PassMRCOG - Antenatal care Flashcards
What is the incidence of early onset neonatal GBS disease in term infants with no risk factors?
0.2/1000 births
Overall incidence 0.57/1000
What is the incidence of early onset neonatal GBS disease in term infant if GBS in previous pregnancy
If GBS in previous pregnancy incidence is 0.9/1000
What is the incidence of early onset neonatal GBS disease in term infant if GBS in current pregnancy
2.3/1000
What is the incidence of early onset neonatal GBS disease if there is intrapartum pyrexia?
5.3/1000
Incidence of polyhydramnios
1%
Causes of polyhydramnios
Idiopathic 60%
Maternal - Diabetes or CHF - 25%
Fetal - CNS, GI and cervicothoracic abnormalities 15%
What constitutes mild, moderate and severe polyhydramnios on AFI
Mild 25-29.9cm
Moderate 30-34.9cm
Severe >35cm
Absolute risk VTE in pregnancy
1-2/1000
How long should a women avoid trying to conceive after travelling to an area affected by Zika?
2 months if only she travelled and not her male partner.
3 months if her partner was also possibly exposed/travelled.
What is the still birth rate with severe ICP and what is the background stillbirth rate?
Severe ICP - 3.44%
Background rate - 0.29%
Diabetes insipidus. What is the typical biochemical findings?
Hypernatraemia
Blood osmolality >285
Urine osmolality <300
What is the incidence of gestational diabetes insipidus?
2-4 per 100,000
What is the typical clinical course of gestational diabetes insipidus?
It usually arises in the third trimester and remits spontaneously 4-6 weeks postpartum.
Conditions causing hepatic dysfunction such as HELLP may cause DI to develop.
How might diabetes insipidus present clinically?
True polydipsia (>3L oral intake) and dilute polyuria >3L a day
What are the contraindications to cabergoline
Pre-eclampsia
Cardiac valvulopathy
History of pericardial, pulmonary or retroperitoneal fibrotic disorders
History of puerperal psychosis
Hypersensitivity to ergot alkaloids
In sepsis, MAP should be maintained above what level with vasopressors?
> 65mmHg
In sepsis aim for a CVP greater than
8mmHg
What are the risks of vertical transmission of parvovirus in pregnancy by gestation?
<15 weeks gestation - 15%
15-20 weeks - 25%
Term - 70%
Incidence of placental abruption
1 in 200 pregnancies
Recurrence rates of placental abruption
4.4% if one previous affected pregnancy
19-25% if 2 previous affected pregnancies
Which anti-TNF drug is considered “safe” throughout all trimesters
Certolizumab
It is not actively transported across the placenta and thus doesn’t accumulate to the same extent as transport is reliant on slow diffusion.
Rituximab is mono-clonal antibody that depletes B-cell. should be discontinued 6 months before conceiving.
What is the most common solid benign liver lesion?
Hepatic hemangioma.
Present in ~10% of healthy individuals.
Well circumscribed and hyperechoic.
Rarely rupture
Grow slowly.
Arise from vascular endothelial cells
Typically asymptomatic.
What is the first line treatment for active TB in pregnancy
Isoniazid, Rifampicin, ethambutol, pyrazinamide
Isoniazid can cause neuropathy - supplement Vit B6 pyridoxine
What is first line treatment for latent TB in pregnancy?
Isoniazid and Rifampicin
Isoniazid can cause neuropathy - supplement Vit B6 pyridoxine
Anti D antibodies. Above which level should patients be referred to FMU.
> 4
Anti-C antibodies. Above which level should patients be referred to FMU.
> 7.5
or if Anti E also detected
Anti K antibodies. Above which level should patients be referred to FMU.
Refer if detected at any level
Anti-E antibodies. Above which level should patients be referred to FMU.
Refer if Anti-C Ab also detected.
What percentage of monochorionic twin pregnancies are complicated by TTTS
10-15%
Cystic fibrosis and pregnancy.
What is proportion of live births?
70-90%
The prematurity rate is ~25%,
Higher rates of spont PTB.
Pre-existing and GDM are more common.
What is dermatographia arterfacta?
A complication sometimes encountered in ICP.
When the skin is stroked it develops a raised pink line.
What is the mechanism by which gestational diabetes insipidus arises?
Typically cause by a transient deficiency Of ADH during pregnancy or postpartum.
Usually as a result of increased vasopressinase activity.
Vassopressinase activity is increased for two reasons:
1) increase in placental vasopressinase production - esp in multiple pregnancy
2) Decreased hepatic degradation of placental vasopressinase.
Individuals with rubella are usually infectious from ________ before symptoms appear to _____ after the onset of the rash.
Infectious for 1 week before symptoms appear to 4 days after the onset of the rash.
A spinal cord injury above which level is associated with a higher frequency of breech or transverse lie.
An injury above T10.
What is the most common cause of an acute surgical abdomen in pregnancy?
Appendicitis
Most commonly presents in 2nd trimester.
What is the risk of fetal loss in simple appendicitis, appendicitis with peritonitis and with appendicitis with a perforated appendix?
In simple appendicitis - 1.5%
Appendicitis with peritonitis - 6%
Fetal loss with perforated appendix 36%
