PACES Viva: O&G

Question 1

What are High and Moderate Risk Factors for Hypertension in pregnancy?

Answer 1

High: (need 1)
Previous HTN in pregnancy
Chronic Hypertension
AI diseases/SLE
DM
CKD

Moderate: (need 2)
Age ≥40
Nullip (or first pregnancy after 10 years)
BMI ≥35
Multi-foetal

Give 75mg Aspirin after 12 weeks

Question 2

What drug not to give in labour in pre-eclampsia and why?

Answer 2

Ergometrin: Causes Hypertension

Question 3

Classification of pre-eclampsia

Answer 3

Mild: 140/90-149/99
Mod: 150/100-159/109
Severe ≥160/110 + Proteinura OR ≥140/90 + Proteinuria + Sx

Question 4

Definition of pre-eclampsia

Answer 4

BP ≥140/90 on 2 occasions 4 hours apart AND proteinuria ≥300mg/24 hours (or PCr ≥30)

• 20 weeks to 6 weeks post-partum

Question 5

Mx Eclampsia

Answer 5

Bedside: BP every 15 mins, ECG, EEG
Bloods: FBC, U&Es, LFTs, Clotting, BM
TVUSS + CTG regualrly

1. A-E with left-lateral position + Oxygen
2. IV MagSulphate 4g/100ml NaCl over 20 mins
3. IV MagSulphate 1g/100ml NaCl hourly/24 hours
4. BP: IV labetalol + Hydralazine
5. Emergency C-Section
6. Monitor for 24 hours in HDU and regular post partum

Question 6

Complications of Pre-eclampsia

Answer 6

Maternal:
HELLP syndrome (3 %)
Disseminated Intravascular Coagulopathy (DIC) (3 %)
Acute Kidney Injury (4 %)
Adult respiratory distress syndrome (3 %)
Cerebrovascular haemorrhage (< 2 %)
Permanent CNS damage.
Death (1.8 %)

Foetal:
Intrauterine growth restriction (IUGR)
Prematurity
Infant respiratory distress syndrome
Intrauterine fetal death
Placental abruption

Question 7

Risk Factors for GDM

Answer 7

BMI >30
Asian ethnicity
Previous gestational diabetes
1st degree relative with diabetes
Polycystic ovarian syndrome
Previous macrosomic baby (>4.5kg)

Question 8

OGTT when to do and values

Answer 8

Booking
24-28wks if RF or Previous GDM
If 2+ once or 1+ twice glycosuria

Fasting ≥5.6
2hr ≥7.8

Question 9

Mx of GDM

Answer 9

MDT: Midwives, DM-specialist nurses, consultant-led care, GP

Meds: If 1 week of lifestyle doesnt change

• Metformin
• Glibenclamide if metofrmin and insulin not tolerated
• Insulin

Question 10

Insulin in GDM

Answer 10

IF Diagnostic Fasting ≥7, OR anytime

(i) pre meal glucose > 6.0mmol/L
(ii) post meal glucose 2hr >7.5mmol/L
(iii) fetal AC (abdominal circumference) >95th centile

Question 11

RF for shoulder dystocia

Answer 11

Pre-Labour
→ Previous shoulder dystocia – x10
→ Macrosomia – fetal weight above >4.5kg
→ Diabetes – increases risk by x2-4 
→ Maternal BMI > 30
→ Induction of labour

Intrapartum
→ Prolonged 1st stage of labour
→ Secondary arrest 
→ Prolonged second stage of labour
→ Augmentation of labour with oxytocin
→ Forceps or ventouse

Question 12

Mx Shoulder Dystocia

Answer 12

“Turtling sign”

1. Call for help
2. Ask the mother to stop pushing
3. Avoid traction
4. Episiotomy to help with manoeuvres
5. Manoeuvres

Question 13

Shoulder Dystocia Manoeuvres

Answer 13

1. McRobert’s (Hyperflexing the hips) ± Suprapubic Pressure
2. Delivery posterior Arm or Woodscrew
3. Try on all 4s before moving on
4. Cleidotomy (break clavicles), Symphisiotomy, Zavenelli

Question 14

Glucose Targets in GDM

Answer 14

Pre-meal: 5.3
1hr Post: 7.8
2hr Post: 6.4