Medical Conditions Pregnancy

Question 1

5 mechanisms PET

Answer 1

Placental dysfunction and maternal response

Placental - defective spiral arteries, increased placental size

Endothelial dysfunction - - sFLT1 PGF from placenta anti angiogenic, increasing vascular permeability

Inflammatory - proinflam cytokines due to placental ischaemia, increased vascular tone

Immunological - poor invasion of cytotrophoblasts

Generic - possible role imprinting, csome 13, family hx

Question 2

Indications delivery PET

Answer 2

Maternal
Uncontrollable BP, >37 week, deteriorating renal/liver/platelet
Eclampsia
Persistent neuro symptoms
Persistent epigastric pain 

Fetal
Abruption
Severe IUGR
Fetal compromise - Eg abN ctg

Question 3

Lupus medications in pregnancy

Answer 3

Green

• prednisone (hydrocortisone in labour)
• hydroxychloroquine

Orange

• azathioprine
• cyclosporine

Red

• MTX
• cyclophosphamide
• myophenolate mofetil

No nsaids after 32 weeks (risk prem closure ductus arteriosus, pulm HTN, fetal renal effects)

Question 4

4 uss features of spina bifida

Answer 4

Dorsal ossification centre’s
Anencephaly/hydrocephaly/ventriculomegaly
Lemon sign: abnormal size or shape of head, narrowing of bones at frontal portion
Banana sign: cerebellum wrapped around medulla as part of Chiari malformation

Question 5

8 clinical features APLs

Answer 5

Recurrent pregnancy loss <10/40
Unexplained >who

Arterial thrombus: MI, ischaemic limb, stroke
venous thrombus: dvt, pe
Skin: livedo reticularis, skin ulcers
Haematological-haemolytic anaemia, thrombocytopenia
Cardiac:valvular involvement, systemic or pulm HTN
Cranial; migraines, chorea, transverse myelitis
Amorosos Fugax

Question 6

Histo of pemphigoid gestationis

Answer 6

Subepidermal vesicles
Perivascular lymphocytic and eosinophilic infiltrates
Basal cell necrosis
Oedema of dermal papillae

Direct immunofluoresence positive

Question 7

Transmission HSV at birth

Answer 7

Primary - up to 15% of primary are actually recurrent
25-50%

Secondary
1-3% if lesions at delivery (15% if HSV1,
<0.01% if none and T2
Overall <1% if no lesions

95% trans vaginal, transplacental rade

Cs reduces risk OR 0.14
Scalp clip OR 6.8

Question 8

Management of suspected listeria

Answer 8

Review
Cultures - blood, gram stain
Po Amox if afebrile
IV amox or ampicillin if febrile
Consider differentials
If severe, consider steroids, delivery, update paeds, culture placenta, inform public health

Question 9

Impact of cholestasis on fetus

Answer 9

Intrapartum fetal distress
Amniotic fluid meconoum
Spontaneous preterm delivery
Intrauterine fetal death
Fetal intrauterine haemorrhage

Question 10

Investigations prior to CTpA/VQ for PE

Answer 10

FBC
LFTs
ferritin
HCG
ECG 
Troponin
CXR

Consider echo - if haemodynmically unstable,SBP <90, if no RV overload or dysfunction, excludes PE as the cause for hypo

Give therapeutic if imaging not available based on current weight
D diner will reduce imaging but miss up to 40% of women with PE

Question 11

CT vs VQ for suspected PE

Answer 11

VQ - if available, preferable if stable with normal cxr, less likely to have non diagnostic result, better at looking at peripheral disease, minimal breast radiation, no contrast, not all hospitals have them

Involves dumping breast milk for 12 hours after tech99 given

CT- if unstable, abnormal CXR, better for proximal Pe, quick, most local hospitals have them, requires IV contrast

Involves increased risk breast cancer

Question 12

When would you consider ivc filter

Answer 12

Imminent birth or surgery

Recurrent PE on coagulation

Question 13

Associations with high grade CIN during smear in 1st trimester

Answer 13

Low grade CIN
Invasive squamous cell cancer
Inflammatory changes from HPV infection, chlamydia/gonorrhea
Squamous metaplasia
Decidualization of cervical mucosa in pregnancy (Arias-Stella reaction)