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TOG vol 22-1 Flashcards

1
Q

Prevalence of puerperal sepsis worldwide (WHO)

after live births

A

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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2
Q

Risk of maternal mortality from sepsis

(WHO, high-income countries)

A

8%

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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3
Q

Risks of sepsis to fetus

A

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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4
Q

Percent of stillbirth cases related to infection/sepsis

A

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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5
Q

pathogen most often implicated in maternal death

A

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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6
Q

criteria for septic shock

Hint: there are 3!

A
  1. sepsis (ie. organ dysfunction + infection)
  2. vasopressor requirements to maintain MAP>65
  3. 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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7
Q

risk of sepsis in operative vaginal birth

A

**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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8
Q

blood cultures positive only in how many percent of cases?

(in maternal sepsis)

A

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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9
Q

incidence of stroke in pregnancy

A

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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10
Q

% of strokes occuring peripartum or in first 6 weeks

A

90%

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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11
Q

independent risk factors for stroke

Hint: there are 5!

A 
age >35
PET/eclampsia
Migraines
GDM
PIH

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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12
Q

case fatality of strokes

(overall, hemorrhagic, ischemic)

A

overall 8.8-20%
hemorrhagic 13.9%
ischemic 3.4%

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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13
Q

single greatest cause of death from stroke

A

intracranial hemorrhage

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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14
Q

% of CVT with typical stroke symptoms

A

40%

may be associated with headache, drowsiness, or confusion

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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15
Q

% of all strokes comprised by recurrent strokes

A

25-30%

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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16
Q

imaging for stroke in pregnancy

A

MRI preferred

however non-contrast CT faster and more widely available

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

17
Q

recombinant tissue plasminogen activator given within

ie. in treatment of stroke during pregnancy

A

4.5h of stroke

2-6% of hemorrhagic transformation

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

18
Q

target BP control for ICH

(in pregnancy)

A

SBP <140

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

19
Q

treatment for CVT

(in pregnancy)

A

LMWH (or UFH)

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

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

20
Q

when to do thrombophilia screen for stroke pts

(ie after stroke in pregnancy)

A

6 weeks postnatally

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

21
Q

max storage for frozen embryos

A

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

22
Q

% of all cycles that are frozen-thawed embryos

A

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

23
Q

98% of embryo transfer occurs at which stage

A

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

24
Q

fTER reduces risks of

A

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

25
Q

fTER increases risks of

A

PIH
PPH
LGA

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

26
Q

freeze all approach better for high-responders ie. ___

A

high AFC >15

ie. PCOS

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

27
Q

% of babies born via IVF

A

1-5%

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

28
Q

risk of miscarriage following ART

(singleton pregnancy)

A

15-20%

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

29
Q

risk of ectopic following ART

(singleton pregnancy)

A

1.4%

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

30
Q

Maternal risks following ART

(singleton pregnancy)

A

PIH/PET RR 1.49 (AR increase 2%)
GDM RR 1.48 (AR 1%)
VTE 2x (but 4x in first trimester)

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

31
Q

OR of placenta previa following ART

(singleton pregnancy)

A

3.76, especially higher for blastocyst pregnancies

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

32
Q

fetal risks following ART

(singleton pregnancy)

A

FGR
Stillbirth
PTL (early <37/40 = 11.2%)
Cerebral palsy OR 2.18

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

part 2 (21 decks)

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