even more obs

Question 1

at what gestation should anti- d be admisnisted - second preg

Answer 1

28 and 34 weeks 2 doses prevent haemolytic disease

Question 2

differentiate between PE and amnitoic fluid embolism

Answer 2

PE- Pregnancy, particularly post-partum, is associated with an increased risk of venous thromboembolism (VTE).Sx SOB , pleuritic chest pain and sometimes haemoptysis. A PE can cause a maternal cardiac arrest; however, it is likely to be less sudden-onset than the patient’s symptoms and signs above.

Amniotic fluid embolism - during labour or after delivery. occur when amniotic fluid enters the maternal circulation, which triggers the maternal immune system to overreact. The symptoms and signs of an amniotic fluid embolism occur suddenly and can quickly lead to disseminated intravascular coagulation (DIC) and maternal cardiac arrest. It occurs in approximately 1 in 20,000 births.

Question 3

types of anal tears

Answer 3

First degree tear
Tear limited to the superficial perineal skin or vaginal mucosa only
Second degree tear
Tear extends to perineal muscles and fascia, but the anal sphincter is intact (episiotomy is anatomically classified as second degree)
Third degree tear
3a: less than 50% of the thickness of the external anal sphincter is torn
3b: more than 50% of the thickness of the external anal sphincter is torn, but the internal anal sphincter is intact
3c: external and internal anal sphincters are torn, but anal mucosa is intact
Fourth degree tear
Perineal skin, muscle, anal sphincter and anal mucosa are torn

Question 4

What investigation can be carried out to confirm this diagnosis PROM

Answer 4

Actim-PROM vaginal swab

An Actim-PROM vaginal swab detects insulin-like growth factor binding protein-1 (IGFBP-1) in vaginal fluid. The concentration of IGFBP-1 is much higher in the amniotic fluid than in the maternal blood. Therefore, a positive Actim-PROM suggests pre-labour rupture of membranes.

Question 5

Which chromosomal abnormality/abnormalities are tested for in the quadruple test? and what are they

Answer 5

Down syndrome

The quadruple test is carried out between 15-20 weeks gestation and tests for Down syndrome. It is a single blood test that assesses for the following markers: PAPP-A, alpha-fetoprotein (AFP), unconjugated oestriol (uE3), beta-HCG and inhibin A. Low PAPP-A, low AFP, low uE3, together with raised beta-HCG & inhibin A are suggestive of a chromosomal abnormality.

Question 6

when is the combined test carried out

Answer 6

The combined test is carried out between 10-14 weeks gestation and tests for Down syndrome, Edward syndrome and Patau syndrome. It involves a combination of an ultrasound scan to assess nuchal translucency and a blood test to assess PAPP-A & beta-HCG.

Question 7

What gestation should the booking appointment be carried out at?

Answer 7

8-10 weeks

Women should attend for their booking appointment (first midwife appointment) at 8-10 weeks. This ensures their blood pressure and BMI are documented and routine urine and blood tests are performed. It also ensures that they can be booked for their dating scan (10-13 weeks) and anomaly scan (18-20 weeks) at the correct gestation to allow for antenatal screening tests should they consent to the

Question 8

dating scan when

Answer 8

10-13weeks

Question 9

anomaly scan when

Answer 9

18-20 weeks

Question 10

define pre-eclampsia

Answer 10

Pre-eclampsia is defined as new onset hypertension that occurs after 20 weeks gestation and the co-existence of ≥1 of the following conditions: proteinuria, maternal organ dysfunction, neurological complications, haematological complications or uteroplacental dysfunction.

Question 11

tried transxameic acid for heavy bleeding what next

Answer 11

IUS

Question 12

tried transxameic acid for heavy bleeding what next

which is normally first line

Answer 12

IUS - this is normally first line

Question 13

A 30-year-old woman presents to her General Practitioner (GP) due to severe pelvic pain. On further Questioning, she reports dysmenorrhoea and deep dyspareunia. She also says she has noticed blood in her urine; however, this is only the case when menstruating. Her GP performs a pelvic examination which reveals a fixed tender uterus and nodularity within the uterosacral ligaments. Her GP suspects a diagnosis of endometriosis.

What is the first-line management for endometriosis?

Answer 13

Paracetamol and/or ibuprofen

Combined oral contraceptive pill
Medroxyprogesterone acetate
Gonadotrophin-releasing hormone agonists
Surgical Management
Diathermy of lesions
Ovarian cystectomy (for endometriomas)
Adhesiolysis
Bilateral oophorectomy (sometimes with a hysterectomy)

Question 14

define primary amenorrhoea

Answer 14

Failure to establish menstruation by the expected time of menarche

This is the failure to establish menstruation by the expected time of menarche. This is defined as by the age of 16 in those with normal secondary sexual characteristics and by the age of 14 in those with no secondary sexual characteristics.

Question 15

how often should you come off the pill to check for no abnormalities

Answer 15

3years

Question 16

rotterdam criteria for PCOS - must have 2 of following

Answer 16

Oligo-/anovulation Clinical or biochemical evidence of hyperandrogenism Polycystic ovaries or an increased ovarian volume on ultrasound.

Question 17

A 32-year-old woman presents to her General Practitioner with a one-year history of increasingly heavy menstrual bleeding. She also reports dysmenorrhoea, pelvic pain and abdominal bloating. She has no past medical history and takes no regular medications. She is sexually active with one partner, and there is no risk of sexually transmitted infections.

On bimanual examination, her uterus is enlarged and non-tender.

what dx

Answer 17

fibroid

Question 18

what stains are used in colposcopy to look for abnromal cells

Answer 18

Acetic acid and iodine can also be used to identify abnormal cells.

Question 18

what stains are used in colposcopy to look for abnromal cells

Answer 18

Acetic acid and iodine can also be used to identify abnormal cells.

Question 19

discharge with atrophic vaginitis

Answer 19

This is a typical presentation of atrophic vaginitis. This condition occurs in post-menopausal women and is caused by low circulating oestrogen levels. This leads to thinning and dryness of the vulval skin and vaginal epithelium. It typically presents with vulval irritation, soreness and superficial dyspareunia. Some women also report vaginal discharge changes. This common condition can be managed with topical lubricants or topical or vaginal oestrogens.

clear discharge