Obstetric Conditions

Question 1

What is the definition of a fetus that is large for dates?

Answer 1

Fetus >2 sizes for the week they are at. E.g Size 35wks at 32wks.

Question 2

What are the diagnostic parameters of fetal macrosomia

Answer 2

Estimated fetal weight >90th centile
or
Abdominal circumference>97th centile

Question 3

At what week gestation will fetal macrosomia most accurately be picked up?

Answer 3

Less than 38wks

Question 4

What is polydramnios?

Answer 4

Where there is excessive fluid in the amniotic sac >25cm

Question 5

What are the diagnostic parameters for gestational diabetes in pregnancy on an oral glucose tolerance test?

Answer 5

Oral glucose tolerance test

Fasting >5.1mmol/l
2hrs later >8.5mmol/l

Question 6

What HBA1c target should people be aiming for in pregnancy?

Answer 6

48mmol/l

Question 7

What are some of the complications of poorly controlled diabetes

Answer 7

Miscarriage
Intrauterine death
Worsesning diabetes complications (neuropathy retinopathy)
Premature
Pre-eclampsia, polyhydramnios, macrosomia, shoulder dystocia

Question 8

You ultrasound a lady whose pregnant at 20wks. And see the lambda sign of the amniotic sacs. What type of twins is she having?

Answer 8

Dichorionic diamniotic (DCDA)

Two placentas and two sacs

Question 9

You ultrasound a lady whose pregnant at 20wks. And see the T- sign of the amniotic sacs. What type of twins is she having?

Answer 9

Monochorionic diamniotic
(MCDA)

One placenta and two sacs

Question 10

If a lady is having monochorionic twins how often should she get clinic appointments?

Answer 10

Monochorionic every two weeks

Question 11

If a lady is having dichorionic twins how often should she get clinic appointments?

Answer 11

Every 4 weeks

Question 12

When should you deliver DCDA twins? (Dichorionic diamniotic twins)

Answer 12

37-38wks

Question 13

When should you deliver MCDA? (Monochorionic diamniotic twins)

Answer 13

> 36wks with steroids

Question 14

What is considered preterm? Extreme, very and moderate to late

Answer 14

Before 37 weeks

Extreme preterm 24-27wks
Very preterm 28-31wks
Moderate to late 32-36 wks

Question 15

What is considered low birth weight?

Answer 15

<2.5kg

Question 16

A lady is carrying a downsyndrome child. What results would you expect from the following parameters;

AFP
Oestriol
HCG
PAPP-A
Nuchal translucency

Answer 16

Low alpha fetoprotein (AFP)
Low oestriol
High human chorionic gonadotrophin beta-subunit (-HCG)
Low pregnancy-associated plasma protein A (PAPP-A)
Thickened nuchal translucency

Question 17

What complications are likely to occur from carrying multiple fetus?

Answer 17

Hyperemesis gravidarum
Anaemia
Pre-eclampsia
Antepartum haemorrhage
Preterm labour
Post partum haemorrhage

Question 18

If there is notching of the umbilical cord as on doppler what conditions would this make you think of?

Answer 18

Pre-eclampsia

BP issues

Question 19

After how long if there is no improvement in CPR should you do a perimortem C-section?

Answer 19

4 minutes

Question 20

How would you treat eclampsia

Answer 20

Should resolve in 2 minutes if >5mins then status epilepticus

Give IV labetalol and IV Hydralazine also Magnesium sulphate .

Question 21

What are the symptoms of a miscarriage

Answer 21

Bleeding and period type cramping

Question 22

If someonw has had multiple miscarriages what condition may they have

Answer 22

Antiphospholipid syndrome

Thrombophilia

Question 23

What symptoms wouldyou expect from placental abruption

Answer 23

Pain continuous and severe with sudden onset
Bleeding
Maternal collapse

Question 24

What is plaenta praevia?

Answer 24

Where lower lying placenta is wholly or partly in the lower uterine segment over the internal os

Question 25

What is placenta accreta?

Answer 25

Where the placenta is abmormally adherent to the uterine wall and can cause severe bleeding

Question 26

What would you prescribe for hyperemesis gravidarum

Answer 26

Cyclizine 50mg once IM

Question 27

During which trimester is pregnancy induced hypertension likely to occur

Answer 27

2nd-3rd trimester

Question 28

From what week gestation would pre’eclampsia occur?

Answer 28

20th week BP goes up

Question 29

What are some of the symptoms of pre-eclampsia

Answer 29

Hypertension, headaches, visual disturbance, epigastric pain, oedema

Question 30

What is HELLP syndrome?

Answer 30

``` Haemolysis Elecvated liver enzymes Low platelts LFTS abnormal Placental abruption ```

Question 31

What is the traetment for pre eclampsia

Answer 31

Labetalol 100mg BD-600mg QID

Question 32

What is the treatment for asthma?

Answer 32

Step 1; inhaled SABA Step 2’; SABA + inhaled steroid Step 3; LABA + SABA/inhaled steroid

Question 33

What is the most common cause of PPH?

Answer 33

Uterine atony

Question 34

What is the most common bacterial cause of lactational mastitis

Answer 34

Staph aureus

Question 35

When would a PPH be referred to as a secondary PPH ?

Answer 35

If it occurs after 24hrs

Question 36

What are some risk factors for postpartum haemorrhage?

Answer 36

Multiple preg Polyhydramnios Fetal macrosomia Obesity

Question 37

In obstetrics what is defined as a major haemorrhage?

Answer 37

>1000mls lost

Question 38

In obstetrics what is defined as a minor haemorrhage?

Answer 38

500-1000mls

Question 39

What is the function of syntometrine?

Answer 39

It is an oxytocin synthetic that is used to prevent and control bleeding after delivery

Question 40

What are the 4 H’s of reversible cauess of maternal collapse

Answer 40

Hypovolaemia Hypoxia Hypo/hyperkalaemia Hypothermia

Question 41

What are the 4ts of maternal collapse

Answer 41

Thromboembolism Toxicity Tension pneumo Tamponade