Obs passmed corrections (exam 2)

Question 1

most common cause of fever straight after giving birth?

Answer 1

ENDOMETRITIS is the most common cause of puerperal pyrexia
- Need to also refer patient to hospital for IV abx: clindamycin and gentamicin until afebrile for more than 24 hours.

Question 2

Pregnant obese women (BMI >30 kg/m2), should be given how much folic acid?

Answer 2

High dose 5mg folic acid

Question 3

If a woman with known placenta praevia goes into labour (with or without bleeding), what should be done to manage it?

Answer 3

Emergency C-section should be performed.

Question 4

When should women with previous pregnancy gestational diabetes be offered OGTT?

Answer 4

Women with gestational diabetes in a previous pregnancy should be offered an OGTT as soon as possible after BOOKING and subsequently at 24-28 weeks.

Question 5

First degree perineal tears Mx:

Answer 5

Usually do not require suturing/ or any management.

Question 6

If at the time of diagnosis of gestational diabetes, the fasting glucose level is >= 7 mmol/l Mx. ?

Answer 6

Immediate INSULIN (this is main treatment) (+/- metformin) should be started
NB: Pioglitazone: must be avoided in pregnancy.

Question 7

what to manage if bishop score is 4?

Answer 7

The Bishop’s score is used to predict whether INDUCTION of labor will be required. A score of 5 or less suggests that labour is unlikely to start without induction. Therefore in this case, Vaginal Prostaglandin is indicated for cervical ripening and labour induction.

Question 8

Postpartum- thyroiditis?

Answer 8

Is an autoimmune condition which presents as the body transitions back from the immunosuppressed state of pregnancy to normal immunity.

Postpartum thyroiditis can present for up to 1 year following delivery, but most frequently occurs 3-4 months post-partum. The hyperthyroid phase should be treated with :
- BETA- BLOCKERS and NOT antithyroid drugs.

Question 9

Vasa Praevia: Triad of symptoms?

Answer 9

Vaginal bleeding, rupture of membranes and fetal compromise(would show up on fetal CTG).

Question 10

Station in relation to labour meaning :

Answer 10

‘Station’: term used to describe the head in relation to the ischial spine. The station is ‘0’ when the head is directly at the level of the ischial spines, if the station was describes as -2, it would be 2cm above the ischial spines, and it was +2 it would be 2cm below the ischial spine.

Question 11

What infectious diseases are usually screened for in pregnancy?

Answer 11

Hep B, Rubella, Syphilis, HIV

Question 12

Two day history of central lower abdominal pain and one day history of vaginal bleeding. Her last period was 8 weeks ago. On examination her cervix is tender to touch, diagnosis?

Answer 12

Ectopic pregnancy

Question 13

Management of placental abruption when the fetus is alive, <36 weeks and not showing signs of distress?

Answer 13

To admit patient to hospital and administer steroids.

Question 14

1st line treatment for magnesium sulphate induced respiratory depression?

Answer 14

Calcium Gluconate

Question 15

Chickenpox exposure in pregnancy:

Answer 15

antivirals or VZIG (if available) should be given at days 7-14 post-exposure, not immediately

Question 16

If fetal movements have not yet been felt by how many weeks does referral need to be made?

Answer 16

24 weeks, referral should be made to a maternal fetal medicine unit

Question 17

is breastfeeding allowed on carbamazepine?

Answer 17

yes, mostly all anti-epileptic drugs are safe to breast feed on.

Question 18

When should magnesium treatment be stopped? (given as a result of eclampsia- seizure)

Answer 18

Magnesium treatment should continue for 24 hours after delivery or after last seizure.

Question 19

Gestational hypertension: is a ddx of pre-eclampsia, when should be admitted to hospital?

Answer 19

Pregnant women with blood pressure ≥ 160/110 mmHg are likely to be admitted and observed.

Question 20

Oligohydraminos can be a clue that infants have:

Answer 20

Renal agenesis (Potter sequence)

Question 21

What labour drug should not be given in hypertension?

Answer 21

• ergometrine
  can give oxytocin

Question 22

Women with grade III/IV placenta praevia should be offered ? delivery method?

Answer 22

Elective caesarean section at 37-38 weeks

Question 23

What drug can be used to suppress lactation?

Answer 23

Cabergoline (is a dopamine agonist: therefore inhibits prolactin= less milk production

Question 24

Following umbilical cord prolapse, if the cord is past the level of the introitus: what should you do? t

Answer 24

Should be minimal handling and it should be kept warm and moist to avoid vasospasm.
- can also ask the patient to go on all 4’s

Question 25

Diagnostic thresholds for gestational diabetes
Gestational diabetes is diagnosed if either: (in terms of fasting glucose and 2-hour glucose)

Answer 25

• Fasting glucose is >= 5.6 mmol/L
• 2-hour glucose is >= 7.8 mmol/L
  normally 1st line treatment: insulin
  but if fasting glucose is less than 7= can first try diet and exercise (lifestyle changes)

Question 26

Suspected PE in pregnant women with a confirmed DVT: Mx?

Answer 26

Treat with LMWH first then investigate to rule in/out.

Question 27

Pregnant women ≥ 20 weeks who develop chickenpox are generally treated with?

Answer 27

Oral aciclovir if they present within 24 hours of the rash.

In other cases:I
f the patient had been asymptomatic post-exposure, and unsure of her immunity, an URGENT BLOOD TEST would be indicated. If this was negative (that is to say, she is not immune), then varicella-zoster immunoglobulin (VZIG) should be administered