Explanation:

Vasa previa is an obstetric complication defined as “fetal vessels crossing or running in close proximity to the inner cervical os. These vessels course within the membranes (unsupported by the umbilical cord or placental tissue) and are at risk of rupture when the supporting membranes rupture.
Vasa previa is present when fetal vessels traverse the fetal membranes over the internal cervical os. These vessels may be torn at the time of labor, delivery or when the membranes rupture. It has a high fetal mortality because of the bleeding that follows.
The classic triad is membrane rupture followed immediately by painless vaginal bleeding and fetal bradycardia.
The diagnosis is usually confirmed after delivery on examination of the placenta and fetal membranes. Treatment immediately with an emergency cesarean delivery is usually indicated.

Explanation:

Deep venous thrombosis (DVT) is clotting of blood in a deep vein of an extremity (usually calf or thigh) or the pelvis. DVT is the primary cause of pulmonary embolism. DVT results from conditions that impair venous return, lead to endothelial injury or dysfunction, or cause hypercoagulability. DVT may be asymptomatic or cause pain and swelling in an extremity.
Diagnosis is by history, physical examination, and duplex ultrasonography, with d-dimer or other testing ax necessary. Treatment is with anticoagulants. In pregnancy, heparin is safe to give.

Explanation:

Premature rupture of membranes (PROM) may occur at term or earlier (called preterm PROM). Preterm PROM predisposes to preterm delivery. PROM at any time increases risk of infection in the woman (chorioamnionitis), neonate (sepsis), or both; prolapse of the cord; and fetal complications, such as abnormal joint positioning and pulmonary hypoplasia, which may occur with PROM at < 24 weeks. Group B streptococci are the most common cause of infection. Unless complications occur, the only symptom is leakage or a sudden gush of fluid from the vagina. Fever, heavy vaginal discharge, abdominal pain, and fetal tachycardia, particularly if out of proportion to maternal temperature, strongly suggest infection. Sterile speculum examination is done to verify PROM, estimate cervical dilation, collect amniotic fluid for culture and fetal maturity tests, and- obtain cervical cultures. Digital pelvic examination, particularly multiple examinations, increases risk of infection and is best avoided. Diagnosis is assumed if amniotic fluid appears to be escaping from the cervix or if the fetal vernix or meconium is visible. Other less accurate indicators include vaginal fluid that ferns when dried on a glass slide or turns Nitrazine paper blue (indicating alkalinity, and hence amniotic fluid, is acidic)

Explanation:

Endometriosis is a noncancerous disorder in which functioning endometrial tissue is implanted outside the uterine cavity. Symptoms depend on location of the implants and may include dysmenorrhea, dyspareunia, infertility, dysuria, and pain during defecation. Diagnosis is by biopsy, usually via laparoscopy.
Diagnostic laparoscopy is a surgical procedure used to evaluate intra- abdominal or pelvic pathology (eg, tumor, endometriosis) in patients with acute or chronic abdominal pain and operability in patients with cancer. It is also used for lymphoma staging and liver biopsy.

Explanation:

Explanation:

Uterine rupture is a concern in women who have had prior cesarean deliveries, and the risk of rupture does rise with the number of previous cesarean deliveries. It is of particular concern if the woman is in labor. A bloody show would not be this dramatic. Placenta previa is implantation of the placenta over or near the internal os of the cervix. Typically, bright red painless vaginal bleeding occurs during late pregnancy.

Explanation:

Disseminated intravascular coagulation (DIC) begins with excessive clotting. The excessive clotting is usually stimulated by a substance that enters the blood as part of a disease (such as an infection or certain cancers) or as a complication of childbirth, retention of a dead fetus, or surgery. As the clotting factors and platelets are depleted, excessive bleeding occurs.
DIC may appear to develop suddenly and usually causes bleeding, which may be very severe. If the condition follows surgery or childbirth, bleeding may be uncontrollable. Bleeding may occur at the site of an intravenous injection or in the brain, digestive tract, skin, muscles, or cavities of the body. If DIC develops more slowly, as in people with cancer, then clots in veins are more common than bleeding.
Blood tests may show that the number of platelets in a blood sample has dropped and that the blood is taking a long time to clot. The diagnosis of DIC is confirmed if test results show diminished amounts of clotting factors and large quantities of proteins that are produced when clots are broken up by the body (fibrin degradation products).

Explanation:

Criteria for methotrexate therapy include hemodynamic stability, confirmation of ectopic pregnancy by ultrasound examination, significant risk associated with general anesthesia, patient compliance, lack of contraindications to methotrexate therapy, small size of ectopic mass (an ectopic mass is less than 3.5 cm in greatest dimension) and lack of fetal cardiac motion.

Explanation:

The causes of galactorrhea are multiple, including intraductal papillomatosis, mammary duct ectasia, empty sella syndrome, hyperprolactinemia, hypothyroidism, and illicit drug ingestion. However, bilateral galactorrhea, or milk production, can be physiologic for up to 2 years after breastfeeding an infant. It is also more likely if there continues to be breast stimulation, such as this woman´s daily expression of milk.

Explanation:

With maternal alpha-fetoprotein elevated levels suggest neural tube defects such as (open spina bifida, meningomyelocele, anencephaly) increased risk of pregnancy complications (eg, intrauterine growth restriction, abruptio placentae), or, occasionally, twins or other- multifetal pregnancy. Closed spina bifida is usually not detected. A meningomyelocele is a defect that is large enough to allow meninges and a portion of spinal cord to protrude through the defect. Such defects can be suggested by an elevated maternal serum alpha-fetoprotein.

Explanation:

Infertility is the inability of a couple to achieve a pregnancy after repeated intercourse without contraception for l year.
Infertility affects about one of five couples in the Canada. It is becoming increasingly common because people are waiting longer to marry and to-have a child. Nevertheless, up to 60% of the couples who have not conceived after a year of trying to conceive eventually, with or without treatment. The goal of treatment is to reduce the time needed to conceive or to provide couples who right not otherwise conceive the opportunity to do so. Before treatment is begun, counseling that provides information about the treatment process (including its .duration) and the chances of success is beneficial.
The cause of infertility may be due to problems in the man, the woman, or both. Problems with sperm, ovulation, or the fallopian tubes each account for almost one third of infertility cases. In a small percentage of cases, infertility is caused by problems with mucus in the cervix or by unidentified factors. Thus, the diagnosis of infertility problems requires a thorough assessment of both partners.

Explanation:

The scenario described represents a case of shoulder dystocia. This complication cannot be reliably predicted prior to delivery, and all physicians performing deliveries must be familiar with its presentation and management. Overly vigorous traction of the infant´s head or neck in this situation may cause serious damage to the infant. Having an assistant apply moderate suprapubic pressure with gentle downward traction of the fetal head is permissible. If this does not result in delivery of the shoulders, the McRoberts maneuver has been universally recognized as a safe and effective procedure for allowing the infant´s anterior shoulder to be freed. Other maneuvers that are more invasive and carry higher risks should be used only if the above maneuvers are ineffective. Applying fundal pressure without other maneuvers has been shown to cause a 77% complication rate and should be avoided.

Explanation:

Ovarian cancer is often fatal because it is usually advanced when diagnosed. Symptoms are usually absent in early stage and nonspecific in advanced stage. Evaluation usually includes ultrasonography, CT or MRI, and measurement of tumor markers (eg, cancer antigen 125).
Diagnosis is by histologic analysis. Staging is surgical.
Treatment requires hysterectomy, bilateral salpingo-oophorectomy, excision of as much involved tissue as possible, and, unless cancer is localized, chemotherapy.

Explanation:

Explanation:

Oral contraceptive pills are widely used and are generally safe and effective for many women. The choice of pill formulation is influenced by clinical considerations. By choosing appropriately from the available pill formulations, physicians can minimize negative side effects and maximize noncontraceptive benefits for their patients. Additional monitoring and follow-up are necessary in special populations, such as women over 35 years of age, smokers, perimenopausal women and adolescents. Third-generation progestins are additional options for achieving noncontraceptive benefits, but their use has raised new questions about thrombogenesis. Whereas only one of 1,000 women who take oral contraceptive pills “perfectly” becomes pregnant within a year, 50 of 1,000 women who take the pills “typically” become pregnant within one year.

Explanation:

Explanation:

Newborns who are exposed to hepatitis B have more than a 90% chance of becoming chronically infected. This means the virus stays in their blood and liver for possibly a lifetime. They can pass the virus on to others. They will also live with a greater chance of developing liver failure or liver cancer later in life.
It is most important that the newborn receive the first dose of the hepatitis B vaccine in the delivery room. If possible, also give the hepatitis B immune globulin (HBIG), which is another medication that helps the vaccine to work even more successfully.

Explanation:

Explanation:

Infants born to intravenous drug addicts may be addicted to the drug themselves and may go through withdrawal if not properly managed. Cardiac valvular lesions are not associated with maternal drug abuse. Babies born to these mothers tend to have low birth weights. Kernicterus and renal anomalies also are not associated with maternal drug abuse.

Explanation:

The fallopian tube is the site of approximately 95% of all ectopic pregnancies. A pregnancy in the uterus is normal, not ectopic. The other sites are much less common for an ectopic pregnancy.

Explanation:

Although this patient is presenting with classic signs of preeclampsia (high blood pressure and proteinuria), one of the major diagnostic criteria for preeclampsia is onset after 20 weeks of gestation. Onset of this condition before the 20th week of pregnancy is suggestive of a hydatidiform mole, a form of gestational trophoblastic disease characterized by: excessive uterine enlargement (“size greater than dates”); vaginal bleeding; passage of edematous, soft, grapelike tissue; and significantly elevated beta-human chorionic gonadotropin (beta-hCG). The diagnosis is strongly suggested by ultrasound, but definitive diagnosis requires histopathologic examination. Anencephaly may cause polyhydramnios that can be associated with the onset of preeclampsia, but not until the sixth month of pregnancy. Maternal renal disease should not particularly be exacerbated at this stage of the pregnancy. Neural tube defect may also lead to polyhydramnios and cause preeclampsia. Twin gestation will increase the risk of preeclampsia but not until the sixth month of pregnancy.

Explanation:

Mitral valve prolapse affects approximately 5% of women of childbearing age. Consequently, the issue of mitral valve prolapse and the need for antibiotics comes up quite often in obstetrics, particularly with delivery (either vaginal delivery or cesarean delivery). Bacterial endocarditis is a life-threatening infection that can develop in patients with structural cardiac disease who are exposed to bacteremia.

The risk for any given procedure depends upon the nature of the procedure itself and on the nature of the cardiac lesion. Periodically, the American Heart Association publishes guidelines for the prevention of bacterial endocarditis. According to the American Heart Association guidelines, antibiotic prophylaxis is not necessary for cesarean delivery or normal vaginal delivery. The possible exception to this is for patients with “high risk” cardiac conditions, which includes women with a history of endocarditis or who have prosthetic heart valves, complex cyanotic congenital heart disease, or surgically corrected systemic pulmonary shunts. Mitral valve prolapse, if associated with mitral regurgitation (demonstrated by Doppler or a murmur), is considered a moderate risk condition and, therefore, antibiotic prophylaxis is not necessary. This patient, therefore, does not require antibiotics prior to, during, or after her cesarean delivery. To administer intravenous antibiotics 30 minutes prior to the procedure (choice A), immediately after the procedure (choice B), 24 hours after the procedure (choice C), or to administer oral antibiotics 6 hours after the procedure (choice D) would all be unnecessary. As explained above, the reason for administering antibiotics to women with structural cardiac disease is to prevent bacterial endocarditis. Bacterial endocarditis is a potentially fatal condition.

However, there are different degrees of structural cardiac disease. Mitral valve prolapse with regurgitation is considered to be a moderate risk condition. The American Heart Association does not recommend endocarditis prophylaxis for women with moderate risk conditions undergoing vaginal or cesarean delivery.

Explanation:

Hypothyroidism is associated with several complications regarding fertility and pregnancy. Women with overt hypothyroidism have increased rates of infertility. Women with uncorrected hypothyroidism that do become pregnant are at increased risk of having stillborn and low-birth-weight infants.

Various studies have also shown that rates of preeclampsia, placental abruption, and heart failure may be increased in pregnant patients with hypothyroidism. Pregnancy often leads to an increased requirement for thyroid hormone replacement (thyroxine) as the pregnancy progresses. Pregnant women with hypothyroidism on thyroxine should have their thyroid stimulating hormone (TSH) level checked periodically to determine if the drug dosage is adequate. This patient, with her history of hypothyroidism, should continue her thyroxine during the pregnancy.

Coumadin (choice A) is contraindicated during pregnancy, as it is a known cause of birth defects. This patient needs anticoagulation, however, and should be placed on heparin, which does not cross the placenta. It is possible to become pregnant while taking the oral contraceptive pill (choice B), as the pill has a small rate of failure. There is no known association between first trimester exposure and birth defects. Now that the patient has become pregnant, however, she should stop taking the OCP. Tetracycline (choice C) is used to treat some forms of acne and, therefore, some women will become pregnant while on the medication. Its use is contraindicated during pregnancy, however, because it is associated with fetal teeth and bone malformations. To state that the patient should discontinue all medications (choice E) is absolutely incorrect. While some medications are contraindicated during pregnancy, many are necessary and should be continued.

Explanation:

This answer is C. Caesarean section under gas induction is an option for category I Caesarean sections. Obese pregnant women should ideally receive antenatal anesthetic input.

Explanation:

Explanation:

This answer is A. Inpatient care is needed for patients with pneumonia. Option E helps decrease transmission of HIV to neonate. HAART therapy is not for pneumonia.

Explanation:

This answer is A. Appendicitis commonly presents in the early second trimester in young mothers. The classical signs might be absent in pregnancy. Abruption will produce anemia + vaginal bleeding. The scenario does not give any history of fibroids or any abdominal mass which negates the option of Red degeneration.

Explanation:

This answer is A. Nifedipine is associated with such side-effects. Labetalol and Methyldopa does not give these effects. Oxytocin is not a tocolytic.

Explanation:

This answer is A. Auditory hallucinations, thought withdrawal, insertion and interruption thought broadcasting, delusional perception and feelings or actions experienced as made or influenced by external agents are considered as first-rank symptoms of schizophrenia. Post-traumatic stress disorder presents as difficulties sleeping, is overactive and expresses feelings of excitement. Depression presents with symptoms of confusion, restless and expressing thoughts of self-harm.

Explanation:

This answer is C. Percentage of breech presentations overall is 3-4 %.

Explanation:

Smoking reduces birth weight which may be of critical importance if the baby is born pre-term.
On average, the babies of smokers weigh 170g less than non-smokers, but the reduction in birth weight is related to the number of cigarettes smoked per day.
Smoking is also associated with an increased risk of miscarriage and still birth. The infant has a greater risk of sudden infant death syndrome.
There is some evidence that maternal smoking may adversely affect ovarian function in female children.
No dysmorphic syndrome has yet been described.

Explanation:

Entonox is a gaseous mixture of nitrous oxide and oxygen and has been has been used since the 1960´s. It is twice as effective as pethidine at providing labour analgesia, but inhalation should begin as soon as the uterine contraction is felt, became it takes forty five seconds before the maximum analgesic effect is achieved.
Low dose isoflurane and sevoflurane have been given in addition to entonox which has demonstrated an increased analgesic efficacy over entonox alone. Combining the analgesic effects of entonox with other analgesics agents provides superior analgesia to using entonox alone.

Explanation:

Cocaine abuse: causes IUGR through uterine vessel vasoconstriction, resulting in decreased uterine blood flow, fetal hypoxia and increased fetal blood pressure. Fetal vasospasm can also occur and mat cause digit loss or cerebral infarction. There is an increased incidence of early pregnancy loss, plus placenta abruption and preterm labour. Unlike opiates, cocaine is not usually associated with neonatal withdrawal.

Explanation:

Pre-implantation genetic screening is increasingly used in embryos produced by IVF prior to implantation. There are many criteria employed but in particular it is used for the detection of X-linked disorders, single gene defects or chromosomal abnormalities. Primarily it is used in women above 35 years of age, when semen has been obtained using ICSI arm when there are particular genetic disorders.

Explanation:

Explanation:

The usual recommendation is to treat postpartum endometritis with clindamycin and gentamicin. This combination covers anaerobes, group B. Streptococcus, and gram-negative organism. Extended-spectrum cephalosporins or imipenem-cilastatin or ampicillin-sulbactam are frequently used; however, the clindamycin / gentamicin regimen remains the gold standard when endometriosis is suspected.

Explanation:

The classical clinical presentation of placenta previa is painless, bright red vaginal bleeding. This diagnosis must be considered in all patients beyond 24 weeks gestation who present with bleeding. Threatened abortion is unlikely at this stage of pregnancy and hemorrhagic cystitis is not accompanied by brisk bleeding. Abruption of the placenta is the most common cause of intrapartum fetal death but is associated not only with brisk vaginal bleeding, but also with uterine tenderness that may be marked. Clinical signs of chorioamnionitis include purulent vaginal discharge, fever, tachycardia, and uterine tenderness.

Explanation:

The following table explains the different types of abortions that may occur during a pregnancy:

The above patient most likely has had a complete abortion.

Explanation:

Uterine fibroids are benign uterine tumors of smooth muscle origin. Fibroids-frequently cause abnormal vaginal bleeding (eg, menorrhagia, menometrorrhagia), pelvic pain and pressure, urinary and intestinal symptoms, and pregnancy complications. Diagnosis is by pelvic examination and imaging. Treatment of symptomatic patients depends on the patient´s desire for fertility and desire to keep her uterus and may include oral contraceptives, brief presurgical gonadotropin releasing hormone therapy to shrink fibroids, and more definitive surgical procedures (eg, myomectomy, hysterectomy, endometrial ablation).
Some pregnant women will have fibroids, some of which occasionally interfere with the normal progress of a pregnancy. Though fibroids tend to grow in size during pregnancy, it is unlikely that they will cause any symptoms. Some pregnant women do experience minor symptoms, particularly pelvic pain and light spotting. The majority of fibroids are of no significance and have no effect upon a woman´s fertility, her pregnancy or delivery. Some, however, impinge upon or distort the actual cavity of the uterus and may causes complications in pregnancy, as may a very large fibroid which by virtue of its size distorts the uterus and the other pelvic organs.

Explanation:

In some target tissues, the main effect of estrogen is to cause cells to grow and divide, a process called cell proliferation.
In breast tissue, for example, estrogen triggers the proliferation of cells lining the milk glands, thereby preparing the breast to produce milk if the woman should become pregnant. Estrogen also promotes proliferation of the cells that form the inner lining, or endometrium, of the uterus, thereby preparing the uterus for possible implantation of an embryo. During a normal menstrual cycle, estrogen levels fall dramatically at the end of each cycle if pregnancy does not occur. As a result, the endometrium disintegrates and is shed from the uterus and vagina in a bleeding process called menstruation.

Explanation:

trauterine growth restriction (IUGR) is a term used to describe a condition in which the fetus is smaller than expected for the number of weeks of pregnancy. Another term for IUGR is fetal growth restriction.
Newborn babies with IUGR are often described as small for gestational age (SGA). A fetus with IUGR often has an estimated fetal weight less than the 10th percentile. Maternal factors associated with IUGR are high blood pressure, chronic kidney disease, advanced diabetes, heart or respiratory disease, malnutrition, anemia, infection, substance abuse (alcohol, drugs) and cigarette smoking. Factors involving the uterus and placenta are decreased blood flow in the uterus and placenta, placental abruption (placenta detaches from the uterus), placenta previa (placenta attaches low in the uterus) and infection in the tissues around the fetus. Factors related to the developing baby (fetus) are multiple gestation (twins, triplets, etc.), infection, birth defects and chromosomal abnormality.

Explanation:

The antibiotics recommended for UTI in pregnant woman are nitrofurantoin and cephalosporins. These antibiotics are very effective in the treatment of pregnant woman against urinary tract infection.
Pregnant woman with recurrent urinary tract infection can also be treated with the antibiotic nitrofurantoin. Normally nitrofurantoin and cephalexin are very effective in the treatment of urinary tract infection in pregnant woman.
Certain antibiotics such as tetracycline, doxycycline and bactrim are not safe to give during a pregnancy because of their teratogenic side effects.

Explanation:

The maternal surface of the placenta should be inspected to be certain that all cotyledons are present. Then the fetal membranes should be inspected past the edges of the placenta. Large vessels beyond these edges indicate the possibility that an entire placental lobe (e.g., succenturiate or accessory lobe) may have been retained. This can be detected by inspection of the fetal side of the placenta.

Explanation:

A general rule of thumb is that it takes about 3 months after delivery or after discontinuance of breast feeding for menses to get back to their normal pattern. That pattern can be different after a delivery. Restoration of normal menses can be interfered with by injectable contraceptives stress/depression or sometimes even sleep deprivation with a new baby.

Explanation:

Routine ultrasonography at around 18-22 weeks gestation has become the standard of care in many communities. Acceptance is based on many, factors, including patient preference, medical-legal pressure, and the ´perceived benefit by physicians. However, rigorous testing has found little scientific benefit for, or harm from, routine screening ultrasonography

Explanation:

Hyperbilirubinemia can occur in up to 60% of term newborns during the first week of life. Early guidelines on management of elevated bilirubin were based on studies of bilirubin toxicity in infants who had hemolytic disease. Current recommendations now support the use of less intensive therapy in term newborns with jaundice who are otherwise healthy. Phototherapy should be initiated when the bilirubin level is above 15 mg/dL for infants at age 29-48 hours old, at 18 mg/dL for infants 49-72, and at 20 mg/dL in infants older than 72 hours. Generally, this problem is not considered pathologic unless it presents during the first hours after birth and the total serum bilirubin rises by more than 5mg dL/day or is higher than 17 mg/dL, or if the infant has signs or symptoms suggestive of a serious underlying illness such as sepsis. Fortunately, very few term newborns with jaundice have serious underlying pathology.
Physiologic jaundice follows a pattern, with the bilirubin level peaking on the third or fourth day of life and then declining over the first week after birth. Infants with multiple risk factors may develop an exaggerated form of physiologic jaundice, with the total bilirubin level rising as high as 17 mg/dL. Breastfed infants are at an increased risk for exaggerated physiologic jaundice because of relative caloric, deprivation in the first few days of life. Compared with formula-fed infants, those who are breastfed are six times more likely to experience moderate jaundice, with the bilirubin rising above 12 mg/dL. For breastfed newborns who have an early onset of hyperbilirubinemia, the frequency of feeding should be increased to more than 10 times per day. If the newborn has a decrease in weight gain, delayed stooling, and continued poor intake, then formula supplementation may be necessary. Breastfeeding should be continued to maintain breast milk production. Supplemental water or dextrose and water should not be given, as thin can decrease breast milk production and may place the infant at risk for iatrogenic hyponatremia.

Explanation:

The patient´s wishes and comfort come first, and override the directive from the attending physician. The student, as a doctor in training should be an advocate for the patient, and respect the patient´s wishes regarding to whom she feels comfortable giving personal information. Remember, the patient is number one, and the patient´s wishes should be of primary concern. Going behind the back of the attending physician (choice A) is deceitful and unprofessional. The student should have the courage of her convictions and maintain what she feels is right even to someone above her in the medical hierarchy.
The aim here is not to convince the patient, but to show respect for the patient´s wishes. Trying to shame, coerce, or bully the professor into acquiescence (choice B) is clearly inappropriate. The student must exercise her own professional judgment and make these decisions on her own. Bringing in the Dean´s Office (choice C) takes time and escalates the situation. The attending physician may well be embarrassed and resentful of the intrusion. If the student feels the attending instructions are wrong she must say so directly and stand her ground. Choice E directly contradicts the patient´s stated wishes, and so is wrong. The patient´s concern was not about confidentiality (choice F) but about allowing someone whom she had taught as a student to deal with her in the role of the physician. Her wishes and her own personal comfort should be respected. If you don´t think it is right then don´t do it. Doing the behavior under protest (choice C) may make the student feel nobler but still violates the patient´s wishes.

Explanation:

The correct; answer is B. The lesion is a neural tube defect, probably a meningomyelocele, in which both meninges and spinal cord herniate through a bony vertebral detect. These detects most commonly occur in the lumbosacral region, typically resulting in motor and sensory deficits in the lower extremities and dysfunction in the bowel and bladder. This condition is now known to be associated with low maternal folate during the first 3 to 4 weeks of pregnancy, a time when many women may be unaware of their pregnancy. It is now recommended that all women of childbearing age consume at least 400 µg of folic acid daily. Anticonvulsants, such as phenytoin, can impair the absorption of folate as well as increase the rate of folate metabolism. ACE inhibitors are contraindicated in pregnancy but are not involved in folate metabolism. Lithium can cross the placenta, resulting in toxicity to the fetus, but does not affect folate levels. Sulpha antimicrobials inhibit folate synthesis in bacteria. However, since humans do not synthesize folate but obtain it from their diets, this medication will not affect dietary folate. Vitamin B12 is often deficient in patients who are also folate deficient. However, supplements of vitamin B12 have no effect on folate levels.

Explanation:

Hypervitaminosis A is associated with craniofacial abnormalities, central nervous system defects, and hearing defects. Excess amounts are considered over 10,000 IU per day; sources include squash, carrots, apricots, and dark-green leafy vegetables. Folate intake of 0.4 mg per day is recommended by the CDC for pregnant women before and during pregnancy to reduce the incidence of neural tube defects in the fetus. This defect can occur during the first two weeks of pregnancy, usually before the pregnancy is recognized. Calcium intake during pregnancy has been shown to reduce the incidence of pregnancy induced hypertension and preeclampsia. Zinc is present in high levels in seafood, milk, nuts, and meat. Zinc supplementation is associated with a normal infant birth weight and development. A zinc deficient diet is associated with central nervous system malformations. Zinc deficiency is rare during pregnancy, except among women who exhibit pica, particularly in the form of geophagia. Pregnant women usually require an iron supplement to prevent anemia.

Explanation:

Maternal pulmonary hypertension is associated with a significant increase in both maternal and fetal mortality. In most patients, the other cardiac conditions are not considered contraindications to pregnancy.

Explanation:

Mitral valve prolapse affects approximately 5% of women of childbearing age. Consequently, the issue of mitral valve prolapse and the need for antibiotics comes up quite often in obstetrics, particularly with delivery (either vaginal delivery or cesarean delivery). Bacterial endocarditis is a life-threatening infection that can develop in patients with structural cardiac disease who are exposed to bacteremia.
The risk for any given procedure depends upon the nature of the procedure itself and on the nature of the cardiac lesion. Periodically, the American Heart Association publishes guidelines for the prevention of bacterial endocarditis. According to the American Heart Association guidelines, antibiotic prophylaxis is not necessary for cesarean delivery or normal vaginal delivery. The possible exception to this is for patients with “high risk” cardiac conditions, which includes women with a history of endocarditis or who have prosthetic heart valves, complex cyanotic congenital heart disease, or surgically corrected systemic pulmonary shunts. Mitral valve prolapse, if associated with mitral regurgitation (demonstrated by Doppler or a murmur), is considered a moderate risk condition and, therefore, antibiotic prophylaxis is not necessary. This patient, therefore, does not require antibiotics prior to, during, or after her cesarean delivery. To administer intravenous antibiotics 30 minutes prior to the procedure (choice A), immediately after the procedure (choice B), 24 hours after the procedure (choice C), or to administer oral antibiotics 6 hours after the procedure (choice D) would all be unnecessary. As explained above, the reason for administering antibiotics to women with structural cardiac disease is to prevent bacterial endocarditis. Bacterial endocarditis is a potentially fatal condition.
However, there are different degrees of structural cardiac disease. Mitral valve prolapse with regurgitation is considered to be a moderate risk condition. The American Heart Association does not recommend endocarditis prophylaxis for women with moderate risk conditions undergoing vaginal or cesarean delivery.

Explanation:

Women who are Rh negative are at risk for developing Rh isoimmunization. Rh isoimmunization occurs when an Rh-negative mother becomes exposed to the Rh antigen on the red blood cells of an Rh-positive fetus. This exposure may lead the mother´s immune system to become sensitized to the Rh antigen such that in a future pregnancy with an Rh-positive fetus, the mother´s immune system may “attack” the Rh antigen on the fetal red blood cells. This immune response may lead to the development of fetal anemia, hydrops, and death. To prevent Rh isoimmunization from occurring, Rh-negative women who are not Rh alloimmunized should receive RhoGAM (anti-D immune globulin) at 28 weeks´ gestation, within 72 hours after the birth of an Rh-positive infant, after a spontaneous abortion, or after invasive procedures such as amniocentesis. RhoGAM should also be strongly considered in cases of threatened abortion, antenatal bleeding, external cephalic version, or abdominal trauma. The amount that is usually given after the delivery of an Rh-positive fetus is 300 μg. This amount is sufficient to cover a fetal to maternal hemorrhage of 30 mL (or 15 mL of fetal cells). However, some women will have a fetal to maternal hemorrhage that is in excess of this 30 mL-especially in cases such as manual removal of the placenta (like this patient had) or placental abruption. To determine the amount of fetal to maternal hemorrhage that occurred, it is necessary to perform a Kleihauer-Betke test. This acid-dilution procedure allows fetal red blood cells to be identified and counted. Knowing the amount of fetal to maternal hemorrhage that took place allows the correct amount of RhoGAM to be given. A complete blood count (choice A) will demonstrate the amount of maternal hemorrhage, but not the amount of fetal to maternal hemorrhage. Liver function tests (choice C), prothrombin time (choice D), and serum potassium (choice E) do not allow for the determination of the amount of fetal to maternal hemorrhage. The scenario already mentions that she is antibody -ve for Rh antigens (choice F).

Explanation:

Pregnancy brings about numerous, normal physiologic changes in the pregnant woman. Some of the most obvious changes are those found in the cardiovascular system. For example, cardiac output rises markedly in pregnancy with increases up to 50% over nonpregnant levels.

Cardiac murmurs are common in pregnancy with as many as 90% of all pregnant women having some degree of a systolic murmur. Diastolic murmurs are different, however. The finding of a diastolic murmur in a pregnant woman must be thoroughly evaluated as this type of murmur is often related to important cardiac disease. For example, mitral stenosis, the most common rheumatic valvular lesion in pregnancy, is characterized by a rumbling diastolic murmur. Therefore, patients with diastolic murmurs should have an echocardiograph and possible referral to a cardiologist for further evaluation.

An enlarged uterus (choice B) is a normal finding in a pregnant woman. It is important to examine the uterus for size at the first prenatal visit to ensure that the size correlates to the patient´s dating by last menstrual period. If there is a discrepancy, then the patient should be sent for an ultrasound to obtain correct dating, which is essential for the management of the pregnancy. Fatigue (choice C) and nausea and vomiting (choice D) are very common findings in the first trimester of pregnancy.

While fatigue can sometimes be a symptom of structural heart disease, it is not nearly as concerning as the diastolic murmur in this patient. Nausea and vomiting is present in anywhere from 50 to 90% of all pregnant women. As noted above, a systolic murmur (choice E) is a very common finding during pregnancy. Up to 90% of all pregnant women will have such a murmur during pregnancy. As long as the murmur is systolic, no louder than III/VI and there is no other symptomatology, the murmur can be considered to be benign.

Explanation:

Down´s syndrome screening is offered to all pregnant women in the UK. She is 42 which gives you an age-related risk of one in 55 of having a child with Down`s syndrome. Early in the second trimester the combined test is offered. This includes an ultrasound scan of the fetal neck looking at the nuchal translucency (NT) and two blood tests – PAPP-A and beta hCG. This can be reliably performed from 10 to 13 weeks. Ideally, an integrated test using the combined test and the quadruple test can be used to create a Down´s risk. As she has missed the chance to have an NT, she would only be offered the quadruple test, which is unconjugated oestradiol, total hCG, AFP and inhibin A. The downside of the quadruple test is that it has a 4.4 per cent false-positive rate compared with 2.2 per cent for the combined test and only 1 per cent for the integrated test. In the event of a high risk result, this woman would be offered an amniocentesis to exclude Down´s syndrome and other chromosome abnormalities.

Explanation:

In diabetes in pregnancy the reference ranges for sugar control are slightly different. Ideally before every meal the blood sugar should be less than 5.5µmol/L and I hour after a meal less than 7.8 µmol/L. Outside of pregnancy 2-hour post meal readings are taken. So (C) is the correct answer. The appointment will involve referral to the dietician, the diabetes nurse (to learn how to test and record her blood sugars) and counseling about the risks of diabetes in pregnancy. These risks involve neonatal hypoglycaemia, pre-eclampsia, preterm labour, polyhydramnios, macrosomia and shoulder dystocia.

Explanation:

This answer is C. The likely reason for a delay in second stage is mal-position of the fetal head. Examination in theatre (not delivery room) and delivery by forceps after manual rotation or rotational forceps delivery is appropriate. Disputed position of presenting part is a contraindication to ventouse. Contractions are normal so syntocinon may not help.

Explanation:

This answer is B. Sickle cell crisis could be precipitated by dehydration and needs aggressive fluid therapy. Hence other options are not suitable.

Explanation:

This answer is H. The treatment dose of Enoxaparin needs to be commenced immediately recommended to be 1.5 mg/kg. 1 mg of heparin is equal to 100 IU. Warfarin takes time to affect so even if started in acute cases; it will not have an effect immediately. Moreover it should be cautiously used due to teratogenicity in early trimesters. Other options are not of immediate importance and are either irrelevant or meant for prevention.

Explanation:

This answer is C. Pelvic manoeuvre such as delivery of the posterior shoulder and Wood´s Cox screw manoeuvres are the next steps after McRoberts maneuver and suprapubic pressure if they fail. Zavanelli´s technique under general anesthesia could be considered in true shoulder dystocia. If McRoberts, suprapubic pressure and pelvic manoeuvre have been unsuccessful, next step is moving onto all fours. In the home set-up, repeating all the manoeuvre on all fours would be the most appropriate.

Explanation:

Explanation:

Cocaine abuse: causes IUGR through uterine vessel vasoconstriction, resulting in decreased uterine blood flow, fetal hypoxia and increased fetal blood pressure. Fetal vasospasm can also occur and mat cause digit loss or cerebral infarction. There is an increased incidence of early pregnancy loss, plus placenta abruption and preterm labour. Unlike opiates, cocaine is not usually associated with neonatal withdrawal.

Explanation:

This patient manifests a rapid onset of preeclampsia at term. The symptoms of epigastric pain and headache categorize her preeclampsia as severe. These symptoms indicate that the progress is well advanced and that convulsions are imminent. Treatment should focus on rapid control of symptoms and delivery of the infant.

Explanation:

Obstetric ultrasound done at 16 weeks can detect abnormalities such as neural tube defects (eg spina bifida, anencephaly). The sex of the baby can usually be determined by ultrasound at any time after l6 weeks, often at the dating scan around 20 weeks into the pregnancy depending upon the quality of the sonographic machine and skill of the operator. This is also the best time to have an ultrasound done as most infants are the same size at this stage of development. Trisomy 21 will be diagnosed by karyotyping. Placenta previa will be diagnosed late in pregnancy as most low-lying placentae move up with development of the lower segment.

Explanation:

The following table shows how to calculate Apgar scores:

This baby would have an APGHAR score of 2+2+0+1+2=7.

Explanation:

Explanation:

In a woman with Rh incompatibility, there is a substance in her baby red blood cells that in not in her blood cells. This substance ie called the Rho (D) factor. People who have the Rho (D) factor are Rh positive. People who do not have it are Rh negative. While pregnant or during delivering, some of the baby´s red blood cells may come in contact with the mother´s blood. The mother´s body may then make antibodies to the Rho (D) factor. This reaction is called- sensitization. The antibodies may cross the placenta and destroy the red blood cells in the baby or any Rh-positive babies you have later. This destruction of red blood cells is called hemolytic disease. Rh incompatibility happens only if you are Rh negative and your baby is Rh positive. RhoGAM contains antibodies to the Rho (D) factor. The antibodies in the shot will destroy any red blood cells from the baby that are the mother´s blood. Then the mother will not make its own antibodies to the Rho (D) factor. A shot at 28 weeks and after delivery, sensitization will be prevented and Rh incompatibility should not be a problem during the next pregnancy.
If a woman has a threatened miscarriage but does not actually miscarry, she will need a RhoGAM shot.

Explanation:

Infertility is the inability of a couple to achieve a pregnancy after repeated intercourse without contraception for l year.
Infertility affects about one of five couples in the Canada. It is becoming increasingly common because people are waiting longer to marry and to-have a child. Nevertheless, up to 60% of the couples who have not conceived after a year of trying to conceive eventually, with or without treatment. The goal of treatment is to reduce the time needed to conceive or to provide couples who right not otherwise conceive the opportunity to do so. Before treatment is begun, counseling that provides information about the treatment process (including its .duration) and the chances of success is beneficial.
The cause of infertility may be due to problems in the man, the woman, or both. Problems with sperm, ovulation, or the fallopian tubes each account for almost one third of infertility cases. In a small percentage of cases, infertility is caused by problems with mucus in the cervix or by unidentified factors. Thus, the diagnosis of infertility problems requires a thorough assessment of both partners.

Explanation:

Absolute contraindications to oral contraceptive pill (OCP) use are: Thrombophlebitis, thromboembolic disorders, cerebrovascular disorders, ischemic heart disease, coronary artery disease, known or suspected cancer of the breast, known or suspected estrogendependent cancer, known or suspected pregnancy, benign or malignant liver tumor, undiagnosed abnormal genital bleeding.

Explanation:

Absolute contraindications to oral contraceptive pill (OCP) use are: Thrombophlebitis, thromboembolic disorders, cerebrovascular disorders, ischemic heart disease, coronary artery disease, known or suspected cancer of the breast, known or suspected estrogendependent cancer, known or suspected pregnancy, benign or malignant liver tumor, undiagnosed abnormal genital bleeding.

Explanation:

Women with antiphospholipid antibodies, including lupus anticoagulant and anticardiolipin antibodies are at significant risk for adverse pregnancy outcome. In primary antiphospholipid syndrome (APS), fetal loss is reported to be between 50% and 75%. Recurrent spontaneous abortion, particularly in the second trimester, is one of the most consistent features of this syndrome. Other pregnancy-related complications include intrauterine growth retardation, placental abruption, preeclampsia, and premature delivery. Dysmenorrhea, metrorrhagia, and amenorrhea are not commonly associated with this condition. A false-positive test for syphilis does not fulfill the laboratory criteria for the diagnosis of APS, and patients with APS are not known to be at increased risk for syphilis.

Explanation:

Most infants with face presentation, mentum anterior, can be delivered vaginally, either spontaneously or with low forceps. Cesarean section is indicated for fetal distress and failure to progress. Midforceps delivery is not indicated. If fetal electrodes are attached, the chin is the preferred location.

Explanation:

A breast infection (mastitis) is rare, except around the time of childbirth after an injury or surgery. The most common symptom is a swollen, red area that feels warm and tender. An uncommon type of breast cancer called inflammatory breast cancer can produce similar symptoms. A breast infection is treated with antibiotics. Staphylococcal breast infections (mastitis) and abscesses typically develop 1 to 4 weeks after delivery. The infected area is red and painful. Breast abscesses often release large numbers of bacteria into the mother´s milk, and these milk-borne bacteria may infect the nursing infant.

Explanation:

With genital herpes, if a woman does have a lesion or prodromal symptoms at delivery, the safest practice is a cesarean delivery to prevent the baby from coming into contact with active virus. Many women find that their outbreaks tend to increase as the pregnancy progresses, probably because of the immune suppression that takes place to prevent the mother´s body from rejecting the fetus. Between 10% and 14% of women with genital herpes have an active lesion at delivery. The odds are higher for women who acquire herpes during pregnancy, and lower for women who have had herpes for more than six years.
If a woman doesn´t have herpes lesions at the time of delivery, the standard of care recommended is vaginal delivery. This does expose the baby to a very small risk of infection from possible asymptomatic shedding.

Explanation:

The risk of vertical transmission of HIV (from mother to child) has been revived a number of times since the initial clinical description of HIV and AIDS in the 1980s. As it currently stands, the consensus opinion on risk is approximately 50% in women with children that have not received perinatal therapy with AZT. The medication protocol reduces the risk to less than 25%. Because newborn children have antibody complements that are from their mothers, it is crucial to follow them over the first year of life as their own immune system develops.
Symptoms of AIDS are not related to risk of transmission of HIV. AIDS is defined as a CD4 count of less than 500 with an HIV associated disease present (such as PCP pneumonia or Kaposi sarcoma). The risk of infection instead relates to the viral burden in the bloodstream of the mother. This burden is quantified using HIV RNA copy number. The HIV RNA copy number relates to symptomatic AIDS in a complex manner but low copy number patients can be symptomatic and vice versa.

Explanation:

Hyperbilirubinemia can occur in up to 60% of term newborns during the first week of life. Early guidelines on management of elevated bilirubin were based on studies of bilirubin toxicity in infants who had hemolytic disease. Current recommendations now support the use of less intensive therapy in term newborns with jaundice who are otherwise healthy. Phototherapy should be initiated when the bilirubin level is above 15 mg/dL for infants at age 29-48 hours old, at 18 mg/dL for infants 49-72, and at 20 mg/dL in infants older than 72 hours. Generally, this problem is not considered pathologic unless it presents during the first hours after birth and the total serum bilirubin rises by more than 5mg dL/day or is higher than 17 mg/dL, or if the infant has signs or symptoms suggestive of a serious underlying illness such as sepsis. Fortunately, very few term newborns with jaundice have serious underlying pathology.
Physiologic jaundice follows a pattern, with the bilirubin level peaking on the third or fourth day of life and then declining over the first week after birth. Infants with multiple risk factors may develop an exaggerated form of physiologic jaundice, with the total bilirubin level rising as high as 17 mg/dL. Breastfed infants are at an increased risk for exaggerated physiologic jaundice because of relative caloric, deprivation in the first few days of life. Compared with formula-fed infants, those who are breastfed are six times more likely to experience moderate jaundice, with the bilirubin rising above 12 mg/dL. For breastfed newborns who have an early onset of hyperbilirubinemia, the frequency of feeding should be increased to more than 10 times per day. If the newborn has a decrease in weight gain, delayed stooling, and continued poor intake, then formula supplementation may be necessary. Breastfeeding should be continued to maintain breast milk production. Supplemental water or dextrose and water should not be given, as thin can decrease breast milk production and may place the infant at risk for iatrogenic hyponatremia.

Explanation:

Erythromycin and other macrolide antibiotics are useful for the treatment of chlamydial urethritis in pregnant women. Although tetracycline is indicated as the first line defense for chlamydial urethritis, it should be avoided during pregnancy because it localizes to enamel and bone in the fetus, causing grey staining and bone growth retardation. Grey baby syndrome is associated with chloramphenicol use.

Explanation:

This patient has classic migraine symptoms, probably induced by hormonal changes during pregnancy and her symptoms will subsequently subside over time with rest and reassurance. Toxemia of pregnancy is not present because of her normal blood pressure and urine. Therefore, magnesium sulfate is not indicated. Ergot alkaloids cause vasoconstriction and should not be given during pregnancy. Demerol should be avoided during pregnancy and sumatriptin, which is a central serotonin receptor agonist, should .be avoided as well because of risks to the fetus.

Explanation:

This case illustrates a classic presentation of ectopic pregnancy with tubular rupture and hemorrhage. The most common predisposing factor is pelvic inflammatory disease, most commonly caused by Chlamydia trachomatis or Neisseria gonorrhoeae. The fallopian tube scarring is due to a type IV hypersensitivity reaction. Chlamydia trachomatis is an intracellular organism that is non Gram staining, but can be identified by iodine or Giemsa staining. Treat with doxycycline or azithromycin. Other risk factors for ectopic pregnancy include a previous ectopic pregnancy, exposure to diethylstilbestrol (DES), and induced abortion. Escherichia does not usually cause female genital disease. Herpes, human papilloma virus, and Treponema can all infect the female genital tract, but are not important causes of pelvic inflammatory disease.

Explanation:

Prostaglandin (PGE2) gel is widely used for labor induction. In simple terms, it is used “to soften” an unfavorable cervix, to make the cervix more favorable for induction. It has been shown to lead to an improvement in the Bishop´s score, a shorter duration of labor, a need for lower maximal doses of oxytocin, and a reduced incidence of cesarean deliveries. PGE2 gel can also cause uterine contractions. One of the major side effects with PGE2 gel is uterine hyperstimulation. This occurs when uterine contractions come one right after the other, or when there is a tetanic contraction (a prolonged uterine contraction with no rest period). In this setting, the fetus can become hypoxic with a resultant bradycardia. This patient had the gel placed and 60 minutes later had uterine hyperstimulation. Infection (choice A) has not been shown to cause uterine hyperstimulation. This patient´s group B Streptococcus colonization is likely noncontributory. IV fluids (choice B), unless oxytocin is present, do not cause uterine hyperstimulation. Postdates pregnancy (choice C) is the reason for this patient´s induction and not likely the direct cause of her uterine hyperstimulation. Vaginal examination (choice E) does not usually cause uterine hyperstimulation. Vaginal examination with a cervical examination can be used for fetal scalp stimulation-rubbing the baby´s head to provoke an acceleration of the fetal heart rate. However, this does not usually provoke uterine hyperstimulation.

Explanation:

Patients with a history of gestational diabetes have a high likelihood for eventually developing overt diabetes. These women should therefore be extensively counseled regarding the importance of diet and exercise. Along with counseling, testing is necessary to determine which patients actually do develop overt diabetes. Testing should be performed in the first few months following the delivery. This testing may be a 75-g, 2- hour, oral glucose tolerance test. Diabetes is diagnosed if the fasting glucose level exceeds 140 mg/dL, or two post-glucose measurements exceed 200 mg/dL. Patients should then undergo fasting glucose testing every 3 years. This patient, given her history of gestational diabetes, needs to have regular testing.

Chest x-ray every 3 years (choice A) is not recommended as a screening test for this patient. Although the number of deaths from lung cancer surpasses that of breast cancer, and lung cancer is the leading cause of cancer death in women, routine chest x-ray is not used as a regular screening test.

Coronary angiography every 3 years (choice B) would not be recommended for this patient. This is an invasive procedure that currently is not used as a regular screening test in the general population. Mammography every 3 years (choice D) would not be recommended for this patient. At 33 years of age, she does not yet require routine mammography. She should have a mammogram every 1-2 years starting at age 40, and then annually starting at age 50. Pap testing every 3 years (choice E) would not be recommended for this patient. Pap testing should be performed annually starting at age 18, or with the initiation of sexual intercourse. Some recommend that the interval can be increased at the physician´s discretion in a low-risk patient with three normal Pap tests in a row. Others dispute this, arguing that annual Pap tests should be performed on all women. In any event, this patient, with her history of Chlamydia and gonorrhea, is not low risk and therefore needs annual Pap testing.

Explanation:

This answer is D. Pregnancy needs to be ruled out prior to initiating contraception or termination.

Explanation:

This answer is C. The likely reason for a delay in second stage is mal-position of the fetal head. Examination in theatre (not delivery room) and delivery by forceps after manual rotation or rotational forceps delivery is appropriate. Disputed position of presenting part is a contraindication to ventouse. Contractions are normal so syntocinon may not help.

Explanation:

This answer is B. Laparoscopic cholecystectomy can be safely performed during pregnancy if indicated. Hence other options are unworthy.

Explanation:

This answer is A. Graves´ disease, if diagnosed during pregnancy, can be treated with Propylthiouracil. However, initial acute-stage management would need beta-blockers and supportive measures. Hence the best initial step will be to give beta-blockers and supportive measures.

Explanation:

This answer is C. Tension headache is typically described as a tight band or squeezing type of headache and is related to stress. Simple analgesics help in relieving the pain. Cluster headache is more common in men than women, but periorbital oedema and unilateral presentation are typical. Iatrogenic headache will follow a stimulus e.g. severe headaches with flushing are common with Nifedipine. Primary brain tumor will produce signs and symptoms of raised ICP and will not present like this pain.

Explanation:

This answer is C. This is the quickest method of delivery under the circumstances. In this case, the heart rate is itself abnormal so prompt delivery is the next step and not wasting time doing investigations. You cannot wait for normal delivery here.

Explanation:

This answer is B. Zavanelli´s technique under general anesthesia could be considered in trueshoulder dystocia. Pelvic manoeuvres such as delivery of the posterior shoulder and Wood´s Cox screw manoeuvres are the next steps after McRoberts manoeuvre and suprapubic pressure if they fail. If McRoberts, suprapubic pressure and pelvic manoeuvres have been unsuccessful, next step is moving onto all fours.

Explanation:

There is no evidence that ranitidine, metformin or the OCP is teratogenic although it was once believed that aspirin and the OCP were, studies indicate otherwise. Similarly, metformin is often used in PCOs to induce fertility through reduction in insulin resistance. Warfarin is associated with CNS and skeletal abnormalities if foetal exposure occurs in the first trimester, plus foetal haemorrhage is more likely. Statins also are associated with teratogenicity. Valproate causes birth defects: exposure during pregnancy is associated with about three times as many major anomalies as usual, mainly spina bifida and, more rarely, with several other defects, possibly including a “valproate syndrome”.

Explanation:

High concentrations of bupivacaine may cause an increase in the rate of instrumental delivery but not an increase in the rate of caesarian sections (NEJM 2005; 352:655-665).
Pruritus is due to opiates.
Tinnitus may occur when bupivacaine is given intravascularly or when the plasma levels of bupvacaine reach toxic levels. A total spinal or high spin block occurs when a large volume of bupivacaine is injected into the subarachnoid space and is a rare complication of an epidural (read the question).
Epidural bupivacaine does not decrease uterine contractility.

Explanation:

In many women, mild thrombocytopenia (not thrombocytosis) occurs toward the end of pregnancy, and the platelet count returns to normal within days after delivery. The etiology for this phenomenon is unknown. This is the most common cause of thrombocytopenia during pregnancy, occurring in approximately 5% of women at term. Thrombocytopenia may be associated with HELLP syndrome (haemolysis, elevated liver enzymes and low platelet count), which can lead to foetal and maternal death.
Pregnancy is associated with clinical features that in a non-pregnant patient would point to organic disease. Polyuria, dyspepsia, decreased exercise tolerance, enlargement of the heart (with lateral displacement of the apex), a loud third heart sound and an ejection systolic murmur (loudest at the left sternal edge) are all common.
Less commonly, a fourth heart sound and a diastolic murmur may be present. Left axis deviation with flattening or T wave inversion in lead III can be seen on the electrocardiograph (ECG).
The alkaline phosphatase is frequently elevated but the remainder of the liver function tests should be in the normal range.

Explanation:

In many women, mild thrombocytopenia (not thrombocytosis) occurs toward the end of pregnancy, and the platelet count returns to normal within days after delivery. The etiology for this phenomenon is unknown. This is the most common cause of thrombocytopenia during pregnancy, occurring in approximately 5% of women at term. Thrombocytopenia may be associated with HELLP syndrome (haemolysis, elevated liver enzymes and low platelet count), which can lead to foetal and maternal death.
Pregnancy is associated with clinical features that in a non-pregnant patient would point to organic disease. Polyuria, dyspepsia, decreased exercise tolerance, enlargement of the heart (with lateral displacement of the apex), a loud third heart sound and an ejection systolic murmur (loudest at the left sternal edge) are all common.
Less commonly, a fourth heart sound and a diastolic murmur may be present. Left axis deviation with flattening or T wave inversion in lead III can be seen on the electrocardiograph (ECG).
The alkaline phosphatase is frequently elevated but the remainder of the liver function tests should be in the normal range.

Explanation:

Due to dilution, urea and Hb (haematocrit) is reduced. Although total T4 is reduced, free T4 concentrations are maintained in a normal range. Raised fasting plasma glucose would not be typical of a normal pregnancy and raised uric acid is found in eclampsia. Typically, the increased GFR also causes a reduction in urea/uric acid etc.

Explanation:

Empty uterus: empty endometrial cavity with or without a thickened endometrium

Explanation:

Newborns who are exposed to hepatitis B have more than a 90% chance of becoming chronically infected. This means the virus stays in their blood and liver for possibly a lifetime. They can pass the virus on to others. They will also live with a greater chance of developing liver failure or liver cancer later in life.
It is most important that the newborn receive the first dose of the hepatitis B vaccine in the delivery room. If possible, also give the hepatitis B immune globulin (HBIG), which is another medication that helps the vaccine to work even more successfully.
According to the Center for Disease Control and Prevention (CDC) and the World Health Organization (WHO), it is safe for an infected woman to breastfeed her child.

Explanation:

The criteria for severe preeclampsia specify a blood pressure of 160/110 mm Hg or above on two occasions, 6 hours apart. Other criteria include proteinuria above 5 g/24 hr, thrombocytopenia with a platelet count < 100,000/mm3, liver enzyme abnormalities, epigastric or right upper quadrant pain; alteration of mental status.

Explanation:

The criteria for severe preeclampsia specify a blood pressure of 160/110 mm Hg or above on two occasions, 6 hours apart. Other criteria include proteinuria above 5 g/24 hr, thrombocytopenia with a platelet count < 100,000/mm3, liver enzyme abnormalities, epigastric or right upper quadrant pain; alteration of mental status.

Explanation:

A nonstress test (NST) measures the fetal heart rate in response to the fetus movements. Generally, the heart rate of a healthy fetus increases when the fetus moves. The NST is usually performed in the last trimester of pregnancy. A nonreactive/non-reassuring NST is when there is no change in the fetal heart rate when the fetus moves. This may indicate a problem that requires further testing.

Explanation:

In a pregnancy complicated by bleeding at less than 8 weeks gestation, it is often difficult to determine whether there is a viable, intrauterine pregnancy, a nonviable intrauterine pregnancy, or an ecopic pregnancy. Vaginal ultrasonography can be used to detect intrauterine pregnancy as early as 1 week after conception if the Beta- hCG level is > 1500 mIU/mL. An empty uterus with a Beta-hCG level > 1500 mIU/mL is highly suggestive of ecoptic pregnancy. When the Beta- -hCG is < 15000 mIU/mL and vaginal ultrasonography is nondiagnostic, the Beta-hCG should be repeated in 2-3 days. Failure of the Beta-hCG to double in 2-3 days suggests a blighted ovum or ectopic pregnancy. The efficacy of progesterone in early pregnancy has not been proven, and there is some potential risk (virilization of the female fetus). An ectopic pregnancy is possible in this situation, but would be more like if the hCG were higher in the presence of an empty uterus, or if there were an adnexal mass on physical examination or ultrasonography.

Explanation:

Contraindications for epidural anesthesia include: patient refusal for surgery, uncooperative patient, abnormal bleeding or clotting parameters, anti-coagulant therapy, skin infection at/near injection site, uncorrected fluid loss (Hypovolemia), and low blood pressure, presence of neurological disorders, cardiovascular diseases and anatomical abnormalities of the vertebral column.

Explanation:

Intrauterine growth restriction (IUGR) is a term used to describe a condition in which the fetus is smaller than expected for the number of weeks of pregnancy. Another term for IUGR is fetal growth restriction.
Newborn babies with IUGR are often described as small for gestational age (SGA). A fetus with IUGR often has an estimated fetal weight less than the 10th percentile. Maternal factors associated with IUGR are high blood pressure, chronic kidney disease, advanced diabetes, heart or respiratory disease, malnutrition, anemia, infection, substance abuse (alcohol, drugs) and cigarette smoking. Factors involving the uterus and placenta are decreased blood flow in the uterus and placenta, placental abruption (placenta detaches from the uterus), placenta previa (placenta attaches low in the uterus) and infection in the tissues around the fetus. Factors related to the developing baby (fetus) are multiple gestation (twins, triplets, etc.), infection, birth defects and chromosomal abnormality.