Obstetrics

Question 1

management of gestational cholestasis

Answer 1

ursodeoxycholic acid. Induce at 37/40

Question 2

features suggestive of acute fatty liver of pregnancy

Answer 2

RUQ pain, nausea, jaundice. High transferases.

Question 3

Management of acute fatty liver of pregnancy

Answer 3

Supportive

Induce once stable

Question 4

HELLP

Answer 4

haemolysis, elevated liver enzymes, low platelets

Question 5

follow-up for GDM patient post-delivery?

Answer 5

Continue therapy immediately after birth
Check bloods before sending home
remind them of hyperglycaemia symptoms and lifestyle management
Postnatal GTT at 6-13 weeks

Question 6

A 27 year-old lady is day 1 post emergency caesarean section for failure to progress in the first stage. She has been complaining of pain and heavy vaginal bleeding since delivery and in the morning was noted to have heavy, offensive lochia and a boggy poorly contracted uterus above the umbilicus.

Answer 6

Retained products of conception.

Management is EUA

Question 7

Management of pregnant woman with negative Rubella IgG

Answer 7

Advise to avoid anyone with rubella. Offer MMR postnatally

Question 8

management of primary genital herpes in pregnancy after in third trimester

Answer 8

oral aciclovir 400mg tds until delivery. Particularly if after 34 weeks (6 weeks to delivery)
Delivery by caesarean
Assume primary if patient has not had similar symptoms in the past

Question 9

Management of primary genital herpes in first or second trimester

Answer 9

5 days of oral aciclovir 400mg tds
Give daily oral suppressive aciclovir (tds) from 36 weeks until delivery to reduce genital lesions
Deliver vaginally

Question 10

Management of reccurence of genital herpes in pregnancy

Answer 10

supportive -warm saline wash, paracetamol
consider oral aciclovir if after 36/40
risk of tranmission is low, even if vesicles present at delivery.
Deliver vaginally

Question 11

NSAIDs in pregnancy

Answer 11

Should be avoided after 32 weeks

Question 12

Management of TTTS?

Answer 12

Stage using Quintero scoring

Medical:
Indomethacin - reduces fetal urine output

Surgical:
laser obliteration of communicating placental vessels
Selective foetal reduction is an option, esp if there is hydrops or evidence of cerebral damage

Question 13

When should you deliver MCDA twins?

Answer 13

36-37 weeks

Question 14

When should DCDA twins be delivered?

Answer 14

37-38 weeks

Question 15

What abnormalities are associated with increased NT?

Answer 15

Downs
Cardiac defects
Bowel wall defects

Question 16

Management of pregnant woman with chickenpox rash

Answer 16

Oral aciclovir. VZIG has no benefit after onset of rash

Question 17

What type of miscarriage is this?

Cervical os - closed
Bleeding - light

Answer 17

Threatened

Question 18

What type of miscarriage is this?

Cervical os - open
Bleeding - starting

Answer 18

Inevitable

Question 19

What type of miscarriage is this?

Cervical os - open
Bleeding - ongoing

Answer 19

Incomplete

Question 20

What type of miscarriage is this?

Cervical os - closed
Bleeding - stopped

Answer 20

Complete

Question 21

What type of miscarriage is this?

Cervical os - closed
Bleeding - not experienced

Answer 21

Missed

Question 22

What results would you expect on antenatal screening of a baby with down syndrome

Answer 22

Low alpha fetoprotein (AFP)
Low oestriol
High BhCG
Low pregnancy-associated plasma protein A (PAPP-A)
Thickened nuchal translucency

Question 23

McRoberts manoeuvre

Answer 23

hips fully flexed and abducted

Question 24

Rubin manoeuvre

Answer 24

suprapubic pressure

Question 25

Woodscrew manoeuvre

Answer 25

put hand in vagina and rotate fetal head 180 degrees

Question 26

treatment of endometritis?

Answer 26

IV clindamycin and gentamicin