Obs and Guidelines: Recent Episodes
Obs and Guidelines
A casual review of Obstetrics and Gynaecology clinical guidelines relevant to practice in New Zealand.
Amazing cover artwork by Anna Lovisa - Ngā mihi nui!
This podcast is not endorsed by RANZCOG and has no affiliation with RANZCOG. This podcast does not constitute medical advice and comes with no assurance of accuracy.
Replaces RANZCOG C-Gyn 26 Long term consequences of PCOS as of October 2021
https://www.monash.edu/__data/assets/pdf_file/0004/1412644/PCOS_Evidence-Based-Guidelines_20181009.pdf
Disclaimer: This podcast reflects our personal views and not the views of RANZCOG, or any RANZCOG committees or boards. This podcast is not endorsed by RANZCOG and has no affiliation with RANZCOG. This podcast does not constitute medical advice and comes with no assurance of accuracy.
Appreciation: Amazing cover artwork by Anna Lovisa - Ngā mihi nui!
RANZCOG guideline July 2021 (guideline published September 2021)
Disclaimer: This podcast reflects our personal views and not the views of RANZCOG, or any RANZCOG committees or boards. This podcast is not endorsed by RANZCOG and has no affiliation with RANZCOG. This podcast does not constitute medical advice and comes with no assurance of accuracy.
Appreciation: Amazing cover artwork by Anna Lovisa - Ngā mihi nui!
RANZCOG guideline July 2021 (guideline published September 2021)
Disclaimer: This podcast reflects our personal views and not the views of RANZCOG, or any RANZCOG committees or boards. This podcast is not endorsed by RANZCOG and has no affiliation with RANZCOG. This podcast does not constitute medical advice and comes with no assurance of accuracy.
Appreciation: Amazing cover artwork by Anna Lovisa - Ngā mihi nui!
HOW Collaborative position paper on the management of thrombocytopenia in pregnancy
Position paper published in ANZJOG Jan 2021.
https://doi.org/10.1111/ajo.13303
Causes
- Gestational (70-80%)
- Primary immune thrombocytopenia (ITP) (1-2%)
- Secondary ITP, eg due to human immunodeficiency virus (HIV), hepatitis C, systemic lupus erythematosus
- Congenital
- Drug-induced
- Type IIb von Willebrand’s disease (VWD)
- Antiphospholipid syndrome
- Splenic sequestration, eg liver disease, portal hypertension
- Bone marrow disorders
- Nutritional deficiency, eg vitamin B12/folate
- Pregnancy-associated microangiopathy
- Preeclampsia/haemolysis, elevated liver enzymes, low platelets syndrome (HELLP)
- Thrombotic thrombocytopenic purpura (TTP)
- Haemolytic uraemic syndrome (HUS)
- Acute fatty liver of pregnancy
- Sepsis
- DIC
- Spurious/Pseudothrombocytopenia (clumping)
Initial investigations (if platelet count <70)
- Full blood count and reticulocyte count
- Peripheral blood film
- Optical platelet count (if available)
- Coagulation screen
- Renal and liver function tests
- Thyroid function tests
- Direct Coombs test
- Antiphospholipid antibodies: lupus anticoagulant, anticardiolipin antibodies, beta 2 glycoprotein 1 antibodies
- Antinuclear antibody (ANA)
- Hepatitis B/C and human immunodeficiency virus (HIV) serology
- Helicobacter pylori
- Vitamin B12/folate
- Immunoglobulins
Management
- Monthly platelet count in pregnancy, fortnightly if <100 from 36 weeks
- Withhold aspirin if platelets <50
- IM injections contraindicated if platelets <50 (Give IV Rhophylac instead of Anti-D)
- Treatment indications: Platelets <20, Bleeding attributed to low platelets, Platelets <50 and pre-procedure (surgery/CVS)/birth imminent/planning neuraxial anaesthesia with platelets <70
Regimens
- IVIG and prednisone are equally effective first-line treatments
- Start with 20-25 mg prednisone PO daily
- 40-50 mg prednisone PO daily for platelets <20 or acute bleeding
- Response takes 4-28 days
- Prednisone side effects: GDM exacerbation, hypertension, poor sleep, gastritis, mood disturbance
- IVIG indicated for life-threatening haemorrhage around delivery
- 1-2 g/kg as single or divided dose
- Response 2-7 days
- Adverse effects: transfusion reaction, headache, aseptic meningitis, thrombosis
Labour and birth
- Platelets <100: MDT approach, Birth in hospital, Induce at term
- Target platelets >50 for: Vaginal birth, Instrumental, Caesarean, Clexane use
- Target platelets >70 for allow regional anaesthesia (spinal is less traumatic than epidural)
- Stress steroids in labour: IV hydrocortisone 50 mg Q6H from established labour to 6 hours after birth. For caesarean, give 100 mg IV hydrocortisone at time of anaesthesia, then 6 hours post-birth
- Mode of birth: Lack of data to inform instrumental risks. ITP is associated with a small increase in neonatal thrombocytopaenia.
This podcast is not endorsed by RANZCOG/ANZJOG and has no affiliation with RANZCOG/ANZJOG. This podcast does not constitute medical advice and comes with no assurance of accuracy. Amazing cover artwork by Anna Lovisa - Ngā mihi nui!
RANZCOG guideline finalised March 2019.
https://ranzcog.edu.au/womens-health/patient-information-guides/patient-information-pamphlets
This podcast is not endorsed by RANZCOG and has no affiliation with RANZCOG. This podcast does not constitute medical advice and comes with no assurance of accuracy. Amazing cover artwork by Anna Lovisa - Ngā mihi nui!
RANZCOG guideline finalised March 2019.
https://ranzcog.edu.au/womens-health/patient-information-guides/patient-information-pamphlets
This podcast is not endorsed by RANZCOG and has no affiliation with RANZCOG. This podcast does not constitute medical advice and comes with no assurance of accuracy. Amazing cover artwork by Anna Lovisa - Ngā mihi nui!
RANZCOG guideline finalised November 2019.
Prescribing recommendations:
Folic acid: 0.8 mcg PO daily (5 mg if BMI >30, prev NT defect, diabetes, risk of malabsorption, anticonvulsants)
Iodine: 150 mcg PO daily
Iron: Ferrous fumarate (60 mg elemental Fe) 200 mg PO daily, or on alternating days. Alternatively use Ferro-F-Tab (100 mg elemental Fe).
Calcium carbonate: 1.25 g PO BD
Cholecalciferol: 1.25mg x2 for loading dose followed by 1.25mg monthly (contains ~40,000 IU per dose)
Vitamin K: 10 mg PO daily in last 4 weeks of pregnancy complicated by cholestasis (use IV formulation)
B12: As part of multivitamin
Multivitamins: Elevit, Blackmores Gold, Swisse, GO Healthy
This podcast is not endorsed by RANZCOG and has no affiliation with RANZCOG. This podcast does not constitute medical advice and comes with no assurance of accuracy. Amazing cover artwork by Anna Lovisa - Ngā mihi nui!
RANZCOG guideline finalised September 2020.
MHT after cancer recommendations comparison: https://www.dropbox.com/s/jbxa3lpfx97m973/MHT%20after%20cancer%20recommendations%20comparison.pdf?dl=0
This podcast is not endorsed by RANZCOG and has no affiliation with RANZCOG. This podcast does not constitute medical advice and comes with no assurance of accuracy. Amazing cover artwork by Anna Lovisa - Ngā mihi nui!