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MRCOG part 2 > Obstetrics Guidelines > Flashcards

Obstetrics Guidelines Flashcards

1
Q

Sepsis definitions and mortality rates
- sepsis
- severe sepsis
- septic shock

A

Sepsis = infection + systemic manifestation
Severe sepsis = sepsis + organ dysfunction/tissue hypoperfusion, mortality 20-40%
Septic shock = persistence of hypoperfusion despite fluid, mortality 60%

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1
Q

AEDs with lowest risk of congenital malformations

A

Lamotrigine (2%)
Carbamazepine (3.4%)

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2
Q

Which AED + oestrogen contraceptives results in increased seizures

A

Lamotrigine

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3
Q

What level of factor VII/IX requires tx

A

<0.5iu/ml

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4
Q

Rate of TB in pregnancy

A

4 in 100,000

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5
Q

Background risk of stillbirth
Risk stillbirth with severe ICP

A

0.29%
3.44%

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6
Q

Sensitivity of amniocentesis for fetal CMV

A

70-80%

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7
Q

How increased is the clot risk in factor V leiden

A

Heterozygous: 6-8 fold higher
Homozygous: 30-120 fold higher

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8
Q

What should peak anti-Xa levels be and what timing post heparin?
When should you monitor?

A

0.5-1.2unit/ml 3hrs post injection
In renal failure, recurrent VTE, extremes of weight (<50kg, >90kg)

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9
Q

Leading cause of death in Marfans

A

Aortic dissection

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10
Q

Cardiovascular changes in pregnancy
- Blood volume
- Heart rate
- Stroke volume
- Cardiac output
- Systemic vascular resistance (SVR)
- Diastolic blood pressure

A

Blood volume slowly increases by 40-50%
Heart rate rises by 15 beats/min above baseline
Stroke volume increases by 25-30%
Cardiac output increases by approximately 30-50%
Systemic vascular resistance (SVR) decreases by 20-30%
Diastolic blood pressure consequently decreases between 12 and 26 weeks but increases again to pre-pregnancy levels by 36 weeks

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11
Q

Tacrolimus MOA

A

macrolide immunosuppressant –> reduced T cell activation by binding calcineurin

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12
Q

Live vaccines

A

BCG, MMR, yellow fever, oral polio and rotavirus

ROBYM (rob em of immunity)

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13
Q

Teratogenic drugs

A

Anticonvulsants: phenytoin, carbemazepine, sodium valproate
Warfarin
Retinoids
Lithium

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14
Q

Affect of ACE-i on fetal developement

A

Renal failure

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15
Q

Affect of ARBs on fetal developement

A

Fetal death

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16
Q

Affect of B-blockerson fetal developement

A

FGR

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17
Q

Affect of topiramate on fetal developement

A

FGR - significantly higher than other AEDs

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18
Q

Affect of tetracyclines on fetal developement

A

Tooth discolouration and inhibition of bone growth

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19
Q

Affect of paroxetine on fetal developement

A

Heart defects

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20
Q

Lithium increases risk of what in fetus

A

Heart defects - nearly 10x higher
Esp Ebsteins anomaly (10x increase)

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21
Q

Affect of valproate on fetus

A

100x increased risk of neural tube defectsA

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22
Q

Affect of carbemazepine on fetus

A

Increased risk of neural tube defects - 3-8x
Increased risk GI and cardiac anomalies

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23
Q

Affect of Lamotrigine on fetus

A

increased risk cleft palate
increased risk derm conditions eg SJS if BF

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24
Leflunamide What is it? How long contraception after? How to measure if safe to conceive?
DMARD for RA and psoriatic arthritis Contraception = 2yrs female, 3 months male Measure concentration of the active metabolite after washout - should be less than 20 micrograms/litre (measured on 2 occasions 14 days apart)
25
What fetal complications associated with anti-Ro and La abs
Congential heart block Neonatal lupus
26
Effect of pregnancy on myasthenia gravis symptoms
40% increase symptoms 30% symptoms unchanged 30% remission
27
Rad = mGy Radiation dose per investigation: CT abdo CT pelvis Barium enema IV urogram
1 rad = 10mGy CT abdo = 0.8-3rad CT pelvis = 2.5-8rad Barium enema = 0.7-1rad IV urogram = 1-4rad
28
Radiation thresholds for adverse fetal outcomes - miscarriage - congenital anomalies - serious anomalies
- miscarriage = 10rad - congenital anomalies = 20rad - serious anomalies = 100 rad = microcephaly, cataracts, SGA, skeletal abnormalities
29
Background radiation level in pregnancy
5rad = 0.5 - 1.6 mGy
30
Risks associated with migraines
2x risk PET 17x risk stroke 4x risk MI
31
Anaemia in beta thalassaemia minor
Reduced MCV, reduced MCHC, increased HbA2
32
Risk of next male baby having haemophilia A after spontaneously affected sibling
45%
33
When is a woman an obligate carrier for haemophilia
- father has haemophilia Or - affected son and an affected relative in maternal line
34
What is HbE
Common Hb variant in SE Asia Assoc with B-thalssaemia phenotype
35
How to differentiate between infection and SLE flare?
Complement C3 and C4 - reduced on SLE
36
Definition of gestational diabetes insipidus
Blood osmolality>285mOsml/kg Urine osmolality <300 Urine specific gravity <1.005
37
Proportion of patients with Marfan syndrome with cardiac involvement
80%
38
Normal levels of hydronephrosis in pregnancy
Pelvicalyceal diameter: Up to 5 mm on the left Up to 15 mm on the right Dilatation of the ureters up to 2 cm in the third trimester
39
Mnemonic for autosomal dominant
All Adult Elite Families Forbid Hunting Hippos, Men + Martians. Mileys New Neurones Ostentatiously Reimagined Spheres + Tubes with Willies +HIIT Achrondoplasia, Adult PCKD, Ehlers-Danlos, Fam hypercholesterolaemia, FAP, Huntingtons, von Hipple Lindau, MEN, Marfans. Myotonic dystrophy, Noonans, neurofibromatosis, osteogenesis imperfecta, retinoblastoma, spherocytosis, TS, von Willebrand, HHT
40
Mneumonic for X-linked dominant
Fragile X Rates Ricketts Rates = Retts syndrome
41
Mneumonic for X-linked Recessive
Little Alport Gave 6 Denmark Duchesses Fabrages Hunted from Home. Menke Couldn't See, Only Pee, Which Always Surprised Isaac Alports, G6PD, Duchennes MD, Fabreys, Hunters, Haemophilia, Menke, Red/Green colourblindness, nephrogenic DI, Wiskott Alrich Syndrome, X-linked ichthyosis
42
hCG in Downs vs Edwards/Pataus
Raised in Downs, decreased in Edwards/Pataus
43
What hormone replacement should be given in Turner's syndrome?
Growth hormone stat aged 2-5yrs HRT at age 12-15
44
Time to results from CVS vs amnio
CVS = 48-72hrs Amnio = 2-3 weeks
45
Incidence of cerebral palsy in term infants
0.1%
46
Findings of ORACLE1 study
Significantly fewer had composite outcome in erythromycin vs co-amox (composite of NND, chronic lung disease, or major cerebral abnormality on USS pre-discharge) Prolongation of pregnancy, reductions in neonatal treatment with surfactant, decreases in oxygen dependence at 28 days of age and older, fewer major cerebral abnormalities on ultrasonography before discharge, and fewer positive blood cultures
47
Best tocolytic for reducing neonatal mortality?
None of them
48
Best tocolytic for reducing perinatal mortality?
Nitrates
49
Best tocolytic for delaying birth >48hours?
prostoglandin inhibitors
50
Best tocolytic for reducing neonatal sepsis and RDS?
CCB
51
Best tocolytic for reducing IVH?
Nitrates
52
What is tetralogy of Fallot
VSD R ventricular outflow obstruction (pulm. stenosis) Overriding aorta RVH
53
Signs of spina bifida on USS
Lemon sign: Scalloping of frontal bones due to caudal displacement of cranial content Banana sign: flattened cerebellar hemispheres with obliteration of the cisterna magna --> CSF obstructed --> hydrocephalus
54
What is the Dandy-Walker malformation?
Complete or partial absence of the cerebellar vermis + posterior fossa cyst
55
How much alcohol for fetal alcohol syndrome
Occurs in 30% women drinking >18units/day
56
Amount of alcohol associated with advserse outcomes: Facial features Reduction in birthweight Intellectual impairment
Facial features: >80g(10 units) per day Reduction in birthweight: >120g (15 units) per week Intellectual impairment: >160g (20 units) per week
57
Risk factors for large feto-maternal haemorrahge
Traumatic birth incl CS MROP Twin birth Stillbirth and IUD Abdo trauma in T3 unexplained hyrops fetalis
58
Features of bloods for fetal/neonatal RBC transfusion
Same ABO (or O) as fetus, Rh-ve, -ve for Ag maternal abs to, K-ve, CMV -ve - fetus = plasma removed, Hct 0.7-0.85, always irradiated - neonate = plasma reduced, Hct 0.5-0.6, aim irradiated unless harm of waiting outweighs risk
59
Under what anti-D antibody titre/level would significant fetal anaemia not be expected?
Below 1:64 Below 4iu/ml, rare below 10-15iu/ml.
60
Quintero staging for TTTS
Stage 1: oligo/poly Stage 2: empty fetal bladder of donor twin Stage 3: abnormal jokes Stage 4: hydrops Stage 5: fetal death
61
1st investigation following detection of maternal red cell antibodies
Non-invasive fetal genotyping for relevant D, C, c, E, e and K antigens.
62
Common peroneal nerve injury and nerve root
L4-55, S1-2 Prolonged/incorrect lithotomy numb lateral aspect lower leg, foot drop Ankle reflex in tact
63
Femoral nerve injury and nerve root
L2-4 Pressure from head in a difficult birth Sensory loss anterior thigh, loss of knee jerk 25% bilateral
64
Obturator nerve injury and nerve root
L2-4 Pressure from head compressing nerve against bony pelvis Sensory loss anterior thigh, weak leg adduction
65
Lumbosacral plexus injury and nerve root
L4-5, S1-5 Fetal head in 2nd stage numbness lateral aspect of thigh, lower leg and foot drop = unilateral, opposite side to occiput
66
Active vs physiological 3rd stage
Nausea and vomiting = 2x increase in active 50 --> 100 in 1000 women PPH>1L = almost 3x higher in physiological 13 in 1000 active 29 in 1000 physiological PPH needing transfusion = almost 4x higher in physio 14 in 1000 active 40 in 1000 physiological
67
What artery bleeds with right mediolateral episiotomy
Perineal artery = branch of internal pudendal artery
68
Suture absorption times: Polyglycolic acid (Dexon) Polyglactin (Vicryl) Polyglactic 910 (Vicryl Rapide) Polydioxanone (PDS) Polyglecaprone (Monocryl) Polytrimethylene carbonate (Maxon)
Polyglycolic acid (Dexon) = 90-120days Polyglactin (Vicryl) = 60-90days Polyglactic 910 (Vicryl Rapide) = 7-14 days Polydioxanone (PDS) = 180-210 days Polyglecaprone (Monocryl) = 90-120 days Polytrimethylene carbonate (Maxon) = 180-210 days
69
Risk of placenta accreta if previous placenta praevia: - and 1 CS - and 2 CS
1 CS = 11-14% 2 CS = 20-40%
70
Risk of infection following needle-stick exposure to an infected source Hep C Hep B HIV
Hep C : 3 - 10% Hep B : 6 - 30% HIV : 0.3 - 0.4% - risk higher with high viral load in the source, deep injury and injury with a device visibly contaminated with blood

MRCOG part 2 (9 decks)

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