24 Questions
What is the recommended initial dose of Nifedipine for the suppression of preterm labor at greater than 34 weeks of gestation?
20mg
Which maternal condition is a contraindication for using Indomethacin as a tocolytic?
Poor control of Diabetes Mellitus
Which fetal heart rate range is considered as bradycardia and indicates a potential acute hypoxic event?
100-109 bpm
What is the main advantage of using Nifedipine over betamimetics for the suppression of preterm labor?
Oral administration
At what gestational age should a 200mg pessary be recommended for women with a cervix less than 20mm?
34 weeks
What is the loading dose of Ampicillin for suspected chorioamnionitis?
3g
Which fetal heart rate pattern is characterized by a transient rise in heart rate above baseline?
Accelerations
'Chorioamnionitis' is suspected during prenatal care. Which antibiotic regimen is typically recommended for treatment?
(Ampicillin or Amoxicillin) and Gentamicin and Metronidazole
Which medication combines the rapid action of syntocinon with the sustained tonic effect of ergometrine?
Syntometrine
What is the main side effect of Syntometrine?
Nausea and vomiting
Which condition is a contraindication for the use of Syntometrine?
Pre-eclampsia
What is the main purpose of Uterine massage in postpartum hemorrhage management?
Encourage uterine contraction
In case of postpartum hemorrhage related to trauma, what is the recommended action?
Repair any trauma
What may follow a massive hemorrhage and is characterized by clotting factors being consumed faster than they can be produced?
Disseminated Intravascular Coagulation (DIC)
Which condition is NOT a risk factor for developing Disseminated Intravascular Coagulation (DIC)?
Premature rupture of membranes
Which type of placental insertion has a higher chance of cord avulsion at birth due to its position?
Velamentous Insertion
What are the signs of low blood pressure in pregnant women?
Light-headedness, fatigue, and fainting
Which hormone is involved in water retention and vasoconstriction in pregnant women with hypertensive disorders?
Antidiuretic hormone
What is the primary function of adrenaline (Epinephrine) and noradrenaline (Norepinephrine) in pregnant women with hypertensive disorders?
Increasing blood pressure
Which condition is characterized by sudden onset of tonic-clonic seizures in pregnant women?
Eclampsia
What is the main cause of HELLP syndrome in pregnancy?
Abnormal placental formation
Which hormone impair insulin function during pregnancy, leading to insulin resistance?
Human placental lactogen (HPL)
What is the diagnostic criteria for Gestational Diabetes Mellitus (GDM) based on the Oral Glucose Tolerance Test (OGTT)?
> 8.5 mmol/L at 2 hours post load
What is the recommended action for pregnant women with hyperthyroidism who require insulin treatment?
Start short-acting insulin like aspart or lispro
Study Notes
CTG Tracing
- Baseline: 140, variability normal, accelerations present: no concerns
- Baseline: 140, variability reduced, early decelerations persist for 30 seconds: escalate findings
- On oxytocin, no accelerations, and reduced variability with persistent variable decelerations: change maternal position, escalate and continue tracing until CTG returns to normal
Hypertension
- Causes of hypertension:
- Reduced variability
- Pethidine
- Betablockers
- Preterm hypoxia
- Prior neurological damage
- Infection
- Anaemia
- CNS malformations
- Cardiac malformations/arrhythmia
- Chromosomal abnormalities
Blood Pressure Regulation
- Cardiac output (CO) = stroke volume (SV) x heart rate (HR)
- Blood pressure (BP) = CO x peripheral resistance
- Factors affecting blood pressure:
- Blood volume
- Dietary salt intake
- Vessel radius
- Blood viscosity
- Autoregulation
- Baroreceptor reflex and renin-angiotensin system (RAS) regulate blood pressure
Pre-Eclampsia
- Definition: hypertension after 20 weeks with one or more of the following:
- Renal involvement
- Liver disease
- Neurological problems
- Haematological disturbances
- Pulmonary oedema
- Fetal growth restriction
- Placental abruption
- Signs and symptoms:
- Headaches
- Visual disturbances
- Oliguria
- +1 on dipstick on two or more occasions, 6 hours apart
- Complications:
- Maternal: eclampsia, HELLP syndrome, placental abruption, fetal growth restriction
- Fetal: hypoxia, acidosis, birth asphyxia, stillbirth
Diabetes
- Insulin:
- Secreted by beta cells in pancreas
- Lowers blood glucose levels
- Facilitates uptake of glucose by cells
- Glucagon:
- Secreted by alpha cells in pancreas
- Raises blood glucose levels
- Carbohydrate metabolism during pregnancy:
- Diabetogenic state
- Increased need for nutrients
- Fat deposition
Gestational Diabetes Mellitus (GDM)
- Screening: OGTT at 24-28 weeks
- Diagnosis: one or more of the following:
- Fasting venous glucose ≥ 5.1 mmol/L
- 1-hour venous glucose ≥ 10.0 mmol/L
- 2-hour venous glucose ≥ 8.5 mmol/L
- Risk factors:
- Obesity
- Family history
- Previous GDM
- Ethnicity
- Complications:
- Pre-eclampsia
- Polyhydramnios
- Macrosomia
- Neonatal complications
PPH Management
- Identify cause of PPH
- Rub: fundal massage to encourage uterine contraction
- Repair: repair trauma to perineum, vagina, cervix, etc.
- Remove: remove retained products, clots, membranes
- Replace: replace blood lost by fluid resuscitation
- Anticoagulation: may be necessary in some cases
Learn to interpret abnormal cardiotocography (CTG) findings in pregnancy, including reduced variability, early decelerations, and the significance of oxytocin use. Understand the potential implications for the baby's well-being.
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