Antenatal Flashcards

Question

OC severe

Answer 1

nasal hypoplasia, absent nasal bone, increased re nasal and nuchal for thickness cardiac defects intracardiac echogenic foci duodenal atresia echogenic bowel mild dydronephrosis short femurs sandal gap clinodactyly or mid phalanx hypoplasia of the 5th finger

Answer 2

if asymptomatic with twins do a single cx measurement from 18w but not repeated cervical length

Answer 3

50% if maternal infection occurs 1-4 w before delivery up top 50% of valves are infected and 23% of them will get clinical varicella despite titres of passively acquired maternal antibody severe chicken pox is most likely to occur if the infant is born within 7 days of onset of the mother rash of it mom develops the rash up to 7 days post delivery **GIVE VZIG with or without aciclovir to the neonate in this case**

Answer 4

yes if lesion close to nipple, express until lesions have crusted over , expressed milk may be given to the baby who is getting VZIG and or aciclovir

Answer 5

one or more of the following skin scarring in a dermatomal distribution eye defects - microphthalmia, chorioretinitis, cataracts hypoplasia of the limbs neurological abnormalities - microcephaly, cortical atrophy, MR, dysfunction of bowel and bladder sphincters

Answer 6

not at the time of initial fetal infection but results from a subsequent herpes zoster reactivation in utero and only occurs in a minority of infected fetuses

Answer 7

if note, if the pregnant woman is immunosuppressed for a reason other than pregnancy, a history of previous infection or vaccination may not be sufficient evidence of immunity and serum should be tested for VZV IgG. PEP should be offered if VZV IgG is negative, or < 150 mIU/ml.

Answer 8

a pregnant woman is not immune to VZV and has significant exposure to chickenpox or shingles, she should be offered (PEP). Oral antiviral therapy i.e. Aciclovir (or Valaciclovir) is recommended as the first choice for PEP by the UKHSA. It should be given from day 7 to 14 post exposure. The dose of Aciclovir recommended for PEP is 800mg 4 times daily. The dose of oral Valaciclovir is 1000mg TDS

Answer 9

VZIG may be considered as PEP. In this context it should be offered if VZV IgG is negative, or < 100 mIU/ml in the immunocompetent pregnant woman and if VZV IgG is negative, or < 150 mIU/ml4 in the immunocompromised pregnant woman.

Answer 10

VZIG is administered as soon as possible or at the very latest within 10 days of the exposure (in the case of continuous household exposures, within 10 days of appearance of the rash in the index case)

Answer 11

If chickenpox does not develop in a seronegative pregnant woman and there is a further exposure to chickenpox during the pregnancy, testing for VZIG should be repeated regardless of whether or not PEP was prescribed after the initial exposure. If seroconversion has not occurred, a second course of antiviral can be prescribed from seven days after the exposure for 7 days. If VZIG is used for PEP, it can be repeated if the repeat exposure occurs **three weeks or more after the last dose.**

Answer 12

800mg FIVE times a day for 7 days - start within 24 h of rash no VZIG

Answer 13

if the woman -smokes cigarettes, -has chronic lung disease, -is immunosuppressed (including those who have taken systemic corticosteroids in the preceding 3 months) -is in the second half of pregnancy, a hospital assessment should be considered even inthe absence of complications. Respiratory symptoms, neurological symptoms such as photophobia, seizures or drowsiness, a haemorrhagic rash or bleeding, or a dense rash with or without mucosal lesions are indicative of potentially life-threatening chickenpox and are indications for referral to a hospital with intensive care access.

Answer 14

yes by USS if abnormalities like limb deformity microcephalic hydrocephalus soft tissue calficication fetal growth restriction can be detected DO USS with a time lag of at least 5 weeks after the primary maternal infection is advised because ultrasound performed at 4 weeks has failed to detect the abnormalities. Fetal magnetic resonance imaging (MRI) may provide additional information in cases where ultrasound has identified morphological abnormalities. VZV DNA can be detected in amniotic fluid by PCR. The presence of VZV DNA has a high sensitivity but a low specificity for the development of FVS.

Answer 15

7 - 28 weeks

Answer 16

prev abruption OR of 7.9

Answer 17

24 (2 days?) before the rash until lesions crusted over

Answer 18

yes if ophthalmic or in an immunocompromised individual where viral shedding can be greater

Answer 19

- if low chance of T21, T18, T13 -higher multiple pre (triplets or more) -after 21+6w also if woman has: -cancer unless is in remission, -received a blood transfusion in the past 4 months - bone marrow transplant or organ trans - immunotherapy in current pregnancy - had stem cell therapy -vanished twin pregnancy - Down syndrome or a balanced translocation or mosaicism of T21,18 or 13

Answer 20

5% 4% infanticide rate 1-2 in 1000 birth incidence

Answer 21

25-49 every 3 years 50-64 every 5 years

Answer 22

abnormal accumulation of serous fluid in at least 2 of the following: skin -oedema body cavity- pericardium, pleural, ascetic effusions placentomegaly - placental thickness>6cm is often present

Answer 23

immune: 10% of cases and it is due to maternal hemolytic antibodies non-immune:90% of cases and it is due to all other etiologies

Answer 24

>= 3.5 this may be associated with T21,18,13, serous cardiac condition - and should be referred to fetal med

Answer 25

15w earlier is associated with talipes equinovarus and pregnancy loss

Answer 26

30% especially T21 - do amnio if double bubble sign

Answer 27

lymphadenopathy and fever but 80% may be asymptomatic

Answer 28

-spontaneous miscarriage in 1st trim

Answer 29

No evidence of an increase risk of spontaneous miscarriage with prim HSV Is genital HSV suspected should go to GUM clinic to confirm diagnosis with PCR Treat right away with PO Aciclovir 400mg TDS for 5 D

Answer 30

Treat with Aciclovir and deliver with CS , this is to reduce exposure of the fetus to HSV which my be present in the maternal genital secretions - some evidence that suggest if membrane have been ruptured for greater than 4 hours the benefit reduces but there’s still some benefit IF VAGINAL DELIVERY- GIVE IV ACICLOVIR to mom - 5mg/kg TDS and then to baby 20mg/kg TDS Unknown if intrapartum Aciclovir reduces risk of neonatal HSV infection

Answer 31

41% Highest risk of perinatal transmission depends on the timing of maternal acquisition of HSV - highest risk in infants born to women who have not completed HSV seroconverstuon so monstly in the 3rd trimester within 6 weeks of delivery If vag delivery chose- avoid ARM, instrumental del and FSE

Answer 32

Urinary tract abnormalities - bilateral renal agenesis, multi cystic or polycystic kidneys and urethral obstruction Preterm pre labor rupture of membranes insufficientcy Uteroplacental insufficiency - FGR with Doppler evidence of high impedance to flow in the uterine and or umbilical arteries and redistribution in the fetal circulation

Answer 33

Whooley questions

Answer 34

Clindamycin

Answer 35

Wide spread macular rash and conjuctival suffusion usually in TSS from staph aureus But only 10% of streptoccoccal TSS causes a rash

Answer 36

Median compression 60% of women Symptoms Numbness and tingling on fingers hand and wrists Pain or throbbing in the fingers hand and wrists Swollen hot fingers and thumb Hard to grip objects and performing fine motor tasks -loss of sensation over thumb index fingers and middle fingers bilaterally

Answer 37

USS first Then mamography with fetal shielding Then tissue biopsy with USS guided biopsy Staging only if suspicious for Mets- Chest x ray, liver USS, or MRI Gadolinium enhanced MRI is not recommended in preg but no adverse effects of gadolinium have been found on the fetus

Answer 38

X ray computed tomography - CT and isotope bone scan But can’t be used in pregnancy

Answer 39

Loco-regional clearance can be done in all trimesters Reconstructive surgery or mastectomy can be considered Readiotherapy to be delayed unless is life saving - spinal cord compression - its contraindicated Can’t have chemo in the first trimester But CAN have chemo in the second trimester Anthracycline regimens are safe No evidence of increased rate of 2nd trimester miscarriage, FGR, organ decimation

Answer 40

Test booking serum IgG avidity If low avidity mean recent primary CMV infection

Answer 41

Do amnio 6-8 weeks after seroconversion to test for fetal infection by viral load or viral PCR Also detailed USS every 2-4 w after confirmation of fetal infection with fetal MRI at 28-32w to assess for features of severe sequelae.

Answer 42

Karyotype reveals cause of abnormalities is only 40% of babies ES -A new genetic test which when combined with testing the DNA of both parents can find changes in the baby’s genetic code If a DNA change is found that can explain the structural changes see on the USS of the baby and info about the diagnosis can be given to parents , can also help plan how to care for pregnancy, and if it can happy again for the parents Sometimes may not give answers or difficult to interpret Two new studyies showed that ES can find a genetic guanos is in at least 10% of pregnancies with structural differences where standard chromosome testing has been negative

Answer 43

Karyotype ES and chromosomal micro-array analysis (CMA)

Answer 44

Occipital cranial bone defect Large herniated fluid filled cyst extruding postriorly Kidneys multi cystic Polydactyl 25% recurrence Autosomal recessive

Answer 45

Turners is 50% of cases with CH Genetic syndrome are in about 40% of cases MC one is noonan syndrome -AD, but 90% are de novo cases

Answer 46

25% are stillborn, 30% die in the neonatal period

Answer 47

Amniocentesis

Answer 48

Remove cerclage and IOL

Antenatal Flashcards

(90 cards)