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MRCOG Part 2 > General Obs > Flashcards

General Obs Flashcards

1
Q

What is the incidence of GBS infections in the new born?

A

Risk of Early onset GBS disease
Overall incidence 0.57/1000 live births

No risk factors/negative testing in current pregnancy 0.2/1000 or 1/5000

Risk if positive in previous pregnancy 1.25/1000 or 1/800
Risk if positive this pregnancy 2.3/1000 or 1/400

Risk of EOGBS if intra-partum pyrexia (>38oC) is 5.3/1000 births

20-40% of women GBS carriers

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2
Q

What are the risks of C/S in cases of placenta praevia?

A

Massive obstetric haemorrhage 21%
Emergency hysterectomy 11% (27% in women with prior c-section)
Further Laparotomy 7.5%
Bladder or ureteric injury up to 6%
VTE up to 3%
Future placenta praevia 2.3%

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3
Q

How do you classify placenta praevia?

A

Placenta praevia: is used when the placenta lies directly over the internal os.
Low lying placenta: For pregnancies greater than 16 weeks of gestation when the placental edge is less than 20 mm from the internal os.
Normal: Placental edge is 20 mm or more from the internal os on TAS or TVS

Old grading system refers to major or minor…

MINOR
Grade I: low lying placenta: placenta lies in lower uterine segment but its lower edge does not abut the internal cervical os (i.e lower edge 0.5-5.0 cm from internal os).
Grade II: marginal praevia: placental tissue reaches the margin of the internal cervical os, but does not cover it

MAJOR
Grade III: partial praevia: placenta partially covers the internal cervical os
Grade IV: complete praevia: placenta completely covers the internal cervical os

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4
Q

What is Autonomic dysreflexia?

A

Occurs after spinal cord injury (above T6)
Uninhibited sympathetic response due to injury

Stimuli such as bladder/bowel filling, tight clothing, gallstones, menstruation, alcohol

Presents with hypertension and bradycardia. A rise in blood pressure of 20-40mmHg from baseline is considered a sign of AD. AD is associated with fetal bradycardia.

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5
Q

What is the management of red cell autoantibodies in pregnancy?

A

Detected in 1.2% or pregnancies
Clinically significant in 0.4%

Level at which patient should be referred to fetal medicine specialist (iu/ml)
Anti-D >4
Anti-C >7.5
Anti-K Refer if detected
Anti-E Refer if anti-C antibodies present

Consider ffDNA to assess fetal presence from 16 weeks (20 for anti-K)
Will need weekly MCAs to monitor for signs of fetal anaemia
G&S should be taken every 4 weeks upto 28 weeks then every 2 weeks until delivery
Early discussion with lab for labour care

Significant fetal anaemia is not expected when the anti-D titre remains below 1:64. Severe fetal anaemia is not expected at anti-D levels below 4iu/ml and is rare below 10-15iu/ml.

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6
Q

What is the success rate of VBAC?

A

Planned VBAC (overall) 72-75%
Previous successful vaginal birth 85-90%
Previous CS for fetal malpresentation 84%
Previous CS for fetal distress 73%
Previous CS for labour dystocia 64%

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7
Q

What is the treatment for toxoplasmosis?

A

From BNF

If toxoplasmosis is acquired in pregnancy, transplacental infection may lead to severe disease in the fetus; specialist advice should be sought on management.
Spiramycin may reduce the risk of transmission of maternal infection to the fetus.

When there is evidence of placental or fetal infection, pyrimethamine may be given with sulfadiazine and folinic acid after the first trimester.

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8
Q

What percentage of twin pregnancies deliver preterm?

A

From NICE
60 in 100 twin pregnancies result in spontaneous birth before 37 weeks.

75 in 100 triplet pregnancies result in spontaneous birth before 35 weeks.

PassMRCOG - 10% twins before 32 weeks

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9
Q

When should timing of delivery be in multiple pregnancies?

A

DCDA twins - 37/40
MCDA - 36/40

MCMA - between 32-33+6
Triplets that are trichorion or dichorion - At 35/40

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10
Q

What is the incidence of cord prolapse?

A

Overall 0.1-0.6%
Breech 1%

Risk factors:
Multiparity
Low birthweight (< 2.5 kg)
Preterm labour (< 37+0 weeks)
Fetal congenital anomalies
Breech presentation
Transverse, oblique and unstable lie
Second twin
Polyhydramnios
Unengaged presenting part
Low-lying placenta

Artificial rupture of membranes
External cephalic version
Vaginal manipulation of the fetus with ruptured membranes
Internal podalico version
Stabilising induction of labour
Insertion of intrauterine pressure transducer
Large balloon catheter induction of labour

Perinatal mortality rate 91 per 1000 (9%)

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11
Q

What is chance of placenta praaevia with previous C/S?

A

No previous CS 1 in 400 0.25%
1 1 in 160 0.6%
2 1 in 60 1.6%
3 1 in 30 3.3%
4 1 in 10 10%

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12
Q

What are additional risk factors that would mean you would recommend C/S over vaginal breech?

A

Hyperextended neck on ultrasound
High estimated fetal weight (> 3.8 kg)
Low estimated weight (< 10th centile)
Footling presentation
Evidence of antenatal fetal compromise

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13
Q

What percentage of women planning a vaginal breech, go on to have an emergency C/S?

A

40%

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14
Q

What are the criteria for cervical cerclage and vaginal progesterone in preventing PTB?

A

Cerclage:
-History of loss/PTB between 16-34 weeks AND evidence of shortening (<25mm) on scan
-See separate slide

Progesterone:
-history of loss OR evidence of shortening on scan

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15
Q

Who would you consider for emergency cerclage?

A

Between 16+27+6 weeks with evidence of cervical dilatation and enraptured membranes

CONTRAINDICATIONS:
-Contracting
-Bleeding
-Infected

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16
Q

What is the ultrasound criteria for diagnosing TPTL

A

15mm or less
Can be used instead of fetal fibronectin above 30 weeks

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17
Q

What is the dose of MgSO4 for neuroprotection?

A

Give a 4 g intravenous bolus of magnesium sulfate over 15 minutes, followed by an intravenous infusion of 1 g per hour until the birth or for 24 hours (whichever is sooner)

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18
Q

What aspects of labour care are contraindicated before 34 weeks?

A

FSE (relatively)
FBS
Ventouse (before 32 weeks, with careful consideration 32-36 weeks)

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19
Q

What dose of anti-D is required for sensitising events?

A

In pregnancies <12 weeks gestation:
Anti-D Ig prophylaxis only required following ectopic pregnancy, molar pregnancy, surgical termination of pregnancy or medical termination >10 weeks, and cases of uterine bleeding where this is repeated, heavy bleeding or associated with abdominal pain. The minimum dose is 250 IU.

In pregnancies 12-20 weeks gestation:
250 IU
A test for FMH is not required.

In beyond 20 weeks gestation:
500 IU
A test for FMH is required

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20
Q

For what time period can PLGF be used to and from?

A

20 weeks to 36+6

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21
Q

What is the post-natal monitoring of hypertension?

A

Daily for first two days
At least once between days 3 and 5

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22
Q

What is the post natal monitoring of pre-ecalampsia?

A

Not on medication:
-4 hourly whilst inpatient (NICE states 4/day)
-Once between days 3-5
-Alternate days until normal, if not normal days 3-5

On medication:
-4 hourly whilst IP
-every 1 to 2 days for up to 2 weeks after transfer to community care until the woman is off treatment and has no hypertension.

-If moderate/severe - check bloods once 48-72 hours after delivery, then no further checks if normal
-urine dip 6-8 weeks after delivery

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23
Q

What frequency of scan monitoring should hypertension patients have antenatally?

A

Hypertension (chronic or gestational) - 4 weekly
PET - 2 weekly

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24
Q

What frequency of blood and BP monitoring should hypertension patients have in the OP setting?

A

Hypertension
Bloods Weekly
BP/urine 1-2/week
If IP then daily urine dip when admitted

PET
BP - 48 hours
Bloods 2/weekly or 3/weekly if severe

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25
Q

Discuss fluid balance in severe PET or hypertension

A

In women with severe pre-eclampsia, limit maintenance fluids to 80 ml/hour unless there are other ongoing fluid losses (for example, haemorrhage)

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26
Q

What factors are associated with failure, in assisted vaginal birth?

A

-maternal BMI greater than 30
-short maternal stature
-estimated fetal weight of greater than 4 kg or a clinically big baby
-head circumference above the 95th percentile
-occipito–posterior position
-midpelvic birth or when one-fifth of the head is palpable per abdomen

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27
Q

1 in 200….

A

Scar rupture in VBAC
Stillbirth
Placental abruption

Polymorphic eruption of pregnancy
ECV requiring emergency C/S

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28
Q

What are risk factors for placental abruption?

A

Abruption in previous pregnancy (most predictive) - 4.4% risk of recurrence
Pre-eclampsia
Fetal growth restriction
Non-vertex presentations
Polyhydramnios
Advanced maternal age
Multiparity
Low BMI
Pregnancy following assisted reproductive techniques
Intrauterine infection
PROM
Abdominal trauma
Smoking
Drug misuse (cocaine and amphetamines) during pregnancy
Weak association with some thrombophilias

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29
Q

What is the incidence of central venous thrombosis in pregnancy?

A

1 in 5000

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30
Q

According to GTG what is the rate of perforation for ERPC for RPOC in context of secondary PPH?

A

1.5%

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31
Q

When is greatest risk of teratogenicity to fetus from ionising radiation?

A

10-17 weeks

The accepted background cumulative dose of ionising radiation during pregnancy is 5 rad (50 mGy) (5 Msv)
The average background dose of naturally occurring radiation in the UK is 2.2 mSv.

Natural background radiation during an entire pregnancy is approximately 0.5 - 1.6 mGy

The commonest teratogenic effects of exposure to high dose radiation are central nervous system changes. These risks may result in microcephaly and severe mental retardation.
This risk is greatest at 10-17 weeks. There is no proven risk before 10 weeks or after 27 weeks

The greatest risk of fetal growth restriction due to radiation is 3-10 weeks
A dose of 250 mGy may be associated with a 0.1% risk of fetal malformation

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32
Q

In the context of VTE risk assessment what are high and low risk thrombophilias?

A

HIGH RISK:
Antithrombin
Antiphospholipid (associated with VTE) Recurrent VTE
- need 50%,75% or full dose of normal anticoagulant

Protein C or S deficiency
Homozygous Factor V Leiden- consider antenatal prophylaxis + 6 weeks post natal clean

LOW RISK:
Heterozygous Factor V Leiden
Antiphospholipid antibodies

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33
Q

What is the stillbirth rate in intrahepatic cholestasis of pregnancy?

A

Only increased in severe ICP (BA >100) 3.44% vs 0.29%

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34
Q

What is the cut off for diagnosis of OC?

A

Bile acids of 19 or more

Mild 19-39 - deliver 40 weeks
Moderate 40-99 - deliver 38-39 weeks
Severe 100 or more - deliver 35-36 weeks

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35
Q

What is the fetal mortality rate from vasa praaevia?

A

The fetal mortality rate in this situation is at least 60% despite urgent caesarean delivery.
However, improved survival rates of over 95% have been reported where the diagnosis has been made antenatally by ultrasound followed by planned caesarean section.

Vasa praevia prevalence: 1 in 1200 and 1 in 5000 pregnancies

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36
Q

What percentage of obstetric admissions are complicated by AKI?

A

1.5%
Mostly due to PET

Any creatinine >90 diagnostic of AKI

A serum urea > 17 mmol/l despite medical management is a pregnancy-specific indicator for renal replacement therapy (urea is teratogenic)

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37
Q

What is the rate of fetal loss in appendicitis in pregnancy?

A

Rates of fetal loss

Simple appendicitis is 1.5%
Appendicitis with peritonitis 6%
Perforated appendix 36%

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38
Q

What is the incidence of cerebral palsy by gestation?

A

22-27 weeks 14.6%
28-31 weeks 6.2%
32-36 weeks 0.7%
term 0.1%

Who should be given IV magnesium sulphate?
Women between 24+0 and 29+6 weeks of pregnancy who are in established preterm labour or having a planned preterm birth within 24 hours

Consider in women between 30+0 and 33+6 weeks of pregnancy who are in established preterm labour or having a planned preterm birth within 24 hours

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39
Q

What percentage of Erb’s palsy go on to have permanent neurological dysfunction

A

About 10%, 90% fully recover

Brachial plexus injury (BPI) is one of the most important fetal complications of shoulder dystocia, complicating 2.3% - 16%

In the UK and Ireland, the incidence of BPI was 0.43 per 1000 live births.

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40
Q

Discuss NNT in context of C/S

A

Caesarean section (compared with vaginal delivery)

NNT to prevent one case fecal incontinence 167
NNT in Breech birth to prevent one case adverse outcome 29
NNT in Breech birth to prevent one case perinatal death 175-400

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41
Q

How do you calculate Number needed to treat?

A

1 / (EER-CER)

Experimental - control rate

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42
Q

What is NNT in prevention of GBS?

A

Intrapartum antibiotic prophylaxis to prevent early onset GBS (compared with expectant management)
NNT in intrapartum fever (>38ºC) 208
Preterm labour <35 weeks 307
Preterm labour <37 weeks 500
PROM (>18 hours) 595
NNT to prevent one case neonatal death from GBS >5000

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43
Q

What are risks of Elective C/S vs VBAC?

A

Risk of transient respiratory morbidity in neonates born via planned VBAC is approximately 2-3%
Risk of transient respiratory morbidity in neonates born via ERCS is approximately 4-5% (higher if born prior to 39 weeks)

Risk of delivery related perinatal death in VBAC is approximately 0.04%
Risk of delivery related perinatal death in ERCS is approximately 0.01%

Risk of maternal death with planned VBAC is approximately 4 per 100000
Risk of maternal death with ERCS is approximately 13 per 100000

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44
Q

What is the dose of cryoprecipitate in PPH

A

2 X 5 UNIT POOL
Then go off bloods
Fibrinogen >2

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45
Q

Who should be offered cervical cerclage according to GTG?

A

Singleton pregnancies and three or more previous PTB
Singleton pregnancy and history of spontaneous second trimester loss + evidence of shortening on scan (<25mm) at less than 24 weeks

Incidental shortening on scan - not to be offered suture

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46
Q

By how much does cerclage delay emergency birth?

A

Average of 34 days (5 weeks)
Two fold reduction in birth before 34 weeks

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47
Q

Which women should be reviewed in PTB clinic, and from what gestation?

A

HIGH RISK - to be seen at 12 weeks and then 2-4 weekly

-those with a previous preterm birth or second trimester loss (16–34 weeks’ gestation)
-previous preterm pre-labour rupture of membranes (PPROM) less than 34 weeks
-previous use of cerclage
-known uterine variant
-intrauterine adhesions
-history of trachelectomy.

INTERMEDIATE RISK - see between 18-22 weeks for one off scan
-Women with C/S at fully dilated
-Women with LLETZ >1cm or repeat procedures

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48
Q

What is the risk of transmission of genital herpes in labour for…

Primary presentation
Recurrence

A

Primary = 41%
Recurrence = up to 3%

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49
Q

What is the risk of transmission of genital herpes in labour for…

Primary presentation
Recurrence

A

Primary = 41%
Recurrence = up to 3%

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50
Q

What is maternal mortality in the UK?

A

MMBRACE October 2023
11.7 per 100,000, 10 per 100,000 if covid excluded

Heart disease still leading cause of indirect deaths
VTE leading cause of direct deaths

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51
Q

What is the incidence of pre-eclampsia?

A

3%

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52
Q

What is the absolute risk of VTE in pregnancy?

A

1-2 in 1000 (x4-6 fold than outside of pregnancy)

PE = 1.3 in 100,000

If DVT remains untreated, 15–24% of these patients will
develop PE.
PE during pregnancy may be fatal in almost 15% of patients, and in 66% of these, death will occur within 30 minutes of the embolic event

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53
Q

What is the number of elective inductions of labour at 40 weeks required to prevent one perinatal death compared to expectant management?

A

1040

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54
Q

What is the NNT for Intrapartum antibiotic prophylaxis (IAP) in preventing early onset group B streptococcal infection compared to expectant management in prolonged rupture of membranes at term?

A

595

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55
Q

What is the NNT for Intrapartum antibiotic prophylaxis (IAP) in preventing early onset group B streptococcal infection compared to expectant management in patients with intrapartum fever (>38ºC)?

A

208

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56
Q
A
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57
Q

What defines polyhdramnios?

A

An AFI above 25cm confirms polyhydramnios.

This may be sub classified based on the AFI result as:
Mild 25cm-29.9cm
Moderate 30cm-34.9cm
Severe 35cm and above

Or DVP >8cm

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58
Q

What is the incidence of twin pregnancies?

A

3%

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59
Q

What is the sensitivity of detecting abruption on scan?

A

Although evidence of occult placental abruption might also be identified, the sensitivity can be as low as 15%. Even large abruptions can be missed.

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60
Q

Autopsy finds a cause of death in what percentage of stillbirths?

A

45%

50% of IUD - no cause found

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61
Q

What blood tests are required at delivery if maternal red cell antibodies have been detected?

A

DAT
FBC
Bilirubin

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62
Q

What is risk of premature delivery based on cervical length?

A

Cervical length at 20-24 weeks

<25mm 25% risk of delivery before 28 weeks gestation
<20mm 42.4% risk of delivery before 32 weeks gestation
<20mm 62% risk of delivery before 34 weeks gestation

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63
Q

What is the chance of having group B strep in subsequent pregnancy, if you tested positive in a previous pregnancy?

A

50%

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64
Q

What is the percentage change of successful pregnancy in those who have abdominal cerclage?

A

85%

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65
Q

How likely are complications following shoulder dystocia?

PPH
3rd or 4th
Brachial plexus injury

A

Post partum haemorrhage 11%
3rd & 4th degree perineal tears 3.8%
Brachial plexus injury 2.3 to 16%

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66
Q

What is the mortality rate from Nec Fasc?

A

25%

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67
Q

What lactate level correlates with tissue hypo perfusion?

A

4 or more

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68
Q

What 2 tests can be performed if PPROm is suspected but not obvious on speculum?

A

Insulin-like growth factor-binding protein 1 (IGFBP-1) or placental alpha microglobulin-1 (PAMG-1) test

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69
Q

What percentage of pregnancies affected by PPROM?

A

3-4%
Affects 30-40% pre term births

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70
Q

What happens to WCC when steroids given?

A

Rises in 24 hours and should return to baseline by 3 days

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71
Q

What is the law surrounding FGM?

A

All health professionals must be aware of the Female Genital Mutilation Act 2003 in England, Wales and Northern Ireland and the Prohibition of Female Genital Mutilation (Scotland) Act 2005 in Scotland. Both Acts provide that:
1. FGM is illegal unless it is a surgical operation on a girl or woman irrespective of her age:
(a) which is necessary for her physical or mental health; or
(b) she is in any stage of labour, or has just given birth, for purposes connected with the labour or birth.
2. It is illegal to arrange, or assist in arranging, for a UK national or UK resident to be taken
overseas for the purpose of FGM.
3. It is an offence for those with parental responsibility to fail to protect a girl from the risk of FGM.
4. If FGM is confirmed in a girl under 18 years of age (either on examination or because the patient or parent says it has been done), reporting to the police is mandatory and this must be within 1 month of confirmation.

The Serious Crime Act 2015 reinforced existing FGM legislation and introduced mandatory reporting of FGM in girls under 18 years by healthcare workers, teachers and social workers to the police

Female cosmetic genital surgery is prohibited unless necessary for mental or physical health.
Re-infibulation is forbidden.

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72
Q

What happens if FGM detected in pregnant woman?

A

CLC
Discuss de-infibulation if indicated on examination
Risk assess and refer if high risk
Add Hep C to booking bloods

DOCUMENT:
Including age at FGM, country where FGM was performed, date of entry to UK (if applicable) and past history of de-infibulation and/or re-infibulation.

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73
Q

What risks are increased in pregnancy/childbirth for people who have had FGM?

A

Increased risk of haemorrhage
Perineal trauma and caesarean
section

May have difficultly with examinations

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74
Q

What are risks of MC twin pregnancies when compared to DC pregnancies?

A

Higher risk of fetal loss - mostly second trimester
Associated neurodevelopment morbidity

Twin to twin transfusion - 15%
TAPS
Selective growth restriction

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75
Q

What scans should MC twin pregnancies have?

A

2 weekly from 16 weeks
Documented DVP, UA PI, fetal bladders and EFW discordance

EFW more than 20% suggestive of selective growth restriction

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76
Q

What is the grading system for twin to twin transfusion?

What is the management of TTTS?

A

Quintero grading system

Management through laser ablation - Solomon technique

Then need weekly monitoring, can be downgraded to 2 weekly if growth normal at 2 weeks
Need assessment for fetal hearts

Delivery between 34 and 36+6

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77
Q

What is management of selective growth restriction in MC twin pregnancies?

A

Monitor at least 2 weekly

In type I sGR, 34–36 weeks of gestation

In type II and III sGR, delivery should be planned by 32 weeks of gestation

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78
Q

What are the risks to the surviving twin, in cases of single twin demise?

A

Death 15%
Neurological abnormality 26%

Fetal MRI of the brain may be performed 4 weeks after co-twin demise to detect neurological morbidity if this information would be of value in planning management.
Monitor for fetal anaemia by MCA

If death of a fetus occurs at <24 weeks’ gestation the co-twin is more likely to also die but if it survives, neurologic damage may be less; if death occurs >24 weeks the co-twin is more likely to survive but also more likely to suffer brain damage.

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79
Q

What are contraindications to VBAC?

A

Previous uterine rupture
Classical C/S
Any other contraindication to vaginal birth
Non cephalic presentation

80
Q

What are risks of IoL and VBAC?

A

2-3x risk of uterine rupture
1.5 x risk of emergency C/S

Lower with CRB, ARM than with prostaglandin

81
Q

What is rate of instrumental delivery if VBAC?

A

The rate of instrumental delivery is also increased up to 39%.

82
Q

What is the definition of anaemia by trimester?

A

First - 110
Second and third - 105
Third - 100

83
Q

How is anaemia managed in pregnancy?

A

If normocytic or microcytic anaemia - trial Ferrous Sulfate for 2 weeks then check for improvement and compliance

Screen everyone at booking and 28 weeks
Multiple pregnancy - additional screen at 20 weeks

84
Q

What is the recommended interval of G&S in pregnancies high risk of bleeding (e.g. praaevia)

A

If no other comorbidities and no antibodies then GTG says weekly

85
Q

What considerations should be taken for rhesus negative women in cell salvage use?

A

Minimum dose 1500IU
Then take blood sample 30-40 mins after to check for fetomaternal haemmorhgage and need for further anti-D

86
Q

In whom is intra-operative cellsalvage recommended?

A

If anticipated blood loss 20% of blood volume or to cause maternal anaemia

87
Q

What dose and regimen of FFP and cryoprecipitate are recommended in PPH?

Target for platelets?

A

FFP at 12-15ml per kg every 6 units of blood
Aim to keep PT and APTT <1.5x normal

Cryo 2 x 5 unit pools
Aim to keep Fibrinogen >1.5

Platelets >50

88
Q

What is the management of women with previous VTE in pregnancy?

A

Ideally seen pre-pregnancy to establish plan

Unless clearly linked to major surgery/provoking factor - for antenatal LMWH and 6 weeks postnatal

If linked to antithrombin, should have higher dose LMWH (either 50,75,100% of treatment dose)
Management with haematologist
May need antiXa levels - use a test that does not use exogenous antithrombin and 4-hour peak levels of 0.5–1.0 iu/ml aimed for.
May need antithrombin replacement pre delivery or C/S

If linked to antiphosphospholipid or arterial VTE then manage with haem/rheum expert

89
Q

If high clinical suspicion of DVT and negative USS, what are next steps?

A

Repeat USS day 3 and 7

90
Q

What are the investigations required for suspected PE?

A

Everyone should have ECG and CXR

If signs of DVT and PE - perform USS Doppler, if this is positive then no need for investigation of PE

Investigations for PE can be either V/Q or CTPA

If abnormal CXR then CTPA over V/Q

91
Q

What counselling should women being investigated for PE be told?

A

Women with suspected PE should be advised that, compared with CTPA, V/Q scanning may carry a slightly increased risk of childhood cancer but is associated with a lower risk of maternal breast cancer; in both situations, the absolute risk is very small

92
Q

What monitoring is required for women on treatment dose LWMH?

A

None unless extremes of body weight or other co-morbidties (renal impairment)

If on UFH then obstetric patients who are postoperative and receiving unfractionated heparin should have platelet count monitoring performed every 2–3 days from days 4 to 14 or until heparin is stopped.

93
Q

What is the treatment for massive PE?

A

IV unfractionated Heparin

94
Q

If DVT/PE diagnosed in pregnancy what is the length of anticoagulant?

A

Rest of pregnancy and at least 6 weeks postnatally - at least 3 months

Liaise with Haematologist

Consider filter if iliac DVT

95
Q

What surgical considerations should be taken for women on treatment anticoagulation at C/S?

A

Wound drain
Interrupted suture to drain haematoma

96
Q

How many scheduled antenatal appointments should…

Primips
Multips

Have?

A

Primips = 10
Multipls = 7

97
Q

What are findings of MMBRACE 2020?

A

compared with white women (8/100,000), the risk of maternal death during pregnancy and up to 6 weeks after birth is:

4 times higher in black women (34/100,000)

3 times higher in women with mixed ethnic background (25/100,000)

2 times higher in Asian women (15/100,000; does not include Chinese women)

compared with white babies (34/10,000), the stillbirth rate is

more than twice as high in black babies (74/10,000)

around 50% higher in Asian babies (53/10,000)

women living in the most deprived areas (15/100,000) are more than 2.5 times more likely to die compared with women living in the least deprived areas (6/100,000)

the stillbirth rate increases according to the level of deprivation in the area the mother lives in, with almost twice as many stillbirths for women living in the most deprived areas (47/10,000) compared with the least deprived areas (26/10,000).

98
Q

What questions should you use when screening for mental health in pregnancy?

A

Depression:
During the past month, have you often been bothered by feeling down, depressed or hopeless?

During the past month, have you often been bothered by having little interest or pleasure in doing things?

Anxiety (GAD-2):
Over the last 2 weeks, how often have you been bothered by feeling nervous, anxious or on edge?

Over the last 2 weeks, how often have you been bothered by not being able to stop or control worrying?

None = 0
Several days = 1
More than 50% - 2
Every day = 3

If 3 - refer
If less than 3 but concerned ask

Do you find yourself avoiding places or activities and does this cause you problems?

99
Q

What drugs can be prescribed for severe or chronic sleep disturbance?

A

Promethazine

100
Q

Which antipsychotics are contraindicated if breast feeding?

A

Lithium
Carbamazepine
Clozapine

101
Q

What specifics are needed when culturing a swab for GBS?

A

After collection, swabs should be placed in a non-nutrient transport medium, such as Amies or Stuart.
Specimens should be transported and processed as soon as possible. If processing is delayed, specimens should be refrigerated.

Enriched culture medium tests are recommended. The clinician should indicate that the swab is being taken for GBS.

102
Q

What is the rate of recurrence of GBS if positive in previous pregnancy?

A

50%

Offer choice of antibiotics or retesting in this pregnancy in 3rd trimester - should be 3-5 weeks before anticipated delivery

103
Q

If known GBS and antibiotics not more than 4 hours before delivery or other risk factors, what monitoring is recommended of the neonate?

A

Hourly until 2 hours of life then 2 hourly until 12 hours

If term baby, and antibiotics 4 hours prior to delivery, then no need for extra monitoring

104
Q

What antibiotics should neonates with suspected GBS infection receive?

A

Penicillin and Gentamicin

105
Q

What are the limitations of swabbing for GBS at 35-37 weeks?

A

Between 17% and 25% of women who have a positive swab at 35–37 weeks of gestation will be GBS negative at delivery.

Between 5% and 7% of women who are GBS negative at 35–37 weeks of gestation will be GBS positive at delivery.

106
Q

What are penicillin allergic patients with GBS given as antibiotic?

A

Non-severe allergy Cefuroxime 1.5 g loading dose followed by 750 mg every 8 hours).

Severe allergy Vancomycin 1 g every 12 hours

107
Q

What blood test can you check to confirm anaphylaxis if suspected as cause of collapse?

A

Mast cell tryptase

108
Q

At what stage of maternal collapse do you consider perimortam C/S?

A

By 4 minutes of CPR

109
Q

What is the management of amniotic fluid embolism?

A

Supportive care
Recombinant factor VII should only be used if coagulopathy cannot be corrected by massive blood component replacement as it causes poorer outcome

110
Q

What is the antidote to magnesium toxicity?

A

10 ml 10% calcium gluconate or 10 ml 10% calciumchloride given by slow intravenous injection

111
Q

What is the treatment for local anaesthetic toxicity?

A

Lipid rescue - intralipid 20%

112
Q

What is the treatment of anaphylaxis?

A

1:1000 500 micrograms 0.5ml adrenaline IM

113
Q
A
114
Q

What is your percentage chance of going into labour, according to gestational age?

A

Gestational age (weeks)

Proportion of spontaneous labours that started at this gestational age

31 weeks and under 2.4%

32+0 to 36+6 weeks 5.3%

37+0 to 37+6 weeks 5.1%

38+0 to 38+6 weeks 12.1%

39+0 to 39+6 weeks 25.4%

40+0 to 40+6 weeks 32.5%

41+0 to 41+6 weeks 16.2%

42+0 weeks and over 0.9%

Cumulative proportion of spontaneous labours that started by this gestational age

31 weeks and under 2.4%

32+0 to 36+6 weeks 7.7%

37+0 to 37+6 weeks 12.8%

38+0 to 38+6 weeks 24.9%

39+0 to 39+6 weeks 50.3%

40+0 to 40+6 weeks 82.8%

41+0 to 41+6 weeks 99.0%

42+0 weeks and over 100%

115
Q

What are risks of continuing birth beyond 41 weeks?

A

Risks associated with a pregnancy continuing beyond 41+0 weeks may increase over time and these include:

increased likelihood of caesarean birth

increased likelihood of the baby needing admission to a neonatal intensive care unit

increased likelihood of stillbirth and neonatal death

116
Q

What monitoring should be offered women declining IoL from T+14?

A

Fetal monitoring might consist of twice-weekly cardiotocography and ultrasound estimation of maximum amniotic pool depth.

117
Q

What is the management of PPROM

Before 34 weeks
Between 34-37 weeks
If GBS positive

A

Before 34 weeks - expectant management until 37/40

Between 34-37 - discuss IoL now vs expectant management taking maternal/fetal risk factors into account

If GBS positive - consider IoL from 34/40

118
Q

What should be included in counselling for women with LGA (and no diabetes)?

A

With induction of labour the risk of shoulder dystocia reduced compared with expectant management

With induction of labour the risk of third- or fourth-degree perineal tears is increased compared with expectant management

Risk of perinatal death, brachial plexus injuries in the baby, or the need for emergency caesarean birth is the same between the 2 options

119
Q

From what gestation can membrane sweeps routinely be offered?

A

39/40

120
Q

What are recommendations for place of birth for low risk

Primips
Multips

A

Primip
MLU - reduced risk intervention
Homebirth - increased risk of poor neonatal outcome

Multip - MLU or home birth reduced risk intervention, comparable outcomes
Labour in a freestanding MLU reduces intervention with comparable neonatal outcomes

121
Q

What are analgesic options for women in labour, and which have been shown to be effective?

A

Breathing exercises, having a shower or bath, and massage may reduce pain during the latent first stage of labour.

Do not offer or advise aromatherapy, yoga or acupressure for pain relief during the latent first stage of labour.

TENS - no harm, no evidence of benefit

Sterile water injections - allowed on NHS
Sterile water injections can provide relief of back pain from 10 minutes after the injection for up to 3 hours, but there can be an initial stinging sensation.
Giveat 4 different injection points around the Rhombus of Michaelis, using doses of 0.1 ml intracutaneously or 0.5 ml subcutaneously at each injection point.

Remifentanil PCA - risk of needing oxygen, benefit is length of half life unaffected by time of use

Epidural

122
Q

What monitoring is needed for women with epidural?

A

during establishment of regional analgesia or after further boluses (10 ml or more of low-dose solutions), measure blood pressure every 5 minutes for 15 minutes

assess the level of the sensory block hourly

if the woman is not mobilising, assess the level of motor block hourly by asking the woman to do a straight leg raise. If she is unable to do this, ask the anaesthetist to review.

123
Q

What medications are included in an epidural?

A

LA - Bupivocaine 0.0625% to 0.1%
Opioid - Fentanyl 2 microgram/ml

124
Q

What percentage of term women who SROM will go into labour?

A

60% by 24 hours

125
Q

If women have not laboured by 24 hours SROM, what recommendations should be made?

A

Offer IoL
Advise to to give birth where there is access to neonatal services (this may be in an obstetric unit or an alongside midwifery unit) and to stay in hospital for at least 12 hours after the birth

126
Q

What is the average length of labour for

Primips
Multips

A

First labours last on average 8 hours and are unlikely to last over 18 hours

Second and subsequent labours last on average 5 hours and are unlikely to last over 12 hours.

127
Q

What is the impact of SSRI/SNRI on labour risk assessment?

A

Increases risk of PPH if taken in month before birth

Also baby needs additional monitoring for 72 hours due to small increased risk of persistent pulmonary hypertension of the newborn or neonatal withdrawal symptoms

128
Q

How long do mec/PROM obs continue?

A

Upto 12 hours

129
Q

At how many hours post-natal do you assess for

Bladder function
Neurological function post epidural?

A

Bladder function - by 6 hours
epidural - SLR by 4 hours

130
Q

What medications should be used to maintain BP during C/S?

A

After spinal, prophylactic intravenous infusion of phenylephrine, started immediately after the spinal injection. Adjust the rate of infusion to keep maternal blood pressure at 90% or more of baseline value and avoid decreases to less than 80% of baseline.

When using phenylephrine infusion, give intravenous ephedrine boluses to manage hypotension during caesarean birth, for example if the heart rate is low and blood pressure is less than 90% of baseline.

Also IV crystalloid

131
Q

What frequency of obs is required after GA for section?

A

When a woman has regained airway control, is haemodynamically stable, and is able to communicate after caesarean birth under a general anaesthetic:

continue observations (oxygen saturations, respiratory rate, heart rate, blood pressure, temperature, pain and sedation) every half hour for 2 hours

after 2 hours, if these observations are stable, carry out routine observations in accordance with local protocols

if these observations are not stable, or the woman has other risk factors or complications (for example, severe hypertension, or signs of infection or sepsis), carry out a medical review and increase the duration and frequency of observations.

132
Q

What considerations should be made for those with diamorphine epidurals?

A

Those with diamorphine + risk factors for respiratory depression:

carry out hourly monitoring of oxygen saturations, respiratory rate and sedation for at least 12 hours after birth, and then routine PN care

Diamorphine 12 hours
Morphine 24 hours

133
Q

What should you be aware of in relation to pulse oximeters and dark skin?

A

Some pulse oximeters can underestimate or overestimate oxygen saturation levels, especially if the saturation level is borderline. Overestimation has been reported in people with dark skin so hypoxaemia may not be detected.

134
Q

What pain relief can be offered following C/S?

A

Offer intrathecal diamorphine (up to 300 micrograms) to reduce the need for supplemental analgesia after a caesarean birth. Use epidural diamorphine (up to 3 mg) as an alternative if intrathecal diamorphine has not been given.

If diamorphine is unavailable, offer intrathecal preservative-free morphine (up to 100 micrograms) plus intrathecal fentanyl (up to 15 micrograms). Use epidural preservative-free morphine (up to 3 mg) as an alternative if intrathecal morphine has not been used.

135
Q

What are the radiation risks associated with V/Q and CTPA for PE?

A

Risk of childhood cancer
VQ 1/280,000
CTPA 1/100,000

Increased risk of fatal childhood cancer to the age of 15 following in utero radiation exposure = 0.006% per mGy (1 in 17000 per mGy)
Fetal radiation
V/Q 0.5mGy
CTPA 0.1mGy

Maternal breast tissue
CTPA 10mGy - increases Breast Ca risk 13.6% above background risk

136
Q

What are blood sugar targets in diabetes?

A

fasting: 5.3 mM and
1 hour after meals: 7.8 mM or
2 hours after meals: 6.4 mM.

137
Q

How long after demise of co-twin should MRI brain of remaining twin be performed?

A

4 weeks

Risk of death 15%
and neurological abnormality 25%

in surviving twin

Damage to the surviving twin is believed to be caused by acute haemodynamic changes around the time of death, with the survivor losing part of its circulating volume into the circulation of the dying twin. This may cause transient or persistent hypotension and low perfusion, leading ischaemic organ damage especially to the watershed areas of the brain

138
Q

What is risk of serious medical problem in baby in primips/multips?

A

Multips - no real difference regardless of location of birth
3/1000

Primips
9/1000 if homebirth
5/1000 if obstetric unit or alongside MLU

139
Q

What is postnatal follow up for women with PET in regards to proteinuria?

A

Urine dipstix at 6 weeks
If still positive recheck at 3 months - then consider referral to renal team ?CKD

140
Q

What thrombophilias are NOT associated with an increased risk of pre-eclampsia?

A

Antithrombin III
protein C
Protein S deficiencies
Lupus anticoagulants
Acquired activated protein C resistance (APCR)
are NOT associated with pre-eclampsia.

Hyperhomocysteinaemia
Anticardiolipin
Prothrombin
Methylenetetrahydrofolae reductase gene mutation homozygous
ARE all associated with PET.

141
Q

What is placental growth factor?

A

PLGF used as predictor for developing PET

Binds to vascular endothelial growth factor receptor
Soluble form regulates activity by binding and inhibiting activity

142
Q

What is ‘shock index’?
How is it calculated?

A

Early marker of compromise
Calculated for ratio of pulse to systolic BP

143
Q

What are the diagnostic criteria for proteinuria in pregnancy?

A

PCR 30mg/mmol
ACR 8mg/mmol.

144
Q

What virus is implicated in Bell’s palsy?

A

Herpes Simplex

145
Q

What is management of women in pregnancy with previous baby affectedly GBS?

A

Always IAP if previous baby had EOGBS
No role for swabs

146
Q

What is the most common cause of postpartum sepsis?

A

E Coli

147
Q

What are normal parameters for pelvicalyceal dilatation in pregnancy?

A

Mild hydronephrosis is normal in pregnancy
Up to 5 mm on the left and 15 mm on the right
Dilatation of the ureters up to 2 cm in the third trimester

are all acceptable

148
Q

When swabbing for GBS, what location is optimum for detection?

A

Lower vagina and rectum

149
Q

What are the 4 types of injury from shoulder dystocia?

A

2)1)Avulsion (tearing from the spine),
2)Rupture (torn but not at spinal attachment)
3)Neuroma (torn but healed and scarring prevents signal conduction)
4)Neuropraxia (stretching) - the most common, most infants recover by 3-4 months, physio/occasionally surgery is required

150
Q

What is the rate of difficult airway intubation in obstetrics?

A

General population 1:3000
Obstetrics 1:300

151
Q

What is risk of low Papp-A?

A

1/4 have early onset fetal growth restriction

152
Q

What CRL is needed for a NT measurement?

A

45-84mm

153
Q

From when must you perform foeticide when performing TOP?

A

From 21+6

154
Q

What are the definitions of mild and severe ventriculomegaly?

A

> 10mm - mild
1-3% chromosomal abnormality

> 15mm - severe
50% neurodevelopment delay

Manage through FMU
Serial USS - want ventricles to stay same size despite fetal growth

155
Q

After which size of head circumference if vaginal delivery not possible?

A

About 40cm

156
Q

What is mirror syndrome?

A

Fetal hydrops results in PET in the mother

157
Q

What are the detection rates for combined and quad screening?

A

Combined (first trimester) - 85% T21 80% T13/18
False positive 2%

Quad (second trimester) 80% T21 only
False positive 3%

158
Q

What is the rate of brachial plexus injury in shoulder dystocia according to the GTG?

A

Brachial plexus injury (BPI) is one of the most important fetal complications of shoulder dystocia, complicating 2.3% to 16% of such deliveries

<10% have permanent neurological dysfunction
0.43 per 1000 live births in the UK

159
Q

What percentage of babies affected by shoulder dystocia are LGA?

A

Equally important, 48% of births complicated by shoulder dystocia occur with infants who weigh less than 4000g (according to GTG)

160
Q

What is the effect of McRobert’s manoeuvre?

A

The McRoberts’manoeuvre is hyperflexion and abduction of the maternal hips,positioning the maternal thighs on her abdomen.

It straightens the lumbosacral angle, rotates the maternal pelvis towards the mother’s head and increases the relative anterior-posterior diameter of the pelvis.

The McRoberts’manoeuvre is an effective intervention,with reported success rates as high as 90%.

161
Q

Discuss Obstetric cardiac arrest

A

Same principles as adult cardiac arrest
Need uterine displacement to be performed whilst doing CPR (push uterus up and left)
Normal 30:2 ratio
Defibrilliation safe
If PEA - immediate Adrenaline 1g IV then every 3-5 minutes
if VF/VT - after 3rd shock and Amiodarone 300mg
Peri-mortem C/S immediately if over 20 weeks and prolonged pre-hospital arrest or by 5 minutes for maternal factors

Obstetric specific causes:
Eclampsia
Cardiac myopathy
Haemmorhage (can be concealed)
Amniotic Fluid Embolism
Uterine rupture
Massive PE

162
Q

What vein is typically affected in postnatal ovarian vein thrombosis?

A

Right side normally affected - drains directly into IVC, more valves + more likely to be compressed by gravid uterus

163
Q

What is the typical presentation of postnatal ovarian vein thrombosis?

A

Between 1-2000 and 1 in 5800 deliveries
Rare presentation, but higher association with caesarean section/twin C/S
POVT characterised by abdominal pain + fever that does not improve with infection
Typically present by day 10
Palpable abdominal mass in up to 50%

USS poor at detecting
CT first line in most units - 78% sensitivity
Require anticoagulation for 3-6 months
High risk for sepsis
No indication for haemophilia testing
LMWH in future pregnancies (similar recurrence as VTE)

164
Q

What is phenylketonuria?

A

1 in 10,000 in Caucasians/East Asians
Not present in Africa

Autosomal recessive metabolic disorder - one of the most common
Caused by deficiency of phenylketonuria hydroxylase (PAH) which converts phenylketonuria to tyrosine

165
Q

How is phenylketonuria managed in pregnancy?

A

Those affected should follow dietary restrictions during the first 5–6 years of life, when brain growth is most rapid - low PKU diet to prevent build up

In pregnancy:
Need to resume Phe-restricted diet, with supplementation of amino acids
Poor tasting - not liked by patients
Need optimal control (tested by blood spots twice weekly) PRIOR to conception
Need four readings of <50 μmol/l before trying to conceive

Untreated or suboptimally treated women with PKU have elevated Phe levels that are teratogenic to the unborn fetus. Phe is actively transported across the placenta, reaching fetal concentrations that are 1.25–2.5 times greater than maternal concentrations

Uncontrolled PKU in pregnancy causes similar presentation to fetal alcohol syndrome - irreversible brain damage
Clinical signs in fetus: IUGR, microcephaly, congenital heart disease and facial dysmorphism

Need regular scanning in pregnancy to assess for signs listed above
Risk of congenital heart defects 7-10%

In older children:
Fair skinned ++ as Tyrosine required for melanin production
Musty-smell
Intellectual disability
Behavioural problems

Breastfeeding safe

166
Q

According to BAPM what is the definition of severe impairment in the context of premature birth?

A

The severe impairment category includes any of:
severe cognitive impairment with an IQ lower than 55 (< -3 standard deviation); this will usually result in the need for special educational support and require supervision in daily activities
severe cerebral palsy – classified as Gross Motor Function Classification System (GMFCS) grade 3 or greater (Appendix 1)
blindness or profound hearing impairment.

167
Q

What factors increase or decrease risk, in the context of extreme prematurity?

A

FETAL:
Gender - female lower risk
FGR
Singleton pregnancy - lower risk

MANAGEMENT:
Full course of steroids
MgSO4
Delivery in tertiary unit

168
Q

What are the rates of survival and disability between 22 and 27 weeks?

A

Survival

22 weeks - 7/10 die
23 weeks -6/10 die
24 weeks - 4/10 die
25 - 3/10 die
26 - 2/10 die

Disability (SEVERE form, up to 1/4 will have milder)
22 weeks - 1/3 have severe disability
23 - 1/4 are disabled
24 - 1/7 are disabled
25 -1/7 are disabled
26 - 1/10 are disabled

169
Q

What is the risk of head entrapment in a extremely preterm breech?

A

10%

170
Q

What are causes of neonatal jaundice?

A

Early (within 24 hours) - always pathological
-Haemolytic disease
-Infection (TORCH screen)
-Haematoma (traumatic birth)
-Maternal autoimmune haemolytic anaemia (SLE)
-Crigler-Najar
-Gilbert’ syndrome

Physiological - normally presents day 2/3 and resolves by day 10. More likely in breastfed infants.

Prolonged - continuing following Day 14 (term) or day 21 (preterm)
-Infection
-Hypothyroid
-Galactosemia
-GI: biliary atresia,

Conjugated hyperbilirubinaemia (does not cause kernicterus as cannot cross blood brain barrier)

Infection.
Cystic fibrosis.
Metabolic: alpha-1-antitrypsin deficiency, galactosaemia, aminoacidurias, organoacidaemias.
GI: biliary atresia , choledochal cyst, neonatal hepatitis.
Endocrine: hypothyroidism, hypopituitarism.
Prolonged TPN

Measure bilirubin - treat with phototherapy/exchange transfusion

171
Q

What are the risks of an epidural?

A

Inadequate labour pain relief: 1/8 women
Inadequate analgesia for caesarean section necessitating general anaesthetic: 1/20
Significant drop in blood pressure: 1/50
Severe headache (dural puncture): 1/100 women (epidural); 1/ 500 women (spinal)
Nerve damage (numb patch on a leg or foot, or having a weak leg): Temporary – 1/1,000
Permanent - 1/13,000
Epidural abscess: 1/50,000
Epidural haematoma: 1/170,000

172
Q

What are acceptable oximetry readings in a new born?

A

Essential to detect duct dependent cardiac disease

Combining pulse oximetry (Pre-ductal – RIGHT HAND and Post-ductal – ANY FOOT SPO2) screening with existing screening methods, antenatal screening and routine examination, will improve detection of critical CHD cases to over 90%.
A sustained, good signal both readings of ≥ 95% and difference less than or equal to 2% is accepted as normal

173
Q

What are the hypoglycaemia thresholds in a new born?

A

<2.5 in a baby with abnormal clinical signs
<2 in a well baby with risk factors (persistent over 2 readings)
<1 at any time

174
Q

Closure of the ductus arterioles is dependent on….

A

Rise in PaO2

Prostaglandin F, low calcium, low glucose and high pulmonary pressure keep ductus arteriosus open in utero. Hypoxia can cause ductus to become patent.

175
Q

What triggers the closure of the foramen ovale?

A

Caused by decreased right atrial pressure and increased left atrial pressure. Held shut by haemodynamic forces only for the first few weeks. Remains potentially patent in 25-30% of normal adults.

176
Q

What are the main differences in cephalohaematoma and subgleal haematoma?

A

Cephalohaematoma - do not cross suture line, occur beneath the periosteum, associated with jaundice, may not appear until second day of life and may take several weeks to finally disappear

Subgleal - crosses the midline, beneath aponeurosis, cause fetal anaemia and shock, associated with ventouse delivery

177
Q

What temperature should the delivery room be for very preterm infants?

A

The delivery room temperature should be at least 26°C for the most immature infants.

178
Q

What is the adjusted stillbirth rate in the UK?

A

The adjusted stillbirth rate in the UK is 4/1000 (excludes late mid-trimester losses and terminations)

179
Q

What is the risk of placenta accrete when low lying placenta is detected on scan?

A

Placenta accreta occurs in 11–14% of women with placenta praevia and one prior caesarean delivery and in 23–40% of women with placenta praevia and two prior caesarean deliveries. In women with placenta praevia and five or more prior caesarean deliveries, the incidence of placenta accreta is up to 67%.

180
Q

What is the success rate of VBAC if …

IoL
Obesity
Labour dystocia
No previous vaginal birth

A

40%

181
Q

What is the most common cause of fetal hydrops?

A

Idiopathic

182
Q

What genetic abnormality are cystic hygromas associated with?

A

Turner’s
45XO

183
Q

When should MCA dopplers be used to time birth?

A

Middle cerebral artery Doppler

  • In preterm SGA, MCA Doppler has limited accuracy to predict acidaemia and adverse outcome and should not be used to time delivery.
  • In SGA detected after 32 weeks where umbilical artery Doppler indices are typically normal, an abnormal middle cerebral artery Doppler (PI < 5thcentile) has moderate predictive value for acidosis at birth and should be used to time delivery
184
Q

What ultrasound features are specific for Down’s syndrome?

A

Absence of nasal bone
Increased resistance to flow in the ductus venosus and tricuspid regurgitation

185
Q

Why are fetal red blood cells not used for karyotyping?

A

They are anucleate

186
Q

How long do karyotype results take to process?

A

Karyotype results available within 48-72h from fetal blood and chorionic villi but in 2-3 weeks from amniotic fluid

NIPT 9 -14 days

187
Q

What is the mode of inheritance for Fragile X syndrome?

A

X-linked dominant
Fragile site at Xq27

Associated with learning disability
Enlarged testes

  • A degree of learning disability is present in 20-30% of carrier females
  • Refer for genetic counselling
188
Q

What is the recurrence risk of T21?

A

No translocation - age related risk + 0.34% at term (0.42% mid-trimester)

Mother carrier of t(14;21) - 15% recurrence risk

Father carrier of t(14;21) - 1% recurrence risk

Mother or father t(21;21) - 100% recurrence risk

189
Q

What are low and high risk results in NIPT?

A

High risk 1:2
Low risk 1:10,000

190
Q

What are X-linked dominant conditions?

A

Rare

3 main conditions:
Rett’s
Vitamin D resistent Rickets
Fragile X

191
Q

What is the recurrence rate of breech presentation at term?

A

10%

192
Q

What is the recommended dose of Vitamin D in pregnancy?

A

10 ug or 400 IU

193
Q

In women who develop chickenpox within the 4 weeks prior to delivery what is the risk of varicella infection of the newborn?

A

50% transmission, about half of which will have clinical neonatal varicella syndrome

194
Q

Discuss pH changes with the following types of fetal hypoxia

Acute
Sub-acute

A

pH drops in..

Acute 0.01/min
Sub-acute 0.01/2-3min

195
Q

How does gradually evolving hypoxia present?

A
  1. Evidence of hypoxic stress (decelerations)
  2. Loss of accelerations and lack of cycling
  3. Exaggerated response to hypoxic stress (decelerations become
    wider and deeper)
  4. Attempted redistribution to perfuse vital organs facilitated by
    catecholamines (first sign noted is a rise in baseline)
  5. Further redistribution with vasoconstriction affecting the brain
    (reduced baseline variability)
  6. Terminal heart failure (unstable/ progressive decline in the
    baseline - “step ladder pattern to death”)
196
Q

Discuss surgical smoke in relation to type of surgery

A

Electrosurgery generates the smallest particles with a mean diameter of 0.07 μm
Laser-generated particles are typically larger, at up to 0.31 μm
Ultrasonic scalpel by-products are the largest, with particle diameters ranging from 0.35 to 6.5 μm

Particle size
Those below 10 μm are classified as inhalable
Particles of 5 μm or less will be deposited on the walls of the nose, pharynx and trachea, irritating the respiratory tract and requiring clearance by mucociliary action
Smaller matter of less than 2.5 μm, including bacteria and viruses, will penetrate deeper into the alveolar region of the lungs, where clearance by macrophage phagocytosis will induce an inflammatory response.

Masks only effective at stopping inhalation of 5um and larger

197
Q

What is the length of treatment for patients with confirmed CVT?

A

6 months LMWH

MRCOG Part 2 (10 decks)

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