Crash course 4 Flashcards
A 31 year old primiparous woman has a forceps delivery and perineal trauma involving the perineal muscles and external anal sphincter muscle? What is the correct classification for the perineal trauma described? A. Midline episiotomy B. 1st degree perineal tear C. 4th degree perineal tear D. 3rd degree perineal tear E. 2nd degree perineal tear
D. A 3rd degree tear involves the external anal sphincter and may also involve the internal anal sphincter. A 4th degree tear goes through to the anal mucosa.
Which of the following is NOT indicated in the care of a woman having a vaginal delivery after caesarean section (VBAC)? A. Continuous fetal monitoring B. Intravenous cannula C. Blood sent for group and save D. Epidural anaesthesia E. Amniotomy
E. Any intervention in labour, including amniotomy, has been shown to increase the risk of scar rupture. Answers a-c are all indicated, whilst d is optional depending on the woman’s choice.

A 19 year old woman attends the Labour Ward at 28 weeks gestation with increasingly regular tightenings every 10 mins. On cervical assessment, there is cervical effacement and dilatation of 1 cm. Which is your 1st line of management? A. Urin a lysis B. Administration of steroids C. Liaising with the paediatric team D. To co lysis E. Caesarean section
B. Although a-d are all part of the management plan, steroids should be given first since the woman already appears to be in labour.
In obstetric palpation, which factor is the most important for assessing progress in labour? A. Symphysis-fundal height B. Fetal presentation C. Engagement D. Fetal position E. Liquor volume
C. Assessment of whether the widest diameter of the presenting part has entered the pelvic brim is essential in monitoring the progress of labour to vaginal delivery.
In vaginal examination, which factor is the most important for assessing progress in labour? A. Presence of caput B. Presence of moulding C. Fetal position D. Cervical dilatation E. Station
E. All answers a-e are important in assessing progress in labour, but station is the most important – even at full dilatation, vaginal delivery is not possible if the presenting part does not descend past the ischial spines.
A 20 year old patient who is 36 weeks pregnant attends clinic with a blood pressure of 156/ 102. She has 2 + of protein in her urine. What investigations are required?
A. ECG, Chest X-ray and V/ Q scan
B. Liver function tests, full blood count, urea &
electrolytes, urine protein:creatine ratio and
clotting
C. Thyroid functions tests
D. Serum cortisol
E. Renal ultrasound
B. The history and examination findings suggest that this patient may have pre-eclampsia. This must be urgently investigated further with liver function tests, a platelet count, clotting studies and urine protein quantification.
Which of the following medications is considered as 1st line for treatment of hypertension in pregnancy in non-asthmatic patients? A. En a la p r il B. Nifedipine C. Methyldopa D. Labetalol E. Hydralazine
D. Labetalol is recommended by NICE guidelines as 1st line treatment for hypertension in pregnant non-asthmatic patients.
Which medication should be administered as soon as possible in a patient thought to be having an eclamptic seizure? A. Diazepam B. Methyldopa C. Labetalol D. Hydralazine E. Magnesium Sulphate
E. An international multicentre study (MAGPIE trial) recommended that magnesium sulphate should be used in the immediate management of an eclamptic seizure.
Which of the following is not a known risk factor for venous thromboembolism in pregnancy?
A. Thrombophilia (Factor V Leiden, Protein C
deficiency, antiphospholipid syndrome)
B. Age>35
C. BMI>30
D. Parity>3
E. Age
E. Older age, rather than younger age, is associated with an increased risk of venous thromboembolism in pregnancy.
Anaemia in pregnancy should be identified and treated where necessary. What levels of haemoglobin are acceptable at booking and at 28 weeks?
A. >11.0g/dlatbookingand>10.5g/dlat
28 weeks
B. >11.0 g/dlat booking and >9.5 g/dlat 28 weeks C. >10.0g/dlatbookingand>10.5g/dlat
28 weeks
D. > 9.0 g/ dl at booking and > 11.g/ dl at 28 weeks E. >7.0 g/dlat booking and >10.5 g/dlat 28 weeks
A. These indices are generally agreed as appropriate normal values for these gestations.
What three steps have been shown to reduce the vertical transmission of HIV from mother to fetus?
A. Antibiotics, elective caesarean section and
breastfeeding
B. Hand washing, vaginal delivery and steroids
C. Avoidance of breastfeeding, anti-retroviral
medication (HAART), elective caesarean section
D. Avoidance of intercourse, avoidance of
breastfeeding and antibiotics
E. Steroids, elective caesarean section and antibiotics
C. These 3 factors have been proven to reduce HIV vertical transmission, although with an undetectable viral load, there is increasing evidence that vaginal delivery has a similar risk to caesarean section.
A 32 year old patient who has had type 1 diabetes since her teens comes to see you because she plans to stop the oral contraceptive pill. What advice is the most important? A. Start taking folic acid 0.4 mg daily B. Start aspirin 75 mg daily C. Book an oral glucose tolerance test D. Start taking folic acid 5 mg daily E. Plan for midwifery-led care
D. Folic acid 5 mg is recommended from pre- conception until 12 weeks gestation in order to reduce the incidence of neural tube defects. Overall, fetal anomalies are increased in patients with diabetes.
Which of the following is NOT part of the antenatal care of patients with epilepsy?
A. Aim to control seizures with monotherapy
B. Take folic acid 5 mg daily from preconception until
12 weeks gestation
C. Prescribe vitamin K 10 mg daily from
preconception until 12 weeks gestation
D. Encourage breastfeeding
E. Arrange a detailed fetal ultrasound scan to exclude
cardiac defects
C. Vitamin K should be prescribed in the 3rd trimester of pregnancy, usually from 36 weeks gestation and should be advised for the neonate.
A 26 year old primiparous woman presents to the Labour Ward at 33 weeks gestation with a 2 day history of feeling increasingly unwell with nausea and vomiting. On admission, she has mildly raised blood pressure. She has blood investigations which show a raised ALT, a very high uric acid level and low blood glucose. What is the most likely diagnosis? A. Fulminating pre-eclampsia B. Acute fatty liver of pregnancy C. Obstetric cholestasis D. Pregnancy-induced hypertension E. Cholelithiasis
B. The history and the investigations, with the very high uric acid and hypoglycaemia, are in keeping with a diagnosis of acute fatty liver of pregnancy. The history fits with a diagnosis of puerperal psychosis. Treatment should involve admission to a mother and baby unit and antipsychotic medication.
About 2 weeks postnatally, a 36 year old multiparous woman starts to worry that her partner is spying on her as she cares for her baby. She begins to think she can hear someone telling she is doing tasks incorrectly. Her partner calls the health visitor who suspects that the most likely diagnosis is: A. Baby blues B. Bipolar disorder C. Schizophrenia D. Postnatal depression E. Puerperal psychosis
E. The history fits with a diagnosis of puerperal psychosis. Treatment should involve admission to a mother and baby unit and antipsychotic medication.
