Download PWH Exam Questions And Answers Graded A+ and more Exams Advanced Education in PDF only on Docsity!
PWH Exam Questions And Answers Graded A+
Define term labour - Answer Labour that begins at any gestational age >37 weeks What are the definitions of each trimester? - Answer T1: 1-14 weeks T2: 14-28 weeksT3: 28-42 weeks
What are the risks when choosing VBAC? - Answer - 0.5% risk of uterine rupture -- if thisoccurs, 1 in 7 chance of adverse neonatal outcome, 0.1% risk of hysterectomy, 0.01% risk of maternal mortality What is the success rate of a VBAC? - Answer High-- 77% What are the seven layers that need dissecting during a caesarean? - Answer 1. Skin2. Fat
- Fascia4. Rectus abdominis
- Peritoneum6. Bladder flap
- Uterus List the skin changes that occur during pregnancy - Answer - Increased pigmentation dueto increased MSH
- Increased elasticity and stretching
- Palmar erythema and Chloasma
List the cardiovascular and haematological changes that occur during pregnancy -Answer - Decreased TPR (prog)
- Decreased SV
- Decreased VR (compression)- Decreased BP
- Increased HR- Increased CO
- Increased BV- Increased EPO-- Increased RBC (still physiological anaemia)
- Decreased albumin concentration (increased BV)-- decreased calcium -- hypercoaguable- Increased platelets
- Increased leukocytes (but decreased action) List the respiratory changes that occur during pregnancy - Answer - Increased BMR--increased O2 demand
- Increased minute ventilation -- blow off more CO2 -- respiratory alkalosis (increased RR)
- Decreased lung capacity (TLC, RV, FRC)-- space occupying foetus (diaphragm movesup)
- Relaxed chest wall (prog) List the renal changes that occur during pregnancy - Answer - Increased GFR due toincreased BV -- increased creatinine excretion
- Dilation of renal pelvic (prog) -- urinary stasis-- increased UTI and progression topyelonephritis
List the gastro changes that occur during pregnancy - Answer - Relaxed LES (prog) andincreased intra-abdominal pressure -- GORD
- Prog -- decreased motilin-- constipation and cholestasis
What are the associated risks with the different nuchal thicknesses? - Answer 3mm= 3xrisk 4mm= 16x risk5mm= 28x risk 6mm= 36x risk What is the false positive rate with nuchal translucency screening? - Answer 5% Can nuchal translucency be used to diagnose Trisomy 21? - Answer No-- it is a screeningtest
When is NIPT performed? - Answer After 10 weeks What is the NIPT looking at? - Answer Non-cellular foetal DNA from the placenta that ispresent in the maternal circulation
What is the sensitivity and specificity of the NIPT? - Answer 99.5% sensitive, 99.8%specific
What are the diagnostic tests for Trisomy 21? - Answer CVS and Amniocentesis Compare CVS and amniocentesis - Answer CVS-- sample of chorionic villi, done at 10-12weeks, less accurate, 1% chance of miscarriage Amnio-- sample of amniotic fluid which contains foetal DNA, done at 14 weeks, moreaccurate, 0.5% chance of miscarriage
What are the features of hyperemesis gravidum? - Answer - 5% weight loss- Dehydration
- Electrolyte imbalance- Ketonuria
- Hospital admission What are some complications that can occur due to hyperemesis gravidum? - Answer -Mallory Weiss tear
- Wernicke's encephalopathy (vit B6 deficiency)
- Pontine demyelination if hydrated too quickly- IUGR
What are some risk factors for HG? - Answer - Multiple gestations
- Previous HG
- Previous eating disorders- IBS
- GORD- Mood disturbances
- Obesity- younger women
How is HG managed? - Answer - IV fluids and pyridoxine (vit B6) and small meals
- Then can give anti-emetics: doxylamine (H1 ant) + ranitidine (H2 ant) or Rabeprazole(PPI)
- Second line anti-emtics may include prochlorperazine, promethazine, metoclopramideetc
What investigations may be done during a booking in appointment? - Answer - Rubella,Varicella, Syphilis, Hep B/C, HIV
foetus or foetuses considered high risk2. Head circumference deviatiing from growth curve
- Ventriculomegaly detected earlier What is Naegele's rule? - Answer 1st day of LMP + 1 year + 7 days - 3 months What CRL measurements correspond to what GAs? - Answer <9mm = 6 weeks 10-15mm = 7 weeks>16mm = determine via CRL
What are the 8 things assessed during the morphology scan? - Answer 1. Number ofbabies
- Placenta and umbilical cord position3. Cervix patency
- Amniotic fluid index5. Foetal biometry
- Foetal abnormalities7. Gender of baby if desired
- GA confirmation Describe Leopold's manoeuvres - Answer 1. Feel fundus for height, shape, consistency
- feel sides for position of baby's back3. Feel inlet to determine position of baby
- Feel sides of inlet to determine attitude and degree of extension Why is folic acid important during pregnancy? - Answer It is a co-enzyme in a methylationreaction required for DNA synthesis:
- Supports maternal blood expansion
- Supports maternal tissue growth- Supports foetal tissue growth, particularly Neural tube growth and closure
What levels of folic acid are recommended? - Answer 0.5mg for low risk5mg for high risk
List medications that are contra-indicated during pregnancy and why - Answer - ACEinhibitors-- Renal defects, IUGR
- Carbamazepine-- NTDs
- Chloramphenicol-- circulatory collapse- Lithium-- Ebstein's cardiac anomaly
- Misoprostol-- Miscarriage
- NSAIDs-- premature DA closure- Phenytoin-- Congenital anomalies
- Retinoids-- CNS, craniofacial, cardiac, thyroid- Sulpha drugs-- anti-folate actions
- Antibiotics: Tetracycline (bone), Aminoglycosides (renal, ear), Fluconazole (teratogenic)- Valproate-- NTD
- Warfarin-- miscarriage, head issues- Opioids-- NAS and congenital issues
- Leflunomide-- CATEGORY X What are the categories of drugs in pregnancy - Answer A- ok B- not sureC- suspected risk C- BadX- DONT GIVE
What are the TORCHS infections? - Answer ToxoplasmosisOther Rubella CMVHerpes Simplex Syphilis What does congenital Toxoplasmosis cause? - Answer - Choriorentinitis- Hydrocephaly
- Intracranial calcification- Mitral regurgitation
- Microcephaly What happens in congenital rubella syndrome? - Answer - Hearing loss
- Cataracts- CV lesions
- Mitral regurgitation- IUGR
- Hepatitis- CNS defects
- Osseous changes 30% mortality rate What does congenital CMV infection cause? - Answer CNS involvement causing mentalretardation, cerebral calcification, microcephaly, deafness, Chorioretinitis
What can congenital herpes cause? - Answer - Disseminated herpes- 20%
- CNS sequelae as herpes encephalitis - 35%or a self-limited infection
What is the treatment for herpes simplex in pregnancy? - Answer Acyclovir forsymptomatic women or as suppressive therapy at 36weeks if there are active genital lesions How can foetal morbidity due to toxoplasmosis be reduced? - Answer Spiramycin What does varicella zoster cause in a foetus? - Answer Congenital varicella syndrome--limb aplasia, chorioretinitis, cataracts, cutaneous scars, cortical atrophy, IUGR, hydrops, pre-term labour How can congeintal varicella be reduced? - Answer Varicella zoster Ig if mother exposed What are the risk factors for neonatal GBS disease? - Answer - Maternal intrapartum GBScolonisation during pregnancy
- Pervious infant with invasive GBS disease
- Prolonged ROM (>18 hours)- Maternal fever >38 degrees
How is a GBS positive woman addressed during labour? - Answer IV ampicillin begun atstart of labour and every 6 hours following, unless maternal fever, then give broad spectrum ABx cover What does listeria cause in a foetus? - Answer - Preterm birth- Miscarriage
- Granulomatosis infantiseptica-- severe systemic infection with disseminated abscesses,Respiratory distress, meningitis
Monoamniotic-- one amniotic sacDichorionic-- two placentas Diamniotic-- two amniotic sacs How are the different types of twins diagnosed? - Answer US:
- Lambda sign= thick placental base-- dichorionic- T sign-- thin placental base-- monochorionic
What gestational age do you give tocolytics and steroids if risk of brith in 7 days is high?- Answer Between 24 and 34
What percentage of pregnancies are complicated by diabetes? - Answer 2-4%, with 0.3%being from pre-existing diabetes, and 2-3% by gestational
What are the risk factors for GDM? - Answer - Ethnicity- AMA
- FHx- Previous GDM
- Previous macrosomic baby- Maternal obesity
- Polyhydramnios- Twins
- PCOS What percentage of women with DM will require insulin during pregnancy? - Answer10-20% -- oral hypoglycaemics may be teratogenic
What are some of the complications that may arise due to diabetes during pregnancy? -Answer MATERNAL:
- diabetes later in life- injury due to macrosomia
- Pre-eclampsia
- PolyhydramniosFOETAL:
- Macrosmia- Shoulder dystocia
- Hypoglycaemia- RDS
- Hyperbilirubineamia- Polycythemia
- Still birth
- Congenital malformations (3x higher) What percentage of pregnancy women are overweight or obese? - Answer 50% What happens to a pregnant woman's blood pressure throughout pregnancy? - AnswerFalls due to decreased TPR until about weeks 20-22 when it increases again as blood volume increases Define gestational hypertension - Answer Blood pressure > 140/90 which developsAFTER 20 weeks of pregnancy and resolves before 12 weeks postpartum
If present before 20 weeks, it is considered chronic What is pre-eclampsia? - Answer Hypertension plus involvement of other organ systems,mainly renal showing proteinuria, increased creatinine, oliguria
What percentage of pregnancies are complicated by pre-eclampsia? - Answer 3-5%
How common is HELLP syndrome? - Answer 1-2 in 1000 How does HELLP syndrome present? - Answer RUQ or epigastric pain, nausea, vomitingmalaise
How is HELLP syndrome managed? - Answer BP control, delivery plan and managementof low platelets -- 50% of women will require blood products
What is isoimmunisation? - Answer When foetal RBC components enter the maternalcirculation, stimulating the maternal immune system to produce antibodies against the foetal cells What may cause isoimmunisation in pregnancy? - Answer - Terminations
- Ectopics- Miscarriages
- Procedures including amnios, CVS, ECV- Any APH
- Placental abruption- Labour and delivery
- Trauma What tests are done to determine if isoimmunisation will occur or has occured? - Answer- Indirect Coombs done on mother initially to determine blood group and antibody presence
- Lleihauer-Betke test done to determine extent of foetal-maternal haemorrhage and see ifmore anti-D is required
- MCA doppler done to determine extent of foetal anaemia- US to look for features of hydrops
- Direct Coombs test done on babies with prolonged jaundice to look for hameolysis
What is hydrops fetalis? - Answer Oedema in more than 2 compartments of the foetusdue to congestive heart failure secondary to anaemia
What is erythroblastosis fetalis? - Answer Moderate to severe immune-mediatedhaemolytic anaemia
What is the prophylaxis for isoimmunisation? - Answer Anti-D: an immunoglobulinagainst Rh antigens, which binds the Rh antigens of the foetal cells in maternal circulation to prevent the maternal immune system from mounting a response When is anti-D administered? - Answer - Routinely at 28 weeks
- Within 72 hors of birth of a Rh positive baby- With any invasive procedure during pregnancy
- Management of ectopic, miscarriage, termination- Any APH (often quantified first via Lleihaur Betke test)
- Trauma How is isoimmunisation treated? - Answer PUBS (chordocentesis) and intrauterinetransfusion-- Percutaneous umbilical blood sampling done to sample foetal blood, then intrauterine transfusion
- 1-5% loss rate What are the affects of alcohol on a baby? - Answer - FASD spectrum: CNS, craniofacial
- Short term: CNS hyperexcitability, GI symptoms, irritability, seizures, NAS- Long term: FASD, variable muscle tone, sleeping/ feeding difficulties, increased SIDS
What are the affects of Nicotine on a baby? - Answer - Placental abruption, IUGR,premature birth
- Buprenorphine further decreases adverse neonatal effects, but is more expensive andhas less maternal compliance, plus effect of buprenorphine in breastmilk hasn't been established yet Define adequate uterine activity - Answer 3-5 strong contractions in 10 minutes What is the smallest presenting diameter? - Answer suboccipito-bregmatic = vertex =9.5cm
What are the two deflexed vertex diameters? - Answer Occipitofrontal= 11cmOccipitomental = 13 cm
Define attitude of foetus - Answer Degree of flexion or extension of head Define lie of the foetus - Answer Way the long axis of the foetus is sitting in relation to thelong axis of the uterus-- longitudinal, transverse, oblique
Define presentation of the foetus - Answer The pole of the foetus which is overlying thepelvic inlet-- cephalic, breech, shoulder
Define position of foetus - Answer The position of the baby's occiput in relation to thematernal pubic symphysis-- OA, OP, OT
What is the most common position of the foetus? - Answer OA (or within 45 degrees ofOA)
Define station - Answer Location of presenting part in birth canal in relation to ischialspines
Define engagement - Answer When the widest part fo the foetal diameter has entered thepelvic inlet
What is the most common shape of the female pelvis? - Answer gynaecoid What are the 4 shapes of the pelvis? - Answer GynacoidAndroid PlatypelloidAnthropoid
What is interventions can be done for birth to still be considered 'normal'? - Answer -Augmentation or ARM
- Entonox
- Opioids
- electronic foetal monitoring- Active management of third stage
What interventions make birth no longer 'normal'? - Answer - Induction of labour
- Epidural or spinal- General anaesthetic
- Forceps or vacuum- Caesarean
- Episiotomy What are the 7 cardinal movements of labour? - Answer 1. Engagement
- Descent3. Flexion
- Internal rotation5. Extension
