MFM&OB&OBID

Question 1

What is the risk of perinatal transmission of varicella?

Answer 1

Dunno

Question 2

What is affected in Erb’s palsy and what is the result?

Answer 2

C5,6+/-7
aka Duchenne paralysis
affected arm is is straight, internally rotated, elbow extended.

injury to C5,6 leads to paralysis of deltoid, infraspinatus, flexor ms of forearm

Question 3

Paroxetine is associated with what fetal effects

Answer 3

Cardiac lesions
Persistent Pulmonary HTN
NNAD

Question 4

What effect do Epidurals have on labour and delivery?

Answer 4

prolonged second stage by 15 min
Increased need for oxytocin
increased forceps
no increase in CS

Question 5

what vaccine is contraindicated in Breast Feeding?

Answer 5

Yellow Fever!

Other live vaccines (rubella, varicella) are okay

Question 6

How do you treat influenza in pregnancy?

Answer 6

Antiviral - oseltamivir

Question 7

who is indicated for MMR>

Answer 7

postpartum if no immunity or vaccine - check IgG - if < 10IU/mL - vaccine PP

Question 8

Risk for Congenital Rubella Syndrome is during what time in pregnancy?

Answer 8

First 16 weeks

Question 9

how long to wait after IVIG, Rhogam or blood products to give rubella vaccine PP?

Answer 9

3-6 months

Question 10

How do you prophylaxis and how do you treat toxoplasmosis Gondii?

Answer 10

Spiramycin - to prevent maternal to fetal transmission

Question 11

How do you treat neonatal HSV>

Answer 11

IV acyclovir

Question 12

What is the mortality with disseminated neonatal HSV?

Answer 12

90%

Question 13

Risks of neonatal HSV with (1) Primary infection in 3rd trimester, (2) Recurrent Lesions at time of labour / delivery, (3) No lesions but hx of recurrent HSV

Answer 13

(1) 30-50% - CS
(2) 2-5% - CS
(3) 0.02-0.05% - suppressive therapy 36 weeks

Question 14

what is the most common cause of intrauterine infection?

Answer 14

CMV 0.2-2.2%

Question 15

What are the fetal risks and management of Parvo-19 diagnosed in pregnancy?

Answer 15

30-15(<20)-0.5

(1) Risk of maternal to fetal transmission if mom is infected is 30%
(2) With fetal infection - risk of fetal death if < 20 weeks is 13%, 0.5% if > 25 weeks
(3) Risk of fetal anemia and hydros
(4) weekly to q 2week US &MCA doppler for up to 12 weeks after infection
(5) IUT, delivery at term or near PRN

Question 16

At what viral load in pregnancy is treatment recommended for women with chronic Hep B and what is treatment?

Answer 16

200 000 IU/mL VL HBV DNA
Tenofivir from 28-32 weeks until delivery, consider 4-12 weeks PP to prevent HBV flare

Neonatal PEP (IVIG, HBV vaccine within 12 hours, then 2 more vaccines)

Avoid invasive procedures in L&D, CS not indicated

Question 17

HBsAg +, HBsAb +, HBcAb +
Patient has:

HBsAg -, HBsAb +, HBcAb -
Patient has

Answer 17

Chronic or acute HBV infection

Immunity from immunization

Question 18

What is the workup for a new dx of HBV in pregnancy

Answer 18

1) HBeAg, HBV DNA, ALT
2) Liver US
3) Referral to specialist (hematologist, ID)

Question 19

What are the conditions for use of a screening test?

Answer 19

Conditions for use of a Screening Test

1) Disease must be of public health importance
2) Sensitive and specific test must exist for its detection
3) Therapeutic and preventive measures must be available
4) Direct and indirect screening costs must be acceptable to individual and society

Question 20

What is the risk of acquiring a bloodborne infection following a needle stick from: HBeAg+, HCV, HIV

Answer 20

1) 30%
2) 1.8%
3) 0.3%

Question 21

What is the rate of PTB in Canada and the most common cause?

Answer 21

7-8%, PPROM (30-40% of PTB)