antenatal

Question 1

placenta increta

Answer 1

abnormal placentation where the chorionic villi invade the myometrium but do not reach the perimetrium

Question 2

risk factors for placenta increta

Answer 2

advanced age
history of multiple pregnancies

Question 3

placenta accreta

Answer 3

chorionic villi attach to the myometrium but do not deeply invade

Question 4

placenta percreta

Answer 4

invades all layers of the uterus and sometimes reaches other pelvic organs

Question 5

placenta previa

Answer 5

when the placenta is attached to the lower uterine segment and causes antepartum haemorrhage from 20 weeks
contraindication to perform vaginal delivery

Question 6

placental abruption presentation

Answer 6

one of the most common causes of antepartum haemorrhage that needs urgery care
presents as severe abdominal pain, uterine contractions and vaginal bleeding

Question 7

what is obstetric cholestasis

Answer 7

reduced outflow of bile acids from the liver which resolves after delivery of the baby

Question 8

aetiology of obstetric cholestasis

Answer 8

underlying cause not known
- may be result of increased oestrogen and progesterone levels

Question 9

risk factors for obstetric cholestasis

Answer 9

south asian ethnicity
past history of obstetric cholestasis
family history
multiple pregnancy
presence of gallstones
hep C

Question 10

clinical presentation for obstetric cholestasis

Answer 10

usually develops later in pregnancy, particularly in 3rd trimester
itching is main symptom: mostly palms of hands and soles of feet
rarely: dark urine, anorexia, steatorrhoea

Question 11

investigations for obstetric cholestasis

Answer 11

abnormal LFTs: mainly ALT, AST, GGT
raised bile acids
diagnosis of exclusion

Question 12

management of obstetric cholestasis

Answer 12

ursodeoxycholic acid improves LFTs, bile acids and symptoms
itch managed with: emollients- calamine lotion, antihistamines- chlorphenamine
water-soluble vit K is PT is deranged
planned delivery after 37 weeks may be considered

Question 13

clinical presentation of mother with rubella

Answer 13

fever
rash
lymphadenopathy
polyarthritis

Question 14

investigations for rubella

Answer 14

swab and serological and or PCR
rubella specific IgG antibody can be detected after natural infection or vaccination
blood IgM should be done within 10 days of exposure

Question 15

management of rubella during pregnancy

Answer 15

if patient has no immunity- consider TOP
supportive treatment

Question 16

management of listeria in pregnancy

Answer 16

ampicillin and gentamicin

Question 17

risk factors for gestational diabetes

Answer 17

previous gestational diabetes
previous macrosomic baby
BMI> 30
Ethnic origin
family history of diabetes

Question 18

investigations for gestational diabetes

Answer 18

OGTT
- diagnosed at 24-28 weeks