Placement Notes

Question 1

What is a molar pregnancy?

Answer 1

Duplicate paternal chromosomes:

YY or XYY - both are non-viable.

Note: Molar pregnancy can cause hyperemesis so an ultrasound is needed in these patients to rule a molar pregnancy out as a cause.

Question 2

What are women whom have molar pregnancies at increased risk of?

Answer 2

Choriocarcinoma

Question 3

How is hyperemesis diagnosed?

Answer 3

Vomitting + 5% of weightloss since start of pregnancy.

++ Ketones in urine = admit

Question 4

What is the management of patients with hyperemesis?

Answer 4

IV Fluids

1st line - Cyclizine

2nd line - Prochlorperazine / Metoclopramide

3rd line - add hydrocortisone

Also give supplements thiamine (B1) to prevent wernicke’s encephalopathy.

Enoxiparin

Question 5

What is the mechanism of metoclopramide?

Answer 5

The antiemetic action of metoclopramide is due to its antagonist activity at D2 receptors in the chemoreceptor trigger zone in the central nervous system — this action prevents nausea and vomiting triggered by most stimuli.

Question 6

What is anti-emetic is contraindicated in pregnancy and why?

Answer 6

Ondansetron - cleft palate formation in the foetus.

Question 7

What is aciclovir used for?

Answer 7

Aciclovir is used to treat herpes and is used in prophylactic treatment for pregnant women against varicella zoster aka chicken pox.

Aciclovir (or acyclovir) is an antiviral medicine. It treats infections caused by the herpes virus (herpes simplex), including: cold sores. genital herpes.

Question 8

What pharmacological or non-pharmacological agents could be used to induce labour?

Answer 8

Pharmacological – syntocinon (synthetic oxytocin) and prostaglandin.

Non-pharmacological – Exercise, nipple stimulation, spicy foods.

Question 9

What does syntocinon do?

Answer 9

Stimulates the muscles of the uterus (womb) to produce rhythmic contractions.

Question 10

How does prostin work and what is it?

Answer 10

Dinoprostone causes the muscle of the cervix to relax and start to dilate. This subsequently triggers the muscle of the uterus (womb) to start contracting and labour to begin. The Prostin E2 vaginal tablet or gel is inserted high up into the vagina to induce labour.

Prostin is a prostaglandin analogue.

Question 11

APGAR score

Answer 11

Used to assess a baby following delivery.

Question 12

Why is dexamethasone given to pre-term women?

Answer 12

Dexamethasone accelerates maturation of fetal lungs, decrease number of neonates with respiratory distress syndrome and improves survival in preterm delivered neonates. Optimal gestational age for use of dexamethasone therapy is 31 to 34 weeks of gestation.

Question 13

What does magnesium sulphate do in pregnancy?

Answer 13

Magnesium sulfate therapy is used to prevent seizures in women with preeclampsia. It can also help prolong a pregnancy for up to two days. This allows drugs that speed up your baby’s lung development to be administered.

Helps prevent cerebral palsy in babies.

Question 14

Describe what screening tests can be undertaken to detect Downs Syndrome and what other chromosomal conditions can be identified?

Answer 14

Edwards Syndrome – Trisomy 18 - Individuals with trisomy 18 often have slow growth before birth (intrauterine growth retardation) and a low birth weight.

Patau Syndrome – Trisomy 13 – Organ defects – fatal.

Question 15

What are the complications of gestational diabetes?

Answer 15

Increases risk of neonatal jaundice and polycythemia.

Question 16

Initial treatment for postpartum haemorrhage:

Answer 16

Oxytocin

Question 17

How does fetal hypoxia present on CTG monitoring?

Answer 17

Subacute hypoxia presents as decelerations for most of the time on the CTG. This is almost invariably caused by uterine hyperstimulation. The fetal pH drops at a rate of 0.01 every 2-3 minutes.