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Obstetrics > General > Flashcards

General Flashcards

1
Q

The CLASP Trial

  • Journal/Author
  • Objective
  • Enrolment
  • Primary outcome
  • Findings
A

The Lancet 1994
Redman et.al.
Prospecitve, multicentre, double blind placebo control RCT
To reliably characterise the safety of LDA and to determine if Rx produces worthwhile effects in pregnancies considered at high risk of PET or IUGR.
9300 women, ’88-’92.
12-32 weeks
Clinician judged to ‘be at risk of PET’ enough for LDA to be contemplated > randomised to LDA or placebo.
> Prophylactic group (previous PET or IUGR, HTN, kidney dx, other RF)
> Rx group (symptoms or signs of PET or IUGR)

> > 60mg Aspirin or placebo from 12/40 to delivery

Primary:

  • Proteinuric PET
  • GA
  • BW, and BW <20/40
  • NON-SIG*
  • 12% redn PET with proteinuria
  • 1 day longer GA
  • BW 32g heavier
  • No increased bleeding risk (APH or abruption)
  • No effect SB/NND/total mortality
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2
Q

Polyhydramnios - Causes

A 
Maternal:
- Diabetes
Foetal:
- Neurological impairment
- GIT obstruction
- Multiple gestation
- Parvo infection 
- Other causes of high output heart failure e.g. foetomaternal haemorrhage or alloimmunisation
- Aneuploidy
Idiopathic
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3
Q

Heparin Induced Thombocytopaenia

A

5% of people on Heparin for >5/7
Usually develops within 5/7
Usually resolves after 7/7

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4
Q

Risk factors for VTE in Pregnancy and the Puerperium

> or = 3 consider AN prophylaxis; >= 2 consider 7/7 PN

A
  • Previous VTE
  • Thrombophilia
  • Medical dx (heart, kidney, sickle, IVDU)
  • > 35y
  • BMI >30
  • Parity >2
  • Smoker
  • Varicose veins
  • Paraplegia
    OBS
  • Multiple pregnancy
  • PET
  • CS
  • OHSS
  • IVF
  • Prolonged labour or rotational delivery
  • PPH > 1L
    OTHER
  • Operation
  • OHSS
  • Hyperemesis
  • Admission/immobility
  • post part wound infection
  • long distance travel
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5
Q

RR of VTE

  • Non-preg
  • LNG
  • Gestodene
  • Pregnancy
A
  • Non=preg 5/100 000
  • LNG RR 3
  • Gesteodene RR 5
  • Pregnancy RR 12
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6
Q

Contraindications for COCP (2 VTE risk)

A
  • Current or previous VTE
  • 1st degree relative w VTE < 45y
  • Known thrombophilia
  • Within the first 3/52 PP
  • Immediately following T1/T2 TOP
  • Smoking (within 1y) and >35y (20x risk)
    Caution…
  • BMI > 35
  • Superficial thrombophlebitis
  • Immobilisation
  • SLE
  • 1/12 pre-op
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7
Q

Foetal risks of PD pregnancy

A 
SB - at 41/40 RR 1.3 (0.1%), and 42/40 RR 2
Birth asphyxia
Macrosomia
IUGR
Birth trauma - CPD, SD, #, BPI
Mec asp
Low apgars
CP
Early epilepsy
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8
Q

Maternal risks of PD pregnancy

A

CS/labour dystocia
3rd/4th degree tears
PPH
Failed VBAC

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9
Q

NNT PD IOL perinatal death

A

410

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10
Q

Cochrane PD IOL

A
  • less CS
  • fewer perinatal deaths
  • less mec asp
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11
Q

Hannah et. al. NEJM 1992. IOL c.f. expectant mgt in PD preg.

A 
Canadian multi centre RCT
3400 women
>41/40, well, singleton
IOL vs expectant (3x/wk CTG and AFI, kick counts)
1: PNM (underpowered)
2: MOD
Findings: 
- more mech and foetal distress in expectant group
- PNM not SS
- less CS IOL (SS)
- Similar rates of instrumental delivery
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12
Q

EDS = >13

A

PPV 62%

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13
Q

Neonates and SSRIs

A

Risk of ‘poor neonatal adaptation:

  • poor sleep, irritability, hypoglycaemia
  • 5-85%
  • usually mild and self limiting
  • resolve within 2/52
  • 0.7% chance of seizure
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14
Q

Folate for prevention of NTD

A

RR 0.28

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15
Q

Causes of thrombocytopenia - Preg

A
  • HELLP
  • PET
  • AFLP
  • DIC
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16
Q

Causes of thrombocytopenia - Not pregnanct

A 
Infection
- malaria
- HIV
HUS
Hypersplenism
Spurious result
Drugs
- Heparin
- Antiinflammatories
- Antidepressants
BM infiltration
17
Q

Neonates affected by ITP

A

10-15% will have plt < 50

5% plt < 20

18
Q

Rx ITP

A

Steroids

IVIG

19
Q

RANZCOG 5 Principles of PPH

A
  • Recognition
  • Communication
  • Resuscitation
  • Monitoring and Ix
  • Direct Rx
20
Q

Anti D prophylaxis - reduction in alloimmunisation

A

1% to 0.3%

70% reduction

21
Q

T1 indications for Anti-D

A

MC
TOP
Ectopic
CVS

22
Q

T2/3 indictations for Anti-D

A
  • ECV
  • Abdo trauma
  • APH
  • Amnio/cordocentesis
23
Q

Puerpeural psychosis - prevalence

A

0.1%

24
Q

AN anxiety/depression

A

10%

25
Q

PN anxiety/depression

A

16%

26
Q

Post birth PTSD

A

2-3%

27
Q

Breech - risk of DDH

A

Girl 12%

boy 2%

28
Q

Timing of division of zygote in twins

A

DCDA 13 days

29
Q

What ar the inherited thrombophilias?

A 
Proteins:
- Antithrombin III
- Protein C
- Protein S
Genes:
- Factor V Leidence (Activated protein C resistance)
- Prothrombin gene mutation 
- Homozygote MTHFR``
30
Q

What are the acquired thrombophilias?

A

Hyperhomocycteinaemia (no good evidence of increase in thrombotic disease)
Antiphospholipid syndrome
Platelet pathology

31
Q

What is the baseline pregnancy risk of VTE?

A

1/1000

32
Q

Why are 85% of DVTs in the L leg?

A

The iliac artery and ovarian artery cross over the iliac vein, thus compressing it. This does not occur on the R side.

33
Q

Which 3 thrombophilias have the highest rate of VTE in pregnancy, and what is the relative risk?

A

Antithrombin 3 deficiency 5-20
Homozygote FVL 10-80
Homozygote prothrombin gene mutation 10-40
Compound heterozygote prothrombin gene mutation and FVL 10-100

Obstetrics (3 decks)

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