Obstetrics

Question 1

What are the different screening tests done in Downs?

Answer 1

• Combined test (10): USS, hCG, PAPP-A
• Nuchal Translucency (10-13)
• Triple test (14-20): hCG, AFP, uE3
• Quadruple test (14-20): hCG, AFP, UE3, inhibin A
• Integrated test (10-20): USS, PAPP-A + quadruple test

Question 2

What are the infections that are screened during pregnancy?

Answer 2

Syphilis
Toxoplasmosis
Other (VZV, parvovirus B19)
Rubella
CMV 
HSV

Question 3

What are the screening results that confirm Downs?

Answer 3

increased inhibin A, hCG

decreased estriol, AFP, PAPP-A

Question 4

What other medical conditions are common in Downs?

Answer 4

Cardiac abnormalities, GI abnormalities (atresia), ALL, AZ, infections and hearing problems, epilepsy, sub-fertility, hypothyroidism

Question 5

What are common teratogenic drugs?

Answer 5

recreational: alcohol, smoking, LSD, sedatives, cocaine
Medications: ACEi, valproate, litium, trimethoprim, warfarin, aspirin, anti-cancer, sex-steroids

Question 6

What are the results of teratogens according to the timing of conception?

Answer 6

Pre-embryonic (conception-17days): miscarriage
Embryonic (17-55) days: congenital malformations (earlier worse)
Fetal (8wks-term): fetal growth + organ function

Question 7

What is the single most important test to rule out in a women in child-bearing age?

Answer 7

PREGNANCY TEST

Question 8

What organisation can you contact when you are not sure about medications in pregnancy?

Answer 8

OTIS (organisation of tetralogy information) open 24hrs

Question 9

What Abx to avoid in pregnancy?

Answer 9

aminoglycosides (ototoxicity), chloramphenicol,

Question 10

What are the symptoms presented with baby in Rhesus -ve mothers?

Answer 10

Mild: Haemolytic disease of newborn
Moderate: neonatal jaundice
Severe: in utero anemia, cardiac failure, ascites, hepatosplenomegaly, kernicterus, death, hydrops

Question 11

What are the symptoms of haemolytic anemia?

Answer 11

abnormal paleness of skin, dark urine, jaundice, hepatosplenomegaly, dizziness, weakness, heart murmur

Question 12

When do you give anti-D immunoglobulin?

Answer 12

-rhesus +ve mother, within 72 hrs of: delivery (live or stillborn), TOP, ectopic (surgical), miscarriage (>12), feto-maternal haemorrhage

Question 13

What is the postnatal management of babies born to Rh-ve mothers?

Answer 13

Bloods from cord:
-FBC, blood group, direct Coombs test, Kleihauer test

correct anemia: blood transfusion
coagulopathy
hyperbilirubinemia and jaundice: phototherapy, exchange transfusion

monitor haematocrit for few weeks

Question 14

What is the management of Rh-ve detection?

Answer 14

• check fetal blood group and PCR
• identify partner’s status
• low antibodies (<10IU/ml): repeat every 4wks
• high antibodies (>10IU/mL): assess fetal anemia, measure peak systolic volume of fetal MCA

Question 15

What is the prenatal management of RhD?

Answer 15

> /=18wks: iraddiated, Rh-ve, CMV -ve red cells