Y5 Obstetrics Cases

Question 1

Short-term and long-term (delivery) management plan if there is INTRA-UTERINE GROWTH RESTRICTION

Answer 1

Short-term - serial USS growth scans + umbilical artery doppler
Long-term - consultant-led care + delivery soon (no more than 37wks if Doppler abnormal)

Question 2

Tests you would arrange in case of IUGR

Answer 2

STI screen
USS
Urine tox screen, toxoplasmosis, CMV screen

Question 3

Differentials for small for gestational age

Answer 3

Infection, placental insuff, undernutrition, normal (small baby, small parents), genetic disorders, multiple pregnancy

Question 4

How often do IUGR patients need to come for scans if doppler is normal or abnormal

Answer 4

If umbilical artery doppler is normal = every 14 days

If umbilical artery doppler is abnormal = 2x weekly

Question 5

Consequences of heroin use in pregnancy

Answer 5

Placental abruption
Low birth weight
Premature
Neonatal abstinence syndrome
Stillbirth

Question 6

MLDx if vaginal bleeding + lower abdo pain <10wks pregnant

Answer 6

Miscarriage

Question 7

Ix if vaginal bleeding in pregnancy

Answer 7

Basic obs (haemodynamic stability)
ABC for bleeding
Speculum exam for cervical os
TVUS
Bloods (FBC, U&E, G&S, Rhesus)

Question 8

Process of speculum exam

Answer 8

Offer chaperone + give privacy to dress/undress
Bring heels towards bottom then let knees flop to side
Inspect area
Lubricate speculum
Breathe normally as speculum inserted and relax as you feel it turned. There will be some pressure as it is being opened which allows us to see the cervix. Then we take it out

Question 9

Risks of surgical management of miscarriage

Answer 9

Surgical - infection, bleeding, anaesthetic-associated risks

Specific - retained products of conception, cervical incompetence in future pregnancies, Asherman syndrome)

Question 10

5 types of miscarriage

Answer 10

Complete
Incomplete
Threatened 
Inevitable
Septic

Question 11

Medical management of miscarriage

Answer 11

Misoprostol alone (oral, vaginal, rectal, subungual)
Can give mifepristone 24/48 hrs before
Take pregnancy test in 3 weeks

Question 12

Downsides of medical management of miscarriage

Answer 12

More pain + bleeding
Needs more than one hospital visit
Risk of failure which needs another dose or surgical management

Question 13

Surgical management of miscarriage

Answer 13

Manual vacuum aspiration under local in outpatient/clinic or surgical in theatre under general (chlamydia risk so azithromycin for 3 days as prophylaxis)

Question 14

How many evacuations of retained products of conception (ERPC) are a risk factor for cervical incompetence

Answer 14

2+

Question 15

When to admit to EPU

Answer 15

Positive pregnancy test + abdo pain/tednerness, pelvic tenderness, cervical motion tenderness

Question 16

Expectant management of miscarriage

Answer 16

Wait and repeat urine pregnancy test in 7-10 days

- come back if positive of sx are worse/continue

Question 17

Use of TVUS in early pregnancy

Answer 17

Assess LOCATION and VIABILITY of the pregnancy