Obstetric medicine

Question 1

In patients post transplant and wanting to become pregnant general advice

Answer 1

1) Commence aspirin 150mg in first trimester to reduced risk of Pre-Eclampsia
2) Effective contraception while on Mycophenolate
> Suggest switching at least 6 weeks prior to falling pregnant
3) Aim to have quiescent disease at the time of becoming pregnant

Nb

Question 2

Which antibodies should you check in women with rheumatological disease.

Answer 2

Anti Ro/La antibodies are able to cross the placenta
> Congenital heart block
> Cardiomyopathy
> Neonatal Lupus

Question 3

Contraindications to pregnancy in women with Lupus

Answer 3

1) Severe pulmonary hypertension
2) Severe LV dysfunction
3) Active disease (nephritis/cerebritis)
4) Severe renal impairment (creatinine >300)

Question 4

Treatment for lupus during pregnancy

Answer 4

Hydroxychloroquine (safe in pregnancy and breast feeding)

• decreases flare in pregnancy
• anti-thrombotic effects
• anti-metabolic effects
• reduced effect of recurrent CHB in women with CHB in previous pregnancy

Nb also commence 150mg aspirin to reduce the risk of pre-eclampsia

Question 5

In patients with APLS (i.e satisifies the Sapporo criteria) how do you prevent VTE

Answer 5

1) Antibodies only (not true APLS): Asprin
2) Previous venous/arterial thrombosis: LMWH + aspirin
3) APL and foetal loss: LMWH and aspirin
4) APL and previous miscarriage (<10 weeks): Aspirin

Question 6

TNF inhibitors and pregnancy

- Which TNF inhibitor has the highest transplacental transfer? And the lowest

Answer 6

Highest: Infliximab
Lowest: Certolizumab/Entanercept
Greatest transfer in 3rd trimester

TNF inhibitors are not teratogenic
Decision to stop is dependent on activity of disease and risk of relapse

Avoid live vaccinations in babies prior to ? 12 months