Explanation:

The pituitary gland increases the production of  prolactin and adrenocorticotrophin (ACTH). Plasma concentrations of cortisol, aldosterone, renin and angiotensin rise. There is an increase in the production thyroid hormone, but an increase in production of thyroid binding globulin means that the free plasma concentration of thyroid hormones (thyroxin) remains unchanged.

Explanation:

Postpartum depression is a highly prevalent disorder with consequences that can be profound. The “postpartum blues” affect up to 85% of women and typically resolve by the tenth postpartum day, whereas the onset of postpartum depression may not occur until 6 months following delivery. Evidence regarding the benefit of hormonal therapy for patients with postpartum depression is lacking. Generally, postpartum depression can be managed on an outpatient basis unless the illness is severe. SSRIs are ideal first-line agents and should be used for similar periods of time and in dosages comparable to those prescribed to patients who suffer from nonpuerperal illness.

Explanation:

Vaginal birth after cesarean (VBAC) is done but only if conditions are favorable. Absolute contraindication to VBAC includes prior classical (vertical) uterine incision.
The most serious risk of a VBAC is that the previous C-section scar could come open. This can be very serious for both the mother and the baby. The risk that a scar will tear open is very low during VBAC when you have just one low horizontal cesarean scar and your labor is not started with medicine.

Explanation:

The relationship between maternal alcohol abuse during pregnancy and developmental birth defects is well-documented in psychological and medical literature. An accurate diagnosis of FAS or Fetal Alcohol Effects (FAB), in which patients display partial effects of the syndrome and evidence many of the same problems as full-blown FAS, must be made by a doctor or geneticist. Patients with FAS are of short stature, slight build, and have a small head. Typically they are below the third to tenth percentile compared to national norms. A pattern of dysmorphic facial features characterizes these persons as well, and include 1) short eye openings; 2) a short, upturned nose; 3) smooth area between the nose and mouth; and 4) a flat midface and thin upper lip. The facial patterns made FAS patients recognizable although not grossly malformed. A considerable range of intellectual functioning is found among patients with FAS. In a report of twenty cases of varying severity, there was a range of IQ scores from 16 to 105 with a mean IQ of 65. Severity of the syndrome was related to IQ, with the most severely affected children having the lowest IQ scores.

Explanation:

An incomplete abortion occurs when the woman´s body expels only a portion of the pregnancy tissue. During an incomplete abortion, portions of the fetus, amniotic sac or placenta may be retained. Symptoms include an open cervix, cramping, and the discharging of blood and fetal matter.

Explanation:

Intrauterine devices (IUDs) are used widely by women as a means of contraception because they are highly effective, have no systemic effects and can last up to 5 years.
IUDs induce endometrial inflammation, this inflammation attracts neutrophils, which are toxic to sperm and prevent fertilization of the ovum.
Absolute contraindications to IUD insertion are: confirmed pregnancy, severe distortion of the uterine cavity (such as by fibroids or anatomic anomalies), acute, recent (within 3 months) or recurrent uterine infection (includes sexually transmitted, postpartum and postabortal infections).
Relative contraindications or warnings for IUD insertion include: risk factors for STDs (non-monogamous relationship, history of STDs), history of a previous IUD problem (perforation, expulsion, significant pain, and menorrhagia), unresolved abnormal uterine bleeding, known immunocompromise, past history of severe vasovagal reactivity.

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:

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:

Hemolytic disease of the newborn (also called erythroblastosis fetalis; is a condition in which red blood cells are broken down or destroyed more rapidly than is normal. The newborn´s red blood cells are destroyed by antibodies that were produced by the mother and crossed the placenta from the mother´s circulation into the fetal circulation before delivery. A mother who is Rh-negative may have produced antibodies against Rh-positive blood cells after she was exposed to red blood cells of a previous fetus that was Rh-positive. Such exposure may occur during pregnancy or labor, but may also occur if the mother had been accidentally transfused with Rh-positive blood at any time earlier in life.
The mother´s body responds to the “incompatible blood” by producing antibodies to destroy the “foreign´ Rh-positive cells. These antibodies cross the placenta during a subsequent pregnancy. If the fetus she is carrying is Rh-negative, there is no consequence. However, if the fetus has Rh-positive red blood cells, the mother´s antibodies attach to, and start to destroy, the fetal red blood cells, leading to anemia of varying degrees. This anemia begins in the fetus and continues after delivery.
Prevention of hemolytic disease due to Rh incompatibility involves injecting the mother with a Rho(D) immune globulin preparation at about 28 weeks of pregnancy and again immediately after delivery. Injection of this immune globulin rapidly destroys any Rh-positive fetal red blood cells that have entered the mother´s circulation before they stimulate the mother´s body to produce antibodies.

Explanation:

Urinary tract infections are common during pregnancy, and the most common causative organism is Escherichia coli. Asymptomatic bacteriuria can lead to the development of cystitis or pyelonephritis. All pregnant women should be screened for bacteriuria and subsequently treated with antibiotics such as nitrofurantoin, sulfisoxazole or cephalexin. Ampicillin should no longer be used in the treatment of asymptomatic bacteriuria because of high rates of resistance. Pyelonephritis can be a life-threatening illness, with increased risk of perinatal and neonatal morbidity. Recurrent infections are common during pregnancy and require prophylactic treatment. Pregnant women with urinary group B streptococcal infection should be treated and should receive intrapartum prophylactic therapy.

Explanation:

Compared with pre-pregnancy values uric acid concentrations decreased significantly by 8 weeks gestation and this reduced level were maintained until about 24 weeks. Proteinuria changes little during pregnancy and if more than 500mg/24h is lost, a disease process should be suspected. Normally, the patient´s blood pressure will not rise in pregnancy.
Glucosuria during pregnancy is not necessarily abnormal, may be explained by the increase in GFR with impairment of tubular re-absorption capacity for filtered glucose. Increased levels of urinary glucose also contribute to increased susceptibility of pregnant women to urinary tract infection. With increased minute ventilation, the gravida will have increased alveolar ventilation, leading to respiratory alkalosis.

Explanation:

Compared with pre-pregnancy values uric acid concentrations decreased significantly by 8 weeks gestation and this reduced level were maintained until about 24 weeks. Proteinuria changes little during pregnancy and if more than 500mg/24h is lost, a disease process should be suspected. Normally, the patient´s blood pressure will not rise in pregnancy.
Glucosuria during pregnancy is not necessarily abnormal, may be explained by the increase in GFR with impairment of tubular re-absorption capacity for filtered glucose. Increased levels of urinary glucose also contribute to increased susceptibility of pregnant women to urinary tract infection. With increased minute ventilation, the gravida will have increased alveolar ventilation, leading to respiratory alkalosis.

Explanation:

A pregnant woman who has never had rubella and has not been immunized should avoid exposure to infected individuals during her pregnancy. Administration of rubella vaccine can cause infection that can be transmitted to the fetus. Exposure to infected patients can cause infection. No antiviral agents are useful in this situation. Genetic counseling would not be helpful, since genetic defects are not involved in the syndrome resulting from intrauterine rubella.

Explanation:

The woman has preeclampsia, the features of which include proteinuria and sustained elevation of blood pressure in pregnancy after 20 weeks of gestation in the absence preexisting hypertension. A wide variety of other features of preeclampsia can also be seen including excessive weight gain, generaIized, edema,ascites, hyperuricemia, hypocalciuria, increased plasma concentration of von Willebrand factor and cellular fibronectin, reduced plasma concentration of anti-thrombin III, thrombocytopenia, increased hematocrit, increased liver enzymes, intrauterine growth retardation, and intrauterine hypoxia. Modern theories suggest that the true primary lesion may involve the endothelium, and that medical control of hypertension actually only treats a small part of the syndrome. At present, the only definitive therapy is delivery of the baby, and obstetricians often play a delicate game trying to delay delivery for a premature baby´s sake as long as possible while judging the severity of the preeclampsia and its immediate risks to mother and fetus. Low dose aspirin may have a modest effect in preventing preeclampsia, but this is not yet well established. Oxygen supplementation is used in some cases of cerebral hemorrhage secondary to preeclampsia, but does not constitute definitive therapy. Renal dialysis is usually not necessary in preeclampsia, although both renal cortical necrosis and renal tubular necrosis can occasionally occur in this disorder.

Explanation:

Thalidomide is a teratogenic drug which causes phocomelia in the newborn, not spina bifida. Alcohol does cause fetal alcohol syndrome, as well as microcephaly and heart disease in some infants. Penicillamine is notorious for causing cutis laxa syndrome in newborns, while testosterone like drugs will result in virilization of the female. Isoretinoin which can cause congenital heart disease may also result in facial and ear defects.

Explanation:

Eclampsia will also have fits in it. Budd chiari and congestive heart failure will have tender hepatomegally and the age in not supportive of CHD. Primary hypertension usually occurs in old age and is not related to pregnancy. Most suitable option therefore is Pre-eclampsia.

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:

Ovulation pain is a common symptom in normal women but may be more apparent in patients with endometriosis. Typically there are painful and occasional heavy bleeds, with dyspareunia being characterisitic. Other symptoms include haematuria dysuria as a consequence of seeding elsewhere. Amenorrhoea is often the objective of treatment with LHRH analogues.

Explanation:

Methyl dopa is the only hypotensive that is safe in all stages of pregnancy. Treatment with isotretinoin is a recognised indication for termination of the pregnancy and contraception is advised for 2 years after cessation of treatment Folic acid supplements reduce the incidence of neural tube defects and would be given to patients taking phenytoin. Warfarin has been shown to can cause central nervous system damage in the foetus if given in the second and third trimesters (not heparin). Thiazide diuretics have been shown to decrease placental perfusion.

Explanation:

This patient has a mild metabolic alkalosis with what appears to be respiratory compensation as reflected by the elevated pCO₂.
Amitriptyline overdose is associated with acidosis as is salicylate poisoning. Hepatic failure usually presents with acidosis.
This type of picture is associated with:

•    – prolonged vomiting (as in pregnancy)
•    –  diarrhoea
•     – diuretic therapy
•      –    Cushing´s syndrome
•        –    those receiving high dose corticosteroids

With no other information provided for this case, common things being common, one should select pregnancy as the best answer for a 20-year- old female.

Explanation:

The patient and fetus are at far more risk from uncontrolled seizures than from any potential teratogenic effect of the therapy.
In pregnancy total plasma concentration of anticonvulsants fall, so the does may need to be increased.
The potential teratogenic effects (particularly neural tube defects) of carbamazepine do need to be explained and in an effort to reduce this risk she should receive folate supplements. Screening with alpha-fetoprotein (AFP) and second trimester ultrasound are required.
Vitamin K should be given to the mother prior to delivery.
There is no point in switching therapies as this could precipitate seizures in an  otherwise stable patient.
Similarly, both phenytoin and valproate are associated with teratogenic effects.

Explanation:

The corpus luteum is maintained by placental HCG secretion and produces progestogens and oestradiol until later the placenta can maintain this role. Relaxin is found in pregnant humans but at higher levels early in pregnancy than close to the time of birth. Relaxin promotes angiogenesis and in humans it probably plays a more important role in the development of the interface between the uterus and the placenta that it does in the birth process.

Explanation:

Stroke volume increases by 20-30% during pregnancy. The systemic vascular resistance decreases by about 30% due to hormone-mediated vasodilation. The systolic and diastolic blood pressures decrease by 10% at 20 weeks gestation. Heart rate increases by 25% in the middle of the third trimester. Central venous pressures and pulmonary capillary wedge pressures remain stable.

Explanation:

The addition of opioids to local anaesthetics solutions used in regional anaesthesia is associated with delayed respiratory depression, and this is more likely to occur with hydrophilic opioids than with lipophilic opioids. The risk of aspiration of gastric contents is reduced under regional anaesthesia but it can still occur, especially with a high block or total spinal. The incidence of a venous air embolism (VAE) during lower segment Caesarean Section (LSCS) under regional is about 25% (using doppler ultrasound and echocardiography). Thrombus and amniotic fluid emboli have also been reported.
The incidence of electrocardiograph (ECG) ischaemic changes demonstrated in ASA 1 females undergoing LSCS is about 35%. This is believed to be due to increase in myocardial work and oxygen demand that occurs secondary to the hypotension induced by the sympathetic blockade.
A postural headache usually suggests that there is a cerebrospinal fluid lead close to the level of insertion of the regional block. This may be an indication for an epidural blood patch in order to seal the puncture.

Explanation:

A common postpartum complication is infection. The presentation of a puerperal infection may be atypical because of the altered physiology of the postpartum period. Abdominal distention (ileus) and lack of appetite may be the first manifestation of abdominopelvic peritonitis. Careful evaluation of the patient is required with respect to the genitourinary tract. Risks for the development of postpartum infection include vaginal trauma (which this patient had), anemia (this patient´s hemoglobin is 10.8), multiple pelvic examinations, internal fetal monitoring, prolonged rupture of the membranes, and indigent status. Continued surveillance is indicated so that the reason for distention and lack of appetite can be identified and treated. The duration of the patient´s labor is not given, but it is likely that she has not eaten solid food in some time. There may not be significant stool in her large intestine available for evacuation. Also, some narcotic medications used for analgesia during labor may contribute to decreased intestinal motility. The mild ileus that follows delivery, together with perineal discomfort and postpartum fluid loss by other routes, predisposes to sluggish bowel evacuation during the puerperium. Strategies to improve postpartum bowel function include initiating a low-residue diet, prescription of a short course of stool softeners, and a mild laxative on the first postpartum night. She should be reassured that normal bowel function can be anticipated.

Explanation:

Antiretroviral treatment has been proven to reduce vertical transmission of HIV from mother to child. Benefits have been shown for antenatal,intrapartum and postpartum, treatment, Zidovudine and nevirapine have the most well-established track record. Maternal vitamin A therapy has not proved to reduce HIV transmission. It was hoped that it would help maintain mucosal integrity; Chlorhexidine vaginal rinses in early labor have also not proven to reduce HIV transmission to the neonate. Cesarean section decreases the frequency of neonatal transmission of HIV, but with current viral n suppression therapy the risk-to-benefit ratio of cesarean delivery is questionable. The immunologic benefits of breastfeeding do not balance the increased risk of HIV transmission to neonates who are breastfed by HIV-infected mothers.

Explanation:

Ordinarily, the hypoglycemia of infants of diabetic mothers is brief and asymptomatic. It is considered to result from fetal hyperinsulinism secondary to prenatal hyperglycemia. However reports of prolonged symptomatic hypoglycemia associated with maternal chlorpropamide (Diabinese) therapy has been reported. Therefore this drug is not recommended in gestational diabetes.
The other choices are commonly uses medicines in the treatment of diabetes.

Explanation:

Explanation:

Explanation:

Adnexal masses are frequently found in both symptomatic and asymptomatic women. In premenopausal women, physiologic follicular cysts and corpus luteum cysts are the most common adnexal masses, but the possibility of ectopic pregnancy must always be considered. Other masses in this age group include endometriomas, polycystic ovaries, tubo-ovarian abscesses and benign neoplasms. Malignant neoplasms are uncommon in younger women but become more frequent with increasing age. In postmenopausal women with adnexal masses, both primary and secondary neoplasms must be considered, along with leiomyomas, ovarian fibromas and other lesions such as diverticular abscesses. Information from the history, physical examination, ultrasound evaluation and selected laboratory tests will enable the physician to find the most likely cause of an adnexal mass.

Explanation:

For patients with uncomplicated gonococcal infections of the cervix, urethra, and rectum, it is recommended treatment with cefixime, cegrtiaxone, ciprofloxacin, ofloxacin, or levofloxacin. If chlamydial infection has not been ruled out, or if the likelihood of chlamydial infection is high, azithromycin or doxycycline should also be given. Because this patient is pregnant, she should not receive quinolones or tetracyclines. She should receive a cephalosporin, and ceftriaxone would be the best choice because it provides higher, more sustained levels of bacterial activity. If chlamydial infection had not been ruled out, erythromycin or amoxicillin would also be recommended.

Explanation:

An Abruptio placenta is typically associated with pain and can cause fetal distress or death. The other conditions do not produce such a clinical picture.

Explanation:

Very tight control of maternal glucose is critical for the outcome of the pregnancy and for the protection of the mother. Diabetes is often more difficult to manage during pregnancy because of the change in metabolic demands. Children born to diabetic women tend to have higher birth weights than the normal. Dietary restrictions regarding carbohydrate intake remains important during pregnancy. Diabetes mellitus does not remit or resolve during or after pregnancy, although cases of latent diabetes manifesting during pregnancy may remit after parturition or weight reduction.

Explanation:

Explanation:

Explanation:

The patient´s problem is that she is able to conceive but not able to maintain pregnancy. Spontaneous abortions very early in the pregnancy are usually due to chromosomal abnormalities, but can be due to abnormal hormone secretion. The fertilized ovum remains in the oviduct for 2 to 3 days then enters the uterus by day 3 or4. Once in the uterus the morula develops into a blastocyst the zona pellucida is shed and the blastocyst implants into me uterine wall on day 7. The movement from the oviduct to the uterus is largely regulated by progesterone and estrogen, so a decrease in progesterone could prevent implantation. However, the patient did obtain a positive pregnancy test, implying hCG production. Around 6 to 8 days post-fertilization, hCG production begins and can be detected by a pregnancy test. Normally, hCG acts like LH to increase luteal progesterone production, which prevents menses. If progesterone secretion is not increased, then the corpus luteum will atrophy and pregnancy will be terminated.
High plasma estrogen and high plasma progesterone are normal during pregnancy and would not lead to spontaneous abortion. However, estrogen levels rise more slowly during the first; half of pregnancy than during the second half, so severely elevated estrogen would not be seen until later in the pregnancy. High plasma hCG would be expected during pregnancy. The plasma levels of hCG double every 2 to 3 days in early pregnancy until about l0 to 15 weeks gestation, when placental progesterone negatively feeds back to greatly reduce hCG production. At this point, the placenta produces the majority of hormones responsible for maintenance of pregnancy. High plasma hPL would not result in spontaneous abortion within a month of fertilization. hPL is produced by the same cells as hCG and levels gradually rise from the third week of pregnancy until term. hPL promotes cell specialization in mammary glands similar to prolactin, but is less potent than prolactin in stimulating milk production. Its main action early in pregnancy is to maintain adequate fuel supply for the fetus. Therefore, an elevation in hPL levels would not cause the patient to abort early in pregnancy.

Explanation:

Asymptomatic bacteriuria is present in 2 to 9% of pregnant women. An association between asymptomatic bacteriuria and preterm delivery flow birth weight has been demonstrated. Untreated asymptomatic bacteriuria, in most cases, progresses to pyelonephritis; therefore, all pregnant women should be screened for asymptomatic bacteriuria early in the pregnancy, and women who demonstrate bacteriuria (defined as a clean-catch, midstream urine specimen with 25,000 to 100,000 colony forming units per milliliter of a single organism) should be treated. E. coli is the organism that is isolated in roughly 80% of cases while other gram negative organisms (e.g., Klebsiella, Enterobacter and Proteus species) and gram-positive cocci (e.g. enterococci and group B Streptococci) are responsible for the remainder. Antibiotic sensitivities are often available at the time of diagnosis of the asymptomatic bacteriuria, which will allow for correct choice of medications. A 3 day course of antibiotics may be given. The acceptable treatment of asymptomatic bacteriuria may include any of the following:

•  Nitrofurantoin
• Sulfisoxazole
• Amoxicillin
• Amoxicillin-clavulanate
• A cephalosporin such as cefpddoxime
• Fosfomycin
• Nitrofurantoin (C) is a safe drug to use in pregnancy and very effectively reaches therapeutic concentration in urine. This drug is renally cleared and caution should be taken in patients with renal failure. Possible choices for treating asymptomatic bacteriuria in a non pregnant patient include fluoroquinolones, trimethoprim- sulfamethoxazole, nitrofurantoin, and cephalexin. Trimethoprim (E) is a folate receptor antagonist and should be avoided in first trimester of pregnancy. Fluoroquinolones such as levofloxacin (B) as well as doxycycline (A) have teratogenic effects and are contraindicated in pregnancy. Asymptomatic bacteriuria doesn´t need to be treated (D) in patients who don´t belong to one of the three groups listed below:

• Pregnant patients
• Immunocompromised patients
• Patients on chronic steroid therapy or posttransplant patients.
• It is appropriate to treat bacteriuria in patients other than those listed above, only if they develop symptomatic urinary tract infection; characterized by fever, chills, flank pain with WBC and >100,000 CFU of bacteria in urine.

Explanation:

Aspiration pneumonitis is a major cause of anesthesia-related death in obstetrics. Most often, these aspiration events occur with the use of general anesthesia. Pregnant patients are at greater risk for aspiration because of the delayed gastric emptying that occurs during pregnancy and labor. Pregnancy is associated with increased levels of progesterone and displacement of the pylorus by the pregnant uterus. Labor is associated with pain and stress. All of these factors lead to delayed gastric emptying. Aspiration pneumonitis is caused by acidic gastric juices entering the lungs and inducing a sometimes-lethal chemical pneumonitis. When epidural anesthesia is administered, there is a risk of complications, including the development of total spinal anesthesia. The treatment for this complication is positive-pressure ventilation with 100% oxygen administered through an endotracheal tube. Therefore, when an epidural is going to be placed, the patient should be given an antacid (often 30 mL of 0.3 mL/L sodium citrate with citric acid, called Bicitra) to increase the stomach pH. This will help to prevent aspiration pneumonitis should an aspiration event take place during the administration of general anesthesia. It is not necessary to give an antibiotic (choice B) prior to the administration of an epidural. Antibiotics are used during labor for the prevention of group B Streptococcus sepsis, for patients with chorioamnionitis, for patients in need of valve or endocarditis prophylaxis, or during cesarean delivery for the prevention of infection. Aspirin (choice C) is not given prior to the placement of an epidural. A clear liquid meal (choice D) or a regular “house” meal (choice E) should not be given to patients prior to the placement of an epidural. Intake of food or liquids during labor places the patient at greater risk of aspiration pneumonitis. Patients in labor should be allowed small sips of water or ice chips.

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:

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:

The anti-convulsant sodium valproate (D) should ideally be avoided in pregnancy as it is associated with the highest risk of congenital malformations among the anti-convulsants. However, if it is the most appropriate agent to control the patient`s seizures it should be used. The others are all to be avoided at all costs. Acitretin (A) and methotrexate (E) are teratogenic. Mebendazole (C), the anti-worming tablet, has been shown to be toxic in animal studies. Multiple congenital abnormalities have been reported with the anti-fungal fluconazole [B].

Explanation:

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 B. Pyelonephritis is common in pregnancy due to physiological changes in the urinary tract during pregnancy. The scenario does not fulfill any other option

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 B because of signs and symptoms of increased ICP. Intracranial symptoms are more difficult to differentiate in pregnancy. 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.

Explanation:

This answer is C. Phenytoin is associated with oral clefting. None of the other drugs are.

Explanation:

This answer is D. If labour is established, watchful expectancy is appropriate. Any intervention, if required, is done.

Explanation:

This answer is A. Maternal age more than 35 years, raised nuchal translucency and reduced serum symmetrical growth markers suggest a possibility of trisomy 18. The combination of increased nuchal translucency and hCG with decreased AFP and uE3 if present is strongly suggestive of Down´s syndrome. Triploidy is a non-specific term and is not a diagnosis. Intrauterine growth retardation is associated with symmetrical growth restriction and may be due to intrauterine infections or genetic causes.

Explanation:

This answer is D. This is equivalent to understanding that there are two alleles and the screening tests will detect approximately 90 percent of mutations. Therefore the risk of the baby being affected is 1:2 x 1:2 x 1:250 x 1:2.

Explanation:

Sulfasalazide and corticosteroids are not known to be teratogenic. The general consensus is that ulcerative colitis does not have an adverse effect on pregnancy outcome, and that pregnancy does not have an adverse effect on disease progression. Furthermore, use of the medications sulfasalazine and prednisone has not been associated with detrimental effects to the mother or the fetus. Some believe that occurrence of spontaneous abortions correlate with disease activity therefore is incorrect.

Explanation:

The vacuum extractor has a probable advantage compared with forceps in a number of areas. These induce easier application; lower maternal anesthesia requirements, and less risk of maternal soft-tissue and fetal facial injury. There is an increased incidence of cephalohematoma, Neonatal outcomes as measured by Apgar scores and. umbilical artery blood gases, have not been shown to be significantly different between forceps and vacuum deliveries. Forceps have been associated with higher rates of successful delivery in some studies, as they may represent an option for delivery when vacuum extraction has failed. Incomplete cervical dilatation is a relative contraindication to use of the vacuum extractor

Explanation:

At this time in the-patient´s pregnancy, a gestational sac should be visible on ultrasonography. An empty uterus presents the highest risk (14%) for ectopic pregnancy, while nonspecific fluid and echogenic material are associated with a 5% and 4% risk, respectively. An abnormal or normal sac is associated with no risk, with the rare exception of multiple pregnancies with one being heterotopic.

Explanation:

Disseminated intravascular coagulation (DIC) involves abnormal, excessive generation of thrombin and fibrin in the circulating blood. During the process, increased platelet aggregation and coagulation factor consumption occur. DIC that evolves slowly (over weeks or months) causes primarily venous thrombotic and embolic manifestations; DIC that evolves rapidly (over hours or days) causes primarily bleeding. Severe, rapidly evolving DIC is diagnosed by demonstrating thrombocytopenia, an elevated PTT and PT, increased levels of serum fibrin degradation products, and a decreasing plasma fibrinogen level. Treatment includes correction of the underlying cause and replacement of platelets, coagulation factors (in fresh frozen plasma), and fibrinogen (in cryoprecipitate) to control severe bleeding. Heparin is used as therapy (or prophylaxis) in patients with slowly evolving DIC who have (or are at risk for) venous thromboembolism.

Explanation:

Renal infection is the most common serious medical problem that complicates pregnancy. Infection is more common after midpregnancy, and is usually caused by bacteria ascending from the lower tract. Escheria coli is the offending bacteria in approximately 75% of cases. About 15% of women with acute pyelonephritis are bacteremic. A common finding is thermoregulatory instability, with very high spiking fevers sometimes followed by hypothermia. Almost 95% of women will be afebrile by 72 hours. However, it is common to see continued fever spikes up until that time. Thus, further evaluation is not indicated unless clinical improvement is not obvious at 48-71 hours. If this is the case, the patient should be evaluated for urinary tract obstruction, urinary calculi and an intrarenal or perinephric abscess-. Ultrasonography, plain radiography, and modified intravenous pyelography are all acceptable methods, depending on the clinical setting.

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:

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:

Phenylketonuria (PKU) is an autosomal recessive genetic disorder characterized by a deficiency in the enzyme phenylalanine hydroxylase. This enzyme is necessary to metabolize the amino acid phenylalanine to the amino acid tyrosine. When it is deficient, phenylalanine accumulates and is converted into phenylketones, which are detected in the urine.
Left untreated, this condition can cause problems with brain development, leading to progressive mental retardation and seizures. However, PKU is one of the few genetic diseases that can be controlled by diet. A diet low in phenylalanine and high in tyrosine can be a very effective treatment. There is no cure. Damage done is irreversible so early detection is crucial.
For women affected with PKU, it is essential for the health of their child to maintain low phenylalanine levels before and during pregnancy. Though the developing fetus may only be a carrier of the PKU gene, the intrauterine environment can have very high levels of phenylalanine, which can cross the placenta. The result is that the child may develop congenital heart disease, growth retardation, microcephaly and mental retardation.

Explanation:

Adnexal masses are frequently found in both symptomatic and asymptomatic women. In premenopausal women, physiologic follicular cysts and corpus luteum cysts are the most common adnexal masses, but the possibility of ectopic pregnancy must always be considered. Other masses in this age group include endometriomas, polycystic ovaries, tubo-ovarian abscesses and benign neoplasms. Malignant neoplasms are uncommon in younger women but become more frequent with increasing age. In postmenopausal women with adnexal masses, both primary and secondary neoplasms must be considered, along with leiomyomas, ovarian fibromas and other lesions such as diverticular abscesses. Information from the history, physical examination, ultrasound evaluation and selected laboratory tests will enable the physician to find the most likely cause of an adnexal mass

Explanation:

Most women who develop primary herpes virus (HSV) infection during pregnancy will deliver healthy babies. Studies have not shown increased V rates of miscarriage, especially after the first trimester. Current guidelines recommend treatment with antiviral agents for primary HSV infection in pregnancy. Caesarean section is not routinely recommended if a woman has had an infection during pregnancy unless active viral lesions are present at the time of delivery. Breastfeeding is unlikely to lead to neonatal infection.

Explanation:

This case demonstrates the clinical outcome of abnormal placental attachment. ln this situation, the uterus has either partially or completely attached to the myometrium instead of the endometrium, which normally sloughs after birth, thus resulting in detachment of the placenta. The three forms of abnormal attachment (accreta, increta, and percreta) are difficult to differentiate by examination and are treated as the same condition, sometimes generally referred to as “placenta accreta”. No conservative mode of management will definitively treat these conditions when a significant portion of the placenta is abnormally attacked. Therefore, if bleeding becomes profuse and the patient´s condition is unstable, prompt hysterectomy is required. This patient has low blood pressure and an elevated pulse, likely due to significant blood loss. It is inappropriate to await spontaneous delivery of the placenta, which may never occur. Trying further to remove the placenta will only result in increased bleeding. Pulling on the umbilical cord may result in uterine inversion. There is no indication for any other manual maneuver.

Explanation:

Preeclampsia is pregnancy-induced hypertension plus proteinuria. Eclampsia is unexplained generalized seizures in patients with preeclampsia. Preeclampsia and eclampsia develop between 20 weeks gestation and the end of the 1st week postpartum. Preeclampsia may be asymptomatic or may cause edema or excessive weight gain. Other signs may include increased reflex reactivity, indicating neuromuscular irritability, which can progress to seizures (eclampsia). Preeclampsia is diagnosed when pregnant women have new-onset hypertension (BP ≥ 140/90 mm Hg) plus unexplained proteinuria of ≥ 1+ on dipstick.
Definitive treatment is delivery. Patients with severe preeclampsia or with eclampsia are often admitted to the ICU. As part of stabilization, these patients are given IV fluids to increase urine output and IV Mg sulfate to stop or prevent seizures.

Explanation:

Preeclampsia is pregnancy-induced hypertension plus proteinuria. Preeclampsia affects 3 to7% of pregnant women, usually primigravidas and women with preexisting hypertension or vascular disorders (eg, renal disorders, diabetic vasculopathy). Other risk factors may include maternal age < 20, a family history of preeclampsia, preeclampsia or poor outcome in previous pregnancies, multifetal pregnancy, obesity, and thrombotic disorders (eg,antiphospholipid antibody syndrome)

Explanation:

Cocaine toxicity results from its intensive activation of the sympathetic nervous system, producing vasoconstriction and hypertension. Vasoconstriction produces decreased placental perfusion and placental insufficiency. Hypertension may result in placental abruption. There may be coexisting factors contributing to placental abruption in cocaine addicts. In addition to an increased risk of abruption, there is an increased incidence of congenital anomalies, particularly of the gastrointestinal and urinary tracts, when cocaine has been abused during pregnancy. This fact may also be used in a persuasive manner to convince the patient to discontinue her abuse of cocaine. Other potential risks to the cocaine abusing gravida include premature labor, premature delivery, and intrauterine growth retardation. If a patient refuses treatment, continued visits and inquiries about substance abuse are appropriate. Any positive efforts by the patient to discontinue use should be encouraged. Documentation of referral efforts and the fact that the patient was informed about the effects of illicit drugs on the pregnancy should be made. There is no effective chemical` detoxification or replacement therapy for cocaine addicts. Treatment emphasizes abstinence and psychosocial counseling.

Explanation:

When the just delivered fetal head retracts firmly against the perineum, shoulder dystocia is apparent. This is an obstetric emergency that requires appropriate assistance and a calm but timely approach to ensure a safe delivery, While all of the maneuvers described are steps in managing shoulder dystocia, the McRoberts maneuver by itself (maximal flexion and abduction of the maternal hips) relieves the impaction of the anterior shoulder against the maternal symphysis in a large percentage of cases, especially when combined with suprapubic pressure

Explanation:

Abruptio placentae is premature separation of a normally implanted placenta from the uterus during late pregnancy. Manifestations include vaginal bleeding, uterine pain and tenderness, hemorrhagic shock, and disseminated intravascular coagulation. Diagnosis is clinical and sometimes by ultrasonography. Treatment is bed rest for mild symptoms and prompt delivery for severe or persistent symptoms.

Explanation:

Nocturnal leg cramps are common in the second and third trimester of pregnancy and are very painful. Iron supplements can treat the anemia in pregnancy but it does not alleviate the symptoms of nocturnal leg cramps. Increasing calcium supplements without the phosphate component can prevent leg cramps. Decreasing the intake of dairy products and meats after evening hours will decrease the phosphorus level and can prevent leg cramps. Flexing the feet can increase the stretch of the muscle and alleviate the leg cramps. After the birth of the baby, these painful symptoms disappear.

Explanation:

Thalidomide is a teratogenic drug which causes phocomelia in the newborn, not spina bifida. Alcohol does cause fetal alcohol syndrome, as well as microcephaly and heart disease in some infants. Penicillamine is notorious for causing cutis laxa syndrome in newborns, while testosterone like drugs will result in virilization of the female. Isoretinoin which can cause congenital heart disease may also result in facial and ear defects.

Explanation:

Magnesium sulfate is highly effective in preventing convulsions in these patients and is the treatment of choice. Dilantin, phenobarbital,Valium, and morphine all have a role in the treatment of established seizures in the nonpregnant patient, but are not part of the treatment of preeclampsia, although benzodiazepines may be necessary once the patient goes into convulsions.

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:

Neisseria gonorrhoeae is a known cause of cervicitis and can also play a role in the pathophysiology of pelvic inflammatory disease (PID). In pregnant women, it is implicated as a cause of preterm birth and chorioamnionitis. In past decades, transmission of the gonococcus at birth from the mother to her infant led to eye infection (gonococcal ophthalmia neonatorum) and blindness in many neonates. Universal neonatal eye prophylaxis with an antibiotic ointment has reduced the rates of gonococcal ophthalmia neonatorum considerably. Any woman who is found to be infected with the gonococcus during pregnancy should be treated.
The treatment of choice is ceftriaxone, which is given as a one-time intramuscular injection. Cefixime can also be used as an oral, one time dose medication that is better tolerated by some. Patients who cannot tolerate cephalosporins can be treated with spectinomycin as a single intramuscular dose. Any patient with gonorrhea should also be given antibiotics that will cover Chlamydia as well. Thus, this patient should be given not only ceftriaxone, but azithromycin (or erythromycin or amoxicillin) as well.
It is also essential that the patient´s sexual partner or partners be treated and that a test of cure be performed approximately 4 weeks later to ensure that the organism has been eradicated. Clindamycin (choice B) does not provide adequate coverage for gonorrhea and therefore would not be the most appropriate pharmacotherapy.
Doxycycline (choice C) is often used to treat Chlamydia in nonpregnant patients. It should not be used during pregnancy because of the effects on fetal teeth and bones. Levofloxacin (choice D) is contraindicated during pregnancy because of a possible link with arthropathies in the offspring of women exposed to the drug. Metronidazole (choice E) is used during pregnancy to treat bacterial vaginosis and Trichomonas. Current recommendations are that it should not be used during the first trimester. It is not used to treat gonorrhea.

Explanation:

Women who develop GDM have a 35-60 per cent chance of developing type 2 diabetes over the next 10-15 years (D). All the others are true statements. Women who develop GDM should have growth scans to ensure the fetus is not growing excessively, in particular looking at the abdominal circumference as babies who are over 4.5kg and born to a diabetic mother are at significant risk of shoulder dystocia (A). NICE recommends delivery after 38 weeks unless glycaemic control is very poor in order to reduce the risk of stillbirth (B). As soon as the cord is clamped the hyperglycaemic environment that the fetus has lived in for 9 months disappears so hypoglycaemia is a risk (C). Pre-eclampsia (E) is more common in diabetic mothers so urine dipsticks and blood pressure monitoring will form part of every clinic visit.

Explanation:

Explanation:

This answer is A. Opiates are considered to be good analgesics in pregnancy but could result in severe constipation. Other factors will not relieve constipation.

Explanation:

Explanation:

Explanation:

This answer is D. Severe headaches with flushing are common with nifedipine. 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. Primary brain tumor will produce signs and symptoms of raised ICP and will not present like this pain.

Explanation:

This answer is C. Rectal mucosa should be repaired prior to the sphincter repair. Other options do not mention repair of rectal mucosa.

Explanation:

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

Explanation:

This answer is D. The combination of increased nuchal translucency and hCG with decreased AFP and uE3 is strongly suggestive of Down´s syndrome. Edward´s syndrome will present with maternal age more than 35 years, raised nuchal translucency and reduced serum markers. Triploidy is a non-specific term and is not a diagnosis. Intrauterine growth retardation is associated with symmetrical growth restriction and may be due to intrauterine infections or genetic causes.

Explanation:

The patient and fetus are at far more risk from uncontrolled seizures than from any potential teratogenic effect of the therapy.
In pregnancy total plasma concentration of anticonvulsants fall, so the does may need to be increased.
The potential teratogenic effects (particularly neural tube defects) of carbamazepine do need to be explained and in an effort to reduce this risk she should receive folate supplements.
Screening with alpha-fetoprotein (AFP) and second trimester ultrasound are required.
Vitamin K should be given to the mother prior to delivery.
There is no point in switching therapies as this could precipitate seizures in an otherwise stable patient.
Similarly, both phenytoin and valproate are associated with teratogenic effects.

Explanation:

Many disorders may now be screened for prenatally including Down´s, Edwards syndrome, Neural tube defects (via AFP) and haemoglobinopathies, retinoblastoma and haemophilias. Congenital hypothyroidism although screened foe postnatally may be picked up antenatally through chorionic villous sampling if suspected.

Explanation:

The corpus luteum is maintained by placental HCG secretion and produces progestogens and oestradiol until later the placenta can maintain this role. Relaxin is found in pregnant humans but at higher levels early in pregnancy than close to the time of birth. Relaxin promotes angiogenesis and in humans it probably plays a more important role in the development of the interface between the uterus and the placenta that it does in the birth process.

Explanation:

A still birth is defined as a fetal death after 24 completed weeks of pregnancy. The stillbirth rate is the number of stillbirths per 1000 total births. Perinatal mortality rate is the still births plus deaths within the fir days per 1000 live and still births. Neonatal mortality rate is the deaths live born infants less than 28 days of age per 1000 live births. A miscarriage is the loss of one products of conception before the fetus is viable, and an abortion is the premature expulsion from the uterus of the products of conception either embryo or non-viable fetus

Explanation:

The size and nutrient transfer capacity of the placenta play central roles in determining the prenatal growth trajectory of the fetus. Abnormalities in placental structure and function are central to many cases of IUGR.
Placental insufficiency results in fetal hypoxia and hypoglycemia during late gestation.

Explanation:

An incomplete abortion occurs when the woman´s body expels only a portion of the pregnancy tissue. During an incomplete abortion, portions of the fetus, amniotic sac or placenta may be retained. Symptoms include an open cervix, cramping, and the discharging of blood and fetal matter.

Explanation:

The vaginal ring works by releasing etonogestrel and ethinyl estradiol intravaginally. Because it is not a barrier method of contraception, it does not protect against STDs. It is currently recommended that the ring be left in place for 3 weeks and then removed for 1 week so that withdrawal bleeding occurs. A new ring is then inserted. The vaginal ring has a lower incidence of breakthrough bleeding than levonorgestrel/ethinyl estradoil oral contraceptives. In a 1-year study, the majority of women who used the vaginal ring considered insertion and removal of the device easy, and 90% used the device correctly. If for some reason the ring is out of the vavgina for more than 3 hours, back-up contraception should be used until the device has been back in place for 7 days.

Explanation:

Treatment of premature labor with betamethasone or dexamethasone has been associated with up to a 65% reduction in necrotizing enterocolitis in the neonate. Weekly treatment is not generally accepted. Increasing reports of adverse consequences with repeated courses of treatment has caused most experts to recommend a single course of antenatal corticosteroids for women at risk of preterm birth at 24-34 weeks gestation.
Reported benefits of antenatal steroid therapy for preterm labor include reduced rates of intraventricular hemorrhage and persistent patent ductus arteriosus. Both neonatal mortality and the incidence of respiratory distress syndrome are also reduced.

Explanation:

Erythromycin is safe and effective for treatment of chlaymdial infection during pregnancy. Ciprofloxacin is not consistently effective and is contraindicated during pregnancy. Ofloxacin and doxycycline are effective, but are contraindicated in pregnancy.

Explanation:

When the just delivered fetal head retracts firmly against the perineum, shoulder dystocia is apparent. This is an obstetric emergency that requires appropriate assistance and a calm but timely approach to ensure a safe delivery, While all of the maneuvers described are steps in managing shoulder dystocia, the McRoberts maneuver by itself (maximal flexion and abduction of the maternal hips) relieves the impaction of the anterior shoulder against the maternal symphysis in a large percentage of cases, especially when combined with suprapubic pressure.

Explanation:

The HIV virus can be transmitted by unprotected sexual contact (vaginal, anal, or oral sex), sharing needles, transfused blood products, mother to newborn (30% risk), and occupational needle stick exposures. A relatively simple, accurate blood test that detects antibodies to HIV (ELISA test) is used to screen people for HIV infection. If the ELISA result is positive, it is confirmed with a more accurate test, usually the Western Blot. Both tests often are not positive in the first month or two after HIV infection because it takes the body that long to produce antibodies against the virus. This baby is definitely HIV positive, who most likely obtained the virus from her mother. Since the age is only 8 months it is unlikely that the child obtained the HIV through the other types of transmission (eg sexual contact, sharing needles). Since 1985 all blood products are tested for HIV before being given to others for transfusion.

Explanation:

Explanation:

There is no association between UTIs during pregnancy and any of the other conditions.

Explanation:

Explanation:

In most instances in which a married person seeks sterilization, the spouse´s consent is also needed. Such consent is not typically extended in cases of abortion. Convincing the patient to use alternative contraception is inappropriate because it ignores the patient´s will. Explaining that the chances of becoming pregnant are very low at her age is factually incorrect, especially considering that she just gave birth at age 45. Although patient confidentiality is important, not disclosing this patient´s desire for sterilization to her husband violates his autonomy with regard to having children in the future. Therefore, he must be involved in the decision making process.

Explanation:

The decision of whether to have a termination of pregnancy is a deeply personal one. This patient has just been notified that she is pregnant with a 10-week fetus. She is unsure whether she wants to keep her pregnancy or terminate it. In this setting, the most appropriate next step is to counsel the patient regarding her options or refer the patient for counseling. In a balanced way, the patient should be fully informed of all of her options including raising the child herself, placing the child up for adoption, and abortion. To notify the patient´s parents (choice B) is not appropriate. Such an act would violate the patient´s confidentiality. A 34-year-old woman is an adult and issues of parental notification do not apply. To notify the patient´s partner (choice C) is not appropriate.

This notification would also violate confidentiality. To schedule a termination of pregnancy (choice D) would not be appropriate. This patient has just informed the physician that she is unsure what she wants to do. To just go ahead and schedule the termination without proper counseling of the patient would not be a balanced or proper approach for the patient. To tell the patient that she is likely to have a miscarriage (choice E) is inappropriate. This patient may have a miscarriage, as might any patient with a first trimester pregnancy. However, once an intrauterine pregnancy with fetal cardiac activity is identified, the risk of miscarriage is approximately 10%. Therefore, she is most likely not to have a miscarriage.

Explanation:

Mothers who have not had chicken pox are at risk of developing the disease in pregnancy. Pregnant women tend to be affected much worse if they contract chicken pox. Also, if chicken pox is contracted before 28 weeks gestation there is the risk of fetal varicella syndrome (eye defects. hypoplasia of limbs and neurological defects). This woman has had a significant contact with chicken pox and the fact that her child has been with the infected child means that he may well now be about to develop chicken pox. Waiting is simply not a sensible option (A) as she is at risk of developing chicken pox herself and potentially developing fetal varicella syndrome. Although the mother thinks that she has never had chicken pox she may have had a previous subclinical or unknown childhood infection, so if site has antibodies no further action is necessary. Aciclovir can be used to treat chicken pox within 24 hours of the rash appearing so does not need to be started straight away (C). The appropriate management here is for VZIG to be administered (on consultation with the blood products laboratory as it may be in short supply) (D) if her antibody screen is negative. This situation will make mothers very anxious and they will want VZIG straight away, which is not appropriate as her antibodies will not be back yet (B). The Health Protection Agency advises that VZIG may be given within l0 days of exposure. Answer (E) is not appropriate as you are not taking any steps to find out whether this mother is at risk.

Explanation:

Listeria monocytogenes (C) can cause listeriosis and pregnant women are at particular risk as they are immunocompromised. It is a food- borne infection and can be present in unpasteurized cheese and pate. In pregnancy it can cause mid-trimester loss, early meconium and preterm labour. It typically presents as a flu-like illness. Toxoplasmosis (A) is caused by the parasite Toxoplasmosis gondii and characteristically is contracted via contact with cats and their faeces. CMV (B) is usually subclinical and 50-60 per cent of women in the UK are already immune having had exposure prior to pregnancy. It is not associated with food. Hepatitis E (D) is a non-chronic hepatitis transmitted by the faeco-oral route but it can have a fulminant course in pregnancy. Parvovirus B 19 (E) causes a facial rash called fifth disease/slapped cheek syndrome or erythema infectiosum. It has a respiratory droplet route of transmission.

Explanation:

Question Explanation:
The answer is A. Anaphylactic shock needs prompt recognition and administration of adrenaline. The diagnosis is clinical and CXR is not essential. The scenario does not support diagnosis of Pneumothorax that rules out options C and D. Fluids are not the best initial step.

Explanation:

This answer is A. A serum positive status for hepatitis B e antigen and the presence of viral DNA is associated with a very high risk of Perinatal transmission.