Valvar Diseases .tog

Question 1

Characteristics of fetal warfarin syndrome

Answer 1

Nasal hyperplasia
Shortening of the long bones and digits
Stippled long bone epiphyses

Question 2

Fetal warfarin syndrome is most encountered where warfarin exposure occurs…..

Answer 2

6-12 weeks

Question 3

At what gestational age The risk of central nervous system and ocular abnormalities is higher when exposed to warfarin?

Answer 3

Later gestations

Question 4

Overall rate of fetal anomaly when exposed to warfarin in the first trimester is…

Answer 4

5-6%

Question 5

The risk of thromboembolic complications with LMWH as alternative to warfarin…

Answer 5

10%

Question 6

Recommended peak anti Xa levels
To guide LMWH dose in women with prosthetic valve

Answer 6

0.8-1.2 iu/ml

Question 7

The dose of LMWH in women with prosthetic valves compared with the dose for treatment venous thromboembolism

Answer 7

> 50% higher than weight based doses

Question 8

When thromboembolic complications frequently reported in pregnant women?

Answer 8

First trimester

Question 9

What dose of warfarin which above it the risk of embryopathy is markedly increased?

Answer 9

> 5 mg daily

Question 10

Recommended peak anti Xa levels for non-aortic valves?

Answer 10

1.0-1.2 iu/ml

Question 11

When to stop warfarin before cs and when to restart after cs?

Answer 11

Stop 2 weeks before
Restart 7 days after

Question 12

When to stop therapeutic LMWH before cs and when to restart after?

Answer 12

Stop 24 hours
Restart 4-6 hours after

Question 13

When to stop therapeutic LMWH before v d ?

Answer 13

Expect delivery within 12 hours

Question 14

How therapeutic LMWH is given in epidural?

Answer 14

Stop 24 hours and insert
Don’t give while catheter in
Remove after 24 hours of last dose
Give prophylactic dose after 4 hours of removal
Give therapeutic after 8-12 hours

Question 15

How to give LMWH in spinal anesthesia?

Answer 15

Stop 24 hours
Do spinal
Next dose not before 4 hours

Question 16

UFH in cs or vd or regional

Answer 16

Stop 4-6 hours
Restart 4-6 hours

Question 17

What to monitor UFH after CS?

Answer 17

Platelets count
Every 2-3 days from day 4 -14
Or until heparin is stopped

Question 18

If the woman presents within 24 hours from the last dose of LMWH
What analgesia is suitable for labour?

Answer 18

Remifentanil patient control anaesthesia

Question 19

If the woman presents within 24 hours from the last dose of LMWH what anaesthesia is suitable for cs?

Answer 19

General anaesthesia

Question 20

In women taking warfarin, what INR ratio is accurate prior to neuro axial anesthesia?

Answer 20

Less than 1.5

Question 21

Are specific surgical measures required for anticoagulanted patients undergoing cs?

Answer 21

Wound drains
Skin incision should be closed with interrupted sutures