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Year 4 > Obstetrics > Flashcards

Obstetrics Flashcards

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)

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2
Q

What is Goodell’s sign?

A

= softer cervix, is an indication of pregnancy

(typically presents at 6 weeks)

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3
Q

What is Chadwick’s sign?

A

= blue discolouration of the cervix, vaginal and vulva

(presents 6-8 weeks after conception)

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4
Q

What is Osianders sign?

A

= pulsation can be felt through the lateral vaginal fornix

(presents typically at 8 weeks post-conception)

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5
Q

Naegele’s rule for estimating due date in pregnancy

A

= add 7 days and subtract 3 months to find due date (EDD)

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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

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7
Q

What is folic acid important for in pregnancy?

A

= foetal neural tube development

Reduces risk of spina bifida, anencephaly and related defects

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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
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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
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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

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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)

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11
Q

Are female or male foetuses a risk factor for acute fatty liver of pregnancy (AFLP)?

A

= male foetuses

(+ multiple pregnancies)

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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)

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13
Q

What is Swansea criteria used to help diagnose?

A

= acute fatty liver of pregnancy (AFLP)

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14
Q

What is the only curative treatment for acute fatty liver of pregnancy (AFLP)?

A

= delivery of foetus

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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

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16
Q

Why might you do an USS in a women with antepartum haemorrhage?

A

= to exclude placenta praevia

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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)

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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)

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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

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20
Q

Management of asymptomatic bacteriuria in pregnancy

A

= treatment with antibiotics

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21
Q

Which antibiotics are commonly used to treat asymptomatic bacteriuria in pregnancy?

A

= Nitrofurantoin + Cefalexin

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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

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23
Q

Up to what % of women experience baby blues?

A

= up to 80% (very common)

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23
Q

Out of the women who develop baby blues, what % go on to develop postnatal depression?

A

= 10%

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24
Q

What screening tool may be used to help identify postnatal depression?

A

= Edinburgh Postnatal Depression Scale

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25
Q

Treatment of baby blues?

When should mothers be advised to seek help (time)?

A

= primarily supportive, reassure this is a common condition

Mothers should be encouraged to seek help if symptoms persist beyond 2 weeks

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26
Q

When should the booking appointment be conducted before?

A

= before 10 weeks gestation

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27
Q

What is the aim of the booking appointment?

A

= to identify women who may require additional support throughout their pregnancy

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28
Q

What blood borne viruses are tested for at the booking appointment? (4)

A
  • rubella
  • HIV
  • syphilis
  • hepatitis B
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29
Q

Which of the following is the preferred opiate analgesia for breastfeeding mothers?

  • codeine
  • dihydrocodeine
  • hydrocodone
A
  • dihydrocodeine
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30
Q

Can a breastfeeding mother use aspirin as a painkiller?

A

= should be avoided

(increased risk of Reye’s syndrome in paediatric viral infection)

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31
Q

Why should aspirin be avoided in breastfeeding mothers?

A

= increased risk of Reye’s syndrome in paediatric viral infection

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32
Q

Are breastfeeding mothers allowed to drink alcohol?

A

= can have occasional, small amounts of alcohol but should not drink regularly or heavily

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33
Q

A HIV-positive mother comes to see you and asks if she is able to breastfeed her child

A

= current recommendations advise that HIV-infected mothers should refrain from breast feeding

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34
Q

Any risk of transmitting hepatitis B or C in a positive-mother breastfeeding her child?

A

= no, provided the infant has received appropriate HBV immunoprophylaxis

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35
Q

What is a primiparous women?

A

= giving birth for the first time

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36
Q

What is a breech presentation?

A

= 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

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37
Q

What is frank breech?

A

= when the baby’s legs are folded flat up against his head and his bottom is closest to the birth canal

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38
Q

What is footling breech?

A

= where one or both feet are presenting

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39
Q

What imaging can be used to assess presentation of foetus?

A

= USS scan

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40
Q

What can be done to help turn a breech presenting foetus?

A

= external cephalic version (ECV), manual procedure where an experienced physician attempts to turn the baby using their hands on the abdomen

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41
Q

When is a primiparous women + multiparous women offered a ECV if their foetus is breech presenting?

A

Primiparous: at 36 weeks
Multiparous: at 37 weeks

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42
Q

Success rate of an external cephalic version (ECV)?

A

= 50%

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43
Q

What are tocolytics?

A

= medications to suppress preterm labour

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44
Q

What will a Rh negative women be given before external cephalic version (ECV)?

A

= anti-D immunoglobulin

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45
Q

What is a category 1 emergency caesarean?

(+ what is decision to delivery time?)

A

= immediate threat to life of mother + baby

Decision to delivery time is 30 minutes

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46
Q

What is a category 2 emergency caesarean?

(+ what is decision to delivery time?)

A

= no imminent threat to life but required urgently due to compromise of mother or baby

Decision to delivery is 75 minutes

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47
Q

What is a category 3 emergency caesarian?

A

= delivery is required but mother and baby are stable

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48
Q

What is a category 4 emergency caesarian?

A

= elective caesarean

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49
Q

What is chorioamnionitis?

A

= bacterial infection that affects the membranes surrounding the foetus (the amniotic sac) and the amniotic fluid within the uterus

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50
Q

Most common organisms in chorioamnionitis? (3)

A
  • Group B streptococcus
  • E. coli
  • anaerobic bacteria
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51
Q

Management of chorioamnionitis

A
  • IV broad spectrum antibiotic therapy (as part of sepsis 6)
  • early delivery necessary in some cases
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52
Q

A baby with congenital cytomegalovirus infection (CMV) may develop long-term neurological consequences such as? (3)

A
  • hearing loss
  • visual impairment
  • learning disability
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53
Q

Antenatally, are foetal abnormalities associated with CMV detected?

A

= USS

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54
Q

Postnatally, how is CMV infection typically diagnosed?

A

= testing an affected infant’s saliva, urine, or blood for the presence of the virus

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55
Q

How is cytomegalovirus transmitted?

A

= through close contact with a person excreting the virus in their saliva, urine, or other bodily fluids

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56
Q

What vaccine protects women + babies from rubella?

A

= MMR vaccine

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57
Q

In which trimester is it more common for a pregnant women to contract rubella?

A

= first trimester

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58
Q

‘Blueberry muffin’ rash is characteristic of?

A

= rubella (or other health conditions)

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59
Q

New-borns with congenital rubella syndrome (CRS) commonly present with? (3)

A
  • sensorineural deafness
  • cataracts or retinopathy
  • congenital heart disease
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60
Q

Investigations of congenital rubella syndrome (CRS)?

A

= serology tests (look for antibodies)

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61
Q

Management of congenital rubella syndrome (CRS)?

A

= mainly supportive + symptomatic

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62
Q

What is a cord prolapse?

A

= refers to a situation during labour when the umbilical cord exits the cervix ahead of the infant

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63
Q

Signs of a cord prolapse? (2)

A
  • feeling cord in vagina
  • abnormal foetal HR
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64
Q

Investigations of a cord prolapse (2)

A

Cardiotocography: monitor foetal HR + maternal contractions

Vaginal examination: to confirm presence of umbilical cord in birth canal

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65
Q

What is cardiotocography (CTG)?

A

= a continuous recording of the fetal heart rate obtained via an ultrasound transducer placed on the mother’s abdomen

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66
Q

What position is best for mum to prevent further cord prolapse?

A

= ‘knees-chest’ position

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67
Q

What is Down syndrome?

A

= trisomy 21, is a genetic condition resulting from the presence of 3 copies of chromosome 21, rather than the typical 2 copies

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68
Q

3 main genetic mechanisms responsible for down syndrome

A

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

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69
Q

Features of Down syndrome (4)

A
  • 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)
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70
Q

At what point in pregnancy are women offered a screening test for down syndrome?

A

= between week 10-14

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71
Q

When screening for Down syndrome, what trisomy’s are tested for? (3)

A
  • 13 (patau syndrome)
  • 18 (Edwards syndrome)
  • 21 (Down syndrome)
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72
Q

What tests are used as part of the screening programme to identify risk of your baby having down syndrome? (3)

A
  • combined test
  • triple test
  • quadruple test
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73
Q

Down syndrome screening: which test is recommended?

A

= combined test

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74
Q

Down syndrome screening: when can combined test be done?

(between week _ +_)

A

= between week 10-14

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75
Q

If a pregnant women presents after week 14, what other tests can be done to screen for down syndrome? (2)

A
  • triple test
  • quadruple test
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76
Q

Down syndrome screening: If a women’s pregnancy is high risk, what is the next step?

A

= women offered a diagnostic test which can provide definitive answer

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77
Q

Down syndrome screening: what diagnostic tests can test for Down syndrome? (2)

A
  • chorionic villus sampling
  • amniocentesis
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78
Q

What is eclampsia?

A

= development of seizures in association pre-eclampsia

Pre-eclampsia:
- condition seen after 20 weeks gestation
- pregnancy-induced hypertension
- proteinuria

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79
Q

Aetiology of pre-eclampsia

A

= 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

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80
Q

Key investigations for pre-eclampsia (3)

A
  • BP measurement (HTN)
  • urinalysis (proteinuria)
  • blood tests (kidney + liver function, clotting status)
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81
Q

What can be given as prophylaxis against developing pre-eclampsia?

A

= Aspirin

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82
Q

When is Aspirin given as prophylaxis for pre-eclampsia?

A

= from 12 weeks’ gestation until birth

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83
Q

Who should be given Aspirin as prophylaxis for pre-eclampsia?

(how many high or moderate risk factors) (2)

A
  • 1 high risk factor, OR
  • 2 moderate risk factors or more
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84
Q

What is the recommended anti-hypertensive treatment for a pregnant women with pre-eclampsia?

A

= Labetalol

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85
Q

What can be given to prevent + treat eclamptic seizures?

A

= magnesium sulphate

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86
Q

Definitive curative treatment of pre-eclampsia/ eclampsia?

A

= delivery of the placenta

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87
Q

Why is it important to monitor plasma anti-epileptic drug levels in a pregnant women with epilepsy?

A

= 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

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88
Q

The safest anti-epileptic drugs in pregnancy (2)

A
  • Levetiracetam
  • Lamotrigine
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89
Q

What is important for pregnant women to take to minimise the risk of neural tube defects?

A

= folic acid, 5mg/ day

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90
Q

What is an important supplement for a pregnant women on an anti-epileptic regime to take?

A

= vitamin K therapy

(anti-epileptic regimes may inhibit foetal clotting factor production)

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91
Q

What is congenital toxoplasmosis?

A

= infection caused by the protozoan parasite Toxoplasma gondii

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92
Q

Primary host of Toxoplasma gondii?

A

= cats

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93
Q

How can humans contract Toxoplasma gondii (protozoan parasite responsible for toxoplasmosis)? (3)

A
  • direct contact with cat faeces
  • ingesting undercooked meat
  • exposure to contaminated soil
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94
Q

What sort of problems can a person go on to develop if they contract congenital toxoplasmosis? (4)

A
  • CNS problems (such as cerebral palsy, epilepsy, hydrocephalus)
  • learning difficulties
  • visual impairment
  • hearing loss
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95
Q

Pharmacological management for congenital toxoplasmosis?

(to reduce transmission to baby)

A

= Spiramycin (antibiotic)

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96
Q

What is congenital varicella zoster virus?

A

= occurs when a non-immune women contracts the varicella zoster virus (VZV) during the first trimester of pregnancy

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97
Q

Clinical features of congenital varicella syndrome (6)

A
  • low birth weight
  • limb hypoplasia
  • skin scarring
  • microcephaly
  • eye defects
  • learning difficulties
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98
Q

What can be given if a non-immune pregnant women comes into contact with a person infected with varicella-zoster virus?

A

= immunoglobulins (as a preventative measure)

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99
Q

Treatment of choice if pregnant women contracts varicella zoster virus (VZV) during pregnancy?

A

= Acyclovir

(should be administered within 24 hours of the onset of the rash)

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100
Q

Congenital varicella zoster virus: post-delivery what can be given to neonate?

A

= IV acyclovir

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101
Q

What is the first stage of labour defined as?

(starts and ends when)

A

Starts with regular uterine contractions, and ends when cervix is fully dilated to 10cm

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102
Q

What can the first stage of labour be further divided into? (2)

A

Latent phase: 0-3cm cervical dilation

Active phase: 3-10cm cervical dilation

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103
Q

What is classed as a fully dilated cervix?

A

= 10cm

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104
Q

Which 2 hormones are primarily involves in stimulating regular uterine contractions during the first stage of labour?

A

Prostaglandins and oxytocin

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105
Q

What is the second stage of labour defined as?

(starts and ends when)

A

Starts with complete cervical dilation, and ends with delivery of the foetus

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106
Q

What is the third stage of labour defined as?

(starts and ends when)

A

Starts at delivery of the foetus and ends with the delivery of the placenta and foetal membranes

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107
Q

How might the third stage of labour be expedited (hurried along)?

A

= administration of oxytocin

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108
Q

What is controlled cord traction?

A

= manual method used to deliver the placenta

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109
Q

What is gestational diabetes (GDM) defined as?

A

= 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’)

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110
Q

Management of gestation diabetes (GDM)

A

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

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111
Q

Gestation diabetes (GDM) blood glucose targets:

Fasting:
1 hour after meals:
2 hours after meals:

A

Fasting: 5.3 mmol/L
1 hour after meals: 7.8 mmol/L OR,
2 hours after meals: 6.4 mmol/L

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112
Q

Clinical features associated with group B streptococcus infection in a new-born (3)

A
  • sepsis
  • pneumonia
  • meningitis
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113
Q

How is Group B streptococcus infection spread from mother to child?

A

= vertical transmission

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114
Q

Management in preventing Group B streptococcus infection in the new-born?

A

= intrapartum antibiotic prophylaxis - Penicillin

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115
Q

What % of pregnant women are estimated to be Group B streptococcus carriers?

A

= approx. 25%

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116
Q

What is HELLP syndrome?

A

= complication of pregnancy characterised by the presence of haemolytic (H), elevated liver enzymes (EL), and low platelets (LP)

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117
Q

In which trimester does HELLP syndrome usually manifest?

A

= 3rd trimester

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118
Q

Definitive treatment for HELLP syndrome?

A

= delivery of the baby

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119
Q

What is the % likelihood of passing HIV from mother to child? (without intervention)

A

= 25-40%

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120
Q

When is HIV transmission from mother to baby most likely to happen during pregnancy?

A

= during delivery

(infection rarely passed in utero)

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121
Q

HIV: What mother’s viral load supports vaginal delivery vs elective caesarian section

A

Viral load <50: normal vaginal delivery can be recommended and supported

Viral load >50: an elective Caesarean section is recommended

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122
Q
A
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123
Q

What is haemolytic disease of the new-born (HDN)?

A

= immunological condition that arises when a rhesus negative mother becomes sensitised to the rhesus positive blood cells of the baby while in utero

124
Q

Features associated with haemolytic disease of the newborn (HDN) (6)

A
  • hydros fetalis (= fluid build-up in baby’s tissues + organs)
  • yellow coloured amniotic fluid
  • neonatal jaundice
  • foetal anaemia
  • hepatomegaly or splenomegaly
  • severe oedema
125
Q

What is a direct anti globulin test (DAT) used for?

A

= used primarily to help determine if the cause of haemolytic anaemia

(used in investigating haemolytic disease of a new-born)

126
Q

What postnatal management options are there to help treat haemolytic disease of a newborn? (2)

A
  • phototherapy OR,
  • exchange transfusion

(to manage high bilirubin)

127
Q

What is hyperemesis gravidarum?

A

= condition characterised by severe nausea and vomiting, commencing before the 20th week of gestation

128
Q

First-line anti-emetic used in hyperemesis gravidarum

A

= cyclizine

129
Q

Management of hyperemesis gravidarum (5)

A
  • 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
Q

What is Queen Anne’s sign? And what is it indicative of?

A

= loss of the outer 1/3 of eyebrows, seen in patients with hypothyroidism

131
Q

First-line treatment in hypothyroidism?

A

= Levothyroxine

132
Q

What is recommended in those taking Levothyroxine whilst pregnant?

(dose)

A

= increase dose (usually by 25-50mcg), due to increased metabolic demand

133
Q

Complications of poorly managed hypothyroidism (2)

A
  • osteoporosis
  • cardiac arrhythmias
134
Q

What is induction of labour?

A

= medically initiated process of starting labour artificially

135
Q

Ways in which labour can be induced (4)

A
  • membrane sweep
  • vaginal Prostaglandins
  • amniotomy
  • balloon catheter
136
Q

What is a membrane sweep?

A

= process of initiating labour, a gloved finger is inserted into the external os and separates the membranes from the cervix

137
Q

Effect of vaginal prostaglandins in inducing labour (2)

A
  • ripen cervix
  • induce contractions
138
Q

What is an amniotomy?

A

= artificial rupture of membranes

139
Q

What are the chances (%) of a couple conceiving within 1 year if the woman < 40, they don’t use contraception, and have regular intercourse

A

= 80%

140
Q

Factors affecting natural fertility (7)

A
  • increasing age
  • obesity
  • smoking
  • tight-fitting underwear (males)
  • excessive alcohol consumption
  • anabolic steroid use
  • illicit drug use
141
Q

What is a hysterosalpingography?

A

= 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
Q

What is the Bishop score, and what is it used for?

A

= clinical tool uses to assess the likelihood of a successful induction of labour in pregnant patients

143
Q

What components are involved in the Bishop score (5)

A
  • position
  • consistency
  • effacement
  • dilation
  • station

(mnemonic: ‘pregnancy can enlarge dainty stomachs’)

144
Q

What is foetal blood sampling (FBS)?

A

= technique used during labour to assess the presence or absence of foetal hypoxia

145
Q

What 2 things can you look at when interpreting foetal blood sampling results?

A
  • lactate OR,
  • pH
146
Q

What is classified as an ‘abnormal’ pH on foetal blood sampling results?

A

= 7.20 or below

147
Q

What is classified as an ‘abnormal’ lactate on foetal blood sampling results?

A

= 4.9 mmol/L or above

148
Q

What is intrauterine growth restriction (IUGR)?

A

= condition in which foetus is unable to reach its genetically determined potential size

149
Q

Management of intrauterine growth restriction (IUGR)? (3)

A
  • close monitoring of foetal growth + well-being
  • manage maternal conditions which are contributing
  • consider early delivery if foetus in distress or condition worsens
150
Q

What is inversion of the uterus?

A

= 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
Q

Primary symptom of inverted uterus?

A

= large post-partum haemorrhage

152
Q

Diagnosis of inverted uterus?

A

= diagnosis primarily clinical

153
Q

Management for inversion of the uterus (3)

A
  • Johnson manoeuvre (= involves using hand to push the funds back into the abdomen)
  • hydrostatic methods
  • laparotomy
154
Q

What is Johnson manoeuvre?

A

= involves using hand to push the funds back into the abdomen

Used in managing an inverted uterus

155
Q

What is kleihauer test?

A

= diagnostic procedure used to quantify the volume of foetal haemoglobin present in maternal circulation, often indicating foeto-maternal haemorrhage

156
Q

Management of a pregnant women about to undergo a ‘sensitising event’ that is rhesus negative and is carrying a RhD +ve child?

A

= anti-D antibodies

157
Q

How is listeria monocytogenes often contracted?

(transmission)

A

= food borne transmission - unpasteurised daily products, and soft cheeses

158
Q

Investigation in suspected Listeria monocytogenes

A

= cultures of Listeria

159
Q

Management of Listeria monocytogenes

A

= antibiotics - combination of Ampicillin and an aminoglycoside

160
Q

What is classed as ‘post-term pregnancy’?

A

= gestation that has advanced beyond 42 weeks, OR 294 days from the first day of the LMP

161
Q

What is given to pregnant ladies to stimulate contractions is membrane sweep is unsuccessful in stimulating spontaneous labour?

A

= Prostaglandins

162
Q

What is meconium?

A

= refers to initial faeces passed by a new-born, typically very thick and dark green in colour

163
Q

What is ‘meconium-stained liquor’?

A

= this refers to meconium-containing amniotic fluid that occurs when foetus expels into the amniotic fluid before birth

164
Q

Concerns with presence of meconium in the amniotic fluid (2)

A
  • meconium aspiration syndrome (MAS)
  • meconium ileus
165
Q

What might ‘meconium-stained liquor’ be a sign of?

A

= foetal distress and hypoxia

166
Q

Meconium ileum can be an early sign of what condition?

A

= cystic fibrosis

167
Q

Symptoms associated with meconium ileus? (3)

A
  • bilious vomiting
  • distended abdomen
  • failure to pass meconium within the first 24 hours of life
168
Q

What is usually prescribed alongside Methotrexate?

A

= Folic acid 5mg

168
Q

What imaging is used in suspected meconium ileus?

A

= abdominal x-ray

169
Q

What does taking Magnesium sulphate during pregnancy help with?

A

= reduces the risk of cerebral palsy

170
Q

What is a miscarriage?

A

= defined as the loss of pregnancy prior to 24 weeks gestation

171
Q

Clinical features of a miscarriage (3)

A
  • vaginal bleeding
  • pain
  • vaginal tissue loss
172
Q

What is a THREATENED miscarriage?

(cervical os?)

A

= 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
Q

What is an INEVITABLE miscarriage?

(cervical os?)

A

= 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
Q

What is a COMPLETE miscarriage?

(cervical os?)

A

= 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
Q

What is a MISSED miscarriage?

(cervical os?)

A

= 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
Q

Imaging used to investigate a miscarriage

A

= transvaginal USS

177
Q

What can be measured to investigate a miscarriage?

And what might the following levels suggest: levels fall, slight increase or plateau, normal increase

A

= 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
Q

Medical management for a miscarriage?

A

= Misoprostol

179
Q

What is a recurrent miscarriage defined as?

A

= loss of 3 or more consecutive pregnancies

180
Q

What is a molar pregnancy?

A

= 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
Q

2 types of molar pregnancies

A
  • complete mole
  • partial mole
182
Q

Molar pregnancy: Difference between complete and partial mole

A

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
Q

How to identify a molar pregnancy (2)

A
  • Transvaginal USS - snowstorm appearance
  • B-hCG levels - significantly higher than what would be expected in normal pregnancy
184
Q

What is a ‘snowstorm’ appearance on trans-vaginal USS indicate, in pregnancy?

A

= molar pregnancy

185
Q

How often is hCG surveillance recommended for those with a partial molar pregnancy vs complete mole?

A

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
Q

Disseminated features of neonatal herpes simplex virus infection (4)

A
  • seizures
  • encephalitis
  • hepatitis
  • sepsis
187
Q

Investigation in neonatal herpes simplex virus (3)

A

Identify presence of virus in new-bon by either:

  • PCR
  • virus culture
  • direct fluorescent antibody testing (DFA) testing
188
Q

Treatment in neonatal herpes simplex virus infection

A

= acyclovir

(parenteral)

189
Q

What type of analgesia is generally avoided in obstetrics due to potential risks to the foetus and mother?

A

= NSAIDs

190
Q

What is obstetric cholestasis?

A

= 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
Q

Signs and symptoms associated with obstetric cholestasis (4)

A
  • pruritus
  • nausea + loss of appetite
  • jaundice (pale stool + dark urine)
  • abdo pain (RUQ)
192
Q

Investigations for suspected obstetric cholestasis (2)

A
  • bile acid measurements
  • LFTs

(important to do foetal monitoring due to risk of spontaneous intra-uterine death)

193
Q

Management of obstetric cholestasis (3)

A
  • 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
Q

What is the risk associated with obstetric cholestasis?

A

= spontaneous intrauterine death

(hence, early delivery planning important)

195
Q

What is oligohydramnios?

A

= defined as the presence of a lower than normal volume of amniotic fluid within the uterus

196
Q

Maternal drugs of which medications could cause oligohydramnios (2)

A
  • ACE I
  • prostaglandin inhibitors
197
Q

What is Potter syndrome?

A

= group of findings associated with a lack of amniotic fluid and kidney failure in an unborn infant

198
Q

How is oligohydramnios diagnosed?

A

= USS, which shows reduced amniotic fluid index (AFI), or single deepest pocked (SDP)

199
Q

Management options for oligohydramnios (3)

A
  • maternal rehydration
  • amnioinfusion
    -delivery
200
Q

What is amnioinfusion?

A

= infusion of saline into the amniotic cavity to increase the volume of amniotic fluid

201
Q

What is ovarian hyper-stimulation syndrome (OHSS)?

A

= 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
Q

Signs and symptoms associated with ovarian hyper-stimulation syndrome (2)

A

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
Q

Investigations for ovarian hyper-stimulation syndrome (OHSS) (2)

A
  • routine blood tests (evaluate haemoconcentration and detect potential organ dysfunction)
  • CXR, to identify presence of pleural effusion
204
Q

Management of ovarian hyper-stimulation syndrome (OHSS)

A

= largely supportive

205
Q

What is pelvic inflammatory disease (PID)?

A

= sexually transmitted infection that spread from the vagina > into cervix > and upper genital tract

205
Q

How is pelvic inflammatory disease typically spread?

A

= sexual contact

205
Q

When might you not milk the cord during third stage of labour?

A

= preterm babies - risk of intraventricular haemorrhage

205
Q

Management of pelvic inflammatory disease (PID)

A

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
Q

Main causes of pelvic inflammatory disease (PID)? (2)

A
  • gonorrhoea
  • chlamydia
205
Q

Postpartum haemorrhage: 4T’s of why she’s bleeding

A

T - tone (failure of uterus to contract after delivery)
T - trauma
T - tissue (retained placental or foetal tissue)
T - thrombin

205
Q

What might RUQ pain in pelvic inflammatory disease (PID) suggest?

A

= Fitz-High-Curtis syndrome

206
Q

Complications of pelvic inflammatory disease (PID) (3)

A
  • chronic pelvic pain
  • infertility
  • ectopic pregnancy
207
Q

What is Fitz-hugh-curtis syndrome?

A

= anterior liver capsule and the anterior abdominal wall or diaphragm in the context of PID

Despite this, LFTs are usually normal

208
Q

What is classed as a first degree perineal tear?

A

= tear limited to the superficial perineal skin or vaginal mucosa only

209
Q

What is classed as a second degree perineal tear?

A

= tear extends to perineal muscles + fascia, but the anal sphincter is intact

210
Q

An episiotomy is classed as a

  • first-degree tear
  • second-degree tear
  • third-degree tear
A
  • second-degree tear
211
Q

What is classed as a third degree 3a, perineal tear?

A

= < 50% of the thickness of external anal sphincter is torn

212
Q

What is classed as a third degree 3b, perineal tear?

A

= > 50% of the thickness of the external anal sphincter is torn, but internal anal sphincter is intact

213
Q

What is classed as a third degree 3c, perineal tear?

A

= external + internal anal sphincters are torn, but anal mucosa is intact

214
Q

What is classed as a fourth degree tear?

A

= perineal skin, muscle, anal sphincter, and anal mucosa are torn

215
Q

Perineal tears: what should be given post-operatively? (2)

A
  • broad-spectrum antibiotics
  • laxatives
216
Q

Do first degree perineal tears require suturing?

A

= if bleeding minimally, no

217
Q

What is placenta accreta vs placenta increta vs placenta percreta?

A

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
Q

Imaging to help diagnose a placenta accreta spectrum? (2)

A
  • doppler USS
  • MRI

(antenatal diagnosis is difficult to make)

218
Q

Complications of abnormal placental implantation (3)

A
  • severe postpartum bleeding
  • preterm delivery
  • uterine rupture
219
Q

If abnormal placental implantation is suspected what is the safest management? (2)

A
  • elective c-section
  • hysterectomy

(if important to preserve patient’s fertility, a less destructive placental resection may be attempted)

220
Q

What is a placental abruption?

A

= premature separation of the placenta from the uterine wall during pregnancy, resulting in maternal haemorrhage

221
Q

What is placenta praevia?

A

= placenta overlying the cervical os

222
Q

Imaging used to investigate placenta praevia?

A

= transvaginal USS

223
Q

What terminology is used to describe the head in relation to the ischial spine?

A

= station

224
Q

What is postpartum depression?

A

= significant mood disorder that can develop at any time up to 1 year after the birth of a baby

225
Q

Prevalence of postpartum depression in mothers within year of childbirth?

A

= 10-20%

226
Q

What screening tool is there for postnatal depression?

A

= 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
Q

First-line treatment in postnatal depression?

A

= self-help strategies, and psychological therapies such as CBT or interpersonal therapy (IPT)

228
Q

Pharmacological treatment used in postnatal depression?

A

= anti-depressants

229
Q

Which type of anti-depressants are used in postnatal depression (2)

A
  • Sertraline
  • Paroxetine

(due to their safety profile in breastfeeding)

230
Q

How is baby blues managed?

A

= with reassurance + support

231
Q

What is pre-eclampsia?

A

= placental condition that often affects pregnant women from around 20 weeks of gestation, characterised by HTN + proteinuria

232
Q

What causes pre-eclampsia?

(pathophysiology)

A

= related to dysfunctional trophoblast invasion of the spiral arterioles, which result in decreased uteroplacental blood flow and subsequent endothelial cell damage

233
Q

Main signs + symptoms in pre-eclampsia (4)

A
  • HTN
  • proteinuria
  • peripheral oedema
  • headaches
234
Q

Key investigations in pre-eclampsia (3)

A
  • BP measurements
  • urinalysis
  • blood tests (kidney function, LFT + clotting status)
235
Q

What can be used for prophylaxis against the development of pre-eclampsia?

A

Aspirin

(given from 12 weeks gestation until birth)

236
Q

Which anti-hypertensive treatment is recommended as first-line agent?

A

= Labetalol

237
Q

What can be given to prevent + treat eclamptic seizures?

A

= magnesium sulphate

238
Q

Definitive curative treatment for pre-eclampsia?

A

= delivery of the placenta

239
Q

What is a postpartum haemorrhage defined as?

A

= defined as the loss of at least 500ml of blood within the first 24 hours of delivery

240
Q

Initial management in post-partum haemorrhage (5)

A
  • resuscitation ABCDE
  • major haemorrhage protocol
  • lay woman flat
  • insert 2 large bore cannulas
  • Oxygen

(consider FFP if clotting abnormalities present)

241
Q

What is B-lynch suture around the uterus used for?

A

= can be used to reduce bleeding in postpartum haemorrhage

242
Q

Pre-labour rupture of membranes (PROMS) at term is associated with what risks? (2)

A
  • chorioamnionitis
  • neonatal infection
243
Q

Signs and symptoms of pre-labour rupture of membranes (3)

A
  • foul-smelling or greenish amniotic fluid
  • maternal fever
  • reduced foetal movements
244
Q

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
A
  • pemphigoid gestationis
245
Q

What is the Foetal fibronectin test (fFN test)?

A

= a screening test used to assess the risk of preterm delivery after the onset of pre-term labour

246
Q

What does a negative Foetal fibronectin (fFN) test suggest?

A

= low risk of delivery occurring within the next 7-14 days

247
Q

Recommended first-line tocolytic agent to delay labour?

A

= Nifedipine

248
Q

Management of preterm labour? (3)

A
  • corticosteroids (to accelerate foetal lung maturation)
  • IV antibiotics, Penicillin - if evidence of infection
  • tocolytic agents can be considered, Nifedipine
249
Q

What is shoulder dystocia?

A

= specific type of obstructed labour, where following the delivery of the foetal head the anterior shoulder becomes impacted behind the maternal pubic symphysis

250
Q

What is the ‘turtle sign’, and what is this indicative of?

A

Turtle sign = retraction of the foetal head back into the birthing canal

This is suggestive of shoulder dystocia

251
Q

Describe McRoberts manoeuvre, and what is this used in?

A

= 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
Q

What is a cleidotomy + symphysiotomy?

A

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
Q

Shoulder dystocia: Describe Zavanelli manoeuvre

A

= replacement of the head into the canal and then subsequent delivery by c-section

254
Q

What is spina bifida occulta?

A

= 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
Q

Spina bifida: meningocele vs. myelomeningocele

A

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
Q

What is taken to decrease the risk of neural tube defects in pregnancy?

A

= Folic acid (400 micrograms/day)

(in high risk women: 5mg/day)

257
Q

What is spinal bifida?

A

= neural tube defect characterised by incomplete development of the spinal column, resulting in herniation of the spinal cord

258
Q

Which type of twins are more common:

  • monozygotic twins
  • dizygotic twins
A
  • dizygotic twins
259
Q

What is twin-to-twin transfusion syndrome (TTTS)?

A

= a condition in which the blood flows unequally between twins that share a placenta (monochorionic twins)

260
Q

In twin-to-twin transfusion syndrome both foetuses are at risk of developing? (2)

A
  • heart failure
  • hydrops (oedema)
261
Q

The following classical triad of symptoms is associated with what obstetric condition?

  • painless vaginal bleeding
  • rupture of membranes
  • foetal bradycardia (or resulting foetal death)
A

= vasa praevia

262
Q

What is vasa praevia?

A

= 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
Q

Primary management for vasa praevia?

A

= elective caesarean section, prior to rupture of membranes

264
Q

Pregnancy-induced HTN vs. pre-eclampsia?

A

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
Q

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
A
  • cesarean
266
Q

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
A
  • commence insulin
267
Q

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
A
  • no change in management
268
Q

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
A
  • delivery at 36 weeks
269
Q

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
A
  • deliver at 38+6 weeks
270
Q

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
A
  • continue serveillance
271
Q

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
A
  • Folic acid 5mg/d
272
Q

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
A
  • Stop alcohol consumption
273
Q

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
A
  • 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
Q

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
A
  • admission for monitoring/ serology

This woman has classic signs of pre-eclampsia and requires careful monitoring

275
Q

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
A
  • endometrial cancer
276
Q

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
A
  • cells are examined for squmaous metaplastic epithelium
277
Q

Fundus at umbilicus suggests what estimated gestation?

  • 18 weeks
  • 20 weeks
  • 24 weeks
  • 28 weeks
  • 38 weeks
A
  • 20 weeks
278
Q

Fundus midway to xiphoid suggests what estimated gestation?

  • 18 weeks
  • 20 weeks
  • 24 weeks
  • 28 weeks
  • 38 weeks
A
  • 28 weeks
279
Q

Fundus at the level of the xiphoid suggests what estimated gestation?

  • 18 weeks
  • 20 weeks
  • 24 weeks
  • 28 weeks
  • 38 weeks
A
  • 38 weeks
280
Q

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
A
  • 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
Q

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
A
  • regular painful contractions with cervical dilatation
282
Q

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
A
  • combined blood test and USS scan
283
Q

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
A
  • endometriosis
284
Q

What is Mittelschmerz?

A

= AKA, ovulation pain - is a benign preovulatory lower abdominal pain that occurs midcycle (between days 7 and 24) in women.

285
Q

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
A
  • start broad spectrum antibiotic
286
Q

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
A
  • increased head to abdominal circumference ratio
287
Q

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
A
  • 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
Q

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
A
  • premature ovarian failure
289
Q

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
A
  • 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
Q

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
A
  • chance at a successful vaginal delivery is 72-75%
291
Q

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
A
  • admit for scan and treat with antibiotics
292
Q

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
A
  • measure endometrial thickness with USS
293
Q

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
A
  • urodynamics
294
Q

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
A
  • anorexia nervosa
295
Q

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
A
  • anovulatory bleed
296
Q

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)
A
  • progesterone releasing intrauterine device (Mirena)
297
Q

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
A
  • pregnancy should be regarded as normal

90% of women who experience vaginal bleeding or spotting during early pregnancy will not miscarry

298
Q

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
A
  • ectopic pregnancy
299
Q

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
A
  • 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
Q

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
A
  • do iron levels and give iron tablets
301
Q

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
A
  • establish a local cause for the bleed

Year 4 (11 decks)

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