Maternal Medicine Mcqs Flashcards
How should levothryoxine be adjusted at the beginning of pregnancy
Increase by 25 micrograms per day. Further dose adjustment may be needed as pregnancy progresses
What is the TSH target for
1) T1
2) T2 and 3
1) 2.5 mU/L
2) 3
What is the frequency of TFT prior to optimization
Q 4-6 weekly
What is the management postpartum of thyroid disease
1) restart prepregnancy dose
2) TFT at 6 weeks
How long should pregnancy be avoided post radioactive iodine therapy
6 months
What antithyrood drugs can cause congenital aplasia cutis
Carbamizole
Methimazole
What is the rate of pyelonephritis in pregnancy
1-2%
Recurrence rate of pyelonephritis in pregnancy
20%
What is the recommended pregnancy deferral time following allograft transplant
2 years
What condition is pemphigoid gestationis linked to
Autoimmune disease
Esp Graves disease
What is the pattern of the rash of PG (4)
- starts periumbilically
- fans outward then involves trunk extremities palms and soles
- vescicles and bullae
- mucosa spearing
Management of PG
- MDT with dermatology
- emollients
- topical steroids
- ## antihistamines
What is a pregnancy concern of PG
Associated with fetal growth restriction
What is the rate of postpartum flare
75%
What is the second most common dermatosis of pregnancy
Polymorphic eruption of pregnancy
What are the risk factors for PEP
(3)
- nulliparity
- multiple pregnancy
- overdistension (fibroids, polyhydramnios)
What is the typical features of PEP
- papules and plaques formed within the distribution of striae gravidarum
- umbilical sparing
What is the recurrence rate of AFLP
25%
What pre conception evaluations should be performed for HBSS within a year of pregnancy (5)
- pulmonary function test
- ECHO
- renal and liver function
- retinopathy screening
What percentage of patients with beta thalassemia major develop hypogonadotrophic hypogonadism
66%
What percentage of beta thal develop diabetes
20%
What percentage of beta thal major develop osteoporosis
40%
What percentage of beta thal develop hypothyroidism
10%
What is the most common cause of death in beta thal major
Cardiac failure (50%)
What is the most common cause of thrombocytopenia in pregnancy
Gestational thrombocytopenia
75%
What are other causes of thrombocytopenia in pregnancy (2)
1- hypertensive disease 15-20%
2- immune causes 3-4%
What percentage of neonates have thrombocytopenia due to maternal ITP
10%
What are delivery condiserations for ITP (3)
- avoid ventouse due to risk of fetal thrombocytopenia
- forceps use possible with consultant advice
- section only for obstetric indications
What is the mortality rate of congenital heart block due to maternal SLE
15-30%
What auto antibodies are associated with CHB
Anti ro/la
What thrombophilia has the highest VTE risk in pregnancy
Antithrombin deficiency type 1
What is the neonatal hsv transmission rate for primary hsv in pregnancy
41%
Placenta praevia odds ratio after one lscs
2.2
Placenta praevia odds ratio after 2 lscs
4.1
Placenta praevia odds ratio after 3 lscs
22.4
Risk of praevia after 3 sections compared to no sections
More than 20 times
What is the leading cause of maternal death
Cardiac disease
What is the second most common cause of maternal death
Neurological : epilepsy and stroke
What drug is safest in pregnancy for the treatment of rheumatoid arthritis
Certolizumab
- does not cross the placenta
- safe in all trimesters
- safe in breastfeeding (all anti- TNF)
-Rituximab should be discontinued 6months before pregnancy
What is the rate of breast cancer in pregnancy
1:3000
How is breast cancer managed in pregnancy
- surgical management as per non pregnant
- chemotherapy safe after T1
- tamoxifen and herceptin not safe
- Radiotherapy contraindicated unless life saving such as spinal compression
- imaging not recommended (only chest xray and liver us)
- do not breastfeed with chemo (2 weeks ) as can cause neonatal leucopenia
Preconception pregnancy planning with history of breast cancer
- tamoxifen free x 3mmths
- Metastatic disease should not get pregnant
- chemotherapy may be gonadotoxic leading to infertility
Medical management of HBSS in pregnancy
- stop ace/arbs
- influenza vaccine yearly
- folic acid 5mg
- pneumococcal vaccine every 5 years
- daily penicillin/erythromycin if allergic
- asa 75mg daily from 12 weeks
- LMWH if admitted
Maternal risk of obesity
- miscarriage
- gdm
- pre eclampsia
- vte
- iol
- lscs
- anaes complications
- wound infections
- breastfeeding concerns
Fetal risk of maternal obesity
- stillbirth
- congenital anomalies
- prematurity
- macrosomia
- neonatal death
- metabolic disorders in childhood
Antenatal adjustments in obesity
- high dose folic acid
- vitamin D 10microgram daily
- vte risk assessment
- anesthesia review if bmi >40
- pre eclampsia surveillance
- active management third stage
What is the course of asthma in pregnancy
1/3 improve
1/3 worsen
1/3 no change
What is the incidence od transient neonatal.myasthenia gravis
20%
What is the effect of pregnancy on myasthenia gravis
Worsen 40%
Unchanged 30%
Remission 30%
When are exacerbations of MG more common
T1 and postpartum up to 3 months
What percentage of patients with MG have thyroid dysfunction
10-15%
What percentage of patients with MS also have a thymoma
15%
What fetal anomaly is associated with lithium use
Ebsteins anomaly
- right ventricular outflow Obstruction
What is the monitoring schedule if lithium continued in pregnancy
- monitor lithium levels every 4 weeks until 36 weeks then weekly
How is labor managed for patients on lithium
- hospital birth
-stop drug during labor - check lithium levels 12 hours after last dose
Neonatal impact of lithium
- floppy muscles
- tachycardia
- lethargy
- jaundice
What is an alternative agent for bipolar disease when lithium is discontinued
Quetiapine
