Pregnancy

Question 1

What are the signs and symptoms of early pregnancy?

Answer 1

Morning sickness
Hyperemesis gravidarum
PV spotting/absence of periods
Breast tenderness
Tiredness
Urinary frequency
Ligamentous pain
Headache

Blue discoloration of cervix and vagina
Darkening of nipples (increased melanin)
Softening of cervix and uterus
Palpable fundus from 12 weeks onwards

Question 2

What hormones are raised in pregnancy?

Answer 2

Oestrogen, Progesterone, Human placental lactogen, beta-HCG Human Chorionic Gonadotropin, placental alkaline phosphatase

Question 3

What are the common complains of pregnant women?

Answer 3

Heartburn, Constipation, Varicose veins, vaginal discharge, oedema, backache,

Question 4

Why is the abdomen palpated at <24 weeks?

Answer 4

To check dates and to identify twins

Question 5

Why is the abdomen palpated at >24 weeks?

Answer 5

To assess well-being by assessing size and liquor

Question 6

Why is the abdomen palpated at >36 weeks?

Answer 6

To check lie, presentation and engagement.

Question 7

If the presenting complain of the mother is antepartum haemorrhage, what important question must you ask?

Answer 7

Whether there is any pain. Painless antepartum haemorrhage can suggest Placenta Preavia whereas painful APH can suggest Placenta abruption.

Question 8

What does “primipara/primip/primigravida” means?

Answer 8

Primipara/Primigravida refers to women who are pregnant for the first time.

Question 9

How much Vitamin D is given if needed?

Answer 9

10mcg

Question 10

Who will be advised to take Vitamin D supplements?

Answer 10

Women of South Asian, African, Caribbean or Middle Eastern family origin.
Women with limited exposure to sunlight.
Women whose diet contains no oily fish, eggs, meat or Vit D fortified food.
Women with BMI >30kg/m2.

Question 11

Which food should pregnant women avoid? State the risks for consumption of each food.

Answer 11

Avoid fresh milk or ripened soft cheese, due to risk of listeriosis.
Avoid raw meat or eggs, due to risk of toxoplasmosis or salmonella.
Avoid unwashed vegetables, due to risk of listeriosis or toxoplasmosis.
Avoid vitamin A supplementation (above 700micrograms), as it can be teratogenic.

Question 12

What is done at 25 weeks of gestation?

Answer 12

Symphyseal-fundus height measurement and ausculatation

Question 13

What is antepartum haemorrhage?

Answer 13

Antepartum haemorrhage is bleeding from the genital tract after 24 weeks of gestation

Question 14

What should be done if there is placenta praevia?

Answer 14

ABC - Large bore cannula and fluid replacement. Blood cross-matching.
If preterm, give steroids and observe. Deliver normally at 37/40 gestation if no further bleeds or if placenta is >4cm from cervical os.
If term, deliver by C-section.

Question 15

Why is C-section usually done on the lower segment of the uterus?

Answer 15

The lower segment of the uterus is less muscular and less vascular. There is also less risk of tear and bleed if there is subsequent pregnancy.

Question 16

Why is steroids given in preterm labor?

Answer 16

Steroids can help speed the development of infant’s lungs, by inducing surfactant production.

Question 17

What are the observations of the uterus and fetal heart sound in placenta preavia as compared to in placenta abruption?

Answer 17

In placenta preavia, uterus is soft and non-tender, with fetal heart sounds heard.
In placenta abruption, uterus is “woody” hard and fetal heart sounds are muffled.

Question 18

What is the cause of painful antenatal haemorrhage? Define this condition.

Answer 18

Placenta abruption, when part of or all of the placenta separates form the endometrium before delivery of the fetus.

Question 19

What are the 2 types of placenta abruption?

Answer 19

Revealed abruption and concealed abruption

Question 20

How is Haemolytic Disease of Newborns prevented?

Answer 20

By intramuscular injection of anti-Rhesus antibody preparation during the first pregnancy at 28 weeks gestation and again at 34 weeks.

Question 21

What is measured when booking bloods in pregnancy?

Answer 21

FBC (to check for anaemia and thrombocytopenia)
Haematocrit (if Hb is low)
Infection screening (for Hep B (and Hep C if Hep B is positive), HIV and Syphilis)
Group and Save: (Blood group and Rhesus status, and atypical antibodies)

Question 22

Describe how the estimated date of delivery is calculated.

Answer 22

Estimated date of delivery is calculated by adding 9 months and 1 week onto the 1st day of the LMP

Question 23

At what stage of gestation would you expect a nulliparous woman to feel foetal movements?

Answer 23

At 18 to 20 weeks of gestation

Question 24

What is the most common cause of PPH?

Answer 24

Uterine atony.

A uterus can become atonic due to prolonged labour, macrosomia, multiple pregnancy and retained placenta.