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Question 1

what is an ectopic pregnancy?

Answer 1

implantation outside uterine cavity

Question 2

what are the most common sites of ectopic?

Answer 2

ampulla and isthmus of fallopian tube

Question 3

what are the risk factors for ectopic?

Answer 3

previous ectopic
pelvic inflammatory disease (adhesions)
endometriosis (adhesions)
IVF
progesterone contraceptive
implant
IUD
pelvic surgery

Question 4

how does ectopic present?

Answer 4

pain +/- bleeding

Question 5

why is there PV bleeding in ectopic?

Answer 5

decidua breakdown following reducing HCG levels

Question 6

where does blood from a ruptured ectopic go

Answer 6

intra-abdominal

may irritate diaphragm and cause shoulder pain

Question 7

what are signs on exam of ectopic?

Answer 7

• abdo pain
• cervical excitation
• adnexal tenderness
• patient may be haemodynamically unstable - shock, pallour

Question 8

how is ectopic investigated?

Answer 8

• pregnancy test

- pelvic USS

Question 9

what is the cut off point for hcg for ectopic?

Answer 9

1500

Question 10

what is medical mgmt of ectopic?

Answer 10

im methotrexate

Question 11

what is surgical mgmt of ectopic?

Answer 11

laparoscopic salpingectomy

Question 12

what must be given to rh neg women who undergo surgical treatment of ectopic?

Answer 12

anti d

Question 13

why is there ruq pain in pre-eclampsia?

Answer 13

stretching of liver capsule due to oedema and haemorrhage

Question 14

what are the symptoms of obstetric cholestasis?

Answer 14

itching, mainly palms and soles
jaundice
NO RASH
dark urine
(itching may be worse in evening)

Question 15

how is obstetric cholestasis treated?

Answer 15

urso

Question 16

how is obstetric cholestasis managed?

Answer 16

monitor lfts weekly

induce at 37 as induced risk of stillbirth

Question 17

how do you treat profuse bleeding in miscarriage?

Answer 17

ergometrine

Question 18

how do you medically manage miscarriage?

Answer 18

misoprostol, if no bleeding after 24hrs, come again

analgesia and antiemetic

Question 19

how do you treat a miscarriage with bleeding?

Answer 19

medically with misoprostol, as there is increased risk of haemorrhage

Question 20

when would you medically treat a miscarriage?

Answer 20

bleeding
previous adverse/traumatic event
signs of infection

Question 21

what is a tender/tense uterus + bleeding a sign of?

Answer 21

placental abruption (+ back ache if posterior!)

Question 22

why is it important to check for domestic abuse in placental abruption?

Answer 22

trauma can cause placental abruption

Question 23

list some risk factors for placental abruption

Answer 23

PROM
IUGR
previous
trauma
cocaine
smoking

Question 24

how do you manage fetal distress in abruption?

Answer 24

deliver vaginally

Question 25

what are the complications of abruption for mum?

Answer 25

PPH DIC renal failure shock

Question 26

what are the complications of abruption for fetus?

Answer 26

IUGR hypoxia death

Question 27

why is placenta praevia bad?

Answer 27

can obstruct birth canal, bleeding

Question 28

what is the threshold for pcr for pre-eclampsia

Answer 28

>30

Question 29

why is aspirin given for pre-eclampsia?

Answer 29

prevent stroke

Question 30

until when should mgso4 be continued?

Answer 30

24 hrs after delivery/last seizure

Question 31

causes of APH

Answer 31

placenta praevia | placental abruption

Question 32

how does placenta praevia present?

Answer 32

painless pv bleeding

Question 33

how does abruption present?

Answer 33

painful bleeding and woody hard uterus

Question 34

what does fetal lie refer to?

Answer 34

relationship between long axis of fetus and mum

Question 35

what are the different types of fetal lie?

Answer 35

longitudinal transverse oblique

Question 36

what does fetal presentation refer to?

Answer 36

fetal part which first enters pelvis

Question 37

what are the different types of fetal presentation?

Answer 37

``` cephalic breech shoulder face brow ```

Question 38

what does fetal position refer to?

Answer 38

position of head as it exits canal

Question 39

what are different types of fetal positions?

Answer 39

occiput-anterior (IDEAL) occiput-posterior occiput-transverse 90% of babies rotate during birth.

Question 40

what are the risk factors for abnormal fetal lie/position/presentation?

Answer 40

- prematurity - multiple pregnancy - uterine abnormalities - fetal abnormalities - placenta praevia - primiparity

Question 41

how is fetal position assessed?

Answer 41

vaginal exam (fontanelles)

Question 42

how is lie and presentation assessed?

Answer 42

abdo exam

Question 43

how is fetal lie managed?

Answer 43

if >36, ECV

Question 44

when is ECV contraindicated?

Answer 44

- previous c section - recent APH - ruptured membranes - uterine abnormalities

Question 45

in which presentations are c-sections necessary?

Answer 45

shoulder brow mento-posterior

Question 46

what is cord prolapse?

Answer 46

umbilical cord descends through cervix with/before presenting part of fetus. can cause hypoxia

Question 47

why is there hypoxia in cord prolapse?

Answer 47

- compression by fetus | - arterial vasospasm bc cold

Question 48

what are the risk factors for cord prolapse?

Answer 48

``` breech (footling) unstable lie artificial rupture of membranes polyhydramnios prematurity ```

Question 49

what are the signs of cord prolapse?

Answer 49

``` fetal distress - non-reassuring trace PV bleeding (due to abruption) ```

Question 50

how is cord prolapse managed?

Answer 50

- avoid handling to prevent vasospasm - elevate presenting part - consider tocolysis with terbutaline to relieve pressure off the cord - encourage into left lateral position - deliver by quickest mode: c-section

Question 51

what does non-reassuring trace and fetal membranes suggest?

Answer 51

cord prolapse