WOMEN'S HEALTH - OBSTETRICS Flashcards

Question 1

Q

ECTOPIC PREGNANCY
What is an ectopic pregnancy?

Answer

A

When a fertilised ovum implants outside of the uterine cavity, 98% tubal

Question 2

Q

ECTOPIC PREGNANCY
Where is the most common site for an ectopic?
What is the most common site for a ruptured ectopic?

Answer

A

Ampulla
Isthmus

Question 3

Q

ECTOPIC PREGNANCY
What is the epidemiology of ectopics?
What are some risk factors for ectopics?

Answer

A

1 in 100 incidence
Previous ectopic (10% recurrence rate), PID, endometriosis, tubal surgery, IUCD, IVF + POP

Question 4

Q

ECTOPIC PREGNANCY
What are some symptoms of ectopics?

Answer

A

Amenorrhoea for 6-8w, PV bleeding (small amount, brown)
Constant lower abdo (iliac fossa) pain
D+V, dizziness + fainting

Question 5

Q

ECTOPIC PREGNANCY
What are some signs of ectopics?

Answer

A

Referred shoulder pain due to haemoperitoneum irritating diaphragm
Abdo or rebound tenderness
Cervical excitation/motion tenderness
Peritonism or collapse if rupture

Question 6

Q

ECTOPIC PREGNANCY
What are some crucial investigations for ectopics?

Answer

A

Beta-hCG to confirm pregnant – should double every 48h in normal
TVS = empty uterus, may show adnexal mass or free fluid

Question 7

Q

ECTOPIC PREGNANCY
What are some other investigations for ectopics?

Answer

A

FBC, group + save, serum progesterone <20nmol/L suggests failing pregnancy
Laparoscopy gold standard but only used as necessary

Question 8

Q

ECTOPIC PREGNANCY
What are the 3 management techniques for ectopic pregnancies?

Answer

A

Expectant
Medical
Surgical

Question 9

Q

ECTOPIC PREGNANCY
What is expectant management?
What are the indications?
What indicates that it has worked?

Answer

A

Effectively do nothing
Clinically stable (no Sx), ectopic <35mm, no heartbeat, serum hCG <1000IU/L (consider up to 1500) + able to return for follow up
Serum hCG days 2, 4 + 7 (drop ≥15% then repeat weekly until negative)

Question 10

Q

ECTOPIC PREGNANCY
What is medical management?
What are the indications?
What indicates that it has worked?

Answer

A

Single dose IM 50mg/m^2 methotrexate
No significant pain, unruptured ectopic <35mm, no heartbeat, serum hCG <1500 (consider up to 5000IU/L) + able to return for follow up
hCG levels at days 4 + 7 then weekly, <15% fall = ?another dose

Question 11

Q

ECTOPIC PREGNANCY
What are the requirements for methotrexate management?
What are some side effects?

Answer

A

Satisfactory liver + renal functions
Teratogenic so effective contraception for 3m
Conjunctivitis, diarrhoea, abdo pain + stomatitis

Question 12

Q

ECTOPIC PREGNANCY
What surgical management is offered?
What are indications?
What else should be given?

Answer

A

Salpingectomy or salpingotomy
Does not meet expectant or medical criteria (>35mm, visible heartbeat, ruptured)
Anti-D for rhesus -ve in surgical management

Question 13

Q

ECTOPIC PREGNANCY
How do you choose which type of surgical management to give?

Answer

A

Salpingectomy if contralateral tube + ovary healthy to reduce recurrence
Salpingotomy if contralateral tube defected
Laparoscopy preferred to laparotomy unless haemodynamically unstable

Question 14

Q

MISCARRIAGE
What is a miscarriage?

Answer

A

Spontaneous termination of a pregnancy before 24w gestation

Question 15

Q

MISCARRIAGE
What is the epidemiology of miscarriage?

Answer

A

15–20% of pregnancies with 85% in first trimester
No increased risk of having another miscarriage after 1 but is after 2

Question 16

Q

MISCARRIAGE
What are the 6 types of miscarriage?

Answer

A

Threatened
Inevitable
Incomplete
Complete
Missed
Septic

Question 17

Q

MISCARRIAGE
What are the most common causes of miscarriage in first trimester?

Answer

A

Chromosome abnormality –
- Autosomal trisomy most common (trisomy 16)
- Most common single chromosomal anomaly is 45X
- Increasing maternal age biggest risk

Question 18

Q

MISCARRIAGE
What is the most common cause of miscarriage in the second trimester?

Answer

A

Incompetent cervix

Question 19

Q

MISCARRIAGE
What are some other causes of miscarriage?

Answer

A

PCOS
TORCH infections
Iatrogenic (amniocentesis, CVS)
Smoking, substance abuse

Question 20

Q

MISCARRIAGE
What are some risk factors for miscarriage in the second trimester?

Answer

A

Previous cervical surgery, BV in 2nd trimester

Question 21

Q

MISCARRIAGE
What is a threatened miscarriage?

Answer

A

Foetus alive but miscarriage may occur (majority don’t)
Painless vaginal bleeding with closed cervical os
TVS = viable intrauterine pregnancy

Question 22

Q

MISCARRIAGE
What is an inevitable miscarriage?

Answer

A

Miscarriage will occur
Heavy PV bleed with clots + crampy abdo pain with open cervical os (1 finger)
POC not passed
TVS = intrauterine gestation sac, foetus may be alive but miscarriage imminent

Question 23

Q

MISCARRIAGE
What is an incomplete miscarriage?

Answer

A

Not all POC been passed
PV bleed, abdo pain + open cervical os with POC in canal
Medical or surgical mx as infection risk

Question 24

Q

MISCARRIAGE
What is a complete miscarriage?

Answer

A

Full miscarriage occurred with all foetal tissue passing
Bleeding + pain cease, uterus no longer enlarged, cervical os closed
TVS = empty uterus, endometrial thickening <15mm, exclude ectopic

Question 25

Q

MISCARRIAGE
What is a missed miscarriage?

Answer

A

Foetus not developed or died in utero but this is not recognised until bleeding occurs or TVS
TVS - non-viable intrauterine pregnancy (smaller than expected) e.g. 12w scan shows 9w foetus with no heartbeat

Question 26

Q

MISCARRIAGE
What is a blighted ovum?

Answer

A

In missed miscarriage, a gestational sac >25mm but no embryonic/foetal pole

Question 27

Q

MISCARRIAGE
What is a septic miscarriage?

Answer

A

Contents of uterus infected causing endometritis

Question 28

Q

MISCARRIAGE
What is a pregnancy of uncertain viability?

Answer

A

Small sac with no visible heartbeat,
rescan 10–14d

Question 29

Q

PREGNANCY OF UNKNOWN LOCATION
What is a pregnancy of unknown location?

Answer

A

No sign of intrauterine, ectopic or retained POC but positive beta-hCG

Question 30

Q

PREGNANCY OF UNKNOWN LOCATION
What is the management of pregnancy of unknown location?

Answer

A

Beta-hCG >1500IU/L ?ectopic
Significant distress = laparoscopy
Stable = repeat beta-hCG after 48h
If no Dx after 3 samples = expectant or methotrexate Mx

Question 31

Q

MISCARRIAGE
What are the generalised investigations and management of miscarriage?

Answer

A

Refer to EPAU for Ix
Speculum exam = cervical os open/closed, remove POC if in cervical os
Serum beta-hCG levels
TVS = location + viability
Histological exam of any tissue passed vaginally

Question 32

Q

MISCARRIAGE
What would serum beta-hCG levels show in miscarriage?

Answer

A

Serial testing as should double every 48h for first few weeks of pregnancy
Levels may be less than expected for dates
Falling indicates failing pregnancy

Question 33

Q

MISCARRIAGE
What is the first line management of miscarriage?
What are the indications?
What is the follow up?

Answer

A

Expectant (wait 7–14d)
<6w, not bleeding heavily, no signs of infection
Urinary beta-hCG after 3w or repeat TVS if persistent or worse bleeding (or not started)

Question 34

Q

MISCARRIAGE
What is the medical management of a miscarriage?
What is the follow up?

Answer

A

PV/PO synthetic prostaglandin misoprostol
Contact HCP if no bleeding in 24h
Urinary beta-hCG 3w after to exclude ectopic or molar

Question 35

Q

MISCARRIAGE
What are the risks of expectant and medical management?

Answer

A

Bleeding continuing
Increased pain
Infected POC
Failure

Question 36

Q

MISCARRIAGE
What are some indications for surgical management?

Answer

A

Heavy bleeding
Infection
Failed other methods

Question 37

Q

MISCARRIAGE
What are the options for surgical management?

Answer

A

Vacuum aspiration (suction curettage) under local as OP
Surgical Mx (evacuation of retained products of conception) under general

Question 38

Q

MISCARRIAGE
What else may be given in the management of miscarriage?

Answer

A

Anti-D to rhesus -ve women if >12w, heavily bleeding or surgical Mx

Question 39

Q

MISCARRIAGE
What is a recurrent miscarriage?

Answer

A

≥3 consecutive miscarriages in the first trimester with the same biological father

Question 40

Q

MISCARRIAGE
What are some causes of recurrent miscarriage?

Answer

A

Antiphospholipid syndrome
Hereditary thrombophilias (Factor V leiden deficiency, factor II prothrombin gene mutation, protein C/S deficiency)
Uterine abnormalities (uterine septate, fibroids)
Poor controlled chronic conditions (DM, thyroid, SLE)

Question 41

Q

MISCARRIAGE
What is antiphospholipid syndrome?

Answer

A

Hypercoaguable state presenting with thrombosis + pregnancy issues (recurrent miscarriage)
Associated with antiphospholipid antibodies
Can occur on own or secondary to SLE

Question 42

Q

MISCARRIAGE
What is the management of antiphospholipid syndrome?

Answer

A

Low dose aspirin + LMWH

Question 43

Q

MISCARRIAGE
What are the investigations for recurrent miscarriage?

Answer

A

≥3 1st trimester, ≥1 in 2nd –
- Lupus anticoagulant, anti-cardiolipin + phospholipid antibodies
- Thrombophilia screen
- Pelvic USS for structural issues
- Cytogenic analysis of POC after 3rd miscarriage
- Parental blood for karyotyping

Question 44

Q

TERMINATING PREGNANCY
What is the legal framework for terminating pregnancies?

Answer

A

1967 Abortion Act (+ 1990 amendment which reduced gestation from 28 to 24w)

Question 45

Q

TERMINATING PREGNANCY
What are the requirements for an abortion?

Answer

A

<24w
Continuing pregnancy = great risk to physical or mental health of woman or existing children in family (clinical judgement)

Question 46

Q

TERMINATING PREGNANCY
When may an abortion be performed after 24w?

Answer

A

Continuing is likely to risk mother’s life
Prevents grave injury to physical or MH of woman
Substantial risk of serious handicap for baby

Question 47

Q

TERMINATING PREGNANCY
What are the legal requirements for an abortion?

Answer

A

2 registered medical practitioners must sign to agree indication
Must be registered medical practitioner in an approved premise

Question 48

Q

TERMINATING PREGNANCY
What is some pre-abortion care?

Answer

A

Marie Stopes UK charity that provides abortion services (remote service if <10w gestation, phone consultation, meds issued remotely to take at home)
Women should be offered counselling

Question 49

Q

TERMINATING PREGNANCY
What is the medical management of abortion?

Answer

A

More appropriate in earlier pregnancy, <24w, <10w can be done at home
Mifepristone (anti-progesterone) to halt pregnancy + relax cervix
Misoprostol (prostaglandin analogue) 24-48h after for contractions

Question 50

Q

TERMINATING PREGNANCY
What is done before surgical management of abortion?

Answer

A

Cervical priming with mifepristone, misoprostol or osmotic dilators (>14w insert into cervix + gradually expand as absorb fluid to open cervical canal)

Question 51

Q

TERMINATING PREGNANCY
What is the surgical management of abortion?

Answer

A

Cervical dilatation + vacuum aspiration of uterus contents <14w
Cervical dilatation + evacuation using forceps >14w
Rh -ve >10w = anti-D

Question 52

Q

TERMINATING PREGNANCY
What is post-abortion care?

Answer

A

Pregnancy test at 3w
Contraception advice
Complications = infection (#1), bleeding, pain, failure or damage to genital tract

Question 53

Q

HYPEREMESIS
How common is nausea and vomiting in pregnancy?

Answer

A

Very, particularly early on starts in early first trimester, peaks 8–12w + resolves 16–20w

Question 54

Q

HYPEREMESIS
What is believed to be responsible for N+V in pregnancy?

Answer

A

Placental beta-hCG

Question 55

Q

HYPEREMESIS
When is N+V worse?

Answer

A

more severe in molar + multiple pregnancies where beta-hCG high

Question 56

Q

HYPEREMESIS
What are some associations of hyperemesis gravidarum?

Answer

A

nulliparity,
hyperthyroid,
obesity,
decreased in smokers

Question 57

Q

HYPEREMESIS
What is the clinical presentation of hyperemesis gravidarum?

Answer

A

Severe + excessive N+V
Associated with dehydration, ketosis + weight loss

Question 58

Q

HYPEREMESIS
What are the complications?

Answer

A

May lead to complications like Mallory-Weiss tear

Question 59

Q

HYPEREMESIS
What is the diagnostic triad for hyperemesis gravidarum?

Answer

A

Triad –
- >5% weight loss compared to before pregnancy
- Dehydration
- Electrolyte imbalance

Question 60

Q

HYPEREMESIS
How is severity assessed?

Answer

A

Pregnancy-Unique Quantification of Emesis (PUQE) –
- <7 mild,
- 7-12 mod,
- >12 severe

Question 61

Q

HYPEREMESIS
What are some investigations for hyperemesis gravidarum?

Answer

A

Urine dipstick for ketones, MSU to exclude UTI
FBC (raised haematocrit)
U+Es (electrolyte imbalances + dehydration)
May have hypochloraemic metabolic alkalosis
Higher beta-hCG levels
USS to reassure + exclude multiple/molar

Question 62

Q

HYPEREMESIS
What would warrant hospital or EPAU admission?

Answer

A

Unable to tolerate PO antiemetics or fluids
> 5% weight loss compared to before pregnancy
Ketones present in dipstick (++ significant)

Question 63

Q

HYPEREMESIS
What is the inpatient management of hyperemesis gravidarum?

Answer

A

Monitor U+Es
NBM until tolerate PO = IV fluids + anti-emetics
Vitamin supplements (incl. thiamine), may need artificial nutrition to prevent Wenicke-Korsakoff
Thromboprophylaxis with TED stockings + LMWH
Small + frequent meals when eating allowed

Question 64

Q

HYPEREMESIS
What is the community management of hyperemesis gravidarum?

Answer

A

1st line antiemetic = promethazine or cyclizine (anti-histamines)
2nd line = ondansetron (5-HT3 antagonist) or metoclopramide (dopamine antagonist)

Answer 65

A

Complementary therapies like ginger or wrist acupressure

Answer 66

A

i) Midwife-led with GP input
ii) Doctor/consultant led with midwives alongside
iii) 10 if nulliparous, subsequent 7
iv) Handheld doppler for heartbeat – USS if not heard, CTG if present

Answer 67

A

i) duration of pregnancy starting from date of LMP
ii) 40w gestation
iii) Total # of pregnancies
iv) number of births ≥24w regardless of outcome

Answer 68

A

Booking 8–12w –
- General info (diet, alcohol, smoking, folic acid + vitamin D advice, antenatal classes, family origin questionnaire
- FBC, blood group, rhesus status, haemoglobinopathies
- HIV, hep B + syphilis screening offered
- Urine MC&S for asymptomatic bacteriuria

Answer 69

A

ALL 400mcg
5mg if – AEDs, coeliac, DM, >30kg/m^2, NTD risk

Answer 70

A

11–13+6w –
- Confirm viability
- Singleton/multiple
- Estimate gestational age with crown rump length (top of head > bottom of buttocks)
- Detect major structural abnormalities like anencephaly
- Offer combined test

Answer 71

A

18–20+6w –
- Detect major abnormalities (NTD, CHD, CNS abnormality, renal agenesis)
- Around 20w foetal movements start + continue (refer if none by 24w)

Answer 72

A

25w (primis)
28w (all)
31w (primis)
34w (all)
36w (all)
38w (all)
40w (primis)
41w (all)

Answer 73

A

BP, urine dipstick, symphysis-fundal height (after 20w should correlate to gestational age ± 2cm)

Answer 74

A

BP, urine dipstick, SFH
OGTT if risk factors for GDM
Second screen for anaemia (FBC), blood group + rhesus status
First dose of anti-D prophylaxis if Rh-ve

Answer 75

A

i) BP, urine dipstick, SFH
ii) BP, urine dipstick, SFH + second dose of anti-D if Rh-ve
iii) BP, urine dipstick, SFH, check presentation (?ECV), info about breastfeeding, vitamin K + baby blues

Answer 76

A

i) BP, urine dipstick, SFH
ii) BP, urine dipstick, SFH, discuss options for prolonged pregnancy
iii) BP, urine dipstick, sFH, discuss induction

Answer 77

A

Conditions screened for
When + how test carried out
How reliable test is
What results mean + options
False +ve/-ve + detection rates

Answer 78

A

Patau’s (trisomy 13)
Edward’s (trisomy 18)
Down’s (trisomy 21)

Answer 79

A

Combined test (11–13+6w) –
- Nuchal translucency (thickness of back of foetus’ neck on USS)
- Beta-hCG
- Pregnancy associated plasma protein-A (PAPP-A)

Answer 80

A

i) >6mm
ii) Higher result
iii) Lower result

Maternal age, USS crown rump length, detection rate 85%

Answer 81

A

Triple or quadruple test 15–20w but only tests for Down’s syndrome –
- Beta-hCG
- Alpha-fetoprotein
- Oestriol
- Inhibin (quadruple)

Answer 82

A

i) Higher result
ii) Lower result
iii) Lower result
iv) Higher result

Answer 83

A

> 1:150 = screen +ve
Amniocentesis
Chorionic villus sampling (CVS)

Answer 84

A

It involves aspiration of amniotic fluid which contains foetal cells shed from the skin and gut.
It is performed transabdominally with ultrasound guidance.

Answer 85

A

from 15 weeks onwards

Answer 86

A

o For karyotyping if screening tests suggest aneuploidy.
o DNA analysis if parents are carriers of an identifiable mutation, like CF or thalassaemia.
o For enzyme assays looking for inborn errors of metabolism.
o For diagnosis of fetal infections such as CMV and toxoplasmosis.

Answer 87

A

o Lower procedure-attributed miscarriage rate than CVS (71%).
o Less risk of maternal contamination or placental mosaicism

Answer 88

A

o Miscarriage (1%)
o Failure to culture cells
o Full karyotyping may take 3wks.

Answer 89

A

Involves aspiration of some trophoblastic cells from the placenta under USS guidance.
It is used for karyotyping
Is usually performed transabdominally, occasionally transcervically.

Answer 90

A

Usually between 10-13 weeks

Answer 91

A

o For karyotyping if 1st trimester screening test suggests high risk for aneuploidy.
o For DNA analysis if parents are carriers of an identifiable gene mutation such as cystic fibrosis or thalassaemia.

Answer 92

A

Allows 1st trimester TOP if an abnormality is detected:
o Can be performed surgically.
o Can be done before the pregnancy has become physically apparent.

Answer 93

A

o Miscarriage as a result of CVS is estimated at 1%.
o Increases risk of vertical transmission of blood-borne viruses such as HIV and hepatitis B.
o False negative results (rare) from contamination with maternal cells—especially with DNA
analysis requiring PCR.
o Placental mosaicism producing misleading results—estimated at <1%.

Answer 94

A

Non-invasive prenatal testing
Analyses fragments of foetal DNA in maternal blood
99% accurate, done from 10w

Answer 95

A

Genital tract bleeding after 24w gestation

Answer 96

A

Majority idiopathic, dangerous causes –
- Placental abruption or praevia
- Vasa praevia
- Morbidly adherent placenta

Answer 97

A

Exclude placenta praevia with USS
Kleihauer test to confirm transplacental blood loss from foetus>mother

Answer 98

A

PPH, DIC
Premature labour
ITU admission
Maternal or foetal death
Sheehan’s syndrome

Answer 99

A

When placenta is inserted wholly, or in part, into the lower segment of the uterus (low lying placenta)

Answer 100

A

Minor (I or II) –
- I = reaches lower segment but not internal os
- II = reaches internal os but doesn’t cover
Major (III or IV) –
- III = covers internal os before dilation (not when dilated)
- IV = completely covers internal os
- Cervical effacement + dilation > catastrophic bleeding + potential maternal + foetal death

Answer 101

A

Embryos more likely to implant on lower segment scar from previous c-section
Multiple pregnancy
Multiparity
Previous praevia
Assisted conception

Answer 102

A

PAINLESS PV bleeding, BRIGHT RED blood, shock IN proportion to visible loss
Foetus may have abnormal lie + presentation (breech + transverse)
Uterus is not tender

Answer 103

A

TV USS safe + more accurate
Can be Dx on routine antenatal USS (20w)
Repeat USS at 36w if minor or 32w if major
If over or close to internal os repeat scans every 2w

Answer 104

A

PPH
Placenta accreta or percreta

Answer 105

A

Asymptomatic can stay at home if access to hospital, aware of risks/Sx, companion (rest + avoid intercourse)
<20mm from os = elective c-section ≥38w or earlier if bleeding does not settle
Anti-D if Rh-ve

Answer 106

A

ABCDE + admission
IV access, fluids (crystalloid), X-match blood, inform senior team + paeds
Foetal monitoring with CTG ± delivery
Steroids if <34w gestation

Answer 107

A

Placenta prematurely separates (in part or fully) from uterus wall leading to APH from where the placenta was previously attached
Blood can accumulate behind placenta in uterine cavity or exit via cervix

Answer 108

A

IUGR, pre-eclampsia or pre-existing HTN, maternal smoking + previous abruption
Cocaine use, multiple pregnancy or high parity, trauma

Answer 109

A

Concealed = cervical os closed so haemorrhage remains in uterus
– Maternal shock out of proportion with visible loss may > underestimation
Revealed = PV bleeding

Answer 110

A

Sudden onset severe abdo PAIN which is continuous
PV bleeding often DARK red
Maternal shock (hypotension, tachycardia = adverse signs)
Foetal distress common on CTG (absent or abnormal FHR)
Posterior placenta may cause severe backache

Answer 111

A

Tender “woody” uterus on palpation (blood invading myometrium)
FBC, coagulation, X-match (may need catheter for urine output + U+Es for renal function)
USS + CTG for foetal wellbeing + exclude praevia

Answer 112

A

Shock, DIC, renal failure, PPH
IUGR, hypoxia + death

Answer 113

A

Mum + foetus stable at <36w then admit + observe carefully, induce after 36w with amniotomy aiming for vaginal delivery, steroids if <34w
Anti-D if Rh-ve

Answer 114

A

A–E resus
IV access, fluids, ABO Rh compatible or O-ve blood
Mum unstable, foetal distress or heavy bleeding = emergency c-section
Steroids if <34w
MUM COMES FIRST

Answer 115

A

The chorionic villi attach to the myometrium rather than being restricted within the decidua basalis

Answer 116

A

Accreta = placenta invades into superficial myometrium
Increta = placenta invades deeper through the myometrium
Percreta = placenta invades through myometrium, into nearby organs of abdomen (bladder, bowel)

Answer 117

A

Previous c-sections (placenta attaches to site)
Myomectomy
Surgical TOP

Answer 118

A

USS may show loss of definition between wall of uterus + abnormal vasculature
MRI scan if degree of adherence uncertain

Answer 119

A

Poor placental separation may occur > difficult to deliver placenta after baby delivered > retained products > infection risk
Delivery risks = PPH, transfusion, caesarean hysterectomy, ITU

Answer 120

A

Elective LSCS at 36–37w
?Caesarean hysterectomy
?Leave in situ (expectant)
?Uterus preserving surgery (resecting part of myometrium + placenta)

Answer 121

A

Blood + blood products available
Local ITU availability
Tamponade with balloon
Hysterectomy last resort

Answer 122

A

Major foetal vessels run in membranes below the presenting foetal part, so they present before the foetus, unsupported by placental tissue or umbilical cord
Exposed mean prone to rupture + bleed

Answer 123

A

Placenta praevia
Multiple pregnancy
IVF pregnancy
Bilobed placentas

Answer 124

A

PV bleed straight after rupture of foetal membranes > rapid foetal distress
CTG abnormalities (bradycardia) with high foetal mortality
No major maternal risk just major foetal risk (massive haemorrhage)

Answer 125

A

A–E approach, manage bleeding
Deliver c-section (elective if antenatally diagnosed, emergency if present with bleeding)

Answer 126

A

Pregnancy induced HTN + proteinuria at >20w gestation
Results due to abnormal development of the placenta

Answer 127

A

Mild-mod = pre-eclampsia without severe HTN (<160/110) and NO Sx, biochemical or haematological impairment
Severe = pre-eclampsia w/ severe HTN ± Sx ± biochem ± haem impairment
Early <34w, late >34w

Answer 128

A

Spiral arteries dilate + develop into large utero-placental arteries, supplying lots of blood to the endometrium > placenta + foetus

Answer 129

A

Spiral arteries do not remodel + dilate but become fibrous so utero-placental arteries deliver less blood > placental ischaemia

Answer 130

A

Pro-inflammatory protein + thromboplastin release leads to endothelial damage > vasoconstriction, clotting dysfunction + increased vascular permeability
Ultimately leads to poor renal perfusion > RAAS activation > HTN, proteinuria ± oedema > pre-eclampsia + eclampsia (if continues)

Answer 131

A

i) Pre-existing HTN, previous pre-eclampsia, CKD, autoimmune (SLE, T1DM)
ii) Nulliparity, multiple pregnancy, >10y pregnancy interval, FHx, >40y, BMI >35kg/m^2

Answer 132

A

Local areas of vasospasm leading to hypoperfusion
Oedema due to increased vascular permeability + hypoproteinaemia

Answer 133

A

Renal = glomerular damage (low GFR) –
- Oliguria + proteinuria
Retinal –
- Visual disturbances (blurred, flashing lights, scotoma)
Liver = injury + swelling stretches liver capsule –
- RUQ or epigastric pain

Answer 134

A

Face, hands + legs (generalised)
SOB + cough (pulmonary)
Headaches, confusion + seizures in eclampsia (cerebral)

Answer 135

A

Raised BP + proteinuria are hallmarks
Rapid weight gain, RUQ tenderness
Ankle clonus (brisk reflexes normal in pregnancy but not clonus)
Papilloedema if severe

Answer 136

A

BP ≥140/90mmHg
Proteinuria in a 24h collection (>0.3g) or dipstick with +

Answer 137

A

FBC with platelets (thrombocytopenia)
Serum uric acid levels (raised due to renal issues)
LFTs (elevated liver enzymes ALT + AST)

Answer 138

A

Proteinuria on dipstick (++ or +++ is severe)
Protein:Creatinine ratio (PCR) ≥30ng/nmol = significant proteinuria
Accurate dating + USS to assess foetal growth

Answer 139

A

Eclampsia
HELLP syndrome

Answer 140

A

Generalised tonic-clonic seizures in a patient with a Dx of pre-eclampsia
Hypoalbuminaemia > hypovolaemia > cerebral hypoperfusion

Answer 141

A

IV magnesium sulfate to prevent + treat seizures –
- Reduces DIC risk as reduced platelet aggregation
- Continue 24h after last seizure or delivery
Treat HTN with labetalol 1st line or nifedipine
Stabilise mum and delivery baby

Answer 142

A

Magnesium levels for toxicity
Reduced reflexes, confusion + respiratory depression
Calcium gluconate first line

Answer 143

A

HELLP syndrome is a subtype of severe pre-eclampsia characterized by
- hemolysis (H),
- elevated liver enzymes (EL),
- low platelets (LP).

Usually occurs within 7 days of delivery.

Answer 144

A

➢ Nausea/vomiting
➢ Hypertension
➢ Brisk tendon reflexes
➢ RUQ/Epigastric pain
➢ General malaise/headache
➢ Oedema/bleeding
➢ Visual problems, jaundice

Answer 145

A

10% have antiphospholipid syndrome

Answer 146

A

➢ White ethnicity
➢ Maternal age >35 yrs.
➢ Obesity
➢ Chronic hypertension
➢ DM
➢ Autoimmune disorders
➢ Abnormal placentation and multiple gestation
➢ Previous pregnancy with preeclampsia

Answer 147

A

➢ FBC with platelets: hemolysis,
elevated LFT, low platelets
➢ Peripheral blood smear, serum LDH, uric acid
➢ LFT, Bilirubin
➢ Fetal ultrasound

Answer 148

A

➢ Seizure prophylaxis (magnesium sulfate), IV dexamethasone, labetalol. IM beclametasone
when patient <36wks
➢ Delivery is definitive treatment (should be done when patient is 37+ wks)

Answer 149

A

DIC, CVA (haemorrhagic)
Multi-organ failure (renal, hepatic)
Foetus = IUGR (poorly perfused placenta), prematurity, placental abruption

Answer 150

A

75mg aspirin PO OD at 12w until birth
Spiral arteries form around 12w so thought to help them develop

Answer 151

A

Treat HTN with –
- PO Labetalol first line (can use IV if severe + inpatient)
- PO nifedipine (used if asthmatic)
- Hydralazine too
- ACEi = CONTRAINDICTAED

Answer 152

A

BP <160/110, no or low proteinuria (≤+, <0.3g/24h) + no symptoms
Weekly review of bloods, twice weekly mother + foetal evaluation (HBPM + urine)
Any changes > hospital

Answer 153

A

Delivery (around 36w)
Mother = liver/renal failure, HELLP, eclampsia, severe Sx
Foetal = severe IUGR, oligohydramnios, abnormal CTG
PV + neuraxial techniques for spinal/epidural preferred

Answer 154

A

Regular investigations (BP, urinalysis, bloods, CTG, fluid balance chart (restrict if severe)
BP control (IV labetalol first line of nifedipine if asthmatic)
IV magnesium sulfate prophylaxis during labour + 24h after

Answer 155

A

Chronic HTN
Gestational/pregnancy induced HTN
Pre-eclampsia superimposed on chronic HTN

Answer 156

A

HTN diagnosed prior to pregnancy, before 20w gestation or that develops during pregnancy but does not resolve postpartum

Answer 157

A

New HTN >20w gestation with NO proteinuria that resolves after giving birth
25% will progress to pre-eclampsia

Answer 158

A

HTN + no proteinuria <20w with new onset proteinuria after 20w
HTN + proteinuria <20w with sudden rise in proteinuria or BP when HTN was well controlled, or development of thrombocytopenia or abnormal ALT/AST

Answer 159

A

Baby has not maintained its growth potential (slows or creases)
I.e. drops below centile line it was following > pathological

Answer 160

A

Symmetrical = entire body is proportionately small, tends to be seen in early onset IUGR, TORCH + chromosomal abnormalities
Asymmetrical = undernourished foetus that is compensating by directing most of its energy to maintain growth of vital organs like brain + heart

Answer 161

A

Head-sparing effect –
- Normal head size but small abdominal circumference + thin limbs
- Mostly secondary to placental insufficiency

Answer 162

A

Estimated foetal weight (EFW) or abdominal circumference (AC) below 10th centile for their gestational age
May be constitutionally small with no pathology identified (parental height)

Answer 163

A

Baby born with a weight <2.5kg (regardless of gestational age)

Answer 164

A

Placental insufficiency (most common cause)
Maternal factors
Foetal factors

Answer 165

A

Abnormal trophoblast invasion (pre-eclampsia, placenta accreta)
Infarction, abruption, location (praevia)

Answer 166

A

Chronic disease (HTN, cardiac, CKD)
Substance abuse (cocaine, alcohol) smoking, previous SGA baby
Autoimmune
Low socioeconomic status
> 40

Answer 167

A

Genetic abnormalities (trisomies 13/18/21, Turner’s)
Congenital infections (TORCH)
Multiple pregnancy

Answer 168

A

Hypoglycaemia
Risk of necrotising enterocolitis
Neonatal jaundice
Hypothermia
Respiratory issues
Long-term sequelae include T2DM, HTN, obesity, behavioural problems, CP

Answer 169

A

i) Blood directed away from liver>brain so glycogen stores don’t develop adequately
ii) Reduced blood to bowel
iii) Compensatory polycythaemia for reduced oxygen supply from mother if reduced placental perfusion

Answer 170

A

i) No fat stores developed so cannot thermoregulate, large surface area
ii) Kidney hypoperfusion > decreased urine output > oligohydramnios > inadequate lung development

Answer 171

A

BP + urine dipstick (?pre-eclampsia)
Karyotyping (?foetal)
Infection screen, TORCH (?infection)

Answer 172

A

SFH < 10th centile, slow or static growth or crossing centiles
Refer for serial growth scans (USS) every 2w, umbilical artery doppler + amniotic fluid volume
MCA doppler performed after 32w

Answer 173

A

Assesses if baby is getting enough blood
Abnormal = twice weekly review

Answer 174

A

Consider delivery (corticosteroids if <34w to mature foetal lungs) if –
- Static growth on growth charts
- Absent end-diastolic flow (AEDF, abnormal doppler)
- Abnormal CTG (foetal distress)
- MCA doppler PI <5% delivery by 37w (early sign of foetal hypoxia in SGA, shows increased diastolic flow > head-sparing effect)

Answer 175

A

identical (come from single zygote)

Answer 176

A

non-identical (come from two different zygotes > diamniotic + dichorionic)

Answer 177

A

share/two separate amniotic sacs

Answer 178

A

share/two separate placentas

Answer 179

A

Previous twins,
FHx,
increasing parity + maternal age,
IVF,
race (Afro-Caribbean)

Answer 180

A

No more than 2 embryos transferred per IVF cycle

Answer 181

A

Uterus larger than expected for dates
May suffer from hyperemesis gravidarum
Multiple foetal poles may be palpable at >24w
Multiple foetal hearts on auscultation
Majority diagnosed on dating scan

Answer 182

A

Anaemia, HTN, APH + PPH, preterm birth, stillbirth
Twin-twin transfusion syndrome, IUGR, polyhydramnios, malpresentation

Answer 183

A

Associated with monoamniotic monochorionic twins
Recipient gets majority of blood so is larger with polyhydramnios
Donor is starved of blood + can become anaemic, recipient worse off (hydrops)
Severe cases > laser ablation of connecting vessels

Answer 184

A

High risk –5mg folic acid, iron supplements to prevent anaemia
Additional scans for growth restriction + twin-twin transfusion (2w from 16w for monochorionic, 4w from 20w for dichorionic)

Answer 185

A

Steroids if <34w
Monochorionic/amniotic twins = elective c-section 32-34w
Diamniotic twins = 37–38w, vaginal if presenting twin cephalic but may need c-section for second

Answer 186

A

Abnormally low levels of amniotic fluid during pregnancy
Amniotic fluid index <5th centile for gestational age

Answer 187

A

PROM or SROM
Renal agenesis (Potter’s syndrome) or non-functional kidneys
Placental insufficiency (pre-eclampsia, post-term gestation) as blood redistributed to brain so reduced urine output
Genetic anomalies
Obstructive uropathy

Answer 188

A

May have experienced leaking fluid or feeling damp
Measure SFH
Sterile speculum may show pool of liquor in birth canal

Answer 189

A

USS foetus = AFI or maximum pool depth calculated + doppler
TORCH screen as may be infection
Test fluid for IGFBP-1 or PAMG-1 if concerned about PPROM.
Foetal CTG for signs of distress

Answer 190

A

2nd trimester = poor prognosis due to PPROM leading to premature delivery + pulmonary hypoplasia > resp distress
Muscle contractures as amniotic fluid allows foetal to move limbs in utero

Answer 191

A

Treat as PROM if present
Frequent monitoring of growth for IUGR

Answer 192

A

Fluid between baby + amnion (sac) acts as a cushion around foetus to protect it from trauma
Foetus can swallow amniotic fluid which helps create urine + meconium

Answer 193

A

Abnormally large levels of amniotic fluid
AFI >95th centile for gestational age

Answer 194

A

Increased foetal urine production (maternal DM), twin-twin transfusion, foetal hydrops
Foetal inability to swallow/absorb amniotic fluid (GI tract obstruction e.g. duodenal atresia, foetal neuro/muscular issues)

Answer 195

A

Maternal discomfort
LGA
Foetal parts hard to palpate
Taut uterus

Answer 196

A

Exclude GDM with OGTT
USS foetus to calculate AFI or maximum pool depth
TORCH screen as can be cause by viral infections

Answer 197

A

Preterm delivery
Malpresentation
Maternal discomfort from abdo distension

Answer 198

A

If severe = amnioreduction or NSAIDs (indomethacin)
If preterm assess risk of delivery with cervical scan ± foetal fibronectin assay

Answer 199

A

Associated with infection + placental abruption
Associated with premature closure of ductus arteriosus so not used beyond 32w

Answer 200

A

On surface of red blood cells + differs to the ABO groups
A+ve is blood group A with rhesus D antigens

Answer 201

A

Rh-ve woman exposed to Rh+ve foetal blood, her immune system recognises as foreign + produce antibodies against rhesus D (sensitisation)
Usually no issues in 1st pregnancy as IgM produced that cannot cross placenta

Answer 202

A

Memory cells produce IgG which can cross placenta so if Rh+ve foetus will attack leading to haemolysis (haemolytic disease of newborn) with jaundice + hydrops fetalis (abnormal accumulation of fluid)

Answer 203

A

Delivery of Rh+ve infant
APH
Amniocentesis or CVS
Abdo trauma
ECV
Surgical Mx of ectopic + miscarriage
PV bleed >12w

Answer 204

A

Kleihauer test (check how much foetal blood > mother’s blood after event)
All babies born to Rh-ve women should have cord blood at delivery for FBC, blood group + Direct Coombs (antiglobulin) test for antibodies on baby’s RBC

Answer 205

A

Add acid + foetal Hb more resistant to acid so number of cells that still contain Hb represents remaining foetal cells

Answer 206

A

Prophylaxis crucial as sensitisation is irreversible
IM anti-D routinely at 28w, 34w + after birth but also potential events
Newborn haemolysis > exchange transfusions (severe) or UV phototherapy

Answer 207

A

Immunoglobulin attaches to Rh D antigens on foetal blood in maternal circulation preventing recognition

Answer 208

A

Carbohydrate intolerance during pregnancy which often resolves after birth

Answer 209

A

Increased insulin resistance due to placental production of anti-insulin hormones
Allows post-prandial glucose peak to be higher for longer to spare glucose for foetus (main source of nutrients)
If maternal pancreas cannot increase insulin production to combat this > GDM

Answer 210

A

Main one is human placental lactogen (hPL)
Also glucagon + cortisol

Answer 211

A

BMI >30kg/m^2
PMH of GDM
FHx of DM (first-degree)
Asian + Afro-Caribbean ethnicity
Previous macrosomic baby

Answer 212

A

May be asymptomatic or present with polydipsia, polyuria, nocturia + fatigue

Answer 213

A

OGTT (75g glucose given in morning after a fast)
Anyone with previous GDM at booking + 24–28w
Anyone with risk factors at 24-28w

Answer 214

A

5-6-7-8 rule:
- Baseline/fasting >5.6mmol/L
- At 2h >7.8mmol/L

Answer 215

A

Macrosomia
Polyhydramnios
Birth trauma
Stillbirth + miscarriage
Congenital malformations (CHD, NTD, cleft palate)
Neonatal hypoglycaemia
RDS, polycythaemia
Obesity + T2DM later in life

Answer 216

A

Excess foetal glucose > hyperinsulinaemia + so increased fat deposition

Answer 217

A

Excess foetal glucose > polyuria

Answer 218

A

Cephalopelvic incompatibility, shoulder dystocia

Answer 219

A

Climatization + hyperinsulinaemia

Answer 220

A

Pre-eclampsia
DKA or hypos
UTIs
IHD
Nephropathy, retinopathy

Answer 221

A

Contraception until good diabetic control
5mg folic acid until 12w
Stop any ACEi or statins
Retinopathy screening at booking + 28w
Aspirin 75mg OD at 12w to reduce pre-eclampsia risk
Monitor BMs regularly

Answer 222

A

Insulin with dose adjustment for normal changes to glucose metabolism in pregnancy

Answer 223

A

Only metformin is safe, may need upgrading to insulin

Answer 224

A

Fasting glucose <7 = lifestyle (low GI foods, exercise) > metformin after 1-2w if targets not met
Fasting glucose ≥7 = insulin ± metformin
Fasting glucose ≥6 + macrosomia or other complications = insulin
Glibenclamide if cannot tolerate metformin or decline insulin

Answer 225

A

i) 37–39w
ii) No need before 41w

Answer 226

A

DVTs + PEs = large cause of mortality in obstetrics
High risk during postpartum period, top cause of direct maternal death

Answer 227

A

i) PMH of VTE, antenatal LMWH requirements, high-risk thrombophilia or low risk + FHx
ii) Smoking, parity >3, age >35, BMI >30, reduced mobility, multiple pregnancy, pre-eclampsia, gross varicose veins, IVF

Answer 228

A

Swollen, warm, tender, red calf, Homan’s sign (calf pain on dorsiflexion) > DVT
SOB, sudden CP (pleuritic), haemoptysis, tachycardia > PE

Answer 229

A

ECG in PE commonly shows sinus tachycardia, rarely S1Q3T3
Doppler USS diagnostic for DVT
FBC, U+Es, LFTs, clotting screen, CXR if ?PE
CTPA gold standard for PE, can do V/Q scan

Answer 230

A

Risk assessment at booking, antenatal admissions + postnatally
Antenatal: LMWH from 28w if increased risk or ASAP if high risk
Postnatal: LMWH for 10d if increased risk or 6w if high risk
TED stockings
Low risk Mx = mobilise early, hydration

Answer 231

A

Embolectomy + anticoagulate ASAP with LMWH
Do NOT use warfarin (or DOACs) as can cross placenta + may cause foetal abnormalities (CHD) + intracranial bleeding

Answer 232

A

Intrahepatic cholestasis = reduced outflow of bile acids from liver

Answer 233

A

Asian women, thought to be due to increased oestrogen + progesterone levels

Answer 234

A

Typically later in pregnancy (3rd trimester)
Itchy skin (palms of hands + soles of feet) but with NO rash – WORSE at night
Jaundice, pale greasy stools + dark urine less common

Answer 235

A

Clotting screen (prothrombin time) deranged
Abnormal LFTs + raised bile acids (ALT, AST, GGT + bilirubin raised, ALP too but that is normal in pregnancy), monitor LFTs weekly

Answer 236

A

Bile acids important for fat soluble vitamin absorption like vitamin K

Answer 237

A

Maternal = vitamin K deficiency (may lead to PPH)
Foetal = stillbirth (#1), increased risk of prematurity (often iatrogenic)

Answer 238

A

Ursodeoxycolic acid first line to improve LFTs + bile acids
Induce labour at 37–38w to reduce stillbirth risk
Vitamin K supplementation
Emollients (calamine lotion to sooth skin)
Antihistamines to help sleep

Answer 239

A

Infection caused by Strep agalactiae

Answer 240

A

Most common cause of early-onset severe infection (Sepsis) in neonates

Answer 241

A

Commonly found in maternal bowel flora

Answer 242

A

Prematurity,
prolonged ROM,
previous GBS sibling,
maternal pyrexia

Answer 243

A

If previous GBS in pregnancy either intrapartum IV Abx prophylaxis or test in late pregnancy (3-5w before EDD) + IV Abx if +ve

Answer 244

A

Previous baby with GBS (no screening), preterm labour or pyrexia >38 during labour
Benzylpenicillin

Answer 245

A

Maternal risk = 5x greater risk of pneumonitis
Foetal varicella syndrome = skin scarring, microphthalmia, limb hypoplasia, microcephaly + learning difficulties

Answer 246

A

Any doubt in immunity, check for varicella zoster IgG
≤20w + not immune = VZIG within 10d
> 20w + not immune = VZIG or aciclovir days 7–14 post-exposure

Answer 247

A

PO aciclovir if ≥20w + presents within 24h of rash onset
<20w then consider

Answer 248

A

Hb normally falls slightly in pregnancy due to increased plasma volume diluting Hb

Answer 249

A

Physiological,
Fe deficiency (increased demand),
B12 or folate deficiency

Answer 250

A

Menorrhagia,
malaria,
hookworm,
twins,
poor diet

Answer 251

A

FBC (normal ranges >110g/L at booking, >105g/L at 28w)
Microcytic hypochromic = Fe deficiency
Macrocytic = B12 or folate
Iron studies = TIBC (high), serum iron (low), serum ferritin (low but acute phase)
Haematinics, intrinsic factor Ab if ?pernicious

Answer 252

A

LBW + preterm delivery
Ferrous sulfate 200mg TDS
If not anaemic but low ferritin indicating iron stores then start them on it
Vitamin C can increase absorption of iron

Answer 253

A

Pernicious = IM hydroxocobalamin
B12 deficiency = B12 tablets (cyanocobalamin)
Folate = increased from 400mcg to 5mg/day to reduce NTD.

Answer 254

A

Foetal membranes = chorion + amnion strengthened by collagen
SROM occurs naturally at any point prior to or during labour due to weakening in chorion/amnion, rarely born en caul
ARM can augment or induce labour

Answer 255

A

Rupture of amniotic sac at least 1h prior to onset of labour at >37w

minimal risk as advanced gestation

Answer 256

A

i) Rupture of amniotic sac at least 1h prior to onset of labour at >37w
ii) Rupture of amniotic sac prior to onset of labour pre-term (<37w)
- PROM = minimal risk as advanced gestation
- PPROM = risk of chorioamnionitis + spontaneous labour

Answer 257

A

Previous PROM/preterm
Smoking
Polyhydramnios
Amniocentesis

Answer 258

A

Gush or constant trickle or dampness from vagina
Clear fluid

Answer 259

A

Sterile speculum 1st for pooling of amniotic fluid
USS may show oligohydramnios if speculum normal
Ferning test (cervical secretion on glass slide shows fern-pattern crystals)
Test fluid for IGFBP-1 or PAMG-1
CTG for foetus (tachycardia is suggestive of infection)

Answer 260

A

Insulin-like growth factor-binding protein-1
Placental alpha-microglobin-1
High concentrations of these proteins in amniotic fluid

Answer 261

A

Risk of prematurity, chorioamnionitis, pulmonary hypoplasia

Answer 262

A

1st line = IM corticosteroids if foetus <34w
Prophylactic PO erythromycin given to prevent chorioamnionitis for 10d or until labour is established if within 10d
Consider induction at 34w (trade off)

Answer 263

A

Spontaneous in onset, low risk at start + remaining throughout labour + delivery
Infant born spontaneously in the vertex position between 37–42w
After birth, mother + infant are in good condition (aka no interventions)

Answer 264

A

Prostaglandins
Oxytocin
Oestrogen
Beta-endorphins
Adrenaline
Prolactin
Relaxin

Answer 265

A

Aids with cervical ripening (effacement)

Answer 266

A

Produced by hypothalamus, secreted by post. pituitary, surge at labour inhibits progesterone to prepare smooth muscle for uterine contractions, milk ejection reflex postpartum

Answer 267

A

Surges at onset of labour to inhibit progesterone to prepare smooth muscle for labour

Answer 268

A

Natural pain relief

Answer 269

A

Released as birth imminent to give energy

Answer 270

A

Produced + secreted by ant. pituitary, allows process of milk production in mammary glands when oestrogen + progesterone decline postpartum

Answer 271

A

Released from placenta to soften ligaments + cartilage of pelvis so it can expand (cervix, vaginal tissues, perineum)

Answer 272

A

‘Practice’ contractions from 3rd trimester
Irregular + not felt by everyone
Mild cramp, last few minutes then ease

Answer 273

A

Show (shedding of mucus plug from cervix that prevents ascending bacteria)
Rupture of membranes
Shortening + dilation of cervix
Regular painful contractions

Answer 274

A

Start in fundus (pacemaker)
Retraction/shortening of muscle fibres with each contraction pulls lower segment of uterus towards fundus
Causes cervical dilation + forces foetus down causing pressure on cervix

Answer 275

A

From onset of labour (true contractions) until the cervix is fully dilated
Latent phase = from 0–3cm dilation
Active phase = from 3–10cm

Answer 276

A

Latent: cervix begins to efface, irregular contractions, ‘show’, can last 2–3d (usually 6h)
Active: stronger, more regular contractions (4:10), cervix continues effacing

Answer 277

A

Primis = 0.5cm/h,
multiparous = 1cm/h

Answer 278

A

From full dilation to delivery of the foetus
Passive stage: complete dilation but no pushing (often 1 hour)
Active stage: maternal pushing until delivery

Answer 279

A

> 2h in nulliparous, 1h in multiparous
3Ps (power, passenger + passage [?Psyche of mum])

Answer 280

A

APGAR score
1, 5 + 10 minutes
10–7 = normal
6–4 = moderately depressed
<4 = severely depressed

Answer 281

A

Activity – absent 0, flexed arms + legs 1, active 2
Pulse – absent 0, <100bpm 1, >100bpm 2
Grimace – floppy 0, minimal response to stimulation 1, prompt response to stimulation 2
Appearance – blue 0, blue extremities 1, pink 2
Respiration – absent 0, slow + irregular 1, vigorous cry 2

Answer 282

A

From birth of the foetus to expulsion of placenta
Physiological Mx = placenta delivered by maternal effort without medications or cord traction, cord clamped + cut after stops pulsating

Answer 283

A

Examine placenta + membranes to check complete as RPOC can cause serious PPH or infection

Answer 284

A

Partogram is graphic record of key maternal + foetal data –
- FHR every 15m (low risk = intermittent auscultation) high = continuous CTG
- Contractions every 30m (4 in 10 in established labour)
- Maternal pulse every 60m
- Maternal BP, temp, urine (ketones + protein) + VE to assess progress every 4h
- Drugs, IV fluids given + Cervical dilation noted too

Answer 285

A

Have alert + action line
Indicates slow progression so if at action line = take action
Provides clear guidance on when to intervene, alert means be wary
Point at which progression stops is useful to see where problem is

Answer 286

A

Engagement + descent
Flexion
Internal rotation
Extension (crowning)
Restitution/external rotation
Expulsion

Answer 287

A

Passage of presenting part into pelvic inlet
Entire head felt = 5/5ths palpable aka not engaged
Unable to feel head = 0/5ths palpable aka fully engaged
Foetus is engaged when >50% of presenting part descended into pelvis

Answer 288

A

Downward passage of presenting part through bony pelvis
Position of baby’s head (cm) in relation to mother’s ischial spines
Increased abdo muscle tone and increased frequency + strength of contractions

Answer 289

A

In relation to ischial spines in cm –
- –5 = baby high up at around the pelvic inlet
- 0 = head at ischial spines (engaged)
- +5 = foetal head descended further out

Answer 290

A

Occiput transverse

Answer 291

A

Uterine contractions exert pressure down foetal spine towards occiput + cause neck flexion, allowing circumference of foetal head to reduce

Answer 292

A

Foetus passively internally rotates from OT to OA/OP to allow shoulders to negotiate pelvic inlet
Pelvic inlet widest diameter is transverse (side-side)

Answer 293

A

Foetal occiput slips beneath suprapubic arch allowing head to extend + foetal head is born, usually facing maternal back (occiput anterior)

Answer 294

A

Shoulders only now negotiating pelvic outlet so head externally rotates to face mother’s L/R medial thigh so shoulders can pass
Pelvic outlet widest diameter is A-P (front-back)

Answer 295

A

Ultimately ends with delivery of foetus
Gentle downwards traction > deliver shoulder below suprapubic arch
Gentle upwards traction > deliver posterior shoulder (caution with excessive force as may cause brachial plexus damage)

Answer 296

A

Diffuse swelling of scalp caused by pressure of scalp against dilating cervix during labour
Caput may lead to moulding of the head (oblong not round shape) but this often disappears after a few days

Answer 297

A

Slow from beginning (primary dysfunctional labour) –may be insufficient uterine contractions
Sudden slowing of labour (secondary arrest) – may be cephalopelvic disproportion

Answer 298

A

Palpate abdomen for lie, head + contractions (may need USS)
CTG, colour of amniotic fluid, VE

Answer 299

A

Baby size + presentation
Well-being of baby + mother
How long labour has been going on for
Maternal exhaustion
Pelvic adequacy

Answer 300

A

Bishop score = used to calculate how likely spontaneous labour is to occur
Score <5 = unripe cervix (less likely for induction success)
Score >9 = favourable cervix ready for labour or induction

Answer 301

A

Cervical dilation – <1cm (0), 1-2 (1), 3-4 (2), >5cm (3)
Cervical consistency – firm (0), intermediate (1), soft (2)
Cervical effacement –<30% (0), 40-50 (1), 60-70 (2), 80% (3)
Cervical position – posterior (0), intermediate (1), anterior (2)
Foetal station – –3 (0), -2 (1), -1/0 (2), ≥1 (3)

Answer 302

A

Membrane sweep
Prostaglandin E2 (PGE2) pessary or gel like dinoprostone
Cervical ripening balloon (gently inflates + dilates cervix)
Amniotomy if not ruptured already
Oxytocin analogue (syntocinon) infusion to cause uterine contractions

Answer 303

A

Done before meds to try + encourage labour to start on its own (promotes positive feedback of stretch > oxytocin release)

Answer 304

A

Stimulates contraction of uterine muscles + ripens cervix
Improve Bishop score by cervical ripening so can induce
Uterine hyperstimulation (>5 in 10 for 20m or contraction >2m)
?Remove PGE2, ?terbutaline tocolytic

Answer 305

A

Uterine hyperstimulation (>5 in 10 for 20m or contraction >2m)
?Remove PGE2, ?terbutaline tocolytic

Answer 306

A

PROM, IUGR, pre-eclampsia, obstetric cholestasis
Severe degree of placenta praevia, transverse foetal lie, severe cephalopelvic disproportion, low Bishop score

Answer 307

A

Obstructed labour is the failure of the fetus to descend through the birth canal, because there is an impossible barrier (obstruction) preventing its descent despite strong uterine contractions.
The obstruction usually occurs at the pelvic brim, but occasionally it may occur in the pelvic cavity or at the outlet of the pelvis. When labour is prolonged because of failure to progress, there is a high risk that the descent of the fetus will become obstructed.

Answer 308

A

Power (most common)
Passage
Passenger
Psyche (maternal exhaustion in second stage)

Answer 309

A

Poor or uncoordinated uterine contractions
Either the uyerine contractions are not strong enough to efface and dilate the cervix in the first stage of labour or the muscular effort of the uterus is insufficient to push the baby down the birth canal during the second stage.
Common in primigravida women
May need instrumental delivery or syntocinon

Answer 310

A

Labour may be prolonged if the mother’s pelvis is too small for the baby to pass through or the pelvis has an abnormal shape, or if there is a tumour or other physical obstruction in the pelvis.
Common in developing countries, risk of infection, fistulas

Answer 311

A

The fetus is the passenger travelling down the birth canal. Prolonged labour may occur if the fetal head is too large to pass through the mother’s pelvis, or the fetal presentation is abnormal. Includes hydrocephalus.

Answer 312

A

Mother anxious, weak, exhausted
Rupture of membranes
Tachy, low blood pressure, high RR…
Foul smelling meconium from vagina
Concentrated urine
Oedema (vulva/cervix)
Caput
Malpresentation and Malposition
Bandl’s Ring

Answer 313

A

Partograph – rate of cervical dilatation vs rate of foetal head descent. Compares it with
normal

Answer 314

A

C section
Supportive treatment (IV, analgesia…)

Answer 315

A

Fistula - Vagina and bladder/rectum/ureter/urethra
Still birth
PPH
Shock/sepsis
Paralytic ileus

Answer 316

A

Presenting part of foetus is not the vertex of the foetal head
Shoulder = c-section
Breech (leg/bottom) = ECV or c-section
Brow = c-section
Face = c-section likely

Answer 317

A

Brow: head between full flexion + extension, associated with mentovertical diameter (chin to highest point of vertex)
Face: head hyperextended >120, associated with submentobregmatic diameter (junction of neck/lower jaw to anterior fontanelle)

Answer 318

A

Refers to foetal head position on VE
Anterior/posterior fontanelles as landmarks, OA ideal
If OP at delivery means head is at posterior quadrant of pelvis requiring greater rotation which can prolong labour

Answer 319

A

PGE2 if low bishop score as if not cannot induce
Oxytocin infusion ± amniotomy (if membranes not ruptured) > reassess in 2h
CTG with foetal blood sample if concerns, consider c-section if doesn’t help

Answer 320

A

Allow to push for 2h if nulliparous or 1h if multiparous
No imminent delivery obstetric review for ?instrumental or c-section

Answer 321

A

IM oxytocin to cause uterus contraction to expel placenta
Cord clamp + careful cord traction to guide placenta out
Haemorrhage or >60m delay in physiological management (delay in active Mx is >30m)

Answer 322

A

Foetal = distress, hypoxia (HIE, cerebral palsy), morbidity + mortality
Maternal = bleeding, tears, amniotic fluid embolism

Answer 323

A

When baby’s buttocks/legs lies over the maternal pelvis
Longitudinal lie but head at fundus
Risk of hypoxia + trauma

Answer 324

A

Idiopathic
Prematurity as baby may not have turned itself yet
Previous breech
Uterine abnormalities (bicornuate uterus), fibroids
Placenta praevia
Foetal abnormalities (CNS malformation
Multiple pregnancy
Poly/oligohydramnios

Answer 325

A

Extended (Frank) = most common, hips flexed, both legs extended with feet by head, buttocks presenting
Flexed (Complete) = hips + knees flexed so buttocks + feet presenting (Cannonballing)
Footling = one leg flexed, one extended, foot hanging through cervix

Answer 326

A

Footling
Nothing to act as plug over cervix if membranes ruptured

Answer 327

A

Ideally antenatal Dx with USS, if <36w unimportant unless in labour
Abdo exam = longitudinal lie, head palpated at fundus, presenting part not head, foetal heart best heard high up uterus

Answer 328

A

External cephalic version to move baby to correct position at 37w
C-section if ECV unsuccessful or contraindicated

Answer 329

A

Absolute = pre-eclampsia, APH, oligohydramnios, foetal compromise
Relative = maternal HTN, foetal abnormality, 1 previous c-section

Answer 330

A

Position of the foetus in relation to the mother’s body
Longitudinal, transverse, oblique, unstable

Answer 331

A

Straight up + down

Answer 332

A

Side-side, foetus perpendicular to long axis of uterus

Answer 333

A

Lie is actively changing (may be transverse, longitudinal, cephalic or breech)

Answer 334

A

Multiparity (>P2) with lax uterus (common)
Polyhydramnios, prematurity
Uterine abnormalities, fibroids
Placenta praevia
Foetal abnormalities

Answer 335

A

Abdo exam = neither head nor buttocks presenting
Transverse = ovoid uterus wider at sides, lower pole empty, head in flank
USS can be used to confirm lie, often antenatally

Answer 336

A

May result in pre-term rupture of membranes
Membrane rupture risks cord prolapse (longitudinal lie prevents descent of cord) so transverse lie = highest risk of prolapse

Answer 337

A

Stable but transverse –
- ECV >36w even in early labour if membranes intact
- C-section if fails or pt choice
Unstable lie –
- Admit whilst unstable from 37w so c-section if labour starts

Answer 338

A

Maternal rupture in last 7d
Multiple pregnancy (except for 2nd twin)
Major uterine abnormality

Answer 339

A

During labour for every woman
High risk pregnancies
Pyrexia (?chorioamnionitis)
Severe HTN ≥160/110
Oxytocin use
Fresh bleeding

Answer 340

A

Dr C Bravado –
- Dr = define risk (high risk = continuous
- C = contractions (bottom trace shows frequency)
- Bra = baseline rate
- V = variability
- A = accelerations
- D = decelerations
- O = overall assessment

Answer 341

A

> 160 may be maternal pyrexia, prematurity, chorioamnionitis
<110 may be maternal beta-blockers, increased foetal vagal tone

Answer 342

A

Reduced variability may be hypoxia, lactic acidosis, prematurity
40m reduced variability accepted as baby may be sleeping

Answer 343

A

Rise in baseline HR by 15 for ≥15s
Reassuring as baby moving

Answer 344

A

Fall in baseline HR by 15 for ≥15s
Early = peak of contraction corresponds with trough of depression (head compression from uterine contraction = normal)
Late = deceleration after contraction (hypoxia = placental insufficiency, asphyxia)
Variable = vary in shape + timing (cord compression)

Answer 345

A

i) 110–160bpm
ii) >5bpm
iii) Present
iv) Early

Answer 346

A

i) 100–109bpm or 161–180bpm
ii) <5bpm for 40–90m
iii) Variable

Answer 347

A

i) <100bpm or >180bpm
ii) <5bpm for >90m
iii) Late

Answer 348

A

i) 1 non-reassuring
ii) ≥2 non-reassuring or 1 abnormal

Answer 349

A

Allows long-term monitoring
Can pick up on foetal distress
Can be on constantly to identify any slight changes

Answer 350

A

No improvement in perinatal outcomes in low-risk pregnancies
Foetal exposure to USS ionisation
Ambulatory monitoring may not be possible
Doesn’t give true beat to beat FHR monitoring or morphological Ax of heart

Answer 351

A

Obtained via scalp
Gold standard for FHR, true beat to beat information
Invasive, associated with scalp injury + perinatal infection, only during labour when membranes ruptured + >2cm dilated

Answer 352

A

Abdominal foetal ECG
Can be used ambulatory at home but only for high risk, morphological analysis possible + non-invasive

Answer 353

A

Umbilical cord descends below the presenting part of the foetus after rupture of the membranes
Presenting part can compress cord or exposure of cord leads to vasospasm > significant risk of foetal morbidity + mortality from hypoxia

Answer 354

A

Prematurity
Polyhydramnios
Long umbilical cord
Malpresentation (Footling breech + transverse lie)
Multiparity + multiple pregnancy
Placenta praevia

Answer 355

A

Foetal CTG distress (heart decelerations + bradycardia)
Dx via VE (cord at introitus), speculum confirms

Answer 356

A

999/emergency buzzer, neonatal team
Fill bladder with 500ml warmed saline via catheter (elevate presenting foetal part + lift off cord)
Left lateral position with head down or knee-chest position
Presenting part pushed back into uterus to prevent compression
Avoid handling cord > vasospasm
Tocolytics like terbutaline (SABA) to abolish contractions if delivery not imminently available

Answer 357

A

Failure of anterior shoulder to pass under symphysis pubis after delivery of foetal head

Answer 358

A

Macrosomia
Maternal DM
High maternal BMI
Cephalopelvic disproportion
Post-maturity
Previous shoulder dystocia

Answer 359

A

Head remaining tightly applied to vulva or retracting (turtle neck sign)
Failure of restitution (head does not turn sideways)

Answer 360

A

PPH, perineal tears (3rd/4th degree), psychological impact
Hypoxia, cerebral palsy, injury to brachial plexus, Erb’s palsy, fits, # humerus or clavicle

Answer 361

A

i) Injury of C5/6 nerves causing paralysis of arm, looks limp, waiters tip position
ii) Painful movements, shoulder asymmetry

Answer 362

A

HELPERR[R] –
- Help (call with emergency buzzer, obs, neonates)
- Evaluate for episiotomy (enlarge opening)
- Legs = McRobert’s
- Pressure = suprapubic
- Enter = pelvis for rotation
- Remove = posterior arm
- Replace = head in vagina + deliver by section (Zavanelli)

Answer 363

A

Hips fully flexed + abducted (knees to abdo)
Posterior pelvic tilt lifting symphysis pubis up + out of way

Answer 364

A

Rubin II = pressure on post. aspect of ant. shoulder to help deliver under symphysis pubis
Woods’ screw = Rubin II + pressure on ant. aspect of post. shoulder
Reverse woods’ screw = pressure on ant. aspect of ant. shoulder + post. aspect of post. shoulder in opposite way

Answer 365

A

Failure to progress in second stage.
Foetal or maternal distress + maternal exhaustion in second stage
Control of head in various foetal positions (incl. breech)

Answer 366

A

Ventouse = suction cup on a cord on baby’s head with traction
Forceps = 2 curved pieces of metal attach either side of baby’s head + grip with traction

Answer 367

A

Cephalohaematoma = collection of blood between periosteum + skull from damaged blood vessels, does not cross suture lines, presents hours after
Caput Succedaneum = Crosses Sutures, diffuse oedema outside periosteum due to pressure to a specific area of scalp, resolve in few days, conehead present at birth

Answer 368

A

Maternal = vaginal tears, anal sphincter trauma
Foetal = facial nerve palsy (main), bruises on baby’s face, fat necrosis > hardened lumps of fat on baby’s cheek that will resolve spontaneously over time, skull #

Answer 369

A

Infection (co-amox stat)
PPH
Episiotomy
Tears
Incontinence

Answer 370

A

Placenta praevia (3/4)
IUGR
Uncontrolled HIV
Active herpes
Cephalopelvic disproportion
Pre-eclampsia
Post-maturity

Answer 371

A

1 = immediate threat to life of mother/baby. Decision>delivery time = 30m
2 = not imminent threat to life but c-section required urgently due to compromise. Decision>Delivery time = 75m
3 = c-section required but both stable
4 = elective section

Answer 372

A

General
Regional block (spinal)
H2 receptor antagonists or PPIs, prophylactic Abx, oxytocin (PPH), LMWH for VTE prophylaxis

Answer 373

A

Imminent threat to mother ± foetus, C/I to regional, maternal preference, failed regional technique
Aspiration, failed intubation, awareness, damage to mouth/throat

Answer 374

A

Safer, see baby immediately, partner present, improved post-op analgesia
Hypotension, headache, discomfort with pressure sensations, failure

Answer 375

A

Surgical risk (bleeding, infection/endometritis, VTE)
Damage risk (ureter, bladder, bowel, vessels)
Future pregnancies (increased risk of uterine rupture, placenta praevia, stillbirth + repeat section)
Baby (risk of lacerations, increased incidence in transient tachypnoea)

Answer 376

A

Yes provided cause of caesarean is unlikely to recur, 75% success rate
Previous uterine rupture, classical caesarean scar

Answer 377

A

Trained support
Relaxation techniques, hypnotherapy
Massage, water births
Comfortable position + environment for birth

Answer 378

A

Paracetamol + codeine useful in early labour
Avoid NSAIDs

Answer 379

A

Gas + air (N2O + O2 50/50 mixed)
Rapid onset analgesia, minimal SEs, self-limiting, available for home delivery
Theoretic risk of bone marrow suppression, greenhouse gas, N+V

Answer 380

A

Single shot IM opioids (diamorphine, pethidine)
Patient-controlled analgesia via IV cannula (fentanyl, alfentanil, remifentanil)

Answer 381

A

Lipid soluble so crosses placenta rapidly
Diamorphine 2x as potent as morphine so faster onset
Pethidine metabolites can cause seizures so avoid in epileptics

Answer 382

A

Fentanyl = very lipid soluble, rapid onset of action, long half-life
Alfentanil + remifentanil = shorter half-lives

Answer 383

A

Foetal = resp depression, diminishes breast seeking + feeding behaviour
Maternal = euphoria + dysphoria, N+V, can prolong 1st + 2nd stages, resp depression + pruritus

Answer 384

A

Epidural, spinal or combined spinal epidural (CSE)
Epidural at L3/4 ‘Tuffiers’ line connecting 2 iliac crests bisects L4 vertebral body or USS to avoid cord damage

Answer 385

A

i) Uterine contraction at T10-L1
ii) Perineum + vaginal stretching S2-4 (pudendal)

Answer 386

A

Intermittent = high conc LA, labour intensive, periods of inadequate analgesia + haemodynamic instability
Continuous = low dose LA + opioid, less labour intensive, constant analgesia + haemodynamic stability
Continuous + bolus = greater maternal satisfaction
CSE = rapid onset, high satisfaction, reduced LA dose

Answer 387

A

LA like bupivacaine
Opioids like fentanyl, diamoprhine

Answer 388

A

Autonomic (vasodilation = reduced MAP)
Sensory (analgesia)
Motor (motor blockade) + fever

Answer 389

A

Maternal request
HTN/pre-eclampsia
Cardiac disease
Induced labour
Multiple births
Instrumental/op delivery likely

Answer 390

A

Potential for spinal cord damage
Hypotension + bradycardia
Haematoma/abscess at injection site
Anaphylaxis if allergic
Post-dural puncture headache

Answer 391

A

Leak of CSF + reduced CSF pressure, within 1–2d (up to 7)
Headache, worse when upright, improves when flat
Supportive, pain >72h = epidural blood patch, IV caffeine

Answer 392

A

Absolute = maternal refusal, local infection, allergy to LA
Relative = coagulopathy, systemic infection, fixed cardiac output

Answer 393

A

Foetal = tachycardia (maternal pyrexia), diminishes breast-feeding behaviour
Maternal = increased length of 1st + 2nd stages, need more oxytocin, increased need for instrumental, loss of mobility + bladder control, pyrexia

Answer 394

A

External vaginal opening is too narrow to accommodate the baby, leading to a ripping of the skin in that area as the baby’s head comes through

Answer 395

A

1st degree = limited to superficial skin of perineum
2nd degree = above PLUS perineal muscles (includes episiotomy)
3rd degree = above PLUS anal sphincter involvement
4th degree = above PLUS injury to rectal mucosa

Answer 396

A

3A = <50% of external anal sphincter thickness torn
3B = >50% of EAS thickness torn
3C = EAS + internal anal sphincter torn

Answer 397

A

Primigravida
Macrosomia
Shoulder dystocia
Forceps

Answer 398

A

Diagonal incision (45 degrees) from opening of vagina downwards + laterally (medio-laterally) to avoid anal sphincter damage or midline in anticipation of needing additional room to delivery baby (e.g. prior to forceps) – suture after
Should be done under LA

Answer 399

A

Complication of labour where myometrium bursts

Answer 400

A

Incomplete = peritoneal lining surrounding uterus intact
Complete = peritoneal lining ruptures so uterine contents released into peritoneal cavity

Answer 401

A

Significant haemorrhage, high morbidity + mortality for baby + mother

Answer 402

A

VBAC
Previous uterine surgery
Increased BMI
High parity
Congenital uterine abnormalities
Oxytocin use

Answer 403

A

Tenderness over previous uterine scars
PV bleed, maternal shock
CTG = foetal distress + no or cessation of contractions

Answer 404

A

ABCDE resus
Cross match blood
Urgent laparotomy to stop bleeding
Repair or remove uterus
C-section to save baby

Answer 405

A

Primary = loss of >500ml blood in the first 24h after delivery
- Minor = 500–1000ml estimated blood loss
- Major = >1000ml, clinically in shock

Answer 406

A

Secondary = excessive blood loss from genital tract between 24h–12w after delivery (can result in Sheehan’s syndrome)

Answer 407

A

Primary (4Ts)–
- Tone (uterine atony = most common)
- Trauma (perineal tear)
- Tissue (retained products)
- Thrombin (clotting issue e.g. DIC in pre-eclampsia)

Answer 408

A

Secondary most common cause is retained placental tissue, endometritis

Answer 409

A

Before birth = previous PPH, APH, twins/triplets, pre-eclampsia, obesity, polyhydramnios
Labour = prolonged, c-section, perineal tear or episiotomy, macrosomia

Answer 410

A

Unpalpable uterus on abdo exam (should normally be palpable in period following birth)

Answer 411

A

Treat anaemia during antenatal period
Empty bladder (?catheter) as full bladder reduces uterine contractions
Active Mx of third stage (IM oxytocin)
IV TXA during c-section in third stage of labour if high risk

Answer 412

A

ABCDE resus
2x large bore cannulas
Group + X match
Activate major haemorrhage protocol for quick blood access
IV fluids/bloods

Answer 413

A

Rub uterus through abdomen to stimulate contraction

Answer 414

A

All stimulate uterine contractions
IV syntocinon
IV/IM ergometrine, C/I in HTN as vasoconstrictor (can combine with syntocinon as syntometrine)
IM carboprost, caution in asthma (prostaglandin analogue)
Sublingual misoprostol (prostaglandin analogue)

Answer 415

A

Intrauterine balloon tamponade (1st line in uterine atony)
B-lynch sutures (suture around uterus to compress it)
Internal iliac/uterine artery ligation (reduces blood flow to stop bleeding)
Hysterectomy as last resort (may save life)

Answer 416

A

Recent change in mental state or new Sx
New thoughts or acts of violence/self-harm
New + persistent feelings of incompetency as mother or estrangement from baby

Answer 417

A

Fear of treatment
Fear of children being removed
Cultural lack of recognition
Denial
Stigma

Answer 418

A

Brief period of tearfulness, anxiety + emotional lability starting 3–10d after birth

Answer 419

A

Affects up to 70% of women, classically primiparous

Answer 420

A

Reassure natural to feel emotional + overwhelmed, health visitor obs

Answer 421

A

Depressive episode, temporally related to childbirth, within 6m post-partum

Answer 422

A

PMH/FHx of MH issues,
Hx of abuse,
lack of support/relationships,
low socioeconomic status,
unemployed

Answer 423

A

Edinburgh postnatal depression scale = screening tool, >10 suspect

Answer 424

A

Typical depression
Sx but may include worries about baby’s health or ability to cope adequately, feeling detached from the baby

Answer 425

A

Early identification + close monitoring of those at risk
CBT may help, sertraline + paroxetine if severe as safer in breastfeeding
?Hospital admission if thoughts of self or baby-harm

Answer 426

A

Acute psychotic episode with peak occurrence at 2w postpartum

Answer 427

A

FHx/PMH of MH (esp. postpartum psychosis),
traumatic birth or pregnancy,
primiparous

Answer 428

A

Prominent affective Sx (mania or depression with psychotic Sx)
Schizophreniform disorder (lasts <6m)
Emotional lability, delusions, hallucinations, suicidality, infanticide

Answer 429

A

Assess suicide risk + risk to baby
Often inpatient admission (mother + baby unit)
Antipsychotics ± antidepressants or mood stabilisers (carbamazepine), ECT for major affective disorder
Psychoeducation for pt + family, CBT
Children + family social service involvement

Answer 430

A

o Maternal death or severe morbidity.
o Cardiac disease.
o Spontaneous 1st trimester or recurrent miscarriage.
o Pre-eclampsia.
o Gestational diabetes.
o Thromboembolism.
o Post-CS wound infection.
o Infection from other causes.
o PPH.
o Low breast-feeding rates.

Answer 431

A

o Stillbirth and neonatal death.
o Congenital abnormalities.
o Prematurity

Answer 432

A

when the cervix effaces, the mucous plug comes loos and passes out of the vagina (could have blood)
seen in the latent phase.

Answer 433

A

Crises are more common during pregnancy
Increased risk of pre-eclampsia
Increased risk of delivery by CS due to fetal distress

Answer 434

A

miscarriage
IUGR
prematurity
stillbirth

Answer 435

A

Pre-Pregnancy counselling
Stop iron chelating agents before pregnancy
Give folic acid and penicillin prophylaxis for hypersplenism
Screen for UTI infections each visit
Crisis Treatment: Analgesics, oxygen, hydration, and
antibiotics if infection is suspected
Regular foetal monitoring
Aim for vaginal delivery

Answer 436

A

Fetal hydrops is the abnormal accumulation of serous fl uid in two or more fetal compartments. This may be pleural or pericardial effusions, ascites, skin oedema, polyhydramnios, or placental oedema.

Answer 437

A

immune and non-immune

Answer 438

A

an imbalance of interstitial fluid production and inadequate lymphatic return. This can result from congestive heart failure, obstructed lymphatic flow, or decreased plasma osmotic pressure.

Answer 439

A

results from blood group incompatibility between the mother and the fetus causing fetal anaemia.
THIS IS RHESUS DISEASE OF THE NEWBORN**

Answer 440

A

severe anaemia (parvovirus B19, thalassaemia, G6PD)
cardiac abnormalities
chromosomal abnormalities (trisomies 13, 18 and 21)
genetic conditions
other infections (toxoplasmosis, rubella, CMV, varicella)
structural abnormalities (CCAM, diaphragmatic hernia)
twin-to-twin transfusion syndrome
chorioangioma

Answer 441

A

ultrasound (diagnostic)
foetal blood/amniotic fluid sampling
maternal blood sampling

Answer 442

A

depends on the cause
- anaemia = in-utero blood transfusion
- pleural effusions/CCAM = shunt
- twin-to-twin transfusion syndrome = laser photocoagulation of placental anastomoses
- cardiac arrhythmias = maternal digoxin + flecanide

Answer 443

A

an infant born weighing 5.5 pounds (2500 grams) or less.
➢ Very low: less than 3.3 pounds
➢ Normal: 5.5 to 8.8 pounds
➢ High: more than 8.8 (could be due to GDM)

Answer 444

A

➢ Low socioeconomic
➢ History of abuse
➢ Age (<15 or >35)
➢ Race (black, ethnic minorities…)

Answer 445

A

➢ Preterm birth (before 37 weeks gestation)
➢ Genetics (could be chromosomal abnormalities…)
➢ Uteroplacental insufficiency
➢ Multiple pregnancy
➢ Substance abuse (smoking, drinking alcohol, illicit drug) causing IUGR
➢ Chronic conditions and infections (hypertension, rubella, CMV, syphilis, toxoplasmosis, BV…)
➢ Medications (sodium valproate, ramipril, warfarin…)

Answer 446

A

➢ Feeding struggles
➢ Respiratory distress syndrome
➢ Jaundice
➢ Infections
➢ PDA
➢ Intraventricular hemorrhage
➢ Retinopathy of prematurity, and hearing problems
➢ Intellectual and developmental disabilities
➢ Diabetes
➢ High blood pressure
➢ Heart disease
➢ Obesity

Answer 447

A

➢ IV fluids or gavage feeding
➢ Light therapy
➢ Supplemental surfactant or oxygen
➢ Surgery or medications (ROP or PDA), and for intraventricular hemorrhage
➢ Kangaroo care (skin to skin contact)
➢ Primary prevention: Avoid drinking, smoking and unhealthy diet during pregnancy. Get the flu vaccine

Answer 448

A

Primary prevention: Avoid drinking, smoking and unhealthy diet during pregnancy. Get the flu vaccine

Answer 449

A

It is an uncommon but serious complication of pregnancy. It occurs when the placenta does not develop properly or is damaged. This blood flow disorder is marked by a
reduction in the mother’s blood supply. The complication can also occur when the mother’s blood supply doesn’t adequately increase by mid-pregnancy.

Answer 450

A

➢Abnormal trophoblast invasion:
▪ Pre-eclampsia
▪ Placenta accreta
➢ Abruption
➢ Infarction
➢ Placenta previa
➢ Tumor: chorioangiomas
➢ Abnormal umbilical cord or cord insertion (i.e., two vessel cord)
➢ Maternal diabetes
➢ Maternal hypertension
➢ Anemia
➢ Smoking
➢ Drug abuse (cocaine, heroin, methamphetamine)
➢ Antiphospholipid syndrome
➢ Renal disease
➢ Advanced age

Answer 451

A

➢ Depending on the cause
➢ Mother may notice uterus is smaller than previous pregnancies
➢ Fetus may be moving less than expected
➢ IUGR
➢ Vaginal bleeding or preterm labor contractions (i.e., during placental abruption)

Answer 452

A

preeclampsia,
placental abruption,
preterm labor, and delivery

Answer 453

A

Oxygen deprivation (cerebral palsy),
learning disabilities,
hypothermia,
hypoglycemia,
hypocalcemia,
polycythemia,
premature labor,
stillbirth,
death

Answer 454

A

➢ USS
➢ Maternal alpha fetoprotein levels
➢ CTG

Answer 455

A

➢ Avoid precipitating factors (drugs, smoking, alcohol…
➢ Treat underlying cause
➢ Education on preeclampsia, frequent monitoring, possibly steroid injections, possible delivery.
➢ FETAL SURVEILLANCE

Answer 456

A

Temperature of above 38 degrees Celsius in the first 14 days following delivery.

Answer 457

A

uterine infection
perineal wound infection

Answer 458

A

Caesarean section,
Pre-labour rupture of membranes,
Intrapartum chorioamnionitis,
Prolonged labor,
Multiple pelvic examinations,
Internal fetal monitoring—use of scalp electrodes/intrauterine pressure catheters,
other risk factors, e.g., anemia, low socio-economic status.

Answer 459

A

Fever usually in proportion to the extent of infection.
Foul smelling, profuse, and bloody discharge.
Subinvolution of uterus.
Tender bulky uterus on abdominal examination.

Answer 460

A

Breast causes (mastitis, abscess)
UTI (i.e., from catheter, hypotonic bladder, KEEPS bacteria)
Thrombophlebitis (high risk of DVT and PE)
Respiratory complications (mainly women with CS; due to atelectasis, aspiration, or bacterial pneumonia) – hence the need for prophylactic antibiotics before CS!
Abdominal wound infection

Answer 461

A

➢ FBC
➢ Blood Cultures
➢ MSU
➢ Swabs from cervix and lochia for chlamydia and bacterial infections
➢ Wound swabs
➢ Throat swabs
➢ Sputum culture and CXR

Answer 462

A

➢ Supportive (analgesics/NSAIDS, wound care, ice packs…)
➢ Antibiotics (for endometritis – IV clindamycin and gentamicin until >24hrs afebrile)
➢ Surgical (drain abscess, secondary repair of wound, drainage of hematomas…)

Answer 463

A

preterm labour
PROM
low birth weight
infection during delivery (conjunctivitis and pneumonia)

Answer 464

A

azithromycin 1g OD followed by 500mg orally OD for 2 days
erythromycin 500mg QD for 7 days
amoxicillin 500mg TD for 7 days

Answer 465

A

miscarriage
premature birth
low birth weight
PROM
chorioamnionitis
eye infection in newborn

Answer 466

A

500mg ceftriaxone IM single dose

Answer 467

A

congenital syphilis
- premature births
- still births
- multi-organ problems to brain, eyes, heart, skin, teeth and bones

Answer 468

A

penicillin

Answer 469

A

PROM
preterm births
low birth weight
female newborns can acquire infection during birth

Answer 470

A

metronidazole

Answer 471

A

due to dilation of the upper renal tract and urinary stasis (hypoactive bladder)

Answer 472

A

it can lead to symptomatic infection if left untreated

Answer 473

A

typical UTI symptoms = frequency, dysuria
cystitis = urgency, frequency, dysuria, hematuria, proteinuria, suprapubic pain
Pyelonephritis = fever, rigors, loin pain (also hyperemesis or preterm labor)

Answer 474

A

Urine analysis (nitrities and leukocytes)
MSU
Bloods
Renal USS

Answer 475

A

Oral antibiotics
- Asymptomatic bacteriuria: 3 days
- Cystitis 7 days

Answer 476

A

antibiotics (IV) for 10-14 days
- Pyelonephritis needs IV antibiotics until pyrexia settles and vomiting stops. IV fluids and antipyretics too.

Answer 477

A

Increase fluid intake
Double voiding and emptying bladder after sex
Cranberry juice
Prophylactic antibiotics

Answer 478

A

previous infection
renal stones
diabetes mellitus
immunosuppression
polycystic kidneys
congenital abnormalites of renal tract
neuropathic bladder

Answer 479

A

the risk is mainly associated with catheterisation
- prolonged labour
- prolonged 2nd stage
- C-section
- pre-eclampsia

Answer 480

A

antibiotics (depends on sensitivities)
- penicillin amoxicillin
- cephalosporin
- gentamycin (have to monitor levels to minimise risk of ototoxicity)

Answer 481

A

trimethoprim
it is a folate antagonist so can reduce folate levels

Answer 482

A

nitrofurantoin - risk of haemolytic anaemia in newborn with G6PD
sulfonamides - risk of kernicterus in newborn due to displacement of protein binding of bilirubin

Answer 483

A

tetracyclines - cause permanent staining of teeth and problems with skeletal development
ciprofloxacin - causes skeletal problems

Answer 484

A

a rare complication of birth where the baby’s head does not clear the opening of the pelvis

Answer 485

A

large baby size due to:
- past due date
- excessive maternal weight gain during pregnancy
- FHx of large babies
- gestational diabets
- multiparity
- parents are obese

Answer 486

A

small pelvis due to:
- birthing in adolescence
- pelvic malformations (bony growths)
- petite birthing parent
- previous trauma e.g. fractured pelvis

Answer 487

A

flat (platypelloid) pelvic opening
heart-shaped (android) pelvis

Answer 488

A

failure to progress
- 1st labour and last >20hrs
- previously given birth and lasts >14hrs
baby’s head is not moving towards pelvic opening
contractions aren’t strong enough to move baby along birth canal
slow/no thinning or dilation of cervix

Answer 489

A

check cervix to see if it is opening
foetal monitor to assess contractions
palpate abdomen to assess foetal position
can be diagnosed via USS if baby is growing fast

Answer 490

A

vacuum extraction or forceps
c-section

Answer 491

A

shoulder dystocia
vaginal tears
postpartum haemorrhage

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WOMEN'S HEALTH - OBSTETRICS Flashcards

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