Pregnancy Emergencies

Question 1

Criteria for Dx gestational diabetes

Answer 1

FBG > 5.1
75g OGTT 1hr > 10
75g OGTT 2hr > 8.5

Question 2

Caesarean delivery Indication for macrosomic baby (Normal and GDM baby)

Answer 2

5000g Normal

4500g GDM

Question 3

When to test OGTT?

Answer 3

26-28 weeks

Question 4

Dx of Hyperemesis gravidarum

Answer 4

Ketonuria on urinalysis
And/with
>5% weight loss

Affects 1:200

Question 5

Treatment of hypremesis gravidarum

Answer 5

1. ABC
2. Small frequent meals of high carb, low fat. Ginger. Acupressure
3. Pyridoxime (B6) + doxylamine (anti histamine)
4. Antiemetics (metoclopramide )
5. Last line IV hydrocortisone

Question 6

Diagnosis criteria for pre eclampsia

Answer 6

140/90
AND
Proteinuria ( or w signs of end organ failure)
after W20

If no proteinuria= gestational hypertension

Moderate = 150/100
Severe= 160/110

Question 7

What is the diagnostic criteria of HELLP syndrome ?

Answer 7

Tennessee criteria x4
Schistocytes on peripheral blood smear ( also seen in MAHA)
Bilirubin > 20 
ALT >70 
Pt <100

Question 8

Hypertension + end organ damage + convulsions =?

Treatment

Answer 8

Eclampsia.

Delivery and removal of placenta is the only treatment. (@W37) Magnesium sulfate IV also administered.

Question 9

Hypertensive agents of choice in pregnancy ? MLNH

My legs need hugs

Answer 9

Methyldopa- avoid in depression
Labetalol - avid in asthmatics -first line!
Nifedipine
Hydralazine

Question 10

How to distinguish between HELLP Sx vs Intrahepatic cholestatic pruritus vs Acute fatty liver of pregnancy

Answer 10

HELLP-Tennessee criteria
ICP- pruritus
AFLP- genetic testing

Question 11

Distinguish between pregnancy loss of miscarriage vs stillbirth

Answer 11

Loss of pregnancy W24 =Stillbirth

NB. Stillbirths count as P1
20% of pregnancies result in miscarriages

Question 12

What are the 4 progressive stages of ‘physiological’ miscarriage ? What is the other one ?

Answer 12

1. Threatened
2. Inevitable
3. Incomplete
4. Complete

Other = missed/ silent miscarriage. Body does not recognize it physiologically

Question 13

Foetal HR present
Bleeding spotting
Cervical os closed

Answer 13

Threatened

Question 14

Foetal HR present
Bleeding spotting
Cervical os open

Answer 14

Inevitable

Question 15

Foetal HR absent
Bleeding spotting
Cervical os closed

Answer 15

Complete

Question 16

Foetal HR absent
Bleeding spotting
Cervical os open

Answer 16

Incomplete

Question 17

Shoulder Dystocia management

HELPER RDD

Answer 17

Help 
Consider episiotomy 
Leg - McRoberts maneuvered
Pressure - suprapubic pressure 
Enter - manoeuver
Remove posterior arm
Roll onto all fours 
(Rupture child's clavicle OR maternal pubic symphysis) Return head..
Debrief and document

Question 18

PPROM management

Answer 18

• Erythromycin
  
  • Benpen -
  • Betamethasone
  • Tocolytics (only give if

Question 19

Postnatal complications - BESLUT

Answer 19

Breast - mastitis 
Endometriosis 
Septicaemia 
Lung - pneumonia 
Urinary 
Thrombosis

Question 20

Mastitis management

Answer 20

Fluclox + analgesia + frequent breastfeeding + improved technique

Question 21

3rd trimester pregnancy, painless vaginal bleeding, low-lying placenta on T2US

Answer 21

Placenta praevia

Question 22

Profuse bleeding during attempted placental separation, PHx C-Section

Answer 22

Placenta accreta

Question 23

Painless bleeding during ROM

Answer 23

vasa praevia

Question 24

3rd trimester pregnancy, sudden painful bleeding, tachysystole, woody hard abdomen

Answer 24

Placental abruption

Question 25

Labour, sudden painful/painless bleeding, contractions stop, loss of foetal station

Answer 25

uterine rupture

Question 26

ROM before labour but still term ROM before labour, pre-term Perineal tear through sphincter and perineal body Postpartum, fever, uterine tenderness, foul smelling lochia Labour, foetal shoulder trapped behind mother’s pubic symphysis

Answer 26

``` PROM PPROM Grade 3 laceration Endometritis Shoulder dystocia ```

Question 27

``` Type of Miscarriage/Ectopic Bleeding/pain, Os open, FH+ Spotting, Os closed, FH+ Bleeding, adnexal pain, BP stable Nil/Spotting, Os closed, FH-, gestational sac present (>20mm). Bleeding/pain, Os open, FH- but POC+ Bleeding, adnexal pain, BP unstable Reduced bleeding/pain, Os closed, FH-, POC- ```

Answer 27

``` Inevitable miscarriage Threatened miscarriage Ectopic pregnancy (stable) Missed miscarriage Incomplete miscarriage Ectopic pregnancy (ruptured) Complete miscarriage ```

Question 28

3rd trimester pregnancy, painless vaginal bleeding, low-lying placenta on T2US

Answer 28

Placenta praevia

Question 29

Profuse bleeding during attempted placental separation, PHx C-Section

Answer 29

Placenta accretia

Question 30

Painless bleeding during ROM

Answer 30

vasa praevia

Question 31

3rd trimester pregnancy, sudden painful bleeding, tachysystole, woody hard abdomen

Answer 31

Placental abruption

Question 32

Labour, sudden painful/painless bleeding, contractions stop, loss of foetal station

Answer 32

uterine rupture

Question 33

ROM before labour but still term ROM before labour, pre-term Perineal tear through sphincter and perineal body Postpartum, fever, uterine tenderness, foul smelling lochia Labour, foetal shoulder trapped behind mother’s pubic symphysis

Answer 33

``` PROM PPROM Grade 3 laceration Endometritis Shoulder dystocia ```

Question 34

``` Type of Miscarriage/Ectopic Bleeding/pain, Os open, FH+ Spotting, Os closed, FH+ Bleeding, adnexal pain, BP stable Nil/Spotting, Os closed, FH-, gestational sac present (>20mm). Bleeding/pain, Os open, FH- but POC+ Bleeding, adnexal pain, BP unstable Reduced bleeding/pain, Os closed, FH-, POC- ```

Answer 34

``` Inevitable miscarriage Threatened miscarriage Ectopic pregnancy (stable) Missed miscarriage Incomplete miscarriage Ectopic pregnancy (ruptured) Complete miscarriage ```