Obstetrics 3

Question 1

Screening

1. What tests are done:
   a) between 11-14 weeks
   b) if women present too late and can be tested 15-20 weeks
2. When is AFP
   a) raised
   b) decreased
3. What results would Down’s syndrome give to 11-14 week testing?

Answer 1

1. a)
   - nuchal translucency
   - pregnancy-asscoiated plasma protein A
   - beta-hCG

b) triple test or quadruple test

triple test: alpha-fetoprotein, unconjugated estriol + HCG

quadruple test: add inhibit A

2. a)
   - neural tube defects
   - abdominal all defects
   - multiple pregnancy

b)
- Down’s syndrome
- Trisomy 18
- maternal diabetes

3. • thickened nuchal translucency
   • increased HCG
   • decreased PAPP-A

NOTE: trisomy 18 (Edward syndrome) and 13 (Patau syndrome) give similar results but the hCG tends to lower

Question 2

What are the absolute contraindications to vaginal birth after previously having had a caesarean section?

Answer 2

• previous uterine rupture

- “classic” caesarean scar (longitudinal incision in upper segment of uterus)

Question 3

Additionally to pharmacology therapy, how should BP >160/110 be managed in pregnancy?

Answer 3

Admit to hospital for observation

Question 4

In pregnancy, what should be considered worrying out of 3rd heart sound, pulmonary oedema, peripheral oedema, ejection systolic murmur and forceful apex beat?

Answer 4

pulmonary oedema

3rd heart sound (84%), ejection systolic murmur (96%) and forceful apex beat could all be caused by increased CO and volume increase

peripheral oedema is caused by sodium and water retention and pelvic obstruction causing venous stasis
-> remember water + Na increased due to increased release of glucocorticoids by placenta

NOTE: rapidly progressing oedema in pre-eclampsia caused by hypertension caused decline in kidney function, reduced GFR

Question 5

Eclampsia

1. What is the first line management?
2. What should be done if this does not work?
3. What should be done if respiratory depression is seen following administration of first line treatment?

Answer 5

1. magnesium sulphate
   - IV bolus of 4g followed by 1g/hr for 24 hrs after last seizure or delivery
   - additional 2g bolus following additional seizures
2. benzodiazepine e.g. midazolam
3. calcium gluconate given

Question 6

Hepatitis B

1. What should be given to babies known to high risk of Hep B?
2. What should be given to babies with Hep B positive mother?

Answer 6

1. should receive the first dose of hepatitis B vaccine soon after birth
2. should receive the first dose of hepatitis B vaccine soon after birth and should also receive 0.5 millilitres of hepatitis B immunoglobulin within 12 hours of birth

Question 7

What should a woman at high risk of VTE be given throughout pregnancy?

Answer 7

LMWH

DOACs + warfarin contraindicated