Obs 15th Nov

Question 1

When are the 3 trimesters of pregnancy

Answer 1

1- LMP - 12wks
2 - 13wks- 27wks
3- 28-40wks

Question 2

Normal changes in pregnancy

Answer 2

Heart burn, back ache, constipation, leg oedema / cramps, some itching, tiredness

Question 3

Pre existing hypertension is defined as? What medication should not be used? What can ?

Answer 3

> 140/90 before 20wks / before pregnancy or on an antihypertensive

ACEI is teratogenic and causes oligohydroaminos
Labetalol / nifedipine is recommended

Question 4

Diagnosis of pre eclampsia needs? Sx? RF?

Answer 4

Bp >140/90 + proteinuria >0.3g/24hr

Headache, visual disturbance, nausea / vomiting, epigastric pain, oedema

Prev Hx / FHx, >40yrs, obesity, nulliparity, multiple pregnancy, HTN, Diabetes, renal disease, CTD

Question 5

Complications of pre-eclampsia

Answer 5

-> eclampsia -> MgSO4 for seizures 
CVA -haemorrhagic 
Renal failure 
DIC 
Pulmonary oedema -> ARDS (high mortality) 
HELLP
Fetal complications eg IUGR

Question 6

What is HELLP syndrome ? When / How does it usually present? Investigations

Answer 6

Haemolysis Elevated Liver enzymes Low Platelet count

Most cases between 27-37wks
Usually non specific - malaise, fatigue, RUQ / epigastric pain and often exacerbated at night

Hamolysis - raised bilirubin / raised LDH
Liver - raised AST / ALT (or raised a-GST)
Platelets <100 x 10^9

Question 7

Mx of HELLP

Answer 7

Delivery of foetus is after 34wks 
If under 34wks -> corticosteroids 
Blood transfusion / FFP as indicated by blood / coagulation tests 
BP control 
May need liver transplant

Question 8

Mx of pre-eclampsia

Answer 8

Admit
Labetalol if >150/100
Monitor regularly - U&E, FBC, LFTs
Delivery - if on MgSO4, severe HTN before 34 or mild before 37

If fetal distress - > deliver at any gestation

Question 9

Diagnosis of diabetes

Answer 9

> 7mmol/l fasting

HbA1C >48mmol/L / 6.5%

Question 10

RF for gestational diabetes

Answer 10

Prev / FHx, South Asia / black, BMI >30, prev foetus >4.5kg, polyhydraminos

Question 11

Mx of gestational diabetes

Answer 11

Lifestyle - diet exercise
Monitoring of blood sugar
Metformin -> insulin if severe

Question 12

What happens in rhesus isoimmunisation ? Egs of sensitising events ? Prevention - how does it work?

Answer 12

Rh negative mother mounts an immune response against Rh positive baby via anti-D antibodies

Delivery, top, ectopic, intrauterine death, invasive uterine procedure

Anti-D to Rh negative women at 28wks + after sensitising events
(Anti D mops up fetal RBCs without initiation of immune response)

Question 13

Treatment of 
Epilepsy  
Hyperthyroidism 
VTE 
Depression 
Bipolar Disorder 
Hyperemesis gravidarum 

Answer 13

Epilepsy -> carbamazepine or lamotrigine
Hyperthyroidism -> propylthiouracil
VTE -> LMWH (10 days or 6 weeks)
Depression -> TCA or SSRI eg. sertraline
Bipolar Disorder -> haloperidol or olanzapine
Hyperemesis gravidarum -> metoclopramide/cyclizine/ondansetron + thiamine

Question 14

Which infections can be teratogenic in pregnancy ? Mnemonic

How do you treat them?

Answer 14

CHRiST
CMV: most develop hearing/visual/mental impairment -> gancyclovir

HERPES ZOSTER: rare -> immunoglobulin to prevent + acyclovir for treatment

RUBELLA: only in early pregnancy, hearing/visual/mental impairment with heart disease -> TOP if < 16 weeks

SYPHILIS: miscarriage, congential disease or still birth -> Benzylpenicillin ASAP to prevent

TOXOPLASMOSIS: retardation, convulsions, visual impairment -> Spiramycin ASAP

Question 15

Most common infection -> cause of maternal death?

Answer 15

Group A strep -> sepsis

Question 16

MX of group B strep in pregnancy ?

Answer 16

Penicillin to prevent transmission to baby

Question 17

Types of miscarriage and what it means? How many threatened go on to fully miscarry ?

Answer 17

Threatened -> fetus alive + os closed

Inevitable -> os open

Incomplete -> some fetal parts passed + os open

Complete -> fetal tissue passed, bleeding stopped, uterus no longer enlarged + os closed

Septic -> contents infected

Missed -> fetus/did not develop but incidental finding (uterus small + os closed)

Question 18

What drug might you give after miscarriage and why?

Answer 18

IM ergometrine -> uterine contraction -> helps deliver placenta / prevent blood loss

Anti-D

Question 19

How many miscarriages in a row for recurrent? Most common cause? What is this disease? How is it treated?

Answer 19

3
Anti-phospholipid syndome (more common if previous VTE’s but miscarriage is often 1st presentation in women)

Autoimmune -> increased clots Eg DVT / stroke / MI

Anticoagulant Eg low dose aspirin (warfarin is risk of neonatal death / premature)

Question 20

What is an ectopic pregnancy ? RFs? Risk of recurrence?

Answer 20

Egg implants outside uterine cavity (95% Fallopian tubes)

RF - PID, prev ectopic , endometriosis, smoking, pelvic surgery, assisted conception

10-20%

Question 21

Features of acute / subacute / when else can ectopic be detected?
Mx?

Answer 21

Clinical features
Acute: shocked patient collapses with pain
Subacute: abdo pain, scanty dark PV loss with adnexal tenderness
Incidental: detected at USS

Any female of childbearing age that presents with collapse needs a pregnancy test

Management
Medical: methotrexate IF unruptured + hCG <3000
Surgical: laparoscopic salpingostomy (?recurrence) or salpingectomy

Question 22

Movements of fetus in childbirth

Answer 22

OT
Descent + flexion
Rotate to OA
Descent + extension
OT for shoulders

Question 23

How to reduce risk of PPH

Answer 23

Oxytocin in 3rd stage