Obstetric conditions/complications

Question 1

what are the risk factors for a molar pregnancy?

Answer 1

extremities of gestational age (<20 or >35yrs)

previous molar pregnancy

Question 2

what is the presentation of a molar pregnancy?

Answer 2

vaginal bleeding (most common)
abnormal uterus size for gestation age (small or large)

Question 3

what investigations are carried out in order to diagnose molar pregnancy?

Answer 3

serum b-HCG

pelvic USS

Question 4

what features on an USS suggest molar pregnancy?

Answer 4

snow storm appearance and no foetal parts or

small placenta with partial foetal development

Question 5

what complication can occur from a molar pregnancy?

Answer 5

choriocarcinoma

Question 6

what is the chance of getting choriocarcinoma from a molar pregnancy and what is the treatment success rate?

Answer 6

20%

success rate is 95%

Question 7

what is the most common site of an ectopic pregnancy?

Answer 7

ampulla

Question 8

what are the risk factors for an ectopic pregnancy?

Answer 8

previous ectopic pregnancy
FH of ectopic pregnancy
reversal of previous sterilisation 
pelvic inflammatory disease (chlamydia, gonorrhoea)
smoking 
assisted contraception

Question 9

what is the presentation of an ectopic pregnancy?

Answer 9

vaginal bleeding
pain
GI/urinary symptoms
may present with shock if it ruptures (tachycardia, hypotension, high RR)

Question 10

what are the treatment options for an ectopic pregnancy?

Answer 10

methotrexate
hysterectomy
salpingectomy
salpingotomy

Question 11

what is the first line treatment for an ectopic pregnancy?

Answer 11

methotrexate

Question 12

what investigations would you carry out to diagnose an ectopic pregnancy?

Answer 12

USS - no foetus in uterus, distended area outwit uterus i.e. tube, fluid in the pouch of douglas
serum progesterone and b-HCG (decreased)

Question 13

what is the aetiology of a spontaneous miscarriage?

Answer 13

congenital abnormality
uterine abnormality i.e. double uterus, uterine septum, fibroids
cervical incompetence (primary vs secondary)
maternal - age, infection, trauma
unknown

Question 14

what is the management of a spontaneous miscarriage?

Answer 14

medical: prostaglandins (misoprostol)
surgical: surgical management of miscarriage

Question 15

what is the teaming of a septic miscarriage?

Answer 15

anti biotics + hysterectomy (removal of uterus)

Question 16

what is the presentation of a spontaneous miscarriage?

Answer 16

vaginal bleeding
pain
open cervix (+/-)

Question 17

what are the different types of spontaneous miscarriages?

Answer 17

threatened
inevitable
incomplete
completed
septic

Question 18

mild bradycardia is common in which situations?

Answer 18

occiput posterior or transverse presentations

postdate gestation

Question 19

what is the normal heart rate range for a foetus?

Answer 19

110-160bpm

Question 20

what is defined as severe foetal bradycardia?

Answer 20

heart rate below 80bpm for > 3 mins

Question 21

what are the causes of severe foetal bradycardia?

Answer 21

cord prolapse
over twisted cord 
maternal seizure 
placental abruption 
prolonged cord compression 
epidural and spinal anaesthesia
rapid foetal descent