Maternal Medicine

Question 1

How soon should methyldopa be stopped postpartum

Answer 1

2 days

Question 2

What treatment reduces pruritis in OC

Answer 2

Ursodeoxychic acid

Chlorpheniramine provides sedation at night but has no significant impact on pruritis

Question 3

At what viral load should a LSCS be considered if on HAART treatment

Answer 3

50-400

Question 4

At what viral load should a LSCS be recommended if on HAART treatment

Answer 4

> 400

ELCS recommended at 38-39 weeks

Question 5

In the U.K. What is the rate of HIV transmission if the mother is on HAART

Answer 5

0.7%

Question 6

Regarding women on ART for HIV at what gestation should a decision on delivery be made

Answer 6

36 weeks

Question 7

In HIV positive women not requiring treatment for themselves, when should cART be commenced

Answer 7

By 24/40

At 13/40 if baseline viral load >30,000

Question 8

In HIV positive women not requiring treatment for themselves, when should zidovudine be commenced

Answer 8

Only if opting for ELCS between 38-39 weeks and baseline viral load <10,000

IV zidovudine to be given at delivery

Stop all medication after delivery

Question 9

What is the management for HIV positive women with PPROM <34 weeks

Answer 9

If no chorioamnionitis

Steroids
Erythromycin
MDT discussion regarding delivery

Question 10

incidence of idiopathic intracranial hypertension in women of childbearing age

Answer 10

0.9/100,000

Obese 19.3/100,000

Question 11

Regarding asthma, what is recommended for maintaining control in labour

Answer 11

Systemic steroids

100mg hydrocortisone 6-8hourly during labour

Question 12

What percentage of sickle patients have a painful crises in pregnancy

Answer 12

27-50%

Question 13

What percentage of women have overt hypothyroidism in pregnancy

Answer 13

0.5%

Question 14

What percentage of women have subclinical hypothyroidism in pregnancy

Answer 14

2.5%

Question 15

A women with hypothyroidism is taking 75mcg at booking, what would you advise

Answer 15

Increase to 100mcg (increase by 25mcg)

Repeat LFT 4-6 weekly to maintain TSH <2.5

Question 16

What medication should be avoided in the acute phase post MI

Answer 16

Nifedipine

Question 17

What is the traid of wernickes

A deficiency of what causes it

Answer 17

Ophthalmoplegia, ataxia and confusion

Vitamin B1 - thiamine

Question 18

What % of women are affected by hyperemesis gravidarum

Answer 18

<1%

Question 19

What percentage of pregnancies are effected by round ligament pain

Answer 19

10-30%

Question 20

How common is pyelonephritis in pregnancy

Answer 20

10-25 in 1000 pregnancies

Question 21

How common is acute appendicitis in pregnancy

Answer 21

1:800-1500

Question 22

What % of pregnant women are affected by OC

Answer 22

0.7%

Question 23

What is the recurrence risk for OC

Answer 23

> 90%

Question 24

What is the rate of fetal mortality within OC

Answer 24

1-4%

But now comparative to normal population due to treatment and delivery at 38 weeks

Question 25

What % of PET are affected by HELLP syndrome

Answer 25

5-20%

Question 26

What is the maternal mortality associated with HELLP

Answer 26

1%

Question 27

Regarding acute fatty liver of pregnancy What deficiency should be screened for in the baby What is the most common mutation

Answer 27

LCHAD deficiency | The most common mutation is E474Q

Question 28

Regarding acute fatty liver of pregnancy

Answer 28

25%

Question 29

What is the risk of VTE in pregnancy with antithrombin deficiency

Answer 29

30%

Question 30

What management should be given a woman IS HIV + untreated and arrives in labour

Answer 30

Nevirapine IV zidovudine Start triple ART

Question 31

What screening should be offered if a HIV woman presents >13+6 What would you warn her

Answer 31

Quad test However increased risk of false positives due to higher hcg and aFP in HIV + population

Question 32

Regarding HIV positive patients When should IV zidovudine be given

Answer 32

In labour with unknown viral load, viral load >1000 Prom with unknown viral load or viral load >1000 Viral load >1000 or zidovudine monotherapy admitted for ELCS

Question 33

What is the risk of HIV vertical transmission in utero if not on ARVs

Answer 33

25-30%

Question 34

What is the risk of HIV vertical transmission during breast feeding if not on ARVs

Answer 34

50-60%

Question 35

What are the cut off values for OGTT | Fasting and 2hr

Answer 35

>5.6 fasting | >7.8 2 hour

Question 36

What is the fetal radiation exposure from a cxr

Answer 36

0.01msu

Question 37

What is the fetal radiation exposure from a CTPa

Answer 37

0.1 mGy

Question 38

What is the fetal radiation exposure from a V/Q scan

Answer 38

0.5mGy

Question 39

By how much is the risk of childhood cancer increased by for fetal exposure to 1 mGy

Answer 39

0.006% Or 1:17,000

Question 40

What finding on echo indicates increased risk of pulmonary HTN

Answer 40

Tricuspid regurg jet velocity >2.5m/sec

Question 41

Women with pre existing diabetes should be advised against conception if their hba1c is over what level

Answer 41

10% 86mmol/mol

Question 42

What % of women will need metformin or insulin after a diagnosis of GDM

Answer 42

15-20% Usually initiated if failure to meet by targets over 1-2 weeks

Question 43

What BM thresholds should prompt initiation of sliding scale in labour How often should bms be checked

Answer 43

4-7 mmol/L Hourly

Question 44

At what gestation should trab Ab be checked

Answer 44

20-24 weeks

Question 45

How long after radioidine therapy should a woman wait to conceive

Answer 45

4 months

Question 46

BM target ranges in pregnancy Fasting 1hr post 2hr post

Answer 46

Fasting 5.3 1hr post 7.8 2hr post 6.4

Question 47

When should women with GDM be started on insulin +/- metformin immediately, without a trial of diet and exercise

Answer 47

fasting BM >7 Fasting 6-6.9 if macrosomia or polyhydramnios

Question 48

What is the fetal radiation exposure from a CT head

Answer 48

<0.005mGy