Obstetric Medicine

Question 1

How is anaemia defined in pregnancy?

Answer 1

First trimester Hb <110
Second and third trimester Hb < 105
Post Partum < 100

Question 2

How is iron deficiency defined in pregnancy?

Answer 2

Ferritin < 20 = deficiency

Ferritin < 30 = insufficiency

Question 3

What should be measured to assess B12 deficiency in pregnancy?

Answer 3

Holotranscobalamin levels

Question 4

Is platelet count higher or lower in pregnancy?

Answer 4

Lower

Question 5

How do lung volumes change in pregnancy?

Answer 5

Tidal volume and inspiratory capacity increase

Functional residual capacity and residual volume decrease

Question 6

How much folate should pregnant women on AEDs take?

Answer 6

5mg daily for one month pre pregnancy and throughout the first trimester

Question 7

What should be done with sodium valproate in pregnancy?

Answer 7

Aim to change to alternative AED or reduce the dose

Question 8

What additional medication needs to be given for pregnant women on enzyme inducing AEDs?

Answer 8

Oral vitamin K supplementation in last 4 weeks

Question 9

What is the preferred AED in pregnancy?

Answer 9

Levetiracetam

Question 10

How is cardiac output increased in pregnancy?

Answer 10

Increased SV and increased HR

Question 11

What happens to RAAS activity in pregnancy?

Answer 11

Increased

Question 12

What happens to urea and creatinine in pregnancy?

Answer 12

Decreased

Question 13

What happens to bicarbonate in pregnancy?

Answer 13

Decreased due to respiratory centre stimulation by progesterone

Question 14

When should you recommend patients become pregnant following renal transplant?

Answer 14

After the first 24 months

Question 15

Is mycophenolate safe in pregnancy?

Answer 15

No

Question 16

Which DMARDs are safe in pregnancy?

Answer 16

Hydroxychloroquine, sulfasalazine, azathioprine

Question 17

What is pre eclampsia?

Answer 17

Hypertension with additional organ involvement

Question 18

What are the potential haematological manifestations of pre eclampsia?

Answer 18

Thrombocytopaenia, haemolysis, DIC

Question 19

What are the potential neurological manifestations of pre eclampsia?

Answer 19

Convulsions, hyperreflexia with clonus, headache, visual disturbance, posterior reversible encephalopathy syndrome, retinal vasospasm, ICH, stroke

Question 20

What are the most commonly used anti hypertensives in pregnancy?

Answer 20

Methyldopa, labetalol, nifedipine SR

Question 21

What is the treatment target for hypertension in pregnancy?

Answer 21

110-140/85

Question 22

What is the management of pre eclampsia at < 24 weeks?

Answer 22

Usually termination of pregnancy

Question 23

What treatment reduces the risk of pre eclampsia?

Answer 23

Aspirin

Supplemental calcium

Question 24

What are the antenatal risk factors for VTE in pregnancy?

Answer 24

Previous VTE
FHx VTE
Age > 35
Parity
Assisted reproductive technology
Hypertensive disease of pregnancy
Antepartum haemorrhage

Question 25

What are the postnatal risk factors for VTE in pregnancy?

Answer 25

Stillbirth/FDIU
Emergency C section
Post partum haemorrhage

Question 26

Which has better sensitivity for PE in pregnancy, V/Q or CTPA?

Answer 26

V/Q – 100%

CTPA – 83%

Question 27

Which has higher lifetime risk of breast cancer – V/Q or CTPA in pregnancy?

Answer 27

CTPA

Question 28

What is the leading cause of direct maternal mortality in Aus/NZ?

Answer 28

Amniotic fluid embolism

Question 29

What investigations should be done for hyperemesis gravidarum?

Answer 29

UEC, LFT, TSH, ultrasound

Question 30

What is the definition of obstetric cholestasis?

Answer 30

Unexplained pruritus with raised ALT or bile acids

Question 31

What are the maternal complications of obstetric cholestasis?

Answer 31

Increased risk of PET, GDM, metabolic syndrome, PPH

Question 32

What are the fetal complications of obstetric cholestasis?

Answer 32

Intrauterine/perinatal death, preterm birth, fetal hypoxia