Maternal Med Flashcards

1
Q

Neonatal outcome with poor glycaemic control

A

Congenital malformations
Stillbirth
Neonatal death

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2
Q

Risk of neonatal+ perinatal death is significantly higher in T2DM than T1DM

A

True

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3
Q

Differentials for skin conditions

A

• PUPPS
• Pemphigoid gestationis
• Atopic eruption in pregnancy
• Eczema/ Psoriasis
• OC -> excoriations but typically no rash
• DHx, allergic reaction, contact dermatitis
• Pre-existing auto immune (SLE/ TB/ Sarcoid etc)
• Viral -> CMV, EBV, Parvovirus, Measles, Rubella, HIV, Zika, VZV, Meningitis…
• Fungal
• Parasitic -> scabies

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4
Q

CF - worse outcomes if

A

FEV1 <60% predicted
B. Cepacia infection (can lead to rapid deterioration of lung function)
Pulmonary hypertension
Cor pulmonale
Cyanosis
Hypoxia
Malnutrition (BMI <22)
Other related conditions (DM, cirrhosis, CKD)

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5
Q

3 skin conditions of pregnancy

A

Polymorphic eruption of pregnancy (PEP). Pemphigoid gestationis. Atopic eruption of pregnancy.
Frequency 1:200, RARE 1:10000, 1:300

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6
Q

Mitral stenosis risk
(Moderate - Severe)

A

Maternal
Death 1-3%
Pulmonary oedema 18-37%
New or recurrent arrhythmia 5-16%
Fetal
Stillbirth 2-4%
Neonatal death 0-2%
PTB 10-18%

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7
Q

APS blood tests (2 tests > 12/52 apart)

A

Anticardiolipin antibodies
Lupus anticoagulant
Anti beta-2-glycoprotein-1 antibodies

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8
Q

SLE bloods

A

Anti nuclear antibodies (ANA)
aPLs (anticardiolipin antibodies and lupus anticoagulant) (40%) - predicts severity
Anti Ro and Anti La (30%)
C3 and C4
Anti dsDNA antibodies
Renal function
Liver function
Proteinuria

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9
Q

Serious associated maternal risks with HG

A

Wernicke’s (vit B1, thiamine Def)
Hyponatremia
Peripheral neuropathy (but B12, B6 Def)
VTE
AKI
GORD, Mallory Weiss year, oesophageal rupture
TOP
Malnutrition & refeeding syndrome
PTL, FGR, placental abruption

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10
Q

Genetic carrier screening
(4 conditions and carrier rates)

A

CF 1:35 (1:25 European)
Spinal muscular atrophy (SMA) 1:50
Fragile X (1:332)
Thalassemia 1:10000 (3% Indians carry beta)

Overall 1:20 carry CF, SMA or Fragile X

1:10 Afrocarribean’s carry SCD.
1:4 West Africans

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11
Q

Maternal infection
3 virus and 1 parasite that you do amnio for

A

CMV, varicella, Rubella
Toxo

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12
Q

Myasthenia Gravis - fetal effects

A

Arthrogryposis (contractures due to lack of movement)
Impaired swallowing - can cause Poly
PTB
IUGR
Transient neonatal MG (10-20%)

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13
Q

Kell summary

A

Pt must be Kell neg
To be affected fetus must be Kell pos
Inhibits erythropoiesis (not haemolysis)
2/52 MCA PSV from 18/40 + for developing hydrops

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14
Q

RA history

A

Extra-articular features - anaemia, fatigue, vasculitis, subcut nodules, pulmonary, cardiac amyloid, pericarditis
Neck involvement - atlanto-axial subluxation
Previous VTE
?Sjogrens

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15
Q

Echogenic bowel f/u

A

Even if no cause found, still need 4/52 scans as increased risk of SGA and IUFD

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16
Q

Tetralogy of Fallot

A

Overing aorta
VSD
Pulmonary (valve) stenosis
Enlarged right ventricle

17
Q

Hyperthyroidism risks + Ix + Mx in pregnancy

A

Risks: SGA, PTB, miscarriage, stillbirth, fetal/neonatal thyrotoxicosis (1-5%). Maternal - higher risk if PET with severe features. Thyrotoxic storm. Preg loss, postnatal flare.
TRAb - Thyroid stimulating receptor antibodies (95% +ve in Graves).
PTU, carbimazole, +/ propranolol (40mg TDS)

18
Q

Risks with thionamides

A

PTU and Carbimazole 2-4% risk of congenital malformations.
Carbimazole can cause aplasia cutis (patches of absent skin - normally scalp)
Agranulocytosis - rash, infection, sore throat.
Can breastfeed on “normal” doses

19
Q

Toxo Abx

A

<18/40 Spiramycin 1g PO TDS (aims to prevent infection rather than treat, concentrates in placenta)
>18/40 Pyrimethamine and Sulfadiazine.
Continue Abx for rest of preg regardless of whether amnio is Pos or Neg.

20
Q

4 treponemal diseases

A

Syphilis, bejel, yaws, pinta

21
Q

Covid Mx (if unwell)

A

Maintain sats >94%.
Gest - Steroids (fetal lung maturity or not)?
Dexamethasone 6mg IM BD for 4 doses. Then Pred 40mg OD
VTE prophylaxis
Antivirals:
Give Paxlovid (nirmatrelvir 300mg + ritonavir 100mg)
Consider remdesivir
Immune modulator:
Tocilizumab
8mg/kg IV (actual body weight) rounded to nearest 80mg
or 200mg vial (max dose 800mg), as a single dose

22
Q

Spinal cord injury at level of T6 or higher. (Can also happen with Guillain Barre)

A

Autonomic dysreflexia

23
Q

Differentials for severe postpartum headache

A

Epidural/ puncture headache
Meningitis
HTN/ PET
Cerebral venous thrombosis
Pituitary apopexy
RCVS (reversible vasoconstriction syndrome)
Subarachnoid haemorrhage

24
Q

Balanced translocations

A

Parental structural chromosomal abnormalities
Found in 2–5% of RPL couples compared with 0.7% of the general population
Most commonly (~85%) balanced translocations
Reciprocal translocations (~60%)
Robertsonian translocations (~40%)

Refer for genetic counselling.
Most men and women with a balanced translocation can and do have children.
Four possible outcomes for offspring
- ordinary chromosome pattern
- same balanced translocation as the parent
- preg loss due to repeated pregnancies with unbalanced chromosomes
- ongoing pregnancy with unbalanced chromosomes -> stillbirth vs. birth defect

25
Q

Hyperthyroidism in pregnancy + most common cause and differentials

A

Occurs in 0.2-0.7% of pregnancies. 95% due to Graves disease
Autoimmune disorder. Thyroid stimulating hormone receptor antibodies (TRAb) mimic the TSH (from pituitary). 95% of pt’s with Graves have raised TRAb.
Differentials: multi-nodular goitre, toxic adenoma, viral thyroiditis (De Quervains), iatrogenic (amiodarone, iodine, lithium)

26
Q

Hydrops - differentials

A

IMMUNE (10%) VS. NON-IMMUNE (90%)
Immune
- Rh incompatibility or other HDFN (Kell etc)
- Maternal abs -> haemolysis
- NOTE -> sig risk in next preg. More severe and 10/40 earlier.
Non-immune
- Cardiac structural (Cardiomyopathy, aortic/pulm stenosis, transposition, ASD/VSD, tetralogy, Ebsteins)
- Cardiac functional (tachy, brady, 3rd degree heart block - i.e. Lupus & Anti Ro + La)
- Chromosomal (aneuploidy, arthrogryposis)
- Haem (Thalassaemia, haemorrhage, G6PD def (X-linked recessive, inborn error of metabolism, predisposes to RBC breakdown))
- Infection (Parvovirus + other viruses)
- Congenital (CPAM, CDH)

27
Q

PET predictors

A

Vasoconstriction, HTN
Antiangiogenic factors. sFlt1 increased and PlGF decreased in maternal circulation weeks before PET onset