March 2015 recall

Question 1

How long do you keep a CTG for?

Answer 1

25 years
If problems, indefinitely

Question 2

Which nerve damaged- following forceps, faecal and urinary incontinence

Answer 2

Puedendal nerve (S2-S3)

Question 3

After vaginal birth, struggling to flex hip, extend knee- which nerve damaged?

Answer 3

Femoral (L2-L4)
(this can also be damaged in an abdominal hyst due to retractor)

Question 4

After lithotomy- foot drop and sensory loss in lateral thigh, which nerve damaged?

Answer 4

Common perineal which is a branch of sciatic nerve (L4-S3)

Question 5

Which nerve is compressed if there is labial numbness?

Answer 5

Genito-femoral nerve (L1-L2)
Labial/ femoral triangle

Question 6

What is the risk of having a baby affected by congenital heart disease?

Answer 6

0.8%

Question 7

What is the risk of death for babys affected by eisenmengers syndrome?

Answer 7

25-40%

Question 8

Which heart conditions is high risk for the mother?

Answer 8

Eisenmengers
Marfans (AD)
Peripartum cardiomyopathy
Hypertrophic cardiomyopathy (AD)
Autosomal dominant conditions, 50% that baby will have it

Question 9

What is the histology behind pemphigoid gestationis?

Answer 9

Immune complex deposits, PG factor which is an IgG binds to the BP-180 in the basement membrane of the epidermis separating the layers and forming a blister.
Tx with topical steroids

Question 10

What is the risk of recurrence with OC?

Answer 10

45-90%

Question 11

How common is pemphigoid gestationis

Answer 11

1 in 50,000 pregnancies
Inc risk of SGA

Question 12

How common is PUPPS?

Answer 12

1 in 250 pregnancies

Question 13

What is the most common symptom in central venous thrombosis?

Answer 13

Headache

Question 14

What is the diameter for face presentation, vertex, deflexed OP and brow presentation?

Answer 14

vertex and face- 9.5
deflexed OP- 11
brow- 13.5

Question 15

What percentage of babies will revert to breech after ECV?

Answer 15

5%

Question 16

How best to date pregnancy using USS?

Answer 16

Use CRL up to 84mm length, ~14 weeks
>100mm can measure HC

Question 17

What is the risk of herpes going to the baby if mum had recurrent episode?

Answer 17

0-3%

Question 18

What is the risk of herpes going to the baby if mum had primary episode?

Answer 18

41%, recommend caesarean section

Question 19

When do you give MgSo4 in PTL?

Answer 19

Definitely 24- 30 weeks
Consider 30-34 weeks

Question 20

Which maternal conditions are more common in a male fetus?

Answer 20

AFLD (3:1)
OC

Question 21

What is the anti D antibody level needed for referral to a FMU?

Answer 21

> 4 for referral
(between 4 and 15, moderate risk of HDFN, >15 severe disease)

Question 22

When to refer anti C antibody level to FMU?

Answer 22

> 7.5
(between 7.5 and 20 moderate HDFN, > 20 high risk HDFN)

Question 23

Which antiepileptic drugs need monitoring in pregnancy?

Answer 23

Lamotagine

Question 24

Which emergency contraception do you use if your patient is on an enzyme inducer eg antiepileptic?

Answer 24

Lng, 3mg (levonelle, double dose)

Question 25

Survival rates for prematurity? 22, 24, 27, 31 weeks

Answer 25

22- 10% 24- 60% 27- 89%, ~10% disability 31- 95%

Question 26

How early do you start USS in MCDA twins?

Answer 26

From 16 weeks and then every 2 weeks

Question 27

Which patients with HIV would you recommend a CS to?

Answer 27

Viral load >400 Concurrent Hep C Not on ART Only taking zidovudine

Question 28

Which patients with HIV would you consider CS or vaginal birth?

Answer 28

If viral load is between 50 and 399, consider options, discuss with patient, consider length of time on ART, adherence, obstetric factors

Question 29

Which HIV ART do you need to increase your folic acid dose to 5mg?

Answer 29

Dolutegravir- they need 5mg a day when trying to conceive and for first trimester All others just need the usual 400micrograms

Question 30

For patients with HIV, if cs is being performed due to viral load and risk of vertical transmission, which gestation should this be performed?

Answer 30

38 weeks

Question 31

When is it indicated to use IV zidovudine for women with HIV?

Answer 31

Presenting in labour or planned ELCS with viral load >1000 Untreated women presenting in labour where viral load is unknown Can 'consider' if viral load between 50 and 1000