Obstetric disease

Question 1

What is gestational HTN

Answer 1

new HTN without proteinuria occurring after 20w gestation

Question 2

what antihypertensives are used in preg

Answer 2

1st = labetalol
2nd = nefedipine
3 = methyldopa

Question 3

what is pre eclam

Answer 3

new HTN occurring with proteinuria after 20w gestation

Question 4

what are the signs/sympto of pre eclam

Answer 4

HTN + proteinuria
headache w/ visual disturbances
RUQ pain
hyperreflexia
liver involvement (inc transaminases)

Question 5

what are the RFs for pre eclam

Answer 5

DM
multiple preg
nulliparity
obesity
kidney D
HTN in prev preg
>40y

Question 6

what should be offered to women at high risk of pre eclam

Answer 6

low dose aspirin (75mg) OD from 12w gestation

Question 7

what is the medical management of antenatal eclampsia

Answer 7

antihypertensives (labetalol + nifedipine)
IV mg sulphate is severe
expedite delivery

Question 8

what is the risk of recurrence of pre eclam

Answer 8

15%

Question 9

what is HELLP syndro

Answer 9

obstetric comp of pre eclam
Haemolysis, elevated liver enz, low platelets
(distinguished by presence of jaundice)

Question 10

what is the medical management of GDM

Answer 10

1st - diet and exercise
2nd - metformin
3rd - insulin

Question 11

what are the RFs for GDM

Answer 11

age, FHx, obesity, multiple preg, asian

Question 12

what are the risks of GDM

Answer 12

maternal - HTN disease, traumatic delivery, stillbirth

foetal - macrosomia, neonatal hypogly, congen abn

Question 13

what is the key sympto of obstetric cholestasis

Answer 13

pruritus without rash (on hands and feet)

dec appt, malaise

Question 14

how is a diagnosis of obstetic cholestasis made

Answer 14

diag of exclusion

• USS liver/biliary tree
• viral serology
• AI screen

Question 15

What monitorring is done in obstetric chol

Answer 15

Doppler/CTG - 2x per w

LFTs - 1 per w

Question 16

what is the medical management of obs chol

Answer 16

offer induction of labour at 37w

ursodeoxycholic acid for pruritus

Question 17

what is the recurrence rate of obs chol

Answer 17

90%

Question 18

how does pre ecam cause FGR

Answer 18

cytotrophoblasts do not invade interstitial and endovasc tissue correctly -> hypoperfusion of placenta

Question 19

what is placental praevia

Answer 19

placenta lies directly over internal os (only applies after 16w)

NB - low lying P -> P lies <2cm from OS

Question 20

what are the RFs for PP

Answer 20

older mother
prev C sec
prev PP
smoking/drug use

Question 21

what are the complications of PP

Answer 21

maternal - shock, renal tubular nec, APH

foetal - hypoxia, SGA/FGR, premature

Question 22

when does FGR become SGA

Answer 22

SGA = <10th centile

Question 23

what is the presentation of PP

Answer 23

soft abdomen, painless bleeding

Question 24

how is PP diagnosed

Answer 24

USS

Question 25

how is a non symptomatic PP managed

Answer 25

explain risk of bleeding explain that 90% of placentas will move away from os rescan 1t 32w avoid sex

Question 26

how does PA present

Answer 26

hard abdo bleeding with pain pain between contractions

Question 27

what are the RFs for PA

Answer 27

drug use - esp crack cocaine FGR polyhydramnios

Question 28

what is the management of PA

Answer 28

if mother stable and no ev of fetal distress - give steroids and admit, deliver at 37w if unstable/fetal distress - expedite delivery

Question 29

what should be given to all PA/PP women depending of status

Answer 29

is Rh-neg, give anti D Ig within 72hr

Question 30

what is placental acreta

Answer 30

placental attaches too deeply into uterine wall

Question 31

what is placental increta

Answer 31

placenta attaches to uterine muscle

Question 32

what is placental percreta

Answer 32

placenta goes completely through uterine wall, sometimes invading nearby organs

Question 33

who should be screened for placental acreta/increta/percreta

Answer 33

women with anterior low lying placental/PP who have had prex C-sec

Question 34

what is a threatened miscarriage

Answer 34

bleeding during preg but cervical os is closed

Question 35

what is an inevitable miscarriage

Answer 35

bleeding during preg and cervical os is open

Question 36

what is an incomplete miscarriage

Answer 36

tissue left in cervical canal