Antenatal Obstetric Complications

Question 1

Minor Complications

Answer 1

1.Backache
2.Symphsis Pubis Dysfunction
3.Carpel Tunnel Syndrome

Question 2

GIT complications

Answer 2

1.Constipation
2.Hyperemesis Gravidarum
3.Gastroesophageal Reflux
4.Haemorrhoids
5.Varicose Veins

Question 3

Antenatal Constipation

Answer 3

Increased by Iron tablets and slow gut motility

Question 4

hyperemesis gravidarum leads to….

Answer 4

1.Imbalance of fluid and electrolytes
2. Nutritional disturbances such as vitamin deficiences (may cause Wernicke’s encephalopathy)
3. Psychological and Physical Toll
4.(May cause mallory weiss tears)
5. Adverse Preg Outcomes

Question 5

Possible cause of Hyperemesis gravidarum

Answer 5

Increase in HCG, T4, Estrogen

Question 6

Treatment of Hyperemesis Gravidarum

Answer 6

Fluids, Thiamine and Antiemetic (Phenothiazine)

Question 7

Treatment of GER

Answer 7

Smoking cessation
frequent light meals
head propped up when lying down

Question 8

Drugs used for GER

Answer 8

Antacids/ Histamine 2 receptor antagonists/ Protein pump inhibitor

Question 9

Why are Haemorrhoids more common in pregnancy?

Answer 9

Increase in pressure on superior rectal veins, increase in circulating volume, increase in progesterone

Question 10

Treatment of Haemorrhoids

Answer 10

Anti irritant cream
Local Anesthetic

Question 11

If tenesmus/ bloody stool accompanies haemorrhoids, what should be done?

Answer 11

Rectal Digital Exam to check for Rectal Carcinoma

Question 12

Varicose Veins cause and treatment

Answer 12

Cause: progestrone effect on vascular smooth muscle
Rx: Support stockings + avoid standing long periods

Question 13

Common outcome of large varicose veins post delivery

Answer 13

Thrombophlebitis

Question 14

Generalized oedema is a feature of

Answer 14

Pre-eclampsia

Question 15

Leiomyomata

Answer 15

mass of smooth muscle in uterus cavity, uterine muscle or outside surface

Question 16

Large Fibroid may cause

Answer 16

Obstruction in vaginal delivery

Question 17

Complication of Fibroid may cause…

Answer 17

Red Degeneration

Question 18

Explain Red Degeneration

Answer 18

Fibroid becomes ischaemic causes pain, tenderness, vomiting.

Question 19

Severe symptoms of Red Degeneration may cause

Answer 19

Uterine Contractions leading to miscarriage or preterm labour

Question 20

Retroversion of Uterus may cause

Answer 20

Long term bladder issues due to stretch of base of bladder and urethra

Question 21

Complications of Bicornuate Uterus

Answer 21

Miscarriage
Preterm Labour
Preterm Prelabour Rupture of Membrane

Question 22

Most common types of Ovarian Cysts

Answer 22

Serous and Benign Teratomas

Question 23

Predisposing factors of UTI

Answer 23

History of recurrent cystitis
Renal Abnormalities
DM
Bladder emptying issues

Question 24

Symptoms of UTI

Answer 24

low back pain
flu-like symptoms
tachycardia
pyrexia
dehydration
(rarely, haematuria, dysuria)

Question 25

Investigations done for sus UTI

Answer 25

CBC Mid-stream specimen of urine (MSU) +10^5 to confirm

Question 26

Treatment for UTI/ sus UTI

Answer 26

Start antibiotic (Amoxicillin/ oral cephalosporin Fluids Paracetamol

Question 27

Patient has Hx of recurrent UTI

Answer 27

Test MSU @ every visit + give prophylactic

Question 28

Common causes of UTI

Answer 28

E.coli (most common) Proteus Pseudomonas Kleibsella

Question 29

Symptoms of Pyelonephritis

Answer 29

Dehydration High Temp (>38.5) Shock

Question 30

Treatment for Pyelonephritis

Answer 30

Admission IV fluids Opiate Analgesics IV antibiotic (Cephalosporin/ Gentamicin) Renal tests done Monitor baby via CTG

Question 31

Most common cause of maternal death

Answer 31

Venous Thromboembolism (VTE)

Question 32

Why is the risk of VTE higher in pregnant women

Answer 32

1. Due to occurence of hypercoagulable state in pregnancy (Increase in Factors 7,8,9,10,12 and Fibrinogen) 2. Venous Stasis due to pressure of gravid uterus on IVC

Question 33

Thrombophilia

Answer 33

Increased tendency to form blood clots

Question 34

Hereditary Thrombophilia is due to

Answer 34

Anticoagulant Defieciences Abnormal procoagulant factors Mutated prothrombin

Question 35

Acquired Thrombophilia is due to

Answer 35

Anti-phosphlipid syndrome Systemic Lupus Erythematous

Question 36

Risk factors for Thromboembolism (Pre-existing before pregnancy)

Answer 36

1. Age 2.Obesity 3. Thrombophilia 4. Prev Hx of Thromboembolism 5. Severe Varicose Veins 6. Smoking 7. Malignancy

Question 37

Pregnancy Specific Risk Factors for Thromboembolism

Answer 37

1. Multiple Pregnancy 2. Multiparous 3.Pre-eclampsia 4.Caesarean Section 5.Sepsis 6.Pelvic vein damage 7.Prolonged bed rest

Question 38

Symptoms of Deep Vain Thrombosis

Answer 38

Calf tenderness, pain Swelling (esp if unilateral)

Question 39

How to diagnose DVT

Answer 39

Compression U/S scan Venography

Question 40

Symptoms of Pulmonary Embolus

Answer 40

Breathlessness Inspiratory pain Mild Pyrexia Slight tachycardia

Question 41

What to do if Pulmonary Embolus is suspected?

Answer 41

ECG CHest Xray ABG ^ to eliminate other resp. diagnoses. if still sus, do: ventilation perfusion scan or Computed tomography pulmonary angiogram

Question 42

Treatment for Venous Thromboembolism

Answer 42

Low Molecular Weight Heparin

Question 43

Why is Warfarin rarely used as treatment for VTE

Answer 43

passes placenta can cause fetal defects and intracranial hemorrhage (can be given post-partum, safe during breastfeeding)

Question 44

Tobacco use during pregnancy can cause

Answer 44

FGR

Question 45

Alcohol Abuse causes

Answer 45

FGR Fetal Alcohol Syndrome

Question 46

Opiates (Heroin etc) abuse

Answer 46

Preterm Labour Neonatal withdrawal

Question 47

Cocaine Abuse

Answer 47

FGR Placental Abruption Preterm Labour

Question 48

Oligohydraminos is

Answer 48

reduced amount of amniotic fluid

Question 49

Maximum Vertical pool and Amniotic fluid index in Oligohydraminos

Answer 49

Maximum Vertical Pool= Less than 2cm AFI= Less than 5cm

Question 50

Oligohydraminos in abdomen exam appearance

Answer 50

Fetal poles very obvious and hard Small for date uterus

Question 51

Oligohydraminos is caused by

Answer 51

FGR Cystic Kidney Renal Agenisis

Question 52

Polyhydraminos is

Answer 52

Increase in Amniotic Fluid

Question 53

MVP and AFI in Polyhydraminos

Answer 53

MVP= +8cm AFI= +25cm

Question 54

Causes of Polyhydraminos

Answer 54

Maternal: 1. DM Placental: 1.Chorioanginoma, 2.Arterio-venus fistula Fetal: 1.Multi preg, 2.Eso/Dud Atresia 3.Anencephaly 4.Neuromuscular condition