Obstetric Emergencies

Question 1

A 29 year old woman in her second pregnancy presents to delivery suite at 29 weeks gestation with an APH of about 500mls and mild uterine contractions. She is haemodynamically stable. The CTG is reassuring. Which of the following is the best answer?

a) This is either a placental abruption or a placenta praevia and an immediate caesarean section is indicated

b) Insert two iv lines, cross match 4 units of blood and proceed with a caesarean section under general anaesthesia

c) Insert two iv lines, cross match 4 units of blood, give steroids and observe

d) Insert two iv lines, cross match 4 units of blood, insert an epidural, monitor the fetus with CTG and wait for spontaneous labour to establish

e) Immediately perform an ultrasound in the Radiology Department

Answer 1

c) Insert two iv lines, cross match 4 units of blood, give steroids and observe

Question 2

Regarding prolonged pregnancy, which one of the following is true?

a) Women with BMI >40 have 10 fold increased perinatal mortality

b) Evidence suggests that fetal surveillance should begin at 280 days in order to improve perinatal outcome

c) Compared with younger women (<35y), rates of stillbirth in women of advanced maternal age (≥40y) are doubled at 40 week’s gestation

d) RCTs have shown Doppler velocimetry is the most reliable method of detecting fetal compromise

e) Postmaturity syndrome can be diagnosed on routine ultrasound at 40 week’s gestation

Answer 2

c) Compared with younger women (<35y), rates of stillbirth in women of advanced maternal age (≥40y) are doubled at 40 week’s gestation

Question 3

Regarding the use of Magnesium Sulphate for the prevention of eclampsia, which of the following statements is true:

a) The loading dose is 4g in 1000mls normal saline over 20 minutes

b) Magnesium levels should be routinely performed 4 hours after the loading dose is complete and then 6 hourly thereafter

c) Reduction of respiratory rate is one of the first signs of toxicity

d) Should be given to all women with a 24 hour urinary protein level >1g/ℓ

e) 10g calcium carbonate is the antidote of choice in the event of toxicity

Answer 3

c) Reduction of respiratory rate is one of the first signs of toxicity

Question 4

A previously healthy 35 year old woman has just delivered her fourth baby spontaneously. Just prior to the delivery fresh bleeding was noted. Shortly after delivery of the placenta, she feels faint, and short of breath. Her blood pressure is 105/60, pulse 90/min. Ongoing heavy vaginal bleeding is seen. Based on the history, which of the following is the most likely diagnosis:

a) Group B streptococcal sepsis

b) Retained placental tissue

c) Uterine atony

d) Amniotic fluid embolus

e) Utero-cervical laceration

Answer 4

d) Amniotic fluid embolus

Question 5

A 35y G2P2 is day 3 post her second Emergency Lower segment CS under epidural anaesthesia for failure to progress. She had prolonged ruptured membranes and the operation was difficult with a prolonged operating time. Her pre-operative Haemoglobin was 124g/L and she had an intra-operative estimated blood loss of 1000ml. She states she feels short of breath and has oxygen saturations of 90% on room air. The LEAST helpful investigation would be:

a) Full blood count

b) Chest XRay

c) D-dimer

d) Doppler Ultrasound of the lower limb

e)CTPA

Answer 5

c) D-dimer

Question 6

With regard to complications of shoulder dystocia, which of the following statements is true:

a) Erb’s palsy can be avoided if downward traction on the fetal head is used to facilitate delivery

b) Three to four minutes can elapse before irreversible hypoxic brain damage will occur

c) 15% of babies weighing over 4kg will have shoulder dystocia

d) The risk of Erb’s palsy associated with Woods manoeuvre makes it very much a last resort for the management of shoulder dystocia

e) Pushing the posterior arm higher into the vagina can allow the anterior shoulder to pass under the symphysis pubis.

Answer 6

b) Three to four minutes can elapse before irreversible hypoxic brain damage will occur

Question 7

Which of the following statements about shoulder dystocia is true:

a) Shoulder dystocia occurs in 1 in 800 deliveries

b) Induction of labour at 38 weeks in a macrosomic baby will reduce the risk of shoulder dystocia

c) In the McRobert’s manoeuvre the maternal hips are hyper-extended.

d) Early episiotomy will facilitate descent and rotation of the shoulders on the pelvic floor

e) Early recourse to the McRobert’s manoeuvre is recommended

Answer 7

e) Early recourse to the McRobert’s manoeuvre is recommended