labour Flashcards
Which is FALSE regarding oxytocin in pregnancy and labour
a. Oxytocin is a nonapeptide
b. Oxytocin receptor concentrations markedly increase with advancing gestation under the influence of rising progesterone
c. Oxytocin receptors in the decidua lead to PGF2-alpha production
d. Oxytocin works largely via an oxytocin receptor initiating a G-protein dependent activation of phospholipase C, inositol triphosphate, and sarcoplasmic reticulum calcium release
b. Oxytocin receptor concentrations markedly increase with advancing gestation under the influence of rising progesterone
From 37/40, levels of oestrogen > progesterone –> increased oxytocin
Which of the following statements about the composition of breast milk is FALSE?
a. Human breast milk has 1/3 of the protein compared with cows milk
b. Human breast milk has 1/3 of the NaCl compared with cows milk
c. Human breast milk has 1/3 of the calcium compared with cows milk
d. Human breast milk has approximately double the vitamin D content in comparison with cows milk
d. Human breast milk has approximately double the vitamin D content in comparison with cows milk
The infant feeding method MOST LIKELY to result in MTCT of HIV is
a. Exclusive breastfeeding
b. Exclusive formula feeding
c. Combination breast and formula feeding
d. Initial colostrum then formula feeding
c. Combination breast and formula feeding
correct answer according to official Feb 2010 MCQ
Lancet trial found combination feeding highest risk
- contaminant foods and fluids in mixed feeding damage bowel –> increased risk of transmission
Why live in Africa should exclusively breastfeed
Transient post partum blues with depressive symptoms that resolve spontaneously affect what percentage of women?
a. 10
b. 25
c. 40
d. >50
d. >50
A 34yo G1P0 has an unsuccessful ECV at 36 weeks for breech. You plan a Caesarean. She requests this to be done at 37 weeks because her husband is in the armed forces. You tell her the risk of neonatal admission to a special care baby unit following elective Caesarean at 37 weeks is
a. 3%
b. 6%
c. 9%
d. 12%
d. 12%
Which of the following is FALSE regarding mode of delivery breech presentation at term?
a. Elective Caesarean at 39 weeks will prevent fetal death from a cord prolapse in spontaneous labour at 40 weeks
b. Morbidity and mortality from head entrapment is reduced by Elective Caesarean compared with vaginal breech delivery
c. All women with breech presentation at term should be advised to have an Elective Caesarean
d. RCT’s indicate lower mortality with Elective Caesarean than attempted vaginal breech delivery
e. Caesarean section is best performed after 39 weeks gestation and prior to the onset of spontaneous labour
c. All women with breech presentation at term should be advised to have an Elective Caesarean
Which of the following would NOT enhance the contraction of a myometrial cell?
a. Binding of intracellular calcium to calmodulin to activate calcium dependent myosin light chain kinase
b. Voltage operated calcium channel activation
c. Receptor operated calcium channel activation
d. Sarcoplasmic reticulum calcium uptake
d. Sarcoplasmic reticulum calcium uptake
The main function of the SR is to store calcium ions
Therefore reduces calcium
Which is LEAST CORRECT regarding meconium in the amniotic fluid at term
a. Meconium is found in around 5% of women in labour at 38 or more weeks gestation
b. The finding of meconium in the amniotic fluid at term increases the perinatal mortality from 0.3/1000 to around 1.5/1000
c. The incidence of meconium aspiration syndrome in the presence of meconium stained liquor is around 1%
d. Meconium stained liquor is an indication for continuous electronic fetal monitoring in labour
a. Meconium is found in around 5% of women in labour at 38 or more weeks gestation
Rare before 38/40
A 37yo G4P3 presents with SRM at term. Her current and prior pregnancies were uncomplicated. FBC is normal, except for a platelet count of 85x10^9 at admission. She is asymptomatic. Management of her labour should include:
a. Fetal platelet count via scalp sample
b. Notification of blood bank to have platelet packs available for maternal transfusion
c. Normal labour management and neonatal platelet count
d. Caesarean section rather than mid cavity forceps to minimise fetal trauma
c. Normal labour management and neonatal platelet count
Which is the MOST APPROPRIATE next step in treating a woman with severe idiopathic cardiomyopathy who is having a 1500mL PPH with ongoing blood loss. She has already had 5iu oxytocin IV.
a. Ergometrine 0.25mg IV
b. Further 10IU oxytocin IV
c. Carboprost 1.5mg IV
d. Oxytocin 40 units in 1 litre Hartmann’s over 4 hours
e. Misoprostol 200-400mcg orally
A - correct answer according to official Feb 2010 MCQ
A 26yo multipara with T2DM had a spontaneous birth 72 hours ago with pudendal block, midline episiotomy, and 3rd degree tear. She now has a temp 39.2, tachycardic, tachypnoeic, hypotensive. The uterus is 2cm below the umbilicus and minimally tender. Lochia is equivalent to normal period, and is malodorous. The perineum, vulva, and lower vagina are oedematous but non tender. The perineal skin and vaginal mucosa are pale grey colour, with diminished sensation to pin prick. The MOST LIKELY diagnosis is:
a. Perirectal abscess
b. Endometritis
c. Rectovaginal fistula
d. Necrotising fasciitis
d. Necrotising fasciitis
