Obstetrics

Question 1

What prophylactic treatment can be offered to pregnant women at high risk of developing pre-eclampsia?

Answer 1

Aspirin 75mg - from 12 weeks until delivery

Question 2

What groups are at high risk of pre-eclampsia?

Answer 2

• Hypertensive disease (inc pre-eclampsia) in previous pregnancies
• CKD
• Autoimmune disorders e.g. SLE, Antiphospholipid syndrome
• Type 1 or 2 diabetes

Question 3

What is pre-eclampsia

Answer 3

Pregnancy induced hypertension associated with proteinuria (>0.3g/24hrs)
Oedema may occur

Question 4

What are the 2 main causes of cervical excitation?

Answer 4

Ectopic pregnancy

Pelvic inflammatory disease

Question 5

25 year old female Patient presents with 8 weeks amenorrhoea and lower abdominal pain. She has recently developed vaginal bleeding, and shoulder tip pain. What is the most likely diagnosis?

Answer 5

Ectopic pregnancy

Question 6

What are the typical presenting features of miscarriage?

Answer 6

Vaginal bleeding and crampy lower abdominal pain following a period of amenorrhoea

Question 7

What is the preferred treatment for hyperthyroidism during pregnancy and why?

Answer 7

Propylthiouracil because it is less likely to cross the placenta than carbimazole

Question 8

Name some treatments which can be used for nausea and vomiting in pregnancy.

Answer 8

cyclizine, metoclopramide, domperidone, ondansetron, chlorpromazine

Question 9

What is pre-existing versus pregnancy-induced hypertension?

Answer 9

Pre-existing: 140/90 mmHg before pregnancy or before 20 weeks gestation
Pregnancy-induced: 140/90 mmHg after 20 weeks gestation

Question 10

What is the first line therapy for hypertension in pregnancy? Name 2 other drugs that can be used.

Answer 10

1st line: Labetalol

Others: Methyldopa and nifedipine

Question 11

What antibiotic therapies can be used for UTIs in pregnancy? Name complications associated with them.

Answer 11

Nitrofurantoin - preferred drug but should be avoided at term due to risk of neonatal haemolysis
Trimethoprim - 2nd line, but should be avoided during first trimester because it is a folic acid antagonist
Cefalexin is the third choice

Question 12

What is Bishop’s score used for?

Answer 12

Used to predict whether induction of labour will be required

Question 13

What Bishop’s score suggests that labour is unlikely to start without induction? What score suggests labour will progress spontaneously?

Answer 13

Induction: 5 or less
Spontaneous: 9

Question 14

What are the indications for induction of labour?

Answer 14

• Prolonged pregnancy >12 days after estimated date of delivery
• pre-labour premature rupture of membranes, where labour does not start
• diabetic mother >38 weeks
• Rhesus incompatibility

Question 15

What is the risk to the foetus if the mother is exposed to varicella zoster:

a) before 20 weeks gestation?
b) third trimester?
c) if mother develops rash between 5 days before and 2 days after birth?

Answer 15

a) Fetal varicella syndrome (skin scarring, eye defects, limb hypoplasia, microcephaly, and learning disabilities)
b) shingles in infancy
c) neonatal varicella (fatal in 20% of cases)

Question 16

How is chickenpox exposure in pregnancy managed?

Answer 16

• if there is doubt about whether mother has previously had chicken pox: urgently check maternal blood for varicella antibodies
• If pregnant woman is not immune: give varicella zoster immunoglobulin (up to 10 days post exposure)
• if pregnant woman has chicken pox and presents within 24hrs of onset of rash: oral aciclovir

Question 17

What conditions are screened for in the Guthrie test?

Answer 17

PKU
Hypothyroidism
MCCAD
Cystic fibrosis
Haemoglobinopathies: Sickle cell disease and thalassaemia in babies with a family history

Question 18

What are the perinatal risk factors for neonatal sepsis?

Answer 18

• Group B strep colonisation of mother’s vagina
• Prolonged rupture of membranes (>18 hours)
• significant GBS bacteriuria during pregnancy
• Maternal temperature >38 degrees during labour
• chorioamnionitis
• sustained intrapartum fetal tachycardia
• previous delivery of infant with GBS disease

Question 19

What are the causative organisms of neonatal sepsis?

Answer 19

• Group B strep (most common)
• E. coli
• staph aureus
• Enterococcus
• Staph epidermidis
• Klebsiella
• Others e.g. listeria

Question 20

What is the antibiotic therapy for neonatal sepsis?

Answer 20

Newly delivered: IV benzylpenicillin and gentamicin

Nosocomial in NICU (with catheters - likely a staph infection): Vancomycin/flucloxacillin

Question 21

What is external cephalic version?

How many weeks gestation can it be done from?

Answer 21

• Externally correcting breech presentation
• after 36 weeks gestation, but leave it till as late as possible as most babies will correct naturally between 36 weeks and labour

Question 22

What screening tool is used to screen for post-natal depression? What does it involve?

Answer 22

Edinburgh post-natal depression scale:

• 10 item questionnaire
• max score of 30
• score of >13 - indicates depressive illness of varying severity
• includes question about self-harm

Question 23

New first-time mother presents to GP 3 days after delivery feeling tearful, anxious and irritable. She does not have thoughts of self-harm. What is the most likely diagnosis? What is the most appropriate management

Answer 23

“Baby blues” (typically occurs 3-7 days following delivery, more common in prims)
management with reassurance and support, involve health visitor

Question 24

Patient presents 3 months following delivery with low mood, low energy, tearfulness, low self-esteem and worries she has not bonded with her baby.

a) What is the most likely diagnosis?
b) What screening tool would help make this decision?
c) what is the most appropriate management?

Answer 24

a) Post-natal depression (onset usually after 1 month following delivery, typically peaking at 3 months; features are similar to other depressive illnesses)
b) Edinburgh post-natal depression scale
c) reassurance and support; CBT; SSRI (paroxetine best due to low milk/plasma ratio

Question 25

A woman who is 20-weeks pregnant and is attending a routine ante-natal clinic appointment. She tells you she has a had a previous baby who had a neonatal group B strep infection. What additional care will this mother require?

Answer 25

Intrapartum abx (prenatal abx not required) - penicillin (unless penicillin allergic - clarithromycin)

Question 26

What are the risk factors for GBS infection in the newborn?

Answer 26

prematurity
prolonged rupture of membranes
previous sibling with GBS infection
maternal pyrexia e.g. due to chorioamnionitis

Question 27

What are the main causes of antepartum haemorrhage in the first trimester?

Answer 27

spontaneous aborption
ectopic pregnancy
hydatidiform mole

Question 28

What are the main causes of antepartum haemorrhage in the 2nd trimester?

Answer 28

spontaneous abortion
hydatidiform mole
placental abruption

Question 29

What are the main causes of antepartum haemorrhage in the 3rd trimester?

Answer 29

Bloody show
Placental abruption
Placenta praevia
Vasa praevia

Question 30

Woman who is 15 weeks pregnant presents with vaginal bleeding. She has been suffering from excessive nausea and vomiting and her uterus is large for date. What is the most likely diagnosis and what blood test might support this diagnosis?

Answer 30

Hydatidifrom mole

Serum Beta-HCG - typically very high

Question 31

Should digital vaginal examination be performed in primary care in women with antepartum haemorrhage?

Answer 31

No - due to risk of placenta praevia

Question 32

What hormone is thought to be responsible for hyperemesis gravidarum?

Answer 32

beta-HCG

Question 33

When is hyperemesis gravidarum most common?

Answer 33

8-12 weeks gestation, but may persist up to 20 weeks (very are beyond 20 weeks)

Question 34

What are the roles of oestrogen and progesterone in preparation of breast for lactation?

Answer 34

Oestrogen - development of ducts

Progesterone - development of lobules/glands