Obstetrics

Question 1

which day do we measure serum progesterone in a woman’s menstrual cycle ?

Answer 1

7 days before the end
normally day 21 in a 28 day cycle

Question 2

Ectopic pregnancy management

Answer 2

Transvaginal USS to locate
1) methotrexate < 35mm
2) x >35 salpingectomy /salpingotomy

Question 3

what epilepsy drugs can you prescribe in pregnancy
what extra thing should you remember to prescribe ?

Answer 3

most epileptic drugs but not valproate , remember they are safe in breastfeeding :)
+ give folic acid 5mg /day

Question 4

placental abruption
- definition
-Features
- treatment

Answer 4

complete or partial detachment of the placenta before delivery

hard woody uterus
Dark red blood, PAIN
fetal distress

it may be revealed or the blood might be accumulating elsewhere so do USS

Anti-natal steroid @ 34 weeks
anti-D prophylaxis
emergency C section If unstable

Question 5

placenta praevia

Answer 5

low lying placenta , graded 1-4( covering the internal OS)
painless bright red vaginal bleeding

steroids
USS
planned C section at 37 weeks

Question 6

PPH

Answer 6

Tone - uterine atony , failure of uterine contraction
Trauma- perineal tears
Tissue - retained placenta
Thrombin - clotting disorders

Management :
ABCDE
->MAJOR haemorrhage protocol
IV OXYTOCIN - to squeeze intrauterine vessels to slow and stop PPH
Ergometrine
Misoprostol -pg analogue , increased tone

Question 7

cord prolapse

Answer 7

mother needs to be on all 4s and then Immediate C section
tocolytics ie : oxytocin

Question 8

Hyperemesis gravidarum

Answer 8

5% pre pregnancy weight loss
Electrolyte imbalance
Ketones have to be present

Treatment :
Oral Cyclizine
Promethazine
Oral prochloroperazine

Question 9

vasa praaevia
(2)

Answer 9

Normally fetal blood vessels travel in the umbilical chord !

Vasa previa is defined when unprotected umbilical vessels run through the amniotic membranes, and pass over the cervix.

1) velementous
2) Multi lobed placenta

Emergency C section at 34-36 weeks
corticosteroids from week 32
and in the case of APH -> C SEC

Question 10

UTI in pregnancy

Answer 10

nitrofurantoin is good
avoid near term

Question 11

antepartum haemorrhage causes

Answer 11

• placenta praaevia
• vasa praaevia
• Placenta abruption

Question 12

gestational diabetes

Answer 12

fasting glucose is >= 5.6 mmol/L
2-hour glucose is >= 7.8 mmol/L

If at the time of diagnosis of gestational diabetes, the fasting glucose level is >= 7 mmol/l immediate insulin (plus or minus metformin) should be started

Question 13

Breech treatment

Answer 13

external cephalic version
(give analgesia , Tocolytics , anti-D immunglobulins)

Question 14

hypertension in pregnancy

Answer 14

when BP>140/90
before 20 weeks is chronic HT–> labetalol (NO ACE/ARB)
After 20 week + no protein = gestational HT
labetalol and nifedipine if asthmatic

Question 15

HELLP syndrome

Answer 15

Haemolysis
Elevated Liver enzymes
Low Platelets

Question 16

vasa previa triad

Answer 16

1) membrane rupture
2) Painless bleed
3) Fetal Brady

Question 17

polyhydramnios

Answer 17

when the fetus can’t swallow amniotic fluid
Causes:
+esophageal and duodenal atresia
+anenecephaly
+ Increased urine production ( multiple gestationm diabetes )

Question 18

Oligiohydramnios

Answer 18

Too little amniotic fluid
- inadequate urine excretion : bilateral renal agenesis and posterior urethral valves
-Placenta insufficiency - reduced blood flow to the kidney of the fetus , Hence reduced urine output

CAN LEAD TO POTTERS SYNDROME :
- lack of fluid , less space for fetus
-flattened face , low set ears, widely separated eyes , clubbed feet

Question 19

Pre eclampsia

Answer 19

proteinuria + bp >140/90 and oedema

Severe:
if above 160/110 = ADMIT and observe
labetalol / nifedipine
if seizures develop -> mg sulphate

to prevent give aspirin 75mg from 12 weeks gestation until birth

Question 20

Eclampsia

what should you be careful of in treatment ?

Answer 20

Once seizures develop and decision to deliver has been made !
Mg Sulphate IV bolus of 4g over 5-10 minutes should be given followed by an infusion of 1g / hour

Mg sulphate can cause respiratory depression , so give Calcium gluconate here !

Question 21

uterine stimulants/inducers
examples and uses

Answer 21

• Oxytocin for labour induction / to treat PPH
  ->for Labour induction / to treat PPH
  causes muscle contraction so that the uterine vessels are compressed
• Ergometrine , causes uterine contraction and is used in PPH
  -Prostagladins –> used to ripen cervix , shorter and softer in preparation for labour = misoprostol

Question 22

Uterine relaxants

Answer 22

• B2 agonists - Terbutaline , inhibits uterine contraction
  -Ca2+ channel blocker
  -Cox inhibitors - indomethacin

Used to delay birth bc lungs wouldn’t have matured

Question 23

Termination of pregnancy

Answer 23

Woman less than 9 weeks
-Oral Mifepristone ( blocks progesterone required for continuation of pregnancy )
- Misoprostol - prostaglandin analogue , smooth muscle contraction resulting in expulsion of the uterine contents

Question 24

intrahepatic cholestasis of pregnancy

Answer 24

Intrahepatic cholestasis of pregnancy increases the risk of stillbirth; therefore induction of labour is generally offered at 37-38 weeks gestation
+ itchy palms and feet
+ jaundice
+ increased BRB

Question 25

Induction of labour

Answer 25

NICE guidelines
if the Bishop score is ≤ 6
vaginal prostaglandins or oral misoprostol

if the Bishop score is > 6
amniotomy and an intravenous oxytocin infusion

A Bishop’s score of ≥ 8 indicates that the cervix is ripe, or ‘favourable’ - there is a high chance of spontaneous labour, or response to interventions made to induce labour

Question 26

Post partum thyroiditis

Answer 26

propranolol
up to 1 year after pregnancy and it should resolve on its own

Question 27

Group B strep
prophylaxis
treatment

Answer 27

Intrapartum IV Benzylpenicillin

Question 28

BMI >30 in pregnancy

Answer 28

FOLIC ACID

Question 29

Amniotic fluid embolism

Answer 29

Symptoms include: chills, shivering, sweating, anxiety and coughing.
Signs include: cyanosis, hypotension, bronchospasms, tachycardia. arrhythmia and myocardial infarction.

Question 30

chicken pox in pregnancy

Answer 30

Chickenpox exposure in pregnancy <= 20 weeks - if not immune give VZIG

if the pregnant woman > 20 weeks gestation is not immune to varicella then either VZIG or antivirals (aciclovir or valaciclovir) should be given days 7 to 14 after exposure