Pregnancy

Question 1

What are the signs and symptoms of pregnancy?

Answer 1

Amenorrhoea
Breast enlargement
Increased frequency of urination without dysuria
Fatigue
Nausea and vomiting

Question 2

When can you visualise the yolk sac on ultrasound?

Answer 2

5-6 weeks until 10weeks

Question 3

When is the fetal pole visible on ultrasound?

Answer 3

5.5-6weeks

Question 4

How do you assess the gestational age?

Answer 4

1) LNMP (estimated date of delivery= LNMP - 3months + 7days)
2) TVUS (visible when Beta HCG >1500) or TAUS (visible when Beta HCG >3000-5000)
>double decidual sign
>Crown rump length (accurate when <10 weeks)

Question 5

What criteria are needed for a late ultrasound to be accurate in dating the pregnancy?

Answer 5

Use bi-parietal diameter, femur length, head circumference, abdominal circumference ALL TOGETHER AND:
>views are adequate and standardised planes are obtained
>measurements are concordant
>no advanced placental maturation
>normal amniotic fluid volume
>no underlying maternal disease that could result in growth restricted foetus

Question 6

What are contraindications to air travel in pregnancy?

Answer 6

> Hb <7,5
unstable fracture
recent haemorrhage
otitis media/sinusitis
respiratory disease
recent suckling crisis

Question 7

What are the leadings causes of maternal death in South Africa?

Answer 7

Non-pregnancy related infections
Hypertension related deaths
Obstetric haemorrhage
Pregnancy related sepsis
Medical conditions

Question 8

What are the goals of resuscitation?

Answer 8

MAP >65
Pulse 60-100
UO >0,5ml/kg/hr
Sats >94%
BE -3< and <3
Lactate <4
Normothermic

Question 9

Define massive blood transfusion

Answer 9

> replacing the entire blood volume in 24 hours (10+ units)
Or
replacing >50% of the total blood volume over 3 hours
Or
more than 4 units in 1 hour

Question 10

What is the suggested massive transfusion protocol?

Answer 10

6 units packed cells
4 units FFP’s
1 unit platelets

Question 11

What are the complications of massive transfusion?

Answer 11

Hypothermia
Hypocalcaemia
Metabolic acidosis
Hyperkalaemia
Hypernatraemia
Transfusion related acute lung injury
Coagulation disorders

Question 12

When are blood products indicated?

Answer 12

Hb<8 = 2 units RBC’s
Platelets <50000 = 6 units platelets
INR >2 = 2 FFP’s
Fibrinogen <100 = cryoprecipitate