Obstetrics

Question 1

What is the expected weight gain during a normal pregnancy?

Answer 1

10-12 kgs total weight gain in pregnancy.

Question 2

What are the main changes seen in the cardiovascular system during pregnancy?

Answer 2

Decrease in Total Peripheral Resistance due to progesterone
Decrease in BP by 5-10 mmHg systolic and 10-15 diastolic up to 24 weeks, then slow return to pre pregnancy level (but never above)
Increase by 30-50% in CO, max at 24 weeks
Increase in Heart Rate.

Question 3

What are the changes to the respiratory system seen in pregnancy?

Answer 3

Increase in respiratory rate
Increase in tidal volume
Increase in arterial and alveolar O2
Decrease in total lung capacity (elevation of diagphragm)
Decrease in alveolar and lung CO2
Decrease in residual volume

Question 4

Describe normal nausea and vomiting in pregnancy.

Answer 4

Normal nausea and vomiting in pregnancy occurs in 70% of pregnancies up to 16 weeks. Caused by increased in progestorone, oestrogen, and BHCG, and decreased in BSL. Treat with metclopromide (Maxolon), prochlorperazine (stematil), adequate hydration, and frequent snacking.

Question 5

What are the normal heamatological changes that occur in pregnancy?

Answer 5

Increase in plasma volume by 40%
Increase in RBC mass 25% (dilutional aneamia,- decreased Hb and heamatocrit)
Increse in WBCs (Normal range 6-16)
Increase in VTE due to increased fibrinogen and increased factors VII-X and vWF. INR and APTT normal.
Slight decrease in platelets

Question 6

At what point in pregnancy does bHCG peak, and at what time would you expect it to level off?

Answer 6

bHCG approximately doubles every 48 hours, peaks at 100,000 at 10-12 weeks, levels off around 15 weeks.

Question 7

What tests can be used to confirm pregnancy?

Answer 7

Pregnancy can be confirmed by measuring b-HCG, or via ultrasound. Trasnvaginal ultrasound can detect a gestational sac at 5-6 weeks, and a heart beat at 6-8 weeks. Doppler ultrasound can detect audible feotal heart sounds at 12 weeks.

Question 8

What testing is available in the first trimester to screen for Down Syndrome?

Answer 8

There is a nuchal lucency ultrasound screening at 11-13 weeks that is combined with testing of beta HCG and Papp-A to predict risk of Trisomy 21 (Down Syndrome), Trisomy 18 (Edward’s Syndrome) and Trisomy 13 (Patau Syndrome). There is a 80-90% sensitivity.

Question 9

What screening for Down Syndrome can be conducted in the second trimester?

Answer 9

The Triple Test is used to screen for Down Syndrome. It occurs in weeks 16-18 and tests bHCG, Oestriol, and aFP. It is less sensitive and has a higher rate of false positives than the nuchal translucency scan. Hence, it is generally only used for people who missed out on the first tests.

Question 10

Describe Chorionic Villus Sampling?

Answer 10

Chorionic Villus Sampling is a diagnostic test that is carried out at 10-12 weeks by taking a villus sample from the placenta using a transcervical or transabdominal approach. It results in a 1% chance of miscarriage, and carries the risk of inducing limb defects. CVS cannot test for neural tube defects, will not pick up moscaism, and also tests maternal cells.

Question 11

Describe the process of amniocentesis.

Answer 11

Amniocentesis is a diagnostic test that is carried out >15weeks. A needle is inserted transabdominally and is used to take an amniotic fluid sample containing foetal cells. Misscariage rate is 0.5%, can do a FISH to quickly detect chromosomes. Feotal blood sampling is done >18weeks.

Question 12

What are the symptoms of early pregnancy?

Answer 12

Early symptoms of pregnancy include loss of menstrual cycle, nausea and vomiting, increased frequency of urination, increased size and sensitivity of breasts, and quickening (foetal movements starts between 16-20 weeks).

Question 13

What are the signs of pregnancy?

Answer 13

Chadwick’s Sign: blue colour of the vagina and the cervix, increase in basal body temperature, abdominal enlargement, breast swelling, hyperpigmentation of the skin, telangiectasia, abdominal swelling.

Question 14

What is Naegle’s rule?

Answer 14

Subtract three months and add 7 days

Question 15

What is the schedule of antenatal visits?

Answer 15

7 weeks- Confirm and date pregnancy (measure crown rump length), exclude ectopic or molar pregnancy.
11-14 weeks: Nuchal translucency
18-20 weeks: FAS (Feotal abnormalitiies, detects multiple pregnancies, assess dates and growth and placental position)
22-42 weeks: feotal growth scan
32 weeks follow up: foetal growth and position, doppler

Question 16

What is the role of peri-conceptual folate in reducing neural tube defects?

Answer 16

Take ~ 0.4mg/day (400micrograms) for 1-3 months prior to conception and 6-12 weeks into the pregnancy for a woman with no history of NTDs.
A women with a history of NTDs should take 0.5mg/day. Patients with IDDM and on anti-seizure medication need 2-3 times the normal amount.

Question 17

What is feotal alcohol syndrome?

Answer 17

FAS occurs due to the itake of EtOH during pregnancy (2-5sd/day). Causes growth retardation, mental retardation, typical facies (smooth filtrum, palpebral fissures, vermillion, microcephaly, micropthalmia), VSD, horseshoe kidney, hypoplastic/aplastic kidney, strabismus.
Barbituates can be used to help maternal withdrawal.

Question 18

What is the effect of caffeine on pregnancy?

Answer 18

> 150mg per day can increase the risk of 2nd and 3rd trimester miscarriage.
30-179mg 1 cup of coffe
10-100mg I cup tea
60mg per can soft drink

Question 19

What are the effects of maternal smoking during pregnancy?

Answer 19

Increased risk of spontaneous abortions, decreased birthweight, placental abruption, decreased birthweight, IUGR, placentra previa, placenta acreta, SIDS, respiratory illness in childhood, reduced performance at school, increased leukaemia,. Nicotine replacement is safe in pregnancy.

Question 20

What are the effects of maternal use of cocaine?

Answer 20

Maternal use of cocaine causes maternal and feotal vasoconstriction, causing HTN -> placental abruption and cerebral infarction. Cocaine use is associated with IUGR, preterm labour, preterm delivery and developmental delay.

Question 21

What is the effect of maternal use of opiates?

Answer 21

Most commonly used opiates are methodone and heroin. No teratogenic effects, can be more harmful to the foetus if there is withdrawal.

Question 22

What screening tests are performed on all patients during their first booking visit?

Answer 22

FBC (Hb, MCV), blood group, antibodies, HIV 1,2 ,(pre and post test counselling), Hep B and C, syphilis, urine microscopy, rubella seroloy, BP
NB: BP and urine is consistently measured throughout pregnancy.

Question 23

What additional tests might you consider to screen a mother for on her first booking test if indicated?

Answer 23

Iron studies and thalasseamia screen (if indicated)
Glucose Tolerance Test
Syphilis, Chlamydia, Gonorrhoea screen
Iodine, Vitamin D

Question 24

When are women given a Glucose Tolerance Test?

Answer 24

Women are screen for gestational diabetes using a glucose tolerance test at 28 weeks?

Question 25

When are women tested for GBS?

Answer 25

Women are tested for GBS using a lower vaginal swab at 35-37 weeks.

Question 26

How is hypertension in pregnancy defined?

Answer 26

Hypertension in pregnancy is defined as >140/90, or >30/15 from admission bookings.

Question 27

How is hypertension catergorised in pregnancy?

Answer 27

a) Preexisiting hypertension. should have no proteinuria and no oedema b) Gestational/ Pregnancy Induced Hypertension: no proteinuria, no oedema, occurs after 20 weeks, resolves following birth, Women at increased risk of preclampsia for following births. c) Preeclampsia: Pregnancy induced hypertension associated with proteinuria (>0.3g/day), may also have oedema

Question 28

How do you manage pre-existing diabetes during pregnancy?

Answer 28

* weight loss for women with BMI of > 27 kg/m^2 * stop oral hypoglycaemic agents, apart from metformin, and commence insulin * folic acid 5 mg/day from pre-conception to 12 weeks gestation * detailed anomaly scan at 18-20 weeks including four-chamber view of the heart and outflow tracts * tight glycaemic control reduces complication rates * treat retinopathy as can worsen during pregnancy

Question 29

How do you manage gestational diabetes?

Answer 29

* responds to changes in diet and exercise in around 80% of women * oral hypoglycaemic agents (metformin or glibenclamide) or insulin injections are needed if blood glucose control is poor or this is any evidence of complications (e.g. macrosomia) * there is increasing evidence that oral hypoglycaemic agents are both safe and give similar outcomes to insulin * hypoglycaemic medication should be stopped following delivery * a fasting glucose should be checked at the 6 week postnatal check

Question 30

What is Feotal varicella syndrome?

Answer 30

* risk of FVS following maternal varicella exposure is around 1% if occurs before 20 weeks gestation * studies have shown a very small number of cases occurring between 20-28 weeks gestation and none following 28 weeks * features of FVS include skin scarring, eye defects (microphthalmia), limb hypoplasia, microcephaly and learning disabilities

Question 31

How do you manage a women with varicella exposure during pregnancy?

Answer 31

* if there is any doubt about the mother previously having chickenpox maternal blood should be checked for varicella antibodies * if the pregnant women is not immune to varicella she should be given varicella zoster immunoglobulin (VZIG) as soon as possible. RCOG and Greenbook guidelines suggest VZIG is effective up to 10 days post exposure * consensus guidelines suggest oral aciclovir should be given if pregnant women with chickenpox present within 24 hours of onset of the rash

Question 32

What is the definition of antepartum heamorrhage?

Answer 32

Antepartum heamorrhage is defined as bleeding after 24 weeks. Vaginal exam should not be performed in primary care for women with an antepartum heamorrhage as women with placenta previa may heamorrhage.

Question 33

What are the common causes of bleeding during each trimester?

Answer 33

First trimester: Spontaneous aborption, hydatiform mole, ectopic pregnancy Second Trimester: Spontaneous abortion, hydatiform mole, placental abruption. Third Trimester: Bloody Show, Placental abruption, placenta previa, vasa previa. Also consider STDs and cervical polyps.

Question 34

How does a threatened miscarraige present?

Answer 34

Painless vaginal bleeding at 6-9 weeks.

Question 35

How does a delayed (missed) miscarriage present?

Answer 35

Light vaginal bleeding and symptoms of pregnancy dissapear.

Question 36

How does an incomplete miscarriage present?

Answer 36

Heavy bleeding and crampy lower abdominal pain.

Question 37

How does an ectopic pregnancy present?

Answer 37

Typically 6-8 weeks of lower abdominal pain (usually unilateral), and then vaginal bleeding later. Shoulder tip pain and cervical excitation may be present.

Question 38

How does a hydatiform mole present?

Answer 38

Usually bleeding in the first or second trimester, exageration of normal pregnancy symptoms (eg. hyperemesis), pregnancy seems large for its dates, and serum HCG is high.

Question 39

How does a placental abruption present?

Answer 39

Persistan lower abdominal pain, woman may be more shocked than expected for the amount of blood loss, tender tense uterus with normal lie and presentation. Feotal heart may be distressed.

Question 40

How does placenta previa and vasa previa present?

Answer 40

Placenta previa presents with painless vaginal bleeding. Vasa previa presents with rupture of membranes followed immediately by vaginal bleeding. foetal bradycardia is classicly seen.

Question 41

When does antiD immunoglobulin need to be given to a Rhesus negative mother?

Answer 41

At 28 and 34 weeks •if event is in 2nd/3rd trimester give large dose of anti-D and perform Kleihauer test - determines proportion of fetal RBCs present •delivery of a Rh +ve infant, whether live or stillborn •any termination of pregnancy •miscarriage if gestation is > 12 weeks •ectopic pregnancy •external cephalic version •antepartum haemorrhage •amniocentesis, chorionic villus sampling, fetal blood sampling

Question 42

What are the signs that a baby who is Rh+ has been born a an Rh- mother who has previously been sensitised? What tests should be conducted?

Answer 42

•oedematous (hydrops fetalis, as liver devoted to RBC production albumin falls) •jaundice, anaemia, hepatosplenomegaly •heart failure •kernicterus •treatment: transfusions, UV phototherapy All babies born to Rh -ve mother should have cord blood taken at delivery for FBC, blood group & direct Coombs test. Coombs test: direct antiglobulin, will demonstrate antibodies on RBCs of baby. Kleihauer test: add acid to maternal blood, fetal cells are resistant

Question 43

What are some of the possible effects of pre ecclampsia?

Answer 43

Pre-ecclampsia can result in •fetal: prematurity, intrauterine growth retardation •eclampsia •haemorrhage: placental abruption, intra-abdominal, intra-cerebral •cardiac failure •multi-organ failure

Question 44

What are the risk factors for pre-ecclampsia?

Answer 44

* > 40 years old * nulliparity (or new partner) * multiple pregnancy * body mass index > 30 kg/m^2 * diabetes mellitus * pregnancy interval of more than 10 years * family history of pre-eclampsia * previous history of pre-eclampsia * pre-existing vascular disease such as hypertension or renal disease

Question 45

What are some of the features of severe pre-ecclampsia?

Answer 45

* hypertension: typically > 170/110 mmHg and proteinuria as above * proteinuria: dipstick ++/+++ * headache * visual disturbance * papilloedema * RUQ/epigastric pain * hyperreflexia * platelet count < 100 * 106/l, abnormal liver enzymes or HELLP syndrome

Question 46

How do you manage pre-ecclampsia?

Answer 46

* consensus guidelines recommend treating blood pressure > 160/110 mmHg although many clinicians have a lower threshold * oral labetalol is now first-line following the 2010 NICE guidelines. Nifedipine and hydralazine may also be used * delivery of the baby is the most important and definitive management step. The timing depends on the individual clinical scenario

Question 47

How do manage pregnancy in HIV?

Answer 47

- Zidovudine)(ZDV) administered during pregnancy and labour and to the newborn –reduce risk of transmission by 2/3 Highly Active Antiretroviral Therapy(HAART) can further decrease viral load) -Overall rate of transmission of 2% - Caesarean section:considered if viral load is> 1000) - Breastfeeding CI in HIV infected woman as virus is found in breast milk) -Postnatal transmission via breastmilk at 2 years~15%

Question 48

What is a hydatidiform mole?

Answer 48

A complete hydatidiform mole is a benign trophoblastic tumour that occurs when an egg contains no maternal DNA, hence the sperm DNA is replicated. A partial hydatiform mole is when there is a normal haploid egg that is fertilised with two sperm, or by one sperm with duplication of chromosomes.

Question 49

What are the presenting features of a hydatidiform mole?

Answer 49

•bleeding in first or early second trimester •exaggerated symptoms of pregnancy e.g. hyperemesis •uterus large for dates •very high serum levels of human chorionic gonadotropin (hCG) •hypertension and hyperthyroidism* may be seen Mange with an urgent referral for uterine evacuation.

Question 50

What are the causes of recurrent miscarriage?

Answer 50

* antiphospholipid syndrome * endocrine disorders: poorly controlled diabetes mellitus/thyroid disorders. Polycystic ovarian syndrome * uterine abnormality: e.g. uterine septum * parental chromosomal abnormalities * smoking

Question 51

What type of twins is most lilkely to be affected by twin-twin transfusion syndrome?

Answer 51

Twin-Twin transfusion syndrome occurs in 17% Monochorionic ( one placenta) monozygotic (identical) twins.

Question 52

In twin-twin transfusion syndrome, what are the symtoms of the donor twin? What are the symptoms of the recipient twin?

Answer 52

Donor Twin: oligohydramnios, IUGR, decreased blood volume, aneamic. Recipient Twin: Polyhydramnios, Increased blood volume -> strain on the heart ->hypertrophy -> cardiac failure, polycythemia

Question 53

How do you treat twin-twin transfusion syndrome?

Answer 53

Not treating is likely to lead to mortality of one or both of the foetuses. Treatment options include: - Serial amniocentesis - Septostomy (to adjust amniotic fluid) - Laser division of the placental connections (90% chance that one twin survives, 70% chance that both will). - Selective feotocide (Clip cord, or inject cord or heart with KCL).

Question 54

What are the effects of maternal diabetes of the foetus?

Answer 54

- Macrosomia - Impaired lung maturation - Neonatal hypoglycaemia - Hypocalcaemia - Hyperbilirubinaemia - Polycythaemia

Question 55

Where is the pelvic inlet widest? Where is the pelvic outlet widest? Where is the feotal head the widest?

Answer 55

The pelvic inlet is widest transversly, and the pelvic outlet is widest along the anteriorposterior plane. The babies head is widest along the anteroposterior plane.

Question 56

What is oligohydramnios? What are the causes of oligohydramnios?

Answer 56

Oligohydramnios is reduced amniotic fluid (<5th precentile). Causes of oligohydramnios include: PROM, Foetal renal problems (eg. renal agenesis), IUGR, post term gestation, pre ecclampsia.

Question 57

What do you use to treat acute hypertension in pregnancy?

Answer 57

Labetelol (beta blocker) Nifedipine (calcium channel blocker) Hydralazine (arteriole vasodilator)

Question 58

How do you treat seizures in ecclampsia?

Answer 58

Treat using MgSO4. It acts as a membrane stabiliser.

Question 59

What is HELLP syndrome?

Answer 59

Heamolysis (schistocytes, elevated LH) Elevated Liver Enzymes (AST, ALT) Low Platelets.

Question 60

Why do we assess dilatation of the cervix during pregnancy?

Answer 60

During labour, a cervix can be dilated between 0-10cm. In a primigravid, it progresses approximately 1cm every hour.

Question 61

What is effacement of the cervix?

Answer 61

Effacement is an estimated length of the cervical canal. In a multigravida, the cervix may start dilating before the effacement is complete. A normal cervix is 3-4cm long.

Question 62

What are the high risk factors that require CTG monitoring during pregnancy?

Answer 62

- Growth restriction (weight <10centile) - HTH, antenatal heamorrhorrhage - Precipitate labour, premature labour, prolonged labour, induced or augmented with syntocinon, epidural, previous cesaerian, significant maternal medical problems - Meconium stained liquor

Question 63

What is the importance of meconium stained liquor?

Answer 63

There is increased risk of meconium stained liquor with increased weeks gestation. It is also association with foetal acidosis, abnormalities in foetal heart rate, and low Apgar scores. There is an increased materal risk of endometritis and choriometritis. There is an increased risk of neonatal meconium aspiration syndrome. Women with Meconium stained liquor should be offered an induction of labour, CTG monitoring, and should have the neonatal resus team present at birth.

Question 64

What are the features of a normal CTG?

Answer 64

HR 110-160, baseline variability between 10-25 beats per minute due to the action of sympathetic and parasympathetic pathways, accelerations with babies movement, accelerations with contractions (at least 2 every 15 mins, >15bpm, last >15secs).

Question 65

What are the causes of foetal tachycardia on CTG?

Answer 65

Maternal pyrexia, beta blocker use, prematurity, or acidosis.

Question 66

What are the causes of foetal bradycardia on CTG?

Answer 66

If bradycardia is present be very suspicious of severe acidosis (eg. uterine rupture or placental abruption). May also be caused by hypotension or maternal sedation.

Question 67

What causes reduced foetal variability on CTG?

Answer 67

Can be caused by acidosis, foetus sleep/quiet phase, prematurity, or drugs.

Question 68

What causes variable decelerations?

Answer 68

Variable decellerations are variable in relation to the timing of the contractions. Variable decellerations are associated with cord compressions and hypoxia. Late decellerations may also be associated with hypoxia, but early decellerations are fairly normal.

Question 69

What is a foetal scalp electrode?

Answer 69

A foetal scalp electrode attaches to the foetuses head and measures an ECG. It can be used to help detect myocardial changes indicating hypoxia.

Question 70

What is foetal blood sampling?

Answer 70

Foetal blood sampling is the same as foetal scalp sampling. Foetal scalp sampling is used to confirm whether CTG abnormalities reflect real hypoxia. Foetal blood sampling is indicated if there are persistent or late decellerations, persistent tachycardia, prolonged loss of baseline variability, meconium stained liquor. Contraindicated for maternal infections, foetal bleeding disorder, or <34wks.

Question 71

What is Entonox?

Answer 71

Entonox is an inhaled mixture of NO and O2 that provides limited pain relief in pregnancy. It can produce nausea, vomiting, drowsiness, and feelings of light headedness.

Question 72

What is the Bishop's Score?

Answer 72

A Bishops Score is used during induction of labour to determine how prepared the cervix is for labour. A Bishop's score 2cm, 1-2cm, 3cm) - Station of the presenting part (-3 -2, -1) - Consistency (soft, firm, hard) - Position (anterior, posterior, central)

Question 73

What is misoprostol?

Answer 73

Misoprostol is a prostaglandin 1 analogue that can be used to induce labour, or to induce abortion, or treat missed miscarriages. PGE2 analogues can also be used to induce labour. Prostaglandin analogues are used to help ripen the cervix and to start contractions. Syntocinon is then used to maintain contractions.

Question 74

What is syntocinon?

Answer 74

Syntocinon is oxytoxin. It is used to stimulate contractions when inducing labour.

Question 75

What is mifepristone?

Answer 75

Mifepristone (RU 486) is a synthetic steroid with an anti-progesterone action exhibited through competitive interaction with progesterone at progesterone receptors. It is used for the termination of pregnancy.

Question 76

What is the 'lie' of a foetus?

Answer 76

The 'lie' refers to the position of the baby in relation to its mother. 99% are longitudinal (may be cephalic or breech), can also be transverse or oblique.

Question 77

What is the 'presentation' of a foetus?

Answer 77

The presentation of a foetus is which part is on the cervix. It may be cephalic, breech, compound or cord presentation.

Question 78

What are the different types cephalic presentations?

Answer 78

Different types of cephalic presentations include: - Vertex (back of the head, normal) - Face (neck is extended) - Brow (supraorbital ridges and brow palpable on VE, may flex into vertex or extend into face presentation, if face presentation persists may need caesarean).

Question 79

What are the different types of breech presentation?

Answer 79

- Frank (feet straight up, extended to face) - Complete (Knees bent) - Incomplete/Footling (one or both hips incompletely flexed so that one or both feet are lower than the buttocks)

Question 80

What counts as 'preterm' or 'prematurity'?

Answer 80

Between 24 and 37 weeks.

Question 81

What is PPROM

Answer 81

Preterm (<37 weeks) premature (before the onset of labour) rupture of membranes

Question 82

What is a LBW?

Answer 82

Low birth weight <2500g. Low birth weight babies may be growth restricted or preterm or both.

Question 83

What is VLBW?

Answer 83

Very Low Birth Weight <1500g

Question 84

What do alpha feto-protein levels indicate during pregnancy?

Answer 84

Low AFP levels are associated with Down Syndrome, high AFP levels are associated with neural tube defects.

Question 85

What is a normal blood loss during labour?

Answer 85

200-300mL

Question 86

What is a primary postpartum haemorrhage?

Answer 86

Blood loss >500mL in the first 24 hours after birth.

Question 87

What are the causes of post partum haemorrhage?

Answer 87

The 4 T's - Tone: failure of the uterus to contract after delivery of the placenta - Tissue: retained products in the uterus (eg. placenta), can be responsible for atonic uterus. - Trauma: bleeding may come from a laceration of the vagina, uterus, cervix, perineum or episiotomy. - Thrombin: eg. coagulation problems. DIC is the most common.

Question 88

What is secondary post partum haemorrhage and what are its causes?

Answer 88

Secondary post partum haemorrhage occurs between 24 hours to 7 days of the delivery. Its causes include: - Infection - Retained products of conception

Question 89

How do you manage a post-partum haemorrhage?

Answer 89

-ABC -IV syntocinon 10 units, or IV ergometrine 500 mcg -IM carbaprost Other options: B Lynch suture, ligation of the uterine arteries, or internal iliac arteries. If severe, then a hysterectomy can be a life saving procedure.

Question 90

Describe the process of active management?

Answer 90

Give IM syntocinon after birth of the anterior shoulder. Clamp and Cut cord early. Watch for signs of seperation (lengthening of the umbilical cord, contraction of uterus, gush of blood), apply cord traction and guard the uterus. Estimate maternal blood loss.

Question 91

What is a stillbirth?

Answer 91

Any feotus born with no signs of life after 20 weeks.

Question 92

How is bilirubin produced in the body?

Answer 92

RBCs are broken down by the liver and the spleen to produce Heme. Heme is then converted into Bilverdin by Heme Oxygenase. Bilverdin is reduced to bilirubin by Bilverdin reductase. Bilirubin attaches to albumin and travels round the circulation. This is unconjugated bilirubin.

Question 93

How is bilirubin metabolised in the body?

Answer 93

Unconjugated bilirubin travels through circulation attached to albumin. Because unconjugated/ indirect bilirubin is attached to albumin, it is lipid soluble. Unconjugated bilirubin is taken up by the liver and conjugated with glucuroonic acid to form bilirubin glucuronides. Bilirubnin glucuronides are excreted as bile and are modified by gut bacteria to colourless urobilinogen. Some of this is excreted in the feaces. A small amount of this is reabsorbed, and a small amount is excreted through the urine.

Question 94

What is kernicterus?

Answer 94

Kernicterus is the term used to describe the chronic and permanent sequelae of hyperbilirubinaemia.