Exam 3- pregnancy

Question 1

When does the booking visit typically occur?

Answer 1

Before 12 weeks gestation

Question 2

Bloods taken at booking visit (5)

Answer 2

Full blood count
ABO/Rh
Red cell alloantibodies
Haemoglobinopathies
Coagulation screen

Question 3

When is the dating scan carried out?

Answer 3

8-14 weeks. Confirms viability, number of foetuses, gestational age (crown-rump length)

Question 4

Downs risk assessment

a) before 14 weeks
c) between 14 and 20 weeks

Answer 4

a) combined test- nuchal thickness + hCG/PAPP-A

b) quadruple test (hCG, AFP, uE3, inhibin A)

Question 5

Further investigations for Downs syndrome

a) after 12 weeks
b) after 15 weeks

Answer 5

a) CVS

b) amnio

Question 6

When does the anomaly scan take place?

Answer 6

18-21 weeks

Question 7

First-line treatment for antenatal nausea and vomiting

Answer 7

Antihistamines (e.g.promethazine)

Question 8

Recommended folic acid intake in pregnancy?

Answer 8

400 micrograms/day (5mg in those taking anti-epileptic drugs)

Question 9

Definition of small for gestational age

Answer 9

Birthweight less than the 10th percentile

Question 10

Methods of assessing foetal growth

Answer 10

Symphyseal-fundal height (in cm should roughly correspond to gestational age)
Ultrasound

Question 11

Normal cardiotocography patterns (3)

Answer 11

Rate 110-160bpm
Baseline variability 5-25bpm
Accelerations associated with movements/contractions

Question 12

Worrying sign on CTG

Answer 12

Late decelerations

Question 13

What does umbilical artery doppler measure? What is an adverse sign?

Answer 13

Flow in the umbilical artery;

reduced or reversed end-diastolic flow (suggests placental resistance)

Question 14

Diagnosis of multiple pregnancy (2)

Answer 14

Usually at dating scan

High AFP and exaggerated pregnancy symptoms

Question 15

Blood pressure changes in pregnancy

Answer 15

Falls to nadir at about 22-24 weeks, rises again steadily until term

Question 16

Risks associated with pre-existing hypertension in pregnancy (3)

Answer 16

Pre-eclampsia and eclampsia
Growth restriction
placental abruption

Question 17

Triad of pre-eclampsia

Answer 17

Hypertension
Proteinuria (more than 0.3g/l)
Oedema

Question 18

What is HELLP syndrome?

Answer 18

Complication of pre-eclampsia

Stands for haemolysis, elevated liver enzymes, low platelets

Question 19

Drugs used to control hypertension and their class/mechanism (4)

Answer 19

Methyldopa (central alpha agonist)
Labetolol (alpha and beta antagonist)
Nifedipine (Calcium blocker)
Hydralazine (vasodilator)

Question 20

What is eclampsia?

Answer 20

Tonic-clonic seizures with hypertension in pregnancy

Question 21

Management of pre-eclampsia (2)

Answer 21

IV labetalol/hydralazine

Magnesium sulfate for seizures

Question 22

Why should the use of ergometrine in the third stage be avoided in eclampsia?

Answer 22

Can further increase the blood pressure

Question 23

Management of pre-existing diabetes in pregnancy (4)

Answer 23

Stop all oral hypoglycaemics except metformin
Commence insulin
Folic acid 5g/day
Detailed anomaly scan at 20 weeks

Question 24

Screening for GDM- diagnostic values?

Answer 24

OGTT close to booking appointment

a) fasting- more than 5.6
b) 2 hour- more than 7.8

Question 25

How should GDM be managed? (2)

Answer 25

Trial of diet and exercise if fasting glucose is less than 7.0
If targets arent met, or initial fasting glucose is more than 7- Metformin + insulin

Question 26

Complications of diabetes in pregnancy

a) maternal (3)
b) neonatal (5)

Answer 26

a) polyhydramnios, pre-eclampsia, pre-term labour

b) malformation risk, neonatal hypoglycaemia, macrosomia + shoulder dystocia, RDS

Question 27

Potential causes of jaundice in pregnancy (3)

Answer 27

Intrahepatic cholestasis of pregnancy
Acute fatty liver of pregnancy
HELLP syndrome

Question 28

Features of acute fatty liver of pregnancy (3)

Answer 28

Raised ALT
Abdominal pain
Jaundice

Question 29

Why is vitamin K prescribed in intrahepatic jaundice of pregnancy?

Answer 29

Cholestasis leads to impaired fat absorption, and vit K is fat soluble

Question 30

What process does bilirubin undergo to make it water soluble?

Answer 30

Conjugation with glucoronic acid

Question 31

How is rhesus sensitization prevented routinely?

Answer 31

anti-D immunoglobulin. Either:

a) 2x500 at 28 and 34 weeks
b) 1500 at 28 weeks

Question 32

How are anti-D antibodies detected in rhesus negative women?

Answer 32

Indirect Coombs test (womens serum with antibodies, and donor rh+ samples)

Question 33

Clinical presentation of haemolytic disease of the newborn (4)

Answer 33

Jaundice
Hepatosplenomegaly
Kernicterus
Hydrops fetalis

Question 34

What is kernicterus?

Answer 34

Bilirubin encephalopathy

Question 35

Management of haemolytic diease of the newborn

a) in utero
b) post-natal (2)

Answer 35

a) intra-uterine transfusions

b) tranfusion, phototherapy

Question 36

Hypertension in pregnancy occuring before 20 weeks is…

Answer 36

Pre-existing hypertension