Obs

Question 1

What is the most common cause of PPH

Answer 1

Uterine Atony
- failure of adequate uterine contractions

Question 2

What does intrahepatic cholestasis of pregnancy increase the risk of

Answer 2

Stillbirth

Question 3

What is indicated in terms of delivery if mother has intrahepatic cholestasis of pregnancy

Answer 3

Induction of labour at 37-38 weeks

Question 4

Management of ectopic pregnancy in the presence of foetal heartbeat

Answer 4

Salpingotomy
Involves removal of trophoblast while preserving fallopian tube

Question 5

Indications for surgical management of ectopic pregnancy

Answer 5

Gestational sac >35mm
Ruptured ectopic
Significant pain
Visible fetal heartbeat
HCG >5000

Question 6

Indications for salpingotomy over other surgical managements of ectopics

Answer 6

In women with risk factors for infertility such as tubal damage from previous PID
Previous surgery eg for endo

Question 7

Indications for continuous CTG monitoring

Answer 7

• suspected chorioamnionitis or sepsis or temp >38
• severe HTN (160/110)
• oxytocin use
• presence of significant meconium
• fresh vaginal bleeding that develops in labour

Question 8

Treatment of intrahepatic cholestasis of pregnancy

Answer 8

Ursodeoxycholic acid

Question 9

At what gestation should women with a multiple pregnancy avoid flying

Answer 9

32 weeks if pregnancy has been uncomplicated

Question 10

If a semen sample is abnormal when should it be repeated

Answer 10

3 months

Question 11

Management of hyperemesis gravidarum

Answer 11

IV 0.9% saline with potassium

Question 12

Clinical presentation of an ectopic pregnancy

Answer 12

RLQ abdominal pain
Vaginal bleeding
Pain radiates to right shoulder

Question 13

Clinical presentation of an ectopic pregnancy

Answer 13

RLQ abdominal pain
Vaginal bleeding
Pain radiates to right shoulder

Question 14

At what BP should a patient be admitted

Answer 14

> 160/110

Question 15

How many contractions is normal

Answer 15

4 or less in 10 mins

Question 16

What is uterine hyperstimulation

Answer 16

High contraction frequency and duration for greater than 20 mins

Question 17

What is the difference between gestational HTN and pre eclampsia

Answer 17

Gestational HTN occurs after 20 weeks gestational and no proteinuria is present

Pre eclampsia presents with proteinuria

Question 18

How should a woman with placental praevia be delivered

Answer 18

Emergency ceserean

Question 19

What drugs are used in a medical termination of pregnancy

Answer 19

Mifepristone and prostaglandins eg misoprostol

Question 20

What Hb level should iron supplements be given in postpartum period

Answer 20

Below 100 g/L

Question 21

What is the bacterium that causes group B strep

Answer 21

Streptococcus agalacticae
- most common cause of severe infection in neonates
- gram positive coccus

Question 22

First line surgical management for PPH

Answer 22

Intrauterine balloon tamponade

Question 23

Management of umbilical cord prolapse

Answer 23

Push the presenting part of the fetus back into the uterus to avoid compression
- this will relieve pressure and restore normal blood flow and oxygen supply

Question 24

Options for inducing labour

Answer 24

Vaginal / oral prostaglandin E1 eg misoprostol if bishop score <6
Amniotomy and IV oxytocin if bishop score >6

Question 25

What is a heterotrophic pregnancy

Answer 25

Presence of multiple gestations One in the uterine cavity and one outside of the uterus

Question 26

What is postpartum thyroiditis

Answer 26

An autoimmune condition which presents as the body transitions back from the immunosuppresed state of pregnancy to normal immunity Treat with B blockers

Question 27

Symptoms of acute fatty liver of pregnancy

Answer 27

Jaundice Mild Pyrexia Hepatitic LFTs Raised WBC Coagulopathy and steatosis on imaging

Question 28

Risk factors for pre eclampsia

Answer 28

>40 Nulliparity Pregnancy interval of >10yrs FH of pre eclampsia PMH of pre eclampsia BMI >30 HTN (or vascular disease) Pre existing renal disease Multiple pregnancy

Question 29

What is McRoberts manoeuvre

Answer 29

An intervention in shoulder dystocia Increases the mobility at the sacroiliac joints aiding rotation of the pelvis and allowing release of the fetal shoulder Get mother to lie supine with both hips fully flexed and abducted Suprapubic pressure can also be used to improve effectiveness

Question 30

Treatment for delayed placental delivery in those with placental accreta

Answer 30

Hysterectomy

Question 31

Medication that can be used to suppress lactation

Answer 31

Cabergoline - dopamine receptor agonist which inhibits prolactin production causing suppression of lactation

Question 32

Management of delivery with a low lying placenta

Answer 32

Elective c section at 37-38 weeks

Question 33

What screening results would be expected in Down’s syndrome

Answer 33

Low AFP Low oestriol High HCG Thickened nuchal translucency

Question 34

Triad of vasa Praevia

Answer 34

Rupture of membranes Painless vaginal bleeding Fetal bradycardia

Question 35

What is vasa praevia

Answer 35

Fetal blood vessels cross or run near the internal orifice of the uterus The vessels can be easily compromised when supporting membranes rupture leading to frank bleeding

Question 36

Describe the stages of labour

Answer 36

Latent 1st stage : cervix dilated 0-3cm Active 1st stage: cervix dilated 3-10cm, more regular contractions 2nd stage: culminates with expulsion of fetus 3rd stage: expulsion of placenta

Question 37

Cut off Hb levels to receive iron supplementation

Answer 37

<100: postpartum women <105: 2nd or 3rd trimester women <110: 1st trimester