Obstetrics

Question 1

What is the primary clinical use of mifepristone?

Answer 1

Medical termination of pregnancy (abortion), usually in combination with misoprostol.

Question 2

What type of drug is mifepristone?

Answer 2

A progesterone receptor antagonist

Question 3

How does mifepristone work to induce abortion?

Answer 3

It blocks the action of progesterone, leading to breakdown of the uterine lining and detachment of the embryo.

Question 4

What drug is typically given after mifepristone for medical abortion?

Answer 4

Misoprostol, a prostaglandin analogue, to stimulate uterine contractions and expel the pregnancy.

Question 5

How long after mifepristone is misoprostol usually given?

Answer 5

24 to 48 hours later.

Question 6

Up to how many weeks of gestation is the mifepristone-misoprostol combination most effective?

Answer 6

Up to 10 weeks (70 days), but can be used beyond this with specialist guidance.

Question 7

What are common side effects of mifepristone?

Answer 7

Nausea, vomiting, abdominal pain, vaginal bleeding, fatigue.

Question 8

What serious complication must be monitored for after medical abortion?

Answer 8

Heavy bleeding, infection, or incomplete abortion.

Question 9

What class of drug is misoprostol?

Answer 9

A prostaglandin E1 analogue.

Question 10

What is the primary use of misoprostol in reproductive health?

Answer 10

To induce uterine contractions for medical abortion, labour induction, or management of miscarriage.

Question 11

How does misoprostol work in medical abortion?

Answer 11

It stimulates uterine contractions to expel the pregnancy after mifepristone has been used to block progesterone.

Orally, sublingually, buccally, or vaginally depending on the indication and clinical protocol.

Question 12

What are common side effects of misoprostol?

Answer 12

Cramping, diarrhoea, nausea, vomiting, fever, chills.

Question 13

What serious complication can misoprostol cause when used in pregnancy?

Answer 13

Uterine rupture, especially in women with a previous C-section or uterine surgery.

Question 14

What are the two main methods of abortion?

Answer 14

Medical abortion and surgical abortion.

Question 15

What medications are used in medical abortion?

Answer 15

Mifepristone followed by misoprostol.

Question 16

What is the legal gestational limit for most abortions in England, Scotland, and Wales?

Answer 16

24 weeks, unless special circumstances apply (e.g. risk to life or severe fetal abnormalities).

Question 17

What is the definition of miscarriage?

Answer 17

The spontaneous loss of pregnancy before the foetus reaches viability (before 24 weeks of gestation).

Question 18

What is recurrent miscarriage?

Answer 18

The loss of three or more pregnancies before 24 weeks of gestation.

Question 19

What symptoms might suggest a miscarriage in early pregnancy?

Answer 19

Vaginal bleeding with or without pain in the first 24 weeks of pregnancy.

Question 20

What is the first step if a miscarriage is suspected?

Answer 20

Confirm pregnancy with a urine pregnancy test.

Question 21

What is expectant management in women <6 weeks gestation with bleeding but no pain or risk factors?

Answer 21

Advise return if bleeding or pain continues

Repeat urine pregnancy test in 7–10 days

If negative, miscarriage is confirmed

Question 22

When is vaginal micronised progesterone offered?

Answer 22

After vaginal bleeding in a woman with viable intrauterine pregnancy and previous miscarriage.

Should be continued if a fetal heartbeat is confirmed until 16 completed weeks of pregnancy.

Question 23

What is an ectopic pregnancy?

Answer 23

Implantation and growth of a fertilised ovum outside the uterine cavity.

In the fallopian tube (97% of cases).

Question 24

Name three risk factors for ectopic pregnancy.

Answer 24

Tubal damage
Maternal age >35 years
Smoking

Question 25

What are common symptoms of ectopic pregnancy?

Answer 25

Abdominal/pelvic pain Amenorrhoea or missed period Vaginal bleeding Less common symptoms: GI symptoms Dizziness Shoulder tip pain Urinary symptoms

Question 26

What is the first step if ectopic pregnancy is suspected?

Answer 26

Confirm pregnancy (if not already done) and examine the patient.

Question 27

When is expectant management appropriate in suspected ectopic pregnancy?

Answer 27

<6 weeks' gestation Bleeding but not in pain No risk factors (e.g., no previous ectopic)

Question 28

What medication is commonly used to treat ectopic pregnancy medically?

Answer 28

Methotrexate (unlicensed use).

Question 29

What antibacterial is commonly used to prevent intra-uterine infection in preterm prelabour rupture of membranes (P‑PROM)?

Answer 29

Erythromycin.

Question 30

What dose of folic acid is recommended in normal pregnancy?

Answer 30

400 micrograms per day during the first 12 weeks.

Question 31

When is 5 mg folic acid daily recommended?

Answer 31

For women at higher risk (e.g., epilepsy, diabetes, prior neural tube defect).

Question 32

What vitamin D dose is recommended in pregnancy?

Answer 32

10 micrograms per day (400 IU).

Question 33

What vitamin should pregnant women avoid supplementing?

Answer 33

Vitamin A (risk of teratogenicity).

Question 34

When should anti-D prophylaxis be given to Rh-negative women?

Answer 34

At 28 weeks. To prevent Rhesus sensitization and haemolytic disease of the new-born.

Question 35

When does nausea and vomiting typically begin, peak, and resolve in pregnancy?

Answer 35

Begins at 4–7 weeks, peaks at 9–16 weeks, and resolves by 16–20 weeks.

Question 36

What condition describes severe nausea/vomiting that affects daily functioning and causes dehydration?

Answer 36

Hyperemesis gravidarum.

Question 37

What is the first-line drug treatment for nausea and vomiting in pregnancy?

Answer 37

Oral cyclizine, promethazine, prochlorperazine, chlorpromazine, or doxylamine/pyridoxine (Xonvea®).

Question 38

What are the second-line antiemetics if first-line treatments fail?

Answer 38

Oral metoclopramide, domperidone, or ondansetron. Possible small increased risk of cleft lip/palate in the first trimester with ondansetron.

Question 39

What is the first-line treatment for constipation in pregnancy?

Answer 39

Bulk-forming laxative (e.g., ispaghula).

Question 40

What laxative is added if stools remain hard?

Answer 40

Osmotic laxative (e.g., lactulose).

Question 41

What is used if stools are soft but difficult to pass?

Answer 41

Stimulant laxative (e.g., senna).

Question 42

Are topical haemorrhoidal treatments licensed in pregnancy?

Answer 42

No, not licensed; simple soothing agents preferred over corticosteroids or anaesthetics.

Question 43

What is the first-line treatment for dyspepsia if lifestyle changes fail?

Answer 43

Antacids and alginates. Brands include Gaviscon Advance and Rennie (calcium carbonate and magnesium carbonate).

Question 44

What antacids should be avoided in pregnancy?

Answer 44

Sodium bicarbonate and magnesium trisilicate.

Question 45

What is the treatment for obstetric cholestasis (itch without a rash)?

Answer 45

Emollients, menthol cream, sedating antihistamines; refer for specialist care.

Question 46

What blood pressure defines hypertension in pregnancy?

Answer 46

Diastolic BP of 90–109 mmHg and/or systolic BP of 140–159 mmHg.

Question 47

What is chronic hypertension in pregnancy?

Answer 47

Hypertension present before the booking visit or before 20 weeks' gestation.

Question 48

What is gestational hypertension?

Answer 48

New hypertension after 20 weeks gestation without significant proteinuria.

Question 49

What is pre-eclampsia?

Answer 49

New hypertension after 20 weeks gestation with significant proteinuria.

Question 50

What is eclampsia?

Answer 50

Occurrence of seizures in a woman with pre-eclampsia.

Question 51

How should proteinuria be assessed during antenatal visits?

Answer 51

With dipstick testing.

Question 52

What should be offered to women at high risk of pre-eclampsia?

Answer 52

Consultant-led care Aspirin 75–150 mg daily from 12 weeks Education on pre-eclampsia symptoms

Question 53

What should be done with methyldopa after birth?

Answer 53

Ideally stopped within 2 days due to risk of depression.

Question 54

What is the first-line antihypertensive for breastfeeding women?

Answer 54

Enalapril (unless contraindicated); nifedipine or amlodipine for Black African/Caribbean origin.

Question 55

What is the first-line antihypertensive in pregnancy?

Answer 55

Labetalol (unless contraindicated).

Question 56

When should ACE inhibitors or ARBs be stopped in pregnancy?

Answer 56

Immediately upon pregnancy confirmation due to fetal risk.

Question 57

What is the target BP for treated chronic hypertension in pregnancy?

Answer 57

135/85 mmHg.

Question 58

What is the WHO recommendation for exclusive breastfeeding?

Answer 58

Until at least 6 months of age, with continued breastfeeding up to 2 years or longer. Benefits include - Reduced risk/severity of infections, asthma, and atopic eczema for the baby. Reduced risk of breast and ovarian cancer, and obesity for the mother.

Question 59

What topical steroid is commonly used for nipple infection?

Answer 59

Hydrocortisone 1% cream. Creams preferred (easier to remove than ointments).

Question 60

What precaution should be taken with topical steroids before breastfeeding?

Answer 60

Wash off with warm water before breastfeeding and reapply after.

Question 61

What defines postnatal depression?

Answer 61

Depression developing up to one year after birth.

Question 62

What antidepressants are preferred during breastfeeding?

Answer 62

SSRIs: Sertraline, Paroxetine.

Question 63

Which antidepressant should be avoided during breastfeeding?

Answer 63

Doxepin.

Question 64

Which common analgesics are safe during breastfeeding?

Answer 64

Paracetamol and ibuprofen.

Question 65

Why should aspirin be avoided when breastfeeding?

Answer 65

Risk of Reye’s syndrome in infants.

Question 66

Why is codeine not recommended during breastfeeding?

Answer 66

It can cause drowsiness or breathing problems in infants.

Question 67

What weak opioid is preferred if stronger pain relief is needed during breastfeeding?

Answer 67

Dihydrocodeine.

Question 68

What is labetalol (beta blocker) commonly used for in pregnancy?

Answer 68

Management of moderate to severe hypertension.

Question 69

What are common side effects of labetalol?

Answer 69

Fatigue, dizziness, headache, bradycardia, gastrointestinal disturbances.

Question 70

What serious side effect must be monitored for with labetalol?

Answer 70

Hepatotoxicity (monitor liver function if symptoms like abdominal pain, nausea, jaundice occur).

Question 71

Can labetalol be used during breastfeeding?

Answer 71

Yes, considered compatible with breastfeeding.

Question 72

What is methyldopa used for in pregnancy? A: Treatment of hypertension, especially in early pregnancy.

Question 73

Management of hypertension in pregnancy - first line...?

Answer 73

First-line treatment is usually labetalol if not contraindicated Consider nifedipine for women in whom labetalol is not suitable. Consider methyldopa if both labetalol and nifedipine are not suitable.

Question 74

What are common side effects of methyldopa?

Answer 74

Sedation, dry mouth, fatigue, depression, liver dysfunction.

Question 75

Why is methyldopa often switched later in pregnancy or postpartum?

Answer 75

Due to central side effects like sedation and potential for depression. Methyldopa taken during pregnancy should ideally be stopped within 2 days of birth.

Question 76

Which class of antidepressants is generally avoided in pregnancy due to teratogenic risks?

Answer 76

Paroxetine (SSRI) and most tricyclics except imipramine/nortriptyline.

Question 77

Which antidepressant is particularly associated with neonatal withdrawal and pulmonary hypertension?

Answer 77

Fluoxetine (especially in late pregnancy).