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RCPSC > mat med 2 > Flashcards

mat med 2 Flashcards

1
Q

cystic fibrosis - what is a contraindication to pregnancy?

A

FEV1 =<50%

pregnancy does not change long term survival

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2
Q

CF in pregnancy - early screening required for?

A

GDM

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3
Q

arthrogryposis multiplex congenita

A

myasthenia gravis
Passive placental transfer of AChR IgG

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4
Q

IBD in pregnancy - active disease associated with higher risks of?

A
  • PTB
  • LBW
  • IUFD
  • CS
  • VTE
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5
Q

if anti-TNF given in pregnancy, how long to avoid live vaccines to newborn?

A

6 months

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6
Q

preconception A1C =<7% decreases risks of

A
  • spont abortion
  • PET
  • progression of retinopathy
  • congenital anomalies
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7
Q

diabetic diet calories

A

1800-2200kcal

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8
Q

pre-existing DM - how often to check HbA1c in pregnancy?

A

every trimester

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9
Q

pre-existing DM - when to do USS for viability and dating

A

7-9 wks

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10
Q

pre-existing DM - postpartum screening for?

A

thyroiditis - TSH

also comprehensive eye exam within 1y

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11
Q

DKA in pregnancy - predisposing causes

A
  • systemic infection
  • pump failure
  • betamimetic tocolytics
  • antenatal steroids
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12
Q

diagnosis of DKA in pregnancy

A
  • BM >13.9mmol/L
  • pH <7.3
  • bicarb <15
  • AG >12
  • ketonemia
  • renal dysfunction
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13
Q

mortality of DKA in pregnancy

A

maternal <1%
perinatal <35%

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14
Q

SLE flare associated with
(Biochemical)

A
  • high anti-ds DNA levels
  • low complement levels
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15
Q

bloodwork for SLE in pregnancy

A
  • CBC monthly
  • renal function monthly
  • anti-Ds DNA + complement in each trimester
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16
Q

if SLE with anti-ro/la ab’s, what to do?

A

FHR weekly between 18-28 weeks

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17
Q

most common indications for ICU admission

A

PPH and HDP

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18
Q

first line vasopressor in pregnancy

A

norepinephrine

19
Q

high risk cardiac disease for pregnancy

WHO 4 - pregnancy contraindicated

A
  • pulmonary arterial HTN
  • NYHA 3/4 or EF<30%
  • aortic coarctation w/valvular involvement
  • marfan’s w/aortic root >40mm

25-50% maternal mortality

20
Q

Marfans contraindication for pregnancy if?

A

aortic root >40mm

21
Q

previous PPCM contraindication for pregnancy if

A

current EF<45%

22
Q

what dilation of aorta should be repaired prior to pregnancy?

A

> 50mm

23
Q

ELCS should be considered for what size aortic root?

A

> 45mm

24
Q

BAV - risk of recurrence/inheritiance?

A

10%

autosomal dominant variable penetrance

25
Q

incidence VTE in pregnancy

A

~1/1000

pregnancy increases risk 4x

26
Q

incidence of PE in pregnancy

A

~1/7000

15x more common PP than AP

27
Q

low risk thrombophilias

A
  • factor V leiden heterozygous
  • PT G20210A heterozygous
  • Prot C deficiency
  • Prot S deficiency
28
Q

high risk thrombophilias

A
  • AT deficiency
  • compound heterozygous FVL/PT G202190
  • Factor V Leiden homozygous
  • PT G20210A homozygous
29
Q

VTE management for low risk thrombophilia and no VTE?

A

AP surveillance
+
PP prophylaxis 6/52

30
Q

VTE management for high risk thrombophilia and no VTE?

A

AP prophylaxis
+
PP prophylaxis x6/52

31
Q

when to test for thrombophilias?

A
  • recurrent early pregnancy losses
  • massive abruption +/- IUFD
  • early/severe PET
  • early/severe IUGR
  • unexplained SB

only test for APLA

32
Q

anticoag - if ELCS or planned IOL, when to stop LMWH?

A

24-36h

33
Q

anticoag- when is neuroaxial anesthesia safe after prophylactic UFH

A

4h

34
Q

anticoag- when is neuroaxial anaesthesia safe after LMWH?

A
  • 12h after prophylactic
  • 24h after therapeutic
35
Q

anticoag- when to resume prophylaxis

A
  • 4-6h after vaginal delivery
  • 6-12h after c/s
36
Q

incidence of cancer in pregnancy (or within 1y PP)

A

1/1000

37
Q

most common malignancies in pregnancy

A
  1. breast (1/5000)
  2. thyroid (1/7000)
  3. cervix (1/8500)
  4. lymphoma
  5. melanoma
38
Q

mets to placenta from fetal malignancies

A
  1. neuroblastoma
  2. leukemia
  3. congenital giant pigmented nevi
39
Q

mets to placenta from maternal malignancies

A
  1. melanoma (30%)
  2. leukemia/lymphoma
  3. breast

melanoma - death within 7 months PP

40
Q

PTU mechanism of action?

A
  • blocks organification of iodine
  • blocks peripheral conversion of T4 to T3
41
Q

PTU use reserved for

A
  • inability to tolerate MMZ
  • contraindications to surgery or I131 ablation
  • preconception or 1st TM
42
Q

how long to avoid pregnancy and/or BF after radioactive ablation

A

4 months

contraindicated in pregnancy; if exposure after 10wk offer TOP

43
Q

incidence of thyroid storm in pregnancy

A

1%

can be precipitated infxn, surgery, L&D

44
Q

general management for thyroid storm

A
  1. PTU
  2. iodide (1-2h after PTU)
  3. Dex
  4. propranolol

don’t worry about fetus until mother is stabilized

RCPSC (17 decks)

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