Hypertensive disorders in pregnancy

Question 1

What is the leading cause of death among pre-eclamptic women?

Answer 1

intra-cranial heamorrhage

Question 2

What can fluid overload in pregnant women cause?

Answer 2

Pulmonary oedema

Question 3

What does a uterus large for dates and glycosuria suggest?

Answer 3

Gestational diabetes with polyhydraminos

Question 4

What could abnormal posture, limb position and possibly polyhydraminos indicate?

Answer 4

Fetal dyskinesia disorder

Question 5

What is a circumvallete placenta?

Answer 5

Circumvallate placenta is a placental disease in which the fetal membranes (chorion and amnion) “double back” on the fetal side around the edge of the placenta. After delivery, a circumvallate placenta has a thick ring of membranes on its fetal surface.

Question 6

What problems can a circumvallete placenta cause?

Answer 6

Circumvallate placenta often causes persistent vaginal bleeding beginning in the 1st trimester, premature rupture of the membranes (PROM), preterm delivery, and placental abruption and is thus associated with poor pregnancy outcomes

Question 7

What is tapipes equniovarus?

Answer 7

Club foot

Question 8

What can DIC after birth be an indication of?

Answer 8

amniotic fluid emboli

Question 9

What is uterine inversion?

Answer 9

When the placenta fails to detach from the uterus

Question 10

What happens to the patient when there is uterine inversion?

Answer 10

They become hypotensive and shocked and often a post-partum heamorrhage occurs.

Question 11

Can you perform a cervical smear in pregnancy if you suspect malignancy?

Answer 11

Yes

Question 12

How could a congential infection such as congenital CMV present in a newborn?

Answer 12

IUGR, petechaie, jaundice and hepatosplenomegaly.

Question 13

Name uterotonic drugs which are used for active management of the third stage of labour?

Answer 13

Oxytocin, ergometrin and a mixture of the 2- syntometrin.

Question 14

When should ergometrin not be used as active management of the third stage of labour?

Answer 14

it is contraindicated in cardiac disease

Question 15

What can commonly be confused with a breech position?

Answer 15

A face presentation

Question 16

So, if there is face presentation, it can either be mento-anterior or mento-posterior. Mento anterior is the mentum (chin). Which one is incompatible with a vaginal delivery?

Answer 16

Mento-posteior. ie chin at the bum

Question 17

What is the risk of a transverse lie to the mother and the fetus.

Answer 17

Mother- obstructed labor, ruptured uterus. and the fetus- chord prolapse

Question 18

How can uterine hyperstimulation be caused in labor and how can it be treated?

Answer 18

It occurs in response to vaginal prostaglandins and you see increased frequency in contractions (7 in10). You need to achieve uterine relaxation with tocolytic such as SC terbutaline.

Question 19

What is the benefit of active management of the third stage of labour?

Answer 19

It reduces the risk of post-partum hemorrhage and the need for blood transfusion

Question 20

What is considered high blood pressure in pregnancy?

Answer 20

systolic > 140 mmHg or diastolic > 90 mmHg

or an increase above booking readings of > 30 mmHg systolic or > 15 mmHg diastolic

Question 21

What is Johnson’s manoeuvre?

Answer 21

Uterine repositioning is best done manually and quickly, firstly using Johnson’s method. This involves slowly and steadily pushing the uterus upwards towards the umbilicus. If this fails, O’Sullivan’s technique can be utilised, which involves infusion of warm saline into the vagina.

Question 22

What do you manage high bp in an asthmatic in pregnancy?

Answer 22

Oral nifedipine

Question 23

What do the degree tears involve?

Answer 23

first degree: superficial damage with no muscle involvement
second degree: injury to the perineal muscle, but not involving the anal sphincter
third degree: injury to perineum involving the anal sphincter complex (external anal sphincter, EAS and internal anal sphincter, IAS):
3a: less than 50% of EAS thickness torn
3b: more than 50% of EAS thickness torn
3c: IAS torn
fourth degree: injury to perineum involving the anal sphincter complex (EAS and
IAS) and rectal mucosa