform? [+]
Abdominal exam:
- ID abdominal wall endometriosis and assess for signs of peritonism
Pelvic exam: speculum and bimanual
- ID areas of tissue present: in cervix or rectovaginal space
- Bimanual exam will ellicit tenderness
What does this image show? [1]
Umbilical endometrial lesion
Describe what this image shows? [1]
Endometriosis typica: - superficial endometriosis
- blue, black or red lesions often clustered together
- fibrotic tissue which has formed small nodule on peritoneum. can be palpated with surgical instruments
Describe what this image shows? [1]
Superficial endometriosis with fibrosis of nodule at base - caused involution of tissue and caused peritoneal pocket called Alan masters pouch
Describe what this image shows? [1]
Superficial endometriosis
- Tannin deposit caused by endometriosis
NB: looks like a cigarette burn
Deep endometriosis on the bowel
Where should patients with deep endometriosis be treated? [1]
Tertiary endometriosis centres
