TOG vol 22-1 Flashcards by evelyn zielinski

Prevalence of puerperal sepsis worldwide (WHO)

after live births

4.4%

with a greater burden in LMICs (7%) than in HICs (1–2%)

Greer, O, Shah, NM, Johnson, MR. Maternal sepsis update: current management and controversies. The Obstetrician & Gynaecologist 2020; 22: 45– 55. https://doi.org/10.1111/tog.12623

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Risk of maternal mortality from sepsis

(WHO, high-income countries)

4th leading direct cause of death

Greer, O, Shah, NM, Johnson, MR. Maternal sepsis update: current management and controversies. The Obstetrician & Gynaecologist 2020; 22: 45– 55. https://doi.org/10.1111/tog.12623

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Risks of sepsis to fetus

miscarriage
stillbirth
Preterm labour

Greer, O, Shah, NM, Johnson, MR. Maternal sepsis update: current management and controversies. The Obstetrician & Gynaecologist 2020; 22: 45– 55. https://doi.org/10.1111/tog.12623

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Percent of stillbirth cases related to infection/sepsis

10-25% HIC

upto 50% LIC

Greer, O, Shah, NM, Johnson, MR. Maternal sepsis update: current management and controversies. The Obstetrician & Gynaecologist 2020; 22: 45– 55. https://doi.org/10.1111/tog.12623

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pathogen most often implicated in maternal death

GAS

notifiable disease

Greer, O, Shah, NM, Johnson, MR. Maternal sepsis update: current management and controversies. The Obstetrician & Gynaecologist 2020; 22: 45– 55. https://doi.org/10.1111/tog.12623

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criteria for septic shock

Hint: there are 3!

sepsis (ie. organ dysfunction + infection)
vasopressor requirements to maintain MAP>65
lactate >2 mmol/L

NB: in absence of hypovolemia

Greer, O, Shah, NM, Johnson, MR. Maternal sepsis update: current management and controversies. The Obstetrician & Gynaecologist 2020; 22: 45– 55. https://doi.org/10.1111/tog.12623

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risk of sepsis in operative vaginal birth

**16% **

Greer, O, Shah, NM, Johnson, MR. Maternal sepsis update: current management and controversies. The Obstetrician & Gynaecologist 2020; 22: 45– 55. https://doi.org/10.1111/tog.12623

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blood cultures positive only in how many percent of cases?

(in maternal sepsis)

30-40%

Greer, O, Shah, NM, Johnson, MR. Maternal sepsis update: current management and controversies. The Obstetrician & Gynaecologist 2020; 22: 45– 55. https://doi.org/10.1111/tog.12623

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incidence of stroke in pregnancy

30/100 000 pregnancies

(3x more common in pregnant than non-pregnant)

Khalid, A, Hadbavna, A, Williams, D, Byrne, B. A review of stroke in pregnancy: incidence, investigations and management. The Obstetrician & Gynaecologist 2020; 22: 21– 33. https://doi.org/10.1111/tog.12624

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% of strokes occuring peripartum or in first 6 weeks

90%

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independent risk factors for stroke

Hint: there are 5!

age >35
PET/eclampsia
Migraines
GDM
PIH

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case fatality of strokes

(overall, hemorrhagic, ischemic)

overall 8.8-20%
hemorrhagic 13.9%
ischemic 3.4%

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single greatest cause of death from stroke

intracranial hemorrhage

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% of CVT with typical stroke symptoms

40%

may be associated with headache, drowsiness, or confusion

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% of all strokes comprised by recurrent strokes

25-30%

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imaging for stroke in pregnancy

MRI preferred

however non-contrast CT faster and more widely available

recombinant tissue plasminogen activator given within

ie. in treatment of stroke during pregnancy

4.5h of stroke

2-6% of hemorrhagic transformation

target BP control for ICH

(in pregnancy)

SBP <140

treatment for CVT

(in pregnancy)

LMWH (or UFH)

+/- IV mannitol if increased ICP, +/- decompressive craniectomy

when to do thrombophilia screen for stroke pts

(ie after stroke in pregnancy)

6 weeks postnatally

max storage for frozen embryos

10 years

extended to 55yo if prematurely infertile

Noble, M, Child, T. The role of frozen–thawed embryo replacement cycles in assisted conception. The Obstetrician & Gynaecologist 2020; 22: 57– 68. https://doi.org/10.1111/tog.12630

% of all cycles that are frozen-thawed embryos

34%

Noble, M, Child, T. The role of frozen–thawed embryo replacement cycles in assisted conception. The Obstetrician & Gynaecologist 2020; 22: 57– 68. https://doi.org/10.1111/tog.12630

98% of embryo transfer occurs at which stage

blastocyst
(day 5-6)

NB: Day 6 is better frozen than fresh

Noble, M, Child, T. The role of frozen–thawed embryo replacement cycles in assisted conception. The Obstetrician & Gynaecologist 2020; 22: 57– 68. https://doi.org/10.1111/tog.12630

fTER reduces risks of

PTL
LBW
SGA

Noble, M, Child, T. The role of frozen–thawed embryo replacement cycles in assisted conception. The Obstetrician & Gynaecologist 2020; 22: 57– 68. https://doi.org/10.1111/tog.12630

fTER increases risks of

PIH PPH LGA ## Footnote *Noble, M, Child, T. The role of frozen–thawed embryo replacement cycles in assisted conception. The Obstetrician & Gynaecologist 2020; 22: 57– 68. https://doi.org/10.1111/tog.12630*

freeze all approach better for high-responders ie. ___

high AFC **>15** | ie. PCOS ## Footnote *Noble, M, Child, T. The role of frozen–thawed embryo replacement cycles in assisted conception. The Obstetrician & Gynaecologist 2020; 22: 57– 68. https://doi.org/10.1111/tog.12630*

% of babies born via IVF

**1-5%** ## Footnote *Richardson, A, Taylor, M, Teoh, JP, Karasu, T. Antenatal management of singleton pregnancies conceived using assisted reproductive technology. The Obstetrician & Gynaecologist 2020; 22: 34– 44. https://doi.org/10.1111/tog.12608*

risk of miscarriage following ART | (singleton pregnancy)

**15-20%** ## Footnote Richardson, A, Taylor, M, Teoh, JP, Karasu, T. Antenatal management of singleton pregnancies conceived using assisted reproductive technology. The Obstetrician & Gynaecologist 2020; 22: 34– 44. https://doi.org/10.1111/tog.12608

risk of ectopic following ART | (singleton pregnancy)

**1.4%** ## Footnote *Richardson, A, Taylor, M, Teoh, JP, Karasu, T. Antenatal management of singleton pregnancies conceived using assisted reproductive technology. The Obstetrician & Gynaecologist 2020; 22: 34– 44. https://doi.org/10.1111/tog.12608*

Maternal risks following ART | (singleton pregnancy)

PIH/PET RR 1.49 (AR increase 2%) GDM RR 1.48 (AR 1%) VTE 2x (but 4x in first trimester) ## Footnote *Richardson, A, Taylor, M, Teoh, JP, Karasu, T. Antenatal management of singleton pregnancies conceived using assisted reproductive technology. The Obstetrician & Gynaecologist 2020; 22: 34– 44. https://doi.org/10.1111/tog.12608*

OR of placenta previa following ART | (singleton pregnancy)

3.76, especially higher for blastocyst pregnancies ## Footnote *Richardson, A, Taylor, M, Teoh, JP, Karasu, T. Antenatal management of singleton pregnancies conceived using assisted reproductive technology. The Obstetrician & Gynaecologist 2020; 22: 34– 44. https://doi.org/10.1111/tog.12608*

fetal risks following ART | (singleton pregnancy)

FGR Stillbirth PTL (early <37/40 = 11.2%) Cerebral palsy OR 2.18 ## Footnote *Richardson, A, Taylor, M, Teoh, JP, Karasu, T. Antenatal management of singleton pregnancies conceived using assisted reproductive technology. The Obstetrician & Gynaecologist 2020; 22: 34– 44. https://doi.org/10.1111/tog.12608*