General obstetrics

Question 1

Risks of crack cocaine use in pregnancy?

Answer 1

• placental abruption - inc risk of prematurity/perinatal death
• IUGR - arterial vasoconstriction

Question 2

Risks of heroin use in pregnancy?

Answer 2

IUGR

premature delivery

Question 3

Risks of tobacco use in pregnancy?

Answer 3

• fetal growth restriction
• low birth weight
• respiratory disease from passive smoking

Question 4

What test is used to detect Down’s syndrome if too late for nuchal translucency?

Answer 4

triple test (serum)

• AFP (decreased)
• oestriol (increased)
• beta-HCG (increased)

Question 5

What is increased AFP associated with?

Answer 5

fetal abnormality

• neural tube defects
• anterior abdominal wall defects
• Patau’s syndrome

also pregnancy complications

• multiple pregnancy
• fetal IUGR
• oligohydramnios

Question 6

Define the diagnosis of gestational diabetes?

Answer 6

based on 2h glucose conc > 11.1mmol/L

diagnosis may also be made if fasting blood glucose >7.8mmol/L

Question 7

Risk factors for GDM?

Answer 7

• obesity
• previous GDM
• FH of diabetes
• women with previously large babies or stillbirth
• increasing maternal age

during pregnancy:

• glycosuria
• large for dates baby
• polyhydramnios

Question 8

Effects of GDM on fetus

Answer 8

• fetal macrosomia
• polyhydramnios
• neonatal hypoglycaemia
• neonatal RDS
• increased stillbirth rate

Question 9

Effects of GDM on mother

Answer 9

• increased risk of traumatic delivery e.g. shoulder dystosia
• increased Caesarean section risk
• increased risk of developing GDM in subsequent pregnancies
• 50% increased risk of developing T2DM within 15 years

Question 10

What problems can maternal anaemia cause for the fetus in utero?

Answer 10

• low birth weight
• neonatal anaemia
• cognitive impairment

Question 11

What are the implications of anaemia in pregnancy for the mother?
Both antenatal and peripartum

Answer 11

antenatal

• fatigue
• fainting
• dizziness

peripartum

• increased risk of haemodynamic compromise
• increased likelihood of transfusion

Question 12

Managment for anaemia in pregnancy?

Answer 12

• ferrous sulphate 200mg bd (can go up to tds if tolerated)
• iron suspension or IM iron if not tolerated
• encourage iron-rich diet
• consider blood transfusion if not possible to increase haemoglobin level by supplementation

Question 13

Which babies are at particular risk of group B strep infection?

Answer 13

• previous pregnancy affected by GBS
• GBS in vagina or urine at any stage during current pregnancy
• preterm delivery
• PROM
• pyrexia in labour

give IV penicillin to mother in labour

Question 14

Management of a neonate at risk of group B strep infection?

Answer 14

• observation of baby for up to 5 days post partum fo rsigns of sepsis
• consideration of culture of baby from ear, nose, axilla for evidence of infection
• IV abx until culture results confirm no evidence of infection

Question 15

What is the most common cause of serious bacterial infection in UK infants?
Mortality?

Answer 15

Group B strep

10%

Question 16

What things do you monitor in twin pregnancies?

Answer 16

• regular FBC
• close BP and urinalysis monitoring
• fetal growth surveillance from 28 weeks
• screening for gestational diabetes

Question 17

Management of twin pregnancy in antenatal care?

Answer 17

• info regarding inc maternal and fetal risks
• regular hospital antenatal assessment from late 2nd tri
• ferrous sulphate and folic acid supplementation
• discussion of mode of delivery - depends on growth and presentation of twins at 36w
• hospital delivery by 40w
• introduce to multiple pregnancy support groups

Question 18

Common causes of APH at term?

Answer 18

• blood-stained show
• bleeding placenta praevia
• placental abruption
• cervical ectropion
• infection e.g. candida
• vasa praevia

Question 19

Causes and associations for breech presentation?

Answer 19

• grand multiparity
• uterine abnormality (bicornuate, septate, fibroids)
• placenta praevia
• polyhydramnios
• oligohydramnios
• multiple pregnancy
• congenital fetal abnormality
• prematurity

Question 20

What is the specific test for syphilis infection?

Answer 20

T. pallidum EIA

Question 21

Symptoms of post-partum blues?

Answer 21

• tearfulness
• fatigue
• anxiety over own/baby’s health
• feelings of inability to cope
  Common, presenting after 3rd day postnatally and resolves spontaneously after a few days

Question 22

Symptoms of post-partum depression?

Answer 22

• low mood
• crying
• anxiety over baby’s health
• feelings of guilt towards baby
• panic attacks
• excessive tiredness
• poor appetite

Occurs in 10% of women any time up to 6m following delivery

Question 23

What is the commonest cause of indirect maternal death (aka not during or straight after delivery)?

Answer 23

suicide

Question 24

How do we reduce the risk of mother-to-baby HIV transmission during and post pregnancy?

Answer 24

• elective C section (if high viral load)
• avoid breast feeding
• IV zidovudine to mother prior to delivery (ideally 4h)
• oral zidovudine to neonate for 6h postnatally

Question 25

What is the management for obstetric cholestasis?

Answer 25

• chlorpheniramine (anithistamine) for itching
• ursodeoxycholic acid in severe itching - reduces serum bile acids
• vitamin K given orally to mother to reduce the risk of fetal or maternal haemorrhage caused by impaired absorption

Question 26

What postnatal advice would you give to a woman who had obstetric cholestasis during pregnancy?

Answer 26

• liver function returns to normal after delivery
  BUT
• 50% recurrence in subsequent pregnancy
• can reoccur with use of COCP