Practice Bulletins Flashcards
Patient presents post medical abortion with flu-like illness, hemo-concentrated, significant leukocytosis without fever. What is a differential diagnosis?
Clostridial toxic shock (PB 143 March 2014)
What is the level A recommendation regarding ECV
Because the risk of an adverse event occurring as a result of ECV is small and the cesarean delivery rate is significantly lower among women who have undergone successful version, all women near-term with breech presentation should be offered a version attempt. (PB #13 reaffirmed 2014)
How is CMV transmitted?
Double-stranded DNA herpes virus transmitted by sexual contact or direct contact with infected blood, urine or saliva
(PB 151, June 2015)
Define primary infection
Infection in a previously seronegative individual
PB 151, June 2015
Define secondary infection
Intermittent viral excretion in the presence of host immunity
(PB 151, June 2015)
List the possible modes of vertical transmission of CMV (3) AND which is the most significant risk of developing clinical sequela
Transplacental infection (may be born asymptomatic but can develop sequela)
exposure to contaminated genital tract secretions at delivery (asymptomatic)
breast-feeding (asymptomatic)
(PB 151, June 2015)
What is the risk of vertical transmission of CMV with primary infection and secondary infection
Primary equals 30 to 40%
Secondary equals .1 to 2%
(PB 151, June 2015)
In what trimester is the risk of vertical transmission of primary CMV greatest AND in what trimester is the clinical sequela greatest if vertical transmission occurs
Transmission rates for primary infection or 30% in the first trimester 34-38% in the second trimester and 40 to 72% third trimester
Clinical sequela are most severe if vertical transmission occurs during the first trimester
(PB 151, June 2015)
What is the prognosis if vertical transmission of primary CMV infection occurs
Of those fetuses infected in utero after a primary infection, 12 to 18% will have signs and symptoms of CMV infection at birth and up to 25% will develop sequela. 30% of severely infected infants die. 65 to 80% of survivors have severe neurologic morbidity.
(PB 151, June 2015)
What is the incidence of nausea and vomiting in pregnancy, and what is the incidence of hyperemesis gravidarum? A. 20% and 2% B. 30% and 3% C. 80% and 10% D. 50% and 0.3-3%
D.
An estimated 50% of pregnant women have nausea and vomiting, 25% have nausea only, and 25% are unaffected (6, 7). The incidence of hyperemesis gravidarum is approximately 0.3–3% of pregnancies
(PB 153, Sept.2015)
Describe hyperemesis gravidarum
There is no single accepted definition of hyperemesis gravidarum; The most commonly cited criteria include persistent vomiting not related to other causes, a measure of acute starvation (usually large ketonuria), and some discrete measure of weight loss, most often at least 5% of prepregnancy weight (PB 153, Sept.2015)
List risk factors for hyperemesis gravidarum.
Which population experiences a decreased incidence?
increased placental mass leading to increased HCG, elevated estrogen, family history, prior affected pregnancy, female fetus, history of motion sickness, history of migraines.
smokers
(PB 153, Sept.2015)
Are there any non-pharmacologic treatments for nausea and vomiting with evidence for efficacy?
prenatal vitamins(start 3 mo prior to conception), ginger, rest and avoidance of sensory stimuli such as odors, heat, humidity, noise, and flickering lights that may provoke symptoms. Frequent, small meals every 1–2 hours to avoid a full stomach often are recommended (47). Other dietary modifications that may be helpful include avoiding spicy or fatty foods; eliminating pills with iron; and eating bland or dry foods, high-protein snacks, and crackers in the morning before arising (PB 153, Sept.2015)
What is the recommended first line pharmacologic therapy for nausea and vomiting in pregnancy?
vitamin B6 10-25mg every 8 hours, or vitamin B6 and doxylamine(Diclegis 10/10mg delayed release)
(PB 153, Sept.2015)
TRUE OR FALSE
pre pregnancy, antepartum and intrapartum risk factors have poor predictive value for shoulder dystocia
TRUE
Although there are a number of known risk factors, shoulder dystocia cannot be accurately predicted or prevented. Clinicians should be aware of the risk factors for shoulder dystocia (PB 178, May 2017)
what is the probability of VBAC for all women attempting TOLAC?
published studies acknowledge 60-80%
PB 115, AUG 2010
how is VBAC success effected by spontaneous labor, augmentation and induction
both augmentation and induction have reduced success relative to spontaneous labor
(PB115, AUG2010)
for the following uterine scars; what is the TOLAC recommendation?
unknown, low vertical, low transverse, T, classical vertical
TOLAC is permissible without documentation of scar if the indication for the section suggests low transverse; both low vertical and transverse can TOLAC; T and classical incisions should be scheduled for repeat
(PB 115 AUG 2010)
