0
Q
A woman should book for antenatal care when…
A
She has missed her 2nd period
1
Q
Extra uterine pregnancy suggested by…
A
Lower abdo pain and vaginal bleeding
2
Q
What C/S patient can have a vaginal labour?
A
Transverse lower segment incision with a non-recurring problem
3
Q
The LMP can be used to calculate duration of preg if
A
Patient has regular cycle and not on contraception.
4
Q
Abdo exam is useful for duration of pregnancy from
A
13-17 weeks
5
Q
Uss accurate for dates until
A
24 weeks
6
Q
Active syphilis
A
+ RPR
+ TPHA
7
Q
Positive RPR if titre is more than
A
1:16
8
Q
Syphilis treated in preg with
A
Benzathene penicillin
9
Q
How often must a low risk preg mum visit clinic between 28 and 34 weeks
A
No visit is required
10
Q
Visit at week 34 is NB because
A
The lie and presentation become NB and have to be determined
11
Q
Oesophageal candidiasis = what HIV stage
A
4
12
Q
ARV prophylaxis provided with what drugs
A
AZT and nevirapine
13
Q
Which clinical technique is best to measure uterine growth between 18 and 36 weeks
A
Sf height
14
Q
Which sf height = intrauterine growth restriction
A
Slowing of sf height til 1 is below 10th centile
15
Q
Severe intrauterine growth restriction = ? Weeks difference between gest age and sf height
A
4 weeks or more
16
Q
Growth restriction at 32 weeks
, what must be done?
A
Refer to level 2 hospital for Doppler umbilical artery flow
17
Q
Antenatal fetal condition determined by
A
Number of fetal movements
18
Q
Essential to determine fetal condition from ? Weeks
A
28 weeks
19
Q
Who needs a fetal movement chart
A
All mums where there is a reason to be worried about fetal condition
20
Q
When to worry about decrease fetal movement
A
Less than half previously counted movements
21
Q
Patients reports few fetal movements in hour. What to do?
A
Ask them to lie on side and count movement for further hour
22
Q
Management for reduced fetal movement when there is no ctg.
A
Exclude death by listening for fetal heart
23
Q
Who should get antenatal fetal hr monitoring?
A
High risk pt where fetal movements not reliable eg. Insulin dependent diabetics, pure labour ROM, conservatively managed preeclampsia
24
Non reactive fetal hr pattern?
Assess beat to beat variability to determine fetal well being
25
Why repeat fetal hr pattern test 45 mins later if beat to beat variability is poor?
Sleeping fetus can produce non reactive fetal hr pattern and poor beat to beat variability
26
Abnormal stress test equals
Uterine contractions with late decelerations
27
Late deceleration defined as...
Biggest decrease in hr occurs 30 or more after peak of contraction.
28
What to do if abnormal stress test?
Rule out false positives. Eg
Postural hypotension
Spontaneous overstimulation of uterus
29
Correct method of intrauterine resus
Suppress uterine contractions
| Decrease uterine tone
30
Hypertension in preg?
>90 diastolic
| >140 systolic
31
Significant proteinuria?
1+ or more
32
Defn preeclampsia
Hypertension + proteinuria after 20 weeks preg
33
Defn chronic hypertension
Hypertension without proteinuria in first half of preg
34
How common preeclampsia
5-6% preg woman
35
Preeclampsia associated with
Abruptioplacenta
Intrauterine growth restriction
Fetal distress
36
Preeclampsia results in fetal distress because
Decrease placental blood flow
37
Sign of imminent eclampsia
Increased tendon reflexes
38
early warning sign of preeclampsia
Generalized oedema esp on face
39
Management of preeclampsia
Hospitalisation
40
Method of deliver usually chosen in preeclampsia
Surgical induction at 36 weeks, if reached
41
NB complications of preeclampsia
Eclampsia
| Intracerebral haemorrhage
42
Management of severe preeclampsia
Stabilize patient and send to level 2 hospital
43
Drug used for diastolic >110
Nifedipine (adalat)
44
Sign of magnesium sulphate overdose
Depressed tendon reflexes
45
Drug used to prevent and manage eclampsia
Magnesium sulphate
46
Borderline preeclampsia at 36 weeks
Weekly check ups and additional visits if needed
47
Defn of antepartum hemorrhage
Any vaginal bleeding between 24 weeks and DELIVERY
48
Antepartum hemorrhage NB because
Mother and fetus may die
49
NB sign of shock due to blood loss
Fast pulse rate
50
Why speculum exam wi antepartum hemorrhage?
Exclude local cause of bleeding from vagina/cervix
51
Antenatal hemorrhage + no fetal heart sounds usually
Abruptioplacenta
52
Massive hemorrhage most likely
Placenta previa
53
Factor causing highest risk of abruptioplacenta
Previous episode
54
What suggests abruptioplacenta
```
Signs of shock
Severe abdo pain
Uterus tonically contracted = hard and tender
Uterus bigger than dates
No fetal hr
Hub is low
Fetal parts hard to palpate
```
55
Management of abruptioplacenta plus intrauterine death
Vaginal exam + ROM + vaginal delivery
56
Risk factors for placenta previa
Multiple fetus
Previous c section
G5 or more
Threatened abortion in 3rd trimester
57
Findings on exam with placenta previa
```
Shocked
Soft non tender abdo
Fetus easily palpated
Head not engaged
Abnormal presentation
```
58
Management of small placenta previa bleed at 34 weeks
Hospitalize, manage conservatively til 36 weeks or until active bleeding
59
What can exclude placenta previa.
Vaginal exam in theatre
60
Management of antepartum hemorrhage of unknown cause
Admit to hospital and monitor fetal movements
61
Antepartum hemorrhage of unknown cause NB because
Can be abruptioplacenta
62
Typical feature of a 'show'
Slight bleed of blood mixed with mucus
63
Management of 30 week patient with blood stained vaginal discharge caused by vaginitis
Metronidazole (flagyl)
64
What is a partogram
Chart for progress of labour, maternal and fetal condition
65
A partogram must be used on all patients in 1st stage of labour. True or dale
True
66
What indicates patient is fine in first stage of labour?
Relaxed between contractions and not pale. (Nothing to do with BP, urine, pulse, temp)
67
Young anxious primigravida with painful contractions must recieve
Comfort, analgesia and a friend/family member if possible
68
What is normal maternal temp during labour
37-38
69
Why is pyrexia an NB complication in first stage?
May cause convulsions
70
Normal pulse in labour
80-100
71
What causes rapid pulse in labour?
Pyrexia
72
How often mus BP be measured in low risk patient in latent phase?
2 hourly
73
Hypotension patient on back must be...
Turned on her side and BP measured soon after
74
Oliguria = urine less than
20 ml per hour
75
Oliguria NB sign of ..
Dehydration
76
UTI may cause how much proteinuria
1+
77
Is ketonuria abnormal
It may be seen in normal patients
78
Signs of maternal exhaustion
```
Tachycardia
Pyrexia
Dry mouth
Oliguria
Ketonuria
```
79
What causes exhaustion
Long labour with low fluid and energy intake
80
How to treat maternal exhaustion
2 liters ringers lactate with 5% dextrose IV and adequate analgesia
81
Commonest cause of reduced blood supply to fetus
Contraction
82
How does fetus respond to lack of oxygen
Decrease HR
83
What is preferred to measure fetal HR in labour
Doptone
84
When should fetal HR be monitored
Before during and after contraction
85
How often to measure fetal HR in low risk pt
2 hourly in latent phase
| Half hourly in active phase
86
Baseline fetal HR in labour
100-160 bpm
87
Early decelerations usually cause bu
Compression of fetal head
88
Defn late decelerations
Return to baseline 30 s or more after contraction has ended
89
What do late decelerations always indicate
Fetal distress
90
What can cause a baseline tachy
```
Maternal pyrexia
Exhaustion
Salbutamol
Chorioamnionitis
Fetal hemorrhage
```
91
Baseline Brady indicates..
Fetal distress caused by hypoxia
| Fetus is at high risk of dying
92
Which HR pattern indicate increased risk of fetal distress
Early decelerations
93
How common is MSL
10-20% of pregs
94
What form of meconium in the liquor most likely indicates distress
Any form of meconium .
95
What cause fetus to pass meconium
Hypoxia
96
Correct management when there is MSL
Monitor fetal HR carefully
97
What is latent phase of first stage of labour
Onset of labour to 3cm dilation
98
What is first oblique line on partogram called
Alert line
99
What rate should cervix dilate in active phase
1cm or more / hour
100
Second oblique line of partogram
Action line
101
If alert line crosses action line?
Very slow progress of labour. Doctor must be in charge of patient.
102
What defines the second stage of labour
Cervix full dilated to complete delivery of baby
103
What suggests patient is full dilated
Contractions increase in freq and time
Restlessness, vomiting, nausea
Uncontrollable urge to push
Perineum bulges
104
Fetal head engaged when..
2/5 or less of head palpable above brim
| Largest transverse diameter of head passes pelvic inlet/brim
105
Why anxiety make pain worse
Lowers pain threshold
106
Defn third stage of labour
Period between delivery of baby and delivery of placenta/membranes
107
Do not give oxytocin (syntometrine) if
Hypertensive disorder of preg
| Valve disease
108
What sign will confirm placenta has separated
Pushing on uterus does not shorten cord
109
What advantage does active method in third stage have
Less blood loss
110
When should umbilical cord be allowed to bleed before delivering placenta
Rhesus negative mother with single baby
111
Management of prolonged third state of labour
IV oxytocin and traction on cord
112
When should post partum hemorrhage be diagnosed
When there is any hemorrhage after delivery that is seen to be excessive
113
Management of retained placenta.?
Give IV oxytocin , if still retained refer to hospital for manual removal under anesthesia
114
Severe hemorrhage before placenta? Management
IV oxytocin in 1000ml basol/saline. Attempt to remove placenta
115
If hemorrhage after placenta delivered, what must be done
Rub up the uterus
116
What sign suggests bleeding is caused by an atomic uterus?
Intermittent vaginal bleeding and presence of dark red clots
117
Most likely cause of post partum hemorrhage due to atomic uterus.
Uterus full of blood clots
118
If a cotyledon is found to be missing what sound be done
Evacuate uterus
119
Clinical finding that indicates a tear
Continuous stream of bright red blood
120
The puerperium starts when...
The placenta is delivered
121
Soon after normal delivery, a mother's pulse should be?
Below 100
122
Hb becomes stable by
Day 4
123
The cervical os should be closed by..
Day 7
124
Normal lochia smells like?
Non offensive
125
How does a normally involuting uterus feel?
Firm and nontender
126
How long is puerperium
42 days
127
How often must primipara visit clinic after birth
Day 1,3,5,7
128
Cystitis is treated with
Single oral dose amoxicillin or co-trimoxazole
129
Why NB to treat asymptomatic bacteruria?
One third develop acute pyelonephritis
130
How asymptomatic bacteruria diagnosed
Culture MSU sample
131
Defn anemia in preg
Hb less than 11
132
Commonest cause if anemia
Fe deficiency
133
Management of anemia depends on
Whether there is SOB or thachycardia
Semester 6
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