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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
Q

Leflunamide
What is it? How long contraception after?
How to measure if safe to conceive?

A

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)

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25
Q

What fetal complications associated with anti-Ro and La abs

A

Congential heart block
Neonatal lupus

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26
Q

Effect of pregnancy on myasthenia gravis symptoms

A

40% increase symptoms
30% symptoms unchanged
30% remission

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27
Q

Rad = mGy
Radiation dose per investigation:
CT abdo
CT pelvis
Barium enema
IV urogram

A

1 rad = 10mGy
CT abdo = 0.8-3rad
CT pelvis = 2.5-8rad
Barium enema = 0.7-1rad
IV urogram = 1-4rad

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28
Q

Radiation thresholds for adverse fetal outcomes
- miscarriage
- congenital anomalies
- serious anomalies

A
  • miscarriage = 10rad
  • congenital anomalies = 20rad
  • serious anomalies = 100 rad = microcephaly, cataracts, SGA, skeletal abnormalities
29
Q

Background radiation level in pregnancy

A

5rad = 0.5 - 1.6 mGy

30
Q

Risks associated with migraines

A

2x risk PET
17x risk stroke
4x risk MI

31
Q

Anaemia in beta thalassaemia minor

A

Reduced MCV, reduced MCHC, increased HbA2

32
Q

Risk of next male baby having haemophilia A after spontaneously affected sibling

A

45%

33
Q

When is a woman an obligate carrier for haemophilia

A
  • father has haemophilia
    Or
  • affected son and an affected relative in maternal line
34
Q

What is HbE

A

Common Hb variant in SE Asia
Assoc with B-thalssaemia phenotype

35
Q

How to differentiate between infection and SLE flare?

A

Complement C3 and C4 - reduced on SLE

36
Q

Definition of gestational diabetes insipidus

A

Blood osmolality>285mOsml/kg
Urine osmolality <300
Urine specific gravity <1.005

37
Q

Proportion of patients with Marfan syndrome with cardiac involvement

A

80%

38
Q

Normal levels of hydronephrosis in pregnancy

A

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
Q

Mnemonic for autosomal dominant

A

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
Q

Mneumonic for X-linked dominant

A

Fragile X Rates Ricketts

Rates = Retts syndrome

41
Q

Mneumonic for X-linked Recessive

A

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
Q

hCG in Downs vs Edwards/Pataus

A

Raised in Downs, decreased in Edwards/Pataus

43
Q

What hormone replacement should be given in Turner’s syndrome?

A

Growth hormone stat aged 2-5yrs
HRT at age 12-15

44
Q

Time to results from CVS vs amnio

A

CVS = 48-72hrs
Amnio = 2-3 weeks

45
Q

Incidence of cerebral palsy in term infants

A

0.1%

46
Q

Findings of ORACLE1 study

A

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
Q

Best tocolytic for reducing neonatal mortality?

A

None of them

48
Q

Best tocolytic for reducing perinatal mortality?

A

Nitrates

49
Q

Best tocolytic for delaying birth >48hours?

A

prostoglandin inhibitors

50
Q

Best tocolytic for reducing neonatal sepsis and RDS?

A

CCB

51
Q

Best tocolytic for reducing IVH?

A

Nitrates

52
Q

What is tetralogy of Fallot

A

VSD
R ventricular outflow obstruction (pulm. stenosis)
Overriding aorta
RVH

53
Q

Signs of spina bifida on USS

A

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
Q

What is the Dandy-Walker malformation?

A

Complete or partial absence of the cerebellar vermis + posterior fossa cyst

55
Q

How much alcohol for fetal alcohol syndrome

A

Occurs in 30% women drinking >18units/day

56
Q

Amount of alcohol associated with advserse outcomes:
Facial features
Reduction in birthweight
Intellectual impairment

A

Facial features: >80g(10 units) per day
Reduction in birthweight: >120g (15 units) per week
Intellectual impairment: >160g (20 units) per week

57
Q

Risk factors for large feto-maternal haemorrahge

A

Traumatic birth incl CS
MROP
Twin birth
Stillbirth and IUD
Abdo trauma in T3
unexplained hyrops fetalis

58
Q

Features of bloods for fetal/neonatal RBC transfusion

A

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
Q

Under what anti-D antibody titre/level would significant fetal anaemia not be expected?

A

Below 1:64
Below 4iu/ml, rare below 10-15iu/ml.

60
Q

Quintero staging for TTTS

A

Stage 1: oligo/poly
Stage 2: empty fetal bladder of donor twin
Stage 3: abnormal jokes
Stage 4: hydrops
Stage 5: fetal death

61
Q

1st investigation following detection of maternal red cell antibodies

A

Non-invasive fetal genotyping for relevant D, C, c, E, e and K antigens.

62
Q

Common peroneal nerve injury and nerve root

A

L4-55, S1-2
Prolonged/incorrect lithotomy

numb lateral aspect lower leg, foot drop
Ankle reflex in tact

63
Q

Femoral nerve injury and nerve root

A

L2-4
Pressure from head in a difficult birth

Sensory loss anterior thigh, loss of knee jerk
25% bilateral

64
Q

Obturator nerve injury and nerve root

A

L2-4
Pressure from head compressing nerve against bony pelvis
Sensory loss anterior thigh, weak leg adduction

65
Q

Lumbosacral plexus injury and nerve root

A

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
Q

Active vs physiological 3rd stage

A

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
Q

What artery bleeds with right mediolateral episiotomy

A

Perineal artery = branch of internal pudendal artery

68
Q

Suture absorption times:
Polyglycolic acid (Dexon)
Polyglactin (Vicryl)
Polyglactic 910 (Vicryl Rapide)
Polydioxanone (PDS)
Polyglecaprone (Monocryl)
Polytrimethylene carbonate (Maxon)

A

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
Q

Risk of placenta accreta if previous placenta praevia:
- and 1 CS
- and 2 CS

A

1 CS = 11-14%
2 CS = 20-40%

70
Q

Risk of infection following needle-stick exposure to an infected source
Hep C
Hep B
HIV

A

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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