Obs And Gynae

Question 1

Name 2 causes of abdominal pain in early pregnancy

Answer 1

Ectopic pregnancy
Miscarriage

Question 2

When do symptoms of ectopic pregnancy typically occur?

Answer 2

6-8 weeks
- many may not know they are pregnant

Question 3

What are the symptoms of ectopic pregnancy?

Answer 3

Lower abdo pain and then vaginal bleeding
May also have shoulder pain (when voiding/defecating) due to peritoneal bleeding

Question 4

What are the characteristics of ectopic pregnancy pain?

Answer 4

Constant and often unilateral

Question 5

What are the 5 types of miscarriage?

Answer 5

Threatened
Missed
Inevitable
Incomplete
Complete

Question 6

Describe threatened miscarriage

Answer 6

Painless vaginal bleeding before 24weeks with closed os - still viable

Question 7

Describe missed miscarriage

Answer 7

Gestational sac with dead fetus before 20w without pain or bleeding, picked up on US

Question 8

Describe inevitable miscarriage

Answer 8

Heavy bleeding with clots and pain, os open, products still in uterus

Question 9

Describe incomplete miscarriage

Answer 9

Not all products of conception are expelled

Question 10

Name 5 causes of abdominal pain in late pregnancy

Answer 10

Labour
Placental abruption
Symphysis pubis dysfunction
Pre-eclampsia/ HELLP
Uterine rupture

Question 11

Define placental abruption

Answer 11

Separation of placenta from uterine wall (decidua) and haemorrhage into space

Question 12

Define complete miscarriage

Answer 12

All products of conception have passed and bleeding has stopped

Question 13

What are 2 non-obstetric related causes of pain during pregnancy?

Answer 13

Appendicitis
UTI

Question 14

What are the 4 legal grounds for abortion?

Answer 14

Before 24w if poses issue to woman
Prevents injury to physical or mental health
Risks the life of the mother
Risk of physical/mental disability to child

Question 15

What is the gestational limit for a medical abortion?

Answer 15

23 weeks + 6

Question 16

How is a medical abortion carried out at <10 weeks?

Answer 16

1. Single dose mifepristone
2. PO/PV misoprostol 48 hours later

Question 17

How is a medical abortion carried out between 10-24 weeks?

Answer 17

1. Single dose mifepristone
2. Serial misoprostol every 3 hours

Question 18

How is a surgical abortion carried out up to 14 weeks?

Answer 18

Cervical priming with mifepristone or misoprostol then vacuum aspiration

Question 19

What analgesics can be used post medical abortion?

Answer 19

NSAIDs/opiates

Question 20

How is a surgical abortion carried out between 14-24 weeks?

Answer 20

Cervical priming with mifepristone and misoprostol or osmotic dilator then dilation and evacuation

Question 21

What antibiotics are given alongside a surgical abortion?

Answer 21

Oral doxycycline

Question 22

What analgesics are given for a surgical abortion?

Answer 22

NSAIDs, local anaesthetic or conscious sedation

Question 23

What is acute fatty liver of pregnancy?

Answer 23

Rare liver disease in pregnancy that can cause hepatic failure

Question 24

What genetic mutation is commonly associated with acute fatty liver of pregnancy?

Answer 24

Fetal homozygous LCHAD

Question 25

How does the LCHAD mutation lead to acute fatty liver of pregnancy?

Answer 25

Accumulation of fatty acid metabolites in the placenta are shunted into maternal circulation and accumulate in the mother’s liver

Question 26

What are the symptoms of acute fatty liver of pregnancy?

Answer 26

N+V, headache, anorexia, abdo pain -> liver failure

Question 27

What blood results are indicative of acute fatty liver of pregnancy?

Answer 27

Raised liver enzymes (AST, ALT, bilirubin) Leukocytosis and normocytic normochromic anaemia

Question 28

How is acute fatty liver of pregnancy managed?

Answer 28

Delivery of fetus and prior maternal stabilisation

Question 29

Define adenomyosis

Answer 29

Presence of endometrial tissue within the myometrium