obstetrics

Question 1

most common cause of neonatal infections inc sepsis

Answer 1

group B streptococcus

(E coli second most common)

commensal organism found in the female genital tract, gastrointestinal tract and perineum
contracted via maternal-to-foetal transmission.

can cause a range of infections such as sepsis, cellulitis, pneumonia and meningitis

tested for during the antenatal period via a vaginal swab

usually treated during delivery with benzylpenicillin.

Question 2

macrosomia

Answer 2

baby over 4kg

Question 3

prolonged pregnancy

Answer 3

advance beyond 42 weeks

at over 40 weeks nulliparous and 41 multiparous membrane sweep is offered to naturally induce labour

prostaglandins to induce if unsuccessful

if refused then expectant management with foetal monitoring is required

Question 4

serum bHCG

Answer 4

hormone produced by placenta during pregnancy or by certain cancer cells

human chorionic gonadotropin

used when confirming a pregnancy eg in suspected ectopic or molar pregnancy

Question 5

molar pregnancy

Answer 5

Trophoblastic disease
type of tumour that grows like a pregnancy inside the uterus
two sperm and an empty ovum or two sperm and a normal ovum
behaves like a normal pregnancy

More severe morning sickness
Vaginal bleeding
Increased enlargement of the uterus
Abnormally high hCG
Thyrotoxicosis (hCG can mimic TSH and stimulate the thyroid to produce excess T3 and T4)

snowstorm appearance on ultrasound

Question 6

what HPVs are a major risk factor for cervical cancer

Answer 6

16 and 18

Question 7

if HPV test smear is positive then

Answer 7

cytology.
if cytology is positive (dyskaryosis) then refer to colposcopy
if negative then retest 1 year later

Question 8

colposcopy

Answer 8

excludes obvious malignancy
use of acetic acid or iodine to show up malignancy white
if uncertain then punch biopsy

Question 9

CIN 2/3

Answer 9

precancerous cervical intraepithelium neoplasm
grade1-3. (can regress apart from 3)
ages 25-29 most common

Question 10

signs of cervical cancer

Answer 10

post coital bleeding
vag bleeding
intermenstrual
brown, smelly discharge
pain if advanced

majority squamous but can be adenocarcinoma

Question 11

trisomy 21 features baby

Answer 11

Flat occiput, Brushfield spots in iris and upslanting palpebral fissures

Question 12

features of congenital rubella syndrome

Answer 12

Sensorineural deafness, congenital cataracts, ‘blueberry muffin’ rash and salt-and-pepper chorioretinitis

Question 12

features of foetal alcohol syndrome

Answer 12

Growth impairment, smooth philtrum and hypertonia

Question 13

chorioamnionitis

Answer 13

Rupture of the amniotic membranes can allow bacteria to enter the uterus
particular risk in pre-term pre-labour rupture of membranes

Question 14

• When considering the choice between CTPA and VQ scan:

Answer 14

• CTPA is the test for choice for patients with an abnormal chest xray
  
  • CTPA carries a higher risk ofbreast cancerfor the mother (minimal absolute risk)
  • VQ scan carriers a higher risk ofchildhood cancerfor the foetus (minimal absolute risk)

Question 15

management of VTE

Answer 15

LMWH- enoxaparin, dalteparin, tinzaparin
warfarin is teratogenic but can be used postnatally

TED stockings
increased mobility and hydration
prophylactic anticoagulation

Question 16

causes of symmetrical IUGR

Answer 16

uteroplacental insufficiency
pre eclampsia
renal/cardiac disease
multiple gestation

Question 17

causes of asymmetrical IUGR

Answer 17

idiopathic
chromosomal
TORCH
maternal smoking or substance abuse
nutritional deficiency

Question 18

investigations and management for IUGR

Answer 18

• Symphysial fundal height (measuring less than number of weeks - 2 cm)
  
  • for example if at 30 weeks pregnant, measuring less than 28 cm
• USS measuring abdominal circumference and estimated foetal weight
• Umbilical artery doppler to assess blood flow

surveillance with USS
delivery by 37 weeks or from 34 weeks if growth ceases

Question 19

obstetric cholestastis complications

Answer 19

spontaneous foetal death and maternal haemorrhage
Planning delivery for 37-38 weeks allows adequate development of the foetus without unnecessarily prolonging the risk of spontaneous death

Question 20

what us the kleihauer test used for

Answer 20

performed in rhesus D negative women to gauge the dose of antiD immunoglobulin required. used to quantify the dose of Rh-D antigen in maternal circulation

Question 21

what is oligohydramnios

Answer 21

less than normal volume of amniotic fluid surrounding foetus
can lead to potter syndrome- clubbed feet, facial deformity, congenital hip dysplasia, pulmonary hypoplasia of fetus
the uterus may feel small and compact and the fetal parts may be easily palpated

Question 23

signs of congenital herpes virus

Answer 23

vesicular herpetic lesions on the skin, eye, oral mucosa, encephalitis and sepsis

if the mother has an active primary infection within 6 weeks of birth

elective caesarean section may be advised to avoid contact with the lesions. If this is declined, intra-partum IV acyclovir can be given to reduce transmission

Question 24

bishops score <5

Answer 24

labour is unlikely to occur without induction
if >8 it is fine
between it may or not be successful