Maternity

Question 1

Dating ultrasound when?

Answer 1

7-12 weeks

Question 2

Dating ultrasound when?

Answer 2

7-12 weeks

Question 3

When to order prenatal genetic testing ?

FTS

Answer 3

11-14 weeks

Question 4

Anatomic US when ?

Answer 4

18-22 weeks

Question 5

When is GDM screening ?

Answer 5

All women 24-28 weeks

Question 6

When do you screen for GBS ?

Answer 6

35-37 weeks

Question 7

How often should you feel fetal movement ?

Answer 7

At least 6 movements in 2 hours,
If you don’t should contact HCP

There isn’t any definition of normal fetal movement l, women need to be made aware of what is normal for their baby and what to do if fetal decreases or changes in their baby’s environment

Question 8

Screening for GDM with what? How is diagnosis made?

Answer 8

50g OGTT at 24-28 weeks

If abnormal needs to follow with 75g OGTT

Diagnosis is made:
FBG >5.3mmol/L
1hr >10.6 mmol/L
2hr > 9.0 mmol/L

Question 9

What’s the alternative approach to GDM rather than the 50g OGTT

Answer 9

75g OGTT

FBG >5.1
1hr >10
2hr > 8.5

If one value is met or exceeded then GDM

Question 10

If you are diagnosed with GDM when should you screen for T2DM ??

Answer 10

Within 6 weeks - 6months of giving birth

Then Q3year depending on risk factors

Question 11

Anti D vaccine should be given when and for who ?

Answer 11

28 weeks gestation for Rh negative non sensitized women when fetal blood type is unknown or to be Rh positive

Question 12

What are the Rh vaccines ?

Answer 12

300 mcq dose x1 at 28 weeks to Rh negative mothers

Alternatively 2 doses 100-120 mcq at 28 weeks then one at 34 weeks

Question 13

First line agent trichomoniasis in pregnant asymptomatic patients

Answer 13

Treatment is not recommended

Treat all cases and their sexual partners regardless of symptoms

Question 14

First line agent trichomoniasis in pregnant symptomatic patients

Answer 14

Metronidazole 2g in a single dose (any stage of pregnancy)

Alternative is metro 500mg PO BID x 7 days

Treat all cases and their sexual partners regardless of symptoms

Question 15

First line treatment for asymptomatic bacterial vaginosis in pregnancy

Answer 15

treatment is unnecessary unless high risk (prior preterm delivery), prior to IUD insertion, gynaecological surgery, induced abortion, or upper tract instrumentation

Question 16

First line for symptomatic BV in pregnancy

Answer 16

Metronidazole 500mg BID orally for 7 days

Metronidazole 0.75% gel , one applicatorful vaginally once nightly for 5 days

• some people would avoid using oral metro in first trimester
• in first and second trimester of pregnancy, topical metronidazole can be used instead of oral. The applicator should not be used after 7th month of pregnancy
• oral is recommended in 3rd trimester

Test of cure 1 month after

topical clindamycin has been associated with adverse outcomes in newborn, if needed only use oral clindamycin

Question 17

First line treatment for asymptomatic vulvovaginal candidiasis

Answer 17

Treatment is unnecessary

Question 18

First line treatment for vulvovaginal candidiasis in symptomatic pregnant patients

Answer 18

Topical antifungals #1

Clotrimazole 1% one applicatorful intravaginally daily for 6 days

Miconazole 2% one applicatorful intravaginally daily for 7 days

Male partners do not need to be treated unless there is candida balanitis

Question 19

First line for Cervicitis in pregnancy and non pregnant individuals

Does it need to be reported ?

Answer 19

Must be reported for medical officer of health

All sex partners should be evaluated if they had sexual contact with the patient during the 60 days preceding the onset of symptoms

S/S= inflammation of the cervix with mucopurulent or purulent cervical discharge

Usually co-exists with vaginitis (Trichomonias)

Probable organisms are chlamydia and gonorrhoea

Non pregnant:
Cefixime 400-800mg single dose
+
Azithro 1g single dose
Or
Doxy 100mg BID x 7 days

Pregnant:
Cefixime 400-800mg single dose
If allergic to penicillin then Azithromycin or erythromycin can be used instead

Question 20

Herpes simplex virus (genital) in pregnancy first line treatment for first episode

Answer 20

Acyclovir 200mg 5 times daily

Or

400mg TID x 5-10 days

A first outbreak in the first trimester constitutes a higher risk for perinatal transmission than does recurrent infection and warrants treatment

If occurs later in trimester consider C-section

Question 21

PID in pregnancy

Answer 21

Uncommon but suspected cases should be hospitalized

All cases should be reported to PHU if confirmed with gonococcal // all partners should be treated

S/s - lower abdominal pain of recent onset, heavy menstruation , vaginal bleeding, deep dyspareunia, vaginal discharge that is unexplained, lower abdominal tenderness, cervical motion tenderness, adnexal tenderness on bimanual exam, Cervicitis, fever

Question 22

PID in pregnancy

Answer 22

Uncommon but suspected cases should be hospitalized

All cases should be reported to PHU if confirmed with gonococcal // all partners should be treated

S/s - lower abdominal pain of recent onset, heavy menstruation , vaginal bleeding, deep dyspareunia, vaginal discharge that is unexplained, lower abdominal tenderness, cervical motion tenderness, adnexal tenderness on bimanual exam, Cervicitis, fever

Question 23

Syphillis infection in pregnancy

Answer 23

Penicillin regimen
Bacillin L-A 2.4 million units IM x single dose

Consider a second dose 1 wk later if pt is pregnant

Question 24

HPV or anogenital warts

Answer 24

HPV infections may be refractory during pregnancy and many specialists recommend removing them in pregnant women

Goal of treatment is to relieve symptoms only

Cryotherapy could be done

All meds are cytotoxic

Question 25

A G2P1 patient presents for an initial prenatal visit at 12 weeks’ gestation. The patient’s blood type is O negative. Which of the following is the best course of action for this patient?

A.Plan delivery via cesarean section
B.Check an antibody screen and, if positive, administer RhoGAM
C.Check an antibody screen and, if negative, recheck at 28 weeks
D.Plan on administering RhoGAM when the patient is 72 hours post partum

Answer 25

Answer: C. Check an antibody screen and, if negative, recheck at 28 weeks

If the patient is Rh negative, the most appropriate course of action is to check an antibody screen. If the screen is negative, it means there has been no alloimmunization, and RhoGAM can be given in the third trimester. If the antibody screen is positive, alloimmunization has occurred and the patient needs to be referred to maternal–fetal medicine. RhoGAM is given post partum if the neonate is found to be Rh positive.

Question 26

A G2P1 patient presents for an initial prenatal visit at 12 weeks’ gestation. The patient’s blood type is O negative. Which of the following is the best course of action for this patient?

A.Plan delivery via cesarean section
B.Check an antibody screen and, if positive, administer RhoGAM
C.Check an antibody screen and, if negative, recheck at 28 weeks
D.Plan on administering RhoGAM when the patient is 72 hours post partum

Answer 26

Answer: C. Check an antibody screen and, if negative, recheck at 28 weeks

If the patient is Rh negative, the most appropriate course of action is to check an antibody screen. If the screen is negative, it means there has been no alloimmunization, and RhoGAM can be given in the third trimester. If the antibody screen is positive, alloimmunization has occurred and the patient needs to be referred to maternal–fetal medicine. RhoGAM is given post partum if the neonate is found to be Rh positive.

Question 27

When do you do a test of cure for chlamydia and gonorrhea infections in pregnancy?

Answer 27

1-2 weeks after completion of therapy

If NAAT test is used , no earlier than 3-4 weeks post treatment

Question 28

Which vaccines should be given for pregnant women

Answer 28

RH- =28 weeks gestation

Influenza - during influenza season

TDAP = 27-32 weeks (every pregnancy)

MMR = if not immune after pregnancy

Question 29

TORCH infections

Answer 29

T-toxoplasmosis
O- other agents (treponema palladium, VZV, parvovirus? HIV)
R- rubella
C- cytomegalovirus
H-HSV