General Obstetrics

Question 1

How is termination of pregnancy conducted?

Answer 1

<9 weeks gestation = Mifepristone (Anti-progestogen) followed by Misoprostol (prostoglandin to stimulate contraction) 48 hours later
<13 weeks gestation = Surgical dilation and suction of uterine contents
>15 weeks gestation = Surgical dilation and exacuation of uterine contents or late medical abortion

Question 2

What are the degrees of perineal tears?

Answer 2

First degree = Tear into perineal skin
Second degree = Tear into perineal muscles
Third degree = Tear into anal sphincter complex
IIIa = <50% external anal sphincter
IIIb = >50% external anal sphincter
IIIc = External and internal anal sphincter tear
Fourth degree = Tear into rectal mucosa

Question 3

What are the problems with third degree or greater tears?

Answer 3

External anal sphincter incompetence -> Faecal urgency

Internal anal sphincter incompetence -> Faecal incontinence (Since both sphincters must have been damaged)

Question 4

What are the indications for an episiotomy?

Answer 4

Instrumental delivery
Shoulder dystocia
Large baby (>4kg)
Prolonged delivery

Question 5

What is the aftercare for OASIs?

Answer 5

Lactulose and bulking agent for 5-10 days
Admission till first bowel movement
Oral broad spectrum antibiotics 5-7 days to reduce risk of infection
Regular oral analgesia
Followup after 12 weeks for symptom evaluation

Question 6

What are the clinical features of vasa praevia?

Answer 6

Rupture of membranes followed by painless bleeding along with foetal bradycardia

Managed by emergency C-section

Question 7

After how many weeks is induction of labour feasible in pre-eclampsia?

Answer 7

34 weeks

Question 8

What are indications for 5mg folic acid?

Answer 8

Women at higher risk of conceiving a child with a NTD should take 5mg of folic acid from before conception until the 12th week of pregnancy

FHx of neural tube defects
Previous child with neural tube defects
Woman is taking anti-epileptic medications
Woman has coeliac disease
Woman has diabetes
Woman has thalassaemia trait
Woman is obese (BMI >30)

Question 9

What conditions does Alpha Fetoprotein change in pregnancy?

Answer 9

Raise in neural tube defects, abdominal wall defects, multiple gestation
Reduced in down’s syndrome or other chromosomal abnormalities, maternal diabetes