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part 2 > mat med > Flashcards

mat med Flashcards

1
Q

anti-D for PVB <12/40

A

ectopic, molar or TOP only: 250 iu

BCSH says for all

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2
Q

anti-D for PVB 12-20/40

A

250iu within 72h

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3
Q

anti-D for PVB >20/40

A

500iu + kleihauer

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4
Q

if >4ml on kleihauer, f/u sample ____

A

at 48h if given IV

at 72h if given IM

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5
Q

cell salvage in anti-D

A

cord blood –> RhD+ –> 1500iu

Kleihauer 30-40min post Tx

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6
Q

anti D for recurrent PVB 12-20/40

A

250iu q6/52

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7
Q

anti D for recurrent PVB >20/40

A

500iu q6/52 + kleihauer q2/52

additional doses 125iu/ml IM, 100iu/ml IV

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8
Q

AFLP: proportion of pts developing AKI

A

14%

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9
Q

AFLP: proportion of pts requiring renal replacement

A

3.5%

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10
Q

enzyme enducing AEDs

A

phenobarbital, phenytoin
Oxcarbazepine
Topiramate
Carbamazepine

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11
Q

Infliximab: stop or continue?

A

Stop by 16/40

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12
Q

Etanercept: stop or continue?

A

Stop by 3rd trimester

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13
Q

Certolizumab: stop or continue?

A

Continue

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14
Q

Adalimubab: stop or continue?

A

Stop by 3rd trimester

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15
Q

autonomic dysreflexia-
what level?
what symptoms?

A

above T6

Hypertension (rise of 20-40mmHg) and bradycardia

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16
Q

injury at what spinal level associated with increased risk of malpresentation at term

A

above T12

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17
Q

injury at what spinal level alters perceptions of FM and unable to feel labor pains

A

above T10

also associated with later preterm labour and UTI

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18
Q

quad test

A

AFP
bHCG
Inhibin A
Unconjugated estriol

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19
Q

most common solid benign liver lesion

A

hepatic hemangioma (present in about 10% of healthy individuals)

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20
Q

appearance of hepatic hemangioma on USS

A

well circumscribed, solid, hyper echoic

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21
Q

lifetime risk of haemorrhage of hepatic adenoma

A

27%

highest risk with larger lesions and THIRD trimester

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22
Q

lifetime risk of rupture of hepatic adenoma with intraperitoneal bleeding

A

17%

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23
Q

risk of malignant transformation of hepatic adenoma

A

5%

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24
Q

toxoplasmosis: risk of fetal transmission <4/40

A

1%

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25
Q

toxoplasmosis: risk of fetal transmission 13/40

A

10%

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26
Q

toxoplasmosis: risk of fetal transmission 36/40

A

> 60%

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27
Q

zika: avoid pregnancy for ?? if male partner traveled

A

3 months

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28
Q

zika: avoid pregnancy for ?? if only female partner traveled

A

8 weeks

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29
Q

high risk thrombophilias (asymptomatic) and management

A
  • asymptomatic antithrombin deficiency
  • protein C or S deficiency
  • homozygous factor V leiden (or compound heterozygote)
  • homozygous prothrombin gene mutation

refer to a local expert and consider antennal LMWH.
Recommend 6 weeks postnatal LMWH

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30
Q

low risk thrombophilia (asymptomatic)

  • list (3)
  • management
A
  1. heterozygous factor V leiden
  2. heterozygous prothrombin gene mutation
  3. antiphospholipid antibodies only

Management:
consider for antenatal thromboprophylaxis in presence of other RFs
10 days LMWH if one other RF present

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31
Q

antithrombin deficiency

A

very high risk

manage by local expert

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32
Q

epilepsy: treat as low risk if

A

seizure free >10y
Off AED for >5y
Resolved childhood epilepsy (seizure and treatment free in adulthood)

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33
Q

lamotrigine lowest risk dose and associated risk of congenital abnormality

A

<300mg/day (<2% risk)

*normal neurodevelopment

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34
Q

carbamazepine lowest risk dose and associated risk of congenital abnormality

A

<400mg/day (<3.4% risk)

*normal neurodevelopment

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35
Q

risk of congenital abnormalities on polytherapy (epilepsy)

A

16.8%

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36
Q

background risk of congenital abnormality

A

2-3%

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37
Q

valproate for epilepsy:

1) risk of congenital abnormality
2) risk of neurodevelopmental impairment

A

1) 10.7%

2) 40% (decreased IQ, Increased autism, reduced verbal and memory skills)

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38
Q

valproate for epilepsy: most common associated congenital defects

A

NTD
Facial cleft
Hypospadias

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39
Q

Phenytoin and carbamazepine: most commonly associated congenital defects

A

cleft palate

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40
Q

phenobarbital and phenytoin: most commonly associated congenital defects

A

cardiac abnormalities

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41
Q

risk of recurrent congenital abnormality if WWE with previous affected child with congenital abnormality

A

16.8%

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42
Q

effect of pregnancy on seizures

A

2/3 will not have deterioration
10% will have reduction
30% will have increase in seizure frequency

(focal epilepsy has a lower seizure-free rate)

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43
Q

how to terminate epileptic seizure intrapartum if no IV access (first line)

A

Diazepam 10-20mg PR, q15min

alternative = midazolam buccal

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44
Q

how to terminate epileptic seizure intrapartum if IV access present (first line)

A

Lorazepam 0.1mg/kg (4mg bolus + 10-20min)

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45
Q

intrapartum epileptic seizure: second line if not controlled

A

phenytoin 10-15mg/kg IV

**if FH not recovered in 5min of recurrent seizures, expedite delivery

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46
Q

side effects of antiepileptic drugs

A

depression, anxiety, neuropsychology sx

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47
Q

risk of FGR for WWE (off or on AED)

A

off: OR 1.26
on: OR 3.56

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48
Q

WWE: general risks

A 
FGR
Misc
IOL
PPH/APH
C/S
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49
Q

risk of intrapartum epileptic seizures

A

1-2%

+1-2% within 24h PN

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50
Q

risk of status epilepticus intrapartum

A

1%

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51
Q

reliable contraception for WWE

A

IUCD, LNG-IUS, DMPA

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52
Q

when to do PN f/u for WWE if medications changed antenatally

A

day 10

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53
Q

pregnancy after breast ca: how long to recommend prior to conception

A

at least 2y

tamoxifen needs to be stopped 3/12 prior to conception

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54
Q

incidence of breast ca in pregnancy

A

1/3000 pregnancies

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55
Q

if having chemo:

1) what interval from last chemo to birth
2) what interval from last chemo to BF

A

1) at least 2-3 weeks

2) allow 14 days

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56
Q

risks of obstetric cholestasis: SB (untreated)

A

1-4%

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57
Q

risk of PTL in OC

A

iatrogenic 7-25%

Spontaneous 4-12%

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58
Q

risk of C/S in OC

A

10-36%

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59
Q

risk of meconium passage in OC

A

25% (more likely if severe)

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60
Q

risk of adverse fetal outcome in OC

A

1-2% for every 1umol/L increase in BA

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61
Q

recurrence of AFLP

A

25%

62
Q

target FT4 in treatment of hyperthyroid

A

1.2-1.8

63
Q

targets TSH in treatment hypothyroid (by trimester)

A 
1st = 0.5-2.5
2nd = 0.2-3.0
3rd = 0.3-3.0
64
Q

incidence of hyperthyroidism in pregnancy

A

1% (Graves in Pregnancy according to TOG)
(??0.2% according to stratOG??)

Gestational thyrotoxicosis (1-3%) is most common cause of biochemical hyperthyroidism in 1st trimester (present in 45% of hyperemesis)

65
Q

risk of neonatal thyrotoxicosis in graves disease

A

1-5%
Mortality 12-20%
Lasts 2-3 months

66
Q

if history of graves, when to measure TRab

A

20-24 weeks

67
Q

incidence of overt hypothyroidism in pregnancy

A

0.5% (~2-10/1000)

68
Q

incidence of subclinical hypothyroidism in pregnancy

A

2-5%

defined as TSH 2.5-10

69
Q

risks of hyperthyroidism (maternal)

A 
PET
FGR
SB
miscarriage
Prematurity
70
Q

risks of overt hypothyroidism

A 
Misc
PET
PIH
PPH
LBW
Low IQ
71
Q

Risks of subclinical hypothyroidism

A

pregnancy loss
abruption
PPROM
NND

**but rule of thyroxine replacement not clear

72
Q

perinatal mortality rate for pre-existing DM

A

28/100 000

73
Q

DM: avoid pregnancy at what threshold level

A

HbA1C >10% (86mmol)

74
Q

DM: targets preconception

A

HbA1c <6.5 (48mmol)
Fasting 5-7mmol
Premeal 4-7mmol

75
Q

DM: what renal threshold to refer to nephrology

A

creat >120
eGFR<45
or ACR >30

76
Q

DM: timing of delivery for T1/T2

A

37-38+6/40 if uncomplicated,

otherwise <37/40

77
Q

DM: intrapartum care BM targets

A

4-7mmol

78
Q

who gets a GTT (24-28/40)

A
  • BMI>30
  • Previous macrosomia
  • Previous GDM
  • FH of DM
  • Minority ethnic group
  • Glycosuria (2+ x1 ,or 1+ x2)
79
Q

DKA diagnosis

A

BM >11
Acidosis ph<7.3 (or HCO3 <15)
Ketones: capillary >3mmol; urine >2+

80
Q

DM: timing of delivery for GDM

A

by 40+6

*planned C/S if DM + EFW >4.5kg

81
Q

% of GDM on lifestyle changes requiring further treatment ie. metformin

A

10-20%

82
Q

SCD: timing of delivery

A

38-40/40, IOL or C/S

83
Q

SCD: fetal risks

A

IUGR
IOL or C/S
Fetal distress
PTL

84
Q

SCD: what medication should be stopped and when

A

hydroxyurea >3/12 prior to conception

85
Q

SCD: incidence of painful crises

A

27-50%

25% postpartum

86
Q

SCD: incidence of ACS

A

7-20%

87
Q

treatment of uncomplicated malaria (falciparum)

A

PO quinine 600mg TDS + clindamycin 450mg TDS

alternative riamet or malerone (atorvaquone -proguanil, 4 tablets daily x3/7)

88
Q

treatment of uncomplicated malaria (vivax, vale, malaria)

A

PO chloroquine 600mg,
then 300mg 68h later
then on day 2 and again on day 3

89
Q

treatment of complicated malaria (any species)

A

IV artesunate 2.4mg/kg - 12, 24h, then daily
when can tolerate oral, switch to PO artesunate + clindamycin

if PO artesunate not available, 3 day course of riamet or malerone;

alternative IV quinine 20mg/kg in dextrose + clindamycin IV 450mg TDS; switching to PO

90
Q

treatment of uncomplicated malaria with vomiting

A

quinine IV 10mg/kg in 5% dextrose over 4h
+ clindamycin IV 450mg TDS

when can tolerate oral, switch to:
PO quinine 600mg TDS x 5-7 days
+/- PO clindamycin 450mg TDS x 7 days

91
Q

prevention of malaria relapse (non-falciparum)

A

chloroquine 300mg once weekly until delivery

92
Q

resistant plasmodium vivax treatment

A

as for uncomplicated falciparum

93
Q

treatment of P vale

A

primaquine 15mg OD x 14/7

94
Q

treatment of P vivax

A

primaquine 30mg OD x 14/7

95
Q

treatment of non-falciparum malaria in presence of G6PD deficiency

A

primaquine 45-60mg once a week for 8 weeks

96
Q

risk of contracting malaria in oceania

A

1:20

97
Q

risk of contracting malaria in sub-saharan africa

A

1:50

98
Q

risk of contracting malaria in Indian subcontinent

A

1:500

99
Q

risk of contracting malaria in southeast asia

A

1:500

100
Q

risk of contracting malaria in south america

A

1:2500

101
Q

risk of contracting malaria in central america/caribbean

A

1:10 000

102
Q

dosing for malaria chemoprophylaxis

A

mefloquine 1 table (250mg) weekly

103
Q

HIV: if unknown viral load/not on treatment; what to give if presents term labour

A

nevirapine stat dose
start ZDV and lamivudine and raltegravir PO
give ZDV IV for duration of labour

104
Q

under what circumstances would you start cART in 1st trimester

A

viral load >100 000

CD4 <200

105
Q

if HBV/HIV co-infection, what should be given?

A

Tenofovir as part of cART

106
Q

if HCV/HIV co-infection, what drug should be avoided?

A

ribavirin

107
Q

postnatal GDM followup

A
  1. test BM prior to discharge
  2. test fasting @ 6-13/52
  3. annual HbA1c thereafter
108
Q

diabetes insipidus in pregnancy associated with what lab abnormalities

A

Blood Osm >285
Urine Osm <300
Hypernatremia

109
Q

DM preconception BM target fasting

A

5-7

110
Q

DM preconception BM target pre-meal

A

4-7

111
Q

DM antenatal BM target fasting

A

<5.3

112
Q

DM antenatal BM target 1h post meal

A

<7.8

113
Q

DM antenatal BM target 3h post meal

A

<6.4

114
Q

DM postnatal BM - normal/low risk

A

<6

115
Q

DM postnatal BM - high risk

A

6.0 - 6.9

116
Q

DM postnatal BM - likely T2DM

A

> 7.0

117
Q

Hemophilia A: factor8/VWF ratio suggestive of carrier status?

A

<0.7

118
Q

hemophilia, de novo mutations

A

30-50%

119
Q

severe hemophilia, level below?

A

0.01

120
Q

moderate hemophilia levels

A

0.01-0.05

121
Q

mild hemophilia levels

A

0.06-0.40

122
Q

risk of ICH and ECH in hemophilia affected male fetuses

A
  • 2.5% ICH (OR 44)

- 3.7% ECH (OR 8)

123
Q

when to do fetal sex determination for hemophilia (for severe carriers)

A

from 9/40 by cffDNA

124
Q

when and what kind of PND to offer for hemophilia carriers pregnant with male fetus

A

CVS at 11-14 weeks;

can also be offered 3rd trimester amniocentesis if not previous done

125
Q

which factor rises in pregnancy

A
  • Factor 8, from 6/40, up to 2-3x baseline

- vWF

126
Q

hemophilia: target factor level prior to surgical or invasive procedures or during spontaneous misc

A

> 0.5

127
Q

what to give to raise Factor levels

A
  • DDAVP 0.3mcg/kg booking weight IV or SC
  • repeat 12-24h
  • recombinant F8 or F9
    +/- TXA
128
Q

hemophilia: factor trget level with treatment

A

1.0

129
Q

ECV in hemophilia?

A

avoid in all male fetuses, and any female who are obligate or possible carriers of severe hemophilias B

130
Q

MOD for hemophilia

A

option of LSCS at 39/40 for affected male babies, or if status unknown.
Aim vaginal delivery otherwise. Avoid ventous and midcavity forceps for males.

131
Q

FBS and FSE in hemophilia?

A
  • NO in severe or moderate

- can consider if mild

132
Q

hemophilia: level required for regional anaesthesia

A

> 0.5

133
Q

hemophilia: how long to maintain levels postpartum

A

3 days if NVD, 5 days if instrumental or C/S.

Continue TA until lochia minimal, or at least 7 days post-c/s

134
Q

hemophilia: what level to avoid VTE prophylaxis

A

<0.6

135
Q

incidence of vWD

A

1/1000 - 10 000

136
Q

Type I vWD

A

partial quantitative; <0.3

137
Q

Type II vWD

A

qualitative; vWF activity: antigen <0.6

138
Q

Type 3 vWD

A

severe quantitative, absent vWF and lowered F8

139
Q

when do VWF and F8 decrease PP?

A

around day 3

140
Q

vWD: PPH risk

A

15-30% primary, 25% secondary

141
Q

vWD: need for RBCs

A

increased 5x

142
Q

vWD: mortality rate

A

increased 10x

143
Q

vWD: APH risk

A

increased 10x

144
Q

which patients to avoid DDAVP

A
  • PET
  • known arterial disease
  • uncontrolled HTN
145
Q

type 3 vWD: regional anaesthesia

A

avoid completely

146
Q

Type 1 vWD: regional anaesthesia

A

can have if normalized VWF activity

147
Q

Type 2 vWD: regional anaeshesia

A

avoid unless levels >0.5

148
Q

severe vWD: HB monitoring PP?

A

at 2/52

149
Q

high risk bleeding disorders for mother

A
  • type 3 vWD
  • severe homozygous rare coagulopathies
  • severe PLT function disorder
  • hemophilia carriers with significant bleeding history
150
Q

high risk bleeding disorders for neonate

A
  • males with severe and moderate Hemophilia
  • type 3 vWD
  • severe homozygous coagulopathies
  • severe PLT disorders
151
Q

deficient factors in Hemophilia A and B?

A 
A= 8, 
B = 9

part 2 (21 decks)

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