Obstetrics

Question 1

First line antibiotics for pre-term prelabour rupture of membranes with prescription details

Answer 1

Erythromycin - 250mg QDS for up to 10/7 or established labour

Question 2

Choice of antibiotic for T1 UTI (and 2 alternatives)

Answer 2

Nitrofurantoin - 100mg MR BD 7/7
Amoxicillin - 500mg TDS 7/7
Cefalexin - 500mg BD 7/7

Question 3

Choice of antibiotic for T3 UTI

Answer 3

Trimethoprim - 200mg BD

Question 4

Antibiotics to avoid in pregnancy

Answer 4

All -
Sulfonamides (sulfamethoxazole)
Quinolones (-floxacin)
Tetracyclines (doxycycline) - stain teeth/discoloured
T1 - avoid trimethoprim (folate issues)
T3 - avoid nitrofurantoin (neonatal jaundice)

Question 5

Two treatment options for IDA in pregancy

Answer 5

1) Oral ferrous sulphate 200mg PO B/QDS for 3/12

2) IV Ferrinject (Ferric Carboxymaltose) 20mg/kg IVI

Question 6

First Line medication for (hospitalised) hyperemesis gravidarum
Name
Mechanism
Dose
Side effects
C/I

Answer 6

Metoclopramide
Dopamine Antagonist/Pro-kinetic
5-10mg TDS max 5/7
Fatigue, diarrhoea, depression, EPSE
Obstruction, prolactin-dependent tumour, Parkinson's

Question 7

Alternatives to metoclopramide for hyperemesis gravidarum

Answer 7

Domperidone (D2 antagonist)
Chlorpromazine - dopamine antagonist
Prochlorperazine - D2 antagonist
Promethazine - H1 antagonist

Question 8

Treatment of pre-term hypertension (3 options, dose, mechanism)

Answer 8

1. Methyldopa - 250mg BD (max 2000mg/day)
   Alpha2 adrenergic inhibition
2. Labetalol - 100mg BD (max 2400mg/day)
   Combined alpha-beta-blocker
3. Nifedipine - 30-60mg XL OD (max 90-120mg/day)
   Peripheral vasodilatation via CCB

Avoid labetalol/CCBs in heart block, cardiogenic shock, hypotension, bradycardia, asthma/COPD

Question 9

Antenatal Corticosteroids
Indications
Choice (pre/post 34/40)
Doses

Answer 9

Preterm premature rupture of membranes
Dex if 24-34/40 - 6mg IM 12hrly, 4 doses

Betamethasone if >34/40 - 12mg IM, 24hrly, 2 doses

Question 10

Active management of S3 labour

Indication

C/Is

S/Es

Answer 10

Syntometrine (Ergometrine 500mcg, Oxytocin 10IU, IM)

Prevention of PPH following delivery of placenta by IM injection on delivery of ant shoulder or after birth

Ergometrine C/I in hypertension

S/E - vomiting, nausea

Question 11

Additional subtance to Syntometrine given in PPH
Class
Mechanism
C/I
Cautions

Answer 11

Carboprost (haemabate) - 250mcg IM, interval up to 15min max 2mg
Prostaglandin F2-alpha
Uterine stimulant contracts uterus
Acute PID, cardiac/pulmonary disease, pregnancy
Potentiates other oxytocics

Question 12

Induction of labour: Adjunct

Answer 12

Membrane sweep

Question 13

Induction of labour: Pharmacological

Answer 13

Vaginal PGE2
Tablet/gel at 0 and 6 hours (if not established)
PV pessary at 0 hours

Continuous CTG assessment once labour established
Risk of rupture

Question 14

Anti-D RH0 Immunoglobulin (IgG)

Indication

Route

Answer 14

Prevention of sensitisation:

1. Following birth (500U)
2. <20 weeks with sensitisation event (250U)
3. > 20 weeks with sensitisation event (500U)
4. Antenatal Prophylaxis (28 and 34/40, 500U)

By deep IM injection