Women's Health: Obstetrics

Question 1

What are the blood sugar targets in antenatal diabetics?

Answer 1

1 hour after meal: 7.8
2 hours after meal: 6.4
Fasting: 5.3

Question 2

When is gestational diabetes screened?

Answer 2

Booking
24-28 weeks to confirm abnormal booking

Question 3

What are the counselling points for miscarriage

Answer 3

ITS NOT THEIR FAULT
Help for common experience of low mood
Urine pregnancy test 3 weeks post event
Can have sex once menstruation resumes 4-8 weeks later

Question 4

How do you investigate suspected pre-term prelabour rupture of membranes?

If confirmed how do you mansge?

Answer 4

Ix: Sterile speculum shows pooling in post. vaginal vault

+/- US if no fluid seen
Rx:
Admit to watch for chorioamnionitis
Oral erythromycin 10 days
Antenatal corticosteroids to reduce foetal distress
Consider delivery from 34 weeks

Question 5

How do you manage a breech presentation

Answer 5

>=36 weeks: ECV if no contraindications
If above fails: C-section

Question 6

What are the risk factors for placental abruption?

Answer 6

Increased age, blood pressure
Essentially any uterine complication
Narcotic use

Question 7

Regarding hyperemesis gravidarum …

1. What is it
2. What warrants admission
3. What is the antiemetic treatment

Answer 7

1. Triad of 5% pre-pregnant weight loss, dehydration + electrolyte imbalance
2. Continued N+V causing feeding difficulty or ketonuria +/- 5% weight loss / confirmed or suspected co-morbidity
3. antihistamines –> ondasetron (1st tri cleft palate) OR metoclopramide (<5 days use to to EPSEs)

Question 8

What is the dose and timescale for vitamin D supplementation in pregnancy

Answer 8

10mg / 4000IU for entire pregnancy

Question 9

What would fulfil a diagnosis of recurrent miscarriage?
What 3 assessments should you undertake?

Answer 9

>=3 before 10 weeks gestation
>=1 normal loss after 10 weeks

APL antibodies –> aspirin + heparin
Genetic screening –> counselling
Pelvic US for uterine pathologies

Question 10

what is given for a missed and incomplete miscarriage

Answer 10

Missed: 800ug misoprostol
Incomplete: 600ug misoprostol
Surgical if medical fails

Question 11

How do you differentiate placenta praevia, vasa praevia and abruption in terms of
Bleeding
Pain
Uterine tenderness
Lie
Foetal heartbeat

Answer 11

Placenta praevia // Vasa praevia // placental abruption
Shock proportional // proportional // excessive shock
no pain // no pain // constant pain
non-tender // non-tender //tender
Abnormal // normal // normal
normal beat // bradycardia // distressed/absent

Question 12

What are the risk factors for placenta praevia

Answer 12

Multiparity, previous C-sections

Question 13

What are four causes of PPH

Answer 13

Tone (atony)
Thrombus
Trauma
Tissue (retained, up to 2 weeks)

Question 14

On assessing pre-eclampsia, who needs
Emergency secondary care assessment
Emergency admission

Answer 14

Assessment: Anyone with symptoms
Admission: BP >=160/110mmHg

Question 15

How do you manage a threatened miscarriage?

Answer 15

Give 400mg BD progesterone until 16 weeks
Return if bleeding has not stopped in 14 days

Question 16

What is the treatment of placental praevia by grade

Answer 16

G1-2: Attempt SVD
G3-4: C-section
If bleeding: Stabilise and C-section

Question 17

What is the gold standard investigation for ectopic pregnancy?

Answer 17

TVUS

Question 18

What warrants gestational diabetes diagnosis in
Fasting glucose
2-hour OGTT

Answer 18

Fasting: >=5.6mmol/L
2hr: >=7.8mmol/L
‘5678’

Question 19

Regarding folic acid supplementation…
What time scale + typical dose
Who gets 5mg

Answer 19

Take 400ug preconception-12 weeks
Take 5mg for same time if…
- FHx neural tube defects
- BMI >=30
- Epilepsy, T2DM, coeliac or thalassaemia trait

Question 20

What is the first line treatment of miscarriage?
Who is eligible for further management?

Answer 20

Expectant management
Increased risk of haemorrhage/haemorrhage side effects psychological trauma/infection

Question 21

How does fasting glucose direct management of gestational diabetes?

Answer 21

<7mmol
- Trial lifestyle
- Metformin if fails
- Insulin if metformin not tolerated
>=7mmol/L OR >=6 + macrosomnia/oligohydramnios
- Insulin

Question 22

What are the risk factors for vasa praevia

Answer 22

IVF, low lying placenta

Question 23

How do you manage vasa praevia?

Answer 23

Corticosteroids from 32 weeks
Elective C-section 34-36 weeks

Question 24

What haemoglobin levels require iron supplementation in pregnancy?

Answer 24

0-12wks: <110
12-term: <105
Post-partum: <100
Take for 3 months

Question 25

How can you differentiate ectopic pregnancy and miscarriage in terms of Pain Vaginal exam US finding

Answer 25

Ectopic // miscarriage Common // if inevitable/incomplete/complete Cervical tenderness // Os may be open 'sliding/bagel/tubal sign' // Repeat gest sac \>25mm/CRL \>7 without heartbeat

Question 26

What is the trend in blood pressure during pregnancy

Answer 26

Falls until ~24 weeks Then increases to pre-pregnancy levels

Question 27

How is gestational HTN distinguished from pre-existing hypertension?

Answer 27

new \>140/90mmHg AFTER 20 weeks OR \>30/15mmHg increase from booking

Question 28

How do you manage pre-existing diabetes in pregnancy in terms of Lifestyle Drugs Appointments

Answer 28

Lose weight if BMI \>27 Stop drugs apart from metformin + commence insulin 20 week heart anomaly scan

Question 29

How do you differentiate between expectant, medical and surgical management of ectopic pregnancy using Pain B-HCG Foetal size and hearbeat

Answer 29

Expectant // Medical // Surgical No // not significant // significant \<1000IU/L // \>1500IU // \>5000IU \<35mm + no beat // \< 35mm + no beat // \>35mm + beat

Question 30

During artificial membrane rupture, you can palpate the cord and foetal heartbeat becomes distressed; what is the management?

Answer 30

Initial - Push presenting foetus back into uterus to reduce compression - Avoid handling + keep cord warm if past introitus - Go on all fours OR left lateral position + tocolytics + Retrofilling bladder 500-700ml Definitive: Delivery via C-section

Question 31

How do you manage ectopic... expectantly Medically Surgically

Answer 31

Watch B-HCG levels 48hrs Methotrexate Laparoscopic removal with Anti-D if Rh-ve

Question 32

What are the contraindications to ECV?

Answer 32

Abnormal CTG, uterine state Multiple pregnancy Ruptured membranes APH in past 7 days

Question 33

How is gestational HTN distinguished from pre-eclampsia or eclampsia?

Answer 33

GHTN: new \>140/90mmHg at \>=20wks Pre-eclampsia: above + proteinuria, headache, N+V Eclampsia: Seizures

Question 34

What is the treatment for placental abruption?

Answer 34

\<36 weeks no distress: Observe + steroids. AVOID TOCOLYTICS Distress: Immediate C-section \>36 weeks: No distress: Delivery Distress: C-section

Question 35

What are the grades of placenta praevia

Answer 35

G1: lower edge low lying G2: lower edge touches os G3: Lower edge partially covers os G4: Lower edge majority covers os

Question 36

For pre-eclampsia treatment what is First-line Definitive

Answer 36

1st: Labetalol (nifedipidine if contraindicated) Def: Delivery of baby

Question 37

How do you diagnose and treat post-partum haemorrhage

Answer 37

\>=500ml blood loss 1. ABCDE 2 x 14 gauge cannulae 2. IV oxytocin (10 units) OR IV erometrine (500ug) 3. IM carboprost 4. IU balloon tamponade/B-lynch/iliac artery ligation 5. Hysterectomy if life-saving Oh/Effing Christ That's Hell Oxytocin/Ergometrine Carboprost IM Tamponade Hysterectomy

Question 38

What is preferable for testing pregnancy: serum or urine HCG?

Answer 38

Urine

Question 39

What should you do if gentle traction does not deliver the foetus?

Answer 39

1. Call for senior help + McRoberts manouvre + Episiotomy to help RISK OF SHOULDER DYSTOCIA, THIS CAUSES TEARS IN MUM, BRACHIAL PLEXUS IN CHILD

Question 40

Outline the stages of labour?

Answer 40

Stage 1: Onset of true labour to full dilation of the cervix Stage II: Full dilation to delivery of foetus Stage III: Delivery of foetus to delivery of membranes

Question 41

What is the difference between latent and active phase in stage I of labour?

Answer 41

Latent: 0-3cm, normally takes 6 hours Active phase: 3-10cm, normally 1cm/hour

Question 42

How can you differentiate between passive and active stage II of labour When is this abnormal?

Answer 42

Reminder: Stage II is full dilation to delivery Passive: no pushing Active: pushing Abnormal if \>1 hour

Question 43

How is bishops score calculated based on... Cervical position Cervical consistency Cervical effacement Cervical dilatation Fetal station

Answer 43

Question 44

What do the following Bishop's scores mean? 4 12

Answer 44

under 5 so spontaneous labour unlikely \>=8 so labour is favourable

Question 45

If labour requires artificial induction, what are the options?

Answer 45

1st: Vaginal prostaglandins Membrane sweep if 40 weeks (primi) 41 (multi)

Question 46

What is the main complication from inducing labour?

Answer 46

Uterine hyperstimulation: Prolonged and frequent contractions Can interrupt foetal blood supply Give tocolysis with terbutaline

Question 47

What are the risk factors for GBS infection?

Answer 47

4 Ps Prematurity Prolonged rupture of the membranes Previous sibling infection Pyrexia in mother due to chorioamnionitis

Question 48

Who gets GBS interventions and what are they?

Answer 48

If mother or baby previously had it, pyrexia \>38 degrees in labour Either... intrapartum benpen prophylaxis OR Test at 35-37 weeks and give if positive

Question 49

Regarding foetal movements, what do if... Reduced foetal movements after 24 weeks?

Answer 49

reduced: Doppler --\> US Absent: Referral to maternal fetal medicine

Question 50

What do the following CTG findings mean? HR \<100/min HR \>160/min variability \<5/min deceleration during contraction that returns to normal deceleration that lags during and \>30s after contraction Decelerations independent of contractions

Answer 50

Baseline bradycardia: foetal tone, maternal beta blocker use Baseline tachycardia: Pyrexia, infection, hypoxia, prematurity Loss of variability: prematurity, hypoxia Early decels: innocuous, contraction compressions Late decels: FOETAL DISTRESS Variable decels: inidicate cord compression

Question 51

How do you investigate and treat suspected DVT/PE in pregnancy?

Answer 51

US doppler for DVT evidence V/Q scanning for PE Treat with SC heparin (IV if have to)

Question 52

Regarding Hep B in pregnancy... Who gets screened What treatment is given How does this affect breastfeeding

Answer 52

All pregnants Full hep B vaccinations + hep B IG for babies It does not

Question 53

Regarding HIV in pregnancy... Who gets screened How does treatment work How does breastfeeding change

Answer 53

All pregnants Mum gets anti-retrovirals Birth: vaginal \< 50 copies/ml \< C-section at 36 weeks Baby: zidovudine \< 50ml viral load \< Triple ART; for 4-6 weeks Dont breastfeed

Question 54

How long can lochia last for post partum?

Answer 54

6 weeks

Question 55

What does the following Down's test consist of and what time is it given? Combined testing quadruple testing

Answer 55

11-13+6 Screening: Thickened nuchal, raised B-HCG, low PAPP-A 15-20 weeks Triple: Raised B-HCG, low AFP, low oestriol Quadruple: triple + low inhibin A

Question 56

How is rhesus -ve pregnancy dealt with... preventatively If event occurs at 2/3rd trimester If complication causes event If baby affected

Answer 56

Test at booking, anti-D at 28 and 34 weeks Large anti-D dose + kleihauer test Give anti-D \<72 hours Test FBCs, Blood group + direct coombs test Transfusions + UV resistance