Maternal medicine

Question 1

What are the respiratory changes associated with pregnancy?

Answer 1

Increased:
-Tidal volume
-O2 carry capacity.
-Inspiratory capacity (IC)

Decreased:
-Residual volume.
-Expiratory reserve volume.
-Functional residual capacity.

Same:
-Vital capacity.
-Respiratory rate.
-FEV1

Question 2

In epileptic patients, how much does the seizure risk increase pregnancy?

Answer 2

25%

Question 3

What effect can myasthenia gravis (MG) have on a pregnancy?

Answer 3

Passive transfer of AchR IgG can lead to:
-arthrogyroposis multiplex congenita (stiff joints)
-polyhydramnios
-neonatal MG.

Question 4

What medication is contraindicated in labor in patients with MG?

Answer 4

MgSO4

Question 5

What are the indications for CS with IBD?

Answer 5

1) Active perianal disease.
2) Ileo-anal pouch anastomosis for UC.

Question 6

What are the risks with active IBD at the time of pregnancy?

Answer 6

PTB, LBW, IUFD, CS, VTE.

Question 7

What INV medications are contraindicated in pregnancy?

Answer 7

Methotrexate, 5-ASA if contains bibutyl phytlate (DBP).

Question 8

If IBD patient is on anti-TNF medication and breast feeding, what advice around neonatal vaccination is recommended?

Answer 8

Avoid live vaccines for 6/12.

Question 9

What pituitary hormones increase in pregnancy?

Answer 9

CRH, ACTH, Prolactin, Oxytocin.

Question 10

For pre-existing diabetes what are the target blood glucose levels in pregnancy?

Answer 10

1) Fasting < 5.3mmol/L.
2) 1 hour post prandial 7.5mmol/L but 7.8mmol/L for GDM.
3) 2 hours post prandial 6.7mmol/L.

Question 11

What is the rate of perinatal mortality with DKA on pregnancy?

Answer 11

Up to 35% but < 1% maternal mortality.