Obs and Gynae

Question 1

What are the principles of Fraser competence? Specifically with 14 year old and sexual intercourse

Answer 1

• The girl should be encouraged to discuss the issue with parents or guardian
• The girl should consent to sex, understand the implications of sex and contraception
• The girl will continue to have sex without intercourse even if contraception is not given and thus is at risk of great harm.
• The age of the partner–> child protection

Question 2

What should be done before hormonal contraception is started in a 14 year old girl who has had unprotected sex?

Answer 2

Pregnancy test, STI screen. Discuss the various methods of contraception and issues with compliance

Question 3

What proportion of vaginal deliveries are successfyk after a caesarian?

Answer 3

70%, emergency caesarian section rate is30%. 1 in 200 risk of uterine rupture (scar dehiscence)

Question 4

If women have previously had a C section, what is not recommended? How should the women be managed?

Answer 4

Pregnancy augmentation. Managed with cardiotocograph monitoring, IV access available and group and save done.

Question 5

What number of C sections does a women need to have to mean that a c section is the only option available for subsequent pregnancies?

Answer 5

2

Question 6

What are c sections associated more with relative to vaginal delivery?

Answer 6

Thrombosis, haemorrhage, infection and visceral damage. Mobility and ability to care for the child are also more impaired by caesarian section

Question 7

What is itching in pregnancy often due to?

Answer 7

Obstetric cholestasis

Question 8

What are Braxton Hicks contractions?

Answer 8

Prodromal labour “practice contractions”

Question 9

What is obstetric cholestasis due to?

Answer 9

A build up of serum bile acids. THis is due to reduced intra hepatic excretion of bile from the liver.

Question 10

When does obstetric cholestasis usually occur?

Answer 10

During the 3rd trimester

Question 11

What needs to be considered in extreme obstetric cholestasis?

Answer 11

HELLP syndrome and deranged liver and clotting function or gallstones.

Question 12

What is raised in the LFTs of Obstetric cholestasis? How else should the lady be investigated?

Answer 12

Bile salts. LIver ultrasound

Question 13

With obstetric cholestasis, what is there an increased risk of?

Answer 13

Still birth

Question 14

How is obstetric cholestasis managed?

Answer 14

Symptomatically with the anti histamine chlorpheniramine. In severe cases ursodeoxycholic acid that reduces bile acids. Give vit K orally to reduce the risk of maternal or foetal haemorrhage due to impaired absorbtion.

Question 15

What post natal advice would you give a lady with obstetric cholestasis?

Answer 15

Liver function should return to normal after pregnancy but there is risk of recurrence in future pregnancies and starting the OCP