Obstetrics

Question 10 (Sept 2019)

The recent Mothers and Babies: reducing risk through Audit and Confidential Enquiries across the UK (MBRRACE-UK) report was released in 2018.

a) What are the two commonest causes of direct maternal death (occurring within 42 days of the end pregnancy) in the latest Mothers and Babies: reducing risk through Audits and Confidential Enquiries

across the UK (MBRRACE-UK) report 2018? (2 marks)

b) What is the leading cause of indirect death in the latest MBRRACE-UK report 2018?(1 mark)

c) Amniotic fluid embolism (AFE) is a direct cause of maternal mortality. How does AFE present clinically? (8 marks)

d) What are the possible obstetric (3 marks) and non-obstetric (4 marks) differential diagnoses of AFE?

e) State two possible theories about the pathophysiology of AFE (2 marks)

Question 4 (March 2019)

A 28-year-old woman presents for an acute appendicectomy under GA – she is 22 weeks pregnant

a) List 5 risks to the foetus during anaesthesia (5 marks)

b) Outline 2 ways the risk to the foetus can be minimised pre-operatively (2 marks)

c) Outline 5 ways the risk to the foetus can be minimised intra-operatively (5 marks)

 

d) Outline 3 specific management decisions to do post-operatively (3 marks)

e) What additional preoperative and intraoperative steps would you take to ensure foetal safety if she is 27 weeks pregnant instead (5 marks)

Question 11 (Sept 2018)

 A primiparous patient with a BMI of 55 presents in the high risk anaesthetic antenatal assessment clinic at 34 weeks gestation. She is hoping to have a normal delivery.

a) Name 5 specific points you need to elicit from anaesthetic history and examination (5 marks)

b) Name 5 specific obstetric risks associated with a raised BMI in pregnancy (5 marks)

c) Explain 8 things you would communicate to the patient about the delivery i no C-section occurs (8 marks)

d) Outline 2 SPECIFIC things you would mention regards a C-section with respect to her BMI (2 marks)

Question 10 (March 2018)

 A 25 year old pregnant woman at 35 weeks gestation is admitted to labour ward with a blood pressure of 180/110mmHg. She is known to have pre-eclampsia and there is a plan to deliver her baby within the next 24 hours

a) What is the definition of pre-eclampsia (1 mark)

b) List 4 symptoms that this oman may complain of due to her pre-eclampsia (4 marks)

c) What are the important priorities in her management when she arrives on the labour ward? (10 marks)

d) A decision has been made to proceed to Caesarean section (CS) andthe patient insists on having a general anaesthetic. Explain 5 potential changes to ryou normal GA technique for CS due to her pre-eclampsia (5 marks)