1
Q
Early Onset FGR <32 weeks
1
2
3
A
• AC/EFW < 3rd centile or UmbA-AEDF
• AC/EFW <10th centile combined with UtA-PI >95th centile
• AC/EFW <10th centile combined with UmbA-PI >95th centile
2
Q
Late Onset FGR >=32 weeks
1.
2.
3.
4.
A
• EFW or AC <3rd
• Two out of three of:
• AC/EFW <10th centile
• AC/EFW crossing centiles >two quartiles on growth centiles
• CPR <5th centile or UmbA-PI >95th centil
3
Q
When do you do Uterine artery Dopplers
A
18w - 23+6w
4
Q
Moderate Risk Factors for FGR
2 Groups
A
Obs History RFs
1.previous SGA
2. Previous stillbirth,AGA birthweight
Current Risk Factors
1. Current smoker (any)
2.Drugs
3. Women >or equal to 40 at booking
4. BMI less than 18.5 and other features eg. eating disorder, bower disorder causing weight loss
5. Gastric bypass surgery
6. Previous preterm birth/2nd trimester miscarriage (placental mediated)
5
Q
High Risk Factors for FGR
(3 groups)
A
MEDICAL HISTORY
1.Maternal medical conditions (CKD, HTN, AUTOIMMUNE Disease- SLE,APLS, complex cardiac disease
OBS HISTORY
1. Previous FGR
2. HTN disease in prev preg.
3. Prev. SGA still birth
CURRENT PREG
1. Papa <5th cent
2. Inhibit A -2nd trimester >2 MoM
3. AFP (2nd Tim) > 2 Mom
4. Echogenic bowel
5. Significant bleeding
6. EFW <10th centipede
7. Single umbilical artery
6
Q
Definitions
- AGA
-SGA
-FGR - static growth
A
AGA = EFW between 10th and 90th
SGA = EFW <10th
FGR= EFW or AC <3rd cent or <10th centile with Doppler abnormalities
Static growth= no forward growth vel in EFW or AC measured at least 14D apart
7
Q
Other Risk Factors for FGR
A
- Women unsuitable for SFH monitoring, (BMI > or equal to 35) /Fibroids
- Congenital uterine anomalies
8
Q
CST - first trimester combined screening when does it occur? What does it test for
A
10-14 w
T21, 18, 13
9
Q
What is the combined screening test ?
A
Mat age + USS CRL and NT + mat serum free HCG and PAPP-A
NT >3 is abnormal
10
Q
When is NT measured?
A
When CRL is 45-85mm
(11+2 to 14+1 weeks of preg)
11
Q
Is a high NT associated with anything?
A
Trisomy 21, 13, 18 and cardiac abnormalities
12
Q
What is the cut off for NT?
A
Cut off is 3.5mm - above this invasive testing is offered and a fetal echo at 16w
13
Q
What is the quad test ?
And what does is test for?
When is it offered ?
A
AFP
HCG
Inhibin A
unconjugated oestriol
Only tests of Down syndrome
** if someone what’s to screen for trisomy 18 and 13 and can’t have combined - then next screening tool is anomaly screen 18 - 23w)
Quad test is offered when HC is 101 - 172mm (14+2 w to 20w ) if can’t do CRL and too late
14
Q
Can twins have a CST?
A
Yes - based on its NT
Twins have a bit more higher chance of trisomy
15
Q
Can you do a CST for MCDA twins?
A
Yes , but for calculation for the NT you hate the NT which is higher - but still calculate the other NT
But for the CST just use one twin NT because they are the same genetic makeup
MC have a lower incidence of trisomies - possibly due to higher miscarriage test
Can do quad test in twins but makes it even poorer
16
Q
When what are contraindications to using NIPT?
A
Triplets
Current cancer
Blood transfusions in 4 prev months
Bone marrow or organ transplants
Prev stem cell therapy
Current immunotherapy
Vanished twin pregnancy
Maternal 21 or balanced translocation or mosaicism of T13/18/21
17
Q
When to do an anomaly USS?
A
18-20+6
18
Q
What does the anomaly scan check for?
A
11 major conditions with detection rates of >50%
Anencephaly
Open spina bifida
Cleft lip
Diaphragmatic hernia
Gastroschisis
Exomphalos
Serious cardiac anomalies
Bilateral renal agenesis
Lethal skeletal dysplasia
Edward syndrome (tris 18)
Patau syndrome Tri 13
19
Q
MC countries that do FGM
A
Somalia
Sudan
Ethiopia
Eritrea
Djibouti
usually don’t between infancy and 15year of age
20
Q
Do you attend colp if preggo?
A
yes, go if preggo to exclude invasive cervical CA esp if meets the criteria for a colp.
this is to exclude invasive disease and to defer biopsy or treatment until delivered
may need another colp in 2nd late trim
21
Q
can we do a cervical biopsy in pregnancy
A
a biopsy can be performed
22
Q
trisomy 13
A
holoprosencephaly
microcephaly
facial abnormalities
cardiac abnormalities
big kidneys
exomphalos
post axial polydactyly
23
Q
OC moderate
A
40-99
24
Q
OC Mild
A
19-39
25
OC severe
>=100
26
trisomy 21
nasal hypoplasia, absent nasal bone,
increased re nasal and nuchal for thickness
cardiac defects
intracardiac echogenic foci
duodenal atresia
echogenic bowel
mild dydronephrosis
short femurs
sandal gap
clinodactyly or mid phalanx hypoplasia of the 5th finger
27
cervical length in twins?
if asymptomatic with twins do a single cx measurement from 18w but not repeated cervical length
28
how many appointments antenatally should a nullip have according to NICe
10
29
parous women how many antenatal appointments should she have
7
30
how has active chickenpox at delivery what is the risk of varicella infection of the newborn
50%
if maternal infection occurs 1-4 w before delivery up top 50% of valves are infected and 23% of them will get clinical varicella despite titres of passively acquired maternal antibody
severe chicken pox is most likely to occur if the infant is born within 7 days of onset of the mother rash of it mom develops the rash up to 7 days post delivery
**GIVE VZIG with or without aciclovir to the neonate in this case**
31
can a woman breast feed if has active chickenpox
yes
if lesion close to nipple, express until lesions have crusted over , expressed milk may be given to the baby who is getting VZIG and or aciclovir
32
what is fetal varicella syndrome
one or more of the following
skin scarring in a dermatomal distribution
eye defects - microphthalmia, chorioretinitis, cataracts
hypoplasia of the limbs
neurological abnormalities - microcephaly, cortical atrophy, MR, dysfunction of bowel and bladder sphincters
33
How does fetal varicella syndrome occurs
not at the time of initial fetal infection but results from a subsequent herpes zoster reactivation in utero and only occurs in a minority of infected fetuses
34
when is PEP offered if women is immunocomprmized other than pregnancy
if note, if the pregnant woman is immunosuppressed for a reason other than pregnancy, a history of previous
infection or vaccination may not be sufficient evidence of immunity and serum should be tested for VZV IgG. PEP
should be offered if VZV IgG is negative, or < 150 mIU/ml.
35
what is PEP in chickenpox
a pregnant woman is not immune to VZV and has significant exposure to chickenpox or shingles, she should be
offered (PEP). Oral antiviral therapy i.e.
Aciclovir (or Valaciclovir) is recommended as
the first choice for PEP by the UKHSA. It should be given from day 7 to 14 post exposure.
The dose of Aciclovir recommended for PEP is 800mg 4 times daily. The dose of oral Valaciclovir is 1000mg TDS
36
what to do in contraindication to antivirals or PEP? In chickenpox
VZIG may be considered as PEP. In this context it
should be offered if VZV IgG is negative, or < 100 mIU/ml in the immunocompetent pregnant woman and if VZV
IgG is negative, or < 150 mIU/ml4 in the immunocompromised pregnant woman.
37
when is VZIG administered?
VZIG is administered as soon as possible or at the very latest within 10 days of the exposure
(in the case of continuous household exposures, within 10 days of appearance of the rash in the index case)
38
If repeated or another exposure in seronegative pregnant women for chicke pox what do you do
If chickenpox does not develop in a seronegative pregnant woman and there is a further exposure to
chickenpox during the pregnancy, testing for VZIG should be repeated regardless of whether or not PEP
was prescribed after the initial exposure.
If seroconversion has not occurred, a second course of antiviral
can be prescribed from seven days after the exposure for 7 days.
If VZIG is used for PEP, it can be
repeated if the repeat exposure occurs **three weeks or more after the last dose.**
39
what is the dose of acyclovir in preg women if she gets chickenpox
800mg FIVE times a day for 7 days - start within 24 h of rash
no VZIG
40
when should women go to hospital with chickenpox
if the woman
-smokes cigarettes,
-has chronic lung disease,
-is immunosuppressed (including those who have taken systemic
corticosteroids in the preceding 3 months)
-is in the second half of pregnancy,
a hospital assessment should be considered even inthe absence of complications.
Respiratory symptoms, neurological symptoms such as photophobia, seizures or drowsiness, a haemorrhagic rash or bleeding,
or a dense rash with or without mucosal lesions are indicative of potentially life-threatening chickenpox and
are indications for referral to a hospital with intensive care access.
41
can varicella infection of the fetus be diagnosed prenatally
yes by USS if abnormalities like limb deformity
microcephalic
hydrocephalus
soft tissue calficication
fetal growth restriction can be detected
DO USS with a time lag of at
least 5 weeks after the primary maternal infection is advised because ultrasound performed at 4 weeks
has failed to detect the abnormalities.
Fetal magnetic resonance imaging (MRI) may provide additional
information in cases
where ultrasound has identified morphological abnormalities.
VZV DNA can be detected in amniotic fluid by PCR.
The presence of VZV DNA has a high sensitivity
but a low specificity
for the development of FVS.
42
when does FVS occur , when does mom need to be infected
7 - 28 weeks
43
is there a significant risk of miscarriage if infected in pregnancy with chicken pox
no
44
highest RF for abruption
prev abruption
OR of 7.9
4.4% risk of recurrence
45
when is chickenpox infectious
24 (2 days?) before the rash until lesions crusted over
46
is shingles infectious
yes if ophthalmic or in an immunocompromised individual where viral shedding can be greater
47
when to do a fetal anatomy and fetal echo if a thick NT?
at 16w
48
when is NIPT contraindicated
- if low chance of T21, T18, T13
-higher multiple pre (triplets or more)
-after 21+6w
also if woman has:
-cancer unless is in remission,
-received a blood transfusion in the past 4 months
- bone marrow transplant or organ trans
- immunotherapy in current pregnancy
- had stem cell therapy
-vanished twin pregnancy
- Down syndrome or a balanced translocation or mosaicism of T21,18 or 13
49
post partum psychosis suicide rate
5%
4% infanticide rate
1-2 in 1000 birth incidence
50
when should you do a port partum bile acid for OC
6 weeks
51
when do you do cervical screening
25-49 every 3 years
50-64 every 5 years
52
what is fetal hydrops
abnormal accumulation of serous fluid in at least 2 of the following:
skin -oedema
body cavity- pericardium, pleural, ascetic effusions
placentomegaly - placental thickness>6cm is often present
53
what is the classification of fetal hydrops
immune: 10% of cases and it is due to maternal hemolytic antibodies
non-immune:90% of cases and it is due to all other etiologies
54
what are causes of fetal hydrops
55
what is an abnormal NT - nuchal translucency
>= 3.5
this may be associated with T21,18,13, serous cardiac condition - and should be referred to fetal med
56
what is the risk of second sampling/repeat procedure for Amniocentesis and CVS
up to 6%
57
vaccines in pregnancy
58
when can you start doing a amniocentesis
15w
earlier is associated with talipes equinovarus and pregnancy loss
59
what is the risk of confined placental mosaicism with CVS
2%
60
if blood-borne disease ie hep B what kind of invasive testing to do
Amnio
61
what percentage of chromosomal abnormalities is duodenal atresia found with
30%
especially T21 - do amnio if double bubble sign
62
% of women immune to toxoplasmosis
20%
63
how do women present if they have toxo
lymphadenopathy and fever but 80% may be asymptomatic
64
Fetal Risks of Toxo in pregnancy
-spontaneous miscarriage in 1st trim
65
66
When best to do pertussis vaccines?
28-38w
67
Genital herpes 1st time in pregnancy how to treat
No evidence of an increase risk of spontaneous miscarriage with prim HSV
Is genital HSV suspected should go to GUM clinic to confirm diagnosis with PCR
Treat right away with PO Aciclovir 400mg TDS for 5 D
68
How to deliver is primary HSV at time of del or within 6 w of due date
Treat with Aciclovir and deliver with CS , this is to reduce exposure of the fetus to HSV which my be present in the maternal genital secretions
- some evidence that suggest if membrane have been ruptured for greater than 4 hours the benefit reduces but there’s still some benefit
IF VAGINAL DELIVERY- GIVE IV ACICLOVIR to mom - 5mg/kg TDS and then to baby 20mg/kg TDS
Unknown if intrapartum Aciclovir reduces risk of neonatal HSV infection
69
Risk of neonatal herpes if primary episode of genital herpes lesions at the time of vag del
41%
Highest risk of perinatal transmission depends on the timing of maternal acquisition of HSV - highest risk in infants born to women who have not completed HSV seroconverstuon so monstly in the 3rd trimester within 6 weeks of delivery
If vag delivery chose- avoid ARM, instrumental del and FSE
70
Causes for oligohydramnios <24w
Urinary tract abnormalities - bilateral renal agenesis, multi cystic or polycystic kidneys and urethral obstruction
Preterm pre labor rupture of membranes
insufficientcy
Uteroplacental insufficiency - FGR with Doppler evidence of high impedance to flow in the uterine and or umbilical arteries and redistribution in the fetal circulation
71
Best depression questionnaire to use at booking and postnatal check
Whooley questions
72
Antibiotic for staphylococcal or streptococcal exotoxin
Clindamycin
73
Signs of TSS - toxic shock syndrome
Wide spread macular rash and conjuctival suffusion usually in TSS from staph aureus
But only 10% of streptoccoccal TSS causes a rash
74
Pregnancy related carpel tunnel symptoms
Median compression
60% of women
Symptoms
Numbness and tingling on fingers hand and wrists
Pain or throbbing in the fingers hand and wrists
Swollen hot fingers and thumb
Hard to grip objects and performing fine motor tasks
-loss of sensation over thumb index fingers and middle fingers bilaterally
75
Risk factors for placenta praevia
76
Risk factors for abruption
77
Breast cancer in pregnancy?
USS first
Then mamography with fetal shielding
Then tissue biopsy with USS guided biopsy
Staging only if suspicious for Mets-
Chest x ray, liver USS, or MRI
Gadolinium enhanced MRI is not recommended in preg but no adverse effects of gadolinium have been found on the fetus
78
To exclude Mets if not pregnant in breast cancer
X ray computed tomography - CT and isotope bone scan
But can’t be used in pregnancy
79
80
Breast cancer treatment in pregnancy
Loco-regional clearance can be done in all trimesters
Reconstructive surgery or mastectomy can be considered
Readiotherapy to be delayed unless is life saving - spinal cord compression - its contraindicated
Can’t have chemo in the first trimester
But CAN have chemo in the second trimester
Anthracycline regimens are safe
No evidence of increased rate of 2nd trimester miscarriage, FGR, organ decimation
81
CMV contact and preg what to do has IgG and IgM pos
Test booking serum IgG avidity
If low avidity mean recent primary CMV infection
82
Risk of congenital CMV if primary infection at 17w
30-40%
83
What to do if primary CMV in preg after avidity confirmed
Do amnio 6-8 weeks after seroconversion to test for fetal infection by viral load or viral PCR
Also detailed USS every 2-4 w after confirmation of fetal infection with fetal MRI at 28-32w to assess for features of severe sequelae.
84
Prenatal exoneration sequencing (ES) what is it
Karyotype reveals cause of abnormalities is only 40% of babies
ES -A new genetic test which when combined with testing the DNA of both parents can find changes in the baby’s genetic code
If a DNA change is found that can explain the structural changes see on the USS of the baby and info about the diagnosis can be given to parents , can also help plan how to care for pregnancy, and if it can happy again for the parents
Sometimes may not give answers or difficult to interpret
Two new studyies showed that ES can find a genetic guanos is in at least 10% of pregnancies with structural differences where standard chromosome testing has been negative
85
If USS grossly abnormal at 20 w what to do
Karyotype ES and chromosomal micro-array analysis (CMA)
86
What is meckel gruber syndrome
Occipital cranial bone defect
Large herniated fluid filled cyst extruding postriorly
Kidneys multi cystic
Polydactyl
25% recurrence
Autosomal recessive
87
Cystic hygroma
Turners is 50% of cases with CH
Genetic syndrome are in about 40% of cases
MC one is noonan syndrome -AD, but 90% are de novo cases
88
Skeletal dysplasia
25% are stillborn, 30% die in the neonatal period
89
What to do if suspected infection before emergency cerclage
Amniocentesis
90
What to do if signs of chorioamionitis with cervical cerclage in situ?r
Remove cerclage and IOL
91
What is the Max number of times you can give steroids
3
Concern about neonatal sepsis and chorio with multiple steroids
92
miso what absorbs the fastest which way ( peak concentration times)
oral and sublingual - 30 min
buccal or vaginally - 70-80min
93
what helps the lowest rated of CS wit IOL but both FH and process in labour
low dose oral miso solution ( 25 mg , 2 hourly)
94
balloon IOL increases what and decreases wha t
decreases hyperstimuation but increases need for synto
95
can you go home with propess?
yes
96
breech presentation
16% at 32w
3-4% at term
97
spontaneous version rates for G1 after 36w
8% but less than 5% after unsuccessful EVC
98
ECV success rates
nulls 40%
60% for multips
99
reversion back to breech post ECV
in less than 5%
100
if women planning vag breech, how many will have EMCS
40%
101
when to consider augmentation in breech delivery
if contraction frequency is low in the presence of epidural analgesia and if contractions less than 4 in 10
102
is a passive stage recommended in breech del?
yes to allow breech to descend to the perineum , if no breech visible in 2 hours then CS recommended
103
how is the woman supposed to push during a breech
only start pushing when breech is visible
104
risk of stillbirth in older women
39-40
2 in 1000 if 40 or older
compared to 1 in 1000 if less than 35
105
in the UK women 40 or older were how much more likely to have a neonatal death compared to women aged 25-29
1.3 times
106
what is the rate of shoulder dystocia if you had previous SD
10 times higher than the general population
107
what is the rate of brachial plexus injuries for SD
2.3-16%
108
when to OFFER vag progesterone and how how long
if a women has both
- a history of spontaneous preterm birth up to 34w or loss from 16 onwards
AND
has a TV USS from 16-24w of pre that show a cervical long of 25mm or less
start vag progesterone from 16 -24w until 34 w
109
when to CONSIDER vag progesterone
if have either :
-a hx of spontaneous preterm with or mid trimester loss
AND
have a cervic of 25mm or less at 16-24w
110
when to consider cerclage according to NICE
consider prophylactic cerclage for women with a short cervix if had a history of : prev Preterm pre labour rupture of membranes or history or cervical trauma
111
What do you do if you suspect preterm labour with intact membranes at 29+6 or less
and at 30 or more
if 29+6 advice treatment for preterm labour
if 30w+ consider TV USS for cervical tenth to dertmine the likelihood of birth in the next 48h
if cervix is more than 15mm - unlikely labour , if cervix is less than 15mm offer treatment
112
if threatened preterm labour and woman does not want a TV USS what do you do? if 30w+
consider FFN
113
when should you hospitalize women with vasa previa
from 30 - 32 w on a individualized approach based on factors that are multiple
114
at what gestation to do the CS for vasa previa
34-36w
steroids pre 32w
115
fetal loss in appendicitis
1.5% with generalized peritonitis
6% if appendix perforates
116
can you push if you've had recent abdominal op/incision?
yes
117
anti D , c & K antibodies when to test
test monthly until 28 w then every 2 weeks until delivery
the cord blood for DAT0 direct anti globulin test , Hb and bilirubin ( all babies with moms who have any antibodies get this )
118
what to do if other clinically significant antibodies present
consider paternal/ fetal genotyping for corresponding antigens
119
doses for non sensitized women of anti D
1500 between 28-32w
two doses- 500iu @ 28 and 34 w
postpartum 500IU
120
how to administer anti D if continuously bleeding
500 IU every 6 weeks
Kleihauer every 2 weeks
121
Do you need anti D for plasma transfusion
no
122
Do you need anti D for Platelet transfusion
yes 250iu every 5 units
123
what do you do with anti D if transfused incompatible RBCs
<15ml - give normal dose for gestation ie 250 or 500IU- can be given IV TO!
>15ml give 1500 iu- 2500 IU **IV** plus kleihause
if transfused more than an Unit do exchange transfusion , 1500-2500 and KB test
124
severity definitions of Anti D present antibodies
4-15 = moderate risk of HDFN
>15 = severe risk of HDFN
125
Anti c present antibodies definitions
7.5-20= moderate risk of HDFN
>20 = severe risk of HDFN
126
anti K present antibodies
any detectable titre is sever HDFN risk
127
what to do if fetus at risk of HDFN with parental antibodies positive - from dads side
refer to FMU, MCA doppler, intrauterine transition if needed,
deliver at 37w
cold bloods, Hb, bill, DAT- direct anti globulin test
128
effect of antibodies on baby antenatally and postnatal - anti D and anti C
antenatal = sever anemia ,
baby heart failure
hydros fettles
PN:
Anti D= early jaundice
anti C = late anemia
anti K = early anemia
129
number of appointments for DCDA
8
130
number of appointments for MCDA and triplets
11
131
at what gestation should non invasive fetal genotyping for anti D be done
16 w
132
at what gestation should non invasive fetal genotyping be done for anti K
20w
133
indications for offering aspirin in SGA
placenta dysfunction was implicated in any women with history of PTN or 2nd trimester preg loss
prev placental dysfunction found as a contributory factor in women with previous FGR including those born preterm
if low Papp-a or raised BHCG
women at risk of PET or placental dysfunction
134
when to get preggo post bariatric op
12-18 months
135
women with a high BMI are at what greatest risk of which fetanl anomaly
spina bifida
136
CVS before 10w is at risk of what
oromandivular and limb defects
can be done if needed past the suggested 13+6 from 14-14+6w
137
what is the risk of cell culture failure with amnio in the 3rd trimester
overall 10% but increases with gestation
138
can you do a CVS or amnio of a woman with HIV
yes but ideally the mom needs to have undetectable viral load prior to test and be on antiretroviral treatment
if HIV status unknown - wait for it to be back before doing test
risk of mother to child transmission of hepatitis B is low with a viral load less than 6.99
139
placenta praevia OR
1 prev PP = 9.7 OR
1 prev CS- OR 2
2 prev OR 4
3 prev OR 22
140
when to determine chronicity in twins
by 14w
141
when to Start SGS in DCDA twins
at 24w
142
can you do NIPT on twins
yes but less accurate
143
when to deliver MCDA twins uncomplicated
from 36w with steroids
144
when to delivery DCDA
from 37- 37+6
145
when to deliver triplets
at 35w post steroids
146
TTTS - quintero
all stages
1 - difference in fluid
oligo DVP <2cm in donor and poly in recipient DVP >8cm before 20 w and >10 cm after 20w
-donor bladder visible , dopplers normal
2- bladder of donor not visible and severe oligo
-dopplers not critically abnormal
3-abnormal dopplers in one or both twins , usu abnormal umbilical arterial Dop velocities in the donor and or abnormal venous dop vel in the recipient ( reversed flow during atrial contraction within the ductus venous and or pulsatile umbilical vein velocities
4- 4. ascites pericardial or pleur effusion, scalp oedema or overt hydrops usually in the recipient
5- one or both dead
147
in how many twins is TTTS associated with
15%
148
TTTS
1
difference in fluid
bladder visible
dopplers normal
149
TTTS
2
2- bladder of donor not visible and severe oligo
-dopplers not critically abnormal
150
TTTS
3
3. abnormal dopplers critically
151
TTTS
4
4. fluid in body parts in recipient
152
TTTS
5
one or both dead
153
percentage of TAPS
2% of uncomplicated MCDA and up to 13% of MCDA post laser ablation
154
what is TAPS
anemia in donor and polycythemia in recipient without significant Oligo/polyH
155
sGR
growth disconcorhedinance of >20%
10-15% of MCDA twins
1- growth disc but POS diastolic velos
2- reverse end diastolic velocities or AREDV
3- growth disc with cyclical umbilical art waveform
156
TRAP
1%
Acardiac twin
157
when to delivery tins treated for TTTS
34-36+6
158
when to deliver sGR
type 1
type 2
3
1- consider del by 34-36w
2- by 32w
159
if one MCDA twin dies what is the risk the other one will die
15%
or 26% of neurological abnormality
DO MRI OF BRAIN 4 WEEKS POST ONE TWIN DEATH
160
if trichorionic twins how many appointments
9 vs 11 like in di chorion ir monochorion triplet preg
161
can you used the quad test or the second trimester screening for downs in triplets
no
162
how many twins birth spontaneously preterm
60 in 100 spent before 37w
163
how many triplets labour spont
75 in 100 triplets before 35w
164
when to deliver MCMA twins
32-33+6
165
when to do cervical length according to NICE
if prev preterm birth pre 37w
if prev 2nd trimester death post 16w with spent labour
if prev LLETZ
166
when to offer and consider cerclage according to NICE
**offer** progesterone or cerclage if have both:
prev preterm birth pre 34 weeks or death and delivery from 16w
&
short Cervix between 16 and 24w
**consider** vag progesterone IF have history of preterm birth or 2nd mid trimester loss
OR
just a short cervix
**consider** prophylactic cerclage if short cervix and prev preterm SROM
OR
history of cervical trauma
167
when to consider emergency cerclage according to NICE
16- 27+6
168
what is the max course of steroids possible to give according to NICE
2
Monica’s Part 2
flashcards
Decks in class (26)
# Cards
-
Antenatal168
-
Urogynae113
-
Subfertility169
-
Fetal Med133
-
Neonatology26
-
Benigne Gynae.213
-
Sexual Health103
-
Mat Med500
-
Early Pregnancy Care132
-
Oncology138
-
Labour339
-
Postpartum Problems110
-
Research And Teaching80
-
CTG18
-
Vulval CA46
-
Ovarian CA Staging17
-
VTE42
-
Statistics31
-
Endometrial CA staging24
-
Vuvlal CA Staging11
-
Cervical CA Staging22
-
Infections in pregnancy39
-
Menopause5
-
Mat Med 2.0109
-
Thyroid35
-
Breast CA In Pregnancy26
