Obstetric

Question 1

when is risk of rubella highest in pregnancy

Answer 1

in first 8-10 weeks risk of damage to fetus is as high as 90%
damage is rare after 16 weeks

Question 2

features of congenital rubella syndrome

Answer 2

sensorineural deafness
congenital cataracts
congenital heart disease
learning difficulties

Question 3

management of rubella exposure in pregnancy

Answer 3

should be discussed with local health protection unit

non-immune mothers should be vaccinated after giving birth

Question 4

pre-eclampsia features a triad of what

Answer 4

hypertension
proteinuria
oedema

Question 5

criteria for diagnosing pre-eclampsia

Answer 5

new hypertension of >140/90mmHg after 20 weeks AND 1 of the following:
proteinuria
end organ dysfunction e.g. raised creatinine, abnormal LFTs

Question 6

features of severe pre-eclampsia

Answer 6

headache
visual changes/papilloedema
RUQ pain/epigastric pain
hyperreflexia
platelet count < 100 * 106/l, abnormal liver enzymes or HELLP syndrome

Question 7

why can’t ACEi or ARBs be used in pregnancy

Answer 7

teratogenic

Question 8

recommendation of folic acid during pregnancy

Answer 8

all women = 400mcg until 12th week of pregnancy

higher risk of conceiving a child with neural tube defects: 5mcg before conception until 12th week
higher risk includes:
either partner has NTD, FHx, or previous pregnancy
women is obese >30kg/m2
women takes anti-epileptic drugs, has coeliacs, diabetes, thalassaemia

Question 9

what is obstetric cholestasis

Answer 9

seen in third trimester, occurs in around 1% of pregnancies
most common liver disease of pregnancy

raised bilirubin
pruritus, often of palms & soles
no rash, but might have excoriation marks

increased risk of stillbirth

Question 10

management of obstetric cholestasis

Answer 10

ursodeoxycholic acid is used for symptomatic relief
weekly liver function tests
women are typically induced at 37 weeks

Question 11

presentation of nipple candidiasis when breastfeeding

Answer 11

bilateral burning pain
itching
hypersensitivity of the niiple

Question 12

what is a galactocele

Answer 12

occurs in women who have recently stopped breastfeeding, occurs due to occlusion of a lactiferous duct

** can be differentiated from an abscess by the fact that a galactocele is usually painless, with no local or systemic signs of infection

Question 13

management of pre-eclampsia

Answer 13

NICE recommend emergency secondary care assessment for any women with suspected pre-eclampsia
>160/110mmHg likely to be admitted & monitored

oral labetalol = first line
delivery of the baby

Question 14

most common cause of early onset severe infection in the neonatal period

Answer 14

group B streptococcus

Question 15

risk factors for GBS infection

Answer 15

prolonged rupture of membranes
previous pregnancy with GBS infection
prematurity
maternal pyrexia e.g. due to chorioamnionitis

Question 16

when should intrapartum antibiotic prophylaxis be given for GBS

Answer 16

preterm deliveries
maternal pyrexia during delivery >38
previous baby with early or late onset GBS disease

Question 17

Hb cut offs to determine if a pregnant women should receive oral iron supplementation

Answer 17

first trimester: <110
second: <105
post-partum: <100

Question 18

Complete hydatidiform mole presentation

Answer 18

painless vaginal bleeding in 1st or 2nd trimester
exaggerated symptoms of pregnancy
uterus large for dates
elevated levels of hCG (may cause hyperthyroidism symptoms)

Question 19

management of complete hydatidiform mole

Answer 19

urgent referral to specialist centre - evacuation of the uterus is performed
effective contraception is recommended to avoid pregnancy in the next 12 months

Question 20

management of mastitis

Answer 20

flucloxacillin for 14 days, continue breastfeeding

Question 21

stages of post partum thyroiditis

Answer 21

thyrotoxicosis
hypothyroidism
normal thyroid function

Question 22

diagnosis of post partum thyroiditis

Answer 22

within 12 months of giving birth
clinical manifestations of hypothyroidism
TFTs support diagnosis

Question 23

management of post partum thyroiditis

Answer 23

propranolol used for symptomatic relief
thyroxine used in hypothyroidism stage

Question 24

treatment of nipple candidiasis when breastfeeding

Answer 24

miconazole cream for the mother and nystatin suspension for the baby

Question 25

when to offer a gestational diabetes test to women after birth

Answer 25

fasting plasma glucose 6-13 weeks after

Question 26

SSRIs of choice in breastfeeding women

Answer 26

sertraline, paroxetine

Question 27

presentation of placental abruption

Answer 27

shock out of keeping with visible blood loss
constant pain
tender, tense uterus
normal lie & presentation
fetal heart: distressed/absent

Question 28

presentation of placenta praevia

Answer 28

shock in keeping with visible blood loss
no pain
uterus not tender
lie & presentation may be abnormal
fetal heart usually normal

Question 29

what should not be performed in primary care for suspected antepartum haemorrhage

Answer 29

a vaginal examination
** a patient with placenta praevia may haemorrhage

Question 30

risk factors for gestational diabetes

Answer 30

previous gestational diabetes
previous macrosomic baby, >4.5kg
first degree family history of diabetes
ethnic origin
BMI >30

Question 31

what causes an increase in alpha-feto protein

Answer 31

abdominal wall defects
neural tube defects
multiple pregnancy

Question 32

what causes a decrease in alpha-feto protein

Answer 32

down syndrome
trisomy 18
maternal diabetes mellitus

Question 33

high risk factors for pre-eclampsia

Answer 33

autoimmune condition e.g. SLE
T1/2DM
pre-existing hypertension
previous hypertension in pregnancy
CKD

Question 34

moderate risk factors for pre-eclampsia

Answer 34

> 40 yrs
BMI >35
multiple pregnancy
first pregnancy
10yrs since last pregnancy
family history of pre-eclampsia

Question 35

management of breech presentation

Answer 35

<36 weeks = many foetus’ will turn spontaneously
>36 weeks: external cephalic version at 36 weeks for nulliparous women and at 37 weeks for multiparous women

if baby is still breech: delivery options include c-section & vaginal delivery

Question 36

what is the antenatal testing done for Down’s syndrome

Answer 36

nuchal translucency measurement + serum B-HCG + pregnancy-associated plasma protein A (PAPP-A)

done between 11-13+6 weeks
Down’s syndrome is suggested by ↑ HCG, ↓ PAPP-A, thickened nuchal translucency

Question 37

use of SSRI in pregnancy

Answer 37

1st trimester - increased risk of congenital malformations
later pregnancy, after 20 weeks - increased risk of pulmonary hypertension
neonatal withdrawal symptoms

Question 38

what is puerperal pyrexia

Answer 38

fever >38 in the first 14 days following delivery

causes:
endometritis
UTI
wound infections e.g. perineal tears, c-section
VTE
mastitis

Question 39

management of puerperal pyrexia

Answer 39

if endometritis suspected:
patient should be admitted for IV antibiotics until afebrile for >24 hours
gentamicin & clindamycin

Question 40

cmanagement of puerperal pyrexia