Module 8

Question 1

Antiepileptic drugs
Generic name
Trade Name:
Category in pregnancy:

Answer 1

Carbemazepine and lamotrigine
Tegretol and lamictal
Ampicillin cat B,

Question 2

maternal mortality rate

Answer 2

5.5 per 100,000 women giving birth in 2020

Question 3

most common cause maternal mortality rate

Answer 3

motor vehicle trauma and cancer

Question 4

ovarian cysts - symptoms

Answer 4

pain, abdominal discomfort-fullness, indigestion, early satiety, urinary urgency, urge to defecate, painful bowel movements, painful sex or none

Question 5

ovarian cysts - diagnosis

Answer 5

palpation, USS, MRI, CT scan

Question 6

bartholins cysts

Answer 6

obstruction of the bartholin’s glands on either side of the vaginal opening causing fluid build up, usually painless but may become infected requiring surgical draining under GA and hospital admission with IV ABX

Question 7

gynaecological conditions

Answer 7

Endometriosis
Structural anomalies
Batholin’s cyst
Uterine fibroids
ovarian cysts
PCOS
Genital tract infections
Abnormal cervical screening
Recurrent UTI
Incontinence
Cancer
cervical cancer
breast cancer
ovarian neoplasia (cancer)
ectopic pregnancy
fistuale/FGM

Question 8

uterine fibroids

Answer 8

Non-cancerous growth on the uterus wall
Generally don’t affect fertility
May complicate pregnancy and labour, risks for fetal malpresentation, labour dystocia, LSCS and PPH
Symptoms menstrual changes, aetiology unknown

Question 9

cancer affects …

Answer 9

approx 1 in 2000 pregnancies

Question 10

most common cancers in pregnancy

Answer 10

melanoma 1:1000,
breast 1:3000,
cervical 1:4500,
hodgkin lymphoma 1:1000-6000,
ovarian 1:8000

Question 11

estrogen is thought to be

Answer 11

an established growth factor in cancers and therefore accelerated disease occurs in pregnancy

Question 12

elective pre-term labour cancer

Answer 12

32-34 weeks
is often favoured by medical staff and the woman, so her condition can be assessed and more appropriate treatments can be administered such as radiation and cytotoxic drugs

Question 13

cervical cancer - HPV

Answer 13

human papillomavirus is the cause of both invasive cervical cancer and the premalignant change in the cervical epithelium. HPV is transmitted sexually but not considered a STD.

Question 14

risk factors of HPV/cervical cancer

Answer 14

multiple sexual partners, experiencing sex at an early age, sex with a male partner who has had multiple partners, oral contraceptive pill more than 4 years.

Question 15

stage 1 cervical cancer

Answer 15

carcinoma confined to the cervix

Question 16

stage 2 cervical cancer

Answer 16

carcinoma is beyond the cervix into surrounding tissue

Question 17

stage 3 cervical cancer

Answer 17

carcinoma extends to the pelvic wall

Question 18

stage 4 cervical cancer

Answer 18

carcinoma beyond the pelvis involvement of bladder and rectum or distant organs such as lungs

Question 19

breast cancer stage 0

Answer 19

non invasive not in surrounding tissue

Question 20

breast cancer stage 1

Answer 20

invasive where tumour measures less than 2 cm with no lymph node involvement

Question 21

breast cancer stage 2

Answer 21

measures a minimum of 2 cm and maximum of 5 cm or has spread to the lymph nodes in the axilla of the affected breast

Question 22

breast cancer stage 3A

Answer 22

size greater than 5 cm or lymph node involvement

Question 23

breast cancer stage 3B

Answer 23

tumour has spread to the breast skin, chest wall or internal mammary lymph nodes

Question 24

breast cancer stage 3C

Answer 24

tumour of any size, spread to the clavicle with lymph node involvement

Question 25

breast cancer stage 4

Answer 25

any size, spread to both lymph nodes and distant organs

Question 26

signs and symptoms of breast cancer

Answer 26

fatigue, anaemia, anorexia, depression, sepsis, pain or metastasis

Question 27

consultation after treatment breast cancer

Answer 27

Pregnancy after treatment should be in consultation with oncologist, breast surgeon and obstetrician, wait at least 2 years after treatment

Question 28

ovarian neoplasia (cancer) stage 1

Answer 28

limited to ovaries

Question 29

stage 2 ovarian cancer

Answer 29

involving one or both ovaries with pelvic extension

Question 30

stage 3 ovarian cancer

Answer 30

involving one or both ovaries with peritoneal deposits outside the pelvis

Question 31

stage 4 ovarian cancer

Answer 31

involving one or both ovaries not limited to the pelvis

Question 32

stage 4 ovarian cancer

Answer 32

involving one or both ovaries not limited to the pelvis

Question 33

how many weeks to expedite delivery for ovarian cancer

Answer 33

32 weeks to minimise delay in treatment

Question 34

neurological disorders

Answer 34

epilepsy multiple sclerosis bells palsy cerebrovascular disease and stroke

Question 35

epilepsy

Answer 35

characterised by recurrent seizures

Question 36

seizure triggers

Answer 36

stress, anxiety, lack of sleep, lack of feed, excess alcohol, binge drinking, drugs, dose of antiepileptic drugs, flickering lights, illness and health condition, antidepressants and antihistamines, hormonal changes

Question 37

epilepsy affects

Answer 37

0.5% of pregnancies

Question 38

pre-conception care epilepsy

Answer 38

folic acid supplementation, counselling to review current medications, explain risk of fetal defects, review of hx, reduce medication where possible, 5mg of folic acid 12 weeks before pregnancy and continue until the end of the first trimester due to the increase risk of folate deficiency, antenatal screening, Vitamin K, consider seizure risk for labour and pain relief, encourage breastfeeding, safety advice in the postnatal period

Question 39

complications epilepsy

Answer 39

status epilepticus (>30 min), sudden unexpected death, trauma, maternal mortality.

Question 40

epilepsy management

Answer 40

obstetric management, seizure control, congenital malformation, folic acid supplementation, antenatal screening, Vitamin K supplementation, no pethidine

Question 41

multiple sclerosis

Answer 41

chronic inflammatory autoimmune disease of the CNS that mostly affects women and those in the childbearing age group Characterised by destruction of the myelin sheaths (lesions) in the brain and spinal cord and has a variety of classification types e.g. relapsing-remitting, primary progressive

Question 42

ms effect on pregnancy

Answer 42

pregnancy has a protective benefit against relapses, however increased chance of relapses postnatally when physical and emotional stressors are greater and results in immune activation

Question 43

meds for ms

Answer 43

Immunomodulatory agents (IMAs) e.g. beta interferon and glatiramer (Copaxone) are not recommended in pregnancy and lactation

Question 44

bells palsy

Answer 44

An idiopathic inflammatory reaction involving the facial nerve and resulting in facial paralysis Three times more common in pregnant women than those of similar age May be caused by oedema, hypertension or secondary to infection Most cases resolve without treatment Treatment eye care, high dose steroids, emotional support

Question 45

cerebrovascular disease and stroke 3 categories

Answer 45

ischaemic (from decreased blood flow), thrombotic (a venous event), haemorrhagic (subarachnoid haemorrhage due to a ruptured blood vessel)

Question 46

signs and symptoms of cerebrovascular disease and stroke

Answer 46

abrupt onset of neurological symptoms and needs urgent medical review

Question 47

risk factors cerebrovascular disease and stroke

Answer 47

hypertension, heart disease, previous ischaemic attacks, diabetes, vasculitis, smoking, obesity, excessive alcohol, over 35, thrombophilia, dehydration, infection, smoking, operative delivery, 6 or more pregnancies, ⅔ have no risk factor

Question 48

complications of cerebrovascular disease and stroke

Answer 48

can result in death or permanent disability, dizziness, weakness, numbness, paralysis, headache, slurred speech, partial vision loss Preconception care review prior to pregnancy where a hx is present, titrate aspirin up, cease warfarin and change to heparin, consult with haematology, support and reassurance

Question 49

labour care cerebrovascular disease and stroke

Answer 49

regular obs, TEDs, hydrate and mobilise, supportive care