OBSTETRICS/ GYNAE

Question 1

OBS examination

Answer 1

Inspection: modesty covers, abdominal swelling in keeping
with pregnancy, linea nigra, striae, surgical scars (LSCS),
jaundice (obstetric cholestasis, HELLP).
Fundal height: cm face down, measure from top of uterus to
pubic symphysis. Should be 1-2 cm within weeks: small
(growth restriction, oligohydramnios, small baby), large
(macrosomia, polyhydramnios, multiple, fibroids).
Palpation: feel one side then the other work from top to
bottom, note position of fetus back (solid and flat), head
(hard pole), limbs (inconsistent pole), fetal lie (longitudinal,
transverse, oblique), number of fetuses, presentation
(cephalic or not), engagement of head (engaged = no gap
between head and pubic symphysis), c-grip.
Auscultation: 2/3rds between ASIS and umbilicus on baby’s
back.
Fetal movements: from 18-20wks.
Position: occipitoanterior (back felt and no limbs, ideal for
delivery), occipitolateral (back felt, lateral limbs),
occipitoposterior (back not felt, limbs anterior)

Question 1

abruption

Answer 1

Abruption: blood loss, pain, tender and tense uterus,
high/low fetal HR. Part of the placenta has come off the womb. Distress = LSCS, no distress >36w = vaginally deliver,
no distress <36w = admit and observe, betamethasone.

Question 2

placenta praevia

Answer 2

Placenta previa: painless blood loss, abnormal lie. Placenta
close to cervix and is at risk of damage during labour. LSCS
38w

Question 3

prom

Answer 3

PROM: waters have broken, admit 48h, IOL >34w, IM
betamethasone x2, erythromycin. Risk of infection,
prematurity.

Question 4

pre eclampsia

Answer 4

Pre-eclampsia: urine dip, regular growth scans,
labetalol/nifedipine, IOL 37w.

Question 5

chorioaminionitis

Answer 5

Chorioamnionitis: infection of womb. LSCS, antibiotics

Question 6

altered hr

Answer 6

Altered HR: <100 or >160bpm chorioamnionitis, cord
entanglement, maternal beta blocker use, maternal pyrexia,
abruption, pre-eclampsia.

Question 7

breech

Answer 7

Breech: <36 weeks may turn spontaneously, 36-37w
external cephalic version (60% success), LSCS 39w (reduces
perinatal mortality and early neonatal morbidity).

Question 8

GDM

Answer 8

GDM: glucose monitoring, fetal growth scans, lifestyle,
metformin, insulin. Risk of growth problems, malformation,
preterm labour

Question 9

Cholestasis

Answer 9

Cholestasis: USS liver, bloods, ursodeoxycholic acid, weekly
blood tests, IOL 38w. Risk of preterm labour, distress,
meconium, stillbirth.

Question 10

small and large for dates

Answer 10

Large for dates: DM, obesity, multiple, constitutional. Risk of
birth injury.

Small for dates: pre-eclampsia, abruption, genetic
abnormalities, smoker, HTN, DM. Serial USS, umbilical artery
doppler, IOL 37w if normal doppler. Risk of higher mortality,
cerebral palsy, distress, meconium aspiration, emergency
CS.

Question 11

uti

Answer 11

UTI: cefalexin. Risk of preterm delivery, IUGR.

Question 12

rhesus incompatibility

Answer 12

Rhesus incompatibility: give anti-D Ig. Risk of heart, spleen,
liver problems.

Question 13

iol

Answer 13

IOL: misoprostol ripening, PGE2 induce, membrane rupture
+/- oxytocin. Risk of uterine hyperstimulation, LSCS,
prolonged labour, fetal distress, scar rupture, cord prolapse.

Question 14

LSCS

Answer 14

LSCS: antibiotics, neutralize stomach acid, speed gastric
emptying. Risk of organ injury, baby injury, hemorrhage,
infection, future pregnancy risks.

Question 15

Torsion

Question 16

ectopic

Question 17

hmb

Question 18

miscarriage