monday 9th

Question 1

When is anti D given?

Answer 1

28 and 34 weeks

Question 2

When is an USS done in placenta praevia?

Answer 2

32 weeks

Question 3

what are 4 things looked at on CTG?

Answer 3

baseline rate (110-160 is reassuring)
variaibility (5-25 is reassuring)
accelerations (good)
descelerations (prolonged are bad)

Question 4

what are the movements of the fetus in labour

Answer 4

descent
engagement
neck flexion
internal rotation
crowning
extension of the presenting part
restitution
external rotation
lateral flexion

Question 5

what are the two stages of the first stage of labour?

Answer 5

latent (0-3cm)
active (3-10cm)

Question 6

how is active management of the third stage managed?

Answer 6

IM oxytocin and controlled cord traction- when the placenta is detached there will be lengthening of the umbilical cord, explusion of blood and ascension of the uterus in the abdomen

Question 7

what are 2 definite indications for active management of the third stage?

Answer 7

haemorrhage or passive management taking over 60 minutes

Question 8

what are the 5 things considered in bishops scoring and what score indicates induction is needed

Answer 8

cervical effacement
cervical consistency
cervical position
cervical dilation
fetal station

Question 9

what antibiotics will be given for asymptomatic bacteriuria in the first trimester and in the third trimester

Answer 9

first- nitrofuratoin
third- amoxicilin

Question 10

what test for syphilis is done at booking appointment

Answer 10

VDRL test

Question 11

what three things will be assessed in determining the risk of premature birth?

Answer 11

• part history of premature birth
• cervical length on transvaginal USS (if less than 25mm it is likely)
• fetal fibronectin (if <50 then unlikely

Question 12

what two things can be done to prevent premature birth and why would one be chosen?

Answer 12

• vaginal progesterones
• cervical clerclage

Cervical clerclage will be done if previous premature labour, or if cervical trauma such as cone biopsy

Question 13

when should someone with gestational diabetes be delivered?

Answer 13

38 weeks

Question 14

when should someone with obstetric cholestasis be delivered?

Answer 14

37 weeks

Question 15

what are some indications for induction of labour

Answer 15

post maturity
decreased fetal movements
conditions such as gestational diabetes (38) and obstetric cholestasis (37 weeks)
pre-eclampsia
fetal death
PPROM

Question 16

What bishops score needs induction of labour ?

Answer 16

5 or below

Question 17

what are 4 methods that will be used in induction of labour

Answer 17

Membrane sweep
Vaginal prostoglandins E2
Balloon catheter
Amniotomy and IM syntocinon

Question 18

what is the main complication of induction of labour and what would it be characterised?

Answer 18

uterine hyperstimulation (indicated by >5 contractions in 10 mins)

Question 19

what defines miscarriage, what is early and what is late?

Answer 19

spontaneous termination of a pregnancy before 24 weeks
early = <12 weeks
late= 12-24 weeks

Question 20

before what gestation can medical management of a miscarraige be used?

Answer 20

before 13 weeks

Question 21

what defines recurrent miscarriages ?

Answer 21

3+ miscarriages

Question 22

what are the main causes of recurrent miscarriage

Answer 22

anti-phospholipid syndrome
endocrine - poorly controlled diabetes
smoking
uterine abnormality

Question 23

what may be given to those with recurrent miscarraiges ?

Answer 23

low molecular weight heparin and aspirin

Question 24

what sign may be seen on transvaginal USS of ectopic

Answer 24

blob sign

Question 25

criteria for expectant management of a ectopic?

Answer 25

<35mm, no heartbeat, asymptomatic, hCG < 1000, not ruptures

Question 26

criteria for medical management of an ectopic?

Answer 26

<35mm, no heartbeat, asymptomatic/no significant pain, hCG <1500, not ruptures

Question 27

when should surgical management of an ectopic be used?

Answer 27

>35mm, heartbeat visible, ruptures, symptomatic, hCG>5000

Question 28

what are some risk factors for molar pregnancy?

Answer 28

extremes of maternal age, multiple pregnancy, oral contraceptive, previous

Question 29

how is molar pregnancy treated?

Answer 29

surgical evacuation

Question 30

what two different surgical options are there for termination of a pregnancy and when can each be done?

Answer 30

cervical dilation and suction-> before 14 weeks cervical dilation and forceps removal-> before 24 weeks

Question 31

when should anti-D be given in termpination of a pregnancy?

Answer 31

if the mother is rhesus negative and it was terminated after 10 weeks

Question 32

what is antepartum haemorrhage?

Answer 32

vaginal bleeding after 24 weeks gestation

Question 33

what are some causes of painless vaginal bleeding in pregnancy?

Answer 33

placenta praevia vasa praevia

Question 34

what are some causes of painful vaginal bleeding in pregnancy ?

Answer 34

placental abruption placental accreta/percreta uterine rupture

Question 35

what are the different classifications of antepartum haemorrahge

Answer 35

spotting minor- <50ml major- 50 to 1000ml massive >1000ml or signs of shock

Question 36

when should USS be done done for placenta praevia?

Answer 36

at 32 weeks then again at 36 weeks

Question 37

what are some RF of placenta praevia?

Answer 37

previous placenta praevia previous caesarean increased maternal age smoking structural uterine abnormalities IVF

Question 38

RF of placental abruption

Answer 38

pre-eclampsia smoking polyhydramnios abnormal fetal lie increasing maternal age maternal trauma multiple pregnancy multigravity

Question 39

who is given intrapartum ABx during labour

Answer 39

any woman in preterm labour women who are GBS positive women with a previous baby with early or late onset GBS disease women with pyrexia during delivery

Question 40

what antibiotic is given for intrapartum Abx

Answer 40

benzylpenicillin

Question 41

when is low molecular weight heparin given for VTE prophylaxis in pregnancy

Answer 41

from 28 weeks if 3 RF from 12 weeks if 4+ RF

Question 42

RF for VTE in pregnancy

Answer 42

smoking parity over 3 BMI>30 age >35 reduced mobility family history of DVT multiple pregnancy pre-eclampsia varicose veins immobility IVF thrombophilia