WOMENS HEALTH - obstetrics

Question 1

what is an ectopic pregnancy?

Answer 1

when a fertilised egg implants anywhere outside of the uterus

Question 2

where is the most common site for ectopic pregnancy?

Answer 2

fallopian tubes

Question 3

RFs for ectopic pregnancy

Answer 3

• previous ectopic
• tubal damage e.g. due to surgery
• hx of infertility
• endometriosis
• smoker
• > 35
• having the coil

Question 4

when does ectopic pregnancy commonly present?

Answer 4

6-8 weeks gestation

Question 5

presentation of an ectopic pregnancy

Answer 5

• missed period
• constant lower abdominal pain
• vaginal bleeding
• cervical motion tenderness (pain when moving cervix during bimanual)

Question 6

investigations for an ectopic pregnancy

Answer 6

1. transvaginal ultrasound scan (TVUS)
   - investigation of choice
   - may see… gestational sac containing sac/fetal pole/non specific mass in tube, empty uterus
2. +/- serum bHCG
   - if high, would expect to see something in uterus, so if uterus is empty suggests pregnancy elsewhere

Question 7

what level of serum bHCG is high an

Answer 7

> 1500

Question 8

what is a pregnancy of unknown location (PUL)? what needs to be ruled out if this is the case?

Answer 8

= a positive pregnancy test but no evidence of pregnancy on US

need to rule out ectopic pregnancy

Question 9

what change in hCG over 48h indicates:
a) intrauterine preg
b) ectopic preg
b) miscarriage

Answer 9

a) rise of more than 63%
b) rise of less than 63%
c) fall of more than 50%

Question 10

when should women take folic acid during pregnancy? what dose?

Answer 10

It is recommended that women take folic acid 400mcg OD ideally 3 months before conception up to 12 weeks gestation

Question 11

results from combined test chromosomal screening that indicate high risk of the baby having Down’s Syndrome

Answer 11

1. thickened nuchal translucency
2. increased B-HCG
3. reduced PAPP-A

Question 12

what is perinatal depression?

Answer 12

encompasses depression occurring during (prenatal depression) and following (postpartum depression) childbirth

Question 13

what are the most commonly used antidepressants in pregnancy? what do patients need to be cautious of?

Answer 13

SSRIs - can cross placenta into foetus so risks need to be balanced against tx benefit

Question 14

what are the potential risks of SSRIs in:

a) first trimester

b) third trimester

c) neonates

Answer 14

a) congenital heart defects

b) persistent pulmonary HTN in the neonate

c) neonates can experience withdrawal sx (usually mild, not requiring tx)

Question 15

which SSRI has the strongest link with congenital malformations when taken in the first trimester?

Answer 15

paroxetine

Question 16

what is the diagnostic criteria triad for hyperemesis gravidarum?

Answer 16

1. 5% pre-pregnancy weight loss
2. dehydration
3. electrolyte imbalance