Obstetrics

Question 1

Which class of diabetes medication is contraindicated in pregnancy AND breastfeeding?

Answer 1

Sulphonylureas (Gibenclamide, Gliplizide
Tolbutamide, Gliclazide)
Glinides (Repaglinides, nateglinide.)

Question 2

What effect does pregnancy have on the thyroid?

Answer 2

Increase in size
Increase TBG levels
IncreasesfT4, decreasesTSH

Question 3

What effect does HCG have on thyoxine levels?

Answer 3

Increases it

Question 4

What effect does pregnancy have on Grave’s Disease?

Answer 4

Grave’s disease is often SUPRESSED during pregnancy (as there is immunosuppression in this time.) BUT rebound postpartum

Thyroid receptor antibodies TRAB should be measured in 3rd trimester to predict thyrotoxicosis risk for baby.
May require small doses of Carbimazole.

Question 5

Managing Grave’s in pregnancy?

Answer 5

‘Wait & See’
1st trimester - avoid carbimazole & use Propythyouracil
2nd trimester - give carbimazole

Question 6

What effect does hypothyroidism have on pregnancy?

Answer 6

Cretinism - dwarfism plus limited mental functioning.

risks infertility, pre-eclampsia, post-partum haemorrhage & preterm labour.

Question 7

How should levels of levothyroxine be altered for pregnant women with hypothyroidim?

Answer 7

Increased by 50%

Question 8

What crisis can be precipitated by labour? (related to the thyroid)

Answer 8

Thyroid crisis & transient neonatal thyrotoxicosis

Question 9

What are the complications of thyroid crisis in labour?

Answer 9

increases risk of miscarriage, stillbirth

Question 10

Which hormones are secreted from the posterior pituitary?

Answer 10

Oxytocin & ADH

Question 11

Where is prolactin released from?

Answer 11

Anterior pituitary

Question 12

How does pregnancy affect the respiratory system?

Answer 12

Tidal volume increases

Minute ventilation increases (Tidal volume x RR)

Question 13

What is dilutional anaemia?

Answer 13

This is when plasma volume rises in pregnancy & RBCs are diluted. Hb conc falls

Question 14

What is first line contraception for women who are breastfeeding?

Answer 14

Progesterone only
Can be used first day postpartum
Implant is most effective
IUS & IUD SHOULD BE AVOIDED DUE TO RISK OF PERFORATION.

Question 15

Which contraceptives are contraindicated postpartum & why?

Answer 15

COC due to increases risk of VTE

IUS & IUD SHOULD BE AVOIDED DUE TO RISK OF PERFORATION.

Question 16

Ibuprofen & Paracetamol can safely be used for analgesia during breastfeeding T/F?

Answer 16

True

Question 17

Is aspiring contraindicated in breastfeeding?

Answer 17

Yes. (can lead to liver failure & thrombocytopenia in infant)

Question 18

Opiates are contraindicated in breastfeeding T/F?

Answer 18

F - use with caution & seek help signs of toxicity

Question 19

In CTG what does prolonged decceleration indicate?

Answer 19

Prolonged deccelaration >3min

Foetal bradycardia

Question 20

On CTG what is a normal baseline variability?

Answer 20

> 5bpm

Question 21

What is normal pH levels on foetal blood sampling?

Answer 21

> 7.25

Question 22

What is a normal foetal heart rate?

Answer 22

100-160bpm

adult 60-100

Question 23

What is Bishop’s score used for?

Answer 23

Check if its safe to induce labour

Question 24

Induction of labour if bishop’s score is?

Answer 24

<5 labour unlikely to start without induction

>9 means its likely to occur spontaneously

Question 25

How do you induce labour?

Answer 25

1. Vaginal membrane sweeping | 2. Vaginal PGE2 (but not misoprostol as this is for miscarriages)

Question 26

What are the foetal cardinal movements in labour?

Answer 26

``` 1…Engagement 2…Decent 3…Flexion 4…Internal Rotation 5…Crowning and extension 6…Restitution and external rotation (head adopts optimal position for shoulder) 7…Expulsion, anterior shoulder first ```

Question 27

Describe foetal descent

Answer 27

Descent inocciput transverse position (widest pelvic diameter available for the widest part of the fetal head.)

Question 28

Describe engagement

Answer 28

largest diameter of the fetal head is engaged when the widest diameter of the brim of the pelvis. occiput transverse position 3/5ths or less of the foetal head should be palpable in the abdomen - station -2. Foetus is at station 0 (ischial spine)

Question 29

Why does flexion of the foetal head occur?

Answer 29

Fundal dominance of uterine contraction exerting pressure down the fetal spine forcing occiput to come into contact with the pelvic floor. Flexion allows the circumference of the foetal head to reduce. This assists passage through the pelvis.

Question 30

Describe internal rotation

Answer 30

Maternal contractions slowly push the foetal head to completing a 90 degree turn. Will only occur in established labour. Commonly completed by the beginning of the second stage of labour (full dilation to delivery.) Occiput transverse -> Occiput anterior position

Question 31

Describe crowning

Answer 31

widest diameter of the fetal head successfully negotiates through the narrowest part of the maternal bony pelvis. Head visible at the vulva and does not disappear between contractions.

Question 32

Describute restitution & external rotation

Answer 32

Return of the fetal head returns to the correct anatomic position relative to the fetal torso. This is shoulders that have only reached pelvic floor. May need to return to occipito-transverse position to get these out.

Question 33

What is the frequency of contractions during latent stage 1 labour?

Answer 33

varies from every 5-30 minute to every 3-5 minutes | or 2-3 every ten minutes

Question 34

What is the frequency of contractions during ACTIVE stage 1 labour?

Answer 34

every 60-90 seconds, can even overlap.

Question 35

What is the normal length (hrs) of the second stage of labour?

Answer 35

``` Prims 3hrs (with analgesia), 2 hrs (without analgesia) Multiparous 2hrs (with analgesia), 1hr (without analgesia) ```

Question 36

What does foetal station measure?

Answer 36

``` The degree of descent Measured as presenting part relative to ischial spines. Pelvic inlet (station -5) Ischial spine (station 0) Vagina (station +5) ```

Question 37

List the indications for continous CTG monitoring in labour:

Answer 37

suspected chorioamnionitis or sepsis, or a temperature of 38°C or above severe hypertension 160/110 mmHg or above oxytocin use the presence of significant meconium fresh vaginal bleeding that develops in labour - this could respresent placental rupture (the most common cause of antepartum haemorrhage) or placental praevia (second most common cause of antepartum haemorrhage) and therefore monitoring of the baby is required.