Case 1 - PBL

Question 1

when is blood pressure lowest

Answer 1

in the middle of pregnancy

Question 2

what is the 12 week scan used for

Answer 2

to check how far along you are and check baby development

Question 3

what is the 20 week scan

Answer 3

anomaly scan: allows the sonogapher look for 11 rare conditions.

Question 4

how much weight should you gain in first timerster

Answer 4

1-5 pounds or no weight at all

Question 5

how much weight should you gain in the second and third trimesters

Answer 5

should be gaining between half a pound and 1 pound per week

Question 6

how is spina bifida diagnosed?

Answer 6

maternal serum alpha fetoprotein (MSAFP)
At 16-18 weeks, sample of mother’s blood is tested for MSAFP. This is made naturally by the foetus and placenta. During pregnancy, a small amount of AFP normally crosses into mothers blood stream. Abnormally high levels of AFP may indicate that the foetus has spina bifida or other neural tube defect. Is not specific for SB. Ultrasound is also needed.
MSAFP is greater than 2.5MoM in 80% of pregnancies with SB. Normal range is 10ng/ml - 150ng/ml.

Question 7

what can be performed to differentiate between types of neural tube defects

Answer 7

amniocentesis can be performed to assess fluid AFP and achelycholinesterase levels

Question 8

what are the four types of breech position?

Answer 8

Frank breech
Complete breech
Footling breech
transverse lie

Question 9

what is the frank breech

Answer 9

the baby’s buttocks are aimed at the vaginal canal with its legs sticking straight up in front of their body and feet near their head

Question 10

what is complete breech

Answer 10

the baby’s buttocks are pointing downward and both the hips and knees are flexed - folded under themselves

Question 11

what is footling breech

Answer 11

one or both of the baby’s feet point downward and will delver before the rest of their body

Question 12

what is transverse lie breech

Answer 12

where baby is positioned horizontally across your uterus instead of vertically. this would make their shoulder enter the vagina first

Question 13

how does depakote interact with folate

Answer 13

disrupted folate mechanise

Question 14

what is bipolar disorder

Answer 14

mental health condition that causes extreme mood swings

Question 15

what are the treatments for spina bifida

Answer 15

foetalscpoic surgery - child will live a completely normal life

Question 16

when is the other surgery performed and why

Answer 16

2 days after birth and so soon because reduces infection risk

Question 17

what can you treat bipolar with if you are pregnant

Answer 17

older generation antipsychotic such as haloperidol (Haldol)

second generation antipsychotics are also used: quetiapine and olazapine

Question 18

what NHS services are free for immigrants

Answer 18

GP and A&E

Question 19

what are the ethical and legal issues regarding termination at different ages

Answer 19

If under 12 yrs old: must have parental consent before having abortion
If 12-16: you need your parents’ consent. Although special circumstance (Gillick Competence and Fraiser Guidelines)
If 16-18: you only need parents’ consent if doctor decides you can’t make own decision
If 18+: do not need your parents’ consent.

Question 20

what is the different between Gillick competence and Fraser guidelines

Answer 20

Gillick competence is used to assess a child’s capability to make and understand their decisions in a wider context. Fraser guidelines are applied specifically to advice and treatment that focuses on a young person’s sexual health and contraception.