Difficult concepts

Question 1

in pregnancy <12 weeks when should you / or should you give anti-D?

Answer 1

rhesus negative mum

1) ectopic
2)molar
3) therapeutic termination
4)interuterine bleed
; repeptive heavy and associated with abdominal pain

Question 2

potentially sensitising event 12-20 weeks what is the minimum dose?

Answer 2

250IU
within 72 hours

Question 3

16 weeks rhesus negative mum

suffers miscarriage

how do you manage?

Answer 3

miscarriage is a potential sensitising event

so
250IU of anti-d

no need to do kleuhauer betke test as <20 weeks

Question 4

potential sensitising eventS?

Answer 4

amniocentesis, CVS
APH,UV bleed
ECV
abdominal taruma
ectopic
evacuation of molar
stillbirth/ intrauterine death
miscarriage, threated
tOP
delivery- normal, instrumeny, c section

Question 5

28 week anti-d dose?

Answer 5

single dose 500IU
double 1500

Question 6

baseline variability - tachycardia?
causes

Answer 6

> 160
161-180 is amber / non reassuring
180 is RED, abnormal

Maternal pyrexia
foetal distress
hypoxia
prematurity
exogenous salbutamol use - beta-2 agonist

Question 7

baseline bradycardia causes?

Answer 7

placental abruption
uterine rupture
foetal acidaemia

Question 8

foetal position

anteriorly you feel a diamond shaped fontanelle

follow line posterior- Y-shaped depression in skull

Answer 8

anterior fontanelle is diamond shaped
posterior is Y shaped

line felt is sagittal suture

so this is occiput-anterior

Question 9

what is best foetal position to be born in?

Answer 9

occiput anterior
so foetus born looking towards mum’s back

Question 10

where does fertilisation of egg occur?

Answer 10

union of ovum and spermatazoon

ampulla -ovum tends to have a physiological rest here

ampulla is longest and widest part

Question 11

what is the role of prostaglandins
ARM
and oxytocin infusion in
IOL?

Answer 11

PGE2; vaginal to ripen cervix

ARM: (if after PGE2 slow progression, minimal contraction) then ARM

oxytocin: Maintains contraction

Question 12

risk factors for ovarian cancer

Answer 12

related to ovulation so more you ovulate more repair more chance for things to turn cancerous

1) Nulliparity
2)infertile
3)late menopause
4)early menarche

Question 13

induction of labour - principles?

Answer 13

stillbirth risk increases over 37 weeks
stretch and sweep

bishop score
if very low then
1)prostaglandin
2)ARM
3)Oxytocin onfusion

Question 14

how is prostaglandin given in IoL?

Answer 14

vaginal prostaglandin
tablet form 6-8 hourly
gel
slow release from tampon 24 hours

Question 15

delay in second stage

occiputanterior presenting baby what forceps to use?

rotation not needed and want to aid delivery?

Answer 15

Neville Barnes
simpsons

Question 16

screening test - first one?

Answer 16

combined test
10-14 weeks

nuchal translucency
serum b-HCG
Pregnancy associated plasma protein A

Question 17

second screening test - screening at 15 weeks?

Answer 17

quadruple test
AFP
oestriol
hCG
inhibin A

> Non invasive prenatal screening test

Question 18

diagnostic test for downs’

Answer 18

CVS- doen earlier 11-144
small sample from placenta

amniocentesis
>15 weeks
fluid from the uterus

Question 19

twin twin transfusion syndrome occurs with what?

Answer 19

monozygotic monochorionic diamniotic

has to occur in monochorionic -one placenta

Question 20

bishop score

Answer 20

dilation
consistency
lengthe of cerix
position
station

Question 21

first line for tubal patency post PID

Answer 21

laporoscopy and dye