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RCPSC > Obs part 2 > Flashcards

Obs part 2 Flashcards

1
Q

pre-existing DM - preconception A1C target

A

=<7.0%

ideally =<6.5%

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2
Q

pre-existing DM - pregnancy A1C target

A

=<6.5%

ideally =<6.1%

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3
Q

timing of delivery for GDM on insulin

A

at 39/40

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4
Q

timing of delivery for GDM diet

A

by 40/40

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5
Q

GDM - what proportion will develop T2DM later in life?

A

15-50%

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6
Q

50g GCT - normal result (at 1h)

A

<7.8 mmol/L

no further testing

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7
Q

GDM screening method

A

screening and diagnostic 2 step:
all pregnant women should be offered screening 24-28 wks with a 50g GCT

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8
Q

50g GCT - what value diagnoses GDM

A

> =11.1mmol/L

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9
Q

50g GCT - what values requires further testing with 2h 75g OGTT?

A

7.8-11.0 mmol/L

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10
Q

75g OGTT - GDM is diagnosed if:

following 50g GCT

A
  • FPG >=5.3mmol/L
  • 1h PG >= 10.6
  • 2h PG >= 9.0
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11
Q

one step 75g OGTT - GDM is diagnosed if

A
  • FPG >=5.1mmol/L
  • 1h PG >=10.0
  • 2h PG >=8.5
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12
Q

when to do early screening if high risk for GDM

A

24-48 weeks

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13
Q

RFs for early GDM screening

A
  • Age >35
  • BMI >30
  • ethnicity
  • FHx DM
  • PCOS, acanthosis nigricans
  • corticosteroid use
  • prev GDM or macrosomia
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14
Q

fetal assessment in GDM or T1/T2

A
  • USS growth + LV q3-4w from 28/40
  • weekly wellbeing at 36/40
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15
Q

comorbid factors in DM indicating need for earlier onset and/or more frequent fetal surveillance

A
  • obesity
  • suboptimal glycemic control
  • LGA (>90%) or SGA (<10%)
  • previous SB
  • HTN

if IUGR, addition of UA and MCA dopplers may be helpful

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16
Q

timing of delivery for pre-existing DM

A

38-40
depending on glycemic control and other co-morbidity factors

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17
Q

insulin adjustment for steroid admin

A
  • D1 = increase night 25%
  • D2/3 = increase all by 40%
  • D4 = increase all by 20%
  • D5 = increase all by 10-20%
  • D6/7 = gradually taper
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18
Q

GDM followup testing - when and how?

A

75g OGTT
between 6w - 6m

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19
Q

postpartum OGTT - Normal results

A
  • FPG <6.1
  • 2h <7.8
  • HbA1c <6%
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20
Q

postpartum OGTT - pre-diabetic ranges

A
  • FPG 6.1-6.9
  • 2h 7.8-11.0
  • HbA1c 6.0-6.4%
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21
Q

postpartum OGTT - T2DM diagnosis

A
  • FPG >=7.0
  • RPG or 2h PG >=11.1
  • HbA1c >=6.5
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22
Q

definition of microcephaly

A

HC =<3 SD below mean

alternative is <2centile

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23
Q

most common cause of microcephaly

A
  1. Unknown 41%
  2. Genetic - 20-30%; eg. PKU
  3. perinatal brain injury (including infxn) 27% congential CMV most common infectious

genetic causes have worse prognosis

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24
Q

microcephaly workup

A
  1. confirm GA
  2. complete maternal hx
  3. detailed 3-generation FhX
  4. detailed tertiary USS
  5. infection workup
  6. +/- MRI
  7. geneticist
  8. serial USS if continuing pregnancy
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25
Q

which side more common for DVT in pregnancy

A

LEFT leg

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26
Q

which side more common for ovarian vein thrombosis

A

RIGHT

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27
Q

EFM recommended for which class obesity

A

> 35 (ie class II and III)

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28
Q

bariatric surgery - who is eligible

A
  • BMI >=40
  • BMI >=35 with comorbidities

if not successful with other management strategies

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29
Q

pharmacotherapy for obesity - who is eligible

A
  • BMI >=30
  • BMI >=27 with comorbidities

orlistat or liraglutide

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30
Q

time to conception delay if bariatric surgery

A

24/12

inc risks of NICU, PTB, SGA

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31
Q

weight gain for singleton pregnancy in obesity

A

5-9kg
(11-20lbs)
better if weight gain in 2nd half

2100 kcal/day, inc to 2400 in 2nd trim

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32
Q

assessment of fetal wellbeing in obesity

A
  • serial growth 28/32/36
  • weekly wellbeing from 37/40 till delivery
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33
Q

timing of delivery for obesity

A

39-40/40

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34
Q

cs wound infection rate for BMI >50

A

30%

persistent risk regardless of MOD and abx prophylaxis

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35
Q

physical activity in pregnancy - recommendation

A
  • >=150 min
  • moderate intensity (aerobic and resistance best)
  • over 3 or more days

below recommendation also incurred some benefit

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36
Q

physical activity in pregnancy showed a dose-response relationship for which outcomes?

A
  • PET & PIH
  • GDM
  • PND
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37
Q

HR ranges for moderate activity in pregnancy

A
  • Age <29 = 125-146
  • Age >30 = 121-141
38
Q

TOLAC - baseline risk of rupture

A

0.47%

39
Q

contraindications to TOLAC

A
  • previous or suspected classical CS
  • previous inverted T or low vertical incision
  • previous uterine rupture
  • previous major uterine reconstruction
  • mat request for ERCS
40
Q

VBAC rate

A

47-50%

ontario, 69%

41
Q

factors increasing likelihood of successful VBAC

A
  • age =<30
  • BMI <30
  • white
  • previous NVD
  • EFW <4kg
  • spont labour
  • Cx >4cm or BS >6 on admission
  • epidural
42
Q

factors reducing likelihood of successful VBAC

A
  • age >=35
  • BMI >30
  • previous c/s for dystocia
  • EFW >4kg
  • PET
  • GA >40/40
  • IOL/augmentation
43
Q

RFs for uterine rupture

A
  • IOL pharmacological agents
  • oxytocin use
  • CS >=2x
  • short interval <18/12
  • thin LUS
  • classical or vertical incision
44
Q

risk of rupture with IOL

A

1.0-1.5%

(up to 2.7%)

highest with PGE2

45
Q

risk of rupture with short pregnancy interval <18/12

A

4.8%

46
Q

risk of rupture with previous classical or vertical incision

A

4-9%

47
Q

maternal conditions precluding repetitive valsalva

A
  • NYHA 3-4
  • severe resp disease
  • cerebral AVM
  • proliferative retinopathy
  • SCI
  • myasthenia gravis
48
Q

classification of outlet delivery

A
  • scalp at introitus
  • skull on pelvic floor
  • rotation <45deg to OA/OP
49
Q

classification of low delivery

A
  • station >= +2
  • with or without rotation
50
Q

classification of mid- delivery

A
  • station 0-+1
  • =<1/5 palp
  • with or without rotation
51
Q

classification of high delivery

A
  • not engaged
  • <0 station
52
Q

anal incontinence following OASI

A

15-61%

53
Q

flatal incontinence following OASI

A

39%

54
Q

risk of recurrent OASI in subsequent pregnancy

A

4-8%

55
Q

max duration allowed for breech delivery for progress between 5-10cm

A

7H

if FTPx2h, c/s

56
Q

overall allowed duration of second stage for breech delivery

A

2.5H

if delivery not imminent after 60min active pushing, CS recommended

57
Q

cord prolapse risk with breech

A

1% frank breech
10% footling breech

58
Q

CS timing for placenta accreta

A

34-36/40

steroids 1 week prior

59
Q

recurrence rate of placenta accreta

A

17-29%

60
Q

1-to-1 support in labour - more likely to have

A
  • increased SVB
  • shorter labour
  • decreased AVB
  • decreased regional or any analgesia
  • fewer lower 5min apgars
  • fewer negative feeling about child birth
61
Q

twin splitting - DCDA

A

1-3 day

62
Q

twin splitting - MCDA

A

4-8 days

63
Q

twin splitting - MCMA

A

8-12 days

>12 days = conjoined

64
Q

CVS - risk of sampling error

A

3-4%

65
Q

amnio - risk of sampling error

A

1.8%

66
Q

twins - increased fetal surveillance from what GA?

A

32/40

67
Q

twins - off work from

A

20-24/40

68
Q

twins - diet recommendations

A
  • increase Fe 30mg/d
  • folic acid 1mg/d
  • extra 300kcal/day
69
Q

average age of delivery for twins

A

36/40

triplets at 32/40

70
Q

discordant growth in DC twins - assessment for?

A
  • infection
  • chromosomal/genetic syndrome
  • structural anomalies
  • placental insufficiency (dopplers)
71
Q

sIUGR in twins - type I

A

normal UA dopplers

72
Q

sIUGR in twins - type II

A

abnormal UA dopplers

73
Q

sIUGR in twins - type III

A

cycling UA dopplers

74
Q

progesterone for twins if?

A
  • cx length =<25mm
  • 16-24wks

400mg PV

75
Q

incidence of TTTS in MCDA and MCMA pregnancies

A
  • 15% MCDA
  • 5% MCMA
76
Q

TTTS - stage 1

A

Poly/oligohydramnios

77
Q

TTTS stage 2

A

Large bladder/absent bladder

78
Q

TTTS classification - stage 3

A

abnormal dopplers
(in one or both twins)

79
Q

TTTS classification stage 4

A

hydrops

80
Q

TTTS classification stage 5

A

death of 1 or both twins

81
Q

incidence of TAPS

A

5% of MCDA twins

82
Q

clinical criteria for dx of TAPS

A
  • no LV discordance
  • MCA-PSV >1.5MoM in one twin
  • MCA-PSV <0.8 MoM in other twin

most likely to occur post laser for TTTS

83
Q

conjoined twins - delivery?

A

C/S at 36-37/40

84
Q

acardiac twins - delivery?

A

34-36/40

85
Q

MCDA timing of delivery

A

36-37/40

86
Q

MCMA timing of delivery

A

32-33/40

87
Q

triplets - average GA for delivery of triplets

A

32/40

88
Q

timing of delivery for higher order multiples

A

36/40 generally by CS

89
Q

key points of DCDA management

A
  • determine chorionicity 10-14
  • offer NT 11-13+6
  • anatomy scan 18-22
  • cx length assessment 18-24
  • USS growth q3-4 wks
  • fetal surveillance from 32/40
  • delivery 37-38
90
Q

summary of MCDA management

A
  • chorionicity at 10-14 wks
  • NT 11-13+6
  • surveillance for TTTS/growth from 16/40
  • anatomy scan 18-22
  • fetal echo 18-22
  • scan for growth q2w
  • increased fetal surveillance from 32/40
  • delivery 36-37/40
91
Q

summary MCMA management

A
  • determine chorionicity 10-14
  • offer NT 11-13+6
  • surveillance TTTS/growth from 16
  • anatomy scan + echo 18-22
  • serial growth q2w
  • inpts or outpt monitoring 24-26w
  • admin steroids
  • delivery by CS 32-33

RCPSC (17 decks)

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