obstetrics

Question 1

why is pre-pregnancy counselling done? 2

Answer 1

1. maternal condition: would need to set up a prepregnancy plan with physicians
2. previous pregnancy loss

Question 2

causes of perinatal loss of fetus?

Answer 2

1. congenital anomaly (33%): nutritional deficiency, alcohol, drug exposure, consanguineous
2. prematurity (33%)
3. normally formed still birth: unexplained: post-mortem, placental pathology, thrombophillia screen, thyroid disorder, diabetes, APAS, abruption

Question 3

pre-pregnancy advise for specific conditions (renal disease, cardiac disease, teratogenic drugs)

Answer 3

1.renal disease: transplant first to avoid dialysing during pregnancy
2. cardiac: maximize the cardiac performance
3. alter drugs to non-teratogenic ones (e.g stop methotrexate)

Question 4

neural tube defects recur at a rate of ?? with folic acid goes down to

Answer 4

5%
2%

Question 5

what is the risk of having a fetus with trisomy 21 at maternal age of 30 vs 39?

Answer 5

age 30: 1/1000
age 39: 1/100
depending on maternal age can advise NIPNT, nuchal transluceny US

Question 6

pre-pregnancy work-up for mother with diabetes? also what congenital abnormalities is diabetes associated with ?

Answer 6

1. nephropathy: protein in urine, protein creatinine ratio
2. retinopathy; eye examination
3. neuro exam for peirpheral neuropathy
4. hypertension
5. HbA1c: should have a target of less than 6.5% or 48 mmol/mol before conception

cardiac abnormality, neural tube defect, sacral agenesis

Question 7

atrial septal defect, ventricular septal defect and patent ductus arteriosus ar usually all fairly ….during pregnancy

Answer 7

well tolerated

Question 8

women with aortic stenosis require … before pregnancy to determine pressure gradient ?

Answer 8

echo

Question 9

risks of aortic stenosis during pregnancy?

Answer 9

angina, HTN and heart failure and sudden death.

Question 10

affects of pregnancy on cyanotic heart disease?

Answer 10

increase in right to left shunt due to decreased peripheral vascular resistance

Question 11

if a mother has a congenital heart defect what is the probability that the fetus will have a congenital heart defect? high risk with what congenital heart defects

Answer 11

2-5%
highest risk with ASD and aortic stenosis

Question 12

artificial heart valves and pregnancy what anti-coagulant to use?

Answer 12

heparin in the first trimester
warfarin in the second trimester
LMWH in the third trimester