Obstetrics

Question 1

Syntometrine route

Answer 1

IM

Question 2

Shoulder Dystocia - Treatment

Answer 2

1) McRoberts
2) Gentle axial traction, up to 30s
3) Suprapubic pressure, 30s, +/- axial traction
4) Rocking suprapubic pressure, up to 30s, +/- axial traction
5) All 4’s +/- axial traction
6) Walk to ambulance and pre-alert to obstetric unit

Question 3

Cord cutting

Answer 3

• Delayed until white
• At least 1 minute
• Unless concerns about mother or baby.
• Cut 5cm from umbilicus

Question 4

Eclampsia - management

Answer 4

• CABC
• Lateral position
• IV access (Large bore)
• Titrate O2 94-98%
• Convulsions >2-3 mins - give Magnesium Sulphate 4g over 10 minutes
  (Or Diazepam IV)

Question 5

Causes of PPH

Answer 5

Tone - Failure of uterine contraction (Uterine atony)

Trauma - tears

Tissue - Retained placenta

Thrombin - coagulation abnormalities

Question 6

PPH Management

Answer 6

If Placenta delivered start with Fundal/uterine massage.

If no placenta delivered progress to next stage. If fundal massage not success progress to next stage

1) Syntometrine IM (1ml)
2) If hypertensive, give misoprostol (800mcg) sublingual
3) IV access & fluids
4) TXA 1g
5) Pre-alert to hospital

Question 7

Benefits of delayed versus immediate cord clamping in term infants

Answer 7

Avoidance of bradycardia seen after ICC and the abrupt cardiovascular changes associated with that

Improved early haematological indices:
- peak haemoglobin in first 24 hours

Improved iron stores in infancy

Question 8

Management of Cord prolapse

Answer 8

Apply dry sanitary pad, walk to ambulance, and convey to Obstetric unit. Knees to chest bum in the air

Question 9

Physiological changes in pregnancy

Answer 9

• 20-30% increase in cardiac output
• HR increase by 10-15bpm
• Decrease in BP due to decrease SVR
• Increase in blood volume up to 45%
• Increase in resp rate but decrease in vital capacity

Question 10

Reasons to convey an obstetric emergency to an ED

Answer 10

• Cardiac arrest
• Major airway problems
• Ongoing eclamptic seizures
• Severe uncontrollable bleeding

Question 11

Fundal height of the umbilicus is approximately ____ weeks gestation

Answer 11

22

Question 12

Risk of maternal death during pregnancy by ethnic group

Answer 12

White women
Asian Women (2x)
Mixed ethnicity (3x)
Black women (4x)

Question 13

EMOTIVE Treatment for PPH

Answer 13

Escalate / Early recognition
Massage
Oxytonics (Syntometrine/Misoprostol)
TXA
IV access/ Fluids
Exit

Question 14

Airway changes in the pregnant woman

Answer 14

Increased oedema in oropharynx
Capillary engorgement of nasal mucosa
Delayed gastric emptying - risk of regurgitation

Question 15

Breathing changes in the pregnant woman

Answer 15

Increased resp rate
Increased tidal volume
Increased O2 requirement
Decreased functional residual capacity
Splinting of diaphragm

Question 16

Circulation changes in the pregnant woman

Answer 16

Increased stroke volume
Increased HR
Decreased BP in 1st trimester
Increase in clotting factors
Physiological anaemia
Compression of the aorta and IVC

Question 17

Potential, early and viable pregnancy definitions

Answer 17

Potential pregnancy includes all women of child bearing age

Early pregnancy should be used for the women of child bearing age who is or suspected to be pregnant, with gestation less than 20 weeks.

Viable pregnancy shall be the term referring to women with a pregnancy is greater than 20 weeks.