OBGYN

Question 1

Definition of preeclampsia/eclampsia

Answer 1

After the 20th gestational week
Preeclampsia: BP > 140/90 mmHg
Proteinuria > 300mg/24 hours
Eclampsia: Tonic-clonic seizures

Question 2

Gestational diabetes

Answer 2

Done in all pregnancies, screen at 24-28w
Fasting glucose < 5.6mmol/l: Healthy
Fasting glucose 5.6-7.0mmol/l: Do OGTT
Fasting glucose > 7.0mmol/l on two separate
measurements: DM

Question 3

Indications for C-section

Answer 3

M/F: Cephalopelvic disproportion or Failed induction of labor
Maternal:
- Eclampsia
- Cervical cancer
- Fibroids, tumor
- Herpes
Fetal: Non-reassuring fetal HR (bradycardia)
- Cord prolapses
- Malpresentation
- Multiple gestations
- Fetal abnormalities - Hydrocephalus
Placental: Previa
- Abruptio

Question 4

US in pregnancy

Answer 4

0 (6-7w) = Confirm (gestational sac, HR)
Location: Intra-/extrauterine
Twins
I (11-13w) = Congenital malformations
Nuchal translucency (Down’s)
Neural tube defects
Biometrics
II (18-20w) = Congenital malformations
Genetics
III (30-31w) = IUGR
Late congenital malformations
IV (36-38w) = Fetal presentation
Fetal weight
Info for delivery

Question 5

Placenta abruptio / placenta previa

Answer 5

Use hands to palpate the uterus
Abruptio: Painful, hard uterus - C-section
Previa: Painless, CTG normal

Question 6

Post-partum haemorrhage

Answer 6

Tissue: Retained placenta
Trauma: Vaginal lacerations
Thrombin: Coagulopathy (DIC)
Tone: Uterine atony (exclude other causes)

Question 7

Stages of birth

Answer 7

1. Onset of labor: Longest stage
   a. Latent (3cm)
   b. Active (3-10cm)
2. Baby: 30-90mins
   a. Propulsive phase (full dilation, descend to pelvic floor)
   b. Expulsion phase (ends with delivery of baby)
3. Placenta: 5-30mins, separation
   a. Expulsion of placenta
   b. Expulsion of membranes
4. Recovery: 2 hours, after expulsion of placenta
   a. Increased risk of bleeding
   b. Repair lacerations
   c. RhoGAM

Question 8

Techniques of C-section

Answer 8

Abdominal wall: Transverse (Pfannenstiel)/Vertical (Midline)
Uterus: Lower segment incision (Transverse) / Classical (Vertical)

Question 9

Pearl index

Answer 9

No. of pregnancies in 100 females/year with chosen contraceptive.
OCP: 0.1-2.5
Post-coital pill: 0.5-2.5
IUD: 0.5-5
Condom: 3-28
Sterilization: 0.3-6

Question 10

Routine exams

Answer 10

Routine exams
Colposcopy
Cytology
Bimanual exam
Breast exam

Question 11

Long-term OCP use

Answer 11

Good:
Decrease ovarian/endometrial cancer
Decrease bone loss
Decrease dysmenorrhea
Decrease acne
Decrease risk of trisomies in high maternal age
Regulates cycle

Bad:
Increase DVT/stroke
Increase BP
Increased Weight
Depression

Question 12

Endometriosis

Answer 12

Endometrial-like tissue outside the uterine cavity.
Dx: Gold standard –> Laparoscopic visualization
Tx:
Surgery
Drugs: Pseudopregnancy, Pseudomenopause: GnRH analogue

Question 13

Urinary incontinence

Answer 13

Irritative: Urinalysis - Cystitis/tumor/foreign body
Stress: Loss of bladder support - Cough
Urge: Hypertonic - increased detrusor (Tx: Anticholinergics)
Overflow/neurogenic: Hypotonic w/ dribbles (Tx: Cholinergics)

Question 14

Main vaginal infections

Answer 14

Bacterial vaginosis
Trichomonas
Mycosis (Candida)
Condyloma

Question 15

Spontaneous abortion

Answer 15

Hx: Pain + bleeding
Dx: Cervix, US, hCG

Question 16

Contraindications to tocolysis

Answer 16

Obstetric:
- Severe abruption
- Ruptured membranes
- Chorioamnionitis
Fetal:
- Lethal anomaly
- Fetus is already dead
- Fetal jeopardy
Maternal:
- Eclampsia
- Advanced dilation

Question 17

Leopold maneuvers

Answer 17

1. Fundal grip = Palpate upper abdomen with both hands
2. Umbilical grip = Palpate to localize fetal back. One palm to fix, while the other explores one side then change.
3. Pelvic grip (1st pelvic grip) = Determine what fetal part is lying above the inlet. Grasp lower portion of abdomen just above the pubic symphysis with thumb and fingers of the right hand.
4. Pawlick grip (2nd pelvic grip) = Face woman’s feet, attempt to locate fetus’ brow. Fingers of both hands moved gently down the sides of the uterus - Pubis. The side where there is resistance to the descent of the fingers is greatest where the brow is located.

Question 18

Stopping uterine bleeding

Answer 18

Young: Progesterone to preserve fertility
Old: D&C

Question 19

Mayer-Rokitansky-Küster-Hauser Syndrome

Answer 19

Fancy word for Müllerian agenesis.
- Congenital malformation
- Failure of Müllerian duct to develop
o Missing uterus, cervix, vagina
o Variable degree of upper vaginal hypoplasia (shortened)
- Causes 15% of primary amenorrhea
- Ovaries intact, ovulation usually occurs
- Will enter puberty and have secondary sexual characteristics

Question 20

Pap smear

Answer 20

P0: Improper sample
P1: Negative, superficial cells on slide
P2: Superficial cells and WBCs
P3: Unsure
P4: Atypical cells - Suspect malignancy
P5: True malignancy

Question 21

Bethesda

Answer 21

Reporting cervical or vaginal cytological Pap smear results.
Important steps:
1. Quality of the slide
2. Whether the result is positive or negative
3. Details of the slide (types of cells, LSIL/HSIL)
4. Physician recommendation of how to proceed

Question 22

Prenatal care

Answer 22

Starts before conception

Question 23

Puerperium

Answer 23

Period beginning immediately after the birth of a
child extending for ~ 6w.

Answer 24

Statistics
Neonatal Mortality Rate: No. of neonatal deaths
during the 1st month/1,000 live births.
Early NMR: 1st week
Late NMR: 2-4th weeks
Perinatal Mortality Rate: No. of perinatal deaths
(stillbirths + neonatal deaths, from 22nd gestational
week to 7th week postpartum)/1,000 total births.