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Flashcards in Pregnancy Deck (9)
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1

What is the risk to the foetus in maternal appendicitis?

There is a 2% risk of foetal loss in uncomplicated appendicitis, though this increases to 30% in the presence of perforation and peritonitis. 
 

Up to 25% of women have perforated at the time of surgery. 

2

Steroids are appropriate up until what gestation?

34 weeks.

3

Define SGA and severe SGA. 

  • SGA is EFW or AC <10th centile. 
  • Severe SGA is EFW or AC <3rd centile. 
  • Customised centile charts are best. 

4

What are the two primary causes for small for gestational age foetus?

  • Constitutionally small (70%). Normal anatomical scan, normal Dopplers, normal AFI and appropriate growth velocity can be reassuring. 
  • Foetal growth restriction (FGR) / intrauterine growth restriction (IUGR) (30%).
    • Associated increased risk of stillbirth, birth hypoxia, neonatal complications, impaired neurodevelopment.
    • Long term there is an increased risk of T2DM and HT.

Think 'CCPP'.

Constitutional

Chromosomal

Perinatal infections

Placental insufficiency

5

What are the considerations regarding laparoscopic surgery in pregnancy?

Generally safe. Elevated maternal pCO2 is likely to result in foetal acidosis though this is thought to be relatively safe. Verres needle induction appears to be safe. Lying supine can compress the inferior vena cava. 

6

What are the causes for FGR / IUGR?

  • Chromosomal (20%). Includes aneuploidy, partial deletions, gene mutations and placental mosaicism. 
  • Perinatal infections (5%). Includes CMV, rubella, toxoplasmosis, VZV, syphilis. 
  • Placental insufficiency. There are many causes and these are often recurrent. Can manifest as preeclampsia, abruption and FGR. 
  • Non-genetic congenital abnormalities (2%).
  • Multiple gestation. Nutritional as well as complciations such as twin-twin, congenital anomalies and preeclampsia. 
  • Maternal factors.
  • Reduced placental blood flow. Includes HT, diabetes mellitus, collagen vascular disease, SLE or preeclampsia. 
  • Hypoxaemia. Include yanotic heart disease or severe anaemia. 
  • Smoking.
  • Toxins. Examples include warfarin and anticonvulsants. 

7

What is HELLP syndrome?

  • H - haemolysis
  • EL - elevated liver enzymes
  • LP - low platelets

1-2% mortality for mother. Up to 30% mortality for foetus. 

8

What are the risk factors for preterm birth?

  • 12% of deliveries in USA Stress – socioeconomic, single, anxiety, depression, life events, surgery

  • Occupational – working in standing position

  • Stretched uterus – multiple preg, polyhydramnios, uterine anomalies, fibroids

  • Weak cervix – cervical surgery, second trimester TOP, short cervix

  • Infections – STIs, BV, pyelonephritis, general sepsis, gum disease

  • Placenta – praevia, abruption, pre-eclampsia, IUGR

  • Previous PTL, smoking, drug use, you / old, anaemia

  • Weight – underweight (obesity decreases risk)

9

What is the significance of asymmetrical growth restriction?

It is suggestive of placental insufficiency.