Obstetric Medicine Module 2

In a 23-year-old female with Crohns disease who becomes pregnant, which of the following medications is most likely to result in an adverse foetal outcome?

A pregnant woman develops an infectious mononucleosis-like illness at 12 weeks gestation, with fever, sore throat, malaise and lymphadenopathy. She is proven serologically to have acute cytomegalovirus (CMV) infection.

What is the most likely immediate outcome for the baby?

As part of the body’s adaptation to pregnancy, which of the following parameter decreases during pregnancy?

Which of the following carries the highest risk for pre-eclampsia?

Which of the following statement is FALSE regarding smoking and preeclampsia?

Which of the following is beneficial in the prevention of pre eclampsia?

Which of the following is the most common cause of thyrotoxicosis in women of reproductive years?

The presence of which of the following antibody is associated with increased risk of fetal loss in pregnancy?

Thromboembolic events such as pulmonary embolism is most likely to occur at which stage of pregnancy?

Which of the following familial thrombophilia is asssociated with the highest risk of venous thromboembolism in pregnancy?

A 30-year-old eight-month pregnant woman, on bed rest because of pregnancy-induced hypertension, presented with acute dyspnoea and left-sided pleuritic chest pain. Physical examination showed: temperature 37.2C
pulse 118/minute respiratory rate 28/minute moderate tenderness over the right calf positive foetal heart sounds
ECG shows sinus tachycardia. Arterial blood gases on room air are PaO2 66 mmHg, PaCO2 28 mmHg and pH of 7.51. A chest X-ray shows minimal shadowing at the left base with obliteration of the left costophrenic angle. A duplex scan of the legs shows a non-occlusive thrombus in the left common femoral vein. A CTPA confirms the presence of pulmonary embolism. She received treatment with therapeutic dose of low molecular weight heparin.

Which one of the following should be the next step in the management of this patient postpartum (considering that she will be breastfeeding her baby)?

Which one of the following is not consistent with the normal physiological changes seen in pregnancy?

Laura is a 29-year-old woman born in Hong Kong who is now living in the New Zealand. She is 28 weeks pregnant and has recently tested positive for hepatitis B surface antigen. This is her second pregnancy. Her firstborn tested positive for HBV.

She feels entirely well.

Her hepatitis B virus (HBV) DNA level is 10⁸ copies/mL. Her aspartate aminotransferase level is 29 U/L and her alanine aminotransferase level is 20 U/L.

Besides giving the baby immunoprophylaxis at the time of birth, how would you manage her HBV infection to further minimize the risk of maternal-fetal transmission?

To an infant born to a chronic Hepatitis B carrier, what is the best way to prevent vertical transmission of Hepatitis B to the baby?

Which one of the following modes of transmission of hepatitis B virus (HBV) is most likely to result in chronic carrier status in the non immunised recipient? 

In pregnant mothers who are chronic carriers of Hepatitis B, the presence of which one of the following serology carries the greatest risk of vertical transmission of Hepatitis B to the newborn infant?

In pregnant patients, which clinical feature is most likely to be associated with acute fatty liver of pregnancy as opposed to HELLP syndrome?

When is acute fatty liver of pregnancy most likely to present?

Most medications used for the management of inflammatory bowel disease are safe in pregnancy except?

What is the most common cause of direct maternal death in Australia?

The following are associated with increased risk of thromboembolism in pregnancy except?

A pregnant patient is noted to have moderate hypertension.

Treatment with anti-hypertensive will reduce the risk of all the following except?

A pregnant patient with suspected pulmonary embolism is investigated with a CTPA.

Following this, she is at risk of developing which type of malignancy?

A 29-year-old primigravida at 29 weeks gestation presents with drowsiness and right upper quadrant pain and vomiting. Physical examination reveals poor peripheral perfusion, a pulse rate of 96/minute and blood pressure of 170/110 mmHg. There is tenderness in the right upper quadrant and brisk reflexes.

Liver function tests show:

• bilirubin 14 μmol/L [2-14]
• alkaline phosphatase (ALP) 200 U/L [40-130]
• gamma glutamyltranspeptidase (GGT) 15 U/L [1-35]
• aspartate transaminase (AST) 630 U/L [8-35]
• alanine transaminase (ALT) 550 U/L [8-40]
• urine dipstick 1+ proteinuria Serum creatinine is 150

Which of the following is the most appropriate intervention?

Which of the following liver function parameter increases during normal pregnancy?

A 34-week pregnant patient presents to emergency with epigastric and right upper quadrant pain and nausea. Blood pressure is 140/85 mmHg.

Relevant blood work shows:

• Aspartate transaminase (AST) 150 IU/L [15 – 45 IU/L]
• Prothrombin Time 14 secs [11 – 15 secs] Bilirubin 25 μmol/L [14 – 22 μmol/L]
• Platelets 75 x 109/L [150 – 400 x 109/L]
• Haemoglobin (Hb) 90 g/L [110 – 130 g/L]

Transabdominal ultrasound reveals sludge in the gall bladder.

The most appropriate management is:

A 34-week pregnant patient presents to emergency with epigastric and right upper quadrant pain and nausea. Blood pressure is 140/85 mmHg.

Relevant blood work shows:

• Aspartate transaminase (AST) 150 IU/L [15 – 45 IU/L]
• Prothrombin Time 14 secs [11 – 15 secs]
• Bilirubin 25 μmol/L [14 – 22 μmol/L]
• Platelets 75 x 109/L [150 – 400 x 109/L]
• Haemoglobin (Hb) 90 g/L [110 – 130 g/L]
• Serum creatinine and uric acid normal.
• Serum glucose normal

Transabdominal ultrasound reveals sludge in the gall bladder.

What is the most likely diagnosis?

A 34-week pregnant patient presents to emergency with whole body itch and jaundice.Blood pressure is 140/85 mmHg.

Relevant blood work shows:

• ALP and GGT mildly elevated.
• Bilirubin 25 μmol/L [14 – 22 μmol/L]
• Haemoglobin (Hb) 110 g/L [110 – 130 g/L]
• Serum creatinine and uric acid normal.
• Serum glucose normal
• Serum bile acid elevated

What is the most appropriate treatment? 

A 23-year-old woman, during her first pregnancy, has a blood pressure of 170/115 mmHg (on repeated measurements) at 32 weeks gestation. Her previous blood pressures have been 125/75 mmHg or less. Her serum electrolytes, urea and creatinine are normal but her serum uric acid is 0.38 mmol/L [0.09-0.36]. Urinalysis shows proteinuria +++, but no evidence of blood or glucose. Liver function tests and full blood count are normal.

Which one of the following is the most appropriate initial treatment?

A drug is described as Pregnancy category C.

What is the best description of the drug’s safety profile in this category?

Which of the following does not have any role in the management of HELLP syndrome?

When considering the use of medication in pregnancy, which category of medication is an absolute contraindication during pregnancy?