Maternal Medicine Flashcards
How soon should methyldopa be stopped postpartum
2 days
What treatment reduces pruritis in OC
Ursodeoxychic acid
Chlorpheniramine provides sedation at night but has no significant impact on pruritis
At what viral load should a LSCS be considered if on HAART treatment
50-400
At what viral load should a LSCS be recommended if on HAART treatment
> 400
ELCS recommended at 38-39 weeks
In the U.K. What is the rate of HIV transmission if the mother is on HAART
0.7%
Regarding women on ART for HIV at what gestation should a decision on delivery be made
36 weeks
In HIV positive women not requiring treatment for themselves, when should cART be commenced
By 24/40
At 13/40 if baseline viral load >30,000
In HIV positive women not requiring treatment for themselves, when should zidovudine be commenced
Only if opting for ELCS between 38-39 weeks and baseline viral load <10,000
IV zidovudine to be given at delivery
Stop all medication after delivery
What is the management for HIV positive women with PPROM <34 weeks
If no chorioamnionitis
Steroids
Erythromycin
MDT discussion regarding delivery
incidence of idiopathic intracranial hypertension in women of childbearing age
0.9/100,000
Obese 19.3/100,000
Regarding asthma, what is recommended for maintaining control in labour
Systemic steroids
100mg hydrocortisone 6-8hourly during labour
What percentage of sickle patients have a painful crises in pregnancy
27-50%
What percentage of women have overt hypothyroidism in pregnancy
0.5%
What percentage of women have subclinical hypothyroidism in pregnancy
2.5%
A women with hypothyroidism is taking 75mcg at booking, what would you advise
Increase to 100mcg (increase by 25mcg)
Repeat LFT 4-6 weekly to maintain TSH <2.5
What medication should be avoided in the acute phase post MI
Nifedipine
What is the traid of wernickes
A deficiency of what causes it
Ophthalmoplegia, ataxia and confusion
Vitamin B1 - thiamine
What % of women are affected by hyperemesis gravidarum
<1%
What percentage of pregnancies are effected by round ligament pain
10-30%
How common is pyelonephritis in pregnancy
10-25 in 1000 pregnancies
How common is acute appendicitis in pregnancy
1:800-1500
What % of pregnant women are affected by OC
0.7%
What is the recurrence risk for OC
> 90%
What is the rate of fetal mortality within OC
1-4%
But now comparative to normal population due to treatment and delivery at 38 weeks
What % of PET are affected by HELLP syndrome
5-20%
What is the maternal mortality associated with HELLP
1%
Regarding acute fatty liver of pregnancy
What deficiency should be screened for in the baby
What is the most common mutation
LCHAD deficiency
The most common mutation is E474Q
Regarding acute fatty liver of pregnancy
25%
What is the risk of VTE in pregnancy with antithrombin deficiency
30%
What management should be given a woman IS HIV + untreated and arrives in labour
Nevirapine
IV zidovudine
Start triple ART
What screening should be offered if a HIV woman presents >13+6
What would you warn her
Quad test
However increased risk of false positives due to higher hcg and aFP in HIV + population
Regarding HIV positive patients
When should IV zidovudine be given
In labour with unknown viral load, viral load >1000
Prom with unknown viral load or viral load >1000
Viral load >1000 or zidovudine monotherapy admitted for ELCS
What is the risk of HIV vertical transmission in utero if not on ARVs
25-30%
What is the risk of HIV vertical transmission during breast feeding if not on ARVs
50-60%
What are the cut off values for OGTT
Fasting and 2hr
> 5.6 fasting
>7.8 2 hour
What is the fetal radiation exposure from a cxr
0.01msu
What is the fetal radiation exposure from a CTPa
0.1 mGy
What is the fetal radiation exposure from a V/Q scan
0.5mGy
By how much is the risk of childhood cancer increased by for fetal exposure to 1 mGy
0.006%
Or 1:17,000
What finding on echo indicates increased risk of pulmonary HTN
Tricuspid regurg jet velocity >2.5m/sec
Women with pre existing diabetes should be advised against conception if their hba1c is over what level
10% 86mmol/mol
What % of women will need metformin or insulin after a diagnosis of GDM
15-20%
Usually initiated if failure to meet by targets over 1-2 weeks
What BM thresholds should prompt initiation of sliding scale in labour
How often should bms be checked
4-7 mmol/L
Hourly
At what gestation should trab Ab be checked
20-24 weeks
How long after radioidine therapy should a woman wait to conceive
4 months
BM target ranges in pregnancy
Fasting
1hr post
2hr post
Fasting 5.3
1hr post 7.8
2hr post 6.4
When should women with GDM be started on insulin +/- metformin immediately, without a trial of diet and exercise
fasting BM >7
Fasting 6-6.9 if macrosomia or polyhydramnios
What is the fetal radiation exposure from a CT head
<0.005mGy
