ANC - P4 Flashcards
1
Q
Cause of CMV (cytomegalovirus)
A
Herpes virus 5
2
Q
What is the most common virus to be transmitted to the fetus during pregnancy?
A
CMV
3
Q
What % of pregnant women are infected by CMV during pregnancy
A
1%
4
Q
What % of those infected w/ CMV pass on to fetus
A
1/3
5
Q
Of fetuses infected, what % will be caused damaged by CMV
A
5%
6
Q
When is the highest risk to fetus for CMV?
A
1st trimester
7
Q
PS CMV (3)
A
Asymp usually
Flu like illness
Or glandular fever type illness - fever, splenomeg, imp LFT
8
Q
Ix CMV
A
Viral serology - CMV IgM + G
9
Q
Mx CMV (3)
A
Rx to fetal medicine specialist
No Tx for mother
TOP
10
Q
Features of congenital CMV (6)
A
IUGR HSmegaly TTP Jaundice Microencephaly Chorioretinitis
11
Q
% mortality congenital CMV
A
20-30%
12
Q
What % of pregnant F have GBS commensally
A
25%
13
Q
RF GBS infection (6)
A
GBS infection in previous baby Prematurity ROM >24hrs before delivery Pyrexia during labour \+ve test GBS in mother Mother diagnosed w/ UTI
14
Q
CF GBS mother (4)
A
UTI
Chorioamnionitis
TachyC
Endometritis
15
Q
CF GBS neonate (5)
A
Neonatal pyrexia Cyanosis difficulty breathing Difficulty feeding FLoppiness
16
Q
Ix GBS
A
Swabs (culture on enriched culture medium)
Urine cultures??
17
Q
Preventing GBS (2)
A
High dose IV BEN PEN throughout labour
If ROM >37w - induce to reduce amount of time fetus is exposed
18
Q
Transmission of Parovirus B19
A
Respiratory droplets
Blood
19
Q
What % of women become infected w/ parovirus in pregnancy
A
1/400
20
Q
Often those infected, what % of pregnant women pass parovirus on to their fetus
A
33%
21
Q
Oft those infected w/ parovirus, what is the outcome for 9% of fetuses
A
Spontaneous miscarriage
Or intrauterine death
22
Q
CF parovirus in mother
A
Asymp
Or symmetrical arthralgia
23
Q
CF parovirus in baby (5)
A
URTI Malaise Headaches Low grade fever Slapped cheek syndrome
24
Q
Ix parovirus
A
Viral serology
IgM = recent infeection
IgG = past infection (immunity)
25
Mx parovirus in pregnancy (3)
Rx
Mum = self limiting
Fetus - main risk = fetal hydrops --> Rx 3' centre for intrauterine erythrocyte transfusion
26
Why is rubella no longer screened for antenatally
Due to success of MMR vaccine
27
Maternal features rubella (6)
```
Asymp
Or non specific:
Malaise
Headache
COryza
Lymphadenopathy
Fine maculopapular rash
```
28
Ix rubella
ELISA - IgG +M
29
Mx rubella if <12w
Rx fetal medicine specialist
| due to 90% risk vert transmission --> multiple defects --> TOP
30
Mx rubella if >20w
Despite 45% risk vert transmission --> no additional risk to fetus :)
31
Congenital rubella syndrome - features present at birth: (6)
```
SNHL
Cardiac defects (PS/PDA/VSD)
Retinopathy/Congenital cataracts
LD
Microencephaly
Thrombocytopenia, blueberry muffin appearance
```
32
Congenital rubella syndrome - features present later on (4)
DM
Thyroiditis
GH abnormalities
Behavioural disorders
33
CF chickenpox in mothers (6)
```
Pneumonia
Hepaitis
Encephalitis
Fever
Malaise
Pruritic maculopapular rash
```
34
Ix chicken pox in preg
Typically clinical
| if in any doubt - immunofluorescence or PCR
35
Maternal Mx chicken pox (5)
Test for immunity
If not immune - VZIG within 10 days contact + before rash appears
If with rash - aciclovir within 24hrs rash onset
USS - check fetal abnorm
Vaccine pre-preg or postpartum
36
When does varicella of the newborn occur
If chicken pox is within the last 4 weeks of pregnancy
37
Sx varicella of the newborn
Often asymp
38
Tx varicella of the new born
VZIG
| Aciclovir
39
What is fetal varicella syndrome
Subsequent reactivation of the virus in utero
40
PS fetal varicella syndrome
Skin scarring
Eye defects
Hypoplasia of limbs
Neurological defects
41
Neurological defects in fetal varicella syndrome (4)
Microcephaly
Cortical/spinal atrophy
Seizures
Horners syndrome
42
Eye defects in fetal varicella syndrome (4)
Microophthalmia
Chorioretinitis
Cataracts
Optic atrophy
43
PS GAS (group A strep) in pregnancy
Chorioamnionitis
| Or Sepsis
44
Tx GAS in pregnancyt
Abx
45
Impact of syphillis in pregnancy
Miscarriage/stillbirth
| Or --> congenital sypphillis
46
Tx HSV during pregnancy
Aciclovir
| Deliver w/ CSC if within 6w 1st attack or genital lesions @ time delivery
47
Impact of herpes zoster <20w pregnant
Rarely teratogenic
48
Impact of herpes zoster at time of delivery
Severe neonatal infection
49
Mx herpes zoster
IgG to neonate
50
Mx chlamydia in pregnancy
ABx - azithro/erythro
51
What is the leading cause of maternal mortality
VTE
52
Why does risk of VTE increase greeatly in pregnacy (2)
Due. tochangesin. the clotting cascade
Incr fibrinogen
Decr protein S
53
What period of pregnancy has the highest risk of VTE
Post partum
54
Why is the L leg most commonly affected by DVT in pregnancy
Due to compression of uterus on L iliac vv
55
Ix VTE
raised D dimer is norm in preg
| FBC/U+E/LFT/Coag screen
56
Extra Ux DVT (2)
Compression duplex uSS
| Venograms
57
Extra Ix PE (2)
ECG/CXR
| CPTA V/Q scan
58
Mx VTE (3)
LMWH until 6-12w post partum
Compression stockings
Mobilisation + hydration
59
VTE prophylaxis in pt who has had CSC
10 day course LMWH
60
Obesity in pregnancy - risks to mum (7)
```
Higher risk VTE
Pre-eclampsia
Diabetes
CSC wound infections
More difficult CSC
PPH
Death
```
61
Obesity in pregnancy - risk to fetus (4)
Congen abnorms (NTDs)
Diabetes
Incr mortality
USS less acurate
62
Mx of obesity during pregnancy
W advice
5mg preconceptual folic acid
+ Vit D
Maintain weight throughout pregnancy as losing weight during pregnancy isnt a good idea
63
Mx pregnancy BMI >35
Screen for GDM
| BP surveillance
64
Mx Pregnancy BMI >40
Formal anaesthetic risk assessment
| Antenatal thromboprophylaxis recommended
65
E.g.s of high risk thrombophilias (4)
APLS
Protein S/C deficiency
Activated protein C resistance
Antithrombin III deficiency
66
E.g.s of lower risk thrombophilias (4)
Factor V Leiden
Prothrombin gene variant
Hyperhomocysteinaemia
Antiphospholipid Ab with no syndrome
67
Complications of thrombophilias in pregnancy (6)
```
VTE
Miscarriage
Preterm
Pre-eclampsia
IUGR
Placental abruption
```
68
Mx of thrombophilias in pregnancy (4)
Incr maternal + fetal surveillance
Aspirin
LMWH postnatally +/- antenatally
ANtenatal LMWH if prev preg lol
69
PS APLS in pregnancy (4)
```
placental thrombosis -->
Rec miscarriage
IUGR
Early pre-eclampsia
Foetal loss
```
70
Mx APLS
USS + elective induction
| Post natal anti-coag - prevent VTE
71
Conseq hyperchromocysteinaemia in pregnancy
Pregnancy loss
| Pre-eclampsia
72
Tx hyperchromocysteinaemia in pregnancy
High dose folic acid
73
Mx of pre-existing cardiac disease in pregnancy (7)
```
Swap out 'bad' meds
Acei --> B-blockers/nifedipine
Warfarin --> LMWH
Echo
Regular anaemia checks
Avoid epidural and forceps
ABx in labour to prevent against endocarditis in high risk pt
```
74
Mx of epilepsy in pregnancy (4)
Preconceptual assessment
Use as few anti-E drugs as poss + 5mg folic acid
Avoid Na valporate
From 36w - 10mg vit K PO
75
Which anti-epileptic meds are safest in pregnancy (2)
Carbamazepine
| Lamotrigine
