HD2

Question 1

1. Below are two CTG traces. In each case, name and briefly describe the condition the fetal heart trace is showing (1 mark for each). (4 marks in total)

Answer 1

Trace A – tachycardia (1 mark). Fetal heart rate (FHR) consistently raised above the normal range (160 bpm) (1 mark)

Trace B – Late decelerations or Type II dips (1 mark). FHR returns to baseline after the contraction has ended (1 mark).

Question 2

2. Name three of the five criteria that are used to evaluate the clinical status of the newborn baby using the Apgar score. (3 marks)

Answer 2

Any three from the following list:
Appearance (skin colour), Pulse, Grimace (reflex irritability), Activity (muscle tone) and Respiration

Question 3

4. A newborn boy with Down syndrome is vomiting all his feeds. What is the most likely cause for this? (1 mark)

Answer 3

Duodenal atresia

Question 4

5. A 27 year old woman who is 12 weeks pregnant attends the antenatal clinic for the results of her nuchal translucency scan and serum screening tests. The results reveal she has an increased nuchal translucency and decreased pregnancy-associated plasma protein A (PAPP-A) levels. What is the single most appropriate intervention at this point and why? (3 marks)

Answer 4

Chorionic villus sampling (1 mark)
Her results indicate a risk of her baby having Down syndrome (1 mark)
CVS would give a definitive diagnosis via karyotyping (1 mark)

Question 5

How does placenta previa present? [1]

Answer 5

• Bleeding without pain in third trimester

Question 6

What is normal newborn resp rate? [1]

Answer 6

2. Newborn respiratory rate: 30-60 breaths/min

Question 7

State 4 acyanotic heart lesions

Answer 7

• Atrial septal defects
• Ventricular septal defects
• Patent ductus arteriosus
• Patent ductus arteriosus:

Question 8

Describe difference in pre- and post-ductal coartation of the aorta? [2]

Answer 8

 Pre-ductal: Ductus arteriosus persists to compensate for blood flow

 Post-ductal: Collateral circulations needed to establish proper perfusion of body and legs (low BP after coarctation)

Question 9

Describe 3 cyanotic heart lesions

Answer 9

Persistent truncus arteriosus:
 Single artery arises from the heart
 Large ventricular septal defect (blood mixing)
 Progressive heart failure

Transposition of the great vessels:
 No spiral septum formed (straight)
 Usually also open ductus arteriosus
 Catheterization and opening of fossa ovalis to allow blood mixing and buy time

Tetralogy of Fallot:
 Ventricular septal defect
 Overriding aorta (on top of septal defect)
 Pulmonary stenosis
 Right ventricular hypertrophy
 Boot shaped on xray

Question 10

State 5 CV changes in mother during pregnancy [5]

Answer 10

o Fluctuation in Hb and haematocrit
o Increased WBC
o Reduction in blood volume
o Reduction in CO / HR
o Reduced progesterone -> reduced tissue fluid

Question 11

Describe the structural changes to new born nn the onset of ventilation and clamping of cord [5]

Answer 11

• Decreased pulmonary resistance
• Increased systemic resistance
• Increased oxygenation leads to closure of ductus arteriosus (aided by decreased PGs, anatomically closes within weeks) Functional: 12-15h / anatomical: 4-7d)
• Atrial pressure changes close foramen ovale
• Umbilical vein forms ligamentum teres (liver)
• Umbilical arteries:
   Partially become medial umbilical ligament
   Partially open as branch of the internal iliac

Question 12

Describe 5 consequencies of meconium aspiration [5]

Answer 12

o Airway obstruction -> increased lung resistance / hypoxia
o Infection
o Pulmonary inflammation
o Surfactant inactivation
o Persistent pulmonary hypertension

Question 13

State 5 causes of non-reassuring fetal status [5]

Answer 13

 Hypoxia
 Maternal anaemia
 Gestational hypertension
 Intrauterine growth retardation
 Meconium stained amniotic fluid

Question 14

Presentation of non-reassuring fetal status [3]

Answer 14

 Irregular heart beat
* Drop after maternal contraction can be sign of uteroplacental insufficiency

 Problems with muscle tone / movements

 Oligohydramnios

Question 15

Complications of perinatal asphyxia? [4]

Answer 15

 Hypoxia
 Hypercapnia
 Acidosis
 Bradycardia

Question 16

Management of perinatal asphyxia? [3]

Answer 16

• Management:
   Oxygen to mother
   C-section
   Mechanical breathing

Question 17

Complications [4] and management [3] of shoulder dystocia?

Answer 17

Complications:
 Erb’s palsy (brachial plexus)
 Fetal fracture
 Hypoxemic-ischaemic brain injury
 Maternal tearing / bleeding

Management:
 Change mother’s position
 Turn baby’s shoulders (McRoberts maneuver)
 Episiotomy

Question 18

Describe difference between type 1 & 2 of excessive bleeding after pregnancy [2]

Answer 18

 Primary: > 500ml within 24h of delivery
 Secondary: 24h-6wks after delivery

Question 19

Most common cause of PPH? [1]

Answer 19

• Most common cause: lack of uterine tone

Question 20

Management of primary PPH?

Answer 20

 Ergotamine
 Misoprostol
 Uterine massage
 Blood transfusion
 Removal of retained placenta
 Tying off blood vessels
 Laparotomy
 Examination under anaesthetic
 Bakri balloon
 Compression sutures
 Artery embolisation
 Hysterectomy

Question 21

Signs of uterine rupture? [5]

Answer 21

 Abnormal fetal heart rate
 Abdominal pain
 Slow progress of labor
 Vaginal bleeding
 Rapid maternal heart rate

Question 22

Risk factors for uterine rupture? [3]

Answer 22

• Most likely if previous C-section / large baby / induction

Question 23

Complications of uterine rupture? [4]

Answer 23

 Fetal hypoxia
 Aspiration of amniotic fluid / infection
 Maternal excessive bleeding
 Laceration of cervix / vagina

Question 24

How long does rapid labour occur in ?[1]

Answer 24

• Labour lasts 3-5h instead of 6-18h

Question 25

Which is preffered: ventouse or forceps? [1]

Answer 25

**ventose**: fewer complications

Question 26

Name two complicatins of ventouse delivery [2]

Answer 26

 Vaginal laceration due to suction  Bruising / laceration of the face / fetal scalp

Question 27

State what tachy- and bradycardia in fetus [2]

Answer 27

Tachycardia > **160bpm** Bradycardia **< 100 bpm**

Question 28

Describe why a fetus HR decelerates during stress [1]

Answer 28

 Hypoxic stress fetus **reduces its heart rate to preserve myocardial oxygenation and perfusion** Unlike an adult, a fetus cannot increase its respiration depth and rate. This reduction in heart rate to reduce myocardial demand is referred to as a deceleration.

Question 29

State three causes of late deceleration [3]

Answer 29

* Maternal hypotension * Pre-eclampsia * Uterine hyperstimulation

Question 30

What do late fetal HR deceleration indicate? [1]

Answer 30

 Show **insufficient uteroplacental flow** -> hypoxia / acidosis to the fetus

Question 31

Describe why variable decelerations occur [4]

Answer 31

 Umbilical cord compressed often in oligohydramnios  Vein gets compressed -> acceleration  Artery gets compressed -> rapid deceleration  Pressure reduced -> baseline