Pregnancy 2 - 235

Question 1

When do cardiovascular changes to the pregnant mother begin and end during pregnancy?

Answer 1

Changes start at 6/40 and plateau in the 2nd trimester

Question 2

What is the change in CO immediately postpartum?

Answer 2

80% increase

Question 3

How does the progesterone effect affect vascular resistance during pregnancy?

Answer 3

It decreases it

Question 4

How does the blood volume of the pregnant women change during pregnancy?

Answer 4

Non-pregnant volume ~2600mL

Pregnant volume ~5000mL

Question 5

Pregnant women are in a pro-thrombotic state. True or false? What is the relevance of this?

Answer 5

True.

Protect from haemorrhage at delivery BUT increased risk of thromboembolism

Question 6

What happens to the tidal volume and residual volume in a pregnant women?

Answer 6

Tidal volume increases by 30-40%

Residual volume decreases by 20%

Question 7

What happens to GI motility during pregnancy?

Answer 7

Reduces to allow better absorption. Due to oestrogen and progesterone

Question 8

Name 4 factors that can increase chance of multiple pregnancy

Answer 8

1) Increasing maternal age
2) FH
3) Race
4) Assisted conception

Question 9

If you have a monochorionic twin pregnancy how often do you scan the mother?

Answer 9

Scan at 16 weeks to exclude TTTS and then every 2-3 weeks for growth

Question 10

When is the anomaly scan in pregnancy?

Answer 10

20 weeks

Question 11

Uncomplicated DCDA twins should be delivered at what gestation?

Answer 11

37-38 weeks

Question 12

Uncomplicated MCDA twins should be delivered at what gestation?

Answer 12

36-37 weeks

Question 13

What 4 things are necessary before commencing an operative vaginal delivery?

Answer 13

1) Adequate analgesia
2) Empty bladder
3) Full dilatation of the cervix
4) Head not palpable per abdomen

Question 14

How long must nulliparous and multiparous women have had lack of progress in labour before an operative vaginal delivery is considered?

Answer 14

Nulli - 3 hours

Multi - 2 hours

Question 15

Where is the ventouse cap fixed?

Answer 15

2-3 cm anterior to the posterior fontanelle (at the flexion point)

Question 16

Name 3 absolute indications for c-section

Answer 16

1) Placenta praevia
2) Severe fetal compromise
3) Uncorrectable abdominal lie
4) Pelvic deformity

Question 17

Give an example of some relative indications for c-section

Answer 17

Breech, DM, other nulliparous women, previous c-sections

Question 18

What is the status of the cervical os in a threatened miscarriage? Incomplete?

Answer 18

Threatened - Closed

Incomplete - Open

Question 19

Give 2 reasons for bleeding in early pregnancy

Answer 19

Miscarriage

Ectopic

Question 20

Roughly how many pregnancies end in spontaneous miscarriage?

Answer 20

14-19%

Question 21

Give some reasons for bleeding in late pregnancy and early labour

Answer 21

Abruption
Placenta praevia
Ruptured uterus
APH

Question 22

How is miscarriage managed medically? (what drugs)

Answer 22

Mifepristone and misoprostol

Question 23

What do you give to all rhesus -ve mothers if they have had a bleed

Answer 23

Anti - D prophylaxis

Question 24

What would serial bHCGs be like in a ectopic and molar pregnancy?

Answer 24

Ectopic - suboptimal rise

Molar - very very high hCG

Question 25

How much blood can a pregnant women lose before showing signs?

Answer 25

1500mL

Question 26

What is the triad of signs in pre-eclampsia?

Answer 26

1) Hypertension
2) Proteinuria
3) Oedema

Question 27

Epigastric pain in a pregnant women (?Pre-eclampsia) suggests what might be developing?

Answer 27

HELLP syndrome. Heamolysis Elevated Liver enzymes, Low Platelet count.
Complication of pre-eclampsia

Question 28

What are some risk factors for pre-eclampsia?

Answer 28

Primiparous
Multiparous but with new partner
Previous history
Multiple birth
Under 20 yrs or over 35 
Obesity
DM
Renal failure

Question 29

What anti-hypertensives can you give to a women with pre-eclampsia?

Answer 29

Labetalol
Nifedipine
Hydralazine

Question 30

What anticonvulsant drug is used in the treatment and prevention of pre-eclampsia?

Answer 30

Magnesium sulphate