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RC OBGYN (CG) > MFM > Flashcards

MFM Flashcards

1
Q

What is the risk associated with PTU use?

A

Hepatotoxicity (0.1-0.2)

Routine LFT not recommended

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2
Q

What is the risk associated with methimazole in pregnancy?

A

Methimazole embryopathy

  • esophageal/ choanal atresia
  • Aplasia cutis = congenital skin defect
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3
Q

What is are common side effects of PTU and methimazole (2)?

A

Transient leukopenia (10%)

– do not stop medication

Agranulocytosis

– discontinue drug

– Fever and sore throat → ER

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4
Q

What is the evolution of the thryroid gland in pregnancy?

A

Enlarges by 30 %

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5
Q

How should you treat hyperthyroidism in pregnancy?

A

T1 : PTU – Propylthiouracil

T2: Methimazole

Switch early 2nd trimester

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6
Q

What are the targets for hyperthyroidism treatment in pregnancy?

A

T4 – High normal range or slightly above

Ignore TSH

Measure Free T4 (NOT TSH) q 2-4 wks

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7
Q

What is the DDx of decreased FEV1 (6) ?

A

Asthma

COPD

CHF

PE

Laryngeal or vocal cord dysfunction

Mechanical airway obstruction

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8
Q

How is asthma classified in terms of intensity?

A

Mild intermittent

Mild persistent

Moderate persistent

Severe persistent

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9
Q

What is the associated of asthma and perinatal outcomes?

A

Well treated asthma NOT related to adverse pregnancy outcomes

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10
Q

What neonatal complications can suboptimal treatment of asthma lead to?

A

Low birth weight

PTB

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11
Q

When to asthma exacerbations usually occur?

A

Between 24 - 36 weeks

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12
Q

What is the proportion of people that improve/ worsen with asthma in pregnancy?

A

2/3 improve

1/3 worsens

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13
Q

Which anti-epileptic drug is associated with the highest chance of congenital malformation?

The lowest?

A

Highest: Valproic acid

Lowest: Lamotrigine (< 2%)

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14
Q

What is the risk of congenital malformation in women taking AED in pregnancy?

A

4 - 8 %

(vs 2-3 % background risk)

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15
Q

What are the most common congenital malformations related to AED in pregnancy?

A

NTD

Cardiac malformations

Cranio-fascial defects

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16
Q

How do you follow a pregnancy of a patient on AED?

A

Folic acid

7 - 8 wks - Dating US

11 - 13 wks - Anatomic US

15 - 18 wks (up to 21 wks) - AFP levels (NTD) (up to 21 wks)

+/- Amnio for amnio fluid AFP + acetylcholinesterase levels

16 - 20 wks - Anatomy scan

22 wks : Fetal echocardiogram

Vitamin K 1 mg IM at birth

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17
Q

How long should a patient be seizure free before conceptions?

A

9 months

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18
Q

When can pt resume their regular AED levels?

A

Usually after 10- 14 days

Measure levels x 8 wks

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19
Q

What is the inheritance pattern of sickle cell disease?

A

Autosomal recessive

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20
Q

What test is used to perform and anti-body screen related to blood type?

A

Indirect Coombs test

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21
Q

What parameters of respiration are increased / decreased in pregnancy?

A

Decrease

Functional residual capacity (FRC) = Residual volume + expiratory reserve volume

Increase

Inspiratory capacity (IC)

Tidal volume

Resting minute ventilation

Unchanged

Total lung capacity (FRC+ IC)

Resp rate

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22
Q

What syndrome is cystic hygroma associated to ?

A

Truner Syndrome

Down’s syndrome

Other causes

  • Infection
  • Inherited as autosomal recessive
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23
Q

What is the significance for the fetus of anti-Ro (SSA) antibodies in the mother?

A

Risk of neonatal Lupus wich presents with congenital heart block (Hydrops Fetalis)

Neonatal lupus is responsible for 90-95% of congenital heart blocks

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24
Q

In which maternal diseases are anti-Ro (SSA) antibodies present (7)?

A

Sjögren (52%)

LSE (32%)

Mixed connective tissue disorder (29%)

Systemic sclerosis (21%)

Idiopathic inflammatory myopathies (19%)

RA (15%)

Primary biliary cholangitis (PBC)

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25
Q

What antibody can be found in ANA-negative (Antinuclear antibody) SLE?

A

Anti-Ro/ SSA

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26
Q

Anti-La Antibodies are specific to which diseases?

A

Sjögren

SLE

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27
Q

What is the upper limit of MCA dopplers?

A

1.5 MoM (multiple of median)

100% sensitive to detect fetal anemmia

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28
Q

What is the most common pathway to fetal demise in hydrops fetalis?

What is a useful US marker predicting fetal demise in hydrops fetalis?

A

Cause of death: fetal congestive heart failure

US finding: Umbilical venous pulsations

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29
Q

What is the definition of hydrops (#363)?

A

Fluid in at least 2 different fetal compartments

  • Pericardial effusion
  • Pleural effusion
  • Ascites
  • Skin edema (>5 mm at the level of the skull of chest wall)

Often associated to:

  • Polyhydramnios (40 - 75% of cases)
  • Placental thickening (> 4 cm (T2)or > 6 cm (T3))
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30
Q

What are the mechanisms leading to hydrops (3 + 2)?

(#363)

A

Intra-uterine anemia

Intra-uterine heart failure

Hypoproteinemia

Skeletal dysplasia

Chromosomal anomalies

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31
Q

What is the name for the most severe form of alpha-thalassemia?

What is the inheritence pattern?

A

Bart’s disease

Autosomal recessive

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32
Q

Who should you screen for alpha thalassemia in Canada?

A

Anyone that is not:

Japanese

Korean

Caucasion with northen european ancestry

First Nation

Inuit

33
Q

What type of blood is used for fetal transfusion?

A

O negative

CMV negative

Maternally crossed-matched

34
Q

What are the indicators of poor prognosis of fetal hydrops?

A

Fetal chromosomal anomalies

GA < 24 wks

Fetal structural anomalies (other then chylothorax)

35
Q

What is the definition of mirror syndrome ?

What is the other name of this disease?

A

Development of maternal edema secondary to fetal hydrops

Often associated to severe PET

Ballantyne’s syndrome

36
Q

Is immune or non-immune hydrops more common?

A

Non immune (85% of cases)

37
Q

What are the two most common NTD?

(#314)

A

Spina bifida - 50 %

Anencephaly - 40 %

38
Q

What is the best time to conduct a fetal MRI for NTD?

(#314)

A

Between 23 and 32 weeks

39
Q

What are potential complications of MRI in pregnancy?

(still under investigation)

(#314)

A

Teratogenesis

Acoustic damage

40
Q

Second trimester ↑ AFP levels can be associated with wich abnormalities (5)?

(#314)

A

Fetal skin disorders

Abdo wall defects

Fetal demise

Fetal nephrosis

Pregnancies with increased risk of placenta-related adverse events

41
Q

How do you manage a positive MSAFP in the second trimester?

(#314)

A

Anatomy scan at 18 - 22 weeks

Amniocentesis

42
Q

When is the ideal time to conduct an amnio?

(#314)

A

15 - 20 weeks

43
Q

What are the risks associated with an amnio?

(# 314)

A

SAB 0.5 - 1 %

PPROM

Infection

Post-procedure spotting

44
Q

What test should be ordered on AF from an amnio conducted for suspected NTD?

(#314)

A

AFP levels

Acetylcholinesterase level

Karyotype

Chromosomal microarray if available

45
Q

What population has a high risk of developing severe life threatening allergy to latex ?

(# 314)

A

Patients with myelomeningocele

46
Q

Recurrence of NTD was decreaed by what % in patients taking folic acid 5 mg?

(# 314)

A

72 %

47
Q

How do you calculate MAP?

A

Systolic BP + 2x (distolic BP) / 3

48
Q

Risk factors for placenta previa in primip

A

Multiple gestation

Increase maternal age

Infertility treatment

Previous abortion

Previous uterine surgical procedure

Maternal smoking

Maternal cocaine use

Male fetus

Non-white race

49
Q

In what percentage of patients with a cystic hygroma are aneuploidies detected?

(Berghella p 481)

A

60 %

50
Q

What are the most common antigens related to alloimmunization?

(Berghella MFM p 467)

A

RhD

Kell

51
Q

What is the cut-off for abnormal MCA PSV?

(Berghella p 468)

A

> or = to 1.5 MoM

52
Q

When can you start monitoring MCA PSV ?

(Berghella p 471)

A

15 weeks

53
Q

How do you measure maternal antibody titers in her blood?

(Berghella p 468)

A

Indirect Coombs test

54
Q

What is the most common cause of intrauterine fetal infection?

(#240)

A

CMV

(0.2-2.2 % of live births)

55
Q

What value of the CMV avidity index indicates :

  • Recent infection
  • Remote infection

(#240)

A

Recent infection (<3 months): Avidity index < 30%

Remote infection (or reactivation): Avidity index > 60%

56
Q

In what % of affected CMV fetus are US findings found?

(# 240)

A

Less than 25 %

57
Q

Before how many weeks is it best to determine chorionicity ?

When does the Lambda sign disapear?

(260)

A

Measure before 14 weeks

Lambda sign may disapear between 16 - 20 wks

58
Q

What medications can be associated with cleft palate ?

A

AED (phenytoin, valproate, topiramate)

MTX

Zofran (possible small association)

59
Q

When dating Twin pregnancy, which twin should be used?

(#260)

A

Largest twin not to miss IUGR

60
Q

What is the rate of congenital anomalies in twins

  • in general
  • in monochorionic?

(#260)

A

General: 1.2 - 2 x higher than singleton

Monozygotic: 2 - 3 x higher

61
Q

When does growth of twins slow down?

( # 260)

A

30 - 32 weeks

62
Q

What is the threashold for abnormal twin growth discordance?

(260)

A

> 20 % is abnormal if using EFW

> 20 mm if using abdominal circumference

63
Q

Pattern of US for monochorionic and dichonionic pregnancies ?

(#260)

A

Monochorionic twins

  • Start at 16 - 18 weeks
  • Growth q 2-3 weeks

Dichorionic twins

  • Start at 18 - 22 weeks
  • Growth q 3-4 weeks
64
Q

At how many weeks should UA dopplers be measured ?

What are the indications ?

(#295)

A

Measured at 19 - 23 weeks

Indications =

Suspicion of IUGR

Maternal RF for IUGR

65
Q

What are the most common cancers in pregnancy?

(W OB)

A

Breast (1/5000)

Thyroid (1/7000)

Cervical (1 /8500)

Melanoma

Lymphoma

66
Q

Is MRI ok in pregnancy?

Gadolinium OK in prengnancy?

FDG and breastfeeding?

A

MRI: Preferably after T1

Gadolinium: DO NOT use in T1, otherwise it’s OK

FDG: Discontinue breastfeeding x 72h post procedure

67
Q

What is the most common gyne cancer in pregnancy?

A

Cervical

68
Q

What are the most common cancers leading to placenta mets ?

A

Melanoma (if fetal mets, in liver and sub Q tissue. 80% mortality)

Leukemia

Lymphoma

Breast cancer

** POOR prognosis

69
Q

Describes the benefits/ disavantages of corticosteroids at:

22 - 24 wks

24 - 34+6

34 - 36+6

Term

(#364)

A

22 - 24 wks

  • ↓ Mortality

24 - 34+6

  • ↓ Mortality
  • ↓ RDS, IVH, NEC

34 - 36+6

  • ↓ RDS, Mechanical ventilation
  • ↑ Neonatal hypoglycemia

Term

  • ↓ RDS, Mechanical ventilation
  • ↑ Low academic abilities
70
Q

Describe advantages of beta over dexa (3) and

dexa over beta (2)

(#395)

A

Beta vs dexa

  • ↓ Chorio
  • ↓ RDS
  • ↓ Chronic lung disease

Dexa vs Beta

  • ↓ IVH
  • ↓ Length of NICU admission
71
Q

Should you give beta to IGUR and what are potential implications?

(#395)

A

YES give to IUGR although resposiveness unknown

IUGR with beta have

  • lower frequency of brain lesions
  • higher frequency of weight < 10 % at shcool age
72
Q

What are the RF for Vasa previa (5+)?

(#231)

A

IVF (LR 7.75)

Placenta previa in T2 (OR 22)

Bilobed placenta or Succenturiate placenta (OR 22)

Fetal anomalies (Renal tract, 2 VC, spina bifida, Exomphalos)

Prematurity, FGR, Antepartum hemorrhage

73
Q

Management of pregnancy complicated by vasa previa ?

(#231)

A

Repeat TVUS serially as 15 % regression rate

Beta at 28 - 32 wks

Hospitalization at 30 -32 wks

CS at 34- 36 wks

O neg, irradiated blood for ressussitation

74
Q

What amout of fetal blood loss can cause fetal death ?

(#231)

A

100 mL (shock and death)

75
Q

What 1st line agents can be used as uterotonics post delivery ?

(#235)

A

Oxytocin = first line in SVD

  • Preferred: 10 U IM at shoulder delivery of anterior shoulder
  • Other :
    • 20 - 40 U in 1000 mL @ 150 mL/h
    • 5 - 10 U IV bolus (ONLY AFTER VAGINAL DELIVERY)

Carbetocin = first line in ELECTIVE CS

  • 100 ug IV bolus over 1 min x 1

Carbetocin = first line if ONE RISK FACTOR for PPH instead of Oxytocin

  • 100 ug IM x 1

Alternatives if oxytocin is not available

Ergonovine 200 ug IM x 1

Cytotec 600 - 800 ug PO/ SL/ PR

76
Q

What measures reduced PPH?

(#235)

A

Uterotonics

Cord traction (modest benefit)

Uterine massage post placental delivery (unclear evidence)

77
Q

List 3 genetic conditions associated with infertility

A

Chromosomal (47 XXX, Turner 45X)

Single gene disorders (Fragile X, Galactosemia)

Myotonic dystrophy

Nanoon Syndrome

Fanconi anemia

78
Q

What is the most common congenital malformation ?

(Gabbe p 825)

A

VSD (35%)

RC OBGYN (CG) (13 decks)

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