Pregnancy

Question 1

ramipril in pregnancy

Answer 1

avoided in 2nd and 3rd trimester due to risk of fetal renal damage

Question 2

citalopram in pregnancy

Answer 2

SSRI associated with increased CHD in 1st trimester

Question 3

nitrofurantoin

Answer 3

caution in > 36 weeks due to assoc with haemolytic anaemia

Question 4

lamotrigine

Answer 4

caution but is safest anti epileptic in pregnancy

Question 5

NSAIDs

Answer 5

contraindicated due to risk of oligohydramnios

Question 6

carbimazole

Answer 6

assoc with rare skin disorder in 1st trimester

Question 7

Na valporate

Answer 7

congenital malformations

Question 8

trimethoprim

Answer 8

interfers with folic acid pathway therefore is teratogenic in 1st trimester

Question 9

propylthiouracil

Answer 9

assoc with severe liver disease

Question 10

when is booking visit?

Answer 10

12 weeks

Question 11

hx for first visit

Answer 11

• medical conditions
• previous surgery
• fertility problems
• previous pregnancies
• hx DVT
• fhx e.g. diabetes + HTN

Question 12

which hormones prepare mother for labour

Answer 12

oestrogen & progresterone

Question 13

what is the role of oestrogen in delivery?

Answer 13

increases oxytocin receptors in the uterus

Question 14

role of progesterone in delivery?

Answer 14

relaxes smooth muscles which inhibits uterine contraction during pregnancy

Question 15

where is oxytocin stored?

Answer 15

posterior pituitary gland

Question 16

what is the longest stage of labour

Answer 16

first stage

Question 17

how is labour established?

Answer 17

cervix dilated to more than 3cm & regular contractions opening the cervix

Question 18

average duration for timing for first time labour?

Answer 18

6-12 Hrs from start to being fully dilated

Question 19

2 ways to speed up labour?

Answer 19

breaking waters through artificial rupture of membranes
&
oxytocin drip

Question 20

what happens in second stage of labour?

Answer 20

cervix fully dilated until birth of baby

Question 21

what happens in the 3rd stage of delivery?

Answer 21

delivery of placenta

Question 22

what does active management of 3rd stage of labour consist of & why?

Answer 22

oxytocin injection into thigh to increase uterine contractions

speeds up delivery of placenta & reduces risk of PPH

Question 23

what happens in ‘engagement’

Answer 23

the fetal head enters the pelvic inlet in an occipitotransverse position

Question 24

what happens in ‘descent and flexion’

Answer 24

the head descends into the mid-cavity and flexes as the cervix dilates

Question 25

what happens in ‘external rotation/restitution’ in delivery

Answer 25

following the delivery of the head, the fetus rotates back to an OT position along with its shoulders. Axial traction is then applied to allow delivery of the anterior shoulder and then the posterior shoulder

Question 26

when the umbilical cord vessels run in the foetal membrane and cross the internal os

Answer 26

vasa praevia

Question 27

the socring system used to proeduct whetehr induction of lanbour will be required

Answer 27

Bishops score

< 5 suggests labour is unlikely to start without induction (give vaginal PGE2)

Question 28

Another name for molar pregnancy

Answer 28

Hydatiform mole

Question 29

what is a hydatiform mole/molar pregnancy

Answer 29

pre cancerous form of gestational trophoblastic disease

Question 30

key features of molar pregnancies?

Answer 30

• painless vaginal bleeding in early pregnancy
• uterus large for dates
• excessive hCG

Question 31

ultraosund findings in molar pregnancies

Answer 31

mole appears as a solic dcollection of echoes wiht numerous small anechoic spaces resembling a bunch of grapes (snow storm appearance)