Random facts

Question 1

pain in in the lower pelvis that radiates to the groin and medial aspect of thigh. a waddling gait may be seen ?

Answer 1

pubis symphysis dysfunction

Question 2

risk factor for uterine rupture ?

Answer 2

previous c -section

Question 3

features of a uterine rupture?

Answer 3

often occurs during labour but may occur in the 3rd trimester
maternal shock, abdominal pain and vaginal bleeding
risk factor - previous c-section

Question 4

causes of increased AFP ?

Answer 4

neural tube defects
abdominal wall defects i.e. omphalocele, gastroschisis
multiple pregnancies

Question 5

causes of decreased AFP ?

Answer 5

maternal diabetes mellitus

downs syndrome

Question 6

cervix is anterior, soft, effacement 50%-69%, foetal station 0 and cervical dilatation 3cm.
what is the bishop score ?
what does this indicate ?

Answer 6

score 9

indicates spontaneous labour is likely to occur

Question 7

cervix is posterior, firm, cervical dilatation 3cm, effacement 50% and foetal station -2.
what is the bishop score ?
what does this indicate ?

Answer 7

score 4

indicates spontaneously labour is unlikely to occur

Question 8

what is the bishop score used to indicate ?

Answer 8

how likely spontaneous labour is to occur

score < 5 = isn’t likely to occur without induction
score > 9 = is likely

Question 9

bleeding in the first trimester, bHCG is high, hyperemesis and foetus large for date.
most likely diagnosis ?

Answer 9

molar pregnancy

Question 10

if breach at 28 weeks, what would be the best course of action ?

Answer 10

re-scan at 36 weeks because majority of breech presentations spontaneously resolve

Question 11

if still breech at 36 weeks what would be the best course of action ?

Answer 11

ECV

if unsuccessful or contraindicated then discussion of either planned c-section or vaginal delivery

Question 12

absolute contraindications to ECV ?

Answer 12

antepartum haemorrhage in previous 7 days 
rupture of the membranes 
multiple pregnancies 
major uterine anomaly 
where cesarean delivery is planned

Question 13

risk factors for breech presentation ?

Answer 13

uterine malformations, fibroids

oligohydramnios, polyhydramnios

placenta praevia

foetal abnormality (i.e. chromosomal, CNS malformation)

prematurity (due to increase incidence in early pregnancy)

Question 14

contraindication to vaginal delivery after previous c-section ?

Answer 14

previous uterine rupture

classical (vertical) cesarean scar

Question 15

treatment for PE during pregnancy ?

Answer 15

LMWH and continue 4-6 weeks after delivery

Question 16

management of chorioamnionitis ?

Answer 16

prom delivery of the foetus (via c-section if necessary) and IV antibiotics for the mother

Question 17

when is the triple or quadruple test for downs syndrome carried out?
what tests does it involve?

Answer 17

if women book later in pregnancy either the triple or quadruple test should be done between 15-20 weeks

triple:

• AFP
• unconjugated oestradiol
• human chorionic gonadotrophin

quadruple:

• AFP
• unconjugated oestradiol
• HCG
• inhibit - A

Question 18

features of combined test suggesting downs syndrome ?

Answer 18

thickened nuchal translucency
elevated b-HCG
decreased PAPP-A

Question 19

1st line treatment for respiratory depression caused by magnesium sulphate in treatment of eclampsia ?

Answer 19

calcium gluconate

Question 20

what dose of folic acid are women advised to take ?

Answer 20

take preconception up to 12 weeks gestation

400mcg
5mg if at high risk;
- either parent has neural tube defect, previous child with NTD or FHx of NTD
- mother is obese (BMI > 30)
- mother is on anti epileptic drugs
- mother has diabetes, coeliac or thalassaemia trait

Question 21

describe the difference between immune thrombocytopenia and gestational thrombocytopenia.

Answer 21

gestation thrombocytopenia results from dilution, decreased production and increased destruction.
If platelets continue to decrease as gestation progresses this can be an indicator but isn’t reliable.
if thrombocytopenia becomes life threatening then diagnosis of ITP is made
maternal serum anti platelet antibodies can be tested to confirm ITP
treatment for ITP= steroids

Question 22

describe the management of a baby who is born to a mother who has either chronic hepatitis B or acute hepatitis b during pregnancy.

Answer 22

vaccination + hepatitis b immunoglobulin

Question 23

is it safe to breast feed with hepatitis B? HIV?

Answer 23

no with HIV

safe to with hepatitis b

Question 24

intense itching particularly palms of hands and soles of feet. Bloods show raised bilirubin.
diagnosis?
management?

Answer 24

intrahepatic cholestasis of pregnancy (obstetric cholestasis)

ursodeoxycholic acid
induction of labour at 37-38 weeks
vitamin K supplement

Question 25

causes of oligohydramnios ?

Answer 25

premature rupture of the membranes 
intrauterine growth restriction 
post term gestation 
renal problems i.e. renal genesis 
preeclampsia

Question 26

definition of oligohydramnios ?

Answer 26

< 500ml amniotic fluid at 32-36 weeks

amniotic fluid index (AFI) < 5th percentile

Question 27

antibodies associated with postpartum thyrotoxicosis ?

Answer 27

anti-thyroid peroxidase

Question 28

what blood result would you expect in acute fatty liver of pregnancy ?

Answer 28

elevated AST (>500)

Question 29

management of acute fatty liver of pregnancy?

Answer 29

supportive care

once established delivery is the definitive treatment

Question 30

features of acute fatty liver of pregnancy ?

Answer 30

usually occurs in 3rd trimester or period immediately after delivery

nausea and vomiting 
abdominal pain 
jaundice 
hypoglycaemia 
headache 
severe cases may result in pre-eclampsia

Question 31

management of PROM ?

Answer 31

10 days of erythromycin

Question 32

treatment for endometritis ?

Answer 32

IV clindamycin + gentamicin until afebrile for 24 hours

Question 33

differentials of puerperal pyrexia ?

Answer 33

endometritis
UTI
mastitis
VTE 
wound infections

Question 34

causes of hyperechogenicity on USS?

Answer 34

cystic fibrosis
downs syndrome
CMV

Question 35

causes of increased nuchal translucency ?

Answer 35

downs syndrome
abdominal wall defect
cardiac defects