problems

Question 1

gestational diabetes when

Answer 1

20wks on

Question 2

foetus can make mother insulin resistant. which hormones does the baby make

Answer 2

hPL PCRH making cortisol and PGH

Question 3

pregnancy is a naturally …resistant state. why?

Answer 3

insulin
excess glucose is what foetus needs for growth

Question 4

is gestational dm more like type 1 or 2

Answer 4

a mixture of both. insulin production is restricted from beta cells AND insulin resistance

Question 5

increased cortisol leads to …resistance

Answer 5

insulin

Question 6

massive baby might need what when it’s born

Answer 6

glucose drip to wean off hyperinsulinemia
perinatal hypoglycemia

Question 7

meds for gestational dm

Answer 7

metformin glyburide

Question 8

what levels of hepcidin in different stages of prg

Answer 8

Up in 1st trimester
Down in 2nd and 3rd trimester

Question 9

when is gestational anemia more common

Answer 9

2 and 3 trimester

Question 10

when is amniotic fluid most. how much

Answer 10

28 wks 800ml

Question 11

what condition oligohydramnios. why?

Answer 11

Potter sequence - flat face, squished face, club foot
normally kidney abnormalities

Question 12

cytomegalovirus what is it

Answer 12

generic sub-clinical virus but can be dangerous if mum catches primary infection in 1st trimester, 10% of asymptomatic babies and 90% of symptomatic babies have hearing probs (sensory neural deafness), mental retardation, microcephaly

Question 13

what is the biggest cause of hearing loss in young children

Answer 13

cytomegalovirus

Question 14

symptomatic baby CMV how does it look

Answer 14

petechial purpuria with jaundice

Question 15

classic triad of gestational rubella

Answer 15

cardiac. cataract/glaucoma, deafness

cardiac probs:
patent ductus arteriosus, pulmonary valve stenosis

Question 16

gestational toxoplasmosis

Answer 16

Chorioretinitis , hydrocephalus, intracranial atherosclerosis

Question 17

mortality in untreated neonate herpes

Answer 17

65%

Question 18

what sort of bateria is listeria

Answer 18

gram+ rod

Question 19

congenital syphilis sequelae

Answer 19

Early 0-2 years
Rash
Rhinorrhoea (mucus full of T.pallidum)
Osteochondritis
Perioral fissures
Lymphadenoapthy
Pemphigus syphiliticus
Late >2 years
Hutchinson’s teeth
Clutton’s joints
Saber shins
High arched palate
Deafness
Saddle nose deformity
Frontal bossing

Question 20

foetus makes what molecule -> Hyperemesis gravidarum

Answer 20

GDF15

Question 21

which vitamin for morning sickness, when

Answer 21

B6 from point of conception

Question 22

which is the only viable aneuploidy

Answer 22

Turner’s (X0)

Question 23

inevitable miscarriage ultrasound

Answer 23

gestational sac is completely detached

Question 24

recurrent miscarriage

Answer 24

3 or more consecutive miscarriages

Question 25

where should pregnancy implant

Answer 25

top back wall

Answer 26

Placenta abruption Placental praevia Incidental genital tract pathology Uterine rupture Vasa praevia Fetal blood vessels run close to or over opening of the uterus

Question 27

symptoms of placental abruption

Answer 27

bleeding tense woody uterus weak or absent fetal heartrate

Question 28

what is placental abruption

Answer 28

retroplacental blood clot

Question 29

placenta praevia tx

Answer 29

lower segment C section

Question 30

describe the placenta accreta etc problems

Answer 30

Question 31

what is pre-eclampsia

Answer 31

hypertension after 20 wks, proteinuria, low placental growth factor

Question 32

in pre-eclampsia, what happens to the spiral arteries

Answer 32

stay narrow so blood is under high pressure, baby gets much less O2

Question 33

active stage of labour starts when

Answer 33

6cm

Question 34

what is prolonged labour

Answer 34

>20h if 1st time >14 if 2nd etc

Question 35

drugs to help labour along

Answer 35

Oxytocin, misoprostol, mifepristone, oestrogen pessary

Question 36

how long is max for forceps or ventouse delivery

Answer 36

15 mins or 3 contractions

Question 37

when can't you use forceps/ventouse

Answer 37

preterm, breech presentation

Question 38

which nerve can be damaged by forceps

Answer 38

facial

Question 39

most common complication of ventouse/forceps

Answer 39

retinal haemorrhage

Question 40

foetal heartrate should be

Answer 40

120-130

Question 41

what is monitored in labouring mother

Answer 41

HR sats, contractiona

Question 42

what heartrate changes is worrying in baby in labour - why

Answer 42

Late decelerations Vagal stimulation or myocardial depression from placental insufficiency Late decelerations and bradycardia emergency C-section

Question 43

what is definition of early deceleration

Answer 43

nadir of HR coincides with peak of contractino

Question 44

are variable decelerations in foetal HR in labour worrying? whyw?

Answer 44

not usually because different parts of baby being compressed

Question 45

late decels and bradycardia in labour in foetus ->

Answer 45

emergency caesarian section

Question 46

early deceleration in foetal HR known as, what shape

Answer 46

type 1 dip, V shape

Question 47

late deceleration in foetal HR known as, what shape

Answer 47

type 2 dip, U shape

Question 48

drugs to delay labour

Answer 48

It’s Not My Time Indomethecin (NSAID Cox inhibitors) Nifedipine (Ca channel blocker) Magnesium sulphate (fetal neuroprotection) Terbutaline (adrenergic agonist (beta)

Question 49

what to do to support foetal distress

Answer 49

Changing the mother’s position Increasing maternal hydration Maintaining oxygenation for the mother Amnioinfusion, where fluid is inserted into the amniotic cavity to relieve pressure on the umbilical cord

Question 50

how to check for cyanotic baby

Answer 50

check mucus membranes

Question 51

danger of meconium in utero

Answer 51

aspiration

Question 52

discuss APGAR score

Question 53

shoulder dystocia what is it

Answer 53

shoulder gets stuck under pubic bone

Question 54

how do you deal with shoulder dystocia

Answer 54

McRoberts manoeuvre episiotomy

Question 55

which nerve is normally stretched in shoudler dystocia

Answer 55

radial

Question 56

which bones can be broken in shoulder dystocia

Answer 56

clavicle and humerus

Question 57

why does haemorrhage in labour occur

Answer 57

Bleeding happens after the placenta is expelled, because uterine contractions are too weak and cannot provide enough compression to the blood vessels at the site of where the placenta was attached to the uterus

Question 58

link between multi preg and haemorrhage

Answer 58

over-distension of uterus

Question 59

best breech presentation

Answer 59

Frank breech

Question 60

worst breech presentation

Answer 60

footling breech

Question 61

main symptom of placenta previa

Answer 61

bleeding in 3rd trimester

Question 62

signs of uterine rupture

Answer 62

Abnormal heart rate in the baby Abdominal pain and uterine tenderness Vaginal bleeding Slow progress in labour Altered uterine contractions Rapid heart rate and low blood pressure in the mother

Question 63

precipitous labour=

Answer 63

birth in <3 hours

Question 64

complcation of precipitous labour

Answer 64

hypotonic uterus - haemorrhage

Question 65

changes in uterus from delivery to 6 wks

Answer 65

900g -> 60g

Question 66

what is leading cause of maternal death in postnatal period (6wks)

Answer 66

thrombosis and thromboembolism

Question 67

2 examples of uterine infection

Answer 67

endometritis, parametritis

Question 68

what do you see on MRI if post-partum uterine infections

Answer 68

purulent uterus and gas pockets

Question 69

causes of post or peri partm haemorrhage (4 T's)

Answer 69

Tone = 75-80% of cases, overdistension, intrinsic or extrinsic dysfunction Tissue = retained products of conception Trauma = tears to vagina, cervix, uterine rupture, instrument delivery Thrombosis = thrombin, anticoagulant use and bleeding tendency

Question 70

what suturing is this to stop PPH

Answer 70

B lynch

Question 71

cause of endometritis

Answer 71

retained products of conceptio

Question 72

what is Homan's sign - what condiiton - what tx

Answer 72

forced dosiflexion of foot elicits pain - DVT - heparin

Question 73

does heparin go to breast milk

Answer 73

no

Question 74

are SSRI's teratogenic?

Answer 74

no

Question 75

which preg related hormone has an effect on serotonin

Answer 75

oestrogen

Question 76

presentation of HELLP syndrome

Answer 76

right upper quadrant abdominal pain or epigastric pain resulting from liver distension. Individuals may experience general symptoms like nausea, vomiting, generalized edema, malaise, headache, visual changes, or jaundice

Question 77

What does HELLP syndrome stand for

Answer 77

Haemolysis Elevated liver enzymes Low Platelets

Question 78

which 2 hormones are tested for in Down Syndrome maternal blood test and what are the levels

Answer 78

B-HCG high and PaPPA low Beta human chorionic gonadotrophin Pregnancy associated Plasma Protein A

Question 79

1. What cells invade the maternal spiral arteries normally that allow these vessels to become low resistance vessels?

Answer 79

endovascular trophoblasts

Question 80

what should you do with pregnant mother who is on ACE or ARB

Answer 80

discontinue immediately and commence labetalol