obstetrics

Question 1

physiological changes in pregnancy

Answer 1

BP reduced in 1st and 2nd trimester
blood volume up by 30%
platelet count falls
pulmonary ventilation up by 40%
Ca requirement increased

Question 2

pre conception care

Answer 2

folic acid - 400mg until 12 weeks
if diabetic 5mg from 12 weeks

Question 3

abdominal discomfort
prelabour rupture of membranes
cord prolapse
tense shiny abdomen
inability to feel fetal parts

Answer 3

polyhydramnios
= excess amniotic fluid

Question 4

investigation for polyhydramnios

Answer 4

ultrasound
oral glucose tolerance test
antibody screen

Question 5

management of polyhydramnios

Answer 5

IOL at 40 weeks
amnioreduction can be considered

Question 6

1st line medication for hypertension caused by pre-eclampsia

Answer 6

labetolol

Question 7

abdominal pain that is unilatelal and lower
amenorrhoea
vaginal bleeding
mass
shoulder tip pain

Answer 7

ectopic pregnancy
= ovum implants outside of uterus usually in fallopian tube

Question 8

investigation for ectopic pregnancy

Answer 8

ultrasound
serum hCG

Question 9

management of ectopic pregnancy

Answer 9

methotrexate - single dose
surgery - salpingectomy or salpingotomy

Question 10

what is a miscarriage

Answer 10

loss of a pregnancy at less than 24 weeks

Question 11

risk factors for miscarriage

Answer 11

age > 35
previous miscarriage
smoking
alcohol
illicit drugs
antiphospholipid syndrome
infections

Question 12

investigation for miscarriage

Answer 12

transvaginal ultrasound
speculum
bHCG

Question 13

management of miscarriage

Answer 13

misoprostol
mifepristone
surgical suction

Question 14

pregnant women with weight loss, dehydration, ketotic breathe, hypotension
cannot keep any foods or liquids down

Answer 14

hyperemesis gravidarum

Question 15

management of hyperemesis gravidarum

Answer 15

antiemetic - promethazine
IV fluids
thiamine

Question 16

women is bleeding PV after 24 weeks differentials

Answer 16

placental abruption
placenta praevia
ectropion
polyp

Question 17

pregnant women has
vaginal bleeding
abdominal pain
uterine contraction
lower back pain
woody abdomen on palpation

Answer 17

placental abruption

Question 18

investigation for placental abruption

Answer 18

clinical
CTG

Question 19

management of placental abruption

Answer 19

resus
c-section

Question 20

antepartum bleeding in a mother who has had multiple c-sections

Answer 20

placental accreta
= placenta implants deeper through the endometrium making it difficult to separate the placenta after the delivery of the baby

Question 21

painless antepartum haemorrhage, fetal movement present, uterus soft and non tender

Answer 21

placenta praevia
= placenta edge is lying directly over cervical os

Question 22

investigation for placenta praevia

Answer 22

midtrimester ultrasound

Question 23

management of placenta praevia

Answer 23

corticosteroids
magnesium suplhate
c section

Question 24

pregnant mother with severe abdominal pain with shoulder tip pain
sudden collapse
vaginal bleeding
acute abdomen

Answer 24

uterine rupture

Question 25

pregnant women after rupture of membranes has a small amount of dark vaginal bleeding fetal bradycardia

Answer 25

vasa praevia = fetal vessels and transverse membranes below presenting part over cervical os

Question 26

management of vasa praevia

Answer 26

corticosteroid elective c section

Question 27

pregnant women with: headache hypertension visual disturbance nausea RUQ pain oedema

Answer 27

pre eclampsia

Question 28

investigation in pre eclampsia

Answer 28

BP - elevated proteinuria ultrasound

Question 29

management of pre eclampsia

Answer 29

aspirin - before 16 weeks in high risk women (obese, diabetics, CKD) hypertension - labetalol nifedipine IV magnesium sulphate - if severe

Question 30

what to give if pregnant mother seizing

Answer 30

IV magnesium sulphate

Question 31

post partum haemorrhage management

Answer 31

ABCDE cross match 6 units of packed red cells warm crystalliod fluid uterine massage oxytocin carboprost misoprostol tranexamic acid surgery

Question 32

post partum mother has vaginal bleeding abnormal vaginal discharge lower abdominal pain fever

Answer 32

retained products of conception

Question 33

investigations for retained product of conception

Answer 33

ultrasound

Question 34

what is a complication of post partum haemorrhage

Answer 34

sheehan syndrome = drop in circulatory blood volume leads to avascular necrosis of pituitary gland

Question 35

symptoms of sheehan syndrome

Answer 35

reduced lactation amenorrhoea adrenal insufficiency hypothyroidism