Obstetrics

Question 1

Type 1 FGM

Answer 1

Partial or total removal of clitoris and/or prepuce

Question 2

Type 2 FGM

Answer 2

Partial or total removal of clitoris and labia minora with or without excision of labia majora

Question 3

Type 3 FGM

Answer 3

Narrowing of vaginal orifice with the creation of a covering seal by cutting and re-positioning of the labia minora and/or labia majora with or without excision of clitoris

Question 4

Type 4 FGM

Answer 4

Any other harmful procedures to the female genitalia for non-medical purposes eg. pricking, piercing, cauterisation, incising, scraping

Question 5

Acute complications of FGM

Answer 5

Death, sepsis, blood loss, pain, urinary retention, tetanus, HIV, hepatitis

Question 6

Chronic complications of FGM

Answer 6

Apareunia, dyspareunia, sexual dysfunction, chronic pain, keloid scarring, UTIs, haematocolpos

Question 7

Management of FGM

Answer 7

Deinfibulation before marriage, antenatally or in first stage of labour
-Screen for hepatitis C

Question 8

Trimester dates

Answer 8

First - up to 12wks
Second - 13-26wks
Third - 27wks+

Question 9

Key milestones

Answer 9

10 weeks - booking clinic
10-14 - dating scan
18-21 - Anomaly scan

Question 10

Vaccine in pregnancy

Answer 10

Whooping cough from 16wks
Influenzae in autumn/winter
Avoid live vaccines

Question 11

Booking clinic

Answer 11

Expectations, lifestyle, folic acid/Vit D, antenatal classes and risk factors
Bloods - Group, antibodies and RhD, FBC, thalassaemia

HIV, Hep B and syphilis

BMI, urine dip, BP, FGM, domestic violence

Question 12

Hormonal changes in pregnancy

Answer 12

↑ACTH - ↑Cortisol & aldosterone
Prolactin - Suppresses FSH/LH
MSH - Causes pigmentation of skin (linea nigra/melasma)

HCG doubles every 48hrs until plateau 12wks
Progesterone rises to maintain, prevent contractions and suppress immune system from fetal antigen

Question 13

Adnexal changes in pregnancy

Answer 13

Uterus increase 10x (hypertrophy of myometrium/vessels)
Oestrogen causes cervical ectropion and ↑discharge, hypertrophy of vaginal muscles/discharge
Prostaglandins breakdown cervical collagen before delivery allowing dilation/effacement

Question 14

Cardiovascular changes in pregnancy

Answer 14

↑Blood volume, CO
↓PVR, BP
Varicose veins (vasodilation & IVC obstruction)

Question 15

Renal changes in pregnancy

Answer 15

↑blood flow
↑GFR
↑Aldosterone causes higher salt/water retention
↑Protein excretion
Dilation of ureters and collecting system causing physiological hydronephrosis

Question 16

Down syndrome tests in pregnancy

Answer 16

Trisomy 21
*Combined test 11-14wk (1st line) - Us measure nuchal translucency (>6mm) with beta-HCG (high) and Pregnancy-associated plasma protein-A (low)
*Triple test 14-20wk - Beta-HCG (high), AFP (low) and serum oestriol (low)
*Quadruple test 14-20wk - Triple PLUS inhibin-A (high)