Obstetrics Flashcards
(311 cards)
1
Q
What does ‘gravida’ and ‘parity’ mean?
(in relation to obstetric hx)
A
Gravida = no of pregnancies no matter of outcome
Parity = no. of pregnancies which surpass 24 weeks or more
(multiple births from a single pregnancy are counted as one parous event)
2
Q
What is Goodell’s sign?
A
= softer cervix, is an indication of pregnancy
(typically presents at 6 weeks)
3
Q
What is Chadwick’s sign?
A
= blue discolouration of the cervix, vaginal and vulva
(presents 6-8 weeks after conception)
4
Q
What is Osianders sign?
A
= pulsation can be felt through the lateral vaginal fornix
(presents typically at 8 weeks post-conception)
5
Q
Naegele’s rule for estimating due date in pregnancy
A
= add 7 days and subtract 3 months to find due date (EDD)
6
Q
What dose of folic acid is recommended for pregnancy? and for how long?
A
= 400mcg/day, recommended from preconception to 12 weeks of pregnancy
7
Q
What is folic acid important for in pregnancy?
A
= foetal neural tube development
Reduces risk of spina bifida, anencephaly and related defects
7
Q
What is involved in the booking appointment (at approx. 8 weeks)? (8)
A
- taking a full history
- risk assessments
- physical examination
- blood tests
- discussing trisomy screening
- mental health
- routine enquiry
- health advice
8
Q
Foods to avoid in pregnancy (7)
A
- unpasteurised milk
- raw or undercooked meat
- liver
- pate
- game meats
- swordfish, marlin, shark, raw shellfish
- alcohol
9
Q
What is acute fatty liver of pregnancy (AFLP)?
A
= severe, rare liver disease related to pregnancy, which can result in hepatic failure and necessitates immediate medical and obstetric intervention
10
Q
What condition is associated with a foetal homozygous mutation for the long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD)
A
= acute fatty liver of pregnancy (AFLP)
11
Q
Are female or male foetuses a risk factor for acute fatty liver of pregnancy (AFLP)?
A
= male foetuses
(+ multiple pregnancies)
12
Q
Pregnant women in her 3rd trimester presents with raised levels of AST, ALT, bilirubin, creatinine, ammonia, lactate, serum uric acid.
She has a leucocytosis, low to normal platelets, and a normocytic normochromic anaemia.
What do you suspect may be the diagnosis?
A
= acute fatty liver of pregnancy (AFLP)
13
Q
What is Swansea criteria used to help diagnose?
A
= acute fatty liver of pregnancy (AFLP)
14
Q
What is the only curative treatment for acute fatty liver of pregnancy (AFLP)?
A
= delivery of foetus
15
Q
What is antepartum haemorrhage?
(between when in pregnancy)
A
= clinical condition characterised by vaginal bleeding that occurs between the 24th week of pregnancy + birth
16
Q
Why might you do an USS in a women with antepartum haemorrhage?
A
= to exclude placenta praevia
17
Q
What is a Keilhauer test for?
A
= used to determine if there is foetal blood in maternal circulation
(used in Rh -ve women)
18
Q
In a pregnant women with antenatal haemorrhage, what may you prescribe if there is a risk of preterm birth?
A
= antenatal corticosteroids
(to help baby’s lungs mature)
19
Q
What is asymptomatic bacteriuria in pregnancy?
A
= clinical condition where a significant amount of bacteria is present in the urine of a pregnant women, without the presence of symptoms indicative of UTI
Characterised by positive urine culture in the absence of UTI symptoms
20
Q
Management of asymptomatic bacteriuria in pregnancy
A
= treatment with antibiotics
21
Q
Which antibiotics are commonly used to treat asymptomatic bacteriuria in pregnancy?
A
= Nitrofurantoin + Cefalexin
22
Q
What are baby blues? and usually how long after birth do the symptoms manifest?
A
= transient mood disorder that typically manifests around 3 days after childbirth. It is characterised by irritability, anxiety about parenting skills, and tearfulness
23
Q
Up to what % of women experience baby blues?
A
= up to 80% (very common)
23
Out of the women who develop baby blues, what % go on to develop postnatal depression?
= 10%
24
What screening tool may be used to help identify postnatal depression?
= Edinburgh Postnatal Depression Scale
25
Treatment of baby blues?
When should mothers be advised to seek help (time)?
= primarily supportive, reassure this is a common condition
Mothers should be encouraged to seek help if symptoms persist beyond 2 weeks
26
When should the booking appointment be conducted before?
= before 10 weeks gestation
27
What is the aim of the booking appointment?
= to identify women who may require additional support throughout their pregnancy
28
What blood borne viruses are tested for at the booking appointment? (4)
- rubella
- HIV
- syphilis
- hepatitis B
29
Which of the following is the preferred opiate analgesia for breastfeeding mothers?
- codeine
- dihydrocodeine
- hydrocodone
- dihydrocodeine
30
Can a breastfeeding mother use aspirin as a painkiller?
= should be avoided
(increased risk of Reye’s syndrome in paediatric viral infection)
31
Why should aspirin be avoided in breastfeeding mothers?
= increased risk of Reye’s syndrome in paediatric viral infection
32
Are breastfeeding mothers allowed to drink alcohol?
= can have occasional, small amounts of alcohol but should not drink regularly or heavily
33
A HIV-positive mother comes to see you and asks if she is able to breastfeed her child
= current recommendations advise that HIV-infected mothers should refrain from breast feeding
34
Any risk of transmitting hepatitis B or C in a positive-mother breastfeeding her child?
= no, provided the infant has received appropriate HBV immunoprophylaxis
35
What is a primiparous women?
= giving birth for the first time
36
What is a breech presentation?
= refers to the positioning of the foetus in a longitudinal lie with the buttocks or feet proximal to the cervix and the head near the fundus
37
What is frank breech?
= when the baby's legs are folded flat up against his head and his bottom is closest to the birth canal
38
What is footling breech?
= where one or both feet are presenting
39
What imaging can be used to assess presentation of foetus?
= USS scan
40
What can be done to help turn a breech presenting foetus?
= external cephalic version (ECV), manual procedure where an experienced physician attempts to turn the baby using their hands on the abdomen
41
When is a primiparous women + multiparous women offered a ECV if their foetus is breech presenting?
Primiparous: at 36 weeks
Multiparous: at 37 weeks
42
Success rate of an external cephalic version (ECV)?
= 50%
43
What are tocolytics?
= medications to suppress preterm labour
44
What will a Rh negative women be given before external cephalic version (ECV)?
= anti-D immunoglobulin
45
What is a category 1 emergency caesarean?
(+ what is decision to delivery time?)
= immediate threat to life of mother + baby
Decision to delivery time is 30 minutes
46
What is a category 2 emergency caesarean?
(+ what is decision to delivery time?)
= no imminent threat to life but required urgently due to compromise of mother or baby
Decision to delivery is 75 minutes
47
What is a category 3 emergency caesarian?
= delivery is required but mother and baby are stable
48
What is a category 4 emergency caesarian?
= elective caesarean
49
What is chorioamnionitis?
= bacterial infection that affects the membranes surrounding the foetus (the amniotic sac) and the amniotic fluid within the uterus
50
Most common organisms in chorioamnionitis? (3)
- Group B streptococcus
- E. coli
- anaerobic bacteria
51
Management of chorioamnionitis
- IV broad spectrum antibiotic therapy (as part of sepsis 6)
- early delivery necessary in some cases
52
A baby with congenital cytomegalovirus infection (CMV) may develop long-term neurological consequences such as? (3)
- hearing loss
- visual impairment
- learning disability
53
Antenatally, are foetal abnormalities associated with CMV detected?
= USS
54
Postnatally, how is CMV infection typically diagnosed?
= testing an affected infant’s saliva, urine, or blood for the presence of the virus
55
How is cytomegalovirus transmitted?
= through close contact with a person excreting the virus in their saliva, urine, or other bodily fluids
56
What vaccine protects women + babies from rubella?
= MMR vaccine
57
In which trimester is it more common for a pregnant women to contract rubella?
= first trimester
58
'Blueberry muffin' rash is characteristic of?
= rubella (or other health conditions)
59
New-borns with congenital rubella syndrome (CRS) commonly present with? (3)
- sensorineural deafness
- cataracts or retinopathy
- congenital heart disease
60
Investigations of congenital rubella syndrome (CRS)?
= serology tests (look for antibodies)
61
Management of congenital rubella syndrome (CRS)?
= mainly supportive + symptomatic
62
What is a cord prolapse?
= refers to a situation during labour when the umbilical cord exits the cervix ahead of the infant
63
Signs of a cord prolapse? (2)
- feeling cord in vagina
- abnormal foetal HR
64
Investigations of a cord prolapse (2)
Cardiotocography: monitor foetal HR + maternal contractions
Vaginal examination: to confirm presence of umbilical cord in birth canal
65
What is cardiotocography (CTG)?
= a continuous recording of the fetal heart rate obtained via an ultrasound transducer placed on the mother's abdomen
66
What position is best for mum to prevent further cord prolapse?
= 'knees-chest' position
67
What is Down syndrome?
= trisomy 21, is a genetic condition resulting from the presence of 3 copies of chromosome 21, rather than the typical 2 copies
68
3 main genetic mechanisms responsible for down syndrome
Gamete non-disjunction: accounts for ~95% of cases; incidence increases with maternal age
Robertsonian translocation: referred to as familial down syndrome, or translocation down syndrome; accounts for ~4% of cases
Mosaic down syndrome: least common form, accounting for ~1% of cases; often leads to variable expression of the down syndrome phenotype
69
Features of Down syndrome (4)
- distinctive facial features including: flat facial profile, an upward slant to the eyes, small ears, and a tongue that tends to stick out
- short stature
- learning difficulties
- congenital heart defects (including ventricular septal defects)
70
At what point in pregnancy are women offered a screening test for down syndrome?
= between week 10-14
71
When screening for Down syndrome, what trisomy's are tested for? (3)
- 13 (patau syndrome)
- 18 (Edwards syndrome)
- 21 (Down syndrome)
72
What tests are used as part of the screening programme to identify risk of your baby having down syndrome? (3)
- combined test
- triple test
- quadruple test
73
Down syndrome screening: which test is recommended?
= combined test
74
Down syndrome screening: when can combined test be done?
(between week _ +_)
= between week 10-14
75
If a pregnant women presents after week 14, what other tests can be done to screen for down syndrome? (2)
- triple test
- quadruple test
76
Down syndrome screening: If a women's pregnancy is high risk, what is the next step?
= women offered a diagnostic test which can provide definitive answer
77
Down syndrome screening: what diagnostic tests can test for Down syndrome? (2)
- chorionic villus sampling
- amniocentesis
78
What is eclampsia?
= development of seizures in association pre-eclampsia
Pre-eclampsia:
- condition seen after 20 weeks gestation
- pregnancy-induced hypertension
- proteinuria
79
Aetiology of pre-eclampsia
= it is believed to be related to dysfunctional trophoblast invasion of spiral arterioles, which results in decreased utero-placental blood flow and subsequent endothelial cell damage
80
Key investigations for pre-eclampsia (3)
- BP measurement (HTN)
- urinalysis (proteinuria)
- blood tests (kidney + liver function, clotting status)
81
What can be given as prophylaxis against developing pre-eclampsia?
= Aspirin
82
When is Aspirin given as prophylaxis for pre-eclampsia?
= from 12 weeks' gestation until birth
83
Who should be given Aspirin as prophylaxis for pre-eclampsia?
(how many high or moderate risk factors) (2)
- 1 high risk factor, OR
- 2 moderate risk factors or more
84
What is the recommended anti-hypertensive treatment for a pregnant women with pre-eclampsia?
= Labetalol
85
What can be given to prevent + treat eclamptic seizures?
= magnesium sulphate
86
Definitive curative treatment of pre-eclampsia/ eclampsia?
= delivery of the placenta
87
Why is it important to monitor plasma anti-epileptic drug levels in a pregnant women with epilepsy?
= as levels are likely to decrease with increasing plasma volume during pregnancy, and postpartum should be reviewed after delivery to prevent postpartum toxicity as plasma levels return to normal
88
The safest anti-epileptic drugs in pregnancy (2)
- Levetiracetam
- Lamotrigine
89
What is important for pregnant women to take to minimise the risk of neural tube defects?
= folic acid, 5mg/ day
90
What is an important supplement for a pregnant women on an anti-epileptic regime to take?
= vitamin K therapy
(anti-epileptic regimes may inhibit foetal clotting factor production)
91
What is congenital toxoplasmosis?
= infection caused by the protozoan parasite Toxoplasma gondii
92
Primary host of Toxoplasma gondii?
= cats
93
How can humans contract Toxoplasma gondii (protozoan parasite responsible for toxoplasmosis)? (3)
- direct contact with cat faeces
- ingesting undercooked meat
- exposure to contaminated soil
94
What sort of problems can a person go on to develop if they contract congenital toxoplasmosis? (4)
- CNS problems (such as cerebral palsy, epilepsy, hydrocephalus)
- learning difficulties
- visual impairment
- hearing loss
95
Pharmacological management for congenital toxoplasmosis?
(to reduce transmission to baby)
= Spiramycin (antibiotic)
96
What is congenital varicella zoster virus?
= occurs when a non-immune women contracts the varicella zoster virus (VZV) during the first trimester of pregnancy
97
Clinical features of congenital varicella syndrome (6)
- low birth weight
- limb hypoplasia
- skin scarring
- microcephaly
- eye defects
- learning difficulties
98
What can be given if a non-immune pregnant women comes into contact with a person infected with varicella-zoster virus?
= immunoglobulins (as a preventative measure)
99
Treatment of choice if pregnant women contracts varicella zoster virus (VZV) during pregnancy?
= Acyclovir
(should be administered within 24 hours of the onset of the rash)
100
Congenital varicella zoster virus: post-delivery what can be given to neonate?
= IV acyclovir
101
What is the first stage of labour defined as?
(starts and ends when)
Starts with regular uterine contractions, and ends when cervix is fully dilated to 10cm
102
What can the first stage of labour be further divided into? (2)
Latent phase: 0-3cm cervical dilation
Active phase: 3-10cm cervical dilation
103
What is classed as a fully dilated cervix?
= 10cm
104
Which 2 hormones are primarily involves in stimulating regular uterine contractions during the first stage of labour?
Prostaglandins and oxytocin
105
What is the second stage of labour defined as?
(starts and ends when)
Starts with complete cervical dilation, and ends with delivery of the foetus
106
What is the third stage of labour defined as?
(starts and ends when)
Starts at delivery of the foetus and ends with the delivery of the placenta and foetal membranes
107
How might the third stage of labour be expedited (hurried along)?
= administration of oxytocin
108
What is controlled cord traction?
= manual method used to deliver the placenta
109
What is gestational diabetes (GDM) defined as?
= glucose intolerance with fasting blood glucose levels >/= 5.6 mmol/L, OR
2-hour plasma glucose levels >/= 7.8 mmol/L, on a 75g oral glucose tolerance test (OGTT)
(can be remembered as 'diagnosis of GDM is as easy as 5678')
110
Management of gestation diabetes (GDM)
If fasting plasma glucose level < 7mmol/L: trial of diet + exercise encouraged
If glucose targets not met within 1-2 weeks - Metformin should be started
If glucose targets still not met - Insulin should be added (short-acting insulin)
--
If fasting glucose level >/= 7mmol/L - Insulin should be started
111
Gestation diabetes (GDM) blood glucose targets:
Fasting:
1 hour after meals:
2 hours after meals:
Fasting: 5.3 mmol/L
1 hour after meals: 7.8 mmol/L OR,
2 hours after meals: 6.4 mmol/L
112
Clinical features associated with group B streptococcus infection in a new-born (3)
- sepsis
- pneumonia
- meningitis
113
How is Group B streptococcus infection spread from mother to child?
= vertical transmission
114
Management in preventing Group B streptococcus infection in the new-born?
= intrapartum antibiotic prophylaxis - Penicillin
115
What % of pregnant women are estimated to be Group B streptococcus carriers?
= approx. 25%
116
What is HELLP syndrome?
= complication of pregnancy characterised by the presence of haemolytic (H), elevated liver enzymes (EL), and low platelets (LP)
117
In which trimester does HELLP syndrome usually manifest?
= 3rd trimester
118
Definitive treatment for HELLP syndrome?
= delivery of the baby
119
What is the % likelihood of passing HIV from mother to child? (without intervention)
= 25-40%
120
When is HIV transmission from mother to baby most likely to happen during pregnancy?
= during delivery
(infection rarely passed in utero)
121
HIV: What mother's viral load supports vaginal delivery vs elective caesarian section
Viral load <50: normal vaginal delivery can be recommended and supported
Viral load >50: an elective Caesarean section is recommended
122
123
What is haemolytic disease of the new-born (HDN)?
= immunological condition that arises when a rhesus negative mother becomes sensitised to the rhesus positive blood cells of the baby while in utero
124
Features associated with haemolytic disease of the newborn (HDN) (6)
- hydros fetalis (= fluid build-up in baby's tissues + organs)
- yellow coloured amniotic fluid
- neonatal jaundice
- foetal anaemia
- hepatomegaly or splenomegaly
- severe oedema
125
What is a direct anti globulin test (DAT) used for?
= used primarily to help determine if the cause of haemolytic anaemia
(used in investigating haemolytic disease of a new-born)
126
What postnatal management options are there to help treat haemolytic disease of a newborn? (2)
- phototherapy OR,
- exchange transfusion
(to manage high bilirubin)
127
What is hyperemesis gravidarum?
= condition characterised by severe nausea and vomiting, commencing before the 20th week of gestation
128
First-line anti-emetic used in hyperemesis gravidarum
= cyclizine
129
Management of hyperemesis gravidarum (5)
- fluid replacement therapy
- Potassium chloride (to address hypokalaemia)
- thiamine + folic acid supplementation (to prevent onset of Wernicke's encephalopathy)
- antacids, to alleviate epigastric discomfort
- thromboembolic (TED) stockings
130
What is Queen Anne's sign? And what is it indicative of?
= loss of the outer 1/3 of eyebrows, seen in patients with hypothyroidism
131
First-line treatment in hypothyroidism?
= Levothyroxine
132
What is recommended in those taking Levothyroxine whilst pregnant?
(dose)
= increase dose (usually by 25-50mcg), due to increased metabolic demand
133
Complications of poorly managed hypothyroidism (2)
- osteoporosis
- cardiac arrhythmias
134
What is induction of labour?
= medically initiated process of starting labour artificially
135
Ways in which labour can be induced (4)
- membrane sweep
- vaginal Prostaglandins
- amniotomy
- balloon catheter
136
What is a membrane sweep?
= process of initiating labour, a gloved finger is inserted into the external os and separates the membranes from the cervix
137
Effect of vaginal prostaglandins in inducing labour (2)
- ripen cervix
- induce contractions
138
What is an amniotomy?
= artificial rupture of membranes
139
What are the chances (%) of a couple conceiving within 1 year if the woman < 40, they don't use contraception, and have regular intercourse
= 80%
140
Factors affecting natural fertility (7)
- increasing age
- obesity
- smoking
- tight-fitting underwear (males)
- excessive alcohol consumption
- anabolic steroid use
- illicit drug use
141
What is a hysterosalpingography?
= radiologic procedure to investigate the shape of the uterine cavity and the shape and patency of the fallopian tubes
It is a special x-ray procedure using dye to look at the womb and fallopian tubes
142
What is the Bishop score, and what is it used for?
= clinical tool uses to assess the likelihood of a successful induction of labour in pregnant patients
143
What components are involved in the Bishop score (5)
- position
- consistency
- effacement
- dilation
- station
(mnemonic: 'pregnancy can enlarge dainty stomachs')
144
What is foetal blood sampling (FBS)?
= technique used during labour to assess the presence or absence of foetal hypoxia
145
What 2 things can you look at when interpreting foetal blood sampling results?
- lactate OR,
- pH
146
What is classified as an 'abnormal' pH on foetal blood sampling results?
= 7.20 or below
147
What is classified as an 'abnormal' lactate on foetal blood sampling results?
= 4.9 mmol/L or above
148
What is intrauterine growth restriction (IUGR)?
= condition in which foetus is unable to reach its genetically determined potential size
149
Management of intrauterine growth restriction (IUGR)? (3)
- close monitoring of foetal growth + well-being
- manage maternal conditions which are contributing
- consider early delivery if foetus in distress or condition worsens
150
What is inversion of the uterus?
= severe obstetric complication in which the fundus of the uterus collapses downwards, passing through the uterine cavity and the cervix, essentially turning the uterus inside out
151
Primary symptom of inverted uterus?
= large post-partum haemorrhage
152
Diagnosis of inverted uterus?
= diagnosis primarily clinical
153
Management for inversion of the uterus (3)
- Johnson manoeuvre (= involves using hand to push the funds back into the abdomen)
- hydrostatic methods
- laparotomy
154
What is Johnson manoeuvre?
= involves using hand to push the funds back into the abdomen
Used in managing an inverted uterus
155
What is kleihauer test?
= diagnostic procedure used to quantify the volume of foetal haemoglobin present in maternal circulation, often indicating foeto-maternal haemorrhage
156
Management of a pregnant women about to undergo a 'sensitising event' that is rhesus negative and is carrying a RhD +ve child?
= anti-D antibodies
157
How is listeria monocytogenes often contracted?
(transmission)
= food borne transmission - unpasteurised daily products, and soft cheeses
158
Investigation in suspected Listeria monocytogenes
= cultures of Listeria
159
Management of Listeria monocytogenes
= antibiotics - combination of Ampicillin and an aminoglycoside
160
What is classed as 'post-term pregnancy'?
= gestation that has advanced beyond 42 weeks, OR 294 days from the first day of the LMP
161
What is given to pregnant ladies to stimulate contractions is membrane sweep is unsuccessful in stimulating spontaneous labour?
= Prostaglandins
162
What is meconium?
= refers to initial faeces passed by a new-born, typically very thick and dark green in colour
163
What is 'meconium-stained liquor'?
= this refers to meconium-containing amniotic fluid that occurs when foetus expels into the amniotic fluid before birth
164
Concerns with presence of meconium in the amniotic fluid (2)
- meconium aspiration syndrome (MAS)
- meconium ileus
165
What might 'meconium-stained liquor' be a sign of?
= foetal distress and hypoxia
166
Meconium ileum can be an early sign of what condition?
= cystic fibrosis
167
Symptoms associated with meconium ileus? (3)
- bilious vomiting
- distended abdomen
- failure to pass meconium within the first 24 hours of life
168
What is usually prescribed alongside Methotrexate?
= Folic acid 5mg
168
What imaging is used in suspected meconium ileus?
= abdominal x-ray
169
What does taking Magnesium sulphate during pregnancy help with?
= reduces the risk of cerebral palsy
170
What is a miscarriage?
= defined as the loss of pregnancy prior to 24 weeks gestation
171
Clinical features of a miscarriage (3)
- vaginal bleeding
- pain
- vaginal tissue loss
172
What is a THREATENED miscarriage?
(cervical os?)
= mild symptoms of bleeding with the foetus retained within the uterus as the cervical os is closed
Hence, there is a ‘threat’ of a miscarriage, but it is not certain
173
What is an INEVITABLE miscarriage?
(cervical os?)
= often heavy bleeding and pain, where the foetus is currently intrauterine but the cervical os is open
Hence, it is inevitable that the foetus will be lost
174
What is a COMPLETE miscarriage?
(cervical os?)
= there was an intrauterine pregnancy which has now fully miscarried, with all products of conception expelled, and the uterus is now empty
The os is usually closed
175
What is a MISSED miscarriage?
(cervical os?)
= uterus still contains foetal tissue, but foetus no longer alive
The miscarriage is ‘missed’ as often the women is asymptomatic so does not realise something is wrong
Cervical os is closed
176
Imaging used to investigate a miscarriage
= transvaginal USS
177
What can be measured to investigate a miscarriage?
And what might the following levels suggest: levels fall, slight increase or plateau, normal increase
= serial hCG measurements
Levels fall: suggest foetus will not develop or there has been a miscarriage
Slight increase or plateau: this may indicate an ectopic pregnancy
Normal increase: foetus growing normally
[serial hCG measurements taken 48 hours apart]
178
Medical management for a miscarriage?
= Misoprostol
179
What is a recurrent miscarriage defined as?
= loss of 3 or more consecutive pregnancies
180
What is a molar pregnancy?
= occurs when there's a problem with a fertilised egg, which means a baby and a placenta do not develop the way they should after conception
181
2 types of molar pregnancies
- complete mole
- partial mole
182
Molar pregnancy: Difference between complete and partial mole
Complete mole = formation of a single sperm + empty egg, with no genetic material
Partial mole = formed from 2 sperm and a normal egg. Genital material present, variable evidence of foetal parts
183
How to identify a molar pregnancy (2)
- Transvaginal USS - snowstorm appearance
- B-hCG levels - significantly higher than what would be expected in normal pregnancy
184
What is a 'snowstorm' appearance on trans-vaginal USS indicate, in pregnancy?
= molar pregnancy
185
How often is hCG surveillance recommended for those with a partial molar pregnancy vs complete mole?
Partial mole: repeat hCG test is done 4 weeks later, if normal pt discharged
Complete mole: monthly repeat hCG are sent for at least 6 months
186
Disseminated features of neonatal herpes simplex virus infection (4)
- seizures
- encephalitis
- hepatitis
- sepsis
187
Investigation in neonatal herpes simplex virus (3)
Identify presence of virus in new-bon by either:
- PCR
- virus culture
- direct fluorescent antibody testing (DFA) testing
188
Treatment in neonatal herpes simplex virus infection
= acyclovir
(parenteral)
189
What type of analgesia is generally avoided in obstetrics due to potential risks to the foetus and mother?
= NSAIDs
190
What is obstetric cholestasis?
= pregnancy-related hepatobiliary disorder which typically manifests after 24th week of gestation
Condition characterised by impaired bile flow leading to accumulation of bile acids
191
Signs and symptoms associated with obstetric cholestasis (4)
- pruritus
- nausea + loss of appetite
- jaundice (pale stool + dark urine)
- abdo pain (RUQ)
192
Investigations for suspected obstetric cholestasis (2)
- bile acid measurements
- LFTs
(important to do foetal monitoring due to risk of spontaneous intra-uterine death)
193
Management of obstetric cholestasis (3)
- Chlorphenamine, to alleviate itching
- Vitamin K, minimise the risk of bleeding
- early delivery
(Ursodeoxycholic acid can be used off-licence to reduce serum bile acids + relieve pruritus)
194
What is the risk associated with obstetric cholestasis?
= spontaneous intrauterine death
(hence, early delivery planning important)
195
What is oligohydramnios?
= defined as the presence of a lower than normal volume of amniotic fluid within the uterus
196
Maternal drugs of which medications could cause oligohydramnios (2)
- ACE I
- prostaglandin inhibitors
197
What is Potter syndrome?
= group of findings associated with a lack of amniotic fluid and kidney failure in an unborn infant
198
How is oligohydramnios diagnosed?
= USS, which shows reduced amniotic fluid index (AFI), or single deepest pocked (SDP)
199
Management options for oligohydramnios (3)
- maternal rehydration
- amnioinfusion
-delivery
200
What is amnioinfusion?
= infusion of saline into the amniotic cavity to increase the volume of amniotic fluid
201
What is ovarian hyper-stimulation syndrome (OHSS)?
= a complication arising from iatrogenic induction of ovulation, characterised by an exaggerated response to hormonal therapies used in procedures such as in-vitro fertilisation (IVF)
202
Signs and symptoms associated with ovarian hyper-stimulation syndrome (2)
Overstimulation of the ovaries can cause significant enlargement, leading to pressure on surrounding structures leading to,
- abdominal discomfort
- bloating
Blood vessels leak, leading to fluid retention:
- oedema
- pleural effusions
- ascites
- weight gain
203
Investigations for ovarian hyper-stimulation syndrome (OHSS) (2)
- routine blood tests (evaluate haemoconcentration and detect potential organ dysfunction)
- CXR, to identify presence of pleural effusion
204
Management of ovarian hyper-stimulation syndrome (OHSS)
= largely supportive
205
What is pelvic inflammatory disease (PID)?
= sexually transmitted infection that spread from the vagina > into cervix > and upper genital tract
205
How is pelvic inflammatory disease typically spread?
= sexual contact
205
When might you not milk the cord during third stage of labour?
= preterm babies - risk of intraventricular haemorrhage
205
Management of pelvic inflammatory disease (PID)
Combination of antibiotics, such as:
- Ceftriaxone (IM) + doxycycline + metronidazole
- Ofloxacin + metronidazole
Analgesia may also be required, and the patient is generally reviewed after 4 weeks
205
Main causes of pelvic inflammatory disease (PID)? (2)
- gonorrhoea
- chlamydia
205
Postpartum haemorrhage: 4T's of why she's bleeding
T - tone (failure of uterus to contract after delivery)
T - trauma
T - tissue (retained placental or foetal tissue)
T - thrombin
205
What might RUQ pain in pelvic inflammatory disease (PID) suggest?
= Fitz-High-Curtis syndrome
206
Complications of pelvic inflammatory disease (PID) (3)
- chronic pelvic pain
- infertility
- ectopic pregnancy
207
What is Fitz-hugh-curtis syndrome?
= anterior liver capsule and the anterior abdominal wall or diaphragm in the context of PID
Despite this, LFTs are usually normal
208
What is classed as a first degree perineal tear?
= tear limited to the superficial perineal skin or vaginal mucosa only
209
What is classed as a second degree perineal tear?
= tear extends to perineal muscles + fascia, but the anal sphincter is intact
210
An episiotomy is classed as a
- first-degree tear
- second-degree tear
- third-degree tear
- second-degree tear
211
What is classed as a third degree 3a, perineal tear?
= < 50% of the thickness of external anal sphincter is torn
212
What is classed as a third degree 3b, perineal tear?
= > 50% of the thickness of the external anal sphincter is torn, but internal anal sphincter is intact
213
What is classed as a third degree 3c, perineal tear?
= external + internal anal sphincters are torn, but anal mucosa is intact
214
What is classed as a fourth degree tear?
= perineal skin, muscle, anal sphincter, and anal mucosa are torn
215
Perineal tears: what should be given post-operatively? (2)
- broad-spectrum antibiotics
- laxatives
216
Do first degree perineal tears require suturing?
= if bleeding minimally, no
217
What is placenta accreta vs placenta increta vs placenta percreta?
Placenta accreta = occurs where there is adherence of the placenta directly to the superficial myometrium but does not penetrate the thickness of the muscle
Placenta increta = occurs where the villi invade into but not through the myometrium
Placenta percreta = occurs when the villi invade through the full thickness of the myometrium to the serosa. There is increased risk of uterine rupture and in severe cases the placenta may attach to other abdominal organs such as the bladder, or rectum
218
Imaging to help diagnose a placenta accreta spectrum? (2)
- doppler USS
- MRI
(antenatal diagnosis is difficult to make)
218
Complications of abnormal placental implantation (3)
- severe postpartum bleeding
- preterm delivery
- uterine rupture
219
If abnormal placental implantation is suspected what is the safest management? (2)
- elective c-section
- hysterectomy
(if important to preserve patient's fertility, a less destructive placental resection may be attempted)
220
What is a placental abruption?
= premature separation of the placenta from the uterine wall during pregnancy, resulting in maternal haemorrhage
221
What is placenta praevia?
= placenta overlying the cervical os
222
Imaging used to investigate placenta praevia?
= transvaginal USS
223
What terminology is used to describe the head in relation to the ischial spine?
= station
224
What is postpartum depression?
= significant mood disorder that can develop at any time up to 1 year after the birth of a baby
225
Prevalence of postpartum depression in mothers within year of childbirth?
= 10-20%
226
What screening tool is there for postnatal depression?
= Edinburgh Postnatal Depression Scale (EPDS)
(consists of 10 questions and takes around 5 minutes to complete. It evaluates the intensity of depression symptoms over the past 7 days)
227
First-line treatment in postnatal depression?
= self-help strategies, and psychological therapies such as CBT or interpersonal therapy (IPT)
228
Pharmacological treatment used in postnatal depression?
= anti-depressants
229
Which type of anti-depressants are used in postnatal depression (2)
- Sertraline
- Paroxetine
(due to their safety profile in breastfeeding)
230
How is baby blues managed?
= with reassurance + support
231
What is pre-eclampsia?
= placental condition that often affects pregnant women from around 20 weeks of gestation, characterised by HTN + proteinuria
232
What causes pre-eclampsia?
(pathophysiology)
= related to dysfunctional trophoblast invasion of the spiral arterioles, which result in decreased uteroplacental blood flow and subsequent endothelial cell damage
233
Main signs + symptoms in pre-eclampsia (4)
- HTN
- proteinuria
- peripheral oedema
- headaches
234
Key investigations in pre-eclampsia (3)
- BP measurements
- urinalysis
- blood tests (kidney function, LFT + clotting status)
235
What can be used for prophylaxis against the development of pre-eclampsia?
Aspirin
(given from 12 weeks gestation until birth)
236
Which anti-hypertensive treatment is recommended as first-line agent?
= Labetalol
237
What can be given to prevent + treat eclamptic seizures?
= magnesium sulphate
238
Definitive curative treatment for pre-eclampsia?
= delivery of the placenta
239
What is a postpartum haemorrhage defined as?
= defined as the loss of at least 500ml of blood within the first 24 hours of delivery
240
Initial management in post-partum haemorrhage (5)
- resuscitation ABCDE
- major haemorrhage protocol
- lay woman flat
- insert 2 large bore cannulas
- Oxygen
(consider FFP if clotting abnormalities present)
241
What is B-lynch suture around the uterus used for?
= can be used to reduce bleeding in postpartum haemorrhage
242
Pre-labour rupture of membranes (PROMS) at term is associated with what risks? (2)
- chorioamnionitis
- neonatal infection
243
Signs and symptoms of pre-labour rupture of membranes (3)
- foul-smelling or greenish amniotic fluid
- maternal fever
- reduced foetal movements
244
Which of the following rashes in pregnancy typically forms around the umbilicus and progresses to form blisters. Is also thought to be auto-immune
- polymorphic eruption of pregnancy (PEP)
- obstetric cholestasis
- atopic eruption of pregnancy
- pemphigoid gestationis
- pemphigoid gestationis
245
What is the Foetal fibronectin test (fFN test)?
= a screening test used to assess the risk of preterm delivery after the onset of pre-term labour
246
What does a negative Foetal fibronectin (fFN) test suggest?
= low risk of delivery occurring within the next 7-14 days
247
Recommended first-line tocolytic agent to delay labour?
= Nifedipine
248
Management of preterm labour? (3)
- corticosteroids (to accelerate foetal lung maturation)
- IV antibiotics, Penicillin - if evidence of infection
- tocolytic agents can be considered, Nifedipine
249
What is shoulder dystocia?
= specific type of obstructed labour, where following the delivery of the foetal head the anterior shoulder becomes impacted behind the maternal pubic symphysis
250
What is the 'turtle sign', and what is this indicative of?
Turtle sign = retraction of the foetal head back into the birthing canal
This is suggestive of shoulder dystocia
251
Describe McRoberts manoeuvre, and what is this used in?
= involves hyperflexion + abduction of the mother’s legs tightly to the abdomen, may be accompanied with applied suprapubic pressure
Manoeuvre used in shoulder dystocia
252
What is a cleidotomy + symphysiotomy?
Cleidotomy = 1 or both clavicles are cut to reduce biacromial diameter in case of shoulder dystocia
Symphysiotomy = fibres of pubic symphysis pubis are divided with a scalpel, allows pubic bones to separate, creating more space in the pelvis for the birth of the baby
253
Shoulder dystocia: Describe Zavanelli manoeuvre
= replacement of the head into the canal and then subsequent delivery by c-section
254
What is spina bifida occulta?
= incomplete fusion of the vertebrae, but with no herniation of the spinal cord. May be visible only as a small tuft of hair overlying the site
255
Spina bifida: meningocele vs. myelomeningocele
Meningocele = incomplete fusion of the vertebrae, with herniation of a meningeal sac containing CSF. Visible prominence at the site, but usually covered by skin
Myelomeningocele = incomplete fusion of the vertebrae with herniation of a meningeal sac containing CSF and the spinal cord
256
What is taken to decrease the risk of neural tube defects in pregnancy?
= Folic acid (400 micrograms/day)
(in high risk women: 5mg/day)
257
What is spinal bifida?
= neural tube defect characterised by incomplete development of the spinal column, resulting in herniation of the spinal cord
258
Which type of twins are more common:
- monozygotic twins
- dizygotic twins
- dizygotic twins
259
What is twin-to-twin transfusion syndrome (TTTS)?
= a condition in which the blood flows unequally between twins that share a placenta (monochorionic twins)
260
In twin-to-twin transfusion syndrome both foetuses are at risk of developing? (2)
- heart failure
- hydrops (oedema)
261
The following classical triad of symptoms is associated with what obstetric condition?
- painless vaginal bleeding
- rupture of membranes
- foetal bradycardia (or resulting foetal death)
= vasa praevia
262
What is vasa praevia?
= condition seen in obstetrics where the foetal vessels, unprotected by the umbilical cord or placental tissue, run dangerously close to or across the internal cervical os
263
Primary management for vasa praevia?
= elective caesarean section, prior to rupture of membranes
264
Pregnancy-induced HTN vs. pre-eclampsia?
Pregnancy-induced hypertension is a rise in blood pressure, without proteinuria, during the second half of pregnancy
Pre-eclampsia is a multisystem disorder, unique to pregnancy, that is usually associated with raised blood pressure and proteinuria.
265
Select most appropriate management option for the following maternal diabetes scenarios
Woman with a bad gycaemic control, macrosomic baby and non-reactive CTG
- cesarean
- delivery at 36 weeks
- deliver at 38+6 weeks
- commence insulin
- no change in management
- continue serveillance
- cesarean
266
Select most appropriate management option for the following maternal diabetes scenarios
Woman with a diabetic diet and home monitoring demonstrating glucose levels of 18 mmol/L after meals
- cesarean
- delivery at 36 weeks
- deliver at 38+6 weeks
- commence insulin
- no change in management
- continue serveillance
- commence insulin
267
Select most appropriate management option for the following maternal diabetes scenarios
Woman with a glucose tolerance test at 28 weeks that shows a fasting glucose of 5.1 and 2 hour value of 7.6 mmol/L
- cesarean
- delivery at 36 weeks
- deliver at 38+6 weeks
- commence insulin
- no change in management
- continue serveillance
- no change in management
268
Select most appropriate management option for the following maternal diabetes scenarios
Woman with using insulin, with a macrosomic baby and poor glycaemic control at 36 weeks gestation
- cesarean
- delivery at 36 weeks
- deliver at 38+6 weeks
- commence insulin
- no change in management
- continue serveillance
- delivery at 36 weeks
269
Select most appropriate management option for the following maternal diabetes scenarios
Woman using insulin with a normal sized baby and good glycaemic control at 36 weeks gestation
- cesarean
- delivery at 36 weeks
- deliver at 38+6 weeks
- commence insulin
- no change in management
- continue serveillance
- deliver at 38+6 weeks
270
Select most appropriate management option for the following maternal diabetes scenarios
Woman using insulin, with a normal sized baby and good glycemic control at 36 weeks
- cesarean
- delivery at 36 weeks
- deliver at 38+6 weeks
- commence insulin
- no change in management
- continue serveillance
- continue serveillance
271
Pre-pregnancy counselling, with concerns about foetal abnormalities:
Woman has had insulin-dependent diabetes for 21 years. Her BMI is 32 kg/m2 and she is currently treated with Nifedipine
- Folic acid 400mcg/d
- Folic acid 5mg/d
- Stop all medication
- Stop alcohol consumption
- No changes advised
- Folic acid 5mg/d
272
Pre-pregnancy counselling, with concerns about foetal abnormalities:
Woman takes methadone 60ml/d, smokes, binge drinks alcohol twice weekly
- Folic acid 400mcg/d
- Folic acid 5mg/d
- Stop all medication
- Stop alcohol consumption
- No changes advised
- Stop alcohol consumption
273
Pre-pregnancy counselling, with concerns about foetal abnormalities:
Woman is a healthy secondary school teacher
- Folic acid 400mcg/d
- Folic acid 5mg/d
- Stop all medication
- Stop alcohol consumption
- No changes advised
- Folic acid 400mcg/d
The Department of Health recommends that women should take a daily supplement of 400 micrograms of folic acid while they are trying to conceive, and should continue taking this dose for the first 12 weeks of pregnancy, when the baby's spine is developing
274
28 year old primigravida presents to the antenatal clinic at 33 weeks, with headache, symptoms of flashing lights in the eyes and proteinuria. She is found to have a BP of 160/95 mmHg
What would be a reasonable management option?
- ACEi administration
- admission for immediate delivery
- admission for monitoring/ serology
- admission for monitoring/ serology
This woman has classic signs of pre-eclampsia and requires careful monitoring
275
2 year old post-menopausal woman has a one month history of passing dark blood PV intermittently.
What is the most likely diagnosis at this stage?
- cervical cancer
- ovarian cancer
- endometrial cancer
- endometrial cancer
276
Which one of the following statements regarding the National Cervical Screening Programme is true?
- available for those between 20 to 75
- has reduced the incidence of CIN
- cells are examined for squmaous metaplastic epithelium
- offered every 2 years
- cells are examined for squmaous metaplastic epithelium
277
Fundus at umbilicus suggests what estimated gestation?
- 18 weeks
- 20 weeks
- 24 weeks
- 28 weeks
- 38 weeks
- 20 weeks
278
Fundus midway to xiphoid suggests what estimated gestation?
- 18 weeks
- 20 weeks
- 24 weeks
- 28 weeks
- 38 weeks
- 28 weeks
279
Fundus at the level of the xiphoid suggests what estimated gestation?
- 18 weeks
- 20 weeks
- 24 weeks
- 28 weeks
- 38 weeks
- 38 weeks
280
A couple have a 2 year history of failure to conceive. The man has a 5 year old child from a previous marriage. The woman has a normal cycle but had an ectopic pregnancy 3 years ago.
What investigation is likely to provide the most useful information relating to their problem?
- hormone profile
- laparoscopy and dye test
- semen analysis
- laparoscopy and dye test
The male partner is fertile, there is a strong possibility that the female has a tubal problem given that she already had a tubal pregnancy
281
Which one of the following situations best defines the onset of the 1st stage of labour?
- Braxton-Hicks contractions
- cervical dilatation at a rate of 1cm per hour
- regular painful contractions
- regular painful contractions with cervical dilatation
- regular painful contractions with cervical dilatation
282
44 year old woman, coming to the end of the first trimester of her pregnancy, is worried that her unborn child may have Down’s syndrome.
What is the most appropriate first test?
- chorionic villous sampling
- beta-human chorionic gonadotrophin
- combined blood test and USS scan
- serum fetoprotein
- combined blood test and USS scan
283
5 year old woman has a long history of pre-menstrual pain, periods are regular and there is no menorrhagia
Pelvic examination reveals some thickening in the Pouch of Douglas and a normal sized uterus
What is the probable cause of her problem?
- endometriosis
- fibroids
- ovarian cyst
- retroverted uterus
- endometriosis
284
What is Mittelschmerz?
= AKA, ovulation pain - is a benign preovulatory lower abdominal pain that occurs midcycle (between days 7 and 24) in women.
285
25 year old primigravida has delivered vaginally two weeks ago. She is worried that she continues to have an offensive vaginal discharge and feels unwell
On examination she has a temperature of 37.2˚C and a uterus just palpable above the pubic symphysis.
What is the most appropriate course of action?
- refer for dilatation and curettage
- prescribe Fluconazole
- start Tranexamic acid
- start broad spectrum antibiotic
- start broad spectrum antibiotic
286
27 year old primigravida is 26 weeks pregnant but fundal height does not match calculated dates. You suspect foetal growth retardation
What finding would favour this diagnosis?
- increased head to abdominal circumference ratio
- decreased head to abdominal circumference ratio
- foetal HR of 170 bpm
- increased end diastolic doppler flow through the placenta
- increased head to abdominal circumference ratio
287
A couple have been trying to conceive for two years with no success. The husband is found to have a reduced sperm count and also to have an excess of white cells in the semen
What further action should be taken?
- investigate women for subfertility
- obtain male urethral specimens for bacteriological investigation
- treat the man with gonadotrophin injections for 6 months
- obtain male urethral specimens for bacteriological investigation
An excess of white cells in the semen is indicative of latent infection possibly prostatitis or urethritis, both of which may be asymptomatic
288
34 year old woman presents with a 6 month history of amenorrhoea. Prior to this her periods were normal. Investigations show a low oestradiol, but FSH and LH are raised
What is the likely diagnosis?
- pituitary adenoma
- PCOS
- premature ovarian failure
- silent miscarriage
- premature ovarian failure
289
A woman at 34 weeks gestation presents with a mild headache and some ankle swelling
What further finding would be consistent with a diagnosis of pre-eclampsia?
- raised alkaline phosphatase
- raised protein/ creatinine ratio
- raised a fetoprotein
- reduced hb
- raised protein/ creatinine ratio
A protein/creatinine ratio(PCR) of 30 mg/mmoL or more on a random sample or a urine protein excretion of 300 mg or more per 24 hours will support diagnosis of pre-eclampsia
290
A 33 year old woman has had a previous delivery by caesarean section (LSCS) for breech presentation. She attends clinic asking what the delivery options are for the next child
What advice would it be most appropriate to give her in this situation?
- chance at a successful vaginal delivery is 72-75%
- chance at a successful vaginal delivery is 95%
- labour should be induced at 38 weeks
- she cannot have a forceps or vacuum assisted delivery
- chance at a successful vaginal delivery is 72-75%
291
42 year old woman has had a vaginal delivery five days ago. She comes to see you complaining of feeling unwell with offensive lochia. Examination shows that she has a low grade fever and that the fundus is at the level of the umbilicus
The cervix admits a finger, what would you do next?
- arrange midwifery review the next day
- take swab and review in 48 hours
- treat with oral antibiotic
- admit for scan and treat with antibiotics
- admit for scan and treat with antibiotics
292
60 year old woman is on tamoxifen as an adjuvant treatment for breast cancer. After three years of treatment she presents with some blood-stained vaginal discharge
What would be the appropriate course of action?
- re-assure that this is an expected SE
- reduce dose and review in 2 weeks
- measure endometrial thickness with USS
- measure endometrial thickness with USS
293
40 year old woman presents with a six month history of frequency of micturition, and of urgency, she gets occasional mild dysuria. Urine culture is negative. You suspect that she has an unstable bladder
What investigation would be best in confirming this?
- cystoscopy
- bladder USS
- radionuclide renogram
- urodynamics
- urodynamics
294
17 year old girl presents with primary amenorrhoea.
On examination she is thin and has normal secondary sexual development. She has fine hair on her face and back. Investigations reveal low levels of oestradiol, luteinising hormone and of follicle stimulating hormone
What is the most likely diagnosis?
- Kleinfelter's syndrome
- anorexia nervosa
- Turner's syndrome
- hypopituitarism
- anorexia nervosa
295
49 year old woman, gravida 3 para 3, presents to you complaining that she missed her period for three months and this was followed by very heavy vaginal bleeding that persisted for three weeks
Which of the following is the most likely cause of her symptoms?
- anovulatory bleed
- endometrial cancer
- multifibroid uterus
- PID
- anovulatory bleed
296
47 year old woman, who smokes 20 cigarettes per day, complains of menorrhagia for one year. You have investigated her and treated her with cyclical progesterone therapy without improvement. She does not want any surgery
What is the most appropriate option for her?
- COCP
- endometrial resection
- laser endometrial ablation
- progesterone releasing intrauterine device (Mirena)
- progesterone releasing intrauterine device (Mirena)
297
28 year old woman in her first pregnancy has a single episode of vaginal bleeding at about ten weeks gestation.
She estimates it to be about 10 ml which settled spontaneously and has not recurred. She consults you two weeks later and you arrange a scan which shows normal pregnancy
What is the guidance you would give her?
- have a Pap smear immediately
- take extra iron tablets
- pregnancy now regarded 'high risk' with weekly scans
- pregnancy should be regarded as normal
- pregnancy should be regarded as normal
90% of women who experience vaginal bleeding or spotting during early pregnancy will not miscarry
298
3 year old woman presents to you complaining of eight weeks of amenorrhoea. She is sexually active and not using any contraception.
She is also complaining of increasingly severe abdominal pain, associated with nausea but no vomiting.
On examination you find that she is apyrexial and, on palpation of the lower abdomen, there is guarding and rebound tenderness. This is confirmed on vaginal examination, which reveals cervical excitation tenderness.
What condition would you consider to be the most likely cause of her symptoms?
- acute appendicitis
- ectopic pregnancy
- PID
- threatened miscarriage
- ectopic pregnancy
299
23 year old woman presents to you complaining of eight weeks of amenorrhoea. She is sexually active and not using any contraception. She is also complaining of increasingly severe abdominal pain, associated with nausea but no vomiting.
On examination you find that she is apyrexial and, on palpation of the lower abdomen, there is guarding and rebound tenderness. This is confirmed on vaginal examination, which reveals cervical excitation tenderness.
What would you consider to be the most appropriate further management of this patient?
- admit to hospital, give analgesia & antibiotic trial
- CT of abdomen
- dilation and curettage
- laparoscopy or laparotomy
- laparoscopy or laparotomy
laparoscopic treatment (salpingostomy or salpingectomy) of EPs offers major benefits superior to laparotomy in terms of less blood loss, less need for blood transfusion, less need for postoperative analgesia and a shorter duration of hospital stay
300
A woman who booked with your clinic at eight weeks by dates has an initial haemoglobin of 11 g/dl. She has a reasonable diet and complains of fatigue at 28 weeks gestation. She looks pale so you retest her blood count which comes back with a haemoglobin of 9 g/dl.
What treatment option is most appropriate?
- do serum folic acid test
- do her iron levels and give IV iron dextran
- do iron levels and give iron tablets
- give folic acid tablets
- do iron levels and give iron tablets
301
A woman reports to you that she had a vaginal bleed the previous day. She says it was about a teaspoon-full amount and has not recurred.
She is 37 weeks by confirmed dates and has an otherwise uncomplicated pregnancy. You elect to do a speculum examination.
What is the reasoning behind this decision?
- to see how dilated the cervix is
- establish a local cause for the bleed
- to exclude a major degree of placenta praevia
- do a Pap smear
- establish a local cause for the bleed
