Antenatal care

Question 1

what happens in acute fatty liver of pregnancy? what condition common in foetus to cause it? what is inheritance pattern of condition?

Answer 1

fetus has LCHAD deficiency (AR inheritance)
fetus and placenta can’t process FA so they accumulate in mothers liver
hepatitis and liver failure in mother

Question 2

what investigations in acute fatty liver of pregnancy?

Answer 2

LFTs - increased ALT, AST
increased bilirubin, WCC, PTT, INR
low platelets

Question 3

symptoms of acute fatty liver of pregnancy?

Answer 3

general malaise
fatigue
nausea
vomiting
jaundice
abdominal pain
ascites

Question 4

management of acute fatty liver of pregnancy

Answer 4

obstetric emergency

prompt delivery of baby

Question 5

when are pregnant women screened for anaemia

Answer 5

booking clinic

28 weeks gestation

Question 6

what is normal Hb ranges at booking, 28 weeks, postpartum

Answer 6

booking >110, 28 weeks >105, postpartum >100

Question 7

what does high / normal / low MCV mean in terms of what is causing anaemia in pregnancy?

Answer 7

low MCV = iron deficiency
normal MCV = physiological anaemia of pregnancy
high MCV = B12 / folate deficiency

Question 8

management of anaemia in pregnancy?

Answer 8

PO ferrous sulfate 200mg TID

can give IV but takes weeks to have effect

Question 9

management of macrocytic anaemia in pregnancy? what else should you check for?

Answer 9

pernicious anaemia (intrinsic factor antibodies)
IM hydroxycobalamin
PO cyancobalamin

Question 10

what dose of folic acid should all pregnant women be on? what about folic acid deficient?

Answer 10

400ug

5mg

Question 11

what are the 4 types of breech?

Answer 11

complete - legs flexed at hip and knees
incomplete - 1 leg flexed at hip + extended at knee
extended (frank) - both legs flexed at hip + extended at knee
footling - foot presenting through cervix with leg extended

Question 12

management of breech baby?

Answer 12

usually turn themselves before 36 weeks

ECV if not

Question 13

delivery of a breech baby that has not turned with ECV?

Answer 13

vaginal delivery or caesarean.
vaginal safer for mother, caesarean safer for baby
needs specialist obstetricians

Question 14

what is ECV? when is it done? what is given before it? anything to consider about rhesus?

Answer 14

turning the baby from breech to cephalic position
36 weeks if nulliparous, 37 if parous
tocolysis (SC terbutaline) given before to relax uterus
prophylactic anti D given to rhesus negative women

Question 15

causes of cardiac arrest in pregnancy?

Answer 15

4T 4H
thrombosis, tension pneumothorax, toxins, cardiac tamponade
hypoxia, hypothermia, hypokalaemia, hypoglycaemia
obstetric haemorrhage
pulmonary embolism PE
sepsis

Question 16

what is aortocaval compression?

Answer 16

when woman lies on back uterus compresses IVC and aorta

Rx - put woman on left lateral side to improve venous return and cardiac output

Question 17

management of cardiac arrest in pregnancy?

Answer 17

immediate caesarean
aim is to deliver baby and placenta within 5 mins of CPR
delivery will improve venous return and cardiac output in mother

Question 18

chickenpox PEP

a) unsure
b) <20 weeks, not immune
c) >20 weeks, not immune

Answer 18

a) check VZIG
b) give VZIG asap
c) give VZIG / aciclovir after 7-14 days

Question 19

chickenpox in pregnancy

a) <20 weeks
b) >20 weeks

Answer 19

a) consider aciclovir

b) give aciclovir within 24h of rash

Question 20

what investigations in suspected DVT in mother?

Answer 20

compression duplex US doppler