obs and gyn

Question 1

what are indications for the induction of labour?

Answer 1

• intrauterine growth retardation
• premature rupture of membranes
• pre eclampsia
• suspicious ctg
• post dates

Question 2

what are the causes of post partum haemorrhage?

Answer 2

• tone (uterine atony)
• trauma
• tissue (retention of placental tissue) eg via placenta accreta or too much traction
• thrombin (coagulopathies)

Question 3

what is involved in the active management of third stage of labour/

Answer 3

• IM oxytocin
• cord clamping and cutting
• controlled cord traction

Question 4

what are risk factors for pph

Answer 4

• c section
• previous pph
• pre eclampsia
• macrosomia
• placenta accreta and placenta praevia
• prolonged labour
• increasing maternal age
• drugs eg ritodrine
• polyhydramnios

Question 5

what is placenta accreta

Answer 5

when the placenta invades into the myometrium

Question 6

how do you treat PPH

Answer 6

• lie flat. ABCDE . O2?
• IV access, ergometrine 500mcg or Syntocinon IV
• IM carboprost
• Group and save, FBC, clotting
• consider iV fluids, blood transfusion
• apply uterine pressure , consider need for cathetre or theatre

Question 7

what are the mechanisms of labour?

Answer 7

engagement, descent, neck flexion, internal rotation , neck extension, external rotation (restitution),

Question 8

how do you manage varizella exposure in pregnancy

Answer 8

if there is any doubt as to whether the patient has been exposed to varizella then do Varizella immunoglobulin test ASAP
if not immune- needs Varizella IG ASAP
-if she has a rash then oral aciclovir should be given

Question 9

risks of varizella infection in pregnancy

Answer 9

to mum - risk pneumonitis

to baby- risk of fetal varizella syndrome

Question 10

downs syndrome screening/ testing

what are the components

Answer 10

11-13 weeks : combined test .
this involves nuchal translucency, Beta HCG, pregnancy associated protein A
If misses this, then a woman can have the quadruple test at 14 weeks which looks at HCG, unconjudgated estradiol, PAPPA and inhibin A

This result will then give the likelihood of having a baby with downs /edwards/pataus . This can be high > 1 in 150 chance

then she will be offered CVS or Amniocentesis , which take place at 14 and 15 weeks respectively
these both carry a 0.5-1% risk od miscarriage