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Question 1

What is maternal mortality defined as in the UK?

Answer 1

Death whilst pregnant or within 42 days of pregnancy ending from any cause related to or aggravated by the pregnancy or its management
But not from accidental or incidental causes

Question 2

Direct causes of maternal mortality

Answer 2

Cause of death is directly attributable to pregnancy

Question 3

Indirect causes of maternal mortality

Answer 3

Resulting from pre-existing disease or disease developed during the pregnancy which therefore not directly due to pregnancy but aggravated by it

Question 4

Late maternal mortality

Answer 4

From 42 days - 1 year by direct or indirect causes

Question 5

Northern Europe rate of maternal mortality

Answer 5

1 in 30,000

Question 6

Chief direct cause of maternal mortality 2006-2008

Answer 6

Genital sepsis

Question 7

Chief cause of maternal mortality overall 2006-2008

Answer 7

Cardiac disease

Question 8

What is perinatal mortality

Answer 8

Stillbirths and deaths in 1st week of life
Stillbirths only include post 24 weeks of gestation
If born with signs of life >24 weeks but then dies within 7 days

Question 9

What is a neonatal death

Answer 9

Dies up to and including 28 days after birth

Question 10

What does triad of abdominal pain, uterine rigidity and vaginal bleeding suggest?

Answer 10

Placental abruption

Question 11

Consequences of placental abruption

Answer 11

Fetal loss is high if >50% of placenta is affected - fetal anoxia

Question 12

What is placental abruption?

Answer 12

Part of the placenta becomes detached from the uterus

Question 13

Associations of placental abruption

Answer 13

Pre-eclampsia, IUGR, smoking, PROM, multiple pregnancy, polyhydramnios, older maternal age, thrombophilia, abdominal trauma, assisted reproduction, cocaine/amphetamine use, infection, non-vertex presentation

Question 14

What is the cause of tenderness in placental abruption

Answer 14

Compression of uterine muscles by the blood - may prevent good contraction during labour - therefore also PPH risk

Question 15

How does uterine torsion present?

Answer 15

Mid-late pregnancy with abdominal pain, shock, a tense uterus and urinary retention (catheterisation may show displaced urethra in twisted vagina)
Fibroids, adnexal masses or congenital asymmetrical uterine anomalies are present in 90%

Question 16

Name of normal c-section scars

Answer 16

Pfannensteil (bikini line)

Question 17

When can fetal heart be heard with doppler and pinnard?

Answer 17

Doppler from 12 weeks and pinnard from 24 weeks

Question 18

When are fetal movements first noticed by mother

Answer 18

Around 18-20 weeks

Question 19

Rate of fetal movements

Answer 19

Increase until 32weeks then plateau at about 31/hr

Question 20

When should CTG be done for reduced fetal movements

Answer 20

If less than 10 - same day CTG

Question 21

What is occiptoposterior fetal position?

Answer 21

Back (occiput) facing to the back - head and limbs forward

Question 22

What is occiptoanterior fetal position

Answer 22

Back to the front

Question 23

What is leftoccipto transverse position

Answer 23

Occiput and back on mothers left side - limbs on mothers right side

Question 24

What foods should be avoided in pregnancy due to risk of listeriosis infection?

Answer 24

Unpasteurised milk, ripened soft cheese, pate, undercooked meat

Question 25

What foods should be avoided in pregnancy due to risk of salmonella

Answer 25

Avoid raw or partially cooked eggs and meat especially poultry

Question 26

Folic acid for non-high risk women

Answer 26

400mcg until 12 weeks

Question 27

Folic acid for high risk women

Answer 27

5mg until 12 weeks

Question 28

Who are high risk women who need folic acid

Answer 28

``` Previous NTD or fhx of NTD Antiepileptics Coeliac DM Thalassaemia Obese BMI >30 ```

Question 29

Painless bleeding after 24 weeks

Answer 29

placenta praevia

Question 30

Treatment for women at high risk of developing pre-eclampsia

Answer 30

Aspirin 75mg OD from 12weeks until birth

Question 31

Which women are high risk for pre-eclampsia

Answer 31

HTN during previous pregnancies CKD SLE antiphospholipid T1 and T2DM

Question 32

4 T's causing PPH

Answer 32

Tone Tissue (retained placenta) Thrombin (coag abnormalities) Trauma

Question 33

What are indomethacin and salbutamol used for in labour

Answer 33

To suppress premature labour - tocolytics

Question 34

Management of primary herpes infection in pregnancy

Answer 34

Risk of transmission is highest within 6 weeks of delivery Elective c-section if primary infection after 28weeks oral aciclovir 400mg TDS given to treat primary infection during pregnancy IV only needed if spontaneous ROM or delivery occurs

Question 35

First line for hyperemesis gravidarum

Answer 35

promethazine

Question 36

Cervical excitation and vaginal bleeding in early pregnancy

Answer 36

Ectopic!!!

Question 37

When are pregnant women screened for anaemia

Answer 37

Booking | 28 weeks

Question 38

Highest risk factor for baby developing Group B strep growth

Answer 38

Previous baby who has grown it - causes x10 increased risk

Question 39

Management of Group B strep mothers

Answer 39

Intrapartum antibiotics

Question 40

What is syntocinon

Answer 40

Oxytocin - used to induce labour

Question 41

What is syntometrine

Answer 41

Oyxtocin + ergometrine - used to deliver placenta - shouldn't be given until baby has been delivered

Question 42

Treatment of hyperthyroidism in pregnancy

Answer 42

Propylthiouracil instead of carbimazole - less likely to cross placenta

Question 43

Most common location of ectopic pregnancy

Answer 43

Ampulla of fallopian tube

Question 44

Management of postpartum endometritis

Answer 44

Admit for IV antibiotics - clindamycin and gentamicin until afebrile for 24hrs

Question 45

When is twin-twin transfusion syndrome identified and in whom

Answer 45

Scans at 16-24 weeks and in monochorionic twins

Question 46

Main purpose of scans post-24 weeks

Answer 46

To detect fetal growth restriction

Question 47

Management of rhesus D negative pregnant women

Answer 47

Anti-D at 28 and 34 weeks

Question 48

Signs of open neural tube defect on amniocentesis

Answer 48

2.5x increase in AFP (compared to mean) | Acetylcholinesterase in amniotic fluid

Question 49

Low AFP, low oestriol and low bHCG on bloods

Answer 49

Edwards syndrome - trisomy 18