Obstetrics 2

Question 1

Rubella contraction in pregnancy
Infectious from what time period?

Answer 1

7 days before sx appear to 4 days after onset of rash

Question 2

Congenital rubella syndrome is as high as 90% during what gestations?
Rare after what gestation

Answer 2

K8-10
K16

Question 3

Sensorineural deafness
Congenital cataracts
Congenital heart disease
Growth retardation
Hepatosplenomegaly
Purpuric skin lesions
Salt and pepper chorioretinitis
Microphthalmia
Cerebral palsy
=

Answer 3

Congenital rubella syndrome

Question 4

Mx of suspected cases of rubella in pregnancy =

Answer 4

Discuss with Health Protection Unit

Question 5

Define RFM

Answer 5

K28>
<10 movements in 2 hours

Question 6

When should RFM be established?
When should they start? Primip multip

Answer 6

K24
K18-20, 16-18

Question 7

RFM Mx
>K28

Answer 7

Handheld doppler
If no heartbeat then US immediately
If heartbeat then CTG for at least 20 mins
If any concerns with CTG then USS within 24 hours

Question 8

RFM Mx
K<28

Answer 8

Doppler for HR

Question 9

When to refer if no fetal movements have been felt?

Answer 9

K24

Question 10

RF for placenta praevia (3)

Answer 10

Multiparity
Multiple pregnancy
Prev CS

Question 11

Grading of placenta praevia

Answer 11

I - lower segment only not then os
II - reaches internal os
III - covers internal os before dilatation but not when dilated
IV - completely covers the os

Question 12

RF for placental abruption (4)

Answer 12

Cocaine
Multip
Maternal trauma
Increasing maternal age

Question 13

When should women have swabs for GBS?

Answer 13

Not routinely offered to everyone
Only if GBS in previous pregnancy
Should be offered at K35-K37 or can have it prophylactically intrapartum

Question 14

HIV positive women when should a vaginal delivery be offered over a CS

Answer 14

If viral load is less than 50 copies/ml at K36

Question 15

What should be given before a CS and when in HIV+ pts and when?

Answer 15

Zidovudine infusion - 4 hours prior to the CS

Question 16

Neonatal antiretroviral therapy
What should be given and for how long?

Answer 16

Zidovudine PO otherwise ART for all neonates
4-6 weeks long treatment

Question 17

Women who are at high risk of developing pre-eclampsia should be given what and for how long?

Answer 17

Aspirin 75mg OD from 12 weeks until birth of baby

Question 18

High risk groups of for pre-eclampsia? (4)

Answer 18

HTN during prev preg
CKD
Autoimmune disorders
DM

Question 19

What is HTN in pregnancy and when does it normally start to rise?

Answer 19

First trimester BP usually falls then rises K20
BP 140/90
OR
Increase in booking reading by 30 or 15 sys/dias

Question 19

Pre-existing HTN definition

Answer 19

> 140/90 before K20

Question 20

PIH definition

Answer 20

> 140/90 >K20

Question 21

Pre-eclampsia definition

Answer 21

With proteinuria >0.3g/24 hours

Question 22

Mx of obstetric cholestasis (3)
Meds (2)
Induction at what K

Answer 22

Induction at K37- K38
Urso
Vitamin K

Question 23

4 causes of PPH

Answer 23

Trauma (tear)
Tone (uterine atony)
Tissue (retained placenta)
Thrombin (bleeding disorder)

Question 24

Poly or oligohydramnios is a RF for PPH

Answer 24

Polyhydramnios

Question 25

Mx PPH (6)

Answer 25

ABC Palpate the uterine IV oxytocin slow IV injection followed by infusion Ergometrine slow IV or IM Carboprost IM (unless asthma) Misoprostol sublingual

Question 26

When is a secondary PPH? Usually secondary to?

Answer 26

24 hours - 6 weeks Retained placenta or endometritis

Question 27

Onset of symptoms for 1. Baby blues 2. Postnatal depression 3. Puerperal psychosis

Answer 27

1. Within 3-7 days 2. Within a month - peaks at 3 months 3. Within 2-3 weeks post birth

Question 28

Which SSRIs can be offered for post natal depression? (2)

Answer 28

Sertraline Paroxetine

Question 29

What are the three stages of postpartum thryroiditis?

Answer 29

Thyrotoxicosis Hypothyroidism Normal thyroid function

Question 30

Which antibodies are found in 90% of cases in postpartum thyroiditis?

Answer 30

Thyroid peroxidase antibodies

Question 31

Name the seven features of severe pre-eclampsia (8)

Answer 31

BP >160/100 Proteinuria Headache Visual disturbances Papilloedema RUQ/ epigastric pain Hyper-reflexia Platelet count <100

Question 32

What is HELLP?

Answer 32

Haemolysis Elevated liver enzymes Low platelets

Question 33

First line management pre-eclampsia First line in asthmatics (2)

Answer 33

1. Labetalol 2. Nifedipine/ hydralazine if asthmatic

Question 34

Anaemia in pregnancy - Hb values First trimester Second/ Third Postpartum How long should treatment continue

Answer 34

<110 <105 <100 3 months post correction of deficiency

Question 35

Puerperal pyrexia is classified as?

Answer 35

T>38 in the first 14 days post delivery

Question 36

Endometritis Mx (2)

Answer 36

Clinda and gent

Question 37

Test of choice for GDM When is it offered Women with any RF Women with prev GDM

Answer 37

OGTT K24-28 Soon after booking and then if negative again at K24-K28

Question 38

Diagnostic threshold for GDM Fasting 2 hour glucose

Answer 38

Fasting glucose >=5.6 2 hour glucose >=7.8

Question 39

Mx of GDM Fasting glucose <7 Fasting glucose >=7

Answer 39

Diet and exercise for 1-2 weeks, if not meeting targets then to start metformin, if still not met, then insulin Insulin

Question 40

When should insulin be offered for GDM (2)

Answer 40

If fasting glucose 6-6.9 and evidence of macrosomia or hydramnios Or fasting glucose >=7

Question 41

When should glibenclamide be offered to women with GDM? (2)

Answer 41

Women who do not tolerate metformin or women who decline insulin

Question 42

Mx of women with pre-existing diabetes (3)

Answer 42

Weight loss if BMI >27 Stop PO hypoglycaemics except metformin and start insulin Folic acid 5mg OD from pre conception to 12 weeks

Question 43

Target glucose for GDM/ DM Fasting 1 hour 2 hour

Answer 43

Fasting --> 5.3 1 hour after meals --> 7.8 2 hours after meals --> 6.4

Question 44

How long to avoid pregnancy post molar pregnancy

Answer 44

Avoid pregnancy for the next 12 months

Question 45

Can hep B be transmitted via breastfeeding?

Answer 45

No

Question 46

Which babies should receive a complete course of vaccination and hep B immunoglobulin?

Answer 46

Babies born to mothers who are chronically infected with hep B or acutely infected during pregnancy

Question 47

Obstetric cholestasis Mx Symptomatic relief How often are LFTs Induced at K?

Answer 47

Urso Weekly LFTs Induced at K37

Question 48

BMI ?>= should give birth in a consultant led obstetric unit BMI?>= should have an antenatal consultation with an obstetric anaesthetist and a plan made

Answer 48

35 and 40