Maternal medicine TOGs

Question 1

Dose of glucocoticoids if sick

Answer 1

• Double the dose

Question 2

Fasting rules for steroids in adrenal disease

Answer 2

• Give IM hydrocortisone

Question 3

Management of gluco/mineralocorticoids in labour

Answer 3

• Hold fludrocortisone
• Give Hydrocortisone

Question 4

TB rate in UK

Answer 4

6.9/1000

Question 5

Testing for TB

Answer 5

Skin tests:
- Tine or Mantoux
- High flase positive- BCG vac, lymphoma etc

C-TB- less false positive

If skin test +, sputum culture:
- Ziehl–Neelsen staining of sputum
- Lowenstein–Jensen medium for culture

Question 6

Other tests

Answer 6

• CXR once diagnosed
• Ghon’s focus- granuloma reaction

Question 7

Treatment for TB

Answer 7

• Isoniazid, Rifampicin, pyrazinamide, ethambitol

GIVE pyridoxine 10mg with isoniazid to prevent nuerotoxicity

Question 8

HF risk with mitral stenosis

Answer 8

• 33% risk if moderate MS
• 50% risk if severe MS

Question 9

Cardiac conditions of HIGH risk in preg

Answer 9

• Severe MS- valve area <1cm
• Marfans w Aortic dilation >45mm
• Pulmonary HTN
• LVEF <30%
• Prev peripartum cardiomyopathy w residual LV impairment

Question 10

Peak levels of anti-Xa level

Answer 10

1.0-1.2IU/ml

Question 11

Uterotonics for PPH in heart disease

Answer 11

• First line- oxytocin
  DO NOT USE ERGOmetrine
• 2nd line- Misoprostol or oxytocin infusion or carboprost

Avoid carboprost if pulmonary HTN

Question 12

When does peripartum cardiomyopathy develop?

Answer 12

• Mostly 4 months PN
  or
  1 month pre-delivery

Question 13

Diagnosis of PPCM

Answer 13

• ECHO, EF<45%
• BNP >100
• ECG- non specific

Question 14

Mx of PPCM

Answer 14

• ACEi/ARB
• MDT approach
• LMWH
• Bromocriptine-
  2.5mg OD 1 week, EF>25%
• If EF <25% 2.5mg BD 2 weeks to stop lactation.

Question 15

Prognosis for PPCM

Answer 15

• 50-80% women get LVEF >50%
• high risk of relapse - 50% chance of LVEF drop in next preg

Question 16

Best method to scan in major trauma in preg?

Answer 16

Whole body CT

Question 17

Incidence of pancreatitis in preg?

Answer 17

3/10 000

Question 18

Causes of pancreatitis

Answer 18

• Gallstones - 65%
• Alcohol
• Hypercholesterol

Question 18

Testing/Diagnosis

Answer 18

• USS
• Bloods- amylase >300

Question 18

Mx of pancreatitis

Answer 18

• IVI
• Nutrition
• Analgeisa
• LMWH

Abx only if signs of infection

Question 19

Screening for retinopathy in diabetes

Answer 19

• Booking
  If normal- 28w
  If abnormal- 16-20w

Question 20

Screening for stroke

Answer 20

• CT head

Question 21

Liver masses

Answer 21

Hepatic haemangiomas:
- Most common
- Benign
- in 10% of healthy people

Focal nodular hyperplaisa
- 2nd most common
- Cause of 85% liver masses in reproductive age

Hepatic adenomas:
- Young females
- COCP users
- High bleeding risk in preg

Question 22

Headaches in preg

Answer 22

• Rule out red flags
• If ?stroke- CT head
• If ?CVT- MRV

Question 23

RF and mx for intracranial HTN

Answer 23

- Obese - High VTE risk - Treat w acetazolamide/lumbar puncture

Question 24

Pregnancy after bariatric surgery

Answer 24

- 12-18months gap

Question 25

Pregnancy after transplant

Answer 25

- Allow 1 year at least

Question 26

Medications post transplant

Answer 26

- Change mycophenolate mofetil to azathioprine

Question 27

Risks in preg after renal transplant

Answer 27

- GDM - Inc CS rates - HTN/PET - if using MgSO4, half maintenance dose - PTB

Question 28

Risk of damage to renal graft at CS

Answer 28

1-2% - Consider midline abdo incision, transverse uterine incision

Question 29

Cancer and pregnancy

Answer 29

- Surgery in all trimesters - Chemo in 2nd and 3rd T - NO Radiotherapy - BF 2 weeks after last chemo

Question 30

DKA dx

Answer 30

- Ketones >3 - BM >11 - HCO3<15

Question 31

Treatment + monitoring of DKA

Answer 31

- Fixed rate insulin - Fluid w K+ - Hourly BM and ketones - 2hourly VBG - 6hourly bloods initially