MedEd Mx Guide

Question 1

How often do you perform vag exam in normal labour in first stage vs second stage

Answer 1

1st stagee: every 4 hours

2nd stage: every hour

Question 2

what ways can you prevent preterm labour if the mother is high risk of PTL

Answer 2

Vaginal prigesterone

Cerclage

Question 3

what are indications for offering ONLY vaginal progesterone to prevent PTB

Answer 3

cervical length <25mm on TVUSS (16-24 wks)

no other relevant hx

Question 4

when would you ONLY offer prophylactic cerclage

Answer 4

cervical length <25mm on TVUSS (16-24 wks)

AND

Prior PTB/Cervical trauma

Question 5

When would you offer the alternative between vag progesterone or cerclage?

Answer 5

cervical length <25mm on TVUSS (16-24 wks)

and PTB/midtrimester loss (16-34)

Question 6

when would you offer a rescue cerclage

Answer 6

cervical dilation WITHOUT contractions at 16 to 27+6 gestation

Question 7

what are the two key tocolytics you can give in PTB

Answer 7

Nifedipine (CCB, first line)

Atosiban (oxytocin receptor antagonist, second line)

Question 8

whata is the maternal corticosteroid that you give if concerned about preterm birth

Answer 8

IM betamethasone 24mg in 2 doses, 12 hours apart

Question 9

what dose of Vit D do you give in pregnancy

Answer 9

10micrograms OD throughout

Question 10

What dose of folic acid to you give and when

Answer 10

400micrograms

from 3 months pre conception to 12 weeks gestation

Question 11

what conditions require the higher dose of folic acid (5mg)

Answer 11

Diabetes 
BMI>30
coeliac
sickle cell 
prior pregnancy with neural tube defect 
metabolic defect

Question 12

when would you do a OGTT if required?

Answer 12

16 weeks

Question 13

How do you manage toxo in a pregnant woman

Answer 13

Spiramycin (3 week course)

if foetal infection confirmed, discuss

• TOP
• continuing pregnancy but with more aggressive tx (sulfadiazine, pyrimethamine)

Question 14

How do you manage a non-immune woman exposed to VZV

Answer 14

Administer IVIG if presenting max 10 days after contact

• advise tyo avoid contact with other pregnant woomen and neonates (infectious for 21 days after exposure if no VZIG, 28 days if VZIG)

Question 15

How do you manage chicken pox infection ( active rash) in pregnant woman

Answer 15

Oral acyclovir if within 24h from rash onset
Avoid contact with other pregnant women until lesion crustedover
Refer to foetal medicine speciaalist

Question 16

When should you give VZIG in a neonate

Answer 16

If birth is within 7 days of onset of rash

OR

if mother develops chicken pox within 7 days of delivery

Question 17

How do you manage labour in a monther with HIV

Answer 17

DEPENDS ON VIRAL LOAD

• virl load <50copies / ml: vaginal
• viral load >50 compies / ml: Elective CS with intrapartum zivodudine

Question 18

how do you tret PN period in infant born to motger with HIV

Answer 18

ALL infants myst be started on HRT within 4 h from virth

• low risk: ZIVODUDINE monotherapy 2-4 weeks
• high risk: Triple ART (Zivodudine, lamivudine, nevirapine) 4 weeks

Question 19

How do you check for HIV transmission in neonate

Answer 19

Direct viral amplification by PCR

• at birth
• on discharge
• 6 weeks
• 6 months

Question 20

How do you manage Hep B infection in pregnant mum

Answer 20

Refer to hepatologist

Offer Tenofovir if high HBV viral load

Question 21

How do you manage PN period in Hep B infection

Answer 21

Offer HBV Ig and Hep B immunisation to newboorn

Question 22

Can mothers breastfeed if Hep B infected?

Answer 22

Yes - no risk of it passing through breastmilk

Question 23

How often do you need to monitor LFTs, bile acids, Doppler and CTG in OC

Answer 23

LFT, bile acids: x1 weekly

Doppler, CTG: x2 weekly

Question 24

what are risk factors for molar pregnancy

Answer 24

extremes of maternal age
prior molar pregnancy
prior miscarriage
asian heritage

Question 25

what is a whiff test used for

Answer 25

BV- add solution to see if fishy odour appens