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MFM Flashcards

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1
Q

What is the risk associated with PTU use?

A

Hepatotoxicity (0.1-0.2)

Routine LFT not recommended

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2
Q

What is the risk associated with methimazole in pregnancy?

A

Methimazole embryopathy

  • esophageal/ choanal atresia
  • Aplasia cutis = congenital skin defect
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3
Q

What is are common side effects of PTU and methimazole (2)?

A

Transient leukopenia (10%)

– do not stop medication

Agranulocytosis

– discontinue drug

– Fever and sore throat → ER

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4
Q

What is the evolution of the thryroid gland in pregnancy?

A

Enlarges by 30 %

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5
Q

How should you treat hyperthyroidism in pregnancy?

A

T1 : PTU – Propylthiouracil

T2: Methimazole

Switch early 2nd trimester

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6
Q

What are the targets for hyperthyroidism treatment in pregnancy?

A

T4 – High normal range or slightly above

Ignore TSH

Measure Free T4 (NOT TSH) q 2-4 wks

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7
Q

What is the DDx of decreased FEV1 (6) ?

A

Asthma

COPD

CHF

PE

Laryngeal or vocal cord dysfunction

Mechanical airway obstruction

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8
Q

How is asthma classified in terms of intensity?

A

Mild intermittent

Mild persistent

Moderate persistent

Severe persistent

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9
Q

What is the associated of asthma and perinatal outcomes?

A

Well treated asthma NOT related to adverse pregnancy outcomes

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10
Q

What neonatal complications can suboptimal treatment of asthma lead to?

A

Low birth weight

PTB

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11
Q

When to asthma exacerbations usually occur?

A

Between 24 - 36 weeks

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12
Q

What is the proportion of people that improve/ worsen with asthma in pregnancy?

A

2/3 improve

1/3 worsens

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13
Q

Which anti-epileptic drug is associated with the highest chance of congenital malformation?

The lowest?

A

Highest: Valproic acid

Lowest: Lamotrigine (< 2%)

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14
Q

What is the risk of congenital malformation in women taking AED in pregnancy?

A

4 - 8 %

(vs 2-3 % background risk)

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15
Q

What are the most common congenital malformations related to AED in pregnancy?

A

NTD

Cardiac malformations

Cranio-fascial defects

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16
Q

How do you follow a pregnancy of a patient on AED?

A

Folic acid

7 - 8 wks - Dating US

11 - 13 wks - Anatomic US

15 - 18 wks (up to 21 wks) - AFP levels (NTD) (up to 21 wks)

+/- Amnio for amnio fluid AFP + acetylcholinesterase levels

16 - 20 wks - Anatomy scan

22 wks : Fetal echocardiogram

Vitamin K 1 mg IM at birth

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17
Q

How long should a patient be seizure free before conceptions?

A

9 months

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18
Q

When can pt resume their regular AED levels?

A

Usually after 10- 14 days

Measure levels x 8 wks

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19
Q

What is the inheritance pattern of sickle cell disease?

A

Autosomal recessive

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20
Q

What test is used to perform and anti-body screen related to blood type?

A

Indirect Coombs test

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21
Q

What parameters of respiration are increased / decreased in pregnancy?

A

Decrease

Functional residual capacity (FRC) = Residual volume + expiratory reserve volume

Increase

Inspiratory capacity (IC)

Tidal volume

Resting minute ventilation

Unchanged

Total lung capacity (FRC+ IC)

Resp rate

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22
Q

What syndrome is cystic hygroma associated to ?

A

Truner Syndrome

Down’s syndrome

Other causes

  • Infection
  • Inherited as autosomal recessive
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23
Q

What is the significance for the fetus of anti-Ro (SSA) antibodies in the mother?

A

Risk of neonatal Lupus wich presents with congenital heart block (Hydrops Fetalis)

Neonatal lupus is responsible for 90-95% of congenital heart blocks

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24
Q

In which maternal diseases are anti-Ro (SSA) antibodies present (7)?

A

Sjögren (52%)

LSE (32%)

Mixed connective tissue disorder (29%)

Systemic sclerosis (21%)

Idiopathic inflammatory myopathies (19%)

RA (15%)

Primary biliary cholangitis (PBC)

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25
What antibody can be found in ANA-negative (Antinuclear antibody) SLE?
Anti-Ro/ SSA
26
Anti-La Antibodies are specific to which diseases?
Sjögren SLE
27
What is the upper limit of MCA dopplers?
1.5 MoM (multiple of median) 100% sensitive to detect fetal anemmia
28
What is the most common pathway to fetal demise in hydrops fetalis? What is a useful US marker predicting fetal demise in hydrops fetalis?
Cause of death: **fetal congestive heart failure** US finding: **Umbilical venous pulsations**
29
What is the definition of hydrops (#363)?
Fluid in at least 2 different fetal compartments * Pericardial effusion * Pleural effusion * Ascites * Skin edema (\>5 mm at the level of the skull of chest wall) Often associated to: * Polyhydramnios (40 - 75% of cases) * Placental thickening (\> 4 cm (T2)or \> 6 cm (T3))
30
What are the mechanisms leading to hydrops (3 + 2)? (#363)
Intra-uterine anemia Intra-uterine heart failure Hypoproteinemia Skeletal dysplasia Chromosomal anomalies
31
What is the name for the most severe form of alpha-thalassemia? What is the inheritence pattern?
Bart's disease Autosomal recessive
32
Who should you screen for alpha thalassemia in Canada?
**Anyone that is not:** Japanese Korean Caucasion with northen european ancestry First Nation Inuit
33
What type of blood is used for fetal transfusion?
O negative CMV negative Maternally crossed-matched
34
What are the indicators of poor prognosis of fetal hydrops?
Fetal chromosomal anomalies GA \< 24 wks Fetal structural anomalies (other then chylothorax)
35
What is the definition of mirror syndrome ? What is the other name of this disease?
Development of maternal edema secondary to fetal hydrops Often associated to severe PET Ballantyne's syndrome
36
Is immune or non-immune hydrops more common?
Non immune (85% of cases)
37
What are the two most common NTD? (#314)
Spina bifida - 50 % Anencephaly - 40 %
38
What is the best time to conduct a fetal MRI for NTD? (#314)
Between 23 and 32 weeks
39
What are potential complications of MRI in pregnancy? (still under investigation) (#314)
Teratogenesis Acoustic damage
40
Second trimester ↑ AFP levels can be associated with wich abnormalities (5)? (#314)
Fetal skin disorders Abdo wall defects Fetal demise Fetal nephrosis Pregnancies with increased risk of placenta-related adverse events
41
How do you manage a positive MSAFP in the second trimester? (#314)
Anatomy scan at 18 - 22 weeks Amniocentesis
42
When is the ideal time to conduct an amnio? (#314)
15 - 20 weeks
43
What are the risks associated with an amnio? (# 314)
SAB 0.5 - 1 % PPROM Infection Post-procedure spotting
44
What test should be ordered on AF from an amnio conducted for suspected NTD? (#314)
AFP levels Acetylcholinesterase level Karyotype Chromosomal microarray if available
45
What population has a high risk of developing severe life threatening allergy to latex ? (# 314)
Patients with myelomeningocele
46
Recurrence of NTD was decreaed by what % in patients taking folic acid 5 mg? (# 314)
72 %
47
How do you calculate MAP?
Systolic BP + 2x (distolic BP) / 3
48
Risk factors for placenta previa in primip
Multiple gestation Increase maternal age Infertility treatment Previous abortion Previous uterine surgical procedure Maternal smoking Maternal cocaine use Male fetus Non-white race
49
In what percentage of patients with a cystic hygroma are aneuploidies detected? (Berghella p 481)
60 %
50
What are the most common antigens related to alloimmunization? (Berghella MFM p 467)
RhD Kell
51
What is the cut-off for abnormal MCA PSV? (Berghella p 468)
\> or = to 1.5 MoM
52
When can you start monitoring MCA PSV ? (Berghella p 471)
15 weeks
53
How do you measure maternal antibody titers in her blood? (Berghella p 468)
Indirect Coombs test
54
What is the most common cause of intrauterine fetal infection? (#240)
CMV | (0.2-2.2 % of live births)
55
What value of the CMV avidity index indicates : - Recent infection - Remote infection (#240)
Recent infection (\<3 months): Avidity index \< 30% Remote infection (or reactivation): Avidity index \> 60%
56
In what % of affected CMV fetus are US findings found? (# 240)
Less than 25 %
57
Before how many weeks is it best to determine chorionicity ? When does the Lambda sign disapear? (260)
Measure before 14 weeks Lambda sign may disapear between 16 - 20 wks
58
What medications can be associated with cleft palate ?
AED (phenytoin, valproate, topiramate) MTX Zofran (possible small association)
59
When dating Twin pregnancy, which twin should be used? (#260)
Largest twin not to miss IUGR
60
What is the rate of congenital anomalies in twins - in general - in monochorionic? (#260)
General: 1.2 - 2 x higher than singleton Monozygotic: 2 - 3 x higher
61
When does growth of twins slow down? ( # 260)
30 - 32 weeks
62
What is the threashold for abnormal twin growth discordance? (260)
\> 20 % is abnormal if using EFW \> 20 mm if using abdominal circumference
63
Pattern of US for monochorionic and dichonionic pregnancies ? (#260)
**Monochorionic twins** * Start at 16 - 18 weeks * Growth q 2-3 weeks **Dichorionic twins** * Start at 18 - 22 weeks * Growth q 3-4 weeks
64
At how many weeks should UA dopplers be measured ? What are the indications ? (#295)
Measured at 19 - 23 weeks Indications = Suspicion of IUGR Maternal RF for IUGR
65
What are the most common cancers in pregnancy? (W OB)
Breast (1/5000) Thyroid (1/7000) Cervical (1 /8500) Melanoma Lymphoma
66
Is MRI ok in pregnancy? Gadolinium OK in prengnancy? FDG and breastfeeding?
**MRI:** Preferably after T1 **Gadolinium:** DO NOT use in T1, otherwise it's OK **FDG:** Discontinue breastfeeding x 72h post procedure
67
What is the most common gyne cancer in pregnancy?
Cervical
68
What are the most common cancers leading to placenta mets ?
Melanoma (if fetal mets, in liver and sub Q tissue. 80% mortality) Leukemia Lymphoma Breast cancer **\*\* POOR prognosis**
69
Describes the benefits/ disavantages of corticosteroids at: 22 - 24 wks 24 - 34+6 34 - 36+6 Term (#364)
22 - 24 wks * ↓ Mortality 24 - 34+6 * ↓ Mortality * ↓ RDS, IVH, NEC 34 - 36+6 * ↓ RDS, Mechanical ventilation * ↑ Neonatal hypoglycemia Term * ↓ RDS, Mechanical ventilation * ↑ Low academic abilities
70
Describe advantages of beta over dexa (3) and dexa over beta (2) (#395)
Beta vs dexa * ↓ Chorio * ↓ RDS * ↓ Chronic lung disease Dexa vs Beta * ↓ IVH * ↓ Length of NICU admission
71
Should you give beta to IGUR and what are potential implications? (#395)
YES give to IUGR although resposiveness unknown IUGR with beta have * lower frequency of brain lesions * higher frequency of weight \< 10 % at shcool age
72
What are the RF for Vasa previa (5+)? | (#231)
**IVF** (LR 7.75) **Placenta previa in T2** (OR 22) **Bilobed placenta or Succenturiate placenta** (OR 22) **Fetal anomalies** (Renal tract, 2 VC, spina bifida, Exomphalos) Prematurity, FGR, Antepartum hemorrhage
73
Management of pregnancy complicated by vasa previa ? (#231)
**Repeat TVUS serially** as 15 % regression rate **Beta** at 28 - 32 wks **Hospitalization** at 30 -32 wks **CS** at 34- 36 wks O neg, irradiated blood for ressussitation
74
What amout of fetal blood loss can cause fetal death ? (#231)
100 mL (shock and death)
75
What 1st line agents can be used as uterotonics post delivery ? (#235)
**Oxytocin = first line in SVD** * Preferred: 10 U IM at shoulder delivery of anterior shoulder * Other : * 20 - 40 U in 1000 mL @ 150 mL/h * 5 - 10 U IV bolus (ONLY AFTER VAGINAL DELIVERY) **Carbetocin = first line in ELECTIVE CS** * 100 ug IV bolus over 1 min x 1 **Carbetocin = first line if ONE RISK FACTOR for PPH instead of Oxytocin** * 100 ug IM x 1 Alternatives if oxytocin is not available Ergonovine 200 ug IM x 1 Cytotec 600 - 800 ug PO/ SL/ PR
76
What measures reduced PPH? | (#235)
Uterotonics Cord traction (modest benefit) Uterine massage post placental delivery (unclear evidence)
77
List 3 genetic conditions associated with infertility
Chromosomal (47 XXX, Turner 45X) Single gene disorders (Fragile X, Galactosemia) Myotonic dystrophy Nanoon Syndrome Fanconi anemia
78
What is the most common congenital malformation ? (Gabbe p 825)
VSD (35%)

RC OBGYN (CG) (13 decks)

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