Learning points

Question 1

Cardinal Movements during normal Labour

Answer 1

Engagement –> Flexion–> descent –> Internal rotation –> Extension –> External rotation/restitution –> Expulsion

Question 2

Mnemonic for cardinal movements during labour

Answer 2

EFDIEEE

Engagingly first deal in evidence of external errors

Question 3

Magnesium toxicity vs hydralazine toxicity

Answer 3

Mg –> parasthesia, facial tingling, (also N&V, headache, slurred speech, blurry vision)
Hydralazine –> SLE like dermatological reaction,

Question 4

Causes of recurrent miscarriage (3 or more)

Answer 4

15% APS
Cervical incompetence causes mid-trimester miscarriage
Chromosomal abnormality accounts for 2% of recurrent miscarriage

Question 5

Risk factors for PE

Answer 5

Raised BMI x2.5
Raised BP at booking x1.4
Previous PE x7.2
Multiple pregnancy x3

Question 6

Management of placenta previa

Answer 6

Often moves between 20wks and term - rescan at 32wks to

Question 7

Breech presentations

Answer 7

Footling has a higher chance of cord prolapse because there is no fetal pole pushing on the cervix
IOL does not reduce birth risks
CTG for all

Question 8

Uterine polyps

Answer 8

Classically associated with IMB while CIN/dyskaryosis tend to produce post-coital, fibroids menorrhagia and endometriosis pain

Question 9

Chronic pelvic pain management

Answer 9

Usually multifactorial, and cyclic pain is gynae.
Mirena coil can be used off licence for endometrosis but adhesiolysis is rarely effective. attempt a trial of medical management first

Question 10

HPV testing after Cervical smear

Answer 10

Only if borderline. any worse progress straight to colposcopy.

Question 11

Formation of a hydatiform mole

Answer 11

Partial - two sperm and a normal egg (69 XXY)

Complete - empty egg with one or two sperms (46 XX)

Question 12

Gestational trophoblastic neoplasia

Answer 12

Choriocarcinoma or placental site trophoblastic tumor
Most commonly from molar pregnancies but can occur after any pregnancy event. Can spread and treat with methotrexate or chemo.

Question 13

Gestational trophoblastic disease

Answer 13

Partial and complete moles and forms of GTN (choriocarcinoma or placental site trophoblastic tumor)

Question 14

Risk factors for hydatiform moles

Answer 14

Maternal age (2x over 35yrs), previous molar preg (10x), long term oral contraceptive use (2x), dietary deficiency (Beta-carotene or Vit A)

Question 15

Signs of hydatiform moles

Answer 15

Normal or elevated BhCG, partial tend to present as missed miscarriages during the first or second trimester
Complete moles are large for dates, very elevated BhCG and abnormal PV bleeding. Increased risks of anaemia, hyperemesis gravidarium or PE

Question 16

Management of Shoulder Dystocia

Answer 16

Identify early and call for help (have 5mins)
Create space (empty bladder, large epsiotomy, etc)
McRobert maneuver + suprapubic pressure
(can also try wood’s screw or Ruben maneuver)

Question 17

Risk factors for Shoulder dystocia

Answer 17

Fetal macrosomia (>4,500g), previous shoulder dystocia, diabetes, Dystocia of labour, Post-dates, Obesity

Question 18

Complications of Shoulder dystocia

Answer 18

Neonatal brachial plexus damage - Klumpke (C8, T1) or Erbs (C5-C7) - limb, rotated arm and permenant damage in 2-5% of cases.

Question 19

McRoberts maneuver

Answer 19

Hyperflexing the hips to push the legs against the abdomen. If this doesnt work apply suprapubic pressure and pull on head gently. – effective in 42% of cases

Question 20

External Cephalic Version (ECV)

Answer 20

performed at 36wks - risk of fetal distress, abruption, cord accident, ROM. Best if frank and non-engaged,
May need tocolysis, anti-D or US guidence
Success rate 50%

Question 21

Breech Presentation

Answer 21

Buttocks first, (3-4% incidence at term). Can be frank (70%) where the legs are straight up by the head, complete (10%) where they are bent and footing (20%) where the feet are presenting.

Question 22

Vaginal Breech delivery

Answer 22

In most cases CS is performed because of the risks - vaginal delivery will be attempted if term frank breech, 2.5-3.5kg baby, no fetal distress, multiparous women, experienced operator and option for CS conversion.

Question 23

Contra-indications of ECV

Answer 23

Absolute - uterine anomaly

Relative - previous CS, IUGR, Twins, Labour, Oligohydramnios

Question 24

Smoking in pregnancy

Answer 24

20-30% of women smoke during pregnancy - decreases fertility, increased risk of preterm labour, spontaneous abortion, perinatal mortality, low birth weight infants (200g less for every 10 smoked/day)
Neonatal exposure is associated with SIDS, asthma, infections and ADHD

Question 25

Folate Supplementation in pregnancy

Answer 25

400mcg/day for all women - higher in unwell or generally shit women. particularly sickle cell women.

Question 26

IUGR vs SGA

Answer 26

Growth retardation of the fetus which mean dropping past centiles BUT SGA is below the 10th centile and is most commonly constituional

Question 27

Labetalol

Answer 27

an Alpha and Beta blocker so it should not be used in asthmatic patients because it can induce bronchospasm.

Question 28

Indometacin

Answer 28

An NSAID used to reduce fever, pain, swelling and stiffness. Can be used to delay premature labour, reduce fluid in polyhydramnios and close a PDA. Should be avoided if pt has HTN

Question 29

Atosiban

Answer 29

Oxytocin and vasopressin inhibitor used as a tocolytic in premature labour. used if >4 regular contractions/min, cervix 1-3cm or >50% effaced.
From 24-33wks gestation with a normal foetal HR

Question 30

Ritodrine

Answer 30

A B2 agonist tocolytic which has been discontinued

Question 31

Tocolytics

Answer 31

Nifedipine and atosiban delay birth up to 7days. They are generally preferred over ritodrine or Indometacin.