Maternal medicine Flashcards

Question

What are the risks of von willebrand disease in pregnancy?

Answer 1

Increased risk of: APH x 10 risk Primary PPH occurs in 15–30% of women Secondary PPH occurs in approximately 25%. Need for blood transfusion is increased x5 Mortality rate is increased x10 Avoid IM injections and NSAIDs

Answer 2

The incidence in the non-Jewish population is 1/1 000 000 it is common in Ashkenazi Jews with heterozygosity in 8% and homozygosity in 0.2–0.5%. Autosomal inheritance, worse symptoms of homozygous/compound heterozygous - not always know by patient Spontaneous bleeding is rare - but risk with surgery/procedures There is poor correlation between factor level and bleeding tendency

Answer 3

Factor XI is a glycoprotein that plays a role in the amplification of the coagulation process after the initial production of thrombin.

Answer 4

Treatment options include tranexamic acid, factor XI concentrate and FFP Don't give TXA and Factor XI together Avoid neuroaxial analgesia

Answer 5

BSS is caused by quantitative or qualitative deficiency of the membrane GP Ib-IX-V complex, leading to abnormal adhesion of platelets Autosomal recessive Thrombocytopenia and large platelets Risks: PPH, wound haematoma, Management: TXA, Platelet transfusion Avoid neuraxial anaesthesia

Answer 6

GT is caused by lack of or nonfunctioning GP IIb/IIIa due to missense mutations in ITGA2B and ITGB3. Platelet–platelet aggregation is impaired Risks MATERNAL Intrapartum bleeding/PPH FETAL Risk of alloimmunisation from platelet transfusions or paternal derived complexes May cause fetal thrombocytopenia/ICH If present, manage through MU - consider steroids or IVIG Avoid vit k following delivery until status known

Answer 7

1-2 in 1000 1 in 4 if Bipolar <1 in 2 if bipolar and family history/personal history Typically presents day 1-3

Answer 8

Rubella: single stranded RNA toga virus Live attenuated vaccine (contraindicated in pregnancy) If caught in first trimester 90% chance of transmission to fetus Incubation around 2 weeks 20% of miscarriage Congenital rubella syndrome: teratogenic with poor prognosis and significant complications (sensorineural deafness, cataracts and cardiac abnormalities most common) No specific treatment in pregnancy

Answer 9

Parvovirus B19 - slapped cheek Upto 50% adults asymptomatic and do not require treatment Incubation 7 days before rash onset and 1 day after Arrange urgent referral to a specialist in fetal medicine for serial fetal ultrasound scans and Doppler assessment to detect fetal anaemia, heart failure, and hydrops Risk of vertical transmission <15 weeks gestation - 15% 15 - 20 weeks - 25% Term - 70%

Answer 10

High miscarriage rate Intrauterine growth restriction (IUGR) Low birth-weight baby Stillbirth Neonatal thyroid dysfunction

Answer 11

If pregnant woman's partner travelled to Zika area - barrier methods rest of pregnancy If symptomatic within 2 weeks of exposure, or after sexual contact with someone who has been exposed within 2 weeks: -Refer for baseline USS assessment -If feeling unwell or has felt unwell, test for ZIKA antibodies by sending serum (and urine if within 21 days of symptoms) to RIPL -If positive Zika or abnormal USS refer to FMU

Answer 12

Flavivirus Single stranded RNA virus Transmitted primarily by Aedes mosquitos (daytime) Can be transmitted sexually but risk is low Incubation period 3-12 days Typical symptoms: fever, maculopapular rash, arthralgia or conjunctivitis Rash usually resolves within 2 days but may persist up to 1 week Many asymptomatic Zika associations: Guillan Barre syndrome Congenital microcephaly* (<2.5th centile) Other congenital abnormalities

Answer 13

2/3 No deterioration in seizure frequency Generalised epilepsy more like to remain seizure free than focal Most important factor in predicting deterioration is seizure-free duration pre pregnancy

Answer 14

Antenatal - Consultant led care, ANC, serial growth, high dose folic acid Intrapartum - If high risk of seizure in Labour consider Clobazam prophylactically No pethidine/carbetocin Terminate seizures ASAP to reduce risk fetal acidosis Delivery on CDS

Answer 15

1-4% Higher in post-natal period

Answer 16

Myasthenia Gravis (MG) is an autoimmune disease caused by antibodies against the nicotinic acetylcholine receptor or other postsynaptic antigens Female:Male ratio 2:1 Typically presents age 20-30 Effect of Pregnancy on Maternal MG Symptoms worsened for 40%* Symptoms unchanged in 30% 30% had remission No evidence that MG adversely affects pregnancy outcomes Effect of Pregnancy on Neonate Transient neonatal MG (TNMG) effects approx 20% of infants born to MG mothers Transient neonatal MG is due to transfer of maternal antibodies (IgG anti‐AChR antibodies) *Exacerbations typically occur in the first trimester and in the first 3 months postpartum Management considerations Starting glucocorticoid therapy or withdrawing immunosuppressant therapy may exacerbate MG Infections require prompt treatment as may cause exacerbation Pregnant patients with MG should be assessed for baseline motor strength, pulmonary function and ECG Thyroid function tests advised. Thyroid dysfunction in 10-15% Approx 15% of persons with MG have thymoma Patients with thymoma who have not undergone thymectomy present with a higher incidence of exacerbation during pregnancy and higher risk neonatal MG Thymectomy should be considered before conception or after delivery (not during pregnancy) MG most commonly caused by IgG anti‐AChR antibodies. Patients with anti‐MuSK antibodies generally have worse clinical symptoms and TNMG TNMG Affects 20% of babies Infants with TNMG typically develop symptoms within 12 h to 4 days of delivery Symptoms resolve spontaneously after 3-4 weeks due to antibody degradation

Answer 17

2-4 in 100,000 Normalyl arises in 3rd trimester and resolves 4-6 weeks post-natal PET/HELLP can cause DI to develop Avoid spinal as can cause rapid shift in BP - epidural OK

Answer 18

Classify as complicated or uncomplicated Uncomplicated is defined as <2% parasitised red blood cells in a woman with no signs of severity and no complicating features Complicated/severe >2% parasitised red blood cells or complicating features e.g. respiratory distress, pulmonary oedema, hypoglycaemia, secondary gram negative sepsis Diagnosis confirmed with blood films Management -Admit to hospital -If uncomplicated, P. falciparum/mixed Quinine and Clindamycin P. vivax Chloroquine P. ovale Chloroquine P. malariae Chloroquine -If complicated - admit to ITU IV artenusate or Quinine -Monitor signs of hypoglycaemia with quinine Primaquine should not be used in pregnancy.

Answer 19

Between 70-80%

Answer 20

Double stranded DNA Herpes 1 - Oral Herpes 2 - Genital In reality, mixed, and 50/50 cause of neonatal herpes

Answer 21

3 types 1. Restricted to skin/superficial infection (eye/mouth) which is the least severe form 2. CNS infection (mortality with antiviral treatment 6% neurological sequelae 70%) 3. Disseminated infection (mortality with antiviral treatment 30% neurological sequelae 17%) 70% of cases are disseminated or CNS involvement

Answer 22

Biologics AKA Anti-TNF or cytokine modulators Used for control of auto immune disease Growing evidence of safety in pregnancy Uncontrolled autoimmune disease poses higher risk of FGR/PTB Before starting: screen for latent TB Live vaccines contraindicated (also contraindicated in pregnancy) Risk of placental accumulation and neonatal immune suppression therefore stopped in late pregnancy Infliximab - stop at 16 weeks Certolizumab - safe throughout All others - stop at 28 weeks All safe in breastfeeding. If surgical delivery or sutured, wait 2-3 days before restarting for optimal wound healing

Answer 23

All pregnant women should be on combined ART If not on, start in second trimester All women should have 2 x CD4 count in pregnancy: baseline or initiation of CART and at delivery If starting cART then need HIV viral load bloods at baseline, 2-4 weeks later, each trimester, and at delivery If ongoing then at baseline and at 36 weeks

Answer 24

Indications for starting ART in the first trimester: Presenting with opportunistic infection VL >100,000 HIV RNA copies/mL CD4 cell count is less than 200 cells/mm³

Answer 25

Women are recommended to start tenofovir disoproxil fumarate or abacavir with emtricitabine or lamivudine as a nucleoside backbone This Doesn’t Follow Any Easy Logic Tenovir Disoproxil Fumarate Abacavir Emtricitabine Lamivudine No dose changes in pregnancy

Answer 26

After 20 weeks gestation, a minimum dose of 500 IU anti-D Ig within 72h of the event. A dose of 500 IU, IM is considered sufficient to treat a FMH of up to 4mL fetal red cells. Additional anti-D Ig doses calculated as 125 IU anti-D Ig/mL fetal red cells (IM)

Answer 27

Low production of or resistance to ADH (cranial or nephrogenic) Typically: HYPERNATREMIA Blood osmolality >285 mOsmol/kg with urinary osmolality <300 mOsmol/kg

Answer 28

Congenital rubella syndrome - poor prognosis -siginificant complications: sensorineural deafness, cataracts, cardiac malformations Before 11 weeks - 90% chance 11 -16 weeks - 20% chance After 20 weeks - no documented cases Rubella is TOGA VIRUS, SINGLE STRANDED RNA

Answer 29

HbA1C target of 48mmol (above 86 increased risk of congenital malformation) Folic Acid 5mg Exercise Review meds Glycaemic control targets Retinal screening -

Answer 30

x3 national average

Answer 31

3.5 - 7.8 range Aiming 70%

Answer 32

HIV: dependent on viral load Hep B: do not routinely offer C/S as transmission reduced with fetal immunoglobulin and vaccine Hep C: Only offer C/S if confection with HIV

Answer 33

Carriers are at increased risk of bleeding with invasive procedures, termination, spontaneous miscarriage and at the time of delivery

Answer 34

2-5x increased risk Neural tube defects, cardiac anomalies (transposition of the great vessels), renal anomalies and sacral agenesis (caudal regression syndrome). Detailed cardiac scan recommended. Diabetes should be considered during serum screening for chromosomal anomalies: associated with lower MSAFP, beta HCG and uE3. The risk of aneuploidy is not increased The prevalence of major congenital anomaly is 46 per 1000 births in women with diabetes (48 per 1000 births for type 1 diabetes, 43 per 1000 births for type 2 diabetes), more than twice the expected rate

Answer 35

Neonatal hypoglycaemia - fetal beta cell hyperplasia and neonatal hyperinsulinaemia and elimination of maternal glucose supply following clamping of the cord Respiratory distress syndrome (RDS) - increased risk though mechanism unknown Hypocalcaemia and hypomagnesaemia Polycythaemia Neonatal jaundice

Answer 36

Neonatal lupus - occurs in up to 3% of babies born to women with SLE Highly associated with maternal anti-Ro and anti-La antibodies Typically presents as congenital heart block or as lupus rash. May also present with hepatic or hematologic abnormalities

Answer 37

Low pH Low Bicarb Increased anion gap Normal K

Answer 38

Monthly FBC Offer the following at the end of every trimester: GFR and urine PCR Anti-phospholipid antibody Complement (C3 and C4) Anti-dsDNAantibody Serial fetal growth scans and echo to detect heart block at an early stage More frequent antenatal visits every 2-4 weeks until 28 weeks then every 1-2 weeks until 36 weeks and then weekly until delivery to screen for hypertensive disorders and IUGR Timing of delivery would depend on fetal growth and the development of maternal / fetal complications. Aim for vaginal delivery with CS for obstetric indications During labour, women who have been taking glucocorticoids will need iv hydrocortisone

Answer 39

Complement C3 and C4 - levels are low in flare of SLE as used up Cellular casts in urine can be helpful in distinguishing lupus nephritis from PET (not present in PET)

Answer 40

APL but no previous VTE: LMWH and Aspririn Women with SLE + antiphospholipid antibodies but no past morbidity: Aspirin +/- hydroxychloroquine

Answer 41

Seizure free for 10 years Off AED medication for 5 years History of childhood epilepsy syndrome that is now resolved Must be discharged from Neurology

Answer 42

Women not exposed to AEDs, the incidence of major congenital malformations is not increased Lamotrigine, and carbamazepine monotherapy at lower doses have the least risk of major congenital malformation. Background 2.3% Sodium Valproate 10.7% Poly 16.8%

Answer 43

TXA and recombinant factor IX - increases clot risk

Answer 44

Difficult to predict fetal impact - not necessarily related to severity of maternal disease The incidence neonatal thrombocytopenia is 14–37%, with 5% having platelet counts <20. Neonatal thrombocytopenia more likely if there has been a sibling with thrombocytopenia, mother has had a splenectomy or her platelet count has been below 50 during the pregnancy FSE / FBS should be avoided Avoid high / mid-cavity operative vaginal deliveries but CS not routinely recommended

Answer 45

Solitary ulcer - non painful, diagnostic of Syphilis Occurs 3 weeks after exposure (9-90 days) Chancres typically heal spontaneously over 3–8 weeks. Approximately 25% of patients will go on to develop secondary syphilis if they do not receive treatment.

Answer 46

If a woman is infected during pregnancy, or becomes pregnant when she already has syphilis and is not treated, the results can be catastrophic for the baby. Transmission from 14 weels Increased risk of miscarriage, PTL, FGR, stillbirth (30-40%). Of the fetuses that survive, around one-third will be born with signs of congenital syphilis. TRANSMISSION Primary up to 100% Early latent 40% Late latent 10%

Answer 47

Must be confirmed on 2 x types of testing due to risk of false positives Blood tests can be divided into treponemal or non-treponemal NON-TREPONEMAL (VDRL and rapid plasma reagin) - can be false positive in endemic treponemal conditions, such as yaws,or in other systemic inflammatory conditions (endocarditis) or pregnancy TREPONEMAL - reported as reactive/non-reative Can be false positive if other immune disease such as SLE Before treatment must have VDRL/rapid plasma reagin test to confirm baseline titres Test 3 monthly in high risk groups If high suspicion but negative screen then repeat 6-12 weeks after last sexual contact

Answer 48

IM Benzathine Penicillin G (2.4 mill units) 2nd dose if in 3rd trimester 1 week later Late disease - 3 doses, weekly intervals Pen allergy: Ceftriaxone 500mg STAT Discuss with micro if true Pen allergy - Erythromycin/Azith no longer recommended by BASHH The oral alternative is amoxicillin 500 mg and probenecid 500 mg, both orally, four times per day for 14 days.

Answer 49

Complicates upto 45% of treatment of Syphilis Associated with large numbers of T. pallidum being killed, which in turn releases excessive cytokines, initiating an acute inflammatory reaction. Symptoms within 24 hours of treatment Fever, rigours, rash, uterine contractions Supportive Mx PRIMARY 50% SECONDARY 90% LATENT 25%

Answer 50

Multisystem infection can result in NND and long term disability 10x more likely to die in first year of life Divided into early and late disease Early = first 2 years of life 2/3 born asymptomatic, of which 2/3 have symptoms by 8 weeks and most by 12 weeks Early disease: skin rashes, stigmata of meningitis and jaundice. Hepatosplenomegaly, deranged LFTS (raised ALP) Blood tests may also show severe anaemia, monocytosis and thrombocytopenia. X-rays may demonstrate periostitis, which leads to the development of bone deformity. ‘Bloody snuffles’, caused by syphilitic rhinitis, create a pink coloured nasal discharge Late disease: Bony deformatites ‘Hutchinson’s Triad’: eighth cranial nerve deafness, interstitial keratitis and ‘Hutchinson’s Teeth’ (notched incisors). Syphilitic rhinitis leads to the characteristic saddle nose and anterior bowing of the mid-tibia creates the classic ‘sabre shins’. 1/3 to 14 have asymptomatic neurosyphilis at presentation

Answer 51

Before, after and 4 hours after treatment

Answer 52

1% in labour 1-2% within 24 hours of delivery

Answer 53

30 - 84% after the index pregnancy If previous Insulin requiring GDM then 75%

Answer 54

Microalbuminuria (incipient nephropathy) – albumin : creatinine ratio 3.5 mg/mmol or more. Macroalbuminuria or proteinuria (overt nephropathy) – widespread glomerular sclerosis ACR ratio 30 mg/mmol or more Pregnancy is not been associated with the development of nephropathy or with accelerated progression of pre-existing nephropathy. In women with moderate to advanced renal disease, pregnancy may accelerate progression to end-stage renal disease.

Answer 55

Mycophenalate and Azathioprine

Answer 56

Avoid hypertension - epidural Avoid prolonged active second stage Aortic root must be <40mm for vaginal birth otherwise recommend C/S. Also recommend if history of previous dissection or evidence of dilatation in pregnancy.

Answer 57

Should be obstetric indication for recommending birth In type 2 or 3 then recommend avoidance of mid-cavity forceps, ventouse, FBS, FSE or ECV

Answer 58

Transmitted through blood, urine, semen, saliva Test by PCR (blood or other bodily fluid) IgM develops by end of first week Cross-reaction with related flaviviruses (e.g., dengue and yellow fever viruses) is common

Answer 59

Cord blood film and then weekly blood films for 28 days High risk of neonatal infection

Answer 60

At term - treat same as non HIV - delivery within 24 hours If low viral load (<50) offer immediate IoL If >50 then recommend C/S (cat 3) This is strong recommendation >400 Same guidance for late preterm 34-37 weeks

Answer 61

Women graded by risk depending on viral load + length of time this had been achieved pre-delivery VERY LOW RISK The woman has been on cART for longer than 10 weeks AND Two documented maternal HIV viral loads less than 50 HIV RNA copies/mL during pregnancy at least 4 weeks apart AND Maternal HIV viral load less than 50 HIV RNA copies/mL at or after 36 weeks. Then 2 weeks of ZIDOVUDINE MONOTHERAPY LOW RISK If the criteria for VERY LOW RISK are not all fulfilled but maternal HIV viral load is less than 50 HIV RNA copies/mL at or after 36 weeks If the infant is born prematurely (<34 weeks) but most recent maternal HIV viral load is less than 50 HIV RNA copies/mL. Recommend 4 weeks of zidovudine monotherapy: HIGH RISK Use combination PEP if maternal birth HIV viral load is known to be or likely to be over 50 HIV RNA copies/mL on day of birth, if uncertainty about recent maternal adherence or if viral load is not known. Neonatal PEP should be commenced as soon as possible after birth, and at least within 4 hours Infant PEP should not be given beyond 2 weeks for VERY LOW-RISK or 4 weeks for LOW-RISK infants even if the infant is breastfed PEP should not be restarted unless significant subsequent exposure (e.g. maternal viral load detectable during breastfeeding).

Answer 62

In the UK and other high-income settings, the safest way to feed infants born to women with HIV is with formula milk. Women advised not to breastfeed for their baby’s health should be provided with free formula feed to minimise vertical transmission of HIV. Women not breastfeeding their infant by choice, or because of viral load over 50 HIV RNA copies/mL, should be offered cabergoline to suppress lactation. Women who are virologically suppressed on cART with good adherence and who choose to breastfeed should be supported to do so, but should be informed about the low risk of transmission of HIV through breastfeeding in this situation and the requirement for extra maternal and infant clinical monitoring... Reviewed monthly in clinic for maternal and infant HIV RNA viral load testing during and for 2 months after stopping breastfeeding Maternal cART (rather than infant pre-exposure prophylaxis [PrEP]) is advised to minimise HIV transmission through breastfeeding and safeguard the woman’s health.

Answer 63

If primary Herpes after 28 weeks - recommend C/S, particularly if delivery within 6 weeks of diagnosis Risk of neonatal transmission very high (41%) If uncertainty if primary/secondary can send Herpes IgG to help determine (if matches Herpes on swab) Up to 15% of cases where a woman presents with a first episode of clinical HSV infection will be a recurrent infection. If conservative Mx (declines C/S or PPROM) - TDS Aciclovir, should be IV when in labour 5mg/kg and 20mg/kg for neonate

Answer 64

38-39 weeks If has well controlled HIV (<50 copies) then 39 weeks as usual

Answer 65

Toxoplasma gondii - obligate intracellular protozoan Incubation period = 5-23 days Becomes sexually mature in cat intestines, producing oocysts which are excreted in stool. Infection occurs through ingestion of contaminated food including vegetable or infected meat. Human infection usually asymptomatic / produces glandular fever - like illness. Lymphadenopathy involving the posterior cervical chain is commonest clinical manifestaton.

Answer 66

1 in 500 About 14% of women of reproductive age are immune to toxoplasmosis About 30% of 30 year olds are immune. Immunity is life-long unless the individual becomes immuno-compromised

Answer 67

Spontaneous first trimester miscarriage - Chorioretinitis - IUGR Microcephaly, Hydrocephalus, Intra-cranial calcification Learning disability, Hepatosplenomegaly Risk of fetal infection increases while the severity of affection decreases with increasing gestation age. Primary infection First trimester ~17% of fetuses affected Second 25% Third 65% Overall 60% of fetuses are born without obvious damage 10% have chorioretinitis only and 20- 30% have multiple anomalies typical of the TORCH syndrome - hydrocephalus, chorioretinitis, intra-cranial calcification, jaundice, microcephaly, anaemia. Chorioretinitis most common

Answer 68

1:20 Detected in 1-2% of pregnant women Most become persistently infected meaning risk of vertical transmission 80% of carriers are asymptomatic Not recommended to screen for it since 2018 HCV is transmitted at birth No evidence of impact of infection on pregnancy in terms of congenital abnormalities, preterm birth etc. which is indicative that vertical transmission occurs perinatally rather than in utero Detection of infant infection is only reliable at 3 months of age No maternal treatment to reduce viral load or vaccine to protect the neonate exists Women may present with gallstones, cholestasis or acute fatty liver of pregnancy

Answer 69

Offer all women planned birth (IoL or C/S) Change from Warfarin at 36/40 or 2 weeks before planned birth Stop Warfarin - start twice daily regimen LMWH 24 hours later Titrate levels by checking Factor Xa Peak levels (3-4 hours after dose) between 1 and 1.2 Trough levels 0.6 (before next dose due) Check levels weekly once in range For planned C/S Stop LMWH 24 hours before Aim to perform C/S 24-30 hours after stopping, or start infusion of unfractionated heparin and stop 4-6 hours before If IoL Try aiming birth 12 hours after LMWH or starting infusion and stopping 4-6 hours before If on Warfarin and present in labour -Check INR -Consider reversal -Senior review Restart LMWH 4-6 hours after birth Consider delaying switch to Warfarin upto 7 days

Answer 70

Consider planned caesarean section for women with: -any disease of the aorta assessed as high risk -pulmonary arterial hypertension -NYHA class III or IV heart disease.

Answer 71

Severe left-sided stenotic lesions (for example, aortic stenosis and mitral stenosis) Hypertrophic cardiomyopathy Cardiomyopathy with systolic ventricular dysfunction Pulmonary arterial hypertension Fontan circulation and other univentricular circulations NYHA class IV heart disease.

Answer 72

Anyone taking equivalent to 5 mg or more prednisolone daily for more than 3 weeks In labour: Continue their regular oral steroids Add intravenous or intramuscular hydrocortisone and consider a minimum dose of 50 mg every 6 hours until 6 hours after the baby is born In C/S: Continue their regular oral steroids and Give intravenous hydrocortisone when starting anaesthesia; the dose will depend on whether the woman has received hydrocortisone in labour, for example: consider giving 50 mg if she has had hydrocortisone in labour consider giving 100 mg if she has not had hydrocortisone in labour give a further dose of hydrocortisone 6 hours after the baby is born (for example, 50 mg intravenously or intramuscularly)

Answer 73

Antenatally: -Weekly FBC from 36/40 -If less than 50 consider steroids or IVIG Labour: Measure platelet count at admission For the baby: -Inform neonates of potential bleeding risk -No FBS/FSE -No ventouse -Mid-cavity instrumental with caution -Bear in mind that a caesarean section may not protect the baby from bleeding -Measure the platelet count in the umbilical cord blood at birth.

Answer 74

Active 3rd stage recommended Avoid IM injections

Answer 75

Those with... an untreated or partially treated cerebrovascular malformation that has bled previously a large aneurysm (7 mm or more) or an aneurysm with other high-risk features as defined by a neuroradiologist a complex arteriovenous malformation cavernoma with high-risk features intracranial bleeding within the past 2 years. Management: Offer C/S Offer PCEA + assisted second stage (reduced pushing time)

Answer 76

For women with chronic kidney disease stage 1, stable renal function and non-nephrotic-range proteinuria (urine protein:creatinine ratio less than 300 mg/mmol), base decisions on timing and mode of birth on the woman's preference and obstetric indications. Aim delivery at 40/40 in CKD stage 1 and nephrotic-range proteinuria (urine protein:creatinine ratio greater than 300 mg/mmol) or CKD stage 2 to 4 with stable renal function. If deteriorating Stage 3b, 4 or 5 after 34 weeks, aim for 38/40 birth If deteriorating before 34/40 try and prolong pregnancy to 34/40 if possible

Answer 77

The prozone phenomenon False negative response (especially with the rapid plasma reagin (RPR) test) resulting from overwhelming antibody titers which interfere with the proper formation of the antigen-antibody lattice network necessary to visualize a positive flocculation test Can occur in cases of disproportionately high antibody titers, such as secondary syphilis (though may happen in any phase), or HIV coinfection

Answer 78

■Atrial and ventricular ectopics ■ Q-wave (small) and inverted T-wave in lead III ■ ST segment depression and T-wave inversion inferior and lateral leads ■ QRS axis leftward shift

Answer 79

IgG can cross the placenta and cause fetal haemmorhage. Risk is about 1% Risk of fetal thrombocytopenia 14-37% Platelet count beneath 20 5%

Answer 80

Advice to wait at least 1 year after living related donor and 2 years after cadaver transplantation.

Maternal medicine Flashcards

(109 cards)