Obstetrics

Question 1

What is the role of progesterone in early pregnancy compared to later pregnancy?

Answer 1

Early pregnancy - induces endometrial secretary changes favourable for blastocyst implantation

Later pregnancy - induce immune tolerance for the pregnancy and prevent myometrial contractions

Question 2

What are the three forms of oestrogen and how are they converted?

Answer 2

Estradiol - non-pregnant reproductive - converted from androgens produced from cholesterol in the follicular theca cells by aromatase enzyme in the follicular granulosa cells

Estriol - during pregnancy - converted from dehydroepiandrosterone-sulfate from the fatal gland by sulfatase enzyme in the placenta

Estrone - menopause - from adrenal androstenedione by peripheral adipose tissue

Question 3

What is Chadwick’s sign?

Answer 3

Bluish or purplish discolouration of the vagina and cervix caused by increased skin vascularity in pregnancy

Question 4

What are the in utero shunts within the foetus?

Answer 4

Ductus venosus - carries blood from umbilical vein to the inferior vena cava

Foramen oval - carries blood from right to left atrium

Ductus arterioles - shunts blood from pulmonary artery to defending aorta

Question 5

What arises from the ectoderm?

Answer 5

CNS, PNS, sensory organs of seeing and hearing, integument layers (skin, nails, hair)

Question 6

What arises from the mesoderm?

Answer 6

muscles, cartilage, CVS, urogenital system

Question 7

What arises from the endoderm?

Answer 7

lining of GI and respiratory tracts

Question 8

What are the effects of alcohol on the growing fetus?

Answer 8

fetal alcohol syndrome - IUGR, mid facial hypoplasia, development delay, short palpebral fissures, long philtrum, multiple joint anomalies, cardiac defects

Question 9

What are the effects of diethylstilbestrol on the growing fetus?

Answer 9

DES syndrome - T shaped uterus, vaginal adenosis (with predisposition to vaginal clear cell carcinoma, cervical hood, incompetent cervix, preterm delivery

Question 10

What are the effects of dilantin on the growing fetus?

Answer 10

fetal hydantoin syndrome - IUGR, craniofacial dysmorphism (epicanthal folds, depressed nasal bridge, oral clefts), intellectual disability, microcephaly, nail hypoplasia, heart defects

Question 11

What are the effects of isotretinoin on the growing fetus?

Answer 11

congential deafness, microtia, CNS defects, congenital heart defects

Question 12

What are the effects of lithium on the growing fetus?

Answer 12

Ebstein’s anomaly (right heart defect)

Question 13

What are the effects of tetracycline on the growing fetus?

Answer 13

after fourth month, deciduous teeth discolouration

Question 14

What are the effects of thalidomide on the growing fetus?

Answer 14

phocomelia, lim reduction defects, ear/nasal anomalies, cardiac defects, pyloric or duodenal stenosis

Question 15

What are the effects of trimethadione on the growing fetus?

Answer 15

facial dysmorphism (short upturned nose, slanted eyebrows), cardiac defects, IUGR, intellectual disability

Question 16

What are the effects of valproic acid on the growing fetus?

Answer 16

neural tube defects (spina bifida), cleft lip, renal defects

Question 17

What are the effects of warfarin on the growing fetus?

Answer 17

chondrodysplasia (stippled epiphysis), microcephaly, intellectual disability, optic atrophy

Question 18

What are the effects of streptomycin on the growing fetus?

Answer 18

VIII nerve damange, hearing loss

Question 19

What are the criteria for the use of methotrexate in an unruptured ectopic pregnancy?

Answer 19

Pregnancy mass <3.5cm diameter
Abcense of fetal heart motion
B-hCG <6 000 mIU
No history of folic supplementation

Question 20

Why are nonsteroidal anti-inflammatory drugs not recommended during pregnancy?

Answer 20

An increased risk of oligohydramnios. Nonsteroidal anti-inflammatory drugs have been shown to increase the risk of spontaneous abortion if taken at the time of conception or for more than 7 consecutive days during the first trimester

Question 21

What is the recommended dose of folic acid for women at high risk for fetuses with neural tube defects?

Answer 21

4mg

Question 22

What is the recommended dose of folic acid for women if no increased risk for neural tube defects exists?

Answer 22

0.4mg

Question 23

What is the recommended dose of folic acid for women with twin pregnancy?

Answer 23

1mg

Question 24

What is the most common cause of ectopic pregnancy?

Answer 24

Previous infection with gonorrhea or chlamydia, resulting in PID

Question 25

What anomaly in Turner syndrome is commonly seen on ultrasound?

Answer 25

Cystic hygroma is the only anomaly in Turner syndrome that is commonly seen on ultrasound

Question 26

What are the risks of the cerclage?

Answer 26

Risks of the cerclage include preterm labor, preterm prerupture of membranes (PPROM), and infections.

Question 27

What cerclages are avaliable and where are they placed?

Answer 27

The two cerclages that are available for obstetrical use are the Shirodkar cerclage, which is placed at the internal os; and the McDonald cerclage, which is placed at the cervical vaginal junction.