Clinical Mangement.doc

8/10/2019 Clinical Mangement.doc

1/19

Clinical MangementWhich of the following conditions is associated with blunt trauma in apregnant ?(A) Abruptio placentae(B) Fetal malformation(C) Placenta accreta(D) Placenta preia(!) Premature rupture of membranes

Answer"#(A) Abruptio placentae$

Abruptio placentae% defined as a premature separation of the placenta from theuterine wall% is commonl& seen with blunt abdominal trauma and can cause fetaldistress$

't occurs in to * of pregnant women with minor trauma and in +, to -,with ma.or life#threatening trauma$

Abruptio placentae ma& be missed on ultrasound e/amination$

0he gold standard for ealuation of placental abruption is cardiotocographicmonitoring to detect uterine irritabilit& and fetal distress$A cesarean section ma& be necessar& to sae the fetus in seere cases ofplacental abruption$

Fetal malformations are not lin1ed to trauma specificall&$ 2oweer% radiatione/posurein earl& pregnanc& ma& lead to fetal malformation$

Placenta accreta% an obstetric complication inoling an abnormal superficialattachment of the placenta to the m&ometrium% and placenta preia% animplantation of the placenta oer the lower part of the uterus coering all ofthe internal cerical os% are not lin1ed to trauma$

Although premature labor ma& occur as a conse3uence of abdominal trauma%premature rupture of membranes is not specificall& lin1ed to trauma

4ne of the following statements is false$$$$$$ Chic1enpo/ in pregnanc&"a ma& become complicated and result in maternal deathb can be ac3uired from contact with shinglesc tends to be more complicated at later gestationsd should be treated with oral ac&cloir within 5+ hours of the onset of therash

e can be alleiated with aricella 6oster immunoglobulin$e7aricella immunoglobulin has no therapeutic benefi t once chic1enpo/ hasdeeloped$

4ne of the following statements is true$$$$ 8enital herpes in pregnanc&"a can be ac3uired from contact with shinglesb if recurrent has a strong association with neonatal herpes


2/19

c if ac3uired for the fi rst time at *- wee1s% aginal delier& should beconsideredd ma& be caused b& herpes simple/ t&pe (297#) or herpes simple/ t&pe 5(297#5)e is low ris1 to the bab& if it has been ac3uired for the first time at theonset of labour$d9hingles is caused b& aricella irus% not herpes$ 0he ris1s to the neonateare small in women presenting with recurrent herpes at the onset oflabour$Primar& rather than recurrent genital herpes is a significant ris1factor for neonatal herpes$ When first#episode genital herpes is ac3uiredwithin si/ wee1s of delier&% then Caesarean section should beconsidered$

4ne of the following statements is false$$$$$ :elating to thromboembolism$a 7enous thromboembolism (70!) is , times more common in the pregnant womancompared to the non#pregnant woman of comparable age$b 0he ris1 of 70! is four times higher in the puerperium compared to theantenatal period$

c A positie D#dimer test in pregnanc& is consistent with 70!$d When pulmonar& thromboembolism is suspected% both a 7;< scan and bilateralDoppler =9 leg studies should be performed$e 0he incidence of post#thrombotic s&ndrome is reduced b& wearing graduatedelastic compression stoc1ings for two &ears after the acute eent$cD#dimer testing should not be used in pregnant women% because of the high rateof false positie results$ 0his is due to ph&siological changes in thecoagulation s&stem resulting in eleated D#dimer leels in pregnanc&$

4ne of the following statements is false$$$'n diabetic pregnanc&"

a insulin re3uirements increase in the second and third trimestersb glucose leels should be maintained between -$- (fasting) and >$, mmol;(post#prandial)c gl&cos&lated haemoglobin should be less than >d insulin re3uirement will remain the same until two wee1s after delier&e 1etoacidosis is associated with a high fetal mortalit&$d'nsulin re3uirements fall immediatel& after delier&$

4ne of the following statements is false$$$$'n seere pre#eclampsia% thefollowing ma& occur"a abnormal lier en6&mesb cholestasis

c epigastric paind lier tendernesse 2!P s&ndrome$bCholestasis in not a feature of pre#

eclampsia$4ne of the following is false$$$ Clinical features of pre#eclampsia include"


3/19

a seere headacheb n&stagmusc epigastric paind lier tendernesse abnormal lier en6&mes$b@&stagmus is not a presenting feature of pre#eclampsia$

4ne of the following is false$$$$ A primiparous woman at *5 wee1s has apersistentl& eleated blood pressure of -;-$ Which of the following would&ou not gie?a oral labetalolb intraenous labetalolc oral nifedipined sublingual nifedipinee intraenous h&drala6ine$d9ublingual nifedipine can cause a rapid fall in blood pressure and is

contraindicated$4ne of the following is false$$$$ 'n a woman with seere pre#eclampsia"a magnesium sulphate should be used when there is a significant ris1 ofeclampsiab magnesium sulphate is the treatment of choice to control sei6uresc antih&pertensie treatment should be commenced when the s&stolic bloodpressure is more than , mmd fluids should be restricted to , m;houre s&ntometrine should be gien for preention of haemorrhage for management ofthe third stage$e

9&ntometrine contains s&ntocinon and ergometrine$ $$ !rgometrine raises bloodpressure and is

contraindicated$4ne of the following is false$$$ 0he following are associated with cordprolapse"a preterm labourb fetal abnormalit&c occipito#transerse positiond internal podalic ersione artificial rupture of the membranes$c0here is no association between cord prolapse and occipito#transerse

position$4ne of the following is false$$$'n a woman with placenta praeia"a morbidl& adherent placenta is more li1el& when the placenta is anterior andthere has been a preious C9b spinal anaesthetic is contraindicated for delier& b& Caesarean sectionc there is no eidence to support the use of autologous transfusiond cell salage has a place in managemente cerical cerclage is not recommended$


4/19

b0here is increasing e/perience in the use of spinal anaesthesia for delier&b& Caesarean section in women with placenta praeia$

4ne of the following is false$$$ 0he following are contraindicated whenaginal breech birth is being considered"a preious Caesarean sectionb footling breechc breech presentation first diagnosed in labourd estimated fetal si6e more than + 1ge a growth#restricted fetus at term estimated at less than 5 1g$

c0here is no absolute contraindication to anticipate aginal breech delier&when a breech presentation is first diagnosed in labour$

4ne of the following is false$$$:elating to the pre#pregnanc& management of

women with diabetes$a 0he longer the woman has had diabetes% the greater the ris1 of pregnanc&complications$

b Folic acid - mg should be ta1en pre#pregnanc& until 5 wee1sgestation$c 0he 2bAc leel should be maintained below $$d 4ral h&pogl&caemic medication should be discontinued prepregnanc& andsubstituted with insulin$e :apid#acting insulin analogues (aspart and lispro) ma& adersel& affect thefetus$e:apidl& acting insulin analogues hae adantages oer soluble human insulinand hae no aderse effect on the fetus$

4ne of the following is false$$$ :elating to gestational diabetes$a A bod& mass inde/ of more than *, 1g;m5 at boo1ing is a ris1 factor forgestational diabetes$b 9creening for gestational diabetes is underta1en using glucose urinal&sis$c Women who had preious gestational diabetes should offered a glucosetolerance test after the st trimester$d 'n women with gestational diabetes% good gl&caemic control will reduce theris1 of macrosomia$e 'f diet and e/ercise fail to control ade3uate blood glucose leels% an oralh&pogl&caemic agent ma& be necessar&$b8lucose urinal&sis is an ineffectie method of screening for gestational

diabetes$4ne of the following is true$$$:elating to the management of diabetes duringpregnanc&$a :apid#acting insulin analogues hae no adantages oer soluble human insulinduring pregnanc&$b After the first trimester% women should be adised that there is ris1 ofh&pogl&caemia$c Diabetic retinopath& is a contraindication to aginal birth$d :outine monitoring of fetal well#being is not recommended before * wee1sunless there is suspected intrauterine growth restriction$


5/19

e Diabetic retinopath& is a contraindication to rapid optimisation of bloodglucose leels in the presence of a high2bAc$d:apid#acting insulin analogues are as effectie as soluble human insulin% withno disadantages$ Diabetic women should be adised of the ris1 ofh&pogl&caemia% particularl& during the first trimester$ 7aginal delier& isnot contraindicated in the presence of diabetic retinopath&$ Diabeticretinopath& should not be considered a contraindication to rapid blood glucoseleel

control$4ne of the following is false$ $$ :elating to group B streptococcus (8B9)$a 8B9 is the most fre3uent cause of seere earlonset infection in neonates$b :outine screening for antenatal 8B9 is recommended$c 0here is insuffi cient eidence for intrapartum antibiotic administration inwomen who hae been found to haecarried 8B9 in a preious pregnanc&$d 'ntrapartum antibiotics are recommended to women who hae had a preiousneonate with 8B9$

e 'n women with preterm rupture of the membranes% 8B9 antibiotic proph&la/isis not necessar&$b:outine screening (either bacteriological or ris1#based) for antenatal 8B9 isnot recommended$

4ne of the following is false$$$$ :elating to intrapartum fetal heart ratemonitoring$

a 0he normal range for the baseline fetal heart rate is ,,$b 0he baseline ariabilit& is normall& more than fie beats per minute$c When the baseline ariabilit& has been reduced for , minutes or more% the

tracing is categorised as pathological$d 0he presence of late decelerations is in 1eeping with h&po/ia$e !en when ariable decelerations occur as the onl& nonreassuring feature% afetal blood sample should be underta1en$e=suall& two or more non#reassuring features or one or more abnormal featuresare re3uired before a tracing is categorised as pathological$ Action is thenre3uired either with a fetal blood sample to assess p2 or with immediatedelier&$ 'f there is onl& one non#reassuring feature% such as ariabledecelerations% it is appropriate simpl& to continue to obsere the tracing

4ne of the following is true$$$ When categorising fetal rate pattern features

into reassuring% non#reassuring and abnormal"a a baseline rate of ,- is reassuringb a single prolonged deceleration lasting up to three minutes is abnormalc earl& decelerations are abnormald ariable decelerations are non#reassuringe baseline ariabilit& of less than fi e for *, minutes is nonreassuring$d


6/19

A baseline rate of ,, is reassuring$ A single prolonged deceleration upto three minutes is non#reassuring more than three minutes is abnormal$ !arl&decelerations are nonreassuring$Baseline ariabilit& of less than fie for more than +, minutes but less than, minutes is non#reassuring, minutes or more is abnormal$

4ne of the following is false$$$$'n the assessment of intrauterine growthrestriction"a the measurement of the abdominal circumference is the single most reliableultrasonic parameterb an amniotic single pool depth of less than 5 cm is abnormalc a cardiotocograph showing no accelerations oer a period of +, minutes isabnormald absent end diastolic fl ow in the Doppler assessment of the umbilical arter&is abnormale the diagnosis is suspected when the fetal head circumference measurement isless than the ,th centile$

eMeasurement of the head circumference alone is inade3uate to ma1e thediagnosis of intrauterine growth restriction$

4ne of the following is false$$$ :elating to smo1ing and substance misuse$a 9mo1ing in pregnanc& is associated with low birthweight$b 9mo1ing in pregnanc& is associated with an increased ris1 of sudden infantdeath s&ndrome$c 9mo1ing in pregnanc& is associated with an increased ris1 of pre#eclampsia$d Cocaine use in pregnanc& is associated with abruption$e Alcohol is a teratogen$c

For un1nown reasons pre#eclampsia is less common in smo1ers$0he incidence of alcohol#related birth defects and the fetal alcohol s&ndromeincreases sharpl& in women who consume more than three units per da&$

4ne of the following is true$$$ :elating to shoulder d&stocia$a 0he recurrence ris1 is -,$b 2alf of all shoulder d&stocia cases occur when the babies haea normal birthweight$c Macrosomia can be reliabl& predicted antenatall&$d !arl& induction in cases of suspected macrosomia has been shown to reducethe ris1 of shoulder d&stocia$e 0he si6e of the pelic outlet in association with the perineum contributesto the mechanism of shoulder d&stocia$

b0he recurrence ris1 is ,$ 0he range of error for ultrasonic estimate offetal weight is , and up to 5, for macrosomic fetuses$ 0here is no eidenceat present to support earl& induction$ 0he pelic outlet is not a significantfactor% and an episiotom& is performed or e/tended to allow better access foraginal manipulations$

4ne of the following is false$ 'n women with obstetric cholestasis"


7/19

a the ris1 of stillbirth is unclear if no interention is underta1enb the current stillbirth rate for obstetric cholestasis is the same as thegeneral population ris1c the incidence of preterm delier& is higherd intrauterine growth restriction is more commone the ris1 of fetal death does not correlate with the derangement in lierfunction tests$d:ecent data does not show an increase in the stillbirth rate compared to thegeneral population$ Preterm delier&% both iatrogenic and spontaneous% ishigher but intrauterine growth restriction is not associated with cholestasis$0here is no proen lin1 between ris1 of fetal death and leel of derangementof lier function tests$

4ne of the following is true$$$ 0he re3uirement for operatie aginaldelier&"a is reduced with the use of epidural analgesiab is increased when pushing is dela&ed in second stage in primiparous women

with epidural analgesiac is increased when women labour in the upright or lateralpositionsd is increased when a partogram is usede is decreased with the use of o/&tocin in primiparous women with epidurals$e!pidural analgesia increases the need for operatie aginal delier&$ Dela&edpushing reduces the need for forceps delier& in primiparous women withepidurals$ =pright or lateral positions and the use of a partogram alldecrease the need for operatie aginal delier&$

4ne of the following is false$$$ :elating to t&pes of operatie delier&$a An outlet forceps is defi ned as such when the fetal head is at or on the

perineum at application$b A low#cait& forceps delier& is defi ned as such when the leading point ofthe fetal head is 5 cm or more below the ischial spines at application$c A mid#cait& forceps is defi ned as such when the leading point of the fetalhead is at the leel of the ischial spines or up to 5 cm below at application$d A mid#cait& forceps is when the head is one#fi fth palpable abdominall&$e A high#cait& forceps is used for delier& of a second twin$e0here is no place for high forceps delieries in modern obstetric practice$5,,-#5,,(march) mrcog part pastpapers recall mrcog total guidehttp";;www$mediafire$com;?15smir3f->.p5

other edition of 3uestions "# 5,,-#5,,http";;www$mediafire$com;?51ghn1+bsbnwmim

http";;www$mediafire$com;?g16*ng6fwca>


8/19

Which of the following is a reactiation and therefore not a ris1 to thefetus?a$ 8roup B co/sac1ieirusb$ :ubella irusc$ Chic1enpo/ irusd$ 9hinglese$ 2erpesirus t&pe 5

5$ A 55#&ear#old 8 at + wee1s gestation presents to &our office with ahistor& of recent e/posure to her *#&ear#old nephew who had a rubella iralinfection$ 'n which time period does maternal infection with rubella iruscarr& the greatest ris1 for congenital rubella s&ndrome in the fetus?a$ Preconceptionb$ First trimesterc$ 9econd trimesterd$ 0hird trimestere$ Postpartum

*$ A pregnant woman is discoered to be an as&mptomatic carrier of @eisseriagonorrhoeae $ A &ear ago% she was treated with penicillin for a gonococcalinfection and deeloped a seere allergic reaction$ Which of the following isthe treatment of choice at this time?a$ 0etrac&clineb$ Ampicillinc$ 9pectinom&cind$ Chloramphenicole$ Penicillin

+$ A 55#&ear#old has .ust been diagnosed with to/oplasmosis$ Eou tr& todetermine what her ris1 factors were$ 0he highest ris1 association is which ofthe following?a$ !ating raw meatb$ !ating raw fishc$ 4wning a dogd$ !nglish nationalit&e$ 2aing iral infections in earl& pregnanc&

-$ A 5#&ear#old 8 presents to &our office at wee1s gestation$ 9he has ahistor& of diabetes since the age of +$ 9he uses insulin and denies an&complications related to her diabetes$ Which of the following is the mostcommon birth defect associated with diabetes?a$ Anencephal&b$ !ncephalocele

c$ Meningom&eloceled$ 9acral agenesise$ 7entricular septal defect

$ A 5,#&ear#old 8 patient deliers a lie#born infant with cutaneouslesions% limb defects% cerebral cortical atroph&% and chorioretinitis$ 2erpregnanc& was complicated b& pneumonia at wee1s$ What is the most li1el&causatie agent?a$ C&tomegaloirus


9/19

b$ 8roup B streptococcusc$ :ubella irusd$ 0reponemal pallidume$ 7aricella 6oster

>$ A *+#&ear#old 85 at * wee1s deliers a growth#restricted infant withcataracts% anemia% patent ductus arteriosus% and sensorineural deafness$ 9hehas a histor& of chronic h&pertension% which was well controlled withmeth&ldopa during pregnanc&$ 9he had a iral s&ndrome with rash in earl&pregnanc&$ What is the most li1el& causatie agent?a$ Paroirusb$ :ubella irusc$ :ubeolad$ 0o/oplasma gondiie$ 0$ pallidum

$ A 5-#&ear#old 8* at * wee1s deliers a small#for#gestational#age infantwith chorioretinitis% intracranial calcifications% .aundice%

hepatosplenomegal&% and anemia$ 0he infant displa&s poor feeding and tone inthe nurser&$ 0he patient denies eating an& raw or undercoo1ed meat and doesnot hae an& cats liing at home with her$ 9he wor1s as a nurse in thepediatric intensie care unit at the local hospital$ What is the most li1el&causatie agent?a$ C&tomegaloirusb$ 8roup B streptococcusc$ 2epatitis Bd$ Paroiruse$ 0$ gondii$ A 5*#&ear#old 8 with a histor& of a fluli1e illness% feer% m&algias% andl&mphadenopath& during her earl& third trimester deliers a growth#restrictedinfant with sei6ures% intracranial calcifications% hepatosplenomegal&%.aundice% and anemia$ What is the most li1el& causatie agent?a$ C&tomegaloirusb$ 2epatitis Bc$ 'nfluen6a Ad$ Paroiruse$ 0$ gondii

,$ A *5#&ear#old 8- deliers a stillborn fetus at *+ wee1s$ 0he placenta isnoted to be much larger than normal$ 0he fetus appeared h&dropic and hadpetechiae oer much of the s1in$ What is the most li1el& causatie agent?a$ 2erpes simple/b$ Paroirus

c$ :ubella irusd$ 0$ pallidume$ 7aricella 6oster

$ A *#&ear#woman at * wee1s deliers a >#lb infant female withoutcomplications$ At 5 wee1s of life% the infant deelops fulminant lierfailureand dies$ What is the most li1el& causatie irus?a$ C&tomegaloirusb$ 2epatitis B


10/19

c$ 2erpes simple/d$ Paroiruse$ :ubeola5$ A 5,#&ear#old woman who wor1s as a 1indergarten teacher presents for herroutine isit at *5 wee1s$ 2er fundal height measures +, cm$ An ultrasoundreeals pol&h&dramnios% an appropriatel& grown fetus with ascites and scalpedema$ 0he patient denies an& recent illnesses% but some of the children ather school hae been sic1 recentl&$ What is the most li1el& cause of the fetalfindings?a$ C&tomegaloirusb$ 2epatitis Bc$ 'nfluen6a Ad$ Paroiruse$ 0o/oplasmosis gondii

*$ A 5-#&ear#old female in her first pregnanc& deliers a #lb male infant at* wee1s$ 0he infant deelops feer% esicular rash% poor feeding% and

listlessness at wee1 of age$ What is the most li1el& cause of the infants

signs and s&mptoms?a$ C&tomegaloirusb$ 8roup B streptococcusc$ 2epatitis Bd$ 2erpes simple/e$ isteria monoc&togenes

+$ A 55#&ear#old woman deliers a >#lb male infant at +, wee1s without an&complications$ 4n da& * of life% the infant deelops respirator& distress%h&potension% tach&cardia% listlessness% and oliguria$ What is the most li1el&

cause of the infants illness?a$ C&tomegaloirus

b$ 8roup B streptococcusc$ 2epatitis Bd$ 2erpes simple/e$ $ monoc&togenes

$ 0he answer is d$ A mild group B co/sac1ieirus infection of the mother during the antepartumperiod ma& gie rise to a irulent infection in the newborn% sometimesresulting in a fatal encephalom&ocarditis$A maternal rubella infection ma& cause neonatal 29M% petechial rash% and.aundice in addition% iral shedding ma& last for months or &ears$ 2erpes 6oster% the causatie agent of aricella (chic1en po/)% is anespeciall& dangerous organism for the newborn$ 7aricella is rare in pregnanc&%

but if it occurs shortl& before delier&% the iremia ma& spread to the fetusbefore protectie maternal antibodies hae had a chance to form$ Congenitalaricella can be fatal to the newborn the increasing aailabilit& of 6osterimmunoglobulin% howeer% ma& allow clinicians to attac1 the infection beforesignificant fetal iremia has deeloped$9hingles% which is a reactiation of aricella% would not li1el& hae fetaleffects because of alread& e/isting maternal 'g8 from the initial e/posure$


11/19

2erpes irus can be ac3uired b& the fetus as it passes down the genitaltract and can cause a seere% often fatal herpes infection in the newborn$

5$ 0he answer is b$:ubella is one of the most teratogenic agents 1nown$ :is1 of congenitalrubella infection in the fetus is , when the mother has a rubella infectionin the first trimester$0his ris1 decreases to 5- b& the end of the second trimester$

*$ 0he answer is c$9pectinom&cin is the treatment of choice for pregnant women who haeas&mptomatic @$ gonorrhoeae infections and who are allergic to penicillin$!r&throm&cin is another drug that is effectie in treating as&mptomaticgonorrhea$ Although tetrac&cline is an effectie alternatie to penicillin%its use is generall& contraindicated in pregnanc&$

Administration of chloramphenicol is not recommended to treat women% pregnantor not% who hae cerical gonorrheathe use of ampicillin or penicillin analogues is contraindicated forpenicillin#allergic patients$

+$ 0he answer is a$0o/oplasmosis% a proto6oal infection caused b& 0$ gondii% can result fromingestion of raw or undercoo1ed meat infected b& the organism or from contactwith infected cat feces$0he French% because their diet includes raw meat% hae a high incidence$

-$ 0he answer is e$0he incidence of ma.or malformations in women with diabetes is - to ,$'t is belieed that the& are a conse3uence of poorl& controlled diabetes inthe preconception and earl& pregnanc& period$8l&cos&lated hemoglobin (2gb Ac) leel greater than ,$ has a 5- ris1 offetal malformations$0he most common single organ s&stem anomalies are cardiac (*)%musculos1eletal (-)% and central nerous s&stem (,)$9acral agenesis is a rare malformation seen commonl& in seerel& diabeticwomen

$ 0he answer is e$Maternal infection with iruses and bacteria during pregnanc& can cause anarra& of fetal effects from none to congenital malformations and death$Maternal infection with aricella#6oster during the first half of pregnanc&can cause malformations such as cutaneous and bon& defects% chorioretinitis%cerebral cortical atroph&% and h&dronephrosis$


12/19

Adults with aricella infection fare much worse than children about , willdeelop a pneumonitis% and some of these will re3uire entilator& support$

>$ 0he answer is b$:ubella is one of the most teratogenic agents 1nown$Fetal manifestations of infection correlate with time of maternal infectionand fetal organ deelopment$'f infection occurs in the first 5 wee1s% , of fetuses manifest congenitalrubella s&ndrome% while onl& 5- if occurs at the end of the second trimester$Congenital rubella s&ndrome includes one or more of the following"e&e lesions% cardiac disease% sensorineural deafness% C@9 defects% growthrestriction% thromboc&topenia% anemia% lier d&sfunction% interstitialpneumonitis% and osseous changes$:ubeola (measles) irus does not appear to hae an& teratogenic effect on the

fetus$ 0he answer is aC&tomegaloirus in the mother is usuall& as&mptomatic% but - of adults willhae a mononucleosis#li1e s&ndrome$Maternal immunit& does not preent recurrence or congenital infection$Congenital infection includes low birth weight% microcephal&% intracranialcalcifications% chorioretinitis% mental and motor retardation% sensorineuraldeficits% hepatosplenomegal&% .aundice% anemia% and thromboc&topenic purpura$

0he irus is shed in the secretions of affected indiiduals$

$ 0he answer is e$0$ gondii is transmitted b& eating infected raw or undercoo1ed meat andcontact with infected cat feces$Maternal immunit& appears to protect against fetal infectionAcute infection in the mother is often subclinical% but s&mptoms can includefatigue% l&mphadenopath&% and m&algias$Fetal infection is more common when disease is ac3uired later in pregnanc&

(, in third trimester s , in first trimester)$Congenital disease consists of low birth weight% hepatosplenomegal&% .aundice%anemia% neurological disease with sei6ures% intracranial calcifications% andmental retardation$'nfluen6a does not cause an& fetal effects$


13/19

,$ 0he answer is d$'n the past% s&philis accounted for about one#third of all stillbirths$0ransplacental infection can occur with an& stage of s&philis% but the highestincidence of congenital infection occurs in women with primar& or secondar&disease$0he fetal and neonatal effects include hepatosplenomegal&% edema% ascites%h&drops% petechiae or purpuric s1in lesions% osteochondritis% l&mphadenopath&%rhinitis% pneumonia% m&ocarditis% and nephrosis$0he placenta is enlarged% sometimes weighing as much as the fetus$While paroirus can cause stillbirth and fetal h&drops% it is not associatedwith s1in lesions or placental h&pertroph&$

$ 0he answer is b$0ransplacental transfer of hepatitis B from the mother to fetus occurs with

acute hepatitis% not chronic seropositiit&$Acute infection in first trimester infects , of fetuses% and in thirdtrimester , to , are affected$Perinatal transmission occurs b& ingestion of infected material duringdelier& or e/posure subse3uent to birth in mothers who are chronic carriers$9ome infected infants ma& be as&mptomatic% and others deelop fulminanthepatic disease$Administration of hepatitis B immune globulin after birth% followed b& theaccine% can preent disease in infants born to mothers who are chronic

carriers$5$ 0he answer is d$Paroirus is trophic for er&throid cells and can cause fetal anemia$Maternal infection can lead to fetal h&drops% abortion% or stillbirth$'n susceptible adults 5, to *, will ac3uire disease during school outbrea1s$'f a pregnant woman has diagnosis confirmed with 'gM antibodies% ultrasound isdone for fetal sureillance$'f h&drops is diagnosed% fetal transfusion can be offered$

4ne#third of fetuses will hae spontaneous resolution of h&drops% and - offetuses who receie transfusion will surie

*$ 0he answer is d$@eonatal herpes infection has three forms"#disseminated with inolement of ma.or organslocali6ed% with inolement confined to the C@9


14/19

and as&mptomatic$A -, ris1 of neonatal infection occurs with primar& maternal infection% butonl& + to - ris1 with recurrent outbrea1s$Postnatal infectionoccur through contact with oral and s1in lesions$@eonatal infection presentation is nonspecific% with signs and s&mptoms suchas irritabilit&% letharg&% feer% and poor feeding$ess than -, of infants do not hae s1in lesions$

+$ 0he answer is b$!arlonset group B streptococcus disease occurs within wee1 of birth$$$$9igns of the disease include respirator& distress% apnea% and shoc1$ate#onset disease usuall& occurs after > da&s and manifests as meningitis$isteriosis during pregnanc& can be as&mptomatic or cause a febrile illness

that is confused with influen6a% p&elonephritis% or meningitis$$ monoc&togenes% the causatie bacteria is usuall& ac3uired through food#borne transmission from manure#contaminated cabbage% pasteuri6ed mil1% andcheeses$Fetal infection is characteri6ed b& granulomatous lesions with microabscesses$!arl& onset neonatal sepsis is a common manifestation of listeriosis duringpregnanc&% and late onset listeriosis occurs after * to + wee1s as meningitis%which is similar to group B streptococci$ 2oweer% listeriosis infection ismuch less common$


15/19

Eou should 3uestion the patient if she has abused which of the followingsubstances during her pregnanc&?a$ Alcoholb$ Ben6odia6epinesc$ 2eroind$ Methadone+$ Eour 5-#&ear#old patient is pregnant at * wee1s gestation$ 9he has anacute urinar& tract infection (=0')$ Which of the following medications iscontraindicated in the treatment of the =0' in this patient?a$ Ampicillinb$ @itrofurantoinc$ 0rimethoprim;sulfametho/a6oled$ Cephale/ine$ Amo/icillin;claulanate-$ Eou diagnose a 5#&ear#old woman at 5 wee1s gestation with gonorrheacericitis$ Which of the following is the most appropriate treatment for herinfection?

a$ Do/&c&clineb$ Chloramphenicolc$ 0etrac&clined$ Minoc&clinee$ Ceftria/one$ During a routine return 4B isit% an #&ear#old 8P, patient at 5* wee1sgestational age undergoes a urinal&sis$ 0he dipstic1 done b& the nurseindicates the presence of trace glucosuria$ All other parameters of the urinetest are normal$ Which of the following is the most li1el& etiolog& of theincreased sugar detected in the urine?a$ 0he patient has diabetes$b$ 0he patient has a urine infection$

c$ 0he patients urinal&sis is consistent with normal pregnanc&$d$ 0he patients urine sample is contaminated$

e$ 0he patient has 1idne& disease$>$Which of the following is the most common form of contraception used b&reproductie#age women in the =nited 9tates?a$ Pillsb$ Condomc$ Diaphragmd$ 'ntrauterine deice ('=D)e$ Permanent sterili6ation$which of the following neoplasms has been associated with the use of oralcontracepties?

a$ Breast cancerb$ 4arian cancerc$ !ndometrial cancerd$ 2epatic cancere$ 2epatic adenoma$Which of the following is the best e/planation for the mechanism of theaction of the intrauterine deice ('=D)?


16/19

a$ 2&perperistalsis of the fallopian tubes accelerates ooc&te transport andpreentsfertili6ation$b$ A subacute or chronic bacterial endometritis interferes with implantation$c$ Premature endometrial sloughing associated with menorrhagia causes earl&abortion$d$ A sterile inflammator& response of the endometrium preents implantation$e$ Cerical mucus is rendered impenetrable to migrating sperm$,$Which of the following is the ma.or cause of unplanned pregnancies in womenusing oral contracepties?a$ Brea1through oulation at midc&cleb$ 2igh fre3uenc& of intercoursec$ 'ncorrect use of oral contraceptiesd$ 8astrointestinal malabsorptione$ Deelopment of antibodies$ An intrauterine pregnanc& of appro/imatel& , wee1s gestation is confirmedin a *,#&ear#old 8-P+ woman with an '=D in place$ 0he patient e/presses astrong desire for the pregnanc& to be continued$ 4n e/amination% the string of

the '=D is noted to be protruding from the cerical os$Which of the following is the most appropriate course of action?a$ eae the '=D in place without an& other treatment$b$ eae the '=D in place and continue proph&lactic antibiotics throughoutpregnanc&$c$ :emoe the '=D immediatel&$d$ 0erminate the pregnanc& because of the high ris1 of infection$e$ Perform a laparoscop& to rule out a heterotopic ectopic pregnanc&$

$ 0he answer is e$'n the case of hepatitis A and B% rabies% tetanus% and aricella% patients ma&

be treated with immunoglobulin $'nactiated bacterial accines can be used for cholera% plague% and t&phoid%as appropriate$7accines for measles and mumps are generall& considered to be contraindicated%as these are lie iruses

5$ 0he answer is d$'nactiated or formalin#1illed accines such as those for influen6a% t&phoidfeer% tetanus% pertussis% diphtheria to/oid% rabies% poliom&elitis% cholera%plague% and :oc1& Mountain spotted feer are probabl& not ha6ardous for eitherthe mother or the fetus$Among the lie iral accines% such as those for measles% mumps% andpoliom&elitis% onl& the rubella accine theoreticall& ma& retain its

teratogenic properties$ 0here is a - to , ris1 of fetal infection when theaccine is administered during the first trimester$ 2oweer% no cases ofcongenital rubella s&ndrome hae been reported in this group of patients$4f the commonl& administered attenuated lie iral accines% onl& the polioirus has the abilit& to spread from a accine to susceptible persons in theimmediate enironment$ 0herefore% the ris1 of infection for the pregnantmother who has been e/posed to children who hae recentl& been accinated formeasles% mumps% and rubella is probabl& minimal$


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*$ 0he answer is a$Chronic alcohol abuse% which can cause lier disease% folate deficienc&% andman& other disorders in a pregnant woman% also can lead to the deelopment ofcongenital abnormalities in the child$!th&l alcohol is one of the most potent teratogens 1nown$0he chief abnormalities associated with the fetal alcohol s&ndrome are cardiacanomalies and .oint defects$Chronic abuse of alcohol ma& also be associated with an increased incidence ofmental retardation in the children of affected women$2eroin% ben6odia6epines% and methadone are not ma.or teratogens$

+ and -$ 0he answers are +#c% -#e$0etrac&cline ma& cause fetal dental anomalies and inhibition of bone growth ifadministered during the second and third trimesters% and it is a potentialteratogen

to first#trimester fetuses$Administration of tetrac&clines can also cause seere hepatic decompensationin the mother% especiall& during the third trimester$Chloramphenicol ma& cause the gra& bab& s&ndrome (s&mptoms of which includeomiting% impaired respiration% h&pothermia% and% finall&% cardioascularcollapse) in neonates who hae receied large doses of the drug$@o notable aderse effects hae been associated with the use of penicillins orcephalosporins$0rimethoprim#sulfametho/a6

ole (Bactrim) should not be used in the third trimester because sulfa drugscan cause 1ernicterus$

$ 0he answer is c$0he finding of glucosuria is common during pregnanc& and usuall& is notindicatie of an& patholog&$During pregnanc&% there is an increase in the glomerular filtration rate and adecrease in tubular reabsorption of filtered glucose$ 'n fact% one of si/women will spill glucose in the urine during pregnanc&$'f the patient has ris1 factors for diabetes% such as obesit&% preious

macrosomicbab&% adanced maternal age% or famil& histor& of diabetes% the ph&sicianma& want to screen for diabetes with a glucose tolerance test$'f the patient has a urinar& tract infection% the dipstic1 will also show anincrease inWBCs and blood$A contaminated urine sample would not be a cause of isolated glucosuria$


18/19

>$ 0he answer is e$contraceptie methods used b& reproductie#age women in the =nited 9tates%*+$ used permanent sterili6ation (tubal ligation b& an& method forthemseles or asectom& for their partners)$4ral contraception was used b& 5% and barrier methods of contraception wereused b& >$- of women sure&ed$

$ 0he answer is e$the progestational component of combination pills (or progestin#onl&minipills) ma& confer a protectie effect against carcinoma of the breast andendometrium% and aoiding oulation ma& decrease the ris1 of deelopingoarian carcinoma$ A slightl&higher ris1 of cerical carcinoma was obsered in some studies of users oforal

contracepties$Although the ris1 of deeloping benign lier adenomas is increasedsomewhat inusers of oral contracepties% the ris1 of hepatic carcinoma is not increased$

$ 0he answer is d$'t is currentl& belieed that alteration in the cellular and biochemicalcomponents of the endometrium occurs with the '=D% culminating in thedeelopment of a sterile inflammator& reaction$Pol&morphonuclear leu1oc&tes% giant cells% plasma cells% and macrophages areseen in the endometrium after placement$@o effects on the fallopian tubes or s&stemic hormone leels hae beenidentified% nor is a bacterial endometritis produced$

,$ 0he answer is c$0he pregnanc& rate with birth control pills% based on theoreticaleffectieness is ,$$ 2oweer% the pregnanc& rate in actual use is ,$>$ 0hisincrease is owing to incorrect use of the pills$Brea1through oulation on combination birth control pills% when the pills areta1en correctl&% is thought to be a er& rare occurrence$=nintended pregnanc& in women correctl& using oral contraceptie pills is notrelated to se/ual fre3uenc&% gastrointestinal disturbances% or the deelopmentof antibodies$

$ 0he answer is c$Although there is an increased ris1 of spontaneous abortion% and a small ris1of infection% an intrauterine pregnanc& can occur and continue successfull& toterm with an '=D in place$ 2oweer% if the patient wishes to 1eep thepregnanc& and if thestring is isible% the '=D should be remoed in an attempt to reduce the ris1of infection% abortion% or both


19/19

A:A C:4F0

abourAbruption of placenta:upture ( ectopic G uterus)Abortion

Cholestasis:ectus sheath heamatoma4arian tumourFibroid0orsion of uterus

warminig signs of C4Cs

AC2!9

Abdominal painChest pain2eadache seer!&e (blurred isio)9harp leg pain

P'D complications "#

' FAC! P'D

'nfertilit&

Fit6 2ugh CurtisAbscesseschronic pelic pain!ctopic preg

pertonitisintestinal obstDisseminated"# sepsis % endocarditis% artitis %meningitis

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Clinical Mangement.doc