Perinatal medicine

Question 1

What is antepartum hemorrhage?

Answer 1

Bleeding after 28w of gestation until delivery

Question 2

What are the causes of antepartum hemorrhage?

Answer 2

Placenta praevia, abruption
Uterine rupture
Vasa praevia
Lower genital tract lesion
Others: coagulopathy, bloody show, APHUO

Question 3

What is placenta praevia?

Answer 3

Placenta implanted partially/wholly into lower uterine segment after 28w

Question 4

What is the difference between antepartum hemorrhage and miscarriage?

Answer 4

Whether the fetus is viable

Question 5

How to differentiate between fetal and maternal blood in APH?

Answer 5

APT test (alkali denaturation test by adding NaOH to blood)

• Maternal blood turns brown (HbA has lower O2 affinity -> denatured)
• Fetal blood remains red (HbF has higher O2 affinity -> x denatured)

Question 6

What is oligohydramnios?

Answer 6

AFI: <8cm

Greatest pocket method: <1cm

Question 7

What is polyhydramnios?

Answer 7

AFI: >24cm

Greatest pocket method: >8cm

Question 8

How to measure amniotic fluid?

Answer 8

Amniotic fluid index: sum of maximal vertical depth in 4 quadrants
Greatest pocket method: maximal vertical depth

Question 9

What is the composition of amniotic fluid?

Answer 9

Fetal cells: amniocytes, fibroblasts, epithelial cells

Molecules: IGFBP1, bilirubin

Question 10

How is amniotic fluid produced & removed?

Answer 10

Production: fetal urine (From 12w), lung fluid, transmembranous
Removal: GIT, trans & intramembranous, rupture in membrane

Question 11

How to mx meconium stained liquor?

Answer 11

Suspected fetal distress -> fetal blood sampling

Question 12

What is IUGR?

Answer 12

Growth below 3rd percentile

Question 13

What is SGA?

Answer 13

Growth between 3rd to 10th percentile

Question 14

How to monitor FGR?

Answer 14

Fetal growth parameters
Doppler (UmA, UtA, MCA)
CTG (FHR)
Biophysical profile (FM, fetal breathing movement, fetal tone, liquor)

Question 15

What are the causes of IUGR?

Answer 15

1) Placental insufficiency
- placenta praevia, abruptio, accrete, infarction
- PET/DM
- post term
2) Maternal
- COH: teenage pregnancy, low pre-preg wt
- PMH: SLE, APLS, HT, renal disease
- SH: S/D/SA, malnutrition
3) Fetal: genetic, congenital inf

Question 16

What are the Cx of FGR?

Answer 16

1) Fetal: IUD, intrapartum fetal distress
2) Neonatal: birth asphyxia, ROP, PPH, NEC, hypogly, polycythemia
3) Long term: CP, HT, obesity

Question 17

What is PPROM?

Answer 17

ROM before 37w of gestation

Question 18

What is the median latency of PPROM?

Answer 18

7d (from ROM to labour)

Shortens as gestation increases

Question 19

What are the RF of PPROM?

Answer 19

Polyhydramnios
Breech
Cervical incompetence
Genital tract inf

Question 20

What are the Cx of PPROM?

Answer 20

Baby: prematurity, sepsis, cord prolapse, pulmonary hypoplasia
Mother: Inf, Placental abruption

Question 21

What are the S/S of PPROM?

Answer 21

Sudden gush of watery vaginal fluid

Question 22

How to Ix PPROM?

Answer 22

Aseptic speculum exam: pool of liquor +/- cough test (oozing of fluid)
Others: Actim PROM test (IGFBP-1), Amniostix (alkaline), microscopic exam (fern pattern in liquor)

Question 23

How to Mx PPROM?

Answer 23

<34w: ABX + corticosteroids +/- MgSO4
>34w: delivery

27-34w: MCE
>34w: GBS regimen

Question 24

How to Mx transverse lie for singleton at term?

Answer 24

Delivery at 37-38w
High risk of CPD: LCSC (convert to longitudinal lie then delivery by breech extraction)
Low risk of CPD: stabilizing induction (ECV then IOL)

Question 25

How to Mx unstable lie?

Answer 25

Admit from 37w

1) Multiparous w/ prev NSD: lax uterus -> stabilizing IOL at 38w (ECV then AROM)
2) Nulliparous w/ normal liquor: contracted pelvis -> LSCS at 38w
3) Polyhydramnios: amnioreduction then stabilizing IOL / LSCS

Question 26

What are the causes of malpresentation?

Answer 26

1) Uterus: SOL in lower segment (fibroid, placenta praevia), congenital abn (bicornuate / septate)
2) Fetal: big head, huge neonatal goitre
3) High amniotic fluid (e.g. preterm)