REPRO 6

Question 1

when does blood pressure normally fall in pregnancy

Answer 1

second trimester

Question 2

when is htn in pregnancy diagnosed (3)

Answer 2

> = 140/90 on two occasions
DBP >110 or SBP >160
rise of SBP by 30 or DBP by 15 or more from booking

Question 3

complications of hypertension during pregnancy

Answer 3

PET, IUGR, abruption

Question 4

when is pregnancy induced hypertension diagnosed and when does it resolve

Answer 4

second half of pregnancy and resolves 6 weeks PN

Question 5

what percentage of patients with hypertension go on to develop PET and what is the recurrence rate

Answer 5

15%

high

Question 6

treatment - in order of hypertension - and CI/SE

Answer 6

Labetalol PO/IV asthma, IUGR
Nifedipine PO
IV hydralazine
Methyldopa - can cause rebound hypertension

Question 7

what is the triad of PET

Answer 7

oedema
hypertension
proteinuria >=3g/24h

Question 8

when is maternal artery doppler done

what is it checking for

Answer 8

20-24weeks

placentation

Question 9

what is abnormal placentation

Answer 9

failure of trophoblasts and placentation leading to low flow and high pressure

Question 10

what is HELLP syndrome

Answer 10

haemolysis, elevated liver enzymes and low platelets

Question 11

what is the normal amniotic fluid index and what is it in PET

Answer 11

6-22

<6

Question 12

complication involving mean arterial pressure

Answer 12

MAP >=150 -> cerebral haemorrhage

Question 13

what should the blood pressure aim be

Answer 13

140-150/90-100

Question 14

what is eclampsia

Answer 14

PET and tonic clonic gen seizures

Question 15

how many patients have seizures before the onset of hypertension/proteinuria

Answer 15

1/3

Question 16

when do most patients have seizures

Answer 16

in labour or after

Question 17

what is eclampsia associated with

Answer 17

ischaemia/cereberal vasospasm

Question 18

treatment of eclampsia - htn

Answer 18

Labetalol, nifedipine, hydralazine

Question 19

treatment for eclampsia - seizures
if further seizure
if even further seizure

Answer 19

4g IV magnesium sulphate loading dose over 5-10mins
then 1g/hour infusion for 24 hours

2g magnesium sulphate

Diazepam 10mg IV

Question 20

eclampsia fluid balance and why is this important

Answer 20

run patient dry at 80mls/hour

giving fluids can lead to pulmonary oedema

Question 21

what is given to induce labour in eclampsia and what should be avoided

Answer 21

syntocin

ergometrine - causes hypertension

Question 22

steroids in pregnancy - what and till when

Answer 22

12mg beclamethasone IM 2 doses 24h apart

up to 36 weeks

Question 23

mod risk factors of PET

Answer 23

first pregnancy 
>=40
pregnancy interval >10y
FH
multuple preg
BMI >35

Question 24

high risk factors for PET

Answer 24

prev PET/htn
CKD
AI disease like SLE antiphos
DM type 1 or 2
chronic hypertension

Question 25

when should aspirin be started | what dose and how often

Answer 25

2 mod or 1 high risk factor | 75mg once daily

Question 26

stage 1 of labour

Answer 26

onset of labour to full dilatation

Question 27

stage 2 of labour

Answer 27

full dilatation to delivery of the baby

Question 28

stage 3 of labour

Answer 28

delivery of the baby to deliver of the placenta

Question 29

normal position of baby lie presentation

Answer 29

occipitoanterior longitudinal cephalic

Question 30

normal labour takes how long from active phase

Answer 30

<24 hours

Question 31

types of analgesia available (6)

Answer 31

``` enterox IV remifentanil PCA spinal block epidural pudendal nerve block ```

Question 32

which works faster spinal block or epidural

Answer 32

spinal

Question 33

what is epidural - whats in it does it impair uterine activity what can it do effects

Answer 33

levobupavicaine +/- opiate no can delay second stage maternal hypotension, headache, back pain, atonic bladder

Question 34

risk of epidural

Answer 34

dural puncture | severe headache and photophobia due to CSF leak

Question 35

induction of labour (4)

Answer 35

membrane sweep prostaglandins amniotomy IV syntocin

Question 36

failure to progress in stage 1 nulli v parous

Answer 36

nulli <2cm in 4h | multi <2cm in 4h or slowing in progress

Question 37

causes of delay in stage 1 of labour

Answer 37

passage, passanger, power

Question 38

delay in second stage of labour para and mult

Answer 38

para 0cm in >2h or 3h with epidural | multi 0cm in 1h or 2h plus epidural

Question 39

approach for delay in second stage

Answer 39

change position amniotomy syntocin deliver

Question 40

fatal distress risk factors

Answer 40

small fetes, prem/post, APH, htn/pet, DM, epidural, PROM >24h, sepsis, IOL, vaginal birth after CS

Question 41

causes for fatal distress

Answer 41

abruption, vasa praevia, cord prolapse, cord prolapse, uterine rupture, haemorrhage, regional anaethesia, hypoxia

Question 42

what does CTG show in fatal dsitress

Answer 42

variable decel or late decel

Question 43

fatal blood sampling

Answer 43

>7.25 normal 7.2 to 7.25 repeat in 30mins <7.2 deliver

Question 44

treatment for fatal distress

Answer 44

``` change maternal position IV fluids stop syntocin terbutaline 250mcg - stops contractions deliver ```

Question 45

Downs test in first trimester

Answer 45

nuchal thickness measurement 11-13(+6) combined with HCG and PAPPA

Question 46

downs quadrouple test

Answer 46

14-20w bloos test | bHCG, AFP, inhibin A, unconjugated bilirubin

Question 47

genetic tests for downs

Answer 47

amniocentesis 15w miscarriage risk 1% | CVS 12w misc risk 2%