Obstétrique Flashcards
Quelle suture utilisé pour une réparation de 3e degré
PDS 3-0 ou Vicryl 2-0 régulier (end to end or overlapping techniques)
Quel suture utilisé pour spincter anal interne
Vicryl 3-0 en surjet continu
Early onset FGR (< 32 weeks) - critère dx
- EFW or AC < 3rd percentile
OU - UA with AEDF or REDF
OU - EFW or AC < 10th percentile + 1 of the following:
-UA-PI > 95th percentile or
-UtA PI > 95th percentile
Late-onset FGR (> 32 weeks)
- EFW or AC < 3rd percentile
OU - 2 of 3 criteria:
-EFW or AC < 10th percentile
-EFW or AC crossing percentiles > 2 quartiles on growth percentile
-CPR < 5th percentile or UA-PI > 95th percentile
Risk factors for FGR
-Maternal Demographics (ethnicity, BMI > 35, low socio-economic, mental health, age > 35, consanguinity, assisted mode of conception)
-Environmental and infectious exposures (smoking, ETOH, polluants, travel hx)
-TORCH (*most common = CMV)
-Maternal Medical Conditions (chronic HTA, pre-pregnancy diabetes, major organ impairment\transplantation - heart\kidneys\liver, auto-immune disorders -SLE, IBD)
-Obstetrics History (previous pre-e or IUGR, previous normally formed stillbirth, recurrent early pregnancy loss ≥3)
-Current pregnancy (1st trimester) - recurrent vaginal bleeding (≥ 3 days), CRL smaller than expected by ≥ 5 days in presence of accurate dating, abnormal level of biomarkers for trisomy 21 (PAPP-A \PlGF decreased, AFP increased)
-Current pregnancy (2nd trimester) - large ≥ 3 cm subchorionic hemorrhage, abnormal levels of biomarkers for trisomy 21 (AFP\HCG\inhibin A increased)
-Abnormal placental morphology
-Abnormal uterine artery doppler
Higher risk of developing FGR with one or more of the ultrasound findings
- Fetal AC more than 1 week behind gestational age
- FL ≤ 5th percentile
- Echogenic bowel
- Abnormal placental shape or texture
- 2-vessels cord
- Velamentous placental cord insertion
Abnormal Symphisis-fundal height value
≥ 3 cm (specificity 87-96%)
Confounded = polyhydramnios, large fibroid, high BMI (need to use US)
Hadlock equation - EFW
- Head circumference
- Abdominal circonférence
- Femur length (*should not be used if suspected FGR ≤ 800g + abnormal UA = can underestimate EFW)
SGA definition
CA or EFW ≤ 10th percentile or birth weight ≤ 10th percentile
(does not have perinatal morbidity risk)
CMV US features
Ventriculomegaly
Calcifications of brain or liver
Echogenic bowel
Non-immune hydros
Serum markers for placental dysfunction as a cause of IUGR
Low Placenta growth factor (PlGF)
or
High sFLT-1\PlGT
*Uterine artery usually abnormal
*Indicative of potential HELLP
Timing of delivery for FGR
-SGA - 37-39 weeks
Uncomplicated FGR - 37 weeks
-FGR with early dopplers changes - 37 weeks
-AEDF (32-34 weeks), REDF (30-32 weeks) c\s
-Elevated DV PIV or absent-reverse a wave in DV - 26-30 weeks (c\s)
Risk of SGA in future pregnancy
- 3-5x increased risk of SGA if had SGA ≤ 34 weeks in previous pregnancy
- AMA ≥ 35 years old
- Racial group (other than white)
- Low socio-economic status
- High BMI ≥ 35
- Maternal comorbidities (HTA)
Most common placental disease in early-onset placenta-mediated FGR
Maternal vascular malperfusion - MVM (85%)
*Recurrence risk is 10% and varies according to GA at time of delivery (proxy of severity)
*ASA is recommended
2 rare placental diseases (higher risk of recurrence)
1. chronic histolytic intervillositis
2. Massive peri-villous fibrin deposition
*Might need LMWH and immunomodulatory drugs
Is cesarean section indicated with Hepatitis B
Not for the sole purpose
Is breastfeeding safe with hepatitis B
Yes
What do you give to baby delivery from a mother with hepatitis B?
Hepatitis B vaccine
Hepatitis B immunoglobulin
(the first 12h of life)
HBsAg positive, what other bloodwork to add?
-Hepatitis B envelop antigen (HBeAg + anti-HBe)
-Hepatitis B virus (HBV) DNA level
-ALT
-Ultrasound of liver
Hepatitis B component
-HBsAg = outer envelope component
-HB core antigen = inner nucleocapsid component
-HBeAg = in serum when active viral replication occurs (mutation can develop and prevent their expression even with high viral load)
-HBV DNA = in serum, for viral replication
Most common cause of Hepatitis B transmission
Perinatal transmission (mother to child) - 1-2% of infant who received appropriate HBV prep
Antiviral treatment in pregnancy
Tenofovir (NRTi) - 300 mg PO die
*start between 28-32 wks GA until delivery
*viral load > 200 000 IU\ml
**could consider continuing for 4-12 weeks post-partum to prevent flare
Hepatitis B serology
-HbsAg-\anti-HBc-\anti-HBs- = susceptible to HBV
-HBsAg-\anti-HBc+\anti-HBs+ = Immune to HBV due to natural infection
-HBsAg-\anti-HBc-\anti-HBs+ = Immune to HBV due to hepatitis B vaccination
-HBsAg+\anti-HBc+\IgM anti-HBc-\anti-HBs- = chronic infection
-HBsAg-\anti-HBc+\anti-HBs- = four possibilities (1-resolved infection *most common 2- false positive anti-HBc thus susceptible 3- low level chronic infection 4- resolving acute infection)
Technique de procréation assisté responsable de ___% des grossesses gémellaires?
35
Mécanismes possibles:
-transfert blastocysts J5
-manipulation zone pellucide dans ICSI
Dans les grossesses monochoriales, quel est le % de?
- Syndrome transfuseur-transfusé (STT)
- Séquence anémie-polycythémie (TAPS)
- Retard de croissance sélectif (RCS)
- Séquence des perfusion artérielle inversée (TRAP)
- 10-15%
- 4-5%
- 10-15%
- 2.5%
