EXTRA

Question 1

breech presentation

Answer 1

caudal end of the foetus is at the presenting part

Question 2

management of breech presentation

Answer 2

<36 weeks - resolves spontaneously
>36 weeks - give external cephalic version
if still breech, consider planned delivery

Question 3

what is folic acid good for and what drugs should be avoided

what is a good source of folic acid

what should high risk women be doing

Answer 3

important for synthesis of DNA and RNA

drugs to avoid:
phenyotin
methotre

green leafy veg

take folic acid pre-conception

Question 4

HIV and pregnancy

Answer 4

all women should be screened

antiretroviral therapy should be given to HIV +ve

mode of delivery:
vaginal if less than 50 copies otherwise CS

avoid breastfeeding

Question 5

oligohydramnios

Answer 5

low levels of amniotic fluid

causes:
PROM
foetal renal issues
post-term gestation
pre-eclampsia

Question 6

perineal tears

Answer 6

1st degree - superficial
2nd degree - involves the perineal muscle
3rd degree - involved the anal sphincter complex
4th degree - involves the anal sphincter complex and rectal mucosa

causes:
prolonged labour
use of forceps
shoulder dystocia
macrosomia

Question 7

premature rupture of membranes

Answer 7

investigation:
sterile speculum examination
USS to check for oligohydramnios

management:
admit
erythromycin for 10 days
steroids
monitor for chorioamnionitis

Question 8

shoulder dystocia

Answer 8

difficulty with vaginal cephalic delivery due to shoulders

risk:
macrsomia
obesity
diabetese

management:
McRoberts manoeuvre with suprapubic pressure

Question 9

intra-hepatic cholestasis

Answer 9

increases risk of premature birth

pruritus
raised bilirubin
jaundice

management:
induction of labour at 37-38 weeks - main management form that reduce risk of stillbirth
ursodeoxycholic acid

Question 10

when are oxytocin and prostaglandins contradindicated

Answer 10

foetal distress

Question 11

amniotic fluid embolism

Answer 11

when amniotic fluid enters maternal bloodstream and causes an emboli

distress signs during or post delivery

supportive management

Question 12

what important test is done if there is abdominal trauma

Answer 12

rhesus testing, need anti-D asap to prevent immobilisation

Question 13

what should be done if previous pregnancy for was Group B strep +ve

Answer 13

IV prophylactic abx

Question 14

galactocele

Answer 14

painless cyst that develops after cessation of breast feeding

Question 15

lochia

Answer 15

natural passing of blood, mucus post-partum, normal only up till 6 weeks

Question 16

how is Hep B managed

Answer 16

if high risk:
give baby vaccine as soon as when delivered

if antigen +ve:
give vaccine and immunoglobulin

Question 17

why should aspirin be avoided during breast feeding

Answer 17

reyes syndrome

Question 18

CS categories

Answer 18

1: immediate as mother/foetal are compromised
2: deliver within 75 mins
3: delivery required but mother and baby are stable
4: elective

Question 19

acute fatty liver

Answer 19

can occur in third trimester or immediately after delivery

nausea/vomiting
jaundice
ascites
unwell

supportive
immediate delivery