Obstetrics

Question 1

Preterm labour

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Question 2

P-PROM

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Question 3

PROM

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Question 4

Shoulder dystocia

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Question 5

Breech

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Question 6

Unstable lie

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Question 7

Induction of labour

Answer 7

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Question 8

VBAC

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Question 9

Umbilical cord prolapse

Answer 9

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Question 10

Uterine rupture

Answer 10

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Question 11

Post-partum haemorrhage

Answer 11

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Question 12

Pre-existing chronic hypertension

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Question 13

Pre-existing Diabetes

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Question 14

Pre-existing Thyroid disease

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Question 15

Pre-existing Asthma

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Question 16

Pre-existing Heart disease

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Question 17

Pre-existing Epilepsy

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Question 18

Gestational HTN

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Question 19

Pre-eclampsia

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Question 20

Eclampsia

Answer 20

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Question 21

Gestational diabetes

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Question 22

Anaemia

Answer 22

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Question 23

Obstetric cholestasis

Answer 23

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Question 24

Acute fatty liver of pregnancy

Answer 24

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Question 25

IUGR - Foetal growth restriction

Answer 25

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Question 26

Placenta praevia

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Question 27

Placental abruption

Answer 27

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Question 28

Amniotic fluid embolism

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Question 29

Multiple pregnancy

Answer 29

Risks of twins:

Anaemia (Screen FBC)
10-15% TTTS (in Monochorionic)
6 in 10 born before 37wks (Preterm birth)
25% Selective IUGR
3-5% Acute TTTS in labour (may need C-section)
Congenital malformations (screening needed)

MCDA = Highest risk for TTTS
Happens to twins who share a placenta (Monochorionic).
Caused by problem with the blood vessels from the placenta. There is imbalance in blood flow from 1 twin to the other, leaving 1 baby with more blood.
Advise to report any changes in abdo size or SOB

Obstetric-led antenatal care rather than midwife

1. FBC at 20wks - ?extra iron + folate
   Down syndrome screening
2. Multiple pregnancy = moderate RF for pre-eclampsia. If 1st pregnancy or BMI >35 or FMH of pre-eclampsia, start ASPIRIN 75mg daily from 12wks until birth
3. Routine anomaly scan at 18-20wks
4. Serial growth/Doppler USS scans, monitor IUGR and TTTS
   DCDA = every 4wks from 20wk GA
   MCDA = every 2wks from 16wk GA
   If MCMA (or other cases where amnion is shared) refer to Fetal Medicine.
   Also refer if any foetal anomalies or >25% discordant growth

Delivery:
Mode = DCDA/MCDA can do vaginal if 1st twin cephalic
If any problems, C-section
Small risk that 2nd twin requires C-section

MCMA and triplets = Elective C-section

Timing:
DCDA = 37
MCDA = 36 (+steroids)
MCMA = 32 (+steroids)
Continuing an uncomplicated pregnancy beyond these points is associated with increased risk of foetal death

Question 30

Baby blues

Answer 30

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Question 31

Postnatal depression

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Question 32

UTI

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Question 33

Syphilis

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Question 34

Toxoplasmosis

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Question 35

CMV

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Question 36

Chickenpox

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Question 37

Parvovirus B19

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Question 38

Listeria

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Question 39

HSV (Herpes Simplex Virus)

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Question 40

Group B Strep

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Question 41

HIV

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Question 42

Hepatitis B

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Question 43

Hepatitis C

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Question 44

Sepsis

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Question 45

N+V / Hyperemesis gravidarum

Answer 45

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Question 46

Molar pregnancy

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