21/3/22

Question 1

In a normal pregnancy what is the first step in helping to induce labour if post term?

Answer 1

Cervical membrane sweep to induce labour as it increases release of prostagladins

Question 2

For PPH what defines

• major
• minor
• primary
• secondary

Answer 2

Minor - 500-1000ml
Major - >1000ml
Primary - within 24hrs
Secondary - post 24hrs

Question 3

What is the most common congenital cause of hearing loss?

Answer 3

CMV infection

Question 4

Uterus is found to be enlarged, irregular and firm. What is the most likely cause?

Answer 4

fibroids

Question 5

Dexemethasone is given to mothers who are having preterm labour.
What is pre-term?
Why given dexemethasone?

Answer 5

<37 wks (40 wks is a normal pregnancy)

Steroids help to clear lungs - as haven’t/have not enough surfactant yet (don’t start producing till 30-32 weeks)

Question 6

At what stage is Rhesus -ve mother given Anti-D routinely?

What other situations is anti-D given?

Answer 6

28 wks

If intrauterine death or surgery

Question 7

Mother (>20wks) presents with bright red painless bleeding post sex.

What needs to be excluded first - how is this done?

What cervical pathology can cause the same symptoms?

Answer 7

Placenta praevia

DO NOT do bimanual examination as can irritate the placenta - perform a TVUS

If that is clear -> speculum examination

If this shows a red swollen cervix = cervical ectropion (erosion) - no need for treatment

Question 8

Should you swap a patient’s meds off of lithium if she was managed with this pre-pregnancy?

Answer 8

Yes - should recommend taking an anti-psychotic instead

Lithium is assoc. with increased risk of major congenital malformation and miscarriage

Question 9

What does variable decelerations in the foetal heart rate indicate?

How do you monitor?

Answer 9

Compression of umbilical cord

To monitor - test foetal blood and check for lactate and pH to assess distress

(lactate increases due to decreased O2 = distress)

Question 10

Sheenan’s syndrome is hypothyroidism post partum - can occur with PPH

What way can a patient present?

Answer 10

Severe headache and visual field defects

Question 11

For mothers who had to be treated for gestational diabetes. What happens check-up wise post partum?

Answer 11

Most stop meds post partum and then get a FASTING BLOOD GLUCOSE by GP 6-13wks later

Question 12

Should you advise a mother to continue breastfeeding with cracked nipples?

Answer 12

No - tell them to express and then once healed back to titty

Question 13

What should you think if a patient presents with new HTN in first trimester?

What can be seen commonly in this condition on USS?

Answer 13

Molar pregnancy

Increase in bCG = increaed stimulation of ovaries = theca lutein cysts bilaterally (these go away after resolution of hormonal imbalance)

Question 14

Your in clinic and a pregnant woman presents with severe headache, visual disturbance and marked oedema.

What would your invx be?

What would your management be based on the likely diagnosis

Answer 14

• BP
• Urine Dipstick
• Abdo USS - assess foetus
• Umblicial doppler
• Bloods to check LFTs and for HELLP (haemolysis, elevated liver enzymes and low platelets)

Pre-eclampsia

• Labetolol
• Regular monitoring
• Seizures - IV magnesium sulphate
• If uncontrollable/danger to foetus or organs then emergency C-Section

Question 15

How would you manage a patient with an incomplete or inevitable miscarriage?

Answer 15

Support groups

Conservative
Medical - oral or vaginal misoprostol
Surgical - manual vacum with Anti-D prophylaxis