Obstetrics - Antepartum

Question 1

Combined screening test for Down’s - when and what markers does it measure

Answer 1

11-14 weeks
PAPPA
Beta HCG
AFP
uE3
Inhibin A
Nucchal transulcency USS

Question 2

Triple/quadruple screening test for Down’s - when and what markers does it measure

Answer 2

15-20 weeks
AFP
uE3
hCG

Question 3

Anomaly scan

Answer 3

18-21 weeks

Question 4

Booking visit with midwife

Answer 4

10 weeks

Question 5

Appointments for nullip

Answer 5

x10

10, 16, 25, 28, 31, 34, 36, 38, 40,41 weeks

Question 6

Appointments for multip

Answer 6

x7

10, 16, 28, 34, 36, 38, 41

Question 7

Anti-D given

Answer 7

28 weeks, 34 weeks

Question 8

Diagnostic testing for Down’s

Answer 8

10-15 weeks, CVS

After 15 weeks, amniocentesis

Question 9

Booking appointment - infectious disease screening (4)

Answer 9

Rubella - if non-immune, avoid all infectious contacts and wait until after this pregnancy until being immunised
Hep B - if positive, newborn immunisation
HIV - antenatal ART, elective CS, no breast feeding
Syphilis - maternal ABx

Question 10

Booking appointment - other bloods (3)

Answer 10

FBC
ABO
Rh

Question 11

When to test for gestational diabetes

Answer 11

If risk factors, OGTT at 24-28wks

Question 12

Common antenatal problems (6)

Answer 12

Constipaion
Reflux
Haemorrhoaids
Varicose veins
Oedema
Nausea/vomiting

Question 13

Respiratory changes in pregnancy (3)

Answer 13

Increased tidal volume
Reduced residual volume
Compensated respiratory alkalosis

Question 14

Cardiovascular changes in pregnancy (3)

Answer 14

Increased blood volume
Increased CO
Decreased BP

Question 15

GI changes in pregnancy (5)

Answer 15

Nausea
Altered appetite
Reflux (delayed emptying)
Gallstone predisposition
Liver signs (difficulty metabolising progesterone and oestrogen)

Question 16

Genitourinary changes in pregnancy (4)

Answer 16

Increased GFR
Increased sodium
Reduced bladder capacity
Mild hydronephrosis

Question 17

Haematological changes in pregnancy (2)

Answer 17

Increased fibrinogen, F VII, VIII, IX, X

Decreased protein S, antithrombin III

Question 18

Endocrine changes in pregnancy (2)

Answer 18

Reduced calcium

Increased aldosterone and cortisol

Question 19

MSK changes in pregnancy (1)

Answer 19

Exaggerated lumbar lordosis (leads to lower back strain)

Question 20

Dermatological changes in pregnancy (2)

Answer 20

Hyperpigmentation of umbilicus, areolae, midline (linea nigra)
Liver skin signs

Question 21

High risk pregnancies (5)

Answer 21

Problems in current pregnancy:
Problems in labour
Pre-existing conditions
Problems in previous pregnancy
Social

Question 22

High risk pregnancy: problems in current pregnancy (5)

Answer 22

IUGR
Multiple pregnancy
Hypertension
Diabetes
Thromboembolism

Question 23

High risk pregnancy: problems in labour (3)

Answer 23

Meconium/bloody liquor
Pathological CTG
Lack of progress

Question 24

High risk pregnancy: pre-existing conditions (5)

Answer 24

Diabetes
Hypertension
VTE
Obesity
Mental illness

Question 25

High risk pregnancy: problems in previous pregnancy (6)

Answer 25

``` Pre-eclampsia Previous CS Recurrent miscarriage Preterm, stillbirth Gestational diabetes Tears ```

Question 26

High risk pregnancy: social (5)

Answer 26

``` Teenage Domestic violence Low SEC Alcohol, drugs Maternal age >40 ```

Question 27

HELLP

Answer 27

Haemolysis Elevated Liver enzymes Low Platelets

Question 28

Presentation of HELLP

Answer 28

RUQ/epigastric pain N&V Headaches

Question 29

Antiphospholipid syndrome in pregnancy - treatment

Answer 29

Aspirin | LMWH

Question 30

Screening for gestational diabetes

Answer 30

Previous gestational diabetes - OGTT at 16-18 weeks | Risk factors - OGTT at 24-28 weeks

Question 31

Management gestational diabetes

Answer 31

Change in diet and exercise (works in 80%) | Metformin or insulin if complications or poor control

Question 32

Management pre-existing diabetes

Answer 32

Stop all oral hypoglycaemics apart from metformin, start insulin

Question 33

Causes of increased nuchal translucency

Answer 33

Down's syndrome Congenital heart defects Abdominal wall defects

Question 34

Causes of hyperechogenic bowel

Answer 34

CF Down's syndrome CMV

Question 35

Vomiting in pregnancy - treatment

Answer 35

Antihistamines e.g. promethazine

Question 36

CTG: causes of early decelerations (3)

Answer 36

Head compression, Cord compression Foetal hypoxia

Question 37

CTG: causes of variable decelerations (1)

Answer 37

Cord compression

Question 38

CTG: causes of late decelerations (1)

Answer 38

Foetal hypoxia

Question 39

CTG: causes of reduced variability (4)

Answer 39

Baby sleeping Depressants e.g. opiates Thumb sucking Maternal dehydration

Question 40

CTG: normal foetal heart rate

Answer 40

110-150

Question 41

CTG: causes of foetal tachycardia (5)

Answer 41

``` Foetal hypoxia Chorioamnionitis (does mother have fever?) Hyperthyroidism Foetal/maternal anaemia Foetal tachyarrhythmia ```

Question 42

CTG: causes of foetal bradycardia (7)

Answer 42

``` Post-date presentation OP or transverse presentation Prolonged: Prolonged cord compression Cord prolapse Epidural/spinal Rapid foetal descent Maternal seizures ```

Question 43

CTG: management early decelerations

Answer 43

Physiological - no management required

Question 44

CTG: management variable decelerations

Answer 44

Change maternal position | Shouldering is reassuring

Question 45

CTG: management late decelerations

Answer 45

Foetal blood sample for pH | If acidotic, emergency LSCS

Question 46

CTG management prolonged decelerations

Answer 46

Foetal blood sample for pH | If acidotic, emergency LSCS

Question 47

CTG: management sinusoidal pattern

Answer 47

(Smooth, regular, wavy) | Immediate C section