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Question 1

RFs for pre-eclampsia

Answer 1

maternal age
high bmi
nulliparous
multiple pregnancy
family history
10 year interval
chronic HTN
CKD
diabetes mellitus
AI disease - antiphospholipid syndrome

Question 2

what is the criteria for diagnosing pre-eclampsia

Answer 2

> 20 weeks
htn
significant proteinuria (sometimes oedema)

Question 3

what are the investigations for pre-eclampsia

Answer 3

blood pressure
protein creatinine ratio
urine dipstick

Question 4

what medication for pre-eclampsia

Answer 4

first line labetolol - not in asthmatics
nifedipine
hydralazine
methyldopa

mag sulf as prophylaxis against seizures

Question 5

what is the prevention medication for pre-eclampsia

Answer 5

75mg aspirin

• PMH of pre-eclampsia
• gestational HTN
• diabetes
• CKD
• SLE/APS

or multiple moderate risk factors

Question 6

what is the treatment for pre-eclampsia

Answer 6

induction of vaginal delivery at 37 weeks, steroids to mature fetal lungs

Question 7

what is HELLP syndrome?

Answer 7

haemolysis
elevated liver enzymes
low platelets

Question 8

what are the symptoms of hellp?

Answer 8

RUQ pain, malaise

Question 9

what are the foetal complications of pre-eclampsia

Answer 9

IUGR
Prematurity
placental abruption

Question 10

why are ACEi contraindicated in preeclampsia

Answer 10

teratogenic

Question 11

what are risk factors for gestational diabetes?

Answer 11

MACROS
Medical/Fam hx of gdm, macrosomia, t2dm
Age >40
Cystic (PCOS)
Race: non-white
Obese
Smoking

Question 12

how is gestational diabetes investigated?

Answer 12

OGTT after overnight fast, if greater than or equal to >5.6, then gdm

Question 13

how is gdm managed?

Answer 13

diet and exercise, metformin. glibenclamide, insulin

Question 14

what is the second line management of gdm?

Answer 14

glibenclamide

Question 15

when must you do growth scans in gdm/

Answer 15

from 28 weeks

Question 16

when should you deliver in gdm?

Answer 16

offer from 37

Question 17

why should you give steroids in baby with macrosomia?

Answer 17

often require c-section early, so mature foetal lungs

Question 18

what are the complications of gdm for mum

Answer 18

htn and pre-eclampsia, inc risk pph

need for c section, instruments, tears

Question 19

how does gdm affect risk of pph?

Answer 19

increases risk of pph

Question 20

what are the risks to foetus from gdm?

Answer 20

Macrosomia
shoulder dystocia
neonatal hypoglycaemia
neonatal jaundice

Question 21

what is placenta praevia?

Answer 21

placenta attached to lower uterine wall

Question 22

why is placenta praevia bad?

Answer 22

placenta at risk of shearing off and bleeding

Question 23

how does placenta praevia present?

Answer 23

painless bright red PV bleeding, may be post coital
CAN be painful

fetal lie/presentation abnormal. rarely fetal distress

Question 24

what is the main risk factor for placenta praevia?

Answer 24

previous c section

Question 25

what can provoke bleeding in placenta praevia?

Answer 25

vaginal exam/coitus

Question 26

when might placenta praevia be picked up?

Answer 26

20 week USS

Question 27

how do you prevent aph in placenta praevia

Answer 27

c-section from 37 is best

Question 28

how would you manage placenta praevia bleeding

Answer 28

abcde transfusions, catheter Anti-D if rhesus negative!! if not stabilised, deliver baby

Question 29

what is placenta accreta?

Answer 29

placenta invades superficial myometrium

Question 30

what is placenta increta?

Answer 30

placenta invades deeper myometrium

Question 31

what is placenta percreta?

Answer 31

placenta invades into nearby organs such as bladder

Question 32

why is placenta accreta/increta/percreta bad?

Answer 32

can cause major aph/pph. deliver baby early by c section. hysterectomy may be required

Question 33

how is placenta accreta diagnosed?

Answer 33

uss

Question 34

risk factors for placenta accreta?

Answer 34

inc age of mum previous c section placenta praevia ivf

Question 35

what is placental abruption

Answer 35

premature placental separation from uterine wall

Question 36

what is the main risk associated with placental abruption

Answer 36

aph

Question 37

what are the risk factors for placental abruption?

Answer 37

- previous placental abruption - pre-eclampsia, htn - abnormal lie of baby - polyhydramnios - trauma - COCAINE - multiple pregnancy - underlying thrombophilias

Question 38

how does abruption present?

Answer 38

painful bleeding (can be minimal/dark red) as often concealed woody/hard uterus uterine contractions rarely, shock, and low back pain

Question 39

how does abruption present in fetus?

Answer 39

fetal distress, absent HR

Question 40

how is placental abruption diagnosed?

Answer 40

clinical, but USS might show haematoma | CTG

Question 41

what is miscarriage

Answer 41

loss of preg before 24 weeks

Question 42

what is threatened miscarriage?

Answer 42

bleeding but closed os

Question 43

what is inevitable miscarriage

Answer 43

heavy bleeding, clots, pain and the cervical os is open.

Question 44

what is complete miscarriage?

Answer 44

all products of conception leave the body

Question 45

what is incomplete miscarriage?

Answer 45

retention of some products of conception in the body

Question 46

what is a missed miscarriage?

Answer 46

fetus dies, is retained, asymptomatic (no fetal HR)

Question 47

what are the symptoms of miscarriage?

Answer 47

pv bleeding (heavier than period usually), lower back pain/suprapubic pain

Question 48

what is recurrent miscarriage?

Answer 48

>3 consecutive miscarriages

Question 49

give 5 potential causes of miscarriage?

Answer 49

1. abnormal foetal development 2. uterine abnormality 3. incompetent cervix 4. placental failure 5. multiple pregnancy

Question 50

what might speculum exam of miscarriage show?

Answer 50

- open os - pregnancy tissue/cause of bleed - Small for Gestational Age fetus

Question 51

what are the risk factors for miscarriage?

Answer 51

SAD BURTH SLE Age Diabetes BV Uterine/ceRvical abnormality Thrombophilia (inc APL syndrome)

Question 52

what would serum bHCG show for miscarriage

Answer 52

serial bhcg levels would show a falling level

Question 53

which investigation would confirm miscarriage?

Answer 53

Transvag uss, abdo uss less sensitive

Question 54

how do you manage a threatened miscarriage?

Answer 54

if threatened, conservative and pregnancy test 3 weeks later. offer medical/surgical treatment if unsuccessful

Question 55

how do you surgically manage an inevitable, incomplete, missed?

Answer 55

- vacuum aspiration local anaesthetic - curettage under general anaesthetic - anti D if rh neg - counselling

Question 56

what is medical management of miscarriage?

Answer 56

remove any visual tissue misoprostol PV or PO may be bleeding for 3 weeks afterwards analgesia

Question 57

how does misoprostol work in miscarriage?

Answer 57

stimulates ripening of cervix and myometrial contractions