Obgyn T9-21 Flashcards

Question

11. What should be included in a complete physical examination during antenatal care?

Answer 1

A complete physical examination should identify any physical problems relevant to antenatal care. Key components include recording height and weight to calculate Body Mass Index (BMI) and measuring blood pressure in different positions.

Answer 2

Blood pressure should be measured with the patient supine and in the left lateral position to avoid vena cava compression by the gravid uterus. If measured sitting, it should be consistent across visits and on the same arm. This helps prevent supine hypotensive syndrome, which can lead to fetal compromise.

Answer 3

Benign flow murmurs due to hyperdynamic circulation are common and usually insignificant. Other murmurs should be evaluated by a cardiologist, as early identification of valvular pathology can affect management during pregnancy, labor, and postpartum.

Answer 4

The respiratory examination should assess the rate of respiration and use of accessory muscles. Identifying gross lung pathology early is crucial as it may adversely affect maternal and fetal outcomes.

Answer 5

Chloasma (brownish pigmentation) over the forehead and cheeks, particularly in sunlight exposure. Examination for pallor of mucosal surfaces and conjunctivae to check for anemia. Assessment of dental hygiene due to potential hypertrophic gingivitis. Some thyroid enlargement may occur but is usually not significant unless other thyroid disease signs are present.

Answer 6

Characteristic signs include: Enlargement in size and increased vascularity. Development of Montgomery's tubercles and increased pigmentation of the areolae. Routine breast examination is not indicated, but inquire about nipple inversion and look for any pathology in symptomatic women.

Answer 7

Common findings include: Stretch marks or striae gravidarum, which appear purplish initially and turn silvery-white in subsequent pregnancies. The linea alba may become pigmented (linea nigra), often persisting after the first pregnancy. Exclusion of hepatosplenomegaly and any evidence of renal enlargement. The uterus becomes palpable as an abdominal organ typically after 12 weeks of gestation.

Answer 8

The examination should include checking for: Hepatosplenomegaly and any signs of renal enlargement. Monitoring for changes such as striae gravidarum and the presence of the linea nigra.

Answer 9

As the abdomen expands, posture changes typically involve: Development of kyphosis and increased lumbar lordosis. The upper trunk is often thrown backward to compensate for the weight of the developing fetus. This can result in backache and sometimes sciatic pain.

Answer 10

Early Pregnancy: A speculum examination is indicated to assess any bleeding. Late Pregnancy: Pelvic examination is performed for cervical assessment, diagnosing labor, and confirming ruptured membranes.

Answer 11

Digital vaginal examination is contraindicated in cases of antepartum hemorrhage until placenta previa is excluded to prevent potential complications.

Answer 12

During pregnancy, the vaginal walls become: More rugous due to thickening of the stratified squamous epithelium and increased glycogen content. Purplish-red in appearance due to increased vascularity of the paravaginal tissues. There is also an increase in vaginal secretions and cervical mucus production.

Answer 13

The cervix undergoes several changes: It becomes softened and shows increased vascularity. There is oedema of connective tissues and hyperplasia/hypertrophy of cells. The glandular content of the endocervix increases, producing a thick plug of viscid cervical mucus that occludes the cervical os.

Answer 14

The false pelvis is the area above the iliopectineal line, while the true pelvis is below the pelvic brim and important for childbirth. The true pelvis consists of the sacrum, ischial bones, and pubic rami, among other structures.

Answer 15

The pelvic inlet (or brim) is important for childbirth and is defined by the sacral promontory, iliopectineal lines, and superior pubic rami. In a normal gynaecoid pelvis, this plane is nearly circular, being slightly wider transversely than anteroposteriorly.

Answer 16

The true conjugate is the anteroposterior diameter between the midpoint of the sacral promontory and the superior border of the pubic symphysis, measuring approximately 11 cm. It is the shortest distance and of greatest clinical significance for assessing pelvic dimensions related to childbirth.

Answer 17

Transverse (Interspinous) Diameter: The narrowest space in the pelvis, measuring approximately 10 cm. Anteroposterior Diameter: Also clinically assessed, along with palpating the ischial spines to estimate the interspinous diameter.

Answer 18

Record blood pressure and test urine for protein. Monitor maternal weight, which should increase by approximately 0.5 kg/week after 18 weeks. Note that rapid weight gain may indicate fluid retention, while static weight or loss may suggest failure of normal fetal growth.

Answer 19

Fundal Height Measurement: The fundus becomes palpable above the symphysis pubis at 12 weeks, reaches the umbilicus at 24 weeks, and is at the xiphoid process by 36 weeks. Symphysial-Fundal Height: Measured to assess fetal growth; should be approximately 20 cm at 20 weeks and increases by 1 cm/week.

Answer 20

Measure abdominal girth at the maternal umbilicus. No significant increase is noted until 24 weeks, after which it should increase by 2.5 cm weekly to reach approximately 100 cm at full term.

Answer 21

Fetal parts are typically not palpable before 24 weeks. Use dipping movements with finger flexion due to the presence of amniotic fluid. The lie of the fetus (relationship of the fetal long axis to the uterine long axis) is assessed through systematic palpation.

Answer 22

Longitudinal Lie: Head or breech palpable over the pelvic inlet. Oblique Lie: Fetal long axis at 45° to the uterus; presenting part palpable in the iliac fossa. Transverse Lie: Fetus lies at right angles to the mother; fetal poles are palpable in the flanks.

Answer 23

Fetal Head: Hard, round, discrete; can be ‘bounced’ and is described as ballotable; typically found in the lower abdomen or uterine fundus. Breech: Softer and more diffuse; not ballotable, making it distinguishable from the head.

Answer 24

Longitudinal Lie: Presenting part may be: Cephalic: Head presenting. Podalic: Breech presenting. Transverse Lie: Presenting part is the shoulder.

Answer 25

Vertex Presentation: Well-flexed head; area between anterior and posterior fontanelles presents. Face Presentation: Head fully extended; face presents to the pelvic inlet. Brow Presentation: Head partially flexed; brow (area between the base of the nose and anterior fontanelle) presents. Deflexed Head: Occipitofrontal diameter presents.

Answer 26

Vaginal Examination: Most accurate when the cervix is dilated, allowing palpation of suture lines and fontanelles. During Established Labor: This examination is most relevant when the mother is well into labor.

Answer 27

The position of the fetus describes the relationship of the denominator (presenting part) to the inlet of the maternal pelvis.

Answer 28

Presentation Denominator Vertex Occiput Face Chin (mentum) Breech Sacrum Shoulder Acromion

Answer 29

Left Occipito-Anterior (LOA) Right Occipito-Anterior (ROA) Left Occipito-Transverse (LOT) Right Occipito-Transverse (ROT) Left Occipito-Posterior (LOP) Right Occipito-Posterior (ROP)

Answer 30

Palpate the anterior shoulder of the fetus: If easily palpable near the midline, the position is anterior. If not easily palpable and limbs are prominent, the position is likely posterior.

Answer 31

Engagement: The greatest transverse diameter (biparietal diameter) of the head passes through the inlet of the true pelvis. Station: Refers to the position of the fetal head in relation to the ischial spines, which are zero station.

Answer 32

A small head may remain mobile even when engaged. A large head may be fixed at the pelvic brim but not yet engaged.

Answer 33

Method: Using a hand-held Doppler ultrasound device, confirmed with a Pinard fetal stethoscope. Location: Best heard below the level of the umbilicus over the anterior fetal shoulder or midline in posterior position. In breech presentation, heart sounds are best heard at the level of the umbilicus.

Answer 34

To ensure optimal health of the mother throughout pregnancy. To detect and treat disorders affecting both the mother and fetus. To promote a healthy outcome for both mother and infant.

Answer 35

The initial health and history influence the combination of screening tests, educational support, emotional support, and monitoring of fetal growth and maternal health throughout the pregnancy.

Answer 36

Timing is closely aligned with attendance for essential screening tests to monitor the health of the mother and fetus.

Answer 37

Immunization assessment for rubella, varicella, and pertussis. Serological tests if vaccination or infection history is uncertain. Seasonal administration of the influenza vaccine. Routine cervical cytology (Papanicolou smear) if due.

Answer 38

Folic Acid: 400 μg daily for at least 1 month before conception and the first three months of pregnancy to reduce neural tube defects. Higher doses (5 mg) for at-risk groups. Iodine: 150 μg daily in regions with dietary deficiency to aid fetal brain development.

Answer 39

Medications can be reviewed and optimized, with alterations or dose reductions as needed to ensure safety during pregnancy.

Answer 40

Reduces fetal growth and development. Increases perinatal mortality and low birth weight. Causes structural changes in the placenta affecting oxygen transfer due to carbon monoxide.

Answer 41

A syndrome caused by excessive alcohol intake during pregnancy. Features include growth retardation, structural defects, facial abnormalities, joint anomalies, and cardiac defects. Risk associated with consumption of 80 g of alcohol/day, often coupled with poor dietary intake.

Answer 42

Common drugs: heroin, amphetamines, cocaine, and marijuana. Risks include intrauterine growth restriction, perinatal death, and preterm labor. Many adverse effects are related to lifestyle choices and malnutrition.

Answer 43

Increased risk of miscarriage Preterm birth Growth restriction Placental abruption Fetal death in utero Developmental anomalies

Answer 44

Cardiac arrhythmias and CNS damage in mothers Placental abruption Fetal growth restriction Preterm labor

Answer 45

Haemoglobin concentration and full blood count: At first visit, then at 28 and 34 weeks. Haemoglobinopathies screening: Offered to at-risk racial groups (e.g., thalassaemia, sickle cell). Blood group and antibodies determination: In all pregnant women; Rh-negative women screened for Rh antibodies at the first visit and again at 28 weeks.

Answer 46

Around 15% of Caucasian women are Rh-negative and at risk of developing anti-D antibodies. These antibodies can cross the placenta and harm a Rh-positive fetus, leading to complications such as anemia, hydrops, jaundice, and fetal death.

Answer 47

Seronegative women should receive immunization with a live attenuated rubella vaccine in the immediate puerperium. Pregnancy should be avoided for 1 month following vaccination.

Answer 48

Routine screening is recommended. Non-specific tests include Wasserman reaction, VDRL, RPR; specific tests include TPI, FTA, and TPHA.

Answer 49

Universal screening for hepatitis B and C is performed. Passive and active vaccination for at-risk infants is recommended, which can protect infants from hepatitis B infection in 90% of cases.

Answer 50

Seropositive mothers can have seropositive babies, but it may not indicate active infection. Effective treatments to reduce transmission include caesarean section, avoidance of breastfeeding, and antiretroviral therapy for mothers and newborns.

Answer 51

GBS can be cultured from up to 25% of pregnant women and may cause UTIs. There is a risk of neonatal transmission during vaginal delivery, especially with preterm delivery or prolonged rupture of membranes. Intrapartum antibiotic treatment (IV penicillin) is recommended; screening occurs via vaginal swab at 34-36 weeks.

Answer 52

Asymptomatic bacteriuria screening is crucial because ascending UTIs can lead to pregnancy loss and preterm birth. Early treatment of asymptomatic bacteriuria reduces infection incidence and improves maternal health.

Answer 53

Screening programs may follow one of two pathways based on risk history: History of previous gestational diabetes or impaired glucose tolerance. First-degree relative with diabetes. Previous unexplained perinatal loss.

Answer 54

Stillbirth Macrosomic infant (birth weight > 4 kg) Maternal weight > 100 kg or BMI > 35 Repeated episodes of glycosuria Maternal age > 30 years

Answer 55

Perform a full glucose tolerance test (GTT) at booking visit and again at 28 weeks if there’s uncertainty. Universal screening at 26–28 weeks using a modified GTT with a 50 g loading dose; a blood glucose level > 7.7 mmol/L is considered positive.

Answer 56

Structural fetal anomalies account for 20–25% of perinatal deaths and about 15% of infant deaths in the first year of life. Congenital anomalies are associated with socioeconomic deprivation. Routine screening for trisomy 21 (Down syndrome) is conducted.

Answer 57

Avoid high-risk foods (e.g., soft cheeses, deli meats, salad bars). Total energy intake should be 2000–2500 kcal/day in the last two trimesters, increasing to 3000 kcal during lactation. Aim for daily protein intake of 60–80 g. Ensure adequate intake of essential fatty acids, carbohydrates, vitamins, and minerals (iron, calcium, iodine, magnesium, zinc).

Answer 58

Reasonable activity should be encouraged, particularly early in pregnancy. Limitations may arise due to physical changes in later pregnancy. No specific limitations on sporting activities unless contraindicated.

Answer 59

No contraindications for coitus in normal pregnancies. Avoid intercourse if there’s evidence of threatened miscarriage or a history of recurrent miscarriage. Women with placenta previa should avoid intercourse.

Answer 60

Encourage breastfeeding unless there are specific contraindications (e.g., certain medications, infections like HIV). Maintain good personal hygiene and breast care during the antenatal period. Support breasts with appropriate maternity bras, especially as colostrum may leak during the third trimester.

Answer 61

Previous breast damage or inverted nipples may complicate breastfeeding. Certain medications may be hazardous if concentrated in breast milk. Specific maternal infections, like HIV, contraindicate breastfeeding.

Answer 62

Hypertension in pregnancy is defined as: Systolic pressure of ≥140 mmHg, or Diastolic pressure of ≥90 mmHg on two or more occasions.

Answer 63

Proteinuria is defined as: Urinary protein concentrations >0.3 g/L in a 24-hour collection, or Concentrations >1 g/L in a random sample on two or more occasions, at least 6 hours apart

Answer 64

Oedema is characterized by: Development of pitting oedema, or Weight gain >2.3 kg in a week, commonly in the feet, ankles, fingers, abdominal wall, or face.

Answer 65

Gestational hypertension is: New onset of hypertension after 20 weeks of pregnancy or within 24 hours postpartum. No features of pre-eclampsia. Blood pressure usually returns to normal within 10 days after delivery and should normalize by 12 weeks postpartum.

Answer 66

Pre-eclampsia is: The development of hypertension with proteinuria after the 20th week of gestation. Commonly affects primigravida women.

Answer 67

Eclampsia is the development of convulsions as a result of pre-eclampsia.

Answer 68

Chronic hypertensive disease is hypertension that was present before pregnancy and may be due to various pathological causes.

Answer 69

Superimposed pre-eclampsia is the development of pre-eclampsia in a woman with chronic hypertensive disease or renal disease.

Answer 70

Arteriolar vasoconstriction, particularly affecting the uterus, placenta, and kidneys. Disseminated intravascular coagulation (DIC). Reduced sensitivity to angiotensin II. Placental damage leading to intrauterine growth restriction, abruption, and possibly fetal death.

Answer 71

Frontal headache Blurred vision Sudden vomiting Right epigastric pain

Answer 72

Swelling and proliferation of endothelial cells causing capillary obstruction. Hypertrophy and hyperplasia of mesangial cells. Deposition of fibrillary material on the basement membrane. Characterized by increased capillary cellularity and reduced vascularity.

Answer 73

Swelling and proliferation of endothelial cells causing capillary obstruction. Hypertrophy and hyperplasia of mesangial cells. Deposition of fibrillary material on the basement membrane. Characterized by increased capillary cellularity and reduced vascularity.

Answer 74

Proteinuria Reduced glomerular filtration rate Elevated serum creatinine Decreased renal blood flow Hyperuricaemia

Answer 75

Vasoconstriction between the radial artery and the decidual portion reduces uteroplacental blood flow, leading to placental hypoxia.

Answer 76

In DIC: Thrombosis occurs in the capillaries of many organs. Increased fibrin deposition and elevated fibrin degradation products result from increased fibrin production and impaired fibrinolysis.

Answer 77

HELLP syndrome is a severe variant of pre-eclampsia, characterized by: Haemolysis (H) Elevated Liver enzymes (EL) Low Platelet count (LP) It is an extension of DIC, leading to haemolysis, low platelets, and liver endothelial dysfunction.

Answer 78

HELLP syndrome is a severe variant of pre-eclampsia, characterized by: Haemolysis (H) Elevated Liver enzymes (EL) Low Platelet count (LP) It is an extension of DIC, leading to haemolysis, low platelets, and liver endothelial dysfunction.

Answer 79

Thrombocytopenia may rapidly progress and can cause haemorrhage into the brain and liver. Requires urgent intervention and termination of pregnancy once hypertension is controlled.

Answer 80

A rise in blood pressure (BP) is usually the first sign of gestational hypertension or pre-eclampsia.

Answer 81

More than 1+ proteinuria, or A spot urinary/creatinine ratio greater than 30 mg/mmol requires hospital admission.

Answer 82

More than 1+ proteinuria, or A spot urinary/creatinine ratio greater than 30 mg/mmol requires hospital admission.

Answer 83

If hypertension persists or is close to term, immediate delivery is advised unless it is deemed that the fetus would benefit from further time in utero.

Answer 84

Methyldopa (oral) Hydralazine (oral/IV) Labetalol (oral/IV) Prazosin (oral) Nifedipine (oral) Note: ACE inhibitors are contraindicated in pregnancy.

Answer 85

For acute hypertension control: IV bolus of Hydralazine 5 mg or Labetalol 20 mg.

Answer 86

Steroids like betamethasone 11.4 mg IM (2 doses 12-24 hours apart) are given to: Minimize neonatal complications such as respiratory distress syndrome (RDS), intraventricular haemorrhage, and necrotizing enterocolitis.

Answer 87

Blood pressure should be measured every 4 hours until it has returned to normal.

Answer 88

Dipsticks are used for regular checks for proteinuria.

Answer 89

Full blood count (particularly platelet count) Renal and liver function tests Uric acid measurements (for disease progression) Clotting studies (in severe pre-eclampsia) Catecholamine measurements (in severe hypertension)

Answer 90

Serial ultrasounds for fetal growth (every 2 weeks) and liquor volume (up to twice weekly) Doppler flow studies (up to twice weekly) for assessing vascular resistance in the umbilical and uterine arteries Antenatal CTG to monitor fetal heart rate and uterine activity

Answer 91

Induction is recommended when: Gestation > 37 weeks Uncontrollable blood pressure HELLP syndrome Deteriorating renal function (creatinine > 90 mmol/L) Eclampsia Acute pulmonary oedema

Answer 92

Fetal/placental indications for labor induction include: Fetal compromise on CTG Absent/reversed end-diastolic flow in the umbilical artery No fetal growth over more than 2 weeks Placental abruption

Answer 93

Fetal complications include: Growth restriction Hypoxia Fetal death

Answer 94

Maternal complications include: Renal, heart, and hepatic failure Intrahepatic hemorrhage Seizures DIC ARDS Cerebral infarction

Answer 95

Placental complications include: Infarction Abruption

Answer 96

Eclampsia is the onset of convulsions in a pregnancy complicated by pre-eclampsia.

Answer 97

Eclampsia risks include: Intrauterine fetal death Maternal death from cerebral hemorrhage, renal, or hepatic failure

Answer 98

Any pregnant woman with convulsions or in a coma with hypertension should be considered to have eclampsia until proven otherwise.

Answer 99

Magnesium sulphate is the drug of choice for controlling fits. It also reduces platelet aggregation and minimizes DIC effects.

Answer 100

Bolus dose: 4 g over 20 minutes as 20 mL of a 20% solution. Maintenance dose: 1 g/hour with 5 g in 500 mL solution running at 100 mL/h.

Answer 101

Therapeutic range: 2–4 mmol/L Loss of patellar reflexes: > 5 mmol/L Respiratory depression: > 6 mmol/L

Answer 102

Hydralazine (IV) is commonly used, with a 5 mg bolus dose repeated after 15 minutes if needed.

Answer 103

Intravenous labetalol, starting with a 20 mg bolus, followed by 40 mg and 80 mg, up to a total of 200 mg.

Answer 104

Epidural analgesia helps control blood pressure by causing vasodilation, reducing the tendency to fit by relieving pain in labor.

Answer 105

Delivery of the infant is the definitive treatment.

Answer 106

Management continues for up to 7 days after delivery.

Answer 107

Maintain the patient in a quiet environment under constant observation. Continue magnesium sulphate infusion for 24 hours after the last fit. Continue antihypertensive therapy until blood pressure returns to normal. Monitor fluid balance, blood pressure, and urine output hourly.

Answer 108

Haemorrhage from the vagina after the 24th week of gestation.

Answer 109

Based on whether the fetus is considered potentially viable.

Answer 110

1. Haemorrhage from the placental site and uterus: placenta praevia, placental abruption, uterine rupture. 2. Lesions of the lower genital tract: cervical ectropion/carcinoma, cervicitis, polyps, vulval varices, trauma, infection. 3. Bleeding from fetal vessels, including vasa praevia.

Answer 111

1. Unclassified/uncertain cause: 50% 2. Placenta praevia: 30% 3. Placental abruption: 20% 4. Vasa praevia: Rare.

Answer 112

A condition where all or part of the placenta implants in the lower uterine segment and lies beside or in front of the presenting part.

Answer 113

It is more common in multiparous women, in multiple pregnancies, and in women who have had a previous caesarean section.

Answer 114

Due to delay in the implantation of the blastocyst, causing it to implant in the lower part of the uterus.

Answer 115

1. Grade I: Placenta encroaches on the lower segment but not the internal cervical os. 2. Grade II: Placenta reaches the internal os. 3. Grade III: Placenta covers the cervical os, with some placental tissue in the upper segment. 4. Grade IV: Entire placenta is in the lower segment, with the central portion close to the cervical os.

Answer 116

Grade I or anterior Grade II often allows normal vaginal delivery. Posterior Grade II, Grade III, and IV usually require caesarean section due to obstruction or risk of bleeding.

Answer 117

Bleeding results from the separation of the placenta as the lower uterine segment forms and the cervix effaces, causing bleeding from venous sinuses in the uterine wall.

Answer 118

1. Painless vaginal bleeding. 2. Lower abdominal discomfort. 3. Malpresentation of the fetus. 4. Normal uterine tone.

Answer 119

1. Clinical findings: Painless bleeding and possible profuse haemorrhage if labour starts. 2. Ultrasound scanning: Transabdominal or transvaginal ultrasound is used to localize the placenta.

Answer 120

A vaginal examination should only be performed in an operating theatre prepared for caesarean section with blood cross-matched, and only when there is serious doubt about the diagnosis due to inadequate ultrasound facilities, and labour appears to have commenced.

Answer 121

Abruptio placentae is defined as haemorrhage resulting from premature separation of the placenta.

Answer 122

The term "accidental" implies separation as the result of trauma, but most cases occur spontaneously and do not involve trauma.

Answer 123

Risk factors include social deprivation, dietary deficiencies (especially folate deficiency), tobacco use, hypertensive disease, maternal thrombophilia, fetal growth restriction, and male fetus.

Answer 124

Trauma, such as motor vehicle accidents, falls, or blows to the abdomen, is a relatively uncommon cause of abruptio placentae.

Answer 125

The three clinical types of placental abruption are revealed, concealed, or mixed, with the classification made after delivery when the concealed clot is discovered.

Answer 126

Placental abruption presents with pain, vaginal bleeding of variable amounts, and increased uterine activity.

Answer 127

In severe cases, haemorrhage penetrates through the uterine wall, causing the uterus to appear bruised (Couvelaire uterus), with the uterus becoming tense, hard, and with a higher fundus than normal for gestational age.

Answer 128

The diagnosis is made based on the history of vaginal bleeding, abdominal pain, increased uterine tonus, and commonly, the presence of a longitudinal lie of the fetus.

Answer 129

Mild cases in preterm pregnancy (where the mother is stable and CTG is normal) may be treated conservatively, with ultrasound used to assess fetal growth and wellbeing, and to confirm the placental site.

Answer 130

The aim is to prolong the pregnancy if the maternal and fetal condition allows.

Answer 131

The first priority is the resuscitation of the mother, followed by addressing the fetal condition.

Answer 132

Intravenous infusion with normal saline, Hartmann’s solution, or blood substitutes should be started until blood is cross-matched and transfusion can be commenced.

Answer 133

Surgical induction is performed if the fetus is alive and close to term with no signs of fetal compromise, or if the fetus is dead.

Answer 134

Labour is induced at 37–38 weeks due to the increased risk of further abruption.

Answer 135

Afibrinogenaemia may occur, leading to DIC (disseminated intravascular coagulation). It is treated with infusion of FFP (fresh frozen plasma), platelet transfusion, and fibrinogen transfusion after delivery of the fetus.

Answer 136

Renal tubular or cortical necrosis can occur, making careful assessment of urinary output essential.

Answer 137

Vasa praevia is a rare condition where one of the branches of the fetal umbilical vessels lies in the membranes and crosses the cervical os, posing a risk of vessel rupture and rapid fetal exsanguination when the membranes rupture.

Answer 138

Vasa praevia is diagnosed with colour Doppler ultrasound during the fetal anatomy scan.

Answer 139

In nearly 50% of cases, the cause of antepartum haemorrhage is unexplained. Regardless of the cause, there is a significant increase in perinatal mortality, requiring close monitoring of placental function and fetal growth for the remainder of the pregnancy.

Answer 140

The pregnancy should not be allowed to proceed beyond term due to increased perinatal risks.

Answer 141

Vaginal moniliasis (yeast infection) or trichomoniasis can cause bloodstained discharge and should be treated with appropriate therapy once diagnosed.

Answer 142

Benign cervical polyps are treated by removal of the polyp.

Answer 143

Cervical erosions are best left untreated during pregnancy.

Answer 144

If carcinoma of the cervix is diagnosed early in pregnancy, termination is indicated, followed by staging of the cancer and definitive therapy.

Answer 145

When cervical carcinoma is diagnosed late in pregnancy, a biopsy should be performed, the baby delivered when mature, and the lesion treated based on staging, including caesarean section and radical hysterectomy for early-stage disease.

Answer 146

A pregnancy with twins, triplets, or higher is considered high risk due to the increased risk of maternal and fetal morbidity and mortality.

Answer 147

The prevalence of twin pregnancies in Europe is intermediate, with rates of 5–13 twin births per 1000 live births.

Answer 148

A monozygotic multiple pregnancy occurs when a single ovum results in multiple embryos, also known as uniovular or identical twins. This happens when the zygote divides after conception.

Answer 149

Monozygotic twins occur in approximately 1/280 pregnancies, unaffected by race but increased by reproductive technology.

Answer 150

0–4 days: 2 embryos, 2 amnions, 2 chorions (25–30%) 4–8 days: 2 embryos, 2 amnions, 1 chorion (65–70%) 9–12 days: 2 embryos, 1 amnion, 1 chorion (1–2%) 13+ days: Conjoined twins, 1 amnion, 1 chorion (<1%)

Answer 151

Monozygosity is determined by early ultrasound, preferably before 14 weeks of gestation.

Answer 152

Dizygotic twins result from the fertilization of two separate ova by two different sperm. They may have separate placentas or a single placenta with a thick membrane and typically display a "twin peak" sign.

Answer 153

Dizygotic twins occur in 50% male-female, 25% male-male, and 25% female-female combinations.

Answer 154

Factors influencing dizygotic twins include familial tendencies on the maternal side, increased parity and maternal age, and the use of ovulation-inducing drugs such as gonadotrophin therapy.

Answer 155

Monochorionic diamniotic twins may have placental vascular anastomosis, leading to complications like twin-to-twin transfusion syndrome.

Answer 156

Complications include increased total weight gain, anaemia due to expanded plasma volume, maternal cardiac output increased by 20%, nausea, vomiting, and the vanishing twin syndrome (resorption of a twin).

Answer 157

Vanishing twin syndrome refers to the resorption of one fetus between 6 and 10 weeks of gestation, occurring in over 15% of twin pregnancies.

Answer 158

Twin pregnancies have an increased incidence of gestational hypertension, pre-eclampsia, and eclampsia.

Answer 159

IUGR occurs in 20% of twin pregnancies, where one fetus is significantly smaller than the other, defined by a difference in abdominal circumference of more than 20%.

Answer 160

The most important complication of twin pregnancy is preterm labour, which occurs before 37 weeks in over 40% of twin pregnancies.

Answer 161

TTTS occurs in 10-15% of monochorionic diamniotic twin pregnancies. The donor twin becomes oliguric and growth-restricted with oligohydramnios, while the recipient has polyhydramnios and is at risk for cardiomegaly and hydrops fetalis.

Answer 162

Treatment options for TTTS include serial amniocenteses to remove fluid, selective feticide, or laser ablation of communicating vessels via fetoscopy. Laser treatment has a survival rate of 49-67%.

Answer 163

The survival rate for monoamniotic twins is around 50%, with cord entanglement by 22 weeks being a common complication.

Answer 164

Conjoined twinning is rare, with fusion occurring at different sites on the bodies of the fetuses.

Answer 165

Management includes treating antenatal complications as in singleton pregnancies but with earlier and more frequent interventions, regular ultrasounds every 2–4 weeks, and early induction if intrauterine growth restriction (IUGR) is detected.

Answer 166

The commonest presentation is cephalic/cephalic (50%), followed by cephalic/breech (25%), breech/cephalic (10%), and breech/breech (10%).

Answer 167

Delivery methods include caesarean section and vaginal delivery. Labour duration is similar to singleton labour, with careful monitoring of both twins and checking the presentation of the second twin immediately after the first is delivered.

Answer 168

An oxytocin infusion should be started if the uterus does not contract within a few minutes.

Answer 169

If fetal heart rate anomalies occur, delivery should be expedited by forceps or breech extraction.

Answer 170

Higher-order multiple births, like triplets or quadruplets, are delivered by caesarean section due to preterm labour, low birth weights, and uncertain presentations.

Answer 171

Locked twins occur when the first twin is breech and the second is cephalic, resulting in their chins locking during descent. This requires an urgent caesarean section for survival.

Answer 172

The most common cause of perinatal mortality in twins is prematurity, with over 50% of twins and 90% of triplets delivering before 37 weeks.

Answer 173

Second-born twins are more likely to die from intrapartum asphyxia due to placental separation after the first twin is delivered or cord prolapse in cases of malpresentation or a high presenting part.

Answer 174

The risk of cerebral palsy is 8 times greater in twins and 47 times greater in triplets compared to singleton pregnancies.

Answer 175

A vertical incision may be preferred if there is an obstructed transverse lie, to avoid extending into the uterine vessels and broad ligaments, which could cause uncontrollable haemorrhage.

Answer 176

The incidence of breech presentation decreases from 16% at 32 weeks to 3-5% at term.

Answer 177

The three types of breech presentation are: 1. Frank breech (legs extended along the fetal trunk, buttocks presenting) 2. Flexed breech (legs flexed at hips and knees, sitting on feet) 3. Footling/knee presentation (one or both lower limbs descend through the cervix).

Answer 178

Hazards include: Increased risk of cord compression or prolapse Entrapment of the head behind the cervix Risk of intracranial hemorrhage Trauma to fetal viscera (e.g., rupture of spleen or gut).

Answer 179

In preterm infants, the bitrochanteric diameter of the breech is smaller than the biparietal diameter of the head, leading to head entrapment if the cervix is incompletely dilated.

Answer 180

ECV is the manual rotation of a breech fetus to a cephalic presentation, indicated when breech presentation persists after 36 weeks gestation.

Answer 181

Contraindications include a history of antepartum hemorrhage, placenta praevia, abnormal CTG, previous uterine scar, and multiple pregnancy.

Answer 182

The technique involves the mother lying supine with a slight tilt, confirming presentation and placental position with ultrasound, monitoring fetal heart rate, administering tocolytics, and manually rotating the fetus.

Answer 183

Tocolytic agents, such as nifedipine or terbutaline, relax the uterus and improve the success rate of External Cephalic Version (ECV).

Answer 184

Risks of ECV include cord entanglement, placental abruption, rupture of membranes, and persistent fetal bradycardia (occurring in 1% of cases), which may necessitate urgent delivery by caesarean section.

Answer 185

Delivery by caesarean section is preferred for fetuses with an estimated weight exceeding 4 kg, especially in cases of breech presentation.

Answer 186

Steps in vaginal breech delivery include: 1. Encouraging the mother to push until fetal buttocks and anus are visible. 2. Performing an episiotomy if needed. 3. Lifting the fetal legs out of the vagina by flexing the hips and knees. 4. Delivering the trunk and ensuring the fetal back remains anterior. 5. Delivering the arms using the Loveset’s maneuver. 6. Allowing the trunk to remain suspended for 30 seconds to facilitate head engagement. 7. Grasping and swinging the legs upwards to deliver the head.

Answer 187

Suspending the trunk allows the fetal head to enter the pelvis, facilitating easier delivery of the head.

Answer 188

Caesarean section is indicated when: Fetal weight is less than 1.5 kg or greater than 4 kg. Footling presentation or deflexed head on ultrasound. Lack of expertise in vaginal breech delivery. Additional complications like pre-eclampsia, placental abruption, placenta previa, or previous caesarean section.

Answer 189

Caesarean section is the preferred method of delivery for very-low-birth-weight infants presenting as breech, as their narrower buttocks and trunk may lead to head entrapment during vaginal delivery.

Answer 190

Loveset’s maneuver is the technique of rotating the fetus’s body to deliver the extended arms during a breech delivery by flexing the elbow and shoulders.

Answer 191

The head may become entrapped during delivery due to the narrower buttocks and trunk of very-low-birth-weight infants unless an adequate uterine incision is made during caesarean section.

Answer 192

An unstable lie is one that is constantly changing.

Answer 193

Common conditions associated with an unstable lie include multiparity (lax maternal abdominal wall), low placental implantation, uterine anomalies (e.g., bicornuate uterus, uterine fibroids), and polyhydramnios.

Answer 194

Complications include cord prolapse, shoulder presentation with a prolapsed arm, and compound presentation (both an arm and a leg may present).

Answer 195

No action is required until 37 weeks gestation unless labor starts spontaneously.

Answer 196

An ultrasound scan should be done to check placental localization, the presence of pelvic tumors, and fetal abnormalities.

Answer 197

After 37 weeks, external cephalic version should be attempted to correct the lie.

Answer 198

The mother should be admitted to hospital after 39 weeks in case spontaneous rupture of membranes occurs, to allow rapid delivery by caesarean section if necessary.

Answer 199

The three approaches are: 1. Keep the mother in hospital and await spontaneous correction or correct the lie at labor onset. 2. Perform stabilizing induction by correcting the lie to cephalic, rupturing membranes, and starting oxytocin infusion. 3. Deliver by caesarean section at term.

Answer 200

Delivery should be performed by caesarean section.

Answer 201

Minor complaints of pregnancy are symptoms that do not cause significant medical problems and are often related to physiological adaptations of the body to pregnancy.

Answer 202

Women should be reassured that minor complaints represent normal pregnancy changes, once pathology has been excluded.

Answer 203

Common physiological causes of abdominal pain during pregnancy include stretching of abdominal ligaments and muscles, pressure of the gravid uterus on abdominal contents, and constipation.

Answer 204

Pathological causes include ectopic pregnancy, miscarriage, ovarian torsion, urinary tract infections, appendicitis, pancreatitis, placental abruption, and labor.

Answer 205

Domestic abuse should be considered as a social cause.

Answer 206

Heartburn is more common due to delayed gastric emptying, reduced lower oesophageal sphincter pressure, and raised intragastric pressure.

Answer 207

Heartburn affects up to 80% of pregnant women, especially in the third trimester.

Answer 208

Differential diagnoses include angina, myocardial infarction, muscular pain, pre-eclampsia, acute fatty liver of pregnancy, and gallstones.

Answer 209

Dietary advice to avoid spicy/acidic foods, not eating before bed, and changing sleeping position to a more upright posture can help alleviate heartburn.

Answer 210

Antacids, histamine-receptor blockers (e.g., ranitidine), and proton pump inhibitors are safe to use during pregnancy.

Answer 211

Constipation in pregnancy is caused by elevated progesterone levels slowing colonic motility and pressure from the uterus on the rectum.

Answer 212

Women should increase fluid and dietary fiber intake. Most laxatives are safe in pregnancy and can be used if conservative management is ineffective.

Answer 213

Severe constipation can cause an unstable lie by preventing the fetal head from descending into the pelvis.

Answer 214

Backache is caused by pressure from the gravid uterus leading to exaggerated lumbar lordosis and hormonal effects on soft tissues.

Answer 215

Differential diagnoses include urinary tract infection, pyelonephritis, and early labor.

Answer 216

Physiotherapy for posture and exercises, and simple analgesics like paracetamol or codeine (avoid aspirin and NSAIDs).

Answer 217

Progesterone causes vasodilation, leading to postural hypotension and syncope, with additional risk from caval compression by the gravid uterus.

Answer 218

Lying supine should be avoided to reduce caval compression and supine hypotension.

Answer 219

Anaemia, hypoglycaemia, dehydration, and arrhythmias should be excluded in cases of recurrent syncope.

Answer 220

Varicosities are caused by pressure on the pelvic veins from the gravid uterus, reducing venous return from the lower limbs, combined with the progestogenic effect that relaxes vascular smooth muscle.

Answer 221

Thrombophlebitis and deep vein thrombosis should be excluded if varicosities are painful.

Answer 222

Elevating the legs while sitting or lying, and using compression stockings can improve symptoms.

Answer 223

Heparin prophylaxis may be considered if severe varicosities are present along with other risk factors for venous thromboembolism.

Answer 224

Carpal tunnel syndrome occurs or worsens due to fluid retention caused by increased capillary permeability in pregnancy.

Answer 225

Wrist splints that reduce wrist flexion are the main treatment for carpal tunnel syndrome during pregnancy.

Answer 226

Steroid injections can be used in severe cases of carpal tunnel syndrome and are safe during pregnancy.

Answer 227

Pelvic girdle dysfunction is caused by raised relaxin levels that increase joint mobility, allowing pelvic expansion for birth, which can be exaggerated in some women causing discomfort.

Answer 228

Characteristic symptoms include pain on walking or standing and tenderness over the pelvic ring.

Answer 229

Urinary tract infection should be excluded in cases of anterior pain.

Answer 230

Physiotherapy for exercises to improve stability, techniques for minimizing daily activity symptoms, and positions for birth, along with simple analgesics, can help alleviate symptoms.

Answer 231

Yes, pelvic girdle dysfunction usually resolves after pregnancy.

Answer 232

Anaemia is common due to an increase in plasma volume and red cell mass, leading to a ‘physiological anaemia,’ along with increased iron and folate demand for fetal development and red cell mass expansion.

Answer 233

Iron deficiency anaemia occurs due to the increased demand for iron and folate in pregnancy, especially in the third trimester, to support the mother's red cell mass and the fetus.

Answer 234

Pre-pregnancy risk factors include poor diet, menorrhagia, short intervals between pregnancies, and pre-existing anaemic conditions like sickle cell disease, thalassaemia, and haemolytic anaemia.

Answer 235

Risk factors within pregnancy include multiple pregnancy due to the increased iron demand.

Answer 236

Symptoms include shortness of breath and lethargy. Anaemia is diagnosed with haemoglobin levels less than 11 g/dL in the first trimester and less than 10.5 g/dL in the second and third trimesters.

Answer 237

Mild anaemia usually does not affect the fetus, but severe anaemia increases the risk of preterm birth, low birth weight, and iron deficiency in the baby during the first year of life.

Answer 238

Maternal implications include fatigue, reduced work performance, increased susceptibility to infections, and a strong association between severe anaemia and maternal mortality.

Answer 239

Oral iron supplementation is the first-line treatment, best absorbed with ascorbic acid, avoiding tea and coffee during ingestion.

Answer 240

Compliance is poor due to side effects such as constipation and gastric irritation.

Answer 241

Parenteral iron may be considered, and routine iron supplementation and dietary changes are recommended for prevention.

Answer 242

Gestational diabetes is a common antenatal condition affecting 2–9% of pregnancies.

Answer 243

Gestational diabetes is caused by pregnancy-induced insulin resistance, driven by placental production of anti-insulin hormones (HPL, glucagon, and cortisol), and increased maternal glucocorticoids and thyroid hormones.

Answer 244

Risk factors include previous large infant (over 4.5 kg), previous gestational diabetes, first-degree relative with diabetes, obesity (BMI over 30 kg/m²), or booking weight over 100 kg.

Answer 245

A 75 g oral glucose tolerance test (OGTT) should be offered to women with one or more risk factors for gestational diabetes.

Answer 246

Gestational diabetes may be asymptomatic. Screening is done with a 75 g OGTT at 28 weeks, or earlier in the second trimester if high risk, and repeated at 28 weeks if the first test is normal.

Answer 247

Gestational diabetes increases the risk of recurrent infections and pre-eclampsia for the mother.

Answer 248

Fetal risks include polyhydramnios, macrosomia (related to glucose control), stillbirth, and admission to the neonatal unit due to neonatal hypoglycaemia.

Answer 249

Women with gestational diabetes are more likely to need induction of labour, have a caesarean section, and experience complications like shoulder dystocia, instrumental delivery, and extended perineal tears during vaginal birth.

Answer 250

Neonatal hypoglycaemia is caused by the over-activity of the fetal pancreas in response to maternal glucose crossing the placenta while insulin does not.

Answer 251

Management includes dietary measures focusing on low glycaemic index foods, use of metformin or glibenclamide to reduce insulin need, and insulin if needed to maintain glucose control (4.0-6.0 mmol/L fasting, 6.0-8.0 mmol/L post-prandial).

Answer 252

Delivery at term is recommended to reduce the risk of stillbirth.

Answer 253

Blood glucose should be regularly measured during labour to reduce the risk of neonatal hypoglycaemia.

Answer 254

The main concern is the high risk of vertical transmission of HIV from mother to baby, which can be up to 45% without medical intervention.

Answer 255

With medical intervention, including HAART, caesarean section, and avoiding breastfeeding, the risk of vertical transmission can be reduced to less than 2%.

Answer 256

Complications include miscarriage, fetal growth restriction, prematurity, and stillbirth.

Answer 257

Women on HAART with viral loads less than 400 copies/mL can deliver vaginally, as the risk of vertical transmission is very low.

Answer 258

Management includes regular viral load and CD4 count monitoring, anti-HIV medications (e.g., zidovudine monotherapy or HAART), caesarean section, and avoiding invasive procedures like amniocentesis and fetal scalp blood sampling.

Answer 259

Pregnancy does not usually change the course of an acute hepatitis infection, although HBV carriers may experience reactivation, and HCV may accelerate disease progression.

Answer 260

The main concern is the risk of transmission to the neonate, particularly with HAV in the last few weeks of pregnancy or perinatally with chronic HBV and HCV.

Answer 261

Vertical transmission is not reduced by caesarean delivery or avoiding breastfeeding. Vaginal delivery is advocated with avoidance of interventions that may increase blood contact.

Answer 262

Hepatitis B immunization can be offered before pregnancy, and babies of hepatitis B-infected mothers can be treated with hepatitis B immunoglobulin and early hepatitis B immunization.

Answer 263

12–30% of pregnant women with bacteriuria will develop pyelonephritis, often due to ascending infection caused by structural and immune changes in the renal tract.

Answer 264

Acute pyelonephritis in pregnancy is usually caused by Escherichia coli. Most community-acquired infections are sensitive to amoxicillin or cefuroxime.

Answer 265

Pregnancy increases coagulation factors, reduces endogenous anticoagulants, and suppresses fibrinolysis, leading to a prothrombotic state. These effects start in the first trimester and last until a few weeks after birth.

Answer 266

Pre-existing risk factors include a personal or family history of VTE, thrombophilias, obesity, cigarette smoking, gross varicose veins, and increased maternal age.

Answer 267

Transient risk factors for VTE include episodes of immobility, dehydration, ovarian hyperstimulation, and surgical procedures.

Answer 268

Obstetric risk factors for VTE include multiple pregnancy, pre-eclampsia, and operative delivery.

Answer 269

Symptoms include swelling and tenderness of a leg, shortness of breath, pleuritic chest pain, and collapse. DVT is more likely to occur on the left due to compression of the left common iliac vein.

Answer 270

Most DVTs in pregnancy occur in the ileofemoral veins, where lower limb symptoms may be less obvious.

Answer 271

Management includes postnatal prophylaxis with elastic compression stockings and low molecular weight heparin (LMWH). Warfarin is avoided due to its risks to the fetus.

Answer 272

Risk factors include certain ethnicities and a past history of obstetric cholestasis. Diagnosis is confirmed by elevated bile acids or liver transaminases after excluding other causes.

Answer 273

Intense itching, especially on the palms of the hands and soles of the feet, usually in the second or third trimester. Rarely a rash, but excoriation marks are present.

Answer 274

It can cause debilitating pruritus, prolong blood clotting time, and slightly increase the risk of stillbirth and preterm birth due to early induction. The recurrence rate is over 90%.

Answer 275

Management includes topical emollients, antihistamines, ursodeoxycholic acid to improve symptoms, and oral vitamin K supplementation.

Answer 276

Risk factors include first pregnancy, multiple pregnancy, and obesity.

Answer 277

Symptoms include nausea, vomiting, abdominal pain, general malaise, and jaundice in the third trimester. It can lead to rapid deterioration with liver failure, renal impairment, and coagulopathy.

Answer 278

It is associated with high maternal and fetal mortality. Management is initially supportive to correct abnormalities, with expedited delivery once the mother is stable. Dialysis or liver transplantation may be required postnatally.

Answer 279

The incidence of pre-existing diabetes in pregnancy is around 0.4%. The majority of these women have type 1 diabetes, while those with type 2 tend to be older and more obese.

Answer 280

Placental hormones have anti-insulin effects, resulting in a larger insulin requirement in pregnancy, sometimes up to threefold. These changes revert to pre-pregnancy levels within hours of birth.

Answer 281

Complications include an increased risk of congenital abnormalities (neural tube defects, congenital heart disease), hypoglycemia, accelerated progression of retinopathy and nephropathy, fetal loss, and fetal macrosomia.

Answer 282

Women with HbA1c levels above 10% have up to a 25% chance of a fetal abnormality.

Answer 283

Management includes achieving an HbA1c level less than 6.1% before conception, continuing insulin therapy, stopping ACE inhibitors, taking a higher periconceptual folic acid dose (5 mg), and fetal assessments for abnormalities and growth patterns.

Answer 284

Delivery is usually recommended at around 38-39 weeks, with vaginal birth often planned, but caesarean section rates are high.

Answer 285

Pregnancy increases oestrogen, leading to increased thyroid-binding globulin (TBG) and thyroid hormone production. There is also a fall in TSH levels and maternal iodine due to increased renal loss, resulting in thyroid gland enlargement.

Answer 286

Hypothyroidism increases the risk of spontaneous abortion, pre-eclampsia, hypertension, postpartum hemorrhage, low birth weight, and slightly reduced IQ in infants. However, it does not increase the risk of congenital malformations.

Answer 287

Management includes performing thyroid function tests every trimester and adjusting thyroid replacement therapy as T4 levels fall. Neonatal surveillance is needed for possible neonatal thyroid dysfunction due to transplacental transmission of thyroid antibodies.

Answer 288

Untreated iodine deficiency can lead to poor fetal outcomes, including miscarriage, stillbirth, neonatal death, and congenital abnormalities like cretinism.

Answer 289

Approximately 95% of hyperthyroidism cases in pregnancy are due to Graves' disease. It is diagnosed by finding elevated T4 and T3 levels along with decreased TSH levels.

Answer 290

Untreated hyperthyroidism can lead to thyroid crisis, heart failure, pre-eclampsia, fetal growth restriction, prematurity, stillbirth, and neonatal thyrotoxicosis.

Answer 291

Management includes thyroid function testing every 4-6 weeks, adjusting therapy as needed, using safe antithyroid medications, serial fetal growth measurements, regular fetal heart rate assessments, and possibly a prolonged postnatal hospital stay to monitor the neonate for signs of thyrotoxicosis.

Answer 292

Obesity increases the risk of miscarriage, congenital abnormalities (especially neural tube defects), venous thromboembolism, preeclampsia, gestational diabetes, stillbirth, fetal macrosomia, childhood obesity, and neonatal death. It also increases the likelihood of caesarean section and postpartum hemorrhage.

Answer 293

Obese women are more likely to require induction of labor, experience poor progress in labor, and have a caesarean section. If vaginal birth occurs, there is a higher risk of shoulder dystocia and extended perineal tears.

Answer 294

Management includes hospital-based care, folic acid supplementation until 12 weeks, assessing for pre-eclampsia and venous thromboembolism risk factors, aspirin use as needed, and a glucose tolerance test in the late second trimester to screen for gestational diabetes.

Answer 295

Thrombophilia refers to a predisposition to blood clots and can be heritable or acquired. It is associated with an increased risk of venous thromboembolism and obstetric complications like fetal loss, pre-eclampsia, placental abruption, and fetal growth restriction.

Answer 296

Antiphospholipid syndrome, the most common acquired thrombophilia, is associated with adverse pregnancy outcomes, including venous thromboembolism, fetal loss, and pre-eclampsia.

Answer 297

Antiphospholipid syndrome is characterized by adverse pregnancy outcomes, including recurrent miscarriage, fetal death, and premature birth, secondary to placental disease.

Answer 298

Screening is recommended for women with a personal or family history of venous thromboembolism, or a poor obstetric history such as recurrent miscarriage, stillbirth, early-onset pre-eclampsia, or placental abruption.

Answer 299

Management includes antenatal and postnatal low molecular weight heparin (LMWH), avoiding dehydration, and using graduated compression stockings.

Answer 300

Epilepsy affects approximately 1% of the obstetric population. Seizure frequency is usually unchanged but may increase due to non-compliance with medication or sleep deprivation.

Answer 301

Epilepsy increases the risk of congenital abnormalities (3% compared to 1-2% in the general population), perinatal loss, and fetal loss due to tonic-clonic seizures or status epilepticus.

Answer 302

Carbamazepine and lamotrigine are considered safest. Sodium valproate should be avoided due to risks of congenital abnormalities, including neural tube defects and long-term neurodevelopmental issues.

Answer 303

Management includes continuing medications, adjusting them if needed, and avoiding abrupt cessation. A 5 mg dose of folic acid is recommended in the first trimester to reduce neural tube defect risk, and vitamin K can be given to reduce the risk of hemorrhagic disease in the newborn.

Answer 304

Pregnancy increases cardiac output, which can worsen conditions like aortic stenosis. Risks include congestive heart failure, hypoxia, arrhythmias, sudden death, bacterial endocarditis, venous thromboembolism, angina, myocardial infarction, and aortic dissection.

Answer 305

Maternal cardiac disease increases the risk of pre-eclampsia, intrauterine growth restriction, preterm birth, fetal loss, and congenital heart disease in offspring (up to 5%).

Answer 306

For women with Eisenmenger’s syndrome, pregnancy may not be advised due to an extremely high maternal death rate (40-50%). The increased cardiac demand in pregnancy can cause severe complications, and management focuses on minimizing stressors like anemia and infection.

Answer 307

Management includes altering medications, possibly requiring anticoagulation, regular fetal surveillance with serial growth scans and screening for cardiac defects, and maternal monitoring via echocardiograms. Pain management and fluid balance are crucial during labor.

Answer 308

SLE increases the risk of early miscarriage, stillbirth, early-onset pre-eclampsia, intrauterine growth restriction, preterm birth, and venous thromboembolism. These risks are higher in women with lupus nephritis or antiphospholipid syndrome.

Answer 309

Infants are at risk for neonatal lupus and congenital heart block due to maternal SLE, especially if antiphospholipid syndrome coexists.

Answer 310

Pregnancy should be delayed until at least six months after an SLE flare. Low-dose aspirin and LMWH may be used, particularly when antiphospholipid syndrome is present. Immunosuppressive therapy can continue if necessary, and labor is usually induced at 37–38 weeks to reduce thrombotic complications.

Answer 311

Pregnancy can cause deterioration in renal function, which may or may not recover postpartum. Risks to the pregnancy include increased chances of pre-eclampsia, fetal growth restriction, preterm birth, and cesarean section.

Answer 312

Management includes baseline assessment of renal function, blood pressure, and proteinuria. Low-dose aspirin from 12 weeks helps reduce the risk of pre-eclampsia. Blood pressure and renal function are closely monitored, and growth scans are done in the third trimester. Prophylactic heparin may be required for women with proteinuria.

Answer 313

Polycystic kidney disease poses an inheritance risk to the baby. For renal transplant patients, most immunosuppressive drugs are safe during pregnancy, but careful monitoring is essential.

Answer 314

Women with renal calculi are at higher risk of urinary tract infections, which should be treated for longer periods. Management includes fluid loading, alkalinization of urine, pain relief, and avoiding lithotripsy during pregnancy.

Answer 315

Women with renal calculi are at higher risk of urinary tract infections, which should be treated for longer periods. Management includes fluid loading, alkalinization of urine, pain relief, and avoiding lithotripsy during pregnancy.