Labour & Postpartum 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
O
Progesterone is responsible for uterine quiescence. High levels of progesterone does not mediate rising oxytocin receptor concentration.
FALLING progesterone mediates this
https://journals.physiology.org/doi/full/10.1152/physrev.2001.81.2.629
**Careful as there has been a previous question stating “nanopeptide” which is incorrect
Which of the following statements about the composition of breast milk is FALSE?
A. Human Breast Milk has approximately one-quarter the amount of protein in comparison with Cow’s Milk
B. Human Breast Milk has approximately one-third the amount of NaCl in comparison with Cow’s Milk
C. Human Breast Milk has approximately one-third the amount of calcium in comparison with Cow’s Milk
D. Human Breast Milk has approximately double the Vitamin D content in comparison with Cow’s Milk
D. Human Breast Milk has approximately double the Vitamin D content in comparison with Cow’s Milk
O
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
O
> 50% transmission if prevention measures not adhered to AND mixed fed
Lancet trial found combination feeding highest risk
- contaminant foods and fluids in mixed feeding damage bowel –> increased risk of transmission
Women who live in Africa should exclusively breastfeed
Transient post partum blues with depressive symptoms that resolve spontaneously affect what percentage of women?
a. 5%
b. 10%
c. 25%
d. 40%
e. >50%
e. >50%
O
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 and is being posted overseas. You tell her the risk of neonatal admission to a special care baby unit following elective Caesarean at this gestation is
a. 3%
b. 6%
c. 9%
d. 12%
c. 9%
According to RANZCOG May 2011 MCQs.
?Refer to AZTECS trial
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
f. Continuous electronic fetal monitoring is indicated in labour
c. All women with breech presentation at term should be advised to have an Elective Caesarean
O
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 intracellular calcium
O
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
O
Overall 12-22%, unsure how stratifies by gestation.
A 37yo G4P3 presents with SROM 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
Don’t understand how this is correct as thought ergometrine contraindicated??
Slow oxytocin infusion is best but in a smaller bag of fluids over a lower rate.
A 26yo multiparous woman with T2DM had a spontaneous vaginal birth 72 hours ago with pudendal block, midline episiotomy, and 3rd degree tear. She now has a temperature of 39.2. Her pulse is 120/min, respiration is 32/min and blood pressure is 90/60 mm Hg. The uterus is 2cm below the umbilicus and minimally tender to manipulation. Lochia is equivalent to a normal period, and is malodorous. The perineum and lower vulva and vagina are oedematous but not tender to touch. The perineal skin and vaginal mucosa are pale grey. Sensation to pinprick is markedly diminished in this area. Of the following, the MOST LIKELY diagnosis is
a. Peri-rectal abscess
b. Endometritis
c. Rectovaginal fistula
d. Necrotising fasciitis
d. Necrotising fasciitis
O
A 26 year old multigravid woman at 30 weeks gestation comes to the labour suite at a Level II hospital with a frank breech presentation at +3 station. Delivery begins to occur spontaneously until expulsion of the fetal thorax, when the cervix is noted to be incompletely dilated and the fetal head entrapped. Which of the following would be of MOST VALUE in this clinical situation?
a. Thiopentone
b. Fentanyl
c. Glyceryl trinitrate (GTN)
d. Salbutamol
e. Nitrous oxide and oxygen
c. Glyceryl trinitrate (GTN)
O
The best routine method of managing the delivery of the placenta at Caesarean Section is:
a) CCT after intravenous Syntocinon
b) Immediate MROP
c) Secure the incisional angles whilst awaiting spontaneous separation
d) Crede’s technique of uterine fundal expression
a) CCT after intravenous Syntocinon
O
Increases in either the number or sensitivity of receptors occurs in the uterus in the late gestation for each of the following EXCEPT:
a) Oxytocin
b) Corticotropin Releasing Hormone
c) Endothelins
d) Beta-adrenergic agents
d) Beta-adrenergic agents
These induce uterine relaxation
O
Which fetal diameter presents in an occipito-posterior presentation?
a. Vertigo-mental
b. Suboccipito-bregmatic
c. Occipito-frontal
d. Submento-bregmatic
c. Occipito-frontal
Vertex - flexion of the fetal head
- Suboccipitobregmatic = Below the occiput to the centre of the anterior fontanelle
- 9.5cm
Deflexed OP
- Occipitofrontal =Occiput to the root of the nose
- 11.5cm
Brow
- Mentovertical = Chin to the centre of the sagittal suture
- 13-14cm
Face
- Submentobregmatic angle = Angle between the neck and chin and the centre of the anterior fontanelle
- 9.5cm
Principles of management of a recto-vaginal fistula complicated by fever following obstetric trauma include:
a. repair after subsiding inflammation with single layer closure without tension.
b. immediate repair with minimal mobilisation of adjacent tissue planes.
c. immediate repair with partial excision of fistula tract.
d. repair after subsiding inflammation with multilayered closure without tension.
d. repair after subsiding inflammation with multilayered closure without tension.
You are the on-call registrar for Obstetrics. A patient has delivered her 5th baby but has not delivered the placenta yet. You receive an urgent call to the delivery suite and on arrival you diagnose acute inversion of the uterus. The patient is in shock.
What is the most appropriate first management step?
a. Attempt to remove the placenta
b. Attempt to reposition the uterus
c. Take the patient immediately to theatre
d. Give Terbutaline 0.25mg subcutaneous/intravenous
b. Attempt to reposition the uterus
Replace 1st THEN deliver placenta after via MROP
Following the conclusion of the ORACLE trials, which of the following antibiotics, or combinations of antibiotics, would be indicated in women with threatened preterm labour (without premature rupture of the membranes) and no other clinical signs of infection?
a. Erythromycin
b. None of these options are indicated
c. Amoxycillin and Metronidazole
d. Amoxycillin-clavulinic acid
b. None of these options are indicated
O
What component for managing the delivery of the placenta at caesarean section has been shown to reduce the amount of blood loss?
a. Controlled cord traction
b. Immediate manual removal of the placenta
c. Secure the incisional angles whilst awaiting spontaneous separation
d. Intravenous oxytocin
d. Intravenous oxytocin
In advising a woman on whether she should continue her pregnancy to 42 weeks or be induced at 41 weeks, which of the following is FALSE?
a. An ultrasound will be indicated if she elects to wait.
b. The Canadian randomised trial (Hannah et al) showed that induction of labour increases the likelihood of caesarean section.
c. If the Bishop’s cervical score is <5, intravaginal prostaglandins will be recommended.
d. Waiting is likely to be associated with a higher perinatal mortality
b. The Canadian randomised trial (Hannah et al) showed that induction of labour increases the likelihood of caesarean section.
1992
Induction of labour as compared with serial antenatal monitoring in post-term pregnancy. A randomised controlled trial. The Canadian Multicenter Post-term Pregnancy Trial Group.
- In post-term pregnancy, IOL results in a lower rate of C/S than serial antenatal monitoring
- Rates of perinatal mortality and neonatal morbidity are similar with the two approaches to management
A woman G3P2 at 35 weeks gestation, has confirmed preterm pre-labour rupture of membranes. In the context of the PPROMT trial which of the following outcomes would be most likely if she was managed expectantly?
a. Higher risk of Caesarean section
b. Shorter hospital stay
c. Higher risk of antepartum haemorrhage
d. Lower risk of intrapartum fever
c. Higher risk of antepartum haemorrhage
The women assigned to expectant management group had higher risks of APH and use of postpartum antibiotics and a longer hospital stay
- Lower risk of CS
Most common cause of post partum endometritis at 6/52 is
a) Streptococcus
b) Peptostreptococcus
c) Chlamydia
d) Klebsiella
e) Proteus
J says b
Difficult to find answer online but chlamydia commonly associated with late onset endometritis so ?c
Patient has epidural topup with marcaine for operative delivery. Immediate tonic clonic seizure then cardiac arrest. Least helpful thing to do
a) Intubate
b) Ventilate with mask / 100%O2
c) Deliver baby urgently
d) Ephedrine IV
e) CPR with patient in left lateral tilt
d) Ephedrine IV
Following the conclusion of the ORACLE trial, which of the following would be the PREFERRED antibiotic therapy in women with preterm premature rupture of the membranes?
a. Amoxicillin
b. Amoxicillin-clavulanic acid
c. Erythromycin
d. Erythromycin and amoxicillin-clavulanic acid
c. Erythromycin
O
Beta sympaticomimetics in randomised, placebo controlled trials, have been demonstrated most convincingly to
a. lower risk of preterm delivery
b. lower risk of delivery within 48 hours
c. cause higher birthweight
d. lower perinatal mortality
b. lower risk of delivery within 48 hours
O
Which of the following statements about endocrinology of lactation is TRUE?
a. In the third trimester pituitary lactotrophs are increased in size but not in number
b. Continued lactation post partum depends upon persistently high basal prolactin levels
c. The progestogen only pill has minimal effect on lactation, but depo medroxyprogesterone acetate is contraindicated in the lactating woman
d. Initiation of lactation is a result of decreased oestrogen and progesterone concentration after delivery
d. Initiation of lactation is a result of decreased oestrogen and progesterone concentration after delivery
O
A CTG is performed on a 24yo woman at 41weeks who has stable mild chronic HTN. The CTG pictured shows
(?baseline, absent variability)
The LEAST appropriate management is:
a. repeat CTG in 12-24hours
b. IOL
c. doppler USS of umbilical artery
d. to continue CTG for a further 60minutes
e. a vibro-acoustic stimulation test
a. repeat CTG in 12-24hours
O
