Obstetric Management

Question 1

PPROM (medications)

Answer 1

Erythromycin (chorioamnionitis prophylaxis), BenPen (intrapartum, GBS prophylaxis), Betamethasone (if < W34), MgSO4 (if < W30), tocolytics (ONLY if transfer)

Question 2

Breech presentation

Answer 2

External cephalic version (W36), also give tocolytics (eg. Terbutaline) beforehand

Question 3

Uterine atony

Answer 3

1) Fundal massage, (2) 10 unit bolus syntocinon (3) IV Oxytocin 40U in 1L Hartmann’s running over 4 hours, (4) IM and IV Ergometrine 500mcg, (4) PR Misoprostol 2-4 200mcg tablets Per vagina/rectum, (5) Intramyometrial PG-F2a into four quadrants of uterus, (6) Bakri balloon and surgical ( uterine artery ligation, last line hysterectomy

Question 4

Lactational mastitis

Answer 4

Fluclox, analgesia, frequent breastfeeding, technique

Question 5

Chorioamnionitis

Answer 5

Ampicillin + Metronidazole + Gentamicin

Question 6

Indication for forceps delivery

Answer 6

Fully dilated
Occiput located 
Rupture of membranes 
Catheter in situ 
Engaged below ischial spines 
Pain relief 
Scissors - episiotomy

Question 7

Definitions of
Amenorrhoea vs Menorrhagia
Polymenorrhoea vs Oligomenorrhoea

Answer 7

Amenorrhoea - no periods for 3/12 in a regular cycle/ no periods for 6/12 in non regular cycle

Menorrhagia >80ml in a cycle

Polymenorhoea course<21 days
Oligomenorrhoea course >35 days

Question 8

Menorrhagia management x 3
Medical (4)
Surgery (2)

Answer 8

1. Identify underlying cause
2. Medical
   - NSAID
   - Transexamic acid
   - COCP
   - Mirena IUD
3. Surgical management
   - ablation
   - hysterectomy

Question 9

What are indications for a biophysical profile? Name the 5 components [4U/S, 1 non U/S]

Answer 9

Concern for foetal development. Abnormal CTG or risk of IUGR

1. AFI
2. Foetal tone
3. Foetal body movement
4. Foetal breathing movement
5. Non stress CTG

Question 10

Name the five components of a Bishop score

Answer 10

Cervical length (effacement)
Cervical dilation 
Cervical consistency 
Foetal station (relative to ischial spine)
CERVICAL POSITION

Question 11

Name 8x maternal risks for C section

Answer 11

1. Anaesthetic risk if GA
2. Infection
3. Bleeding
4. Damage to surrounding structures
5. DVT, PE
6. Incisional hernia
7. Adhesions
8. Risk in subsequent pregnancies - accrete, uterine rupture, Cx scar pregnancy

Question 12

Name 6x neonatal risks for C section

Answer 12

1. Sepsis
2. Respiratory distress syndrome
3. Hypoglycaemia
4. Respiratory support
5. NICU admission
6. Longer hospital admission

Question 13

Management of cholestasis of pregnancy

Answer 13

1. Ursodeoxycholic acid
2. Symptomatic management (moisturiser, topical steroid, antihistamine at night)
3. Vit K
4. Monitoring
   - Maternal weekly LFT, foetal movement and CTG
5. Full obstetric care
6. Deliver based on severity of maternal symptoms

Question 14

Name three MOA of the COCP

Answer 14

1. Inhibition of ovulation
2. Thickening of cervical mucous
3. Thinning of endometrium

Question 15

How to manage patient who has missed a pill for >48 hours ?

Answer 15

> 48 hours + first 2 weeks - keep taking pills+ barrier for 7 days
48 + third week - keep taking pills, skip sugar pills, barrier for 7 days
<48 - take forgotten pill immediately, resume normal process

Question 16

Indications for a forceps delivery?

Answer 16

Fully dilated 
Occiput presentation 
Rupture of membranes 
Catheter* - empty bladder 
Engaged - station below ischial spines
Pain relief adequate 
Scissors - episiotomy

Question 17

For abortion, what procedures are suggested for what dates ?

Answer 17

Surgical suction abortion: W9-14
Medical abortion : week 7 and before method of choice. Best for Incomplete miscarriage. 400 mcg misoprostol. Vaginal or oral

Question 18

Treatment for endometritis

Answer 18

Metronidazole + Clindamycin

Question 19

Ideal date for cervical cerclage

Answer 19

W14-17

Question 20

Management for shoulder dystocia

Answer 20

HELPERRD

Call for help 
Episiotomy 
Legs - mcroberts
Supra public pressure 
Enter: 
Rotational maneuveres
Roll on all fours
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