Pregnancy

Question 1

What is the risk to the foetus in maternal appendicitis?

Answer 1

There is a 2% risk of foetal loss in uncomplicated appendicitis, though this increases to 30% in the presence of perforation and peritonitis.

Up to 25% of women have perforated at the time of surgery.

Question 2

Steroids are appropriate up until what gestation?

Answer 2

34 weeks.

Question 3

Define SGA and severe SGA.

Answer 3

• SGA is EFW or AC <10th centile.
• Severe SGA is EFW or AC <3rd centile.
• Customised centile charts are best.

Question 4

What are the two primary causes for small for gestational age foetus?

Answer 4

• Constitutionally small (70%). Normal anatomical scan, normal Dopplers, normal AFI and appropriate growth velocity can be reassuring.
• Foetal growth restriction (FGR) / intrauterine growth restriction (IUGR) (30%).
  
  • Associated increased risk of stillbirth, birth hypoxia, neonatal complications, impaired neurodevelopment.
  • Long term there is an increased risk of T2DM and HT.

Think ‘CCPP’.

Constitutional

Chromosomal

Perinatal infections

Placental insufficiency

Question 5

What are the considerations regarding laparoscopic surgery in pregnancy?

Answer 5

Generally safe. Elevated maternal pCO₂ is likely to result in foetal acidosis though this is thought to be relatively safe. Verres needle induction appears to be safe. Lying supine can compress the inferior vena cava.

Question 6

What are the causes for FGR / IUGR?

Answer 6

• Chromosomal (20%). Includes aneuploidy, partial deletions, gene mutations and placental mosaicism.
• Perinatal infections (5%). Includes CMV, rubella, toxoplasmosis, VZV, syphilis.
• Placental insufficiency. There are many causes and these are often recurrent. Can manifest as preeclampsia, abruption and FGR.
• Non-genetic congenital abnormalities (2%).
• Multiple gestation. Nutritional as well as complciations such as twin-twin, congenital anomalies and preeclampsia.
• Maternal factors.
• Reduced placental blood flow. Includes HT, diabetes mellitus, collagen vascular disease, SLE or preeclampsia.
• Hypoxaemia. Include yanotic heart disease or severe anaemia.
• Smoking.
• Toxins. Examples include warfarin and anticonvulsants.

Question 7

What is HELLP syndrome?

Answer 7

• H - haemolysis
• EL - elevated liver enzymes
• LP - low platelets

1-2% mortality for mother. Up to 30% mortality for foetus.

Question 8

What are the risk factors for preterm birth?

Answer 8

• 12% of deliveries in USA Stress – socioeconomic, single, anxiety, depression, life events, surgery
• Occupational – working in standing position
• Stretched uterus – multiple preg, polyhydramnios, uterine anomalies, fibroids
• Weak cervix – cervical surgery, second trimester TOP, short cervix
• Infections – STIs, BV, pyelonephritis, general sepsis, gum disease
• Placenta – praevia, abruption, pre-eclampsia, IUGR
• Previous PTL, smoking, drug use, you / old, anaemia
• Weight – underweight (obesity decreases risk)

Question 9

What is the significance of asymmetrical growth restriction?

Answer 9

It is suggestive of placental insufficiency.