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Obstétrique > Obstétrique > Flashcards

Obstétrique Flashcards

1
Q

Quelle suture utilisé pour une réparation de 3e degré

A

PDS 3-0 ou Vicryl 2-0 régulier (end to end or overlapping techniques)

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2
Q

Quel suture utilisé pour spincter anal interne

A

Vicryl 3-0 en surjet continu

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3
Q

Early onset FGR (< 32 weeks) - critère dx

A
  1. EFW or AC < 3rd percentile
    OU
  2. UA with AEDF or REDF
    OU
  3. EFW or AC < 10th percentile + 1 of the following:
    -UA-PI > 95th percentile or
    -UtA PI > 95th percentile
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4
Q

Late-onset FGR (> 32 weeks)

A
  1. EFW or AC < 3rd percentile
    OU
  2. 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
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5
Q

Risk factors for FGR

A

-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

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6
Q

Higher risk of developing FGR with one or more of the ultrasound findings

A
  1. Fetal AC more than 1 week behind gestational age
  2. FL ≤ 5th percentile
  3. Echogenic bowel
  4. Abnormal placental shape or texture
  5. 2-vessels cord
  6. Velamentous placental cord insertion
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7
Q

Abnormal Symphisis-fundal height value

A

≥ 3 cm (specificity 87-96%)

Confounded = polyhydramnios, large fibroid, high BMI (need to use US)

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8
Q

Hadlock equation - EFW

A
  1. Head circumference
  2. Abdominal circonférence
  3. Femur length (*should not be used if suspected FGR ≤ 800g + abnormal UA = can underestimate EFW)
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9
Q

SGA definition

A

CA or EFW ≤ 10th percentile or birth weight ≤ 10th percentile
(does not have perinatal morbidity risk)

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10
Q

CMV US features

A

Ventriculomegaly
Calcifications of brain or liver
Echogenic bowel
Non-immune hydros

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11
Q

Serum markers for placental dysfunction as a cause of IUGR

A

Low Placenta growth factor (PlGF)
or
High sFLT-1\PlGT

*Uterine artery usually abnormal
*Indicative of potential HELLP

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12
Q

Timing of delivery for FGR

A

-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)

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13
Q

Risk of SGA in future pregnancy

A
  1. 3-5x increased risk of SGA if had SGA ≤ 34 weeks in previous pregnancy
  2. AMA ≥ 35 years old
  3. Racial group (other than white)
  4. Low socio-economic status
  5. High BMI ≥ 35
  6. Maternal comorbidities (HTA)
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14
Q

Most common placental disease in early-onset placenta-mediated FGR

A

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

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15
Q

Is cesarean section indicated with Hepatitis B

A

Not for the sole purpose

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16
Q

Is breastfeeding safe with hepatitis B

A

Yes

17
Q

What do you give to baby delivery from a mother with hepatitis B?

A

Hepatitis B vaccine
Hepatitis B immunoglobulin
(the first 12h of life)

18
Q

HBsAg positive, what other bloodwork to add?

A

-Hepatitis B envelop antigen (HBeAg + anti-HBe)
-Hepatitis B virus (HBV) DNA level
-ALT
-Ultrasound of liver

19
Q

Hepatitis B component

A

-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

20
Q

Most common cause of Hepatitis B transmission

A

Perinatal transmission (mother to child) - 1-2% of infant who received appropriate HBV prep

21
Q

Antiviral treatment in pregnancy

A

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

22
Q

Hepatitis B serology

A

-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)

23
Q

Technique de procréation assisté responsable de ___% des grossesses gémellaires?

A

35

Mécanismes possibles:
-transfert blastocysts J5
-manipulation zone pellucide dans ICSI

24
Q

Dans les grossesses monochoriales, quel est le % de?

  1. Syndrome transfuseur-transfusé (STT)
  2. Séquence anémie-polycythémie (TAPS)
  3. Retard de croissance sélectif (RCS)
  4. Séquence des perfusion artérielle inversée (TRAP)
A
  1. 10-15%
  2. 4-5%
  3. 10-15%
  4. 2.5%
25
Q

Dans les grossesses monochoriales, les 2 jumeaux survivent dans ___% des cas; 1 seul dans ___% des cas et aucun dans ___% des cas?

A

85%
7.5%
7.5%

26
Q

Dans les grossesses gémellaires monochoriales, ____% naissent après 32 semaines, __% avant 28 semaines, et ___% entre 28-32 semaines.

A

85%
5%
10%

27
Q

Détermination âge gestationnel pour grossesse gémellaire?

A

-LCC entre 45-84 mm
-Utilise la plus grande LCC
-Chorionicité et amnionicité (se forme après 8 sem) déterminé entre 11+0 et 13+6

28
Q

Signe lambda

A

Grossesse bichoriale (2 placentas) = parenchyme chorale s’insère entre les couches de la membrane inter amniotique

29
Q

Signe T

A

Grossesse monochoriale = pas de tissu choral dispersé entre les couches de la membrane

30
Q

Surveillance échographie pour les grossesses monochoriales?

A

Écho q2 semaines (pour identifier STT, TAPS, RCS)

31
Q

Âge gestationnel pour accouchement grossesse gémellaire:

-Bichoriale?

-Monochoriale?

A

-Bichoriale: 37-38 sem AG

-Monochoriale: 36-37 sem AG

32
Q

Système de stratification de Quintero pour STT

A

Stade I - PGP < 2 cm chez donneur; PGP > 8 cm (< 20 sem) ou > 10 cm (> 20 sem) chez le receveur. Vessie présente chez donneur.

Stade II - Vessie vide chez donneur

Stade III - Vélocité télédiastolique absente ou inversée (AO), onde a inversée du DV, flux veineux pulsatile chez l’un ou l’autre des jumeaux

Stade IV - Anarsaque chez un jumeau ou les deux

Stade V - décès d’un ou des deux jumeaux

33
Q

Quel sont les 3 plus grands facteurs prédictifs de mort périnatale chez les STT avec traitement au laser?

A
  1. la grande prématurité à l’accouchement
  2. discordance de poids de plus de 30% pour le donneur
  3. doppler anormal artère ombilicale
34
Q

Traitement pour STT

A

Coagulation laser foetoscopique des anastomoses vasculaires placentaires (entre 14-30 sem) Technique de Salomon (occlusion de l’ensemble de l’équateur vasculaire du placenta)- *améliore le devenir neurodéveloppemental à long terme peut importe le stade

*amniodrainage = réserver au T3 ou si laser pas accessible facilement

35
Q

Risque de récidive du STT et incidence du TAPS post-laser

A

9 à 13%

36
Q

Suivi post-laser STT

A

-suivi échographie qsemaine x 4 semaines puis q2 semaines après résolution clinique

-IRM cérébrale 4 semaines post-laser

-Accouchement entre 34+0 et 36+6 (après dose BM)
*AVS peut être envisagé

*Stade de Quintero sert d’indicateur prognostic post-laser

37
Q

Taux de survie globale post-laser pour STT est de ___% pour les deux jumeaux et ___% pour au moins un jumeau?

A

65-70% pour les deux jumeaux
85-90% pour au moins un jumeau

*Atteinte neurologiques = 8-10% (lié à prématurité)

*RPPM < 34 sem = 7-8% des cas

Obstétrique (6 decks)

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