Obs VIVAs

Question 1

obstetric cholestasis vs acute fatty liver of pregnancy

Answer 1

OC: itching + jaundice

AFLP: n&v, abdo pain, jaundice, fever
transaminitis + steatosis

Question 2

normal physiological skin changes in pregnancy

Answer 2

linea nigra
striae gravidarum
striae albicans

Question 3

cause of itching in obstetric cholestasis

Answer 3

bile acids in skin

Question 3

lack of bile affects absorption of which vitamins

Answer 3

fat soluble: A, D, E, K

Question 4

types of breech presentation

Answer 4

frank
flexed
footling

Question 5

RFs for breech presentation

Answer 5

maternal:
multiparity
fibroids
previous Hx
placenta praevia

foetal:
preterm
oligohydramnios
macrosomia
multiple pregnancy

Question 6

CIs for ECV

Answer 6

abnormal CTG
ROM
multiple pregnancy

Question 7

neonatal resp phenomenon associated w. CS delivery

Answer 7

TTN

Question 8

sensitising events which require anti-D prophylaxis

Answer 8

ECV
surgical management of miscarriage/ectopic
abdo trauma
amniocentesis/CVS
antepartum haemorrhage

Question 9

pathophysiology of gestational diabetes

Answer 9

placenta produced progesterone, hCG, cortisol, cytokines = anti-insulin effect
increased insulin resistance

Question 10

why do neonates of mothers with GDM develop hypoglycaemia

Answer 10

maternal glucose crosses placenta but not insulin
foetus produces high levels of insulin

Question 11

RFs for GDM

Answer 11

BMI > 30
macrosomia
FH of diabetes
ethnicity

Question 12

target level of plasma glucose in GDM

Answer 12

fasting <5.3
2hr <6.4

Question 13

what to arrange at first antenatal visit if pre-existing diabetes

Answer 13

digital retinal assessment
renal function
HbA1c

Question 14

risks of GDM

Answer 14

maternal:
trauma
T2DM
pre-eclampsia

foetal:
macrosomia
polyhydramnios
neonatal hypoglycaemia

Question 15

how often to monitor HIV viral load in pregnancy

Answer 15

2 weekly

Question 16

how to reduce risk of HIV transmission to baby

Answer 16

aim viral load <50
ART at birth and for 2-4 weeks
no breastfeeding

Question 17

if HIV positive, screen for what other infections

Answer 17

hep B/C

Question 18

triad of hyperemesis gravidarum

Answer 18

> 5% pre-pregnancy weight loss
electrolyte imbalance
dehydration

Question 19

SEs of antiemetics

Answer 19

cyclizine - anticholinergic
promethazine - sedation

Question 20

when does normal morning sickness resolve

Answer 20

~14 weeks

Question 21

RFs for hyperemesis

Answer 21

molar pregnancy
multiple pregnancy
previous Hx
FHx

Question 22

complications of hyperemesis

Answer 22

maternal:
mallory-weirs tears
muscle wasting
malnutrition

foetal:
LBW
miscarriage/stillbirth

Question 23

causes of symmetric IUGR

Answer 23

early pregnancy

chromosomal abnormalities
anaemia
pre-existing medical conditions

Question 24

causes of asymmetric IUGR

Answer 24

late pregnancy smoking alcohol placental insufficiency pre-eclampsia abruption

Question 25

complications of IUGR

Answer 25

short term: resp distress hypoglycaemia jaundice long term: CP diabetes chronic hypertension

Question 26

how to date pregnancy in 1st and 2nd trimester

Answer 26

10-14 weeks: CRL 14-20 weeks: EFW/head circumference

Question 27

how is IOL performed

Answer 27

membrane sweep vaginal prostaglandin ARM

Question 28

what is a concerning finding on doppler ultrasound of umbilical artery

Answer 28

absence/reversal of end-diastolic flow

Question 29

define stages of labour

Answer 29

1: passive (0-3/4cm dilation) active (3/4-10cm dilation) 2: delivery of baby 3: delivery of placenta and membranes

Question 30

causes of prolonged labour

Answer 30

malposition epidural obstructed labour

Question 31

rate of dilation during 1st stage of labour

Answer 31

0.5cm/hour

Question 32

how often to perform vaginal examinations during labour

Answer 32

every 4 hours

Question 33

antepartum haemorrhage vs threatened miscarriage

Answer 33

threatened miscarriage <20 weeks antepartum haemorrhage >20 weeks

Question 34

causes of antepartum haemorrhage

Answer 34

placental abruption placental accreta placenta praevia vasa praevia trauma bloody show cervical ectropion

Question 35

RFs for placental abruption

Answer 35

previous Hx CS pre-eclampsia smoking cocaine

Question 36

how to prevent PPROM in high risk women

Answer 36

prophylactic vaginal progesterone cervical cerclage

Question 37

what tests for suspected PPROM

Answer 37

IGF binding protein-1 test alpha-microglobulin-1 test

Question 38

common causative organisms of chorioamnionitis

Answer 38

GBS E coli

Question 39

define pre-eclampsia

Answer 39

hypertension after 20 weeks + significant proteinuria

Question 40

pathophysiology of pre-eclampsia

Answer 40

hypertension -> spiral artery remodelling -> poor placental perfusion -> less nutrients delivered to foetus

Question 41

complications of pre-eclampsia

Answer 41

eclampsia stroke HELLP

Question 42

what is eclampsia

Answer 42

seizures in patient w. pre-eclampsia

Question 43

risks of pre-eclampsia to baby

Answer 43

IUGR/LBW preterm stillbirth

Question 44

RFs for pre-eclampsia

Answer 44

previous Hx FHx obesity hypertension primip

Question 45

physiological changes to BP in pregnancy

Answer 45

falls in 2nd trimester, normalises by term

Question 46

risks of twin pregnancies

Answer 46

maternal: miscarriage/stillbirth pre-eclampsia placenta praaevia anaemia foetal: IUGR TTTS congenital abnormalities polyhydramnios

Question 47

ultrasound finding suggestive of MCDA pregnancy

Answer 47

lamda sign

Question 48

when to deliver MCDA pregnancy

Answer 48

32-34 ELCS

Question 49

RFs for twin pregnancy

Answer 49

AMA IVF ART

Question 50

conceptus splitting and consequences for pregnancy

Answer 50

0-4 days: DCDA 4-8 days: MCDA 8-12 days: MCMA >13 days: conjoined MCMA

Question 51

indications for EMCS

Answer 51

failure to progress foetal compromise cord prolapse placental abruption

Question 52

categories of CS

Answer 52

1: immediate threat to life of mother/foetus 2: no immediate threat to life 3: early delivery required 4: elective

Question 53

incision names for CS

Answer 53

pfannenstiel (pubic hairline) Joel-Cohen (MC)

Question 54

percentage of successful VBAC after 1 CS

Answer 54

70%

Question 55

layers of CS

Answer 55

skin fat anterior rectus sheath rectus muscles parietal peritoneum visceral peritoneum uterine muscle

Question 56

complications of CS

Answer 56

acute: infection bleeding longer recovery scars long term: uterine prolapse placenta praevia placenta accreta