Obs dead station CCT

Question 1

A woman with bicornuate uterus got pregnant.
1. What is the embryological defect that causes a bicornuate uterus?
2. What is the associated abnormality and how will you confirm it?
3. Give THREE possible complications of bicornuate uterus in pregnancy.

Answer 1

1. Mullerian anomaly in which the proximal portion of the paramesonephric ducts do not fuse (while the distal segment fuses normally into the lower uterine segment, cervix and upper vagina)
2. 20-30% of Mullerian anomalies are associated with renal anomalies eg: duplex / horseshoe / unilateral renal agenesis / pelvic kidney; confirmed with transabdominal ultrasound
   Cervical insufficiency is associated with bicornuate uterus; confirm by transvaginal ultrasound
3. Spontaneous miscarriage, preterm labour, malpresentation, foetal growth restriction

Question 2

The mother comes at 37 week and the fetus found to be in breech presentation.

1. What mode of delivery will you advice to her? Explain your rationale. (3 marks)
2. If she has another pregnancy in future, what advice will you give her? (1 marks)

Answer 2

1. Ultrasound examination to exclude foetal anomalies and placenta praevia.
   C/S is recommended – LSCS as 38-39 weeks.
   Vaginal delivery is high risk in breech presentation and ECV is relatively contra-indicated in bicornuate uterus
2. Attend antenatal check-ups as advised to ensure complications are detected as early as possible for prevention, and to seek medical attention earlier if problems arise (eg: any abnormal PV bleeding or abdominal pain).

Question 3

33 yo woman at 38 week gestation, previously given birth to a 1.3kg baby at gestational week 32 due to pre-eclampsia, by LSCS. This time during her antenatal period she was given medicine A. Her BP is 160/90 and proteinuria +++
1. What is medicine A and what’s its use?
2. What blood test would you perform? (2 marks)
3. After admission she developed symptoms of headache? Baby was in breech position. What medication would you give and what is its use? (2mark)
4. After giving the medication in question 3, what clinical parameters you have to monitor? (4 marks)
5. The symptoms resolved and BP went down after given the medication. What mode of delivery do you suggest?
6. If she suddenly developed abdominal pain, what are the 2 DDX that you have to look for?

Answer 3

1. Low dose aspirin to prevent pre-eclampsia
2. CBC (thrombocytopenia), LFT, RFT (elevated creatinin, urate due to risk of AKI + serum urate level, clotting profile. T&S since she may need emergency LSCS
3. MgSO4, anticonvulsive therapy to prevent eclampsia in patients with severe pre-clampsia
4. Tendon reflexes (loss of patellar reflex: withhold MgSO4), respiratory rate (<16 per min –> withhold MgSO4), BP (+pulse), urine output (<30ml/hour –> withhold MgSO4)
5. C section
6. Placental abruption (preeclampsia is a RF), uterine rupture (previous LSCS)