Maternal Med Flashcards
Neonatal outcome with poor glycaemic control
Congenital malformations
Stillbirth
Neonatal death
Risk of neonatal+ perinatal death is significantly higher in T2DM than T1DM
True
Differentials for skin conditions
• PUPPS
• Pemphigoid gestationis
• Atopic eruption in pregnancy
• Eczema/ Psoriasis
• OC -> excoriations but typically no rash
• DHx, allergic reaction, contact dermatitis
• Pre-existing auto immune (SLE/ TB/ Sarcoid etc)
• Viral -> CMV, EBV, Parvovirus, Measles, Rubella, HIV, Zika, VZV, Meningitis…
• Fungal
• Parasitic -> scabies
CF - worse outcomes if
FEV1 <60% predicted
B. Cepacia infection (can lead to rapid deterioration of lung function)
Pulmonary hypertension
Cor pulmonale
Cyanosis
Hypoxia
Malnutrition (BMI <22)
Other related conditions (DM, cirrhosis, CKD)
3 skin conditions of pregnancy
Polymorphic eruption of pregnancy (PEP). Pemphigoid gestationis. Atopic eruption of pregnancy.
Frequency 1:200, RARE 1:10000, 1:300
Mitral stenosis risk
(Moderate - Severe)
Maternal
Death 1-3%
Pulmonary oedema 18-37%
New or recurrent arrhythmia 5-16%
Fetal
Stillbirth 2-4%
Neonatal death 0-2%
PTB 10-18%
APS blood tests (2 tests > 12/52 apart)
Anticardiolipin antibodies
Lupus anticoagulant
Anti beta-2-glycoprotein-1 antibodies
SLE bloods
Anti nuclear antibodies (ANA)
aPLs (anticardiolipin antibodies and lupus anticoagulant) (40%) - predicts severity
Anti Ro and Anti La (30%)
C3 and C4
Anti dsDNA antibodies
Renal function
Liver function
Proteinuria
Serious associated maternal risks with HG
Wernicke’s (vit B1, thiamine Def)
Hyponatremia
Peripheral neuropathy (but B12, B6 Def)
VTE
AKI
GORD, Mallory Weiss year, oesophageal rupture
TOP
Malnutrition & refeeding syndrome
PTL, FGR, placental abruption
Genetic carrier screening
(4 conditions and carrier rates)
CF 1:35 (1:25 European)
Spinal muscular atrophy (SMA) 1:50
Fragile X (1:332)
Thalassemia 1:10000 (3% Indians carry beta)
Overall 1:20 carry CF, SMA or Fragile X
1:10 Afrocarribean’s carry SCD.
1:4 West Africans
Maternal infection
3 virus and 1 parasite that you do amnio for
CMV, varicella, Rubella
Toxo
Myasthenia Gravis - fetal effects
Arthrogryposis (contractures due to lack of movement)
Impaired swallowing - can cause Poly
PTB
IUGR
Transient neonatal MG (10-20%)
Kell summary
Pt must be Kell neg
To be affected fetus must be Kell pos
Inhibits erythropoiesis (not haemolysis)
2/52 MCA PSV from 18/40 + for developing hydrops
RA history
Extra-articular features - anaemia, fatigue, vasculitis, subcut nodules, pulmonary, cardiac amyloid, pericarditis
Neck involvement - atlanto-axial subluxation
Previous VTE
?Sjogrens
Echogenic bowel f/u
Even if no cause found, still need 4/52 scans as increased risk of SGA and IUFD
Tetralogy of Fallot
Overing aorta
VSD
Pulmonary (valve) stenosis
Enlarged right ventricle
Hyperthyroidism risks + Ix + Mx in pregnancy
Risks: SGA, PTB, miscarriage, stillbirth, fetal/neonatal thyrotoxicosis (1-5%). Maternal - higher risk if PET with severe features. Thyrotoxic storm. Preg loss, postnatal flare.
TRAb - Thyroid stimulating receptor antibodies (95% +ve in Graves).
PTU, carbimazole, +/ propranolol (40mg TDS)
Risks with thionamides
PTU and Carbimazole 2-4% risk of congenital malformations.
Carbimazole can cause aplasia cutis (patches of absent skin - normally scalp)
Agranulocytosis - rash, infection, sore throat.
Can breastfeed on “normal” doses
Toxo Abx
<18/40 Spiramycin 1g PO TDS (aims to prevent infection rather than treat, concentrates in placenta)
>18/40 Pyrimethamine and Sulfadiazine.
Continue Abx for rest of preg regardless of whether amnio is Pos or Neg.
4 treponemal diseases
Syphilis, bejel, yaws, pinta
Covid Mx (if unwell)
Maintain sats >94%.
Gest - Steroids (fetal lung maturity or not)?
Dexamethasone 6mg IM BD for 4 doses. Then Pred 40mg OD
VTE prophylaxis
Antivirals:
Give Paxlovid (nirmatrelvir 300mg + ritonavir 100mg)
Consider remdesivir
Immune modulator:
Tocilizumab
8mg/kg IV (actual body weight) rounded to nearest 80mg
or 200mg vial (max dose 800mg), as a single dose
Spinal cord injury at level of T6 or higher. (Can also happen with Guillain Barre)
Autonomic dysreflexia
Differentials for severe postpartum headache
Epidural/ puncture headache
Meningitis
HTN/ PET
Cerebral venous thrombosis
Pituitary apopexy
RCVS (reversible vasoconstriction syndrome)
Subarachnoid haemorrhage
Balanced translocations
Parental structural chromosomal abnormalities
Found in 2–5% of RPL couples compared with 0.7% of the general population
Most commonly (~85%) balanced translocations
Reciprocal translocations (~60%)
Robertsonian translocations (~40%)
Refer for genetic counselling.
Most men and women with a balanced translocation can and do have children.
Four possible outcomes for offspring
- ordinary chromosome pattern
- same balanced translocation as the parent
- preg loss due to repeated pregnancies with unbalanced chromosomes
- ongoing pregnancy with unbalanced chromosomes -> stillbirth vs. birth defect
