Passmed obstetrics

Question 1

causes of folic acid deficiency and its consequences

Answer 1

Causes of folic acid deficiency:
phenytoin
methotrexate
pregnancy
alcohol excess

Consequences of folic acid deficiency:
macrocytic, megaloblastic anaemia
neural tube defects

Question 2

which women need to tak high dose folic acid?

Answer 2

women at higher risk of conceiving a child with a NTD should take 5mg of folic acid from before conception until the 12th week of pregnancy

women are considered higher risk if any of the following apply:
* either partner has a NTD, they have had a previous pregnancy affected by a NTD, or they have a family history of a NTD
* the woman is taking antiepileptic drugs or has coeliac disease, diabetes, or thalassaemia trait.
* the woman is obese (defined as a body mass index [BMI] of 30 kg/m2 or more).

Question 3

first line drug for vomiting in pregnancy

Answer 3

antihistamines are first-line
Promethazine

Question 4

Antepartum haemorrhage is defined as

Answer 4

Antepartum haemorrhage is defined as bleeding from the genital tract after 24 weeks pregnancy, prior to delivery of the fetus

Question 5

distinguishing placenta abruption from placenta praevia

Answer 5

Placental abruption
* shock out of keeping with visible loss
* pain constant
* tender, tense uterus*
* normal lie and presentation
* fetal heart: absent/distressed
* coagulation problems
* beware pre-eclampsia, DIC, anuria

Placenta praevia
* shock in proportion to visible loss
* no pain
* uterus not tender*
* lie and presentation may be abnormal
* fetal heart usually normal
* coagulation problems rare
* small bleeds before large

*vaginal examination should not be performed in primary care for suspected antepartum haemorrhage - women with placenta praevia may haemorrhage

Question 6

high risk factors and moderate risk factors for pre-eclampsia.
what is done as prevention?

Answer 6

Question 7

what produces HCG? what is its role?

Answer 7

Human chorionic gonadotrophin (HCG) is secreted by the syncytiotrophoblast into the maternal bloodstream, where is acts to maintain the production of progesterone by the corpus luteum in early pregnancy

Human chorionic gonadotropin (hCG) is a hormone first produced by the embryo and later by the placental trophoblast. Its main role is to prevent the disintegration of the corpus luteum

Question 8

how early can HCG be detected?

Answer 8

HCG can be detected in the maternal blood as early as day 8 after conception

Question 9

how do HCG levels vary throughout pregnancy? when do they peak?

Answer 9

hCG levels double approximately every 48 hours in the first few weeks of pregnancy.
Levels peak at around 8-10 weeks gestation.