Passmed

Question 1

When should women trying to have a baby start taking folic acid

Answer 1

Women should be encouraged to take folic acid 400mcg OD 3 months before conception up to 12 weeks gestation

Question 2

If there’s a low lying placenta at/after 20 week scan…

Answer 2

• Rescan at 32 weeks
• No need to limit activity or intercourse unless they bleed
• If still present at 32 weeks and grade I/II then scan every 2 weeks
• Final ultrasound at 36-37 weeks to determine the method of delivery
• Elective caesarean section for grades III/IV between 37-38 weeks
  -If grade I then a trial of vaginal delivery may be offered
• If a woman with known placenta praevia goes into labour prior to the elective caesarean section an emergency caesarean section should be performed due to the risk of post-partum haemorrhage

Question 3

First line for menorrhagia in women not wishing to conceive

Answer 3

IUS (Mirena) is a form of long-acting reversible contraception that remains effective for 5-7 years, exerting its effects through the sustained release of low doses of progesterone into the uterine cavity.

Question 4

2nd line for menorrhagia but not wanting to conceive

Answer 4

• COCP
• Long acting progesterones

Question 5

Advice for women who miss one pill of COCP

Answer 5

Take the last pill even if it means taking two pills in one day and then continue taking pills daily, one each day. No further advice needed

Question 6

Standard antenatal testing for Downs

Answer 6

Combined test:
- Done between 11 - 13+6 weeks
- Down’s syndrome is suggested by ↑ HCG, ↓ PAPP-A (pregnancy associated plasma protein A), thickened nuchal translucency

Question 7

A mother brings her 6-day old son to see you as she is concerned that her son has lost weight. He was born at term and there were no complications around the time of birth. He is exclusively breastfed. The infant has had a normal amount of wet nappies so far today and is not in any distress. Observations are all within normal limits and he is well hydrated. His birth weight was 3000g and today he weighs 2680g.

What would be the most appropriate next step in managing this infant’s weight loss?

Answer 7

Referral to midwife-led breastfeeding clinic:
- A baby who is exclusively breastfed and loses >10% of their birth weight within the first week of life should be referred to a midwife-led breastfeeding clinic. Infants commonly lose weight in the first 3-4 days of life but this usually stops after around day 3 or 4, and they should be back to their birth weight by the time they are 3 weeks old. The purpose of referral to a feeding service is for direct observation of feeding and support from an appropriately trained person (i.e a member of the midwifery team).