Week 6

Question 1

Risk to child from untreated depression

Answer 1

Low birth weight
Pre-term delivery
Adverse childhood outcomes
- ADHD, conduct disorder
Poor engagement/bonding
- reduced infant learning, cog development

Question 2

2 generally safest SSRIs in pregnancy

Answer 2

Sertraline
FLuoxetine (least placental exposure)

Question 3

Why no aripiprazole in breastfeeding?

Answer 3

Partial dopamine antagonist, decr prolactin levels, prevents effective breastfeeding

Question 4

Describe Ebstein’s anomaly

Answer 4

Enlarged RV
Adhered and abnormally shaped tricuspid leaflet

Question 5

Lithium in breastfeeding?

Answer 5

NO
- lithium leaks into breast milk

Question 6

How can lithium be taken in pregnancy?

Answer 6

Risks less than what was originally thought, still avoid if possible
Slow reduction pre-conception
Re-introduce in 2nd or 3rd trimester
Lots of blood tests and dose changes to manage risks
No breastfeeding

Question 7

Define tokophobia

Answer 7

Pathologically extreme fear of childbirth/pregnancy

Question 8

Psych red flags in perinatal period

Answer 8

Thoughts of acts of self harm/suicide
Estrangement from baby
Significant change in mental state

Question 9

Risk factors for prolapse

Answer 9

Female
Old age
Obesity
Smoking/chronic cough
Heavy lifting
Connective tissue disease
Constipation
Prev pelvic surgery

Question 10

Symptoms of pelvic prolapse

Answer 10

Sensation of heaviness or pulling in your pelvis
Tissue protruding from your vagina
Urinary incontinence/overactivity
Trouble having a bowel movement
Feeling as if you’re sitting on a small ball/as if something is falling out of your vagina
Sexual concerns

Question 10

Why do you get urinary symptoms in uterine prolapse?

Answer 10

Incontinence at start as bladder muscles stretched/weakened
Failure to urinate due to kink in urethra
Then overflow incontinence due to pressure relflex to protect kidneys etc

Question 11

Degrees of uterovaginal prolapse

Answer 11

1st degree (in vagina),
2nd degree (at interiotus),
3rd degree (outside vagina)
Procidentia (entirely outside vagina)

Question 12

Symptoms of cystocele

Answer 12

bulging/pressure/“mass”
difficulty voiding/incomplete emptying
splinting vaginal wall
difficulty inserting tampon
pain with intercourse

Question 13

Symptoms of rectocele

Answer 13

bulging/pressure/“mass”
difficulty defecating/incomplete defecation
splinting vaginal wall or perineum
difficulty inserting tampon
pain with intercourse

Question 14

Baden Walker halfway grading system for prolapse

Answer 14

0 no prolapse
1 halfway to hymen
2 hymen
3 halfway past hymn
4 maximum descent

Question 15

Management of pelvic organ prolapse

Answer 15

Lifestyle advice
Pelvic floor physio
Vaginal pessaries
Reconstructive surgery
- laparoscopic/vaginal approach

Question 16

Side effects of pessary

Answer 16

Infection
Adhesions
Erosions from pessary

Question 18

Surgical repair of uterine prolapse/vault prolapse

Answer 18

Vaginal hysterectomy
Manchester repair (cervix amputated, uterosacral ligaments shortened)
Sacrospinous Fixation (attach to sacrospinous ligament)
Colpocliesis
Sacrohysteropexy

Question 19

Describe colpocliesis

Answer 19

Obliteration of the vagina
In elderly where intercourse is not intended
Successive purse string sutures to include uterosacrals ligaments, then levator ani and finally superficial perineal muscles

Small opening if uterine bleeding

Question 21

Describe sacrohysteropexy with dynamesh

Answer 21

Net around uterus/vagina attached to sacrum
Really good outcomes and few complicatiosns (e.g. discitis)