Medical Problems in Pregnancy

Question 1

What happens to the risk of transmission of toxoplasmosis and CMV infections as pregnancy progresses?

Answer 1

Increases

Question 2

What happens to the consequences of infection with toxoplasmosis and CMV as pregnancy progresses?

Answer 2

They become less severe

Question 3

Parvovirus infection in pregnancy only causes foetal complications before what gestation?

Answer 3

20 weeks

Question 4

Rubella infection in pregnancy only causes foetal complications before what gestation?

Answer 4

16 weeks

Question 5

Herpes infection is most likely to cause foetal complications if primary infection takes place when?

Answer 5

Third trimester

Question 6

Infection with toxoplasmosis, especially within the first 10 weeks of pregnancy, is most associated with what complication?

Answer 6

Miscarriage

Question 7

Is there an increased risk of miscarriage with varicella-zoster infection in pregnancy?

Answer 7

No

Question 8

What is the most significant foetal complication of maternal parvovirus infection?

Answer 8

Hydrops foetalis

Question 9

Maternal rubella infection in pregnancy causes the child to develop which type of hearing loss?

Answer 9

Sensorineural

Question 10

Hepatosplenomegaly is most likely to be a foetal feature of which TORCH infection in pregnancy?

Answer 10

CMV

Question 11

Screening for which infections in pregnancy should be carried out after ultrasound detection of congenital anomalies and severe growth restriction?

Answer 11

TORCH infections

Question 12

Women who are known to be HIV positive undergo what monitoring in pregnancy?

Answer 12

Viral load and CD4 count at least once every trimester

Question 13

A positive test for which type of antibody is diagnostic for recent infection with a TORCH organism?

Answer 13

IgM

Question 14

What pattern of IgG serology would confirm the acute disease with a TORCH organism?

Answer 14

Increasing titre

Question 15

What investigations can be used to determine if there is foetal infection with a TORCH organism after the mother has tested positive?

Answer 15

Amniocentesis for PCR or culture

Question 16

What investigation is required to screen for complications of TORCH organisms in foetuses with proven infection?

Answer 16

Serial ultrasound scans

Question 17

In women with pre-existing HIV on anti-retroviral therapy, should this therapy be continued in pregnancy?

Answer 17

Yes

Question 18

In women with pre-existing HIV not on anti-retroviral therapy, when should this be started in pregnancy?

Answer 18

By 24 weeks

Question 19

How should pregnant women with HIV and a viral load of < 50 RNA copies/ml at 36 weeks gestation be delivered of their babies?

Answer 19

Vaginal delivery

Question 20

How should pregnant women with HIV and a viral load of > 50 RNA copies/ml at 36 weeks gestation be delivered of their babies?

Answer 20

C-section

Question 21

Is breastfeeding advised in women with HIV?

Answer 21

No

Question 22

What medication is used to suppress lactation post-natally in women with HIV?

Answer 22

Cabergoline

Question 23

Anti-virals can be used when in pregnancy for women with hepatitis B and a high viral load?

Answer 23

Third trimester

Question 24

Is there any safe drug treatment for hepatitis C in pregnancy?

Answer 24

No

Question 25

Does the mode of delivery affect the transmission of hepatitis?

Answer 25

No

Question 26

Is breastfeeding advised for women with hepatitis?

Answer 26

Yes

Question 27

What additional medication do babies born to hepatitis B positive mothers receive within 12 hours of delivery?

Answer 27

Hepatitis B vaccine and a dose of hepatitis B immunoglobulin

Question 28

After a baby born to a hepatitis B positive mother has received the first dose of hepatitis B vaccine at delivery, when should the other doses be given?

Answer 28

At 1 and 6 months of age

Question 29

How are women with a primary infection of herpes simplex in pregnancy treated?

Answer 29

Aciclovir from 36 weeks

Question 30

How are women with a recurrence of herpes simplex in pregnancy treated?

Answer 30

No treatment is required

Question 31

What additional management must be put in place, in addition to aciclovir, for women with a primary infection of herpes simplex in the third trimester?

Answer 31

C-section

Question 32

How should women with recurrent herpes simplex infection in pregnancy be advised to deliver their baby?

Answer 32

Vaginally

Question 33

Does mode of delivery have any effect on transmission of TORCH organisms?

Answer 33

No

Question 34

Does breastfeeding have any effect on transmission of TORCH organisms?

Answer 34

No

Question 35

What advice is given regarding weight in pregnancy for women with a BMI > 30?

Answer 35

They should aim for a weight neutral pregnancy

Question 36

What prophylactic medications should be offered to all women with obesity in pregnancy?

Answer 36

5mg folic acid, 10mcg vitamin D, 75mg aspirin

Question 37

What investigation is used in obese pregnant women to detect early miscarriage, screen for foetal anomalies and assess growth of the foetus?

Answer 37

Ultrasound

Question 38

What maternal conditions should be screened for in obese pregnant women?

Answer 38

Pre-eclampsia and gestational diabetes

Question 39

What medication is used to reduce the risk of VTE in obese women with additional risk factors?

Answer 39

LMWH

Question 40

Women with a BMI > 40 should receive what extra prophylaxis against VTE?

Answer 40

Heparin injections for at least 1 week after delivery

Question 41

A first seizure in pregnancy is due to what until proven otherwise?

Answer 41

Eclampsia

Question 42

What effect does pregnancy have on seizure frequency in women with epilepsy?

Answer 42

No effect

Question 43

Which anti-epileptic drug has the highest risk of foetal abnormalities?

Answer 43

Sodium valproate

Question 44

Generally, should anti-epileptic drugs be continued in pregnancy?

Answer 44

Yes

Question 45

If sodium valproate absolutely has to be used in pregnancy, what is done to try to reduce the risk of teratogenicity?

Answer 45

Split into multiple daily doses

Question 46

How long should women with epilepsy take folic acid supplements for?

Answer 46

From pre-conception, all through pregnancy

Question 47

Women with epilepsy taking liver enzyme inducing drugs should also taken which other medication and from what gestation?

Answer 47

Vitamin K from 36 weeks

Question 48

Is epilepsy an indication for C-section?

Answer 48

No

Question 49

Epileptic seizures can be triggered in labour by pain, anxiety and sleep deprivation. What can be given to try and reduce this risk?

Answer 49

Epidural

Question 50

What type of cardiomyopathy is peri-partum cardiomyopathy?

Answer 50

Dilated

Question 51

When can peri-partum cardiomyopathy occur?

Answer 51

The last month of pregnancy and 6 months after delivery

Question 52

Pregnancy is contraindicated in women with what cardiovascular complication due to the mortality rate being so high?

Answer 52

Pulmonary hypertension

Question 53

In general, what happens to symptoms of cardiovascular disease in pregnancy?

Answer 53

They worsen

Question 54

What 3 investigations are required to assess maternal wellbeing in pregnant women with cardiovascular disease?

Answer 54

ECG, ECHO, exercise testing

Question 55

What 3 investigations are required to assess foetal wellbeing in babies of women with cardiovascular disease?

Answer 55

Ultrasound, genetic testing, growth scans from 28 weeks

Question 56

What is used for thromboprophylaxis in pregnant women with metallic heart valves?

Answer 56

High-dose heparin

Question 57

What mode of delivery is preferred for women with cardiovascular disease?

Answer 57

Vaginal

Question 58

How is oxytocin given to women with cardiovascular disease?

Answer 58

Low-dose infusions

Question 59

What medication, often used in labour, is contraindicated in women with pre-existing cardiovascular disease due to the risk of hypertension causing MI and pulmonary oedema?

Answer 59

Ergometrine