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Obstetrics > RANZCOG Guidelines > Flashcards

RANZCOG Guidelines Flashcards

1
Q

Pre-Pregnancy Counselling (July 14)

- 10 domains of assessment

A
  1. Clinical assessment
  2. Med hx
  3. Past jobs hx
  4. Genetic/FHx
  5. Medication use
  6. Vaccinations - MMR, DPT, Varicella, Influenza
  7. Lifestyle changes
  8. Folic acid and iodine supplementation
  9. Smoking/etoh/ illicit drugs
  10. Healthy environment
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2
Q

Management of Obesity in Pregnancy - Adverse outcomes AN

A

AN

  • IGT/GDM
  • MC
  • SB
  • PET
  • VTE
  • OSA
  • Maternal death
  • Abn in foetal growth and development
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3
Q

Management of Obesity in Pregnancy - Adverse outcomes intrapartum

A
  • IOL, prolonged labour, FTP
  • Instrumental, CS and PPH
  • SD
  • Difficulties with heart rate monitoring
  • Difficulties with analgesia
  • Use of GA
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4
Q

Management of Obesity in Pregnancy - Anaesthetic risks

A
  • Difficulty w position
  • Difficulty w catheter siting and increased risk of dislodgement
  • Difficulty maintaining airways
  • Increased need for ICU post op
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5
Q

Management of Obesity in Pregnancy - Adverse outcomes PP

A
  • Delayed wound healing
  • Increased wound infection
  • Greater likelihood of needing support with maintenance and establishment of BF
  • PND
  • Long term neonatal consequences: composition, weight gain, obesity
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6
Q

Obesity - 8 preconception domains

A
  1. Identify/monitor weight/recommend lifestyle changes
  2. Discuss risks of obesity on fertility/preg outcomes
  3. Inform even modest increase in BMI associated w worse outcomes
  4. Daily exercise
  5. Consider bariatric surgery (decreased mat risk, ? increase IUGR)
  6. Folate (5mg if BMI >30), iodine supplementation
  7. Deprrssion assessment
  8. HINI vaccine
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7
Q

Obesity - GWG Ranges per BMI

A

30 - 5-9

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8
Q

Obesity - 9 AN domains

A
  1. Document BMI and refer
  2. Monitor GWG
  3. Vitamin supplementation
  4. OGTT - early and at 28/40
  5. Anaesthetic referral
  6. PET surveillance
  7. IUGR surveillance w USS
  8. Previous CS - less success, higher risk
  9. Start or continue exercise
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9
Q

Obesity - Intrapartum

A
  1. IV line for those w BMI > 40
  2. Awareness of increased risk SD and PPH
  3. Alert OT for weight > 120kg
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10
Q

Obesity - Post Partum

A
  1. VTE prophylaxis
  2. Breastfeeding support
  3. Advice and referal for weight management post partum
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11
Q

Major RF for PPH (7)

A 
Placenta praevia
Placental abrutpion
Multiple pregnancy
PET/Gest HTN
Delivery by em CS
Retained placenta
Mediolateral episiotomy
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12
Q

Minor RF PPH

A 
Previous PPH
Asian
Obesity
Anaemia
CS
IOL
Operative vaginal delivery
Prolonged labour
Macrosomia
Pyrexia in labour
Nullip > 40y
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13
Q

Early vs delayed cord clamping term infants

A

Early:

  • Less jaundice/phototherapy
  • Lower mean Hb
  • Iron deficiency persistent to 6/12
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14
Q

Early vs delayed cord clamping preterm infants

A

Early:

  • More blood transfusion
  • More IVH
  • No studies beyond discharge from hospital
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15
Q

Chronicity of Hep B w neonatal infection

A

40%

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16
Q

Risks of Hep B on pregnancy

A
  • Neonatal transmission
  • Acute - minima;
  • Chronic - increased LFTs
  • Cirrhosis (usually amenorrhoea w advanced cirrhosis):
  • IUGR
  • PTB
  • FDIU
  • Choreo
  • PIH
  • Abruption
  • PPH
  • 15% have hepatic compensation
17
Q

Rationale for HBV Rx in pregnancy

A
  • Prevent maternal complications (25% die from HBV, 40% HCC)
  • Prevention of perinatal transmission
    (Usually Telbivudine)
18
Q

Risk of foetal/neonatal transmission

A

AN 5% (abruption, TPL or invasive procedures), Intrapartum 95%
No intervention 90%
W HBIG and vaccine at birth and 1 months of age ~5%

19
Q

House hold members, sexual partners and children with Hep BsAg + woman

A

Should all be screened and vaccinated if not already immune

20
Q

Prevalence of HBV infection

A

1%

Majority are people from an area of high prevalence

21
Q

Definition chronic HBV

A

HBVsAg + > 6/12 after exposure

22
Q

How can HBV be prevented?

A
  • Vaccine - children, contacts, HCW
  • Safe blood products
  • Prevention of vertical infection
  • Sexual prevention
23
Q

IS HBV vaccine safe in pregnancy

A

Yes
It is safe and effective
Only use if recommended e.g. post exposure and non-immune (give w immune globulin also)

24
Q

Is invasive testing safe in pregnancy?

A
  • Higher rate of transmission, but not extensively studied. Likely higher in women with a high viral load.
  • Likely higher w CVS and amnio
  • Consider NIPT
  • Careful counselling re risks involved
25
Q

What are the predictors of perinatal transmission?

A
  • HBeAg status (+ ~80% transmission, - ~20% transmission)

- Viral load (>108IU/mL)

26
Q

What is the role of antivirals in pregnancy for HBV? (RANZCOG statement)

A
  • it is emerging as a possible means of reducing viral load and subsequent perinatal transmission in those at high risk of immunoprophylaxis failure
  • currently no clear guidelines
  • management should be individualised
  • refer to specialised hep B clinic for immediate decision making and long term follow up
  • known association with post partum flare
27
Q

What is the recommended MOD for pts with HBV?

A

MOD has not been shown to affect transmission

Invasive procedures should be avoided

28
Q

What are the recommended infant immunisations for the prevention of HBV in ANZ?

A

RR transmission w vaccine and HBIG 0.08
RR transmission w vaccine only 0.28

Monovalent vaccine for ALL infants at 0,2,4,6 months

HepBSAg + HB IG 100IU (separate thigh to the vaccine) one the day of birth

Test baby at 9-12 months for HBVsAg and sAb > refer to paed

29
Q

What about high risk preterm and LBW infants? (<32/40)

A

Do not respond as well to the vaccine
4 dose regeime (0,2,4,6) then either check the titre at 7/12 and give booster as required, or just give a booster at 12/12.

30
Q

IS there a difference in HBV infection between bottle fed and breast fed infants?

A

No difference provided appropriate immunoprophylaxis given at birth

31
Q

What long term follow up and care should women with HbsAG + receive?

A

Close monitoring for several months post partum to monitor flare
lifelong follow up for complications of liver disease and HCC

32
Q

ASID - when the Rx w Lamivudine/Tenofovir or Telbivudine

A

HbsAg + > HBV DNA

If > log 7 from 30/40 recommend antiviral Rx, stopping between 4 and 12 weeks post partum

33
Q

Effects Hep E Virus pregnancy

A

high mortality
15-20% fulminant hepatic failure
mortality 5%
predilection for pregnancy

34
Q

Parvo B19 - % of population immune

A

~50% (30-60)

35
Q

Parvo B19 - % of pregnancies affected

A

3%

36
Q

Symptoms of maternal infection Parvo b19 = erythema infectiosum = slapped cheek = 5th disease

A

Adults rarely develop the facial rash
Usually limb arthropathy x 1-2/52
viraemia from 1/52 post exposure for 1/52
not infectious after onset of rash/arthralgia

37
Q

Pregnancy effects of Parvo B19

A
  • Anaemia > 3% usually 5/52 after infection > 1/3 death. 1/3 resolution. 1/3 IUT.
  • Foetal loss - 10% w infection 20/40
38
Q

Does Parvo cause congenital anomalies?

A

No

Obstetrics (3 decks)

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