Pregnancy

Question 1

When is the first episode of maternal perception of movements? In parous/ and nullparous

Answer 1

Parous- 14-16

Nulll 18-20

Question 2

When is the peak onset of ‘baby blues’- feeling tired, sad and low?

Answer 2

2-4 days post-partum

Question 3

When is the fundus of the uterus palpable at the xiphisternum?

Answer 3

38 weeks

Question 4

When, in nullparous women should the presenting part ‘engage’?

Answer 4

36-38 weeks

Question 5

When is the uterine fundus palpable at the level of the umbilicus?

Answer 5

22 weeks

Question 6

Which two drugs are safe to prescribe in pregnancy for epilepsy?

Answer 6

Carbimazipine and lamotrigine

Question 7

Which drug is safe to treat hyperthyroidism in pregnancy?

Answer 7

Propylthiouracil

Question 8

Why should trimethoprim be avoided in the first trimester?

Answer 8

Folic acid antagonist

Question 9

Why should nitrofurantoin be avoided at term?

Answer 9

Risk of neonatal haemolysis

Question 10

What is classified as a ‘prolonged labour’?

Answer 10

12 days after expected due date

Question 11

When do pregnancy related hypertension or pre-eclampsia not occur before?

Answer 11

20 weeks

Question 12

How do you manage mastitis post partum?

Answer 12

Continue breast feeding, simple analgesia and warm compresses

Question 13

When is the use of antibiotic indicated in treating mastitis?

Answer 13

When there is an infected nipple fissure, if symptoms have not improved over 12-24 hours despite effective milk removal or if the milk culture is postitive

Question 14

When antibiotics are indicated for mastitis, what should be given and for how long?

Answer 14

Oral Fluclox 10-14 days.

Erythro/Clarithro if pen allergic

Question 15

What are the cut off values for anaemia in pregnancy?

Answer 15

first trimester Hb less than 110 g/l
second/third trimester Hb less than 105 g/l
postpartum Hb less than 100 g/l

Question 16

What is a post partum heamorrhage?

Answer 16

Primary postpartum haemorrhage is defined as the loss of 500ml or more from the genital tract within 24 hours of the birth of a baby.

Question 17

What are the four T’s defining the causes of a PPH?

Answer 17

Tone (uterine atony), tissue (retained placenta), trauma, thrombin (coagulation abnormalities)

Question 18

What is the typical clinical presentation of placenta praevia?

Answer 18

he key clinical feature is painless bleeding after 24 weeks of gestation.

Question 19

What are the risk factors for placenta preavia?

Answer 19

previous placenta praevia, previous caesarean section, endometrium damage and multiple pregnancies.

Question 20

What is the ‘let down’ reflex?

Answer 20

Its when the milk is ejected from the breasts in lactation

Question 21

What is lactation dependent upon?

Answer 21

Prolactin and Oxytocin

Question 22

Which one stimulates milk secretion- prolactin or oxytocin?

Answer 22

Prolactin

Question 23

What actually causes milk to be secreted?

Answer 23

The rapid decline in oestrogen and progesterone levels after birth, these are both antagonised by prolactin.

Question 24

What role does oxytocin play in lactation?

Answer 24

Oxytocin stimulates ejection in response to nipple suckling, which also stimulates prolactin release and therefore more milk secretion.

Question 25

Since oxytocin release is controlled via the hypothalamus, what factors can affect lactation?

Answer 25

It can be inhibited by emotional or physical stress

Question 26

What is passed for the first 3 days before the milk comes in?

Answer 26

Colostrum. this is a yellow fluid containing fat-laden cells, proteins (including IgA) and minerals.

Question 27

How many calories are present per 100ml of breast milk?

Answer 27

70kcals

Question 28

Which contraceptive methods are safe with breast-feeding?

Answer 28

Progesterone only pill or depot, and the IUD but make sure to screen for infection first.

Question 29

When should contraception be commenced after birth?

Answer 29

4-6 weeks

Question 30

What happens to the level of HCG in pregnancy?

Answer 30

It rises (doubles every 48 hours) until roughly 9 weeks then drops.

Question 31

What happens to the level of oestrogen and progesterone in pregnancy?

Answer 31

They slowly increase until 24 weeks then rise more steeply.

Question 32

What are the parameters of biophysical profile?

Answer 32

CTG, fetal breathing, fetal movement, fetal tone, liqua volume

Question 33

When should ECV be carried out?

Answer 33

Repeat examination at 36 weeks, if nulliparous can do ECV at 36 weeks and if multi do at 37 weeks.