Obstetrics Flashcards

Question

Teenage pregnancy complication

Answer 1

- maternal poor weight gain - premature delivery - low birth weight - increased risk of pregnancy-induced hypertension - increased risk of violence

Answer 2

- anticoagulation therapy - severe cough - pregnancy - previous or recent abdominal surgery - abdominal trauma - chronic kidney disease - steroid/immunosuppressive therapy - vigorous uncoordinated rectus muscle contraction

Answer 3

- PAINFUL vaginal bleeding or without bleeding (concealed bleeding) - uterine tenderness - foetal compromise on CTG

Answer 4

- painless vaginal bleeding (low in comparison to other forms) - with or without uterine tenderness (AMC handbook) - foetal compromise on CTG (can also be without AMC handbook) - tender rigid abdomen

Answer 5

Carries minimal maternal risk but has serious fetal risk - no bleeding when ROM ∗ Causes fresh painless vaginal bleeding when membranes rupture just before labour starts ∗ Can be detected by transvaginal ultrasound ∗ If detected early, c – c-section will be done between 34 to 37 weeks

Answer 6

Wait one menstrual period after abortion

Answer 7

magnesium sulphate is contraindicated. as it impairs already slowed nerve muscle connections

Answer 8

70000-100000/mm3

Answer 9

- Gestational/incidental thrombocytopenia (most common) - Acute fatty liver - HELLP syndrome - Pre-eclampsia - Eclampsia

Answer 10

H- haemolysis EL -elevated liver enzyme levels LP -low platelet levels

Answer 11

- average between 32-34 weeks - postpartum in up to 30% of cases - right upper quadrant pain or epigastric pain - nausea, vomiting, and malaise - hypertension 80% - low level proteinuria 5-15% - AST/ALT elevated secondary to liver dysfunction - High blood urea and creatinine with acute renal failure - bilirubin level is increased secondary to haemolysis

Answer 12

>20 weeks + Hypertension (1st symptom) + end-organ damage such as ankle and facial edema or placental insufficiency - proteinuria (2nd symptom) after 20 weeks -headache, dizziness and abdominal pain just below the ribs.

Answer 13

BP > 160/110mmHg + proteinuria

Answer 14

gestational hypertension acute fatty liver

Answer 15

>300g protein in 24hr urine

Answer 16

Used to diagnose pre-eclampsia - >30mmol

Answer 17

- Previous eclampsia [7x] - Chronic hypertension [5] - Pre-existing diabetes [4x] - Multiple pregnancy (twin) [3x] - Autoimmune disease (SLE, antiphospholipid syndrome) [3x] - Nulliparity [3x] - 1st degree family history [3x} - Age >40 [2x] - Pre-existing kidney disease [2x] - BMI > 30 [2x] - Prolonged interpregnancy interval

Answer 18

> 20 weeks - without pre-eclampsia features - resolves within 3 months after delivery - good prognosis

Answer 19

**monitor to exclude development of pre-eclampsia** - if BP >140/90: start antihypertensives - aim to maintain BP at 110-140/80-90

Answer 20

gestational age +- 2 - if low check for pre-eclampsia

Answer 21

Moderate: - Methyldopa - labetalol/atenolol - Nifedipine Severe: - IV Hydralazine 5mg bolus every 20 min

Answer 22

- Cease as it can increase risk of postpartum depression - Switch to enalapril - Add nifedipine if above don't work (acts very quickly)

Answer 23

- mild/asymptomatic thrombocytopenia - no past hx (unless previous pregnancy) - no foetal thrombocytopenia association - spontaneous resolution upon delivery

Answer 24

- late second and early third trimester of pregnancy - **pruritus** and rash on the palms of the feet worse at night - increased serum bile acids and other liver function tests. - **jaundice uncommon but could be present** - 40% of recurring in subsequent pregnancies

Answer 25

weekly LFT - increased ALP - mildly increased AST/ALT & bilirubin Monitor foetus - deliver if distressed

Answer 26

- usually clears up rapidly after delivery - often recurs in future pregnancies or using OCP (which are contraindicated)

Answer 27

- relieve bile acids with ursodeoxycholic acids - antihistamine/emollients

Answer 28

- foetal distress/death - preterm delivery - meconium ingestion - meconium aspiration syndrome

Answer 29

**Life threatening** - Late 3rd trimester/ early postpartum period (35-36 weeks) - 1 in 10000 pregnancies - mortality rate 50% - Jaundice prevalent

Answer 30

disordered fatty acid metabolism by mitochondria in mother - due to LCHAD enzyme deficiency - hepatotoxic agents given to mother

Answer 31

- ascites - pancreatitis - liver encephalopathy - disseminated intravascular coagulation (DIC) **Acute fatty liver of pregnancy (AFLP)** is a rare but serious condition that occurs in the third trimester of pregnancy, where fat accumulates in the liver cells, leading to liver dysfunction. Here’s why it can cause these complications in simple terms: ### 1. **Ascites**: - **What It Is**: Ascites is the buildup of fluid in the abdomen. - **Why It Happens**: In AFLP, the liver is damaged and can’t produce enough proteins like albumin, which normally helps keep fluid inside blood vessels. Without enough albumin, fluid leaks out into the abdomen, causing ascites. ### 2. **Pancreatitis**: - **What It Is**: Pancreatitis is inflammation of the pancreas. - **Why It Happens**: The liver and pancreas are closely connected in the digestive process. When the liver is severely damaged in AFLP, it can disrupt normal digestion and lead to the inflammation of the pancreas, causing pancreatitis. ### 3. **Liver Encephalopathy**: - **What It Is**: Liver encephalopathy is brain dysfunction caused by severe liver disease. - **Why It Happens**: The liver usually filters toxins from the blood. In AFLP, the liver’s ability to do this is impaired, so toxins build up in the blood and eventually affect the brain, leading to confusion, drowsiness, or even coma. ### 4. **Disseminated Intravascular Coagulation (DIC)**: - **What It Is**: DIC is a serious condition where blood clots form throughout the body’s small blood vessels. - **Why It Happens**: In AFLP, the liver can’t produce enough of the proteins needed for normal blood clotting. This can trigger widespread clotting (using up clotting factors), followed by excessive bleeding because the clotting system becomes exhausted. ### Summary: - **Ascites** happens because a damaged liver can’t keep fluid in the blood vessels, leading to fluid buildup in the abdomen. - **Pancreatitis** can occur as liver damage disrupts normal digestive processes, causing inflammation in the pancreas. - **Liver encephalopathy** occurs when a failing liver can’t filter toxins from the blood, leading to brain dysfunction. - **DIC** is a severe clotting disorder triggered by the liver’s inability to properly manage blood clotting, leading to both excessive clotting and bleeding. These complications arise because the liver is crucial for many bodily functions, and when it’s damaged, multiple systems can be affected, leading to serious health problems.

Answer 32

Liver failure -increased AST + ALT (200) - increased bilirubin - ALP normal

Answer 33

Liver biopsy confirms dx

Answer 34

- DRABCD - Admission to ICU - Termination of pregnancy (lifesaving for both mother and baby) - prevent/treat DIC - may require liver transplant

Answer 35

more than 5 active labour contractions in 10 minutes (tachysystole) - contractions lasting more than 2 mins/ occurring within 60 secs of each other (hypertonus)

Answer 36

- Variable decelerations - persistent foetal bradycardia - prolonged decelerations for over 1 minute

Answer 37

-PPROM. -Polyhydramnios -Breech presentation. -Multiparity. -Multiple gestations. -GDM increasing the risk of polyhydramnios, fetal malpresentation, premature rupture of membrane.

Answer 38

- primary pulmonary hypertension is a contraindication - increases the risk of pre-eclampsia - increases the risk of foetal growth restriction - Daily intake of 1000mg of calcium to reduce incidence of hypertensive disorders and preterm labour

Answer 39

- Check mothers IgG status for antibodies: positive = no further action needed negative = within first 96 hours, give immunoglobulin (VZIG)

Answer 40

1st trimester if no prior/uncertain history

Answer 41

Acyclovir (1st line) valaciclovir: -2nd half of pregnancy - underlying history of lung disease - smoker - immunocompromised

Answer 42

without complications: - Rash < 24 hours - give oral antivirals (acyclovir) Rash >24 hours - no treatment is required. With complications / immunocompromised: - Intravenous acyclovir

Answer 43

Chicken pox ### **If Symptoms Appear More Than 7 Days Before Delivery:** - **No special treatment**: The baby does not need VZIG (a protective shot). - **No isolation needed**: The baby does not need to be separated from others. - **Breastfeeding encouraged**: The mother should continue breastfeeding as usual. ### **If Symptoms Appear Between 7 Days Before and 2 Days After Birth:** - **VZIG for the Baby**: The baby should receive a shot of VZIG (200 IU) right after birth to help protect against chickenpox. Ideally, this should be done within the first 24 hours but can be given up to 72 hours after birth. - **Early Discharge**: Full-term babies should be discharged from the hospital as soon as possible. - **No isolation needed**: The baby does not need to be isolated. - **Breastfeeding encouraged**: The mother should continue breastfeeding as usual. ### **If Symptoms Appear Between 2 Days After Birth and 28 Days Later:** - **VZIG for Certain Babies**: - If the baby was born before 28 weeks gestation or weighs less than 1000 grams, they should receive VZIG within 96 hours of exposure, but it can be given up to 10 days after the mother develops a rash. - If the mother has never had chickenpox or doesn’t have immunity, the baby should get VZIG if exposed between 2 and 28 days after birth. - **Early Discharge**: Full-term babies should be discharged from the hospital as soon as possible. - **No isolation needed**: The baby does not need to be isolated. - **Breastfeeding encouraged**: The mother should continue breastfeeding as usual. ### Summary: - The need for VZIG and other measures depends on when the mother shows symptoms in relation to delivery. - Isolation is generally not required, and breastfeeding is always encouraged. Presentation of the symptoms >7 days before delivery: - No VZIG required. - No isolation required. - Encourage breastfeeding Maternal chickenpox 7 days before to 2 days after birth: - Give newborn VZIG 200 1U bone vial) intramuscularly (IM) immediately after birth. VZIG should be given as soon as possible within the first 24 hours of birth but may be given up to 72 hours. - Discharge term neonates as soon as possible. - No isolation required. - Encourage breastfeeding. Maternal chickenpox > 2 to 28 days after birth: - If neonate < 28 weeks gestation or 1000 g birth weight, give VZIG (preferably within 96 hours but can be given up to 10 days post-maternal rash. - Due to the increased risk of severe varicella in newborns of seronegative women (if the mother has no personal history of infection with VZV), give VZIG to neonates exposed to varicella between 2 to 28 days of age. - Discharge term neonates as soon as possible. - No isolation required. - Encourage breastfeeding.

Answer 44

- Varicella Zoster (chicken pox) - Rubella - Measles

Answer 45

- can give vaccine - usually recommended at 28 weeks

Answer 46

- uterine stimulation - antidiuretic - mammary gland stimulation - labor induction

Answer 47

- Dairy: soft cheese, soft serve ice cream, unpasteurised - Smoked salmon, trout

Answer 48

Listeriosis (meningitis, meningoencephalitis)

Answer 49

PROM - <37 weeks

Answer 50

- Rupture of foetal membranes before labour at any gestational age - 50% progression into labour with 24 hrs - 80% in 7 days - preterm delivery - presence of liquor flow from the cervical os - pooling of liquor flow in the posterior vaginal fornix - Neonatal complications -intrauterine infections (chorioamnionitis) NOTE: DON'T DO vaginal swabs due to high risk of infections

Answer 51

- fluid loss - urinary incontinence -

Answer 52

- cord prolapse - preterm labour - placental abruption - chorioamnionitis - foetal pulmonary hypoplasia/ other features of prematurity - limb positioning defects - perinatal mortality

Answer 53

-admit to hospital - **< 34 week + 6 days**: corticosteroids (IM betamethasone) to decrease neonatal complications - oral erythromycin or IV prophylactic antibiotics 48hrs (amoxicillin) to prevent chorioamnionitis - - Baby born < 34 weeks would need to be monitored in the NICU (**tertiary hospital**) - weekly bloods + CRP + vaginal swabs

Answer 54

- absence is best negative predictor of PTD. negative test means preterm labour within the next 7 days would be unlikely. criteria: - Intact foetal membranes - Cervical dilation less than 3 cm - Gestational age of between 22 +0d - 34+6d weeks

Answer 55

< 36 + 6 weeks

Answer 56

1. history two or more miscarriages occurring after the 12th weeks gestation, usually starting with painless leaking of amniotic fluid 2. The easy passage of a size 9 cervical dilator through the internal os of the cervix when the woman is not pregnant, and the absence of a ‘snap’ on its withdrawal 3. cervical length of **less than 25mm** or cervical funnelling >40% prior to 24 weeks gestation

Answer 57

- idiopathic 40% - cervical incompetence - multiple pregnancy - polyhydramnios - uterus abnormalities, septum - infections: GBS, measles, SMV, UTI - DM - haemorrhage: pre-eclampsia

Answer 58

- pre-eclampsia - IVF - IUGR - Cephalic presentation

Answer 59

- Signs of chorioamnionitis - antepartum haemorrhage - request of mother - neonatal jeopardy

Answer 60

- Usually no moulding of the foetal head - +/- caput formation of foetal head - usually absent cervical oedema - + tachycardia - Can be above or below IS - Usually < 1 finger breadths of head palpable above the pelvic brim when the lowest point of the head is at the IS

Answer 61

- ++ moulding of foetal head - ++ caput formation on foetal head - anterior lip cervical oedema - ++ progressive foetal tachycardia - just at or above the ischial spines (IS) > 2 finger breadths of head palpable above the pelvic brim when the lowest point of the head is at the IS These signs suggest that the baby is having difficulty moving down through the birth canal during labor. Here's what each point means in simple terms: 1. **++ Moulding of the Fetal Head**: - The baby’s head is being squeezed tightly as it tries to fit through the mother’s pelvis. The skull bones overlap more than usual. 2. **++ Caput Formation on the Fetal Head**: - A swelling (caput) forms on the baby’s head due to pressure during labor. This is a soft bump on the top of the baby’s head. 3. **Anterior Lip Cervical Edema**: - Part of the cervix (the opening of the uterus) is swollen. This can happen if the baby's head is pushing against it before the cervix is fully dilated. 4. **++ Progressive Fetal Tachycardia**: - The baby’s heart rate is getting faster than normal, which can be a sign of distress. 5. **Just at or Above the Ischial Spines (IS)**: - The baby’s head is either at or just above a specific point in the pelvis called the ischial spines. This means the baby hasn’t moved down very far during labor. 6. **> 2 Finger Breadths of Head Palpable Above the Pelvic Brim When the Lowest Point of the Head is at the IS**: - Even though the baby’s head is at the ischial spines, you can still feel a good portion of the head (more than 2 finger widths) above the pelvic brim. This suggests the baby’s head hasn’t descended properly into the pelvis. ### Summary: These signs indicate that the baby is having a tough time moving down into the birth canal, possibly due to the head not fitting well through the mother’s pelvis. This situation might require closer monitoring or intervention to ensure the baby and mother stay safe during labor.

Answer 62

- increased WBC (>15x 10^9/L) -Maternal tachycardia >100 bpm - foetal tachycardia > 160 bpm - uterine tenderness - offensive vaginal discharge - CRP > 40

Answer 63

- chorioamnionitis (absolute)

Answer 64

- Notifiable disease therefore contact tracing - **Immunoglobulin is used as prophylactic only, not for established** - symptomatic treatment

Answer 65

10-14 days

Answer 66

- fever - malaise - cough - coryza - conjunctivitis - white spots surrounded by red ring in the buccal mucosa (Koplik's) - **maculopapular rash 2-4 days after initial symptoms** - **infection periods start 2 days after rash onset, 4 days after eruption**

Answer 67

- Otitis media 7% - Bronchopneumonia 6% - acute encephalitis 2-10/10000

Answer 68

- preterm labour - spontaneous abortion - foetal/neonatal loss - maternal mortality Complications in the Fetus 1. Congenital Measles: Though rare, the virus can cross the placenta and infect the fetus, leading to congenital infection. 2. Preterm Birth: Due to complications like pneumonia and systemic infection in the mother. 3. Low Birth Weight: Associated with preterm birth and maternal infection. 4. Stillbirth: Severe cases of measles can lead to fetal death.

Answer 69

- separation of placenta from uterus - 3rd trimester bleeding - foetal morbidity and mortality - MVA

Answer 70

- vaginal bleeding 80% - Abdominal/back pain 70% - uterine tenderness 70% - abnormal uterine contractions - 35% - idiopathic premature labour - 25% - foetal death 15% -hypofibriogemia

Answer 71

foetus is dead. Commence amniotomy as it'll induce spontaneous labour

Answer 72

- check serology (IgM and IgG) (IgG titer of = >than 10 IU/ml) - Rubella infection in the first trimester (<8 weeks) causes severe foetal anomalies 85% - If infected termination is recommended

Answer 73

- usually asymptomatic 25- 50% cases - low grade fever - transient erythematous rash - post- auricular/ sub-occipital nodes lymphadenopathy Maculopapular rash on the face and spreads to trunk and extremities (resolves within 3 days)

Answer 74

- <8 weeks 85% foetal infection (congenital rubella syndrome) - 8< - <12: 50 - 80% infected 65 -85 **clinically** infected - 13 -16 weeks 30% infected, 1/3 have sensorineural deafness - 16 -19 weeks: 10% infected, clinical features rare - > 19 weeks: no apparent risk

Answer 75

Reassure if not exposed to Rubella

Answer 76

- CNS dysfunction 10 25% (intellectual impairment developmental delay, microcephaly) - eye 10 -25% (cataracts, retinopathy, glaucoma) - sensorineural deafness 60-75% cardiac 10-20% (PDA wide pulse pressure, PA stenosis, ) - intrauterine growth restriction, short stature - inflammatory lesions (brain, liver, lungs, bone marrow

Answer 77

- nausea and vomiting at 5-6 weeks of gestation, peaking at 9 weeks -Weight loss (more than 5% of weight) -Ketosis - urine analysis to check for hydration status

Answer 78

Measles: 5 days Mumps: 9 days Rubella: 5 days

Answer 79

- pregnant uterus entrapped in the pelvis by subpromontary sacrum - retroverted uterus?

Answer 80

- < 3cm conservative management - > 3cm surgical excision/exploration

Answer 81

- Hypokalemia - On ECG: such as inverted T waves and prolonged QT and PR intervals

Answer 82

- Ginger 250mg orally, 4 times/day Pyridoxine (Vit B6) 10-25mg 3-4 times/day

Answer 83

Cyclizine 12.5-50mg oral 3/d Promethazine 10-25mg oral 3/day Prochlorperazine 5-10mg oral 3-4/day **Metoclopramide 10mg oral/IV/IM** Domperidone 10mg 3/day Ondesatron 4-8mg oral/IV

Answer 84

Hydrocortisone IV 100mg 2/day Prednisolone 40-50mg oral 1/day

Answer 85

- Hyponatremia - caused by vomiting and Gl loss - Hypokalemia - caused by vomiting and Gl loss - Hypochloremic alkalosis - caused by vomiting and GI loss - Ketosis - resulting from decreased oral intake, starvation and dehydration - Abnormal liver enzymes (ALT>AST) - Increased serum amylase and lipase - Vitamin deficiency in pregnancy (very rare)

Answer 86

1st line: metoclopramide 2nd line: Ondansetron if metoclopramide doesn't' work 3rd: steroids (prednisolone) last resort

Answer 87

management depends on gestation duration: - < 37 weeks even with large amounts of bleeding can be safely monitored - > 37 weeks with bleeding delivery through C section

Answer 88

- Check TSH and free T4 foetus: - foetal tachycardia - small gestational size - premature/stillborn - Graves - if px

Answer 89

- radioactive iodine therapy if patient is not pregnant (postpone pregnancy for 6 months) - PTU if already pregnant - Don't give carbimazole in first trimester as if causes scalp defects

Answer 90

-BP > 160mm/hg on 2 occasions 6 hours apart - Proteinuria of > 5g - cerebral/visual disturbances drowsiness, droopy eyelids - pulmonary oedema

Answer 91

IV diazepam with Magnesium sulphate (phenytoin teratogenic)

Answer 92

- respiratory rate < 12 breaths/minute - urine output < 100mLs in 4 hours (renal insufficiency) - loss of patellar reflexes; further seizures occur - Muscle paralysis and respiratory difficulty at >7.5 mmol/L - cardiac arrest at levels greater than >12 mmol/L

Answer 93

serum magnesium level is >3.5mmol/L, cease infusion and consult with obstetrician

Answer 94

1. intrauterine restriction - Maternal hypertension (SLE, lupus nephritis) 2. Congenital - Trisomy 21, 18, 13 Turner's 3. Infections -- Cytomegalovirus (CMV) /intrauterine infection 4. Maternal - smoking, alcohol, phenytoin

Answer 95

- maternal primary infection often asymptomatic - IgG seropositive up to 50% of pregnant women - Transplacental foetal infection is 50% with primary infection

Answer 96

- retardation - microcephaly - seizures - hearing deficits - chorioretinitis - optic atrophy - brain architectural changes

Answer 97

combination of foetal ultrasound, amniocentesis + /- foetal serology **definite diagnosis of foetal infection is by amniocentesis**

Answer 98

IgM-ve/IgG-ve: No CMV infection/susceptible **IgM-ve/IgG+ve: repeat serology after 2 weeks** IgM+ve/IgG+ve: Test immediately/repeat testing - low: recent primary infection - intermediate: not sure if primary - high: past infection

Answer 99

24 hours - 12 weeks - bright red haemorrhage - fever - Scant lochia **bright red**, brown red - **retained products of conception (RPOC)** endometritis ddx: look for bleeding colour

Answer 100

-**C Section delivery** (most common) - Young maternal age. -Multiple digital cervical examinations. -Prolonged rupture of membranes. -Retention of placental products. -Prolonged labour. -Chorioamnionitis

Answer 101

- Neural Tube Defects (NTD)

Answer 102

- Phenytoin is teratogenic - Enzyme inducer

Answer 103

- 0.5mg recommended dose - 1 month before conception to 3 months after - 5 mg unless: - family history of NTD - Enzyme inducing medication (epileptic) - BMI > 35 – Pre-pregnancy diabetes – Risk of malabsorption syndrome – A family history of congenital heart disease – Multiple pregnancy

Answer 104

- **foetal bradycardia** - **previous uterine surgery (C -section)** - constant abdominal pain - intraabdominal haemorrhage signs - little vaginal bleeding (usually concealed) - maternal tachycardia/hypotension - uterine contraction cessation -foetal loss of station - uterine tenderness

Answer 105

Laparotomy

Answer 106

- uterine atony - amniotic fluid embolism

Answer 107

- high parity - pendulous abdomen - **placenta previa** - polyhydramnios -pelvic inlet contracture/ foetal macrosomia - uterine abnormalities (fibroids, bicornuate uterus) - foetal abnormalities (neck/sacrum tumours, hydrocephaly, abdominal distension) - distended maternal bladder - poorly formed lower segment - more premature (wrong date) - undiagnosed twins - preterm delivery

Answer 108

If placenta previa excluded - Cephalic version is < 36 - C section if >37 weeks or in labour

Answer 109

height correlates to gestational age (weeks) with > 2cm discrepancy < gestational age: - dating errors - foetal growth restriction (3rd trimester) - reduction in liquor volume (3rd trimester) - oligohydramnios - traverse/oblique lie - small gestational age - late ovulation (if px ceased OCP: 2 weeks 50%, 6 weeks 90%, 12 months 1%) > gestational age: -dating errors - large gestational age - polyhydramnios - molar pregnancy

Answer 110

- 12 weeks: palpable above the pubis - 20 weeks: level of umbilicus

Answer 111

US to check for dating error as wells as polyhydramnios, multiple gestation

Answer 112

I: placenta is lower segment, but lower edge doesn't reach internal os II: lower edge reaches internal os but doesn't cover it III: placenta partially covers internal is IV: completely covers internal os

Answer 113

Routine OGTT at 24-28 weeks If risk index > 2 OGTT at 14 weeks

Answer 114

a fasting plasma level: > 5.5mmol/L 1hr: 10.1mmol/L 2 hours after a 75g OGTT: 8.5mmol/L

Answer 115

if routine exam at 18 weeks shows low lying placenta, then another US should be done at **32-34 weeks** - Vital signs, IV if needed - uterine tenderness - US - Anti-D (RhoGAM) (mum is Rh- but foetus Rh+)

Answer 116

- 30% in the next 10 years - 50% risk of type 2 DM within 20 years diagnosed should have - 75g OGTT 6 -12 weeks postpartum HbA1c every 3 months during pregnancy - FBS and/or HbA1C **3 yearly**

Answer 117

Consult risk index to assess px score: If < 2: 75g OGTT 24-28 weeks if >2: 75g OGTT at 14 weeks (earlier if px can tolerate it)

Answer 118

BMI: 25-35 = 1 BMI: > 35 = 2 Ethnicity: not white = 1 Previous GDM = 2 Previous elevated blood glucose = 2 Maternal age > 40 years = 2 Family hx: 1st degree relative or sister = 2 Previous macrosomia = 2 Previous perinatal loss = 2 PCOS = 2 Medications (corticosteroids, antipsychotics) = 2

Answer 119

aim to achieve a target HbA1c value less than 6-7%

Answer 120

if well controlled, continue to 40 weeks

Answer 121

if good control: 38-39 weeks (try for 39 weeks onwards) If poorly controlled: induce at 38 weeks

Answer 122

- 2-7 weeks incubation - doesn't transmit to foetus - Infectious mononucleosis - 3-3.4% susceptible - 50% infected develop clinical disease - recurrent infection can cause shortened pregnancy and low birth weight - **only need to deal with px if symptoms arise**

Answer 123

- fever - sore throat - **cervical/ post auricular lymphadenopathy** - characteristic increases in monocytes and lymphocytes - hepatosplenomegaly -hepatic transaminase increase

Answer 124

Symptomatic treatment - Antibiotics in bacterial URTI

Answer 125

- USED WITH CAUTION - not more than 48 hours -PDA -delayed labour and birth - oligohydramnios via decreased foetal GFR

Answer 126

codeine and metoclopramide correct

Answer 127

- 2nd trimester -RLQ pain - aggravated by moving - all vital signs normal

Answer 128

- closed cervical os - absent history of passing foetal tissue - uterine size is the expected size

Answer 129

- open cervical os - bulging of membranes of the os < 20 weeks - uterine size is smaller than the expected size

Answer 130

- open cervical os - bulging of membranes of the os >10 weeks - uterine size is smaller than the expected size

Answer 131

- closed cervical os - passing of foetal tissue - uterine size is smaller than the expected size

Answer 132

- uterine infection during any time - vaginal bleeding -cramping pain - fever - purulent cervical discharge

Answer 133

- Closed cervical os - No spotting or bleeding (no foetal tissue passed) - Ultrasound scans diagnosis of a non-viable IUP (empty sac) - uterine size is smaller than the expected size

Answer 134

- age > 35 - previous miscarriages - antiphospholipid syndrome 15% - parenteral chromosomal derangements - embryonic chromosomal abnormalities - congenital uterine malformations -cervical weakness - DM, thyroid disease - Immune factors - Infections _ inherited thrombophilic defects - caffeine, smoking, alcohol -uterine adhesions

Answer 135

4 to 9 weeks: mifepristone and misoprostol 6 to 14 weeks: D&C Legal for up to 24 weeks > 16weeks: get 2nd opinion and if ok then D&C

Answer 136

Transvaginal US at 8 weeks

Answer 137

- cervical insufficiency or labour - placenta previa -placental abruption - uterine rupture - vasa previa

Answer 138

Sx usually persisting for several days or weeks: - increased pelvic pressure (similar to labour discomfort) - premenstrual-like cramping - backache - increased vaginal discharge - seen between 14-20 weeks - soft effaced cervix, with minimal dilation - advanced clinical - uterine size is the expected size presentation - more than 4 cm dilated and more than 80% effaced

Answer 139

-Congenital disorders of collagen synthesis (Ehlers-Danlos syndrome). -Prior cone biopsies. -Prior deep cervical lacerations, usually secondary to vaginal or C section. -Müllerian duct defects (e.g., bicornuate or septate uterus). -More than three prior foetal losses during the 2nd trimester

Answer 140

- ectopic pregnancy - occurs in 20-30% of all pregnancies - significantly increases the risk of preterm birth by 28-31 weeks

Answer 141

- Placental abruption - Placenta Previa

Answer 142

Bleeding 2 weeks postpartum is normal bleeding 2 weeks indicate placental site subinvolution - retention of small placental fragments (estimate blood loss and then perform a pelvic examination top check for uterine subinvolutionor tenderness)

Answer 143

- angiomas - common findings during pregnancy - hyperestrogenemia - resolve spontaneously after delivery

Answer 144

- Increased risk of maternal mortality - thromboembolism - haemorrhage - infection - incidental surgical injuries - more postpartum pain - adhesions - hospital readmission -infertility/sub infertility - uterine rupture -abnormal plancetation

Answer 145

- neonatal death - reparatory problems - asthma - iatrogenic prematurity - trauma (laceration) - breastfeeding failure

Answer 146

- C section - Smoking - avoidance of house dust mite or pet allergens - Probiotic dietary supplements, vitamin A, D or E supplements, or fish oil

Answer 147

- Hypocalcaemia in newborn. – Rickets later in life. – Defective tooth enamel. – Small for gestational due to effect on skeletal growth – Foetal convulsions or seizures due to hypocalcaemia.

Answer 148

- sudden haemorrhage - excruciating headache - diplopia ( oculomotor nerve) - life threatening hypotension - Fall in ACTH, sortisol

Answer 149

- CT/MRI (**MRI for pregnancy**)

Answer 150

- both warfarin and heparin safe to use for breastfeeding mothers

Answer 151

- Beta blockers: Propranolol, labetalol and metoprolol - Anticoagulation: Warfarin and Heparin

Answer 152

- Both warfarin and heparin can be given to the mother. - Heparin doesn't cross the placenta - Heparin is preferred due to the quick reversal by protamine sulphate, compared to warfarin, especially if labour occurs

Answer 153

**LMWH enoxaparin** is treatment of choice Below knee: 3 months Above knee: 6 months Postpartum: 6 weeks

Answer 154

CONTRAINDICATION - crosses placenta 1st trimester: **foetal warfarin syndrome:** 6-12 weeks' gestation - nasal hypoplasia - short fingers. Hypoplastic nails - calcified epiphyses (chondrodysplasia) - intellectual disability - low birth weight 2nd trimester (>12 weeks): - microcephaly - hydrocephalus - corpus callosum agenesis - Dandy walker malformation - mental retardation -optic atrophy, peter anomaly, microphthalmia - blindness

Answer 155

Switch to unfractionated heparin (UFH) at 36 weeks to avoid epidural haematoma

Answer 156

Pregnancy is hypercoagulable state due to - drop in C and S proteins - increased procoagulant factor V and VII - antithrombin - more common in left leg (85%) due to left iliac vein compression

Answer 157

1 or > 1 foetal losses beyond 10 weeks of gestation

Answer 158

- low-dose aspirin (50 to 100 mg per day) - Low dose prophylactic LMWH

Answer 159

- Contraindicated for pregnancy - maternal death 30-56% - most dangerous at peripartum period and immediate postpartum period (2 months) - C section preferred

Answer 160

- CTPA 1st-2nd trimester (uses less radiation than VQ, therefore safer during pregnancy) - Ventilation perfusion 3rd trimester scan (to rule out PE)

Answer 161

- thyroid gland increases by 15% - increased T3 and T4 - Free T3 and T4 unchanged - increases demand of thyroxine by 25-30% -TSH should be monitored every 8 to 10 weeks during pregnancy Here’s a simplified overview of **hypothyroidism in pregnancy**: 1. **Thyroid Changes**: - During pregnancy, the thyroid gland grows by about 15% to meet the increased demands of the body. 2. **Hormone Levels**: - **Total T3 and T4**: These thyroid hormones increase during pregnancy. - **Free T3 and T4**: These levels (the active form of the hormones) usually stay the same, even though the total levels go up. 3. **Increased Demand for Thyroxine**: - Pregnancy increases the body's need for thyroxine (a key thyroid hormone) by about 25-30%. This means that women with hypothyroidism might need a higher dose of thyroid medication during pregnancy. 4. **Monitoring TSH**: - Thyroid-stimulating hormone (TSH) should be checked every 8 to 10 weeks throughout pregnancy to ensure the thyroid hormone levels are well-managed. This helps keep both the mother and baby healthy. These points highlight how pregnancy affects thyroid function and the importance of monitoring and adjusting treatment for hypothyroidism to support a healthy pregnancy.

Answer 162

levothyroxine

Answer 163

- prolactin - alkaline phosphatase - iron binding capacity - cortisol

Answer 164

- 18% of pregnant women - screened at 1st trimester and at 28 weeks - 1000–1200 mg iron is required - serum ferritin test investigation of choice - microsomia

Answer 165

- increases the risk of preterm delivery - increases the risk of microsomia or low birth weight

Answer 166

- **routine supplementation not recommended** - oral iron 20mg/day first line - IV iron at 2nd & 3rd trimester

Answer 167

- unwashed fruits and vegetables - untreated water - raw meat - cat litter

Answer 168

1st trimester:  Chorionic Villus Sampling;  Miscarriage;  Abortion (medical after 10 weeks of gestation or surgical)  Ectopic pregnancy.  Molar pregnancy - blood transfusion Second and third trimester: (basic dose 625 IU)  Obstetric haemorrhage;  Amniocentesis or other invasive foetal intervention;  External cephalic version of a breech presentation, whether successful or not  Abdominal trauma, or any other suspected intra-uterine bleeding or sensitising event.  Abortion

Answer 169

monochorionic

Answer 170

- placenta previa - vase previa - placental abruption - cervical previa (cancer

Answer 171

vaginal 500ml - balloon, uterine ligation, hysterectomy C sec 1L

Answer 172

tone trauma tissue thrombin - Uterine atony **(most common)** 70% - Genital Tract trauma/laceration 20% - Retained products of conception/invasive placenta 10% - Coagulation abnormalities <1%

Answer 173

- atony: fundal massage + oxytocin maintained placenta - exploration under anaesthesia to remove laceration - repair if unstable: DRABCD oxygen blood match

Answer 174

- Antepartum haemorrhage (especially placental abruption and placenta praevia) - Postpartum haemorrhage with a previous pregnancy - Known placenta accreta - Multiple pregnancy - Coagulopathies

Answer 175

Placenta accreta due to deep invasion to the uterine wall not the myometrium

Answer 176

Placenta accreta Gas gangrene (clostridia 5-10%) haemolysis renal failure

Answer 177

- seizure free at least 2 years - no epileptic activity on EEG - no neurological finding

Answer 178

- Cause of Ebstein anomaly - in cases of severe bipolar disorder, lithium may outweigh the risks - Lithium use during the first trimester of pregnancy has been reported to be associated with foetal cardiovascular anomalies (e.g. Ebstein’s anomaly) and midfacial and other defects.

Answer 179

approximately 1 in 1000 to 2000 compared with 1 in 20000 in the general population.

Answer 180

an ultrasound and echocardiogram should be performed at 16-20weeks gestation to exclude foetal anomalies, especially cardiac anomalies

Answer 181

1st trimester: keep same dose as before pregnancy but heavily monitor foetus by US at 16-20 weeks. 2nd trimester: continue same lithium dosage. 3rd trimester: decrease lithium dosage by 25% to avoid floppy baby syndrome due to neonatal toxicity. After delivery **immediately** increase lithium dosage due to increased risk of relapse in postpartum period.

Answer 182

1st trimester: decrease dose to prevent neural tube defects 2nd semester: continue decreased dosage through to 3rd semester 3rd trimester: increase the dosage to prevent seizures

Answer 183

Paroxetine

Answer 184

- First antenatal visit

Answer 185

- **assess mother's viral load:** - if viral load >1000 copies/mL/unknown then intrapartum zidovudine and elective C section - If mother hasn't taken antiretroviral therapy (including only intrapartum) add lamivudine plus nevirapine to zidovudine - if viral load <1000 copies/mL then no retroviral therapy needed, allow for vaginal delivery - peripartum intravenous zidovudine - Elective C section - Bottle feeding Intervention decreases risk to <2%

Answer 186

- Usually asymptomatic 75% - acyclovir before delivery recommended - Foetal infection risk significantly higher in primary infection - Presence of lesions on the genital (vulva, cervix) require immediate C section - <30 weeks, risk of shedding during normal birth is 7% with an overall risk of <3% for neonatal HSV

Answer 187

Mitral stenosis secondary to pulmonary hypertension

Answer 188

38.7 for the first 24 hours, > 38 after 10 days post. Depends fever onset and uterine tenderness: - endometritis= uterine tenderness with/o lochia - UTI: 1-2 postpartum and urinary symptoms (dysuria) - Wound infection: 4-5 days - Septic thrombophlebitis: 5-6 days - breast engorgement: 7-21 days -atelectasis: 1st 24 hours

Answer 189

Amoxicillin + metronidazole + gentamycin IF CI: vancomycin

Answer 190

Escherichia coli

Answer 191

Obstetric - abortion/miscarriage - placental abruption - placenta previa -preterm birth < 37 weeks pre-eclampsia -PROM -ectopic pregnancy - Still birth foetal - low birth weight - - Intrauterine growth restriction - birth defects Childhood/adult - SIDS - developmental delay - Type 2 DM - Obesity - hypertension - decreased HDL

Answer 192

- Small teeth/faulty enamel

Answer 193

Most are contraindicated - ACE inhibitors -ARB's -Diuretics (1st sem teratogenic, 2-3 sem foetal renal dysfunctions, oligohydramnios, skull hypoplasia) - Beta blockers (foetal bradycardia, growth restriction) recommendation: Methyldopa, if contraindicated due to other reasons then hydralazine or labetalol

Answer 194

- Intravenous labetalol unless in patients with bradycardia (ie, <60/min) - Intravenous hydralazine if bradycardia is present - Oral nifedipine unless px nausea/vomiting

Answer 195

- Gestation > 34 weeks or <24 weeks - Labor is too advanced - advanced cervical dilation (>4cm) - Chorioamnionitis - In utero foetal death - Abnormal CTG suggesting non-reassuring foetal Status - Lethal foetal anomalies - Intrauterine foetal demise - Suspected foetal compromise - Significant antepartum haemorrhage, such as placental abruption/ active vaginal bleeding - Suspected intrauterine infections (e.g. chorioamnionitis) - Maternal hypotension - Haemorrhage with hemodynamic instability - Pregnancy-induced hypertension/ eclampsia/ - pre-eclampsia - Placenta previa - Placental insufficiency - Intrauterine growth retardation – Congestive cardiac failure. – Diabetes mellitus - Severe pre-eclampsia - Maternal allergy to specific tocolytic agents, or where tocolytics are contraindicated due to specific co-morbidities (e.g. beta agonists should not be given in case of cardiac disease)

Answer 196

1st choice: nifedipine 2nd: salbutamol and terbutaline 3rd: Ato Sibam (oxytocin antagonist)

Answer 197

– Hyperthyroidism. – Foetal cardiac disease. – Maternal cardiac disease. – **Insulin-dependent diabetes mellitus**

Answer 198

– Hyperglycaemia. – Hypokalaemia. – The maternal tachycardia. – Pulmonary oedema. – Hypotension. – Tremors

Answer 199

Ato Sibam (oxytocin antagonist) ---> CHECHK this info - Magnesium sulphate (stabilises cardiac membrane & also decreases uterine contractions)

Answer 200

- Minimum 24 hrs look for: -Regular uterine contractions -Vaginal bleeding - non-reassuring foetal heart rate tracing - Abdominal/uterine pain - Significant trauma to the abdomen

Answer 201

History: 12-14 weeks - Two or more second trimester pregnancy losses - Each loss earlier than the previous pregnancy Ultrasound: 14-26 weeks - progressive cervical shortening on serial ultrasounds - external os is closed Rescue: - Cervix dilated > 2 cm no perceived uterine contractions - > 50 % Premature cervical effacement - Increased pelvic pressure -Heavy mucoid vaginal discharge / bulging membranes through the cervical os

Answer 202

Maternal: Nulliparity Previous breech birth Uterine (anatomical) anomaly Placental abnormalities (previa, cornual) Oligohydramnios Polyhydramnios Multiple pregnancy Grand multiparity Foetal: - Extended foetal legs - Short umbilical cord - Early gestation - Foetal abnormality - Poor foetal growth

Answer 203

- Cord presentation - Any presentation other than frank or complete -breech with a flexed or neutral head attitude - Clinically inadequate maternal pelvis - Foetal anomaly incompatible with vaginal delivery - The foetal weight less than 2500g or over 3800g

Answer 204

- Frank breech: The foetal hips are flexed, and the knees extended. - Complete breech: The foetus seems to be sitting with hips and knees flexed. - Footling breech: One or both legs are completely extended and present before the buttocks. - Kneeling breech: The baby is in a kneeling position, with one or both legs extended at the hips and flexed at the knees.

Answer 205

- external cephalic version if not at term < 36 weeks - if in labour and/or >37 weeks: elective C-sec Don't allow for vaginal delivery

Answer 206

-folic acid (0.5-5mg depending on situation) - 150mcg iodine throughout pregnancy

Answer 207

Breast abscess HIV

Answer 208

Usually SAH CT (cover the uterus)

Answer 209

-most common exam finding: Marked rebound tenderness in the suprapubic region with only little or absent guarding - cervical motion tenderness - PID major predisposing factor

Answer 210

- Common - increased GFR - decreased tubular reabsorption of filtered glucose - Common in 1/6 women

Answer 211

also known as fifth disease or slapped cheek syndrome - fetal parvovirus syndrome.

Answer 212

abnormal accumulation of fluid in 2 or more foetal compartments including: - ascites -pleural effusion - pericardial effusion - skin oedema

Answer 213

-Haemolytic disease of the newborn -Severe anaemia. -Chromosomal abnormalities. -Congenital heart disease. Effects of tobacco smoking during pregnancy include: -Premature birth, -**Placental abruption (double the risk for smokers who consume more than 20 cigarettes a day)** -Spontaneous abortion. -Low birth weight. -Stillbirth. -Placenta praevia

Answer 214

IgM- IgG- - mother not immune, infection possible = repeat serology in 2 weeks IgM+ IgG-: infection established = foetal monitoring 1- 2 weeks for next 6-12 weeks IgM+ IgG+: infection established = foetal monitoring 1- 2 weeks for next 6-12 weeks IgM- IgG+: mother immune = reassurance

Answer 215

- Maternal fever more than or equal to 38°C either intrapartum or within 24 hours of giving birth - Group-B streptococcus bacteriuria and colonization in current pregnancy - Rupture of membranes prior to birth for more than 18 hours -Preterm labour (less than 37 weeks) - Previous GBS related early onset sepsis

Answer 216

- first-line: cephalexin 500mg orally, 12 hourly for 10 days (category A) - Second-line: nitrofurantoin 50mg orally, 6 hourly for 10 days (category A) Trimethoprim 300 mg oral daily for 5 days **(avoid 1st trimester due to folic acid deficeiency) - Third-line: amoxicillin + clavulanate 500+125mg orally, 12-hourly for 10 days (category B1) - Augmentin if px allergic to penicillin

Answer 217

- acute pyelonephritis 50% - acute cystitis 30%

Answer 218

Escherichia coli 80% Staphylococcus Saprophyticus 5-10%

Answer 219

Pregnant women Elderly

Answer 220

1st degree: tear involves the vaginal mucosa or perineal skin only 2nd degree: underlying subcutaneous tissue is also involved 3rd degree: rectal sphincter is affected 4th degree: extends into the rectal mucosa

Answer 221

IF vaginal discharge but no urinary symptoms: no treatment necessary Vaginal discharge WITH urinary symptoms: IV penicillin (clinda if CI) 5-7 days - Consult with Obstetrician - Commence parental treatment in labour and IM (penicillin) injection to the baby after delivery is sign of infection

Answer 222

Asymptomatic bacteriuria doesn't present with vaginal discharge as well as no urinary symptoms. Treatment cephalexin GBS comes with vaginal discharge with/o urinary symptoms

Answer 223

35-37 weeks

Answer 224

- HBsAg-positive with high viral load should be offered antiviral therapy during late pregnancy to reduce viral load before delivery - amniocentesis is probably safer than CVS - Universal screening for Hepatitis B is recommended for all pregnant women, regardless of previous testing or vaccination

Answer 225

- **PCR test for HCV RNA ** - liver function tests (LFT) for concomitant HIV - transmission rate to foetus is 5% - co-infection with HIV, transmission rate increases to 25%. (**avoid foetal blood sampling/foetal scalp electrode**) - Infant HCV screening at 12-18months - Ribavirin teratogenic

Answer 226

- C section - amniocentesis - FBS - amniotomy

Answer 227

1st trimester: Reduced pregnancy-associated plasma protein A (PAPP-A) 2nd trimester: Increased Inhibin A + increased free Beta HCG, decreased AFP + decreased unconjugated estriol (60-75% sensitivity) Tiple test common. Quadruple if indicated 2nd trimester: Free bhCG increased AFP decreased Unconjugated estriol decreased 70-75% sensitivity

Answer 228

Amniocentesis at 16 weeks

Answer 229

Cocaine: most severe neurological defects Increased ICH

Answer 230

Tachycardia

Answer 231

– Rural or remote residents. – Sexual abuse survivors. – Early age at first sexual intercourse. – Aboriginal and Torren Street islander. – Disrupted home and family life. – Teenage mothers. – Inconsistent use of contraceptives

Answer 232

delayed first/2nd delivery

Answer 233

- Prolonged pregnancy - Pre-eclampsia - Congenital infections (CMV, toxoplasmosis) - Placental insufficiency

Answer 234

- foetal kidneys congenital abnormalities -genitourinary tract (renal agenesis or obstruction)

Answer 235

Azithromycin 1 g oral

Answer 236

1- Gestational diabetes (GDM) 2- Pre-eclampsia 3- Sleep apnoea 4- Macrosomia (increased baby weight > 4kg)

Answer 237

- US to differentiate between “hot” and “cold” nodule - FNAC after for all cold nodules to establish a histopathological diagnosis NOTE: Radioisotope or radionuclide Technetium uptake scan **absolute contraindication** -

Answer 238

greenish fluid

Answer 239

Foetal respiratory distress

Answer 240

- CTG remains normal then spontaneous vaginal delivery - minor abnormality **(early deceleration)** on CTG then foetal scalp blood sampling to see blood pH and or lactate level

Answer 241

- occurs when breadth of the shoulders diameter exceeds the diameter of the pelvic inlet - brachial plexus palsies including Erb’s palsy (waiter step) (C5-C6 compression) - McRoberts manoeuvre ( hyperflexing the mother’s legs tightly to her abdomen) is employed - If manoeuvre fails, apply pressure on the lower abdomen (suprapubic pressure), and delivered head is also gently pulled. Useful in about 42% of cases.

Answer 242

- Maternal DM - foetal macrosomia - Oxytocin augmentation - epidural anaesthesia

Answer 243

- confirmed by eggs in faeces - may develop respiratory tract symptoms - gastrointestinal symptoms - **Pyrantel pamoate 11mg/kg single dose** **benzimidazoles absolutely contraindicated**

Answer 244

- excessive weight loss >10% -excessive weight loss - suspected domestic violence - court order

Answer 245

Face presentation

Answer 246

previous C sec

Answer 247

– Uterine infection. – Haemorrhagic shock. – Sepsis. – Pre-eclampsia. – Metastasis to the lungs/breast

Answer 248

- Hydatidiform mole may be complete with no fetal tissue or incomplete with some fetal tissue - vaginal bleeding in early pregnancy (“grape like debris”) - Uterus is large for date - hyperemesis gravidarum - hyperthyroidism - high Beta-hCG - ultrasound shows “typical snow-storm appearance”

Answer 249

- Hydatidiform Moles (HM) - Complete HM. - Partial HM. - Gestational Trophoblastic Neoplasia (GTN) - Invasive moles. - Choriocarcinomas. - Placental-site trophoblastic tumors (PSTT; very rare)

Answer 250

- suction & curettage - Consider hysterectomy if patient has completed family

Answer 251

-Cord presentation. -Foetal growth retardation or macrosomia. -Any presentation is other than frank or complete breech. -Clinically inadequate pelvis. -Extension of the foetal head. -The foetal anomaly is incompatible with vaginal delivery

Answer 252

- Previous influenza allergy - Egg allergy

Answer 253

> 42 weeks - induce labour

Answer 254

- Treponema pallidum - spontaneous miscarriage or stillbirth - 2 serological tests: treponemal tests non-treponemal tests -routine testing at first antenatal contact - Prenatal screening tests offered as a choice

Answer 255

- screening done after delivery if urgent can done immediately? - vaccination done after delivery

Answer 256

- can improve in 75% of the cases and can get worse in 25% - methotrexate and leflunomide contraindicated (folic congenital disabilities) - methotrexate can be switched to **sulfasalazine**

Answer 257

- Safe at even high doses, can be given during breastfeeding

Answer 258

- 30% increase in seizures/relapse (level of anti-epileptic drugs falls in pregnancy)

Answer 259

Sodium Valproate/Valproic acid

Answer 260

- Wait for spontaneous vagina delivery at 41st week - After 41 weeks, induce labour

Answer 261

significant arterial hypotension resulting from inferior vena cava compression (supine hypotensive syndrome or inferior vena cava syndrome)

Answer 262

- If mother asymptomatic: oxytocin and amniotomy - if symptomatic: C section

Answer 263

<18.5 kg/m : 12.7-18 kg 18.5-24.9 kg/m : 11.4-15.9 kg 25-29.9 kg/m : 6.8-11.4 kg ≥30 kg/m : 5-9 kg

Answer 264

- cardinal symptom of cervical cancer red and inflamed appearance of the cervix (cervical ectropion) - **HPV and liquid based cytology test**

Answer 265

- dichorionic and diamniotic placenta regardless of the sex of the foetuses - placentas of dizygotic twins may be totally separated or intimately fused

Answer 266

- are always of the same sex but may be monochorionic or dichorionic depending upon when the separation of the twins occurred - 20% to 30% have dichorionic placentation

Answer 267

- Obstetric haemorrhage complicated by hypotension - Postpartum pituitary infarction

Answer 268

Lactation failure (low prolactin) Amenorrhea, hot flashes, vaginal atrophy (low FSH, LH) Fatigue, bradycardia (low TSH) Anorexia, weight loss, hypotension (low ACTH) Decreased lean body mass (low growth hormone)

Answer 269

- hypotension (Vasodilation and venous pooling) - bradycardia - respiratory difficulty - Leakage of CSF (no hypotension)

Answer 270

asymptomatic: no treatment needed symptomatic: large lesions with cryotherapy or keratolytics such as trichloracetic acid (TCA) or bichloracetic acid (BCA)

Answer 271

- cystic fibrosis - sweat chloride test for confirmation - for conception/fertility, sperm can be aspirated from the epididymis

Answer 272

Less than three months old: - sepsis, - meningitis - pneumonia

Answer 273

**Incoordinate uterine action** other causes: - prolonged labour - intrauterine infection - increased analgesia required - obstructed labour

Answer 274

foetal distress

Answer 275

**Incoordinate uterine action** resulting in occipito-posterior (OP) position in labour

Answer 276

11cm (vs normal 9.5 cm) - CTG monitoring recommended even more common if oxytocin & epidural were used (CTG mandatory) associated with poor quality uterine contraction - if this is excluded, cephalopelvic disproportion **incoordinate uterine action almost always occurs** (AMC Handbook)

Answer 277

Stimulate labour: - amniotomy - oxytocin Epidural (often necessary) C-sec (in case of obstructed labour/foetal distress)

Answer 278

atrophic vaginal epithelium - low oestrogen level due to high prolactin level

Answer 279

**Positive foetal fibronectin test** Previous premature delivery Increased uterine size - foetal macrosomia - polyhydramnios - multiple pregnancies shortened cervix - <1.5cm in length Opened cervix - open internal os bacterial vaginosis only if - in case of increased cervical length - open cervix

Answer 280

- IUGR - monochorionic twins twin to twin transfusion