A bank of 300 viva voce questions and model answers (150 undergraduate + 150 postgraduate/FCPS), sourced from Essentials of Obstetrics by Prof. Dr. Tayyaba Majeed & Prof. Dr. Zahid Mahmood. Click “Show Answer” under any question to reveal the model answer, with the source chapter cited below each one.
Answer Labour is the process of regular, painful, progressive uterine contractions leading to cervical changes (dilatation, effacement, descent of the presenting part), resulting in delivery of the fetus and placenta with membranes, along with complete contraction and retraction of the uterus.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Labour and Management, p.1
Q2.What are the three stages of labour?
Answer First stage — from diagnosis of labour to full dilatation of the cervix (10cm), divided into latent and active phases. Second stage — from full dilatation to delivery of the fetus, divided into passive and active phases. Third stage — from delivery of the fetus to complete delivery of the placenta and membranes.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Labour and Management, p.1
Q3.What are the latent and active phases of the first stage of labour?
Answer The latent phase is from the onset of labour to 3-4cm dilatation, lasting 3-8 hours (shorter in multiparous women). The active phase is from 3-4cm to full dilatation (10cm), lasting 2-6 hours (shorter in multiparous women).Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Labour and Management, p.1
Q4.What is the expected duration of the second stage of labour?
Answer 2 hours in primigravida and 1 hour in multigravida without epidural; with epidural analgesia this extends to 3 hours in primigravida and 2 hours in multigravida.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Labour and Management, p.1-2
Q5.List the mechanisms of normal labour in order.
Answer Engagement, descent, flexion, internal rotation, extension (crowning), restitution, external rotation, then delivery of the shoulders and body.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Labour and Management, p.1-2
Q6.What is crowning?
Answer Crowning is when, after extension of the fetal head, the occiput has escaped from beneath the symphysis pubis and the head distends the vulva without receding between contractions.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Labour and Management, p.1
Q7.What is given to actively manage the third stage of labour, and when?
Answer 10 units of syntocinon (oxytocin) IV, given on delivery of the anterior shoulder of the baby, followed by controlled cord traction to deliver the placenta.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Labour and Management, p.4
Postgraduate / FCPS (7 questions)
Q8.How should fetal heart rate be monitored in the latent and active phases of the first stage, for low- and high-risk women?
Answer Latent phase — low risk every 30 minutes, high risk every 15 minutes. Active phase — low risk every 15 minutes, high risk every 5 minutes after every contraction (continuous electronic monitoring if available).Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Labour and Management, p.3
Q9.What is restitution, and how does it differ from external rotation?
Answer Restitution is the slight jerky rotation of the fetal head through one-eighth of a circle immediately after delivery of the head, realigning it with the shoulders. External rotation follows, as the occiput rotates a further eighth of a circle to the transverse diameter so the shoulders align in the anteroposterior diameter for delivery.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Labour and Management, p.1-2
Q10.What is the prophylactic dose of misoprostol given per rectum in high-risk patients for PPH prevention, and when is it given?
Answer 800 micrograms (4 tablets) given per rectum as a stat dose, as part of active management of the third stage in high-risk patients (e.g. grand multiparity, multiple pregnancy).Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Labour and Management, p.4
Q11.What analgesia options are available during the active phase of the first stage of labour?
Answer Paracetamol, tramadol, entonox (nitrous oxide/oxygen), and epidural analgesia where available.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Labour and Management, p.3
Q12.What postnatal monitoring is required in the first 2 hours after a normal vaginal delivery?
Answer Blood pressure, pulse, and temperature should be checked every half hour for 2 hours; the mother should be observed for signs of PPH, breastfeeding should be established as soon as possible, and bladder emptying should occur within 4 hours.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Labour and Management, p.4
Q13.When should a primigravida versus a multigravida be shifted to the delivery room in the second stage?
Answer A primigravida is shifted at crowning of the head; a multigravida is shifted at full dilatation of the cervix, since labour typically progresses faster in multiparous women.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Labour and Management, p.3
Q14.How is an episiotomy performed, and when?
Answer At crowning, the perineum is infiltrated with 1% lignocaine, and the episiotomy is made to facilitate safe delivery of the fetal head; it is later repaired in three layers.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Labour and Management, p.3-4
Abnormal Labour
Undergraduate (6 questions)
Q15.How is poor progress in labour defined?
Answer Cervical dilatation of less than 2cm in 4 hours, usually associated with failure of descent and rotation of the fetal head.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Abnormal Labour, p.5
Q16.What three factors (the “3 Ps”) determine normal progress of labour?
Answer Power (uterine contractions), Passenger (fetal size, presentation, position), and Passage (the maternal pelvis and soft tissues).Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Abnormal Labour, p.5
Q17.What is the most common cause of poor progress in labour, and how is it managed?
Answer Dysfunctional uterine activity, most common in primigravidae. It is managed with artificial rupture of membranes; if progress remains poor after 2 hours, augmentation with an oxytocin infusion is used.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Abnormal Labour, p.5
Q18.Define cephalopelvic disproportion (CPD) and distinguish absolute from relative CPD.
Answer CPD is an anatomical disproportion between the fetal head and maternal pelvis. Absolute CPD occurs when the head is too large for a normal pelvis (e.g. hydrocephalus) or the pelvis is contracted with a normal-sized head (e.g. metabolic bone disease). Relative CPD occurs when head size and pelvis are normal but there is an abnormal position of the head (e.g. occipitoposterior position, brow presentation).Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Abnormal Labour, p.5-6
Q19.What is the presenting diameter in face presentation, and what determines whether vaginal delivery is possible?
Answer The submentobregmatic diameter (about 9.5cm). Vaginal delivery is possible if the chin is in the mentoanterior position; otherwise Caesarean section is needed.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Abnormal Labour, p.6
Q20.What is the mode of delivery for shoulder presentation, and why?
Answer Caesarean section, because shoulder presentation (from a transverse or oblique lie) carries an increased risk of cord prolapse and uterine rupture if labour is allowed to continue.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Abnormal Labour, p.6
Postgraduate / FCPS (6 questions)
Q21.How is relative cephalopelvic disproportion diagnosed, and can it be overcome?
Answer It is diagnosed only once the patient is in labour: progress is slow despite efficient contractions, the fetal head is not engaged, there is severe moulding and caput formation, and the head is poorly applied to the cervix. It can potentially be overcome if the underlying malposition (e.g. occipitoposterior position) is corrected.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Abnormal Labour, p.5-6
Q22.What is the incidence of brow presentation, and what is its presenting diameter?
Answer Approximately 1 in 2000. The presenting diameter is mentovertical, measuring about 13.5cm — the largest presenting diameter — which is why persistent brow presentation requires Caesarean section.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Abnormal Labour, p.6
Q23.What is secondary uterine inertia, and how is it managed?
Answer The most common cause of delay in the second stage of labour — the cervix has reached full dilatation but uterine contractions become weak and inefficient, often associated with maternal dehydration and ketosis. In the absence of a mechanical problem, it is managed with rehydration and IV oxytocin.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Abnormal Labour, p.7
Q24.What is deep transverse arrest, and what commonly causes it?
Answer Despite good uterine contractions and full cervical dilatation, the fetal head fails to descend and becomes arrested at the level of the ischial spines with one fontanelle facing each ischial spine. It is commonly caused by an android pelvis (straight anterior sacral surface, prominent ischial spines, convergent side walls).Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Abnormal Labour, p.7
Q25.How is deep transverse arrest managed?
Answer Manual rotation of the fetal head to the occipitoanterior position, application of mid-cavity rotational forceps, or Caesarean section — the safest option when the head is firmly arrested transversely.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Abnormal Labour, p.7
Q26.What abnormalities of the birth canal can delay labour, and how are they managed?
Answer Fibroids in the lower uterine segment can prevent descent of the fetal head, and cervical dystocia (a non-compliant cervix that effaces but fails to dilate due to scarring) can also delay labour; both are managed by Caesarean section.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Abnormal Labour, p.6
Induction of Labour
Undergraduate (7 questions)
Q27.What is the most common obstetric indication for induction of labour?
Answer Uteroplacental insufficiency.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Induction of Labour, p.8
Q28.List the contraindications to induction of labour.
Answer Placenta or vasa previa, transverse fetal lie, prolapsed umbilical cord, prior classical uterine incision, active genital herpes infection, pelvic structural deformities, grand multiparity, overdistended uterus, and non-vertex presentation.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Induction of Labour, p.8
Q29.What is membrane stripping (stretch and sweep), and when is it offered?
Answer A mechanical method of cervical ripening involving digital separation of the membranes from the cervix when the os admits a finger, causing local prostaglandin release; it is offered prior to formal induction, typically at the 40+ week antenatal visit, and may trigger spontaneous labour within 7 days.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Induction of Labour, p.8
Q30.What is the dosing regimen for vaginal dinoprostone (PGE2) in induction of labour?
Answer 1 tablet (3mg) or gel (2mg), with a second dose after 6 hours if labour is not established, and a third dose can be repeated after a further 6 hours if the feto-maternal condition is satisfactory.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Induction of Labour, p.9
Q31.What is failed induction, and how common is it?
Answer Failure to establish labour after one full cycle of treatment (two doses); it occurs in about 15% of inductions.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Induction of Labour, p.10
Q32.What is uterine hyperstimulation, how common is it, and how is it treated?
Answer More than 5 contractions in 10 minutes; occurs in 1-5% of inductions. Treated with subcutaneous terbutaline (bricanyl) 0.25mg, hydration, oxygen, and CTG monitoring; emergency Caesarean section if fetal heart rate changes do not reverse.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Induction of Labour, p.10
Q33.What four components make up the modified Bishop score?
Answer Cervical dilatation, length (effacement), consistency, and position.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Induction of Labour, p.9
Postgraduate / FCPS (7 questions)
Q34.How is the Bishop score used clinically?
Answer It assesses cervical favourability for induction; a higher score (favourable cervix) is associated with an increased chance of successful induction, while a low score predicts a reduced chance of success and greater likelihood of needing multiple cycles or Caesarean section.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Induction of Labour, p.9
Q35.Compare the safety profile of PGE2, misoprostol, and amniotomy for induction of labour.
Answer PGE2 appears the safer method. Misoprostol is associated with increased risk of PPH, rupture of the unscarred uterus, meconium-stained liquor, and precipitate delivery with poor perinatal outcome. Amniotomy carries an increased risk of cord prolapse and introduction of infection.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Induction of Labour, p.10
Q36.When should amniotomy (alone or with oxytocin) be used as a primary method of induction?
Answer It should not be used as a primary method except when there is a contraindication to vaginal PGE2, such as risk of uterine hyperstimulation.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Induction of Labour, p.9
Q37.What are the risks of induction of labour that should be discussed with a patient?
Answer Increased hospital stay, increased need for analgesia, uterine hyperstimulation (1%), cord prolapse, greater risk of uterine rupture during VBAC, failure of induction, increased need for Caesarean section or instrumental delivery, fetal compromise, low Apgar, and increased risk of instrumental delivery.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Induction of Labour, p.9
Q38.What FIGO-recommended misoprostol dose is used for induction in intrauterine fetal death?
Answer 25-50 micrograms vaginally or orally at term.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Induction of Labour, p.9
Q39.Why is exact calculation of gestational age critical before induction of labour?
Answer To avoid iatrogenic prematurity — inducing labour based on an inaccurate gestational age could deliver a fetus that is, in reality, preterm.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Induction of Labour, p.9
Q40.How frequently should the Bishop score be reassessed after a dose of vaginal PGE2?
Answer Every 6 hours, to determine cervical progress and guide the need for a further dose or the establishment of labour.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Induction of Labour, p.9
Malposition of Fetal Head
Undergraduate (5 questions)
Q41.What is occipitoposterior (OP) position, and which variant is more common?
Answer The fetal head enters the pelvis in an oblique diameter with the occiput directed posteriorly. Right occipitoposterior (ROP) is more common than left (LOP).Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Malposition of Fetal Head, p.11
Q42.What are the recognised causes of occipitoposterior position?
Answer Android pelvis, anterior placenta, multiparity, and idiopathic cases.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Malposition of Fetal Head, p.11
Q43.What are the four possible fates of an OP position in labour?
Answer Long anterior rotation (3/8 of a circle), short posterior rotation (face to pubes, 1/8 of a circle), incomplete forward rotation (deep transverse arrest), and persistent OP position.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Malposition of Fetal Head, p.11
Q44.What happens in “face to pubes” delivery?
Answer The head undergoes short posterior rotation; the occiput rotates into the hollow of the sacrum, the vertex is born by flexion, then the head extends so the face and chin emerge from beneath the pubic arch — this carries an increased risk of severe perineal tear.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Malposition of Fetal Head, p.11
Q45.How is the degree of flexion of the fetal head assessed on vaginal examination?
Answer If only the anterior fontanelle is felt, the head is poorly flexed; if both fontanelles are felt, the head is less flexed; if only the posterior fontanelle is felt, the head is well flexed and more likely to rotate anteriorly.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Malposition of Fetal Head, p.12
Postgraduate / FCPS (5 questions)
Q46.What proportion of occipitoposterior labours result in spontaneous anterior rotation and normal delivery?
Answer About 70%; about 10% deliver face-to-pubes, and in the remaining 20% there is failure of rotation/descent requiring Caesarean section or assisted rotation.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Malposition of Fetal Head, p.13
Q47.How can the diagnosis of OP position be confirmed in the second stage when caput succedaneum obscures the fontanelles?
Answer By passing the examining fingers higher to feel the free margin of the fetal ear, which points toward the occiput.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Malposition of Fetal Head, p.12
Q48.What antenatal abdominal findings suggest an occipitoposterior position?
Answer Non-engagement of the fetal head before labour in a primigravida, flattening of the lower abdomen, easily palpable fetal limbs anteriorly, a poorly defined back felt far in the flank, and fetal heart sounds heard in the flank.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Malposition of Fetal Head, p.12
Q49.How is the first stage of labour managed in a woman with occipitoposterior position?
Answer As a normal case — nothing can be done to actively correct the malposition at this stage. A partogram monitors progress; oxytocin augmentation is used if dilatation stalls, and Caesarean section if progress still fails.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Malposition of Fetal Head, p.13
Q50.What are the options for assisting delivery when the fetal head needs rotation?
Answer Manual rotation and forceps delivery, Kielland forceps, or vacuum extraction.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Malposition of Fetal Head, p.13
Post-term Delivery
Undergraduate (4 questions)
Q51.How is post-term (prolonged) pregnancy defined?
Answer A pregnancy that continues to or beyond 42 completed weeks of gestation.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Induction of Labour (prolonged pregnancy indication), p.8
Q52.From what gestation should induction of labour be offered for an uncomplicated prolonged pregnancy?
Answer Beyond 41 weeks.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Induction of Labour (prolonged pregnancy indication), p.8
Q53.What simple procedure can be offered at the 40-week visit to reduce the chance of needing formal induction?
Answer Membrane stripping (stretch and sweep).Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Induction of Labour (prolonged pregnancy indication), p.8
Q54.What are the fetal risks of prolonged pregnancy?
Answer Increased risk of oligohydramnios, meconium-stained liquor (and meconium aspiration), macrosomia, and stillbirth.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Induction of Labour (prolonged pregnancy indication), p.8
Postgraduate / FCPS (4 questions)
Q55.What surveillance should be offered to a woman who declines induction beyond 41 weeks?
Answer Increased fetal surveillance, including serial cardiotocography and ultrasound assessment of amniotic fluid volume.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Induction of Labour, p.8
Q56.Why is non-vertex presentation relevant when planning induction for prolonged pregnancy?
Answer Non-vertex presentation is a listed contraindication to induction of labour generally; if found at term, the delivery plan should be reconsidered, typically toward Caesarean section rather than induction.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Induction of Labour, p.8
Q57.How does a low (unfavourable) Bishop score affect the plan for induction in prolonged pregnancy?
Answer It predicts a reduced chance of successful induction, with a greater likelihood of needing multiple cycles of prostaglandin or ultimately Caesarean section.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Induction of Labour, p.9
Q58.What risks specific to induction should be discussed with a woman being induced for prolonged pregnancy?
Answer Increased need for instrumental or Caesarean delivery, uterine hyperstimulation, cord prolapse, failure of induction, and increased hospital stay — balanced against the risks of continuing the pregnancy.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Induction of Labour, p.9
Vaginal Birth After Caesarean Section
Undergraduate (5 questions)
Q59.What success rate should a woman attempting VBAC after one previous uncomplicated LSCS be counselled to expect?
Answer Approximately 76%.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Vaginal Birth After Caesarean Section, p.17
Q60.After what gestation should an elective repeat Caesarean section be performed?
Answer After 39+0 weeks.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Vaginal Birth After Caesarean Section, p.17
Q61.What is the quoted risk of uterine rupture during a VBAC attempt?
Answer Approximately 0.5% (1 in 200).Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Vaginal Birth After Caesarean Section, p.17
Q62.What is the single best predictor of a successful VBAC?
Answer Previous vaginal delivery, particularly a previous successful VBAC (success rate as high as 87-90%).Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Vaginal Birth After Caesarean Section, p.17
Q63.What are the selection criteria for offering VBAC?
Answer Singleton pregnancy, cephalic presentation, and no contraindication to VBAC.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Vaginal Birth After Caesarean Section, p.17
Postgraduate / FCPS (5 questions)
Q64.Give an example of a “recurrent cause” versus a “non-recurrent cause” contraindication to VBAC.
Answer Absolute cephalopelvic disproportion is a recurrent cause (the same mismatch is likely to recur). Major degree placenta previa or malpresentation in the previous pregnancy are non-recurrent causes.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Vaginal Birth After Caesarean Section, p.17
Q65.What factors are associated with a reduced likelihood of successful VBAC?
Answer Advanced gestation (>40 weeks), advanced maternal age (>40 years), high maternal BMI (>30kg/m2), no previous vaginal births, fetal macrosomia, inter-pregnancy interval <2 years, and cervical dilatation <4cm at admission.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Vaginal Birth After Caesarean Section, p.17
Q66.What increased risks does induction or augmentation of labour carry in a VBAC attempt?
Answer A 2-3 fold increased risk of uterine rupture and around a 1.5-fold increased risk of Caesarean delivery compared to spontaneous VBAC labour; induction should only proceed after consultant advice.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Vaginal Birth After Caesarean Section, p.17
Q67.Should the uterine scar be examined digitally after a VBAC delivery?
Answer No — the previous scar should not be checked digitally after delivery; the senior clinician should instead be informed if there is excessive bleeding or retained placenta, which raises concern for a possible adherent placenta at the scar site.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Vaginal Birth After Caesarean Section, p.18
Q68.What clinical features suggest uterine scar rupture during a VBAC attempt?
Answer Abnormal CTG, severe abdominal pain (especially persisting between contractions), acute-onset scar tenderness, abnormal vaginal bleeding, haematuria, cessation of previously efficient uterine activity, maternal tachycardia/hypotension/shock, loss of station of the presenting part, and inability to pick up the fetal heart rate at the old transducer site.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Vaginal Birth After Caesarean Section, p.18
Q69.Define antepartum haemorrhage (APH) and state its incidence.
Answer APH is bleeding from or into the genital tract from 24 weeks of pregnancy and prior to the birth of the baby. Incidence is 2-5%.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Antepartum Haemorrhage, p.19
Q70.List the causes of APH by category.
Answer Placental (placenta previa, placental abruption, marginal placental bleeding), fetal (vasa previa), maternal (vulval/vaginal trauma, cervical ectropion, local cervical infection, cervical carcinoma, varicosities, uterine rupture), and unknown.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Antepartum Haemorrhage, p.19
Q71.Contrast the clinical presentation of placenta previa and placental abruption.
Answer Placenta previa causes painless, unprovoked, sudden-onset bleeding that is always revealed, with a soft abdomen, fundal height corresponding to dates, easily palpable fetal parts, and usually present fetal heart sounds. Placental abruption causes continuous abdominal pain with painful bleeding that may be concealed or revealed, a hard rigid uterus with fundal height often larger than dates, fetal parts difficult to palpate, and fetal heart sounds often absent.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Antepartum Haemorrhage, p.19-20
Q72.Why must vaginal examination be avoided in APH before a specific step?
Answer Vaginal examination must not be performed until placenta previa has been excluded (usually by ultrasound), as digital examination of a previa can provoke catastrophic haemorrhage.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Antepartum Haemorrhage, p.20
Q73.Describe the initial resuscitation steps for a woman with major APH.
Answer Call for help, left lateral tilt, secure the airway and give 100% oxygen (10-15L/min), pass two 14G IV lines and send blood for FBC/clotting/cross-match of 6 units, keep the woman warm, and give warmed crystalloids/colloids while awaiting blood.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Antepartum Haemorrhage, p.20
Q74.What are the maternal and fetal complications of APH?
Answer Maternal — anaemia, shock, acute tubular necrosis, DIC, PPH, transfusion complications. Fetal — hypoxia, fetal death, SGA/IUGR, prematurity.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Antepartum Haemorrhage, p.21
Postgraduate / FCPS (6 questions)
Q75.List the risk factors specific to placenta previa.
Answer Previous uterine surgery (D&C, Caesarean section, myomectomy with a breached cavity), maternal age over 40, multiparity, smoking, and assisted conception.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Antepartum Haemorrhage, p.19
Q76.List the risk factors specific to placental abruption.
Answer Family history of abruption, trauma, chorioamnionitis, smoking, pre-eclampsia, and rapid uterine decompression.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Antepartum Haemorrhage, p.19
Q77.What blood products are given based on coagulation results in massive APH, and at what thresholds?
Answer Fresh frozen plasma — 4 units (12-15ml/kg or 1 litre per 6 units of red cells) if PT/APTT >1.5x mean control. Platelet concentrate if platelet count <50×10^9/L. Cryoprecipitate if fibrinogen <1g/L.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Antepartum Haemorrhage, p.20
Q78.How does mode of delivery differ for a live versus a dead fetus in major placental abruption?
Answer If the fetus is dead, vaginal birth is preferred irrespective of gestation. If alive, delivery is by Caesarean section for a viable fetus with massive/mild-moderate abruption at term, or when there is uncontrolled haemorrhage, failed induction, malpresentation, or multiple previous Caesarean scars.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Antepartum Haemorrhage, p.20
Q79.What special precautions are needed for delivery of major degree placenta previa?
Answer Presence of a consultant obstetrician, anaesthetist, and paediatrician; at least 6 units of blood cross-matched and ready; high-risk written consent for possible hysterectomy; and all uterotonic drugs and surgical material available.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Antepartum Haemorrhage, p.21
Q80.How is minor placental abruption between 34-38 weeks managed?
Answer Admission for observation with vigilant fetomaternal monitoring, rather than immediate delivery, provided the fetal heart rate is normal.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Antepartum Haemorrhage, p.20
Postpartum Haemorrhage / Shock
Undergraduate (8 questions)
Q81.Define primary and secondary PPH.
Answer Primary PPH is loss of 500mL or more of blood from the genital tract within 24 hours of birth. Secondary PPH is abnormal or excessive bleeding from the birth canal between 24 hours and 12 weeks postnatally.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Postpartum Haemorrhage/Shock, p.22
Q82.How is PPH classified by severity?
Answer Minor (500-1000mL) or major (>1000mL); major PPH is further divided into moderate (1000-2000mL) and severe (>2000mL).Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Postpartum Haemorrhage/Shock, p.22
Q83.What are the “Four T’s” of PPH?
Answer Tone (uterine atony), Tissue (retained products), Trauma (genital tract injury), and Thrombin (coagulopathy).Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Postpartum Haemorrhage/Shock, p.22
Q84.Give an example of a risk factor for each of the Four T’s.
Answer Tone — multiple pregnancy, prolonged third stage. Tissue — retained placenta, placenta accreta. Trauma — episiotomy, perineal laceration. Thrombin — pre-eclampsia.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Postpartum Haemorrhage/Shock, p.22
Q85.What is the initial resuscitation for PPH?
Answer Call for help, secure the airway with 100% oxygen, two 14G IV lines with blood sent for FBC/clotting/cross-match of 6 units, warmed crystalloid/colloid while awaiting blood, a Foley’s catheter, and monitoring of pulse/BP/temperature/oxygen saturation.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Postpartum Haemorrhage/Shock, p.23
Q86.What is the first-line uterotonic combination for an atonic uterus?
Answer Syntometrine (5IU oxytocin plus 0.5mg ergometrine), alongside bimanual uterine compression.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Postpartum Haemorrhage/Shock, p.23
Q87.What is the stepwise drug escalation for ongoing atonic PPH after Syntometrine?
Answer Carboprost 250 micrograms IM, repeated every 15 minutes; then IV syntocinon infusion; then misoprostol 800 micrograms (4 tablets) per rectum.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Postpartum Haemorrhage/Shock, p.23
Q88.What surgical options are used for atonic PPH unresponsive to medical management?
Answer Uterine artery ligation, B-Lynch brace suture, hysterectomy, and embolization (interventional radiology).Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Postpartum Haemorrhage/Shock, p.23
Postgraduate / FCPS (8 questions)
Q89.What is done if the uterus is well contracted but bleeding continues?
Answer Look for and manage retained products of conception (remove plus antibiotics), repair genital tract trauma (± vaginal packing), reduce uterine inversion if present, and if a clotting disorder is suspected, give warm fresh blood, FFP, and cryoprecipitate.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Postpartum Haemorrhage/Shock, p.23
Q90.What step comes between drug therapy and surgery in the PPH pathway if bleeding continues?
Answer Hydrostatic balloon tamponade.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Postpartum Haemorrhage/Shock, p.23
Q91.What is uterine inversion, and how does it present?
Answer Sudden severe pain and profound shock following delivery of the placenta, with a mass palpable at the introitus and an impalpable uterine fundus abdominally; it is managed by prompt manual reduction.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Postpartum Haemorrhage/Shock, p.23
Q92.At what fibrinogen level is cryoprecipitate indicated in PPH?
Answer Below 1g/L.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Postpartum Haemorrhage/Shock (haemorrhage resuscitation principles), p.20, 23
Q93.Which risk factor for PPH falls under “Thrombin”?
Answer Pre-eclampsia (via coagulopathy, including HELLP and DIC).Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Postpartum Haemorrhage/Shock, p.22
Q94.Which risk factors for PPH fall under “Tone”?
Answer Multiple pregnancy, previous PPH, fetal macrosomia, failure to progress in the second stage, prolonged third stage, and general anaesthesia.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Postpartum Haemorrhage/Shock, p.22
Q95.What invasive monitoring should be considered in major PPH resuscitation?
Answer A central venous pressure (CVP) line, if there is no contraindication.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Postpartum Haemorrhage/Shock, p.23
Q96.In what order is medical and surgical management escalated for an atonic uterus?
Answer Bimanual compression → Syntometrine → carboprost 250mcg IM every 15 minutes → IV syntocinon infusion → rectal misoprostol 800mcg → hydrostatic balloon tamponade → surgical management (uterine artery ligation, B-Lynch suture, hysterectomy, embolization).Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Postpartum Haemorrhage/Shock, p.23
Cord Prolapse
Undergraduate (5 questions)
Q97.Define cord prolapse.
Answer Descent of the umbilical cord through the cervix, alongside or past the presenting part, in the presence of ruptured membranes.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Cord Prolapse, p.24
Q98.What is the incidence of cord prolapse overall, and with breech presentation?
Answer 0.1-0.6% overall, increasing to about 1% with breech presentation.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Cord Prolapse, p.24
Q99.What fetal heart rate abnormalities should raise suspicion of cord prolapse?
Answer Sustained bradycardia or variable decelerations occurring after spontaneous or artificial rupture of membranes.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Cord Prolapse, p.25
Q100.What maternal position helps reduce cord compression while preparing for delivery?
Answer The knee-chest position or left lateral position, preferably with the head down and a pillow under the left hip.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Cord Prolapse, p.25
Q101.What is the recommended mode of delivery for cord prolapse when vaginal birth is not imminent?
Answer Caesarean section, to prevent hypoxic acidosis.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Cord Prolapse, p.25
Postgraduate / FCPS (5 questions)
Q102.Why is artificial rupture of membranes with a high presenting part discouraged?
Answer It increases the risk of cord prolapse, since an unengaged presenting part does not adequately occlude the pelvic inlet, allowing the cord to slip down alongside or past it.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Cord Prolapse, p.24
Q103.From what gestation should elective hospital admission be discussed for a woman with an unstable lie?
Answer From 37+0 weeks.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Cord Prolapse, p.24
Q104.What is the immediate action if loops of cord are found lying outside the vagina?
Answer Gently replace them back into the vagina, to prevent vasospasm of the umbilical vessels.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Cord Prolapse, p.25
Q105.When can tocolysis be used in cord prolapse?
Answer While preparing for Caesarean section, if there are persistent fetal heart rate abnormalities despite mechanical attempts to prevent cord compression, particularly if delivery is likely to be delayed.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Cord Prolapse, p.25
Q106.What is cord presentation, and how does its management differ from cord prolapse?
Answer Cord presentation is when the cord is felt below the presenting part with membranes still intact (no rupture yet). If diagnosed in established labour, Caesarean section is usually indicated to avoid the high risk of prolapse and cord compression with further dilatation or membrane rupture.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Cord Prolapse, p.25
Shoulder Dystocia
Undergraduate (6 questions)
Q107.Define shoulder dystocia.
Answer A vaginal cephalic delivery that requires additional obstetric manoeuvres to deliver the fetus after the head has delivered and gentle traction has been unsuccessful in delivering the shoulders.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Shoulder Dystocia, p.26
Q108.What is the incidence of shoulder dystocia?
Answer Approximately 0.58-0.7%.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Shoulder Dystocia, p.26
Q109.What is the “turtleneck sign”?
Answer Retraction of the fetal head tightly against the vulva immediately after delivery — a classic sign of shoulder dystocia, alongside failure of restitution and failure of the shoulders to descend.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Shoulder Dystocia, p.27
Q110.What is the first manoeuvre performed for shoulder dystocia after calling for help?
Answer McRoberts’ manoeuvre (hyperflexing the maternal thighs onto the abdomen), which has a success rate as high as 90%.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Shoulder Dystocia, p.28
Q111.Why should fundal pressure never be used in shoulder dystocia?
Answer It can further impact the anterior shoulder against the symphysis pubis, increasing the risk of brachial plexus injury and uterine rupture.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Shoulder Dystocia, p.27
Q112.What head-to-body delivery interval should not be exceeded in shoulder dystocia, and why?
Answer 5 minutes, as perinatal mortality rates increase significantly beyond this interval.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Shoulder Dystocia, p.27
Postgraduate / FCPS (6 questions)
Q113.What recurrence risk of shoulder dystocia should a woman with a previous history be counselled about?
Answer Approximately 25%.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Shoulder Dystocia, p.26
Q114.At what estimated fetal weight threshold should elective Caesarean section be considered in diabetic pregnancy to reduce shoulder dystocia risk?
Answer Greater than 4.5kg.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Shoulder Dystocia, p.26
Q115.What proportion of brachial plexus injuries from shoulder dystocia result in permanent neurological dysfunction?
Answer Approximately 10% (injury occurs in 2.3-16% at birth, reducing to 1-3% still affected at 12 months, of which about 10% have permanent dysfunction).Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Shoulder Dystocia, p.29
Q116.What is the approximate risk of PPH following shoulder dystocia?
Answer About 11%; increased perineal trauma (third/fourth-degree tears) occurs in about 3.8%.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Shoulder Dystocia, p.29
Q117.What is done if McRoberts’ manoeuvre and suprapubic pressure fail to resolve shoulder dystocia?
Answer Attempt either delivery of the posterior arm or internal rotational manoeuvres, and inform the consultant obstetrician and anaesthetist.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Shoulder Dystocia, p.28
Q118.What are the last-resort options if all standard manoeuvres for shoulder dystocia fail?
Answer Cleidotomy, the Zavanelli manoeuvre, or symphysiotomy.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Shoulder Dystocia, p.28
Puerperal Sepsis
Undergraduate (5 questions)
Q119.Define puerperal sepsis.
Answer Infection occurring at any time between the onset of rupture of membranes, labour, and the 42nd day postpartum, with fever plus either abnormal/foul-smelling discharge or delay in uterine involution.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Puerperal Sepsis, p.30
Q120.What proportion of direct maternal deaths in Africa and Asia is puerperal sepsis responsible for?
Answer Approximately 10%.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Puerperal Sepsis, p.30
Q121.What proportion of puerperal sepsis cases are due to mastitis?
Answer Approximately 15%.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Puerperal Sepsis, p.30
Q122.What broad-spectrum antibiotic combination is used to treat puerperal sepsis?
Answer A combination of clindamycin and an aminoglycoside; tetracycline should be avoided in breastfeeding women.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Puerperal Sepsis, p.31
Q123.For how long should antibiotics be continued in puerperal sepsis?
Answer Until the patient has made significant clinical improvement and has been afebrile for at least 24 hours.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Puerperal Sepsis, p.31
Postgraduate / FCPS (5 questions)
Q124.Give examples of aerobic, anaerobic, and miscellaneous organisms causing puerperal sepsis.
Answer Aerobes — beta-haemolytic streptococcus, Staph epidermidis/aureus, E.coli, H.influenzae, klebsiella, proteus, Pseudomonas. Anaerobes — Peptococcus, Bacteroides, fusobacterium. Miscellaneous — Chlamydia trachomatis, Mycoplasma hominis, Ureaplasma urealyticum.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Puerperal Sepsis, p.30
Q125.List the “red flags” for puerperal sepsis.
Answer Pyrexia >38°C, sustained tachycardia >90bpm, breathlessness (respiratory rate >20/min), abdominal/chest pain, uterine/renal angle pain, and being anxious/distressed.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Puerperal Sepsis, p.31
Q126.What are the non-infective risk factors for puerperal sepsis?
Answer Obesity, diabetes, corticosteroid therapy, immunosuppressant medications, anaemia, thrombophlebitis, and VTE.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Puerperal Sepsis, p.30
Q127.Distinguish general from specific investigations in suspected puerperal sepsis.
Answer General — FBC, serum electrolytes, CRP. Specific — blood culture, throat/wound/vaginal swabs, urine culture and examination, serum lactate and ABGs, and chest X-ray and pelvic scan.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Puerperal Sepsis, p.31
Q128.What surgical interventions may be needed for puerperal sepsis?
Answer Incision and drainage of a breast abscess, secondary repair of wound dehiscence, and drainage of a pelvic hematoma or abscess.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Puerperal Sepsis, p.31
Q129.Define multiple gestation and state its incidence.
Answer A pregnancy with 2 or more fetuses with one or more amniotic cavities and placentas. Incidence is about 16 in 1000 pregnancies.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Multiple Gestation, p.32
Q130.What determines chorionicity/amnionicity based on the timing of zygote division?
Answer Division at 1-3 days gives DCDA (70%), 4-7 days gives MCDA (20%), 8-13 days gives MCMA (1%), and beyond 13 days gives conjoined twins.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Multiple Gestation, p.32
Q131.List risk factors for dizygotic twinning.
Answer Assisted reproductive techniques (IVF, ovulation induction), increasing maternal age, high parity, black race, and family history.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Multiple Gestation, p.32
Q132.What proportion of monochorionic twin pregnancies develop TTTS?
Answer About 15%.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Multiple Gestation, p.33
Q133.At what gestation should elective birth be offered for uncomplicated monochorionic twins, and dichorionic twins?
Answer Monochorionic — 36 weeks after steroids. Dichorionic — 37 weeks. Triplets — 35 weeks after steroids.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Multiple Gestation, p.34
Q134.What is the recommended mode of delivery when the first (presenting) twin is non-cephalic?
Answer Caesarean section.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Multiple Gestation, p.34
Postgraduate / FCPS (6 questions)
Q135.What is the risk to a surviving twin after single fetal demise occurring after 14 weeks?
Answer About 15% risk of death and 26% risk of neurological damage.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Multiple Gestation, p.33
Q136.How is chorionicity determined on ultrasound, and when?
Answer Between 11-13+6 weeks, using the lambda sign (dichorionic) versus the T sign (monochorionic), together with membrane thickness.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Multiple Gestation, p.33
Q137.What prophylactic medication should be started from 12 weeks in twin pregnancy, and why?
Answer Aspirin (Loprin) 75mg daily, to reduce the risk of pre-eclampsia.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Multiple Gestation, p.33
Q138.What is the surveillance schedule for monochorionic monoamniotic twins?
Answer From 16-20 weeks, every 2 weeks, then at 24, 28-32, and 34-36 weeks.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Multiple Gestation, p.34
Q139.What dose of misoprostol is used for active management of the third stage in twin delivery?
Answer 600 micrograms, given prophylactically due to the increased PPH risk from uterine overdistension.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Multiple Gestation, p.34
Q140.What are the specific hazards of inducing labour in a twin pregnancy?
Answer Increased risk of Caesarean section (failed induction, FHR abnormalities, or second twin complications in about 4% of cases) and increased risk of PPH.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Multiple Gestation, p.35
Polyhydramnios
Undergraduate (5 questions)
Q141.How is polyhydramnios diagnosed on ultrasound, and how is severity graded?
Answer DVP >8cm (or AFI 18-25/above 95th centile). Mild DVP 8-12cm, moderate 12-15cm, severe >15cm.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Polyhydramnios, p.36
Q142.Give an example of a fetal cause of polyhydramnios and explain the mechanism.
Answer Oesophageal atresia (with or without tracheo-oesophageal fistula) prevents the fetus from swallowing amniotic fluid, leading to its accumulation.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Polyhydramnios, p.36
Q143.What is the main maternal cause of polyhydramnios?
Answer Diabetes mellitus, thought to relate to fetal hyperglycaemia-induced polyuria.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Polyhydramnios, p.36
Q144.What clinical findings should raise suspicion of polyhydramnios?
Answer Symphysio-fundal height greater than gestational age, a tense/tender abdomen with shiny skin, fetal parts difficult to palpate, and excessive fetal movements.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Polyhydramnios, p.36
Q145.What complications are anticipated with polyhydramnios?
Answer Malpresentation, preterm labour, cord prolapse, placental abruption, higher rates of operative delivery, maternal discomfort/respiratory distress, and PPH.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Polyhydramnios, p.37
Postgraduate / FCPS (5 questions)
Q146.When is amnioreduction indicated for polyhydramnios, and what is a risk of the procedure?
Answer For severe maternal discomfort or respiratory symptoms; rapid re-accumulation can occur, and repeated amnioreductions can cause chorioamnionitis.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Polyhydramnios, p.37
Q147.Up to what gestation can indomethacin be used for polyhydramnios, and why?
Answer Before 32 weeks, due to the risk of premature closure of the fetal ductus arteriosus with more prolonged or later use.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Polyhydramnios, p.37
Q148.At what MCA peak systolic velocity should a woman with polyhydramnios be referred to a fetal medicine unit for suspected fetal anaemia?
Answer Greater than 1.5 MoM.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Polyhydramnios, p.37
Q149.Under what circumstance should cervical cerclage be considered in polyhydramnios?
Answer If the patient is under 24 weeks and cervical length after amnioreduction is less than 2.5cm.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Polyhydramnios, p.37
Q150.Why is spontaneous onset of labour generally preferred over induction in polyhydramnios?
Answer Because induction in the context of an overdistended uterus carries a high chance of ending in Caesarean section.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Polyhydramnios, p.37
Oligohydramnios
Undergraduate (5 questions)
Q151.Define oligohydramnios.
Answer AFI less than the 5th centile for gestational age, maximum vertical pocket less than 2cm, or AFI less than 5cm.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Oligohydramnios, p.39
Q152.Give an example of a fetal cause of oligohydramnios.
Answer Bilateral renal agenesis, posterior urethral valves, or rupture of membranes.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Oligohydramnios, p.39
Q153.What proportion of oligohydramnios cases are idiopathic?
Answer About 65%.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Oligohydramnios, p.39
Q154.How is severe oligohydramnios with a lethal anomaly before 24 weeks managed?
Answer Termination of pregnancy is offered after counselling, given the very high risk of lethal pulmonary hypoplasia.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Oligohydramnios, p.39
Q155.What is the major long-term complication of early, severe oligohydramnios?
Answer Pulmonary hypoplasia, as adequate amniotic fluid is needed for normal fetal lung development.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Oligohydramnios, p.40
Postgraduate / FCPS (5 questions)
Q156.What surveillance is recommended for borderline oligohydramnios (AFI 5-8cm)?
Answer 2-weekly growth scans, with weekly AFI and Doppler assessment.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Oligohydramnios, p.39
Q157.What surveillance is used for severe oligohydramnios diagnosed between 24-36 weeks, after steroid cover?
Answer Twice-weekly CTG, weekly AFI scan until term, and weekly Doppler.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Oligohydramnios, p.39
Q158.Which causes of oligohydramnios fall under “uteroplacental insufficiency”?
Answer Pre-eclampsia, chronic hypertension, thrombophilia, and collagen vascular disease.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Oligohydramnios, p.39
Q159.Which drug classes are associated with oligohydramnios?
Answer ACE inhibitors, NSAIDs, and prostaglandin synthase inhibitors.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Oligohydramnios, p.39
Q160.Why is continuous intrapartum FHR monitoring recommended in oligohydramnios?
Answer Because reduced amniotic fluid volume increases the risk of cord compression during contractions, which can cause FHR abnormalities and intrauterine death if not recognised.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Oligohydramnios, p.40
Pre-Term Pre-Labour Rupture of Membranes
Undergraduate (6 questions)
Q161.Define PPROM.
Answer Rupture of membranes between 24 and 36+6 weeks, before the onset of labour; responsible for about one-third of preterm deliveries.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Pre-Term Pre-Labour Rupture of Membranes, p.41
Q162.What proportion of women deliver within 1 week, and within 2 weeks, of a PPROM diagnosis?
Answer 50% within 1 week and 75% within 2 weeks.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Pre-Term Pre-Labour Rupture of Membranes, p.41
Q163.How is PPROM diagnosed on sterile speculum examination?
Answer By pooling of amniotic fluid observed in the posterior vaginal fornix; digital vaginal examination is avoided due to infection risk.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Pre-Term Pre-Labour Rupture of Membranes, p.41
Q164.What is the first-line antibiotic for PPROM, and for how long?
Answer Erythromycin 250mg four times daily for 10 days, or until established labour, whichever is sooner.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Pre-Term Pre-Labour Rupture of Membranes, p.42
Q165.How is PPROM managed in the absence of contraindications to continuing pregnancy?
Answer Expectant (conservative) management until 37 weeks, with daily observation, antibiotics, and steroid cover.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Pre-Term Pre-Labour Rupture of Membranes, p.43
Q166.What is the steroid regimen for fetal lung maturity in PPROM?
Answer Injectable Dexamethasone 6mg IM, four doses 12 hours apart.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Pre-Term Pre-Labour Rupture of Membranes, p.42
Postgraduate / FCPS (6 questions)
Q167.What bedside biochemical tests can be used to diagnose PPROM if there is no pooling on speculum exam, and what is their accuracy?
Answer IGFBP-1 or PAMG-1, with sensitivity 96% and specificity 98% (though not available in all hospitals); fetal fibronectin and the amino-dye test are alternatives.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Pre-Term Pre-Labour Rupture of Membranes, p.41
Q168.What is the most informative maternal blood marker for detecting infection in PPROM, and its sensitivity/specificity?
Answer C-reactive protein, with sensitivity 68.7% and specificity 77.1%.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Pre-Term Pre-Labour Rupture of Membranes, p.42
Q169.At what gestational window does magnesium sulphate for fetal neuroprotection have the greatest benefit?
Answer 24-29+6 weeks.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Pre-Term Pre-Labour Rupture of Membranes, p.42
Q170.Why is co-amoxiclav avoided as prophylaxis in PPROM?
Answer Because of an increased risk of neonatal necrotising enterocolitis.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Pre-Term Pre-Labour Rupture of Membranes, p.42
Q171.What is the role of tocolysis in PPROM?
Answer Only to allow completion of steroid cover for fetal lung maturity and to facilitate in-utero transfer to a unit with appropriate neonatal facilities.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Pre-Term Pre-Labour Rupture of Membranes, p.42
Q172.What should a woman with a previous PPROM be counselled about in a subsequent pregnancy?
Answer Her risk of PPROM increases in subsequent pregnancies, with a short inter-pregnancy interval associated with greater risk; she should be booked under a consultant obstetrician.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Pre-Term Pre-Labour Rupture of Membranes, p.43
Preterm Labour and Delivery
Undergraduate (6 questions)
Q173.How is preterm delivery defined, and what are the sub-categories by gestation?
Answer Delivery between 24-36+6 weeks with a baby weighing above 500g. Moderate to late preterm = 32-36+6 weeks. Very preterm = 27-31+6 weeks. Extreme preterm = 24-26+6 weeks.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Pre-Term Delivery, p.44
Q174.What recurrence risk of preterm delivery applies after one, and after two, previous preterm deliveries?
Answer About 20% after one previous preterm delivery, rising to 35-40% after two.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Pre-Term Delivery, p.44
Q175.What is the tocolytic drug of choice for threatened preterm labour?
Answer A calcium channel blocker (e.g. nifedipine).Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Pre-Term Delivery, p.44
Q176.List the risk factors for preterm delivery.
Answer Low BMI, anaemia, short inter-pregnancy interval (<1 year), extremes of maternal age (teenage and >35), nulliparity or grand multiparity, and previous preterm delivery.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Pre-Term Delivery, p.44
Q177.List the aetiological categories of preterm delivery.
Answer Cervical incompetence, infections, PPROM, multiple pregnancy (uterine overdistension), polyhydramnios, pyelonephritis/appendicitis/pneumonia/any surgical procedure, and uterine or cervical anomalies.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Pre-Term Delivery, p.44
Q178.What preventive measures are used for women at high risk of preterm delivery?
Answer Progesterone supplementation, cervical cerclage, cervical length surveillance, and treatment of infections (bacterial vaginosis, candidiasis, chlamydia/gonorrhoea, asymptomatic bacteriuria).Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Pre-Term Delivery, p.45
Postgraduate / FCPS (6 questions)
Q179.What is the role of magnesium sulphate in preterm labour management?
Answer Fetal neuroprotection, reducing the risk of cerebral palsy and other neurodevelopmental complications in the preterm infant.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Pre-Term Delivery, p.44
Q180.What is the proposed mechanism by which progesterone helps prevent preterm delivery?
Answer It promotes uterine quiescence, reducing myometrial contractility.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Pre-Term Delivery, p.44-45
Q181.Why are appendicitis and other surgical procedures listed as causes of preterm labour?
Answer They are associated with the systemic inflammatory response and local uterine irritability related to intra-abdominal pathology or surgery.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Pre-Term Delivery, p.44
Q182.Give an example of a uterine anomaly and a cervical anomaly associated with preterm delivery.
Answer Uterine — unicornuate uterus with fibroid. Cervical — history of cone biopsy causing cervical incompetence.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Pre-Term Delivery, p.44
Q183.Does parity at either extreme (nulliparity vs grand multiparity) increase preterm delivery risk?
Answer Yes, both nulliparous and grand multiparous women are at increased risk.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Pre-Term Delivery, p.44
Q184.What four components make up the management approach to preterm labour?
Answer History, examination, investigation, and therapy (steroid cover, MgSO4 for neuroprotection, tocolysis, progesterone supplements, and lifestyle modification).Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Pre-Term Delivery, p.44
Small for Gestational Age
Undergraduate (5 questions)
Q185.Define small for gestational age (SGA).
Answer Estimated fetal weight (EFW) or abdominal circumference (AC) below the 10th centile for gestational age.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Small for Gestational Age, p.46
Q186.How is severe SGA defined?
Answer EFW or AC below the 3rd centile for gestational age.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Small for Gestational Age, p.46
Q187.What is the sensitivity and specificity of symphysio-fundal height (SFH) measurement for detecting SGA?
Answer Sensitivity about 27%, specificity 88% — highly variable.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Small for Gestational Age, p.46
Q188.Give an example each of a minor and a major risk factor for SGA.
Answer Minor — maternal age >35, BMI <20. Major — chronic hypertension, previous stillbirth, antiphospholipid syndrome.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Small for Gestational Age, p.46
Q189.Why is serial growth assessment preferred over a single abdominal circumference measurement?
Answer Assessment of growth velocity over time is superior to a single estimate of fetal size; two measurements at least 3 weeks apart are needed to reliably assess growth trajectory.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Small for Gestational Age, p.46
Postgraduate / FCPS (5 questions)
Q190.What PAPP-A level is a major risk factor for SGA, and what surveillance follows?
Answer PAPP-A below 0.4 MoM; this prompts reassessment at 20 weeks with uterine artery Doppler at 20-24 weeks.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Small for Gestational Age, p.46
Q191.What surveillance pathway follows 3 or more minor risk factors for SGA?
Answer Reassessment at 20 weeks, followed by uterine artery Doppler at 20-24 weeks, with the results determining whether third-trimester or earlier serial surveillance (from 26-28 weeks) is needed.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Small for Gestational Age, p.47
Q192.What is the recommended delivery timing when umbilical artery Doppler shows absent or reversed end-diastolic flow with an abnormal ductus venosus Doppler?
Answer Delivery before 32 weeks, after steroid cover.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Small for Gestational Age, p.48
Q193.What investigations should be offered for a severely SGA fetus before 23 weeks with a normal uterine artery Doppler?
Answer Karyotyping with a detailed survey of structural abnormalities, and serology screening for CMV, toxoplasmosis, syphilis, and malaria.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Small for Gestational Age, p.47
Q194.When is delivery offered for an SGA fetus with a normal umbilical artery Doppler?
Answer By 37 weeks with senior clinician involvement; earlier if MCA Doppler PI is below the 5th centile or growth is static over 3 weeks.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Small for Gestational Age, p.48
Thromboembolism in Pregnancy
Undergraduate (6 questions)
Q195.What are the three components of Virchow’s triad, and how does pregnancy affect them?
Answer Blood stasis (lower limb flow slows up to 50% by 29 weeks, persisting 6 weeks postpartum), hypercoagulability (increased factor VIII/fibrinogen, decreased protein S, impaired fibrinolysis), and vessel wall damage (during delivery).Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Thromboembolism in Pregnancy and Puerperium, p.49
Q196.What is the most common cause of direct maternal death in the UK?
Answer Thromboembolism (venous thromboembolism, including pulmonary embolism).Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Thromboembolism in Pregnancy and Puerperium, p.49
Q197.What is the investigation of choice for diagnosing DVT in pregnancy?
Answer Duplex ultrasound.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Thromboembolism in Pregnancy and Puerperium, p.49
Q198.Why is warfarin avoided for antenatal VTE treatment?
Answer It is associated with miscarriage, prematurity, low birthweight, neurodevelopmental problems, fetal/neonatal bleeding, and a characteristic embryopathy with first-trimester exposure.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Thromboembolism in Pregnancy and Puerperium, p.50
Q199.Describe the most common presentation of pulmonary embolism in pregnancy.
Answer Mild breathlessness or inspiratory chest pain, palpitations, slight tachycardia, tachypnoea, and mild pyrexia, without cyanosis.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Thromboembolism in Pregnancy and Puerperium, p.50
Q200.From what postnatal day can warfarin be considered after VTE treatment with LMWH?
Answer From day 5 at the earliest.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Thromboembolism in Pregnancy and Puerperium, p.51
Postgraduate / FCPS (6 questions)
Q201.Why is UFH preferred over LMWH in acute life-threatening pulmonary embolism?
Answer Its short half-life and reversibility allow more rapid titration and control in an unstable patient.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Thromboembolism in Pregnancy and Puerperium, p.51
Q202.What is the APTT monitoring schedule for a woman on UFH infusion?
Answer Measured 4-6 hours after the loading dose, 6 hours after any dose change, then at least daily once in the therapeutic range (target ratio 1.5-2.5x normal).Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Thromboembolism in Pregnancy and Puerperium, p.51
Q203.What is the enoxaparin thromboprophylaxis dose for a woman weighing 50-90kg?
Answer 40mg daily.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Thromboembolism in Pregnancy and Puerperium, p.53
Q204.How long before regional anaesthesia should the last prophylactic (and therapeutic) dose of LMWH be given?
Answer At least 12 hours for a prophylactic dose, 24 hours for a therapeutic dose.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Thromboembolism in Pregnancy and Puerperium, p.51
Q205.In the low-risk thromboprophylaxis category, what determines whether prophylaxis starts at 28 weeks versus the first trimester?
Answer 3 or more risk factors warrant prophylaxis from 28 weeks; 4 or more warrant prophylaxis from the first trimester.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Thromboembolism in Pregnancy and Puerperium, p.53
Q206.For how long should postnatal LMWH thromboprophylaxis continue in a high-risk woman (e.g. previous VTE)?
Answer At least 6 weeks.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Thromboembolism in Pregnancy and Puerperium, p.54
Rh Incompatibility
Undergraduate (5 questions)
Q207.Why does Rh incompatibility not typically affect the first pregnancy?
Answer The mother’s primary immune response is weak, producing only IgM antibodies, which do not cross the placenta.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Rh Incompatibility, p.55
Q208.What is the minimum volume of fetal blood that can cause isoimmunization?
Answer As little as 0.5mL.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Rh Incompatibility, p.55
Q209.What are the antenatal anti-D dosing regimens?
Answer A single dose at 28 weeks, or a two-dose regimen at 28 and 34 weeks (if the indirect Coombs test is negative).Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Rh Incompatibility, p.55
Q210.Give three examples of potential sensitising events.
Answer Miscarriage, ectopic pregnancy, molar pregnancy, amniocentesis/CVS, abdominal trauma, external cephalic version, antepartum haemorrhage, stillbirth, and traumatic delivery.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Rh Incompatibility, p.55
Q211.What does an anti-D level below 4 IU/ml, versus above 15 IU/ml, indicate?
Answer Below 4 IU/ml — HDFN is unlikely. Above 15 IU/ml — high risk of hydrops fetalis.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Rh Incompatibility, p.56
Postgraduate / FCPS (5 questions)
Q212.What anti-D dose is given for a sensitising event between 12-20 weeks?
Answer 250 IU within 72 hours of the event, alongside a Kleihauer test.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Rh Incompatibility, p.55
Q213.What is the approach to anti-D dosing for a sensitising event after 20 weeks?
Answer A minimum dose of 500 IU within 72 hours, pending the Kleihauer test result, with further anti-D given if indicated by that result.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Rh Incompatibility, p.55
Q214.At what minimum interval should anti-D be repeated in recurrent vaginal bleeding after 20+0 weeks?
Answer Every 6 weeks.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Rh Incompatibility, p.55
Q215.What is the sensitivity of MCA Doppler for detecting fetal anaemia, and its main limitation?
Answer 100% sensitivity, but with a false positive rate of about 12%.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Rh Incompatibility, p.56
Q216.What are the treatment options once significant fetal anaemia is suspected in a sensitised pregnancy?
Answer Delivery or intrauterine fetal blood transfusion, at a centre with facilities for neonatal support and blood/exchange transfusion.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Rh Incompatibility, p.56
Answer Blood pressure ≥140/90mmHg on two occasions 4 hours apart after 20 weeks in a previously normotensive woman without significant proteinuria.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Hypertensive Disorders in Pregnancy, p.57
Q218.Define pre-eclampsia.
Answer New hypertension after 20 weeks with significant proteinuria (>300mg/day, protein:creatinine ratio >30mg/mmol, or albumin:creatinine >8mg/mmol).Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Hypertensive Disorders in Pregnancy, p.57
Q219.What blood pressure defines severe hypertension in pregnancy?
Answer 160/110mmHg or more.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Hypertensive Disorders in Pregnancy, p.57
Q220.What is the target blood pressure for treating PIH?
Answer 135/85mmHg.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Hypertensive Disorders in Pregnancy, p.58
Q221.Which conditions qualify as a single high-risk factor for pre-eclampsia, warranting aspirin prophylaxis on their own?
Answer Hypertensive disease in a previous pregnancy, chronic kidney disease, autoimmune disease (SLE/APLS), type 1 or 2 diabetes, and chronic hypertension.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Hypertensive Disorders in Pregnancy, p.59
Q222.List the symptoms of pre-eclampsia.
Answer Severe headache, blurring of vision/flashes of light, epigastric pain, nausea/vomiting, and sudden swelling of the face, hands, or feet.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Hypertensive Disorders in Pregnancy, p.59
Q223.When is uncomplicated PIH delivered?
Answer Spontaneous onset of labour is awaited until 40 weeks; severe hypertension controlled on antihypertensives is delivered after 37 weeks and can be induced.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Hypertensive Disorders in Pregnancy, p.58
Q224.Which uterotonic should be avoided in the intrapartum management of hypertensive disorders?
Answer Ergometrine, as it can cause a significant rise in blood pressure.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Hypertensive Disorders in Pregnancy, p.58
Q225.Within what time frame should methyldopa be switched to an alternative antihypertensive postnatally?
Answer Within 2 days.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Hypertensive Disorders in Pregnancy, p.58
Postgraduate / FCPS (9 questions)
Q226.What are the diagnostic laboratory criteria for HELLP syndrome?
Answer Haemolysis (characteristic red cell morphology, LDH >600 units/L), elevated liver enzymes (AST >70 units/L), and low platelets (<100×10^9/L).Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Hypertensive Disorders in Pregnancy, p.65
Q227.Describe the two waves of trophoblastic invasion in normal pregnancy and how they fail in pre-eclampsia.
Answer The first wave completes by the end of the first trimester; the second wave occurs in early second trimester, involving the myometrial segment of the spiral arteries. In pre-eclampsia, the primary wave is impaired and the second wave fails to occur, leaving vessels sensitive to vasomotor stimuli and restricting placental blood flow.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Hypertensive Disorders in Pregnancy, p.64
Q228.What is acute atherosis, and is it specific to pre-eclampsia?
Answer A non-specific vascular lesion (“necrotizing arteriopathy”) with fibrinoid necrosis, lipid-laden foam cells, and mononucleated perivascular infiltrate; not specific to pre-eclampsia, as it is also seen in IUGR without pre-eclampsia.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Hypertensive Disorders in Pregnancy, p.64
Q229.Describe the characteristic renal lesion of pre-eclampsia.
Answer Glomerular endotheliosis — swelling and lipid vacuolation of glomerular cell cytoplasm, increased mesangial matrix, and IgM/fibrin deposits, causing decreased GFR and proteinuria.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Hypertensive Disorders in Pregnancy, p.64
Q230.What does hyperuricaemia in pre-eclampsia reflect, and what is a proposed benefit?
Answer It reflects tubular dysfunction; it may act as an antioxidant, offering some protection against oxidative stress.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Hypertensive Disorders in Pregnancy, p.64
Q231.How do PAI-1 and PAI-2 changes reflect endothelial and placental status in pre-eclampsia?
Answer Increased PAI-1 reflects endothelial activation; decreased PAI-2 reflects impaired placental function.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Hypertensive Disorders in Pregnancy, p.65-66
Q232.Do normal routine coagulation tests exclude coagulation activation in pre-eclampsia?
Answer No — a normal PT/APTT with slightly prolonged TT do not reliably exclude coagulation activation, as these tests are relatively insensitive.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Hypertensive Disorders in Pregnancy, p.66
Q233.Trace the metabolic pathway from insulin resistance to acute atherosis in pre-eclampsia.
Answer Insulin resistance → increased FFA and triglycerides → hyperlipidaemia → vascular damage (e.g. via VLDL) → stimulates VCAM-1 → activates monocytes → transform to macrophages → take up lipids → foam cells → acute atherosis.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Hypertensive Disorders in Pregnancy, p.66
Q234.What is the eclampsia seizure management protocol if fits persist despite magnesium sulphate?
Answer Diazepam or thiopentone, both requiring an anaesthetist to intubate/protect the airway and ventilate; BP control is established, and the patient is delivered once stable; if fits recur, general anaesthesia with muscle relaxation is needed.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Hypertensive Disorders in Pregnancy, p.61
Diabetes in Pregnancy
Undergraduate (8 questions)
Q235.What proportion of diabetes in pregnancy is due to GDM versus pre-existing diabetes?
Answer GDM accounts for 87.5%; pre-existing Type I diabetes 7.5%, Type II 5%.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Protocol for Diabetes in Pregnancy, p.67
Q236.What folic acid dose should women with pre-existing diabetes take pre-conception?
Answer 5mg/day, from 3 months before conception until 12 weeks of gestation.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Protocol for Diabetes in Pregnancy, p.67
Q237.What are the NICE diagnostic criteria for GDM?
Answer Fasting blood sugar ≥100mg/dl (5.6mmol/l), or 2-hour plasma glucose ≥140mg/dl (7.8mmol/l).Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Protocol for Diabetes in Pregnancy, p.67
Q238.Why should women with pre-existing diabetes start aspirin from 12 weeks?
Answer To help prevent pre-eclampsia, given the roughly 3-fold increased risk in diabetic pregnancy.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Protocol for Diabetes in Pregnancy, p.68
Q239.What is the target fasting blood sugar during antenatal management of diabetes in pregnancy?
Answer ≤95mg/dl.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Protocol for Diabetes in Pregnancy, p.68
Q240.What additional views should the 20-week anomaly scan include in a diabetic pregnancy?
Answer A 4-chamber heart view plus outflow tract and vessels, given the increased risk of cardiac and neural tube defects.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Protocol for Diabetes in Pregnancy, p.68
Q241.When is uncomplicated GDM delivered?
Answer Spontaneous onset of labour can be awaited until 40 weeks.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Protocol for Diabetes in Pregnancy, p.69
Q242.How should insulin dosing change immediately postpartum in a woman with insulin-treated pre-existing diabetes?
Answer Reduced to half of the pre-delivery dose.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Protocol for Diabetes in Pregnancy, p.70
Postgraduate / FCPS (8 questions)
Q243.How do the WHO fasting glucose criteria for GDM differ from NICE criteria?
Answer WHO uses a lower fasting threshold of 91mg/dl (5.1mmol/l), compared to NICE’s 100mg/dl (5.6mmol/l); WHO also includes 1-hour (180mg/dl) and 2-hour (153mg/dl) values.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Protocol for Diabetes in Pregnancy, p.67-68
Q244.What miscarriage risk is associated with an HbA1c above 85mmol/l pre-conception?
Answer Approximately 30%.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Protocol for Diabetes in Pregnancy, p.67
Q245.What insulin infusion rate corresponds to a blood glucose of 9.0-10.9 mmol/L on the intrapartum sliding scale?
Answer 4 units per hour, with the consultant called.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Protocol for Diabetes in Pregnancy, p.69
Q246.How does recommended insulin dosing per kg change across the trimesters?
Answer 0.7 units/kg in the first trimester, 0.8 units/kg in the second, and 0.9-1 units/kg in the third.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Protocol for Diabetes in Pregnancy, p.69
Q247.How does serum creatinine level affect the chance of successful pregnancy in diabetic nephropathy?
Answer About 80% chance at 125-180 µmol/L, 75% at 180-220 µmol/L, and 60% above 220 µmol/L.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Protocol for Diabetes in Pregnancy, p.72
Q248.What congenital anomaly is seen almost exclusively in babies of diabetic mothers?
Answer Sacral agenesis.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Protocol for Diabetes in Pregnancy, p.72
Q249.What proportion of perinatal mortality in diabetic pregnancies is attributed to malformations?
Answer Approximately 40%.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Protocol for Diabetes in Pregnancy, p.72
Q250.When do accelerated fetal growth patterns typically appear in poorly controlled diabetic pregnancy?
Answer In the late second and third trimester.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Protocol for Diabetes in Pregnancy, p.72
Anemia in Pregnancy
Undergraduate (6 questions)
Q251.What is the WHO definition of anaemia in pregnancy?
Answer Haemoglobin less than 11.0g/dl, or hematocrit less than 30%.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Anemia in Pregnancy, p.73
Q252.What proportion of anaemia in pregnancy is due to iron deficiency?
Answer Approximately 75%.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Anemia in Pregnancy, p.73
Q253.How is anaemia severity graded?
Answer Mild (Hb 10.0-10.9g/dl), moderate (7.0-10.0g/dl), severe (4.0-7.0g/dl), very severe (<4.0g/dl).Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Anemia in Pregnancy, p.73
Q254.What nail sign is associated with iron deficiency anaemia?
Answer Koilonychia (spoon-shaped nails).Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Anemia in Pregnancy, p.74
Q255.How do MCV, MCH and MCHC differ between iron deficiency anaemia and thalassemia?
Answer Both show reduced MCV and MCH; MCHC is reduced in iron deficiency but normal in thalassemia.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Anemia in Pregnancy, p.74-75
Q256.At what haemoglobin level at term is blood transfusion indicated?
Answer Below 8.0g/dl.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Anemia in Pregnancy, p.77
Postgraduate / FCPS (6 questions)
Q257.What is the total iron requirement over pregnancy, and its components?
Answer About 1360mg total: 500mg for the fetus and placenta, 500mg for expansion of red cell mass, 180mg lost at delivery, 180mg for lactation.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Anemia in Pregnancy, p.77
Q258.How much elemental iron does a 200mg ferrous sulfate tablet provide?
Answer 65mg.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Anemia in Pregnancy, p.78
Q259.What is iron carboxymaltose, and what response rate does it produce?
Answer A newer iron preparation given as a single dose over 15 minutes; produces approximately 10g/L improvement in haemoglobin per week, useful for women presenting late in pregnancy.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Anemia in Pregnancy, p.78
Q260.By how much does moderate versus severe anaemia increase the risk of PPH?
Answer Moderate anaemia increases risk by 50%; severe anaemia increases it up to 10-fold.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Anemia in Pregnancy, p.75
Q261.What test differentiates folate deficiency from vitamin B12 deficiency?
Answer The deoxyuridine suppression test.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Anemia in Pregnancy, p.75
Q262.How is compliance with oral iron therapy assessed?
Answer Reticulocyte count — a rise to greater than 4-5% after about 1 week confirms a good marrow response and compliance.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Anemia in Pregnancy, p.76
Thyroid Diseases in Pregnancy
Undergraduate (5 questions)
Q263.What proportion of hyperthyroidism in pregnancy is due to Graves disease?
Answer Approximately 90%.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Thyroid Diseases in Pregnancy, p.79
Q264.What is the first-line anti-thyroid drug in early pregnancy?
Answer Propylthiouracil.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Thyroid Diseases in Pregnancy, p.79-80
Q265.For how long should conception be avoided after radioactive iodine treatment?
Answer 6 months.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Thyroid Diseases in Pregnancy, p.79
Q266.What is the typical starting dose of thyroxine for hypothyroidism in pregnancy?
Answer 100 micrograms/day, titrated to TSH (maximum dose 300 micrograms/day).Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Thyroid Diseases in Pregnancy, p.83
Q267.Describe the typical course of postpartum thyroiditis.
Answer Initial hyperthyroidism followed by hypothyroidism; about 90% resolve within 6-10 months, though it can recur in 70% of subsequent pregnancies.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Thyroid Diseases in Pregnancy, p.81
Postgraduate / FCPS (5 questions)
Q268.Why can conditions like molar pregnancy or hyperemesis gravidarum cause clinical hyperthyroidism?
Answer HCG and TSH share a common alpha subunit and similar beta subunit, so very high HCG levels can stimulate TSH receptors.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Thyroid Diseases in Pregnancy, p.79-80
Q269.From what gestation can the fetal thyroid respond to maternal TSH receptor stimulating antibodies?
Answer After 20 weeks.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Thyroid Diseases in Pregnancy, p.81
Q270.What is the mortality if neonatal hyperthyroidism (from maternal Graves antibodies) is left untreated?
Answer Approximately 15%.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Thyroid Diseases in Pregnancy, p.81
Q271.What are the approximate maternal and fetal mortality rates in thyroid storm?
Answer Maternal 10-20%, fetal 20-50%.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Thyroid Diseases in Pregnancy, p.82
Q272.Is PTU safe during breastfeeding?
Answer Relatively safe at the lowest effective dose, as its concentration in breast milk and neonatal serum is very low; infant TFTs should be monitored.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Thyroid Diseases in Pregnancy, p.80
Cardiac Disease in Pregnancy
Undergraduate (5 questions)
Q273.What is the overall incidence of serious heart disease complicating pregnancy?
Answer Approximately 1%.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Cardiac Disease in Pregnancy, p.84
Q274.In which conditions is pregnancy specifically advised against?
Answer Pre-existing pulmonary hypertension, Eisenmenger syndrome, Marfan syndrome, severe cardiomyopathy, large left-to-right shunt, and severe mitral stenosis (<1cm2).Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Cardiac Disease in Pregnancy, p.84
Answer Mild symptoms (mild shortness of breath and/or angina) with slight limitation during ordinary activity.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Cardiac Disease in Pregnancy, p.85
Q276.What is the endocarditis prophylaxis regimen given in labour for at-risk cardiac patients?
Answer Amoxicillin 2g IV plus Gentamicin 1.5mg/kg IV, followed by oral Amoxicillin 500mg 6 hours later.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Cardiac Disease in Pregnancy, p.86
Q277.Which uterotonic should be avoided, and why, in women with cardiac disease?
Answer Ergometrine, as it can precipitate acute cardiac decompensation via a rise in venous return/vascular resistance; oxytocin is used instead (as a slow infusion, not repeated boluses).Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Cardiac Disease in Pregnancy, p.86
Postgraduate / FCPS (5 questions)
Q278.During which weeks of pregnancy can warfarin be used for anticoagulation in cardiac disease, if the patient prefers oral treatment?
Answer Weeks 13-36, with LMWH used in the first trimester and again closer to delivery.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Cardiac Disease in Pregnancy, p.85
Q279.By what gestation, or how many days before delivery, should warfarin be switched to LMWH?
Answer 10 days prior to delivery or by 36 weeks.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Cardiac Disease in Pregnancy, p.85
Q280.What monitoring should be considered for NYHA class III/IV patients in labour?
Answer A central venous pressure (CVP) line, in a fully equipped room.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Cardiac Disease in Pregnancy, p.85
Q281.Describe the “5 minutes/5 hours/5 days/5 weeks” framework of postpartum cardiac risk.
Answer 5 minutes — increased blood volume/cardiac failure risk; 5 hours — pulmonary oedema; 5 days — DVT/PE; 5 weeks — bacterial endocarditis.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Cardiac Disease in Pregnancy, p.87
Q282.What fetal complications are associated with warfarin exposure in pregnancy?
Answer Achondroplasia, facial and skeletal anomalies, mental retardation, and haemorrhage (warfarin embryopathy).Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Cardiac Disease in Pregnancy, p.87
Epilepsy in Pregnancy
Undergraduate (5 questions)
Q283.What is the prevalence of epilepsy in pregnant women?
Answer Approximately 0.5-1%.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Epilepsy in Pregnancy, p.88
Q284.What folic acid dose is recommended for women with epilepsy planning pregnancy?
Answer 5mg/day for at least 3 months before conception, continued until at least 12 weeks.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Epilepsy in Pregnancy, p.88
Q285.What proportion of women with epilepsy have unchanged seizure control during pregnancy?
Answer About 50% (25% worsen, 25% improve).Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Epilepsy in Pregnancy, p.89
Q286.What is the drug of choice for terminating a seizure occurring during labour?
Answer Long-acting benzodiazepines (e.g. clobazam).Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Epilepsy in Pregnancy, p.90
Q287.Why is vitamin K given to the newborn of a mother with epilepsy on anti-epileptic drugs?
Answer To prevent haemorrhagic disease of the newborn, a risk with certain AEDs (e.g. phenytoin) affecting vitamin K-dependent clotting factors.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Epilepsy in Pregnancy, p.90
Postgraduate / FCPS (5 questions)
Q288.Which anti-epileptic drug is most specifically associated with neural tube defects?
Answer Sodium valproate.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Epilepsy in Pregnancy, p.89
Q289.Why does carbamazepine reduce the reliability of hormonal contraception?
Answer It is an enzyme-inducing AED, increasing hepatic metabolism of hormonal contraceptives.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Epilepsy in Pregnancy, p.91
Q290.What is the preferred method of emergency contraception for a woman on enzyme-inducing AEDs?
Answer The copper IUD, as its efficacy is unaffected by enzyme-inducing AEDs.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Epilepsy in Pregnancy, p.88
Q291.What is the risk of a child developing epilepsy if both parents are affected?
Answer Approximately 15%.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Epilepsy in Pregnancy, p.90
Q292.Within what time frame after delivery should an AED dose that was increased during pregnancy be revised?
Answer Within 10 days, to avoid postpartum toxicity.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Epilepsy in Pregnancy, p.90
Jaundice in Pregnancy
Undergraduate (4 questions)
Q293.What is the most common cause of jaundice in pregnancy?
Answer Viral hepatitis, usually hepatitis A.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Jaundice in Pregnancy, p.92
Q294.What symptom is classic for obstetric cholestasis?
Answer Severe pruritus, particularly affecting the palms and soles.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Jaundice in Pregnancy, p.92
Q295.What is the first-line treatment for obstetric cholestasis?
Answer Ursodeoxycholic acid (Cap Urso) 250-500mg twice daily.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Jaundice in Pregnancy, p.93
Q296.Why is a coagulation profile important in suspected fulminant hepatic failure in pregnancy?
Answer Coagulopathy can develop due to lack of vitamin K-dependent clotting factors.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Jaundice in Pregnancy, p.92
Postgraduate / FCPS (4 questions)
Q297.How is HELLP syndrome managed?
Answer Immediate delivery after maternal stabilisation, blood pressure control, and seizure prophylaxis with magnesium sulphate.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Jaundice in Pregnancy, p.93
Q298.How is acute fatty liver of pregnancy (AFLP) managed?
Answer Supportive hepatic therapy with delivery in a tertiary care unit.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Jaundice in Pregnancy, p.93
Q299.Why should interferons be avoided for viral hepatitis during pregnancy?
Answer They are not used in pregnancy for managing viral hepatitis; management instead focuses on isolation, medical consultation, and hepatic supportive therapy.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Jaundice in Pregnancy, p.93
Q300.What two conditions are specifically associated with splenomegaly in a jaundiced pregnant patient?
Answer Enteric fever and haemolysis.Essentials of Obstetrics, Prof. Dr. Tayyaba Majeed, 1st Ed — Jaundice in Pregnancy, p.92
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