Obs

Question 1

What is Sheehan’s syndrome

Answer 1

Post partum pituitary gland necrosis
Caused from hypovolaemia shock-> ischaemia

Can’t lactate, hypothyroid adrenal insufficiency amenorrhoea

Low t4 tsh gonadotropin cortisol and acth

Question 2

What are the two types of pph

Answer 2

Primary - first 24hrs

Secondary - 24- 6weeks

Question 3

Grading of pph

Answer 3

Minor - 500-1000
Major moderate- 1-2
Major severe > 2

Question 4

Causes of pph

Answer 4

Tone: Uterine atony
Tissue: Retained products
Trauma: Long labour
Miltiparity 
Tear to cervix/ vagina / uterus 
Instruments 
Thrombus: Coagulopathy

Question 5

Management of pph

Answer 5

Access
Resus 
Drugs Oxytocin
External compression 
Backari ballon
Hysterectomy 
Internal iliac ligation 
Brace suture / b lynch

Question 6

Drugs used in pph

Answer 6

Oxytocin
Ergometrine
Carboprost
Misoprostol

Question 7

Causes of antepartum haemorrhage

Answer 7

Placental abruption
Placenta prévia
Local causes ( vulval/ vaginal/ cervix bleed)

Question 8

Define antepartum haemorrhage

Answer 8

24 weeks to prior to birth

Question 9

Grades of ante partum haemorrhage

Answer 9

Spotting
Minor haemorrhage <50mls
Major haemorrhage <1l
Massive >1l

Question 10

What is placenta previa

Answer 10

Insertion of the placenta into the lower uterine segment

Question 11

What is placenta abruption

Answer 11

Separation of the placenta from the uterus

Question 12

Define post partum cardiomyopathy

Answer 12

Occurs 1 month prior to 5 month post delivery
Diagnosis of exclusion
Heart failure secondary to lv systolic dysfunction
EF <45%

Question 13

Define pre eclampsia

Answer 13

HTN > 140 or >90
After 20 weeks
With protein : creat > 30

Question 14

What is severe pre eclampsia

Answer 14

Proteinuria + >160
Or
140 + features - headache, vomiting, papiloedena, clonus, low plts

Question 15

Define HELLP

Answer 15

Heamolysis
Elevated liver enzymes
Low platelets

Associated with pre eclampsia

Question 16

Pathophysiology of pre eclampsia

Answer 16

Abnormal implantation of the placenta and failure of the spiral arteries to dilate
Hypoperfusion of the placenta
Cytokinins release due to hypoxia
Increased vascular reactivity and activation of clotting cascade

Question 17

Define HELLP

Answer 17

Haemolysis, elevated liver enzymes and low platelets

Right upper quadrant pain
Low platelet, vomiting headache
High ldh, proteinuria

Question 18

Define acute fatty liver of pregnancy

Answer 18

Rare life threatening complication of the third trimester of pregnancy
Fatty infiltration of hepatocytes -> nausea vomiting abdominal pain ascites and jaundice

Question 19

Define intrahepatic cholestasis

Answer 19

Seen in the late second and third trimester with slowing of bile transit leading to itch, nausea, malaise and raised alt.