Obs + Gynae

Question 1

Components of Triple test?

Answer 1

Beta-hCG, AFP, unconjucated oestradiol

Question 2

Components of combined test?

Answer 2

Nuchal tranluscency
PAPP-A
AFP

Question 3

Window for combined test?

Answer 3

10-13w.

Question 4

Components of quadruple test?

Answer 4

AFP, unconjugated oestradiol (UE3), beta-hCG, Inhibin A

Question 5

Difference in false results in quadruple test v combined test?

Answer 5

Quadruple test: 4.4% false positive

Combined test: 2.2% false positive

Question 6

What should be offered to mothers BMI>30 at booking?

Answer 6

Preconception advice: 5mg folic acid
Vitamin D 10mg OD
Postnatal LMWH for 7d (+ antenatal LMWH if moderate risk)
Screening for diabetes (OGTT)
Active management of 3rd stage of labour
Aspirin after 12w if moderate risk of pre-eclampsia

Question 7

Glucose tolerance test abnormal result

Answer 7

2h plasma glucose 7.8mmol/l or above = diagnosis of GDM

Question 8

Booking bloods for infection?

Answer 8

Syphilis, HIV, Hep B, rubella.

Question 9

What is placental adhesion to uterine wall without extension though full myometrium?

Answer 9

Placenta accreta

Question 10

What is placental adhesion through full myometrium, but not beyond?

Answer 10

Placenta increased

Question 11

What is placentation fully through myometrium and into surrounding structures?

Answer 11

Placenta percreta

Question 12

Causes of postpartum haemorrhage

Answer 12

Tone
Trauma
Tissues (e.g. Placenta not fully out)
Thrombin

Question 13

What is asherman’s syndrome?

Answer 13

Placentation into site of uterine scar

Question 14

Worrying causes of PV bleeding in pregnancy (to rule out):

Answer 14

Placenta praevia
Vasa praevia
Abruption

Question 15

how to distinguish placenta praevia v abruption v vasa praevia?

Answer 15

Placenta praevia: painless PV bleeding.
Abruption: tender, woody uterus
Vasa praevia: rare. Use apt test on PV blood.

Question 16

Management of known placenta praevia + small PV bleed. 30w

Answer 16

Assess foetal condition: CTG, movements 
Assess maternal condition: BP, HR, etc.
Small bleeds can precede big bleeds
Do USS to assess placental location
IV access, group + save (2-4 units). Steroids if bleed again.

Question 17

Management of 37w with PV bleed

Answer 17

Assess foetal + maternal stability
If stable: ?double set up exam - is there placenta praevia
If so: C-section
If not: rule out local causes and then manage as abruption.

Question 18

Causes of oligohydramnios?

Answer 18

Increased absorption/loss of fluid: premature rupture of membranes.
Decreased production:
-congenital renal anomalies/ACEi exposure
-uteroplacental insufficiency: abruption, pre-eclampsia, post-mature
-others: congenital infection, Neural tube defects, TTTS, NSAIDs

Question 19

Causes of polyhydramnios?

Answer 19

Idiopathic (50-60%)
Maternal: isoimmunisation (immune hydrops), diabetes mellitus
Foetal 10-15%: non-immune hydrops; multifoetal gestation; structural anomalies (foetal DI, GI obstruct, defective swallowing)
Placental: placental chorioangioma (rare)

Question 20

Outcome of oligohydramnios?

Answer 20

Increased perinatal morbidity and mortality at any gestation.
Complications: amniotic band syndrome; MSK deformities (club foot)

Question 21

Outcomes of polyhydramnios?

Answer 21

Increased maternal morbidity, increased perinatal morbidity and mortality.
Complications: maternal SOB/refractory oedema in legs/vulva. Foetal malpresentation, dysfunctional labour, PPH.

Question 22

How to measure amniotic fluid volume?

Answer 22

(Fundal height)
Maximal vertical pocket: single deepest pocket free of umbilical cord
Amniotic fluid index: sum of MVPs in 4 quadrants of uterus. Normal AFP >20w: 5-20cm

Question 23

Roles of amniotic fluid

Answer 23

Shock absorption
Protect cord from compression
Allow unrestricted foetal movement (MSK development)
Lung development
Lubricate foetal skin
Prevent maternal chorioamnionitis + foetal infection
Help foetal temperature regulation

Question 24

What produces amniotic fluid?

Answer 24

Transudation in <8w (across amnion and foetal skin)
Urination of foetus (near term ~1l)
Foetal lungs (but mostly swallowed)

Question 25

What absorbs amniotic fluid?

Answer 25

Transudation <8w
Swallow >8w. 500-1000ml pd at term
Absorption through foetal membranes (smaller)
Some cross amnion -> maternal blood.

Question 26

Complications of diabetes in pregnancy

Answer 26

SMASH
Stillbirth
Macrosomia
Amniotic fluid overload
Shoulder dystocia
Hypertension

Question 27

Effect of maternal hypothyroidism in pregnancy? Management?

Answer 27

Early diagnosis to avoid IUGR and cretinism. Levothyroxine 100-150microg OD. Monitor every 4w

Question 28

Effect of maternal hyperthyroidism in pregnancy?

Answer 28

Preterm delivery, IUGR
If due to Graves’s disease: IgG TSH can cross placenta to foetus.
Regular foetal testing after 32w. E.g. Tachycardia

Question 29

Management for hyperthyroidism in pregnancy?

Answer 29

Propylthiouracil (PTU). Blocks release of hormone from thryoid gland. (Takes 3-4w to effect)
Carbamizole is AVOIDED (block peripheral conversion) + risk of aplasia cutis congenita

Question 30

Causes of menorrhagia

Answer 30

Pregnancy + dysfunctional uterine bleeding
Fibroids
Pelvic infection
Polyps
Endometriosis
Hypothyroidism
Blood dyscrasias e.g. VWD.

Question 31

Treatment of menorrhagia?

Answer 31

1. Mirena
2. Antifibrinolytics/anti-PGs
3. Progestagens/nor-esphisterone.

Question 32

What is the triple assessment in breast disease?

Answer 32

History and examination
Diagnostic imagining by mammography +/- USS
Cytology or histology.

Question 33

Likely differentials of a painless breast lump:

Answer 33

Carcinoma
Cyst
Fibroadenoma
Fibroadenosis