Obs and Guidelines

International evidence-based guideline for the assessment and management of polycystic ovary syndrome 2018

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!

3 years ago

56 minutes 48 seconds

Obs and Guidelines

Management of breech presentation (C-Obs 11)

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!

4 years ago

38 minutes 18 seconds

Obs and Guidelines

Term Prelabour Rupture of Membranes (Term PROM) (C-Obs 36)

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!

4 years ago

28 minutes 29 seconds

Obs and Guidelines

HOW Collaborative position paper on thrombocytopenia in pregnancy

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!

4 years ago

23 minutes 9 seconds

Obs and Guidelines

Prevention of congenital cytomegalovirus (CMV) infection (C-Obs 64)

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!

4 years ago

24 minutes 32 seconds

Obs and Guidelines

Genetic carrier screening (C-Obs 63)

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!

4 years ago

32 minutes 10 seconds

Obs and Guidelines

Vitamin and Mineral Supplementation and Pregnancy (C-Obs 25)

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!

4 years ago

21 minutes 50 seconds

Obs and Guidelines

Managing menopausal symptoms (C-Gyn-9)

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!

4 years ago

42 minutes 13 seconds