1. What was your most stressful case during your training in a hospital?
Niech się każdy wysili i wymyśli co stresującego przeżył…
2. There are 3 patients in the waiting room on the obstetric clinic
a) what`s wrong with them? b) describe their syndroms.
Do wyboru, ale możecie sobie wymyślić swoje, co bardzo polecam J:
- first one is teenager, who want to initiate sexual contacts. She is healthy, has no syndroms. She wants a prescription for oral contraception.- second one is pregnant lady who is after date. She is waiting for KTG. No worrying syndromes. - third one is young lady, who suspects candidosa, she is having pruritus vulve; last week she was taking antibiotic because of bronchitis.- fourth one is pregnant – 22 week – she is waiting for USG. She is little nervous because she is 37 and it is her first baby, so she suspect something could be wrong.- fifth one is pregnant – 35 week; from yesterday evening her hands and feet are itchy, she could not sleep all the night because she was scratching. Her problem is pruritus gravidarum and probably it is caused by intrahepatic cholestasis.
3. What are the first syndroms of the pregnancy? Describe them.
· Amenorrhea
· Tender, swollen breasts
· Fatigue
· Slight vaginal bleeding or cramping
· Nusea with or without vomiting
· Food aversions or cravings
· Mood swings
· Headaches
· Constipation
· Raised basal body temperature
· bHCG in urine and blood - positive result of pregnancy test
4. How do you calculate EDD?
· basing on LMP (Negele’s role) – LMP +7 days – 3 months + 1 year
· basing on ovulation – ovulation date - 7 days – 3 months + 1 year
· basing on measurement of CRL and BPD under US in 1st trimester
5. What are the types of miscarrage?
1. An empty sac is a condition where the gestational sac develops normally, while the embryonic part of the pregnancy is either absent or stops growing very early. Other terms for this condition are blighted ovum and anembryonic pregnancy.
2. An inevitable abortion describes where the fetal heart beat is shown to have stopped and the cervix has already dilated open, but the fetus has yet to be expelled. This usually will progress to a complete abortion.
3. A complete abortion is when all products of conception have been expelled. Products of conception may include the trophoblast, chorionic villi, gestational sac, yolk sac, and fetal pole (embryo); or later in pregnancy the fetus, umbilical cord, placenta, amniotic fluid, and amniotic membrane.
4. An incomplete abortion occurs when tissue has been passed, but some remains in utero.
5. A missed abortion is when the embryo or fetus has died, but a miscarriage has not yet occurred. It is also referred to as delayed miscarriage.
6. A septic abortion occurs when the tissue from a missed or incomplete abortion becomes infected. The infection of the womb carries risk of spreading infection (septicaemia) and is a grave risk to the life of the woman.
7. Recurrent pregnancy loss (RPL) or recurrent miscarriage (medically termed habitual abortion) is the occurrence of three consecutive miscarriages.
6. What is the management of the ectopic pregnancy?
Early treatment of an ectopic pregnancy with the antimetabolite methotrexate has proven to be a viable alternative to surgical treatment. If administered early in the pregnancy, methotrexate can disrupt the growth of the developing embryo causing the cessation of pregnancy.
Surgical treatment
If hemorrhaging has already occurred, surgical intervention may be necessary if there is evidence of ongoing blood loss. Surgeons use laparoscopy or laparotomy to gain access to the pelvis and can either incise the affected fallopian and remove only the pregnancy (salpingostomy) or remove the affected tube with the pregnancy (salpingectomy).
7. Give examples of 3-5 congenital infections and briefly describe one of them.
1. T – Toxoplasmosis / Toxoplasma gondii
2. O – Other infections (Hepatitis B, Syphilis, Varicella-Zoster Virus, HIV, and Parvovirus B19)
3. R – Rubella
4. C – Cytomegalovirus
5. H – Herpes simplex virus
Rubella can cause congenital rubella syndrome in the newly born. The syndrome (CRS) follows intrauterine infection by Rubella virus and comprises cardiac, cerebral, ophthalmic and auditory defects. It may also cause prematurity, low birth weight, and neonatal thrombocytopenia, anaemia and hepatitis. The risk of major defects or organogenesis is highest for infection in the first trimester. CRS is the main reason a vaccine for rubella was developed. Many mothers who contract rubella within the first critical trimester either have a miscarriage or a still born baby. If the baby survives the infection, it can be born with severe heart disorders (PDA being the most common), blindness, deafness, or other life threatening organ disorders. The skin manifestations are called "blueberry muffin lesions."
8. Give examples of 3-5 chromosomal abnormalities and briefly describe one of them.
· Cri du chat, which is caused by the deletion of part of the short arm of chromosome 5. "Cri du chat" means "cry of the cat" in French, and the condition was so-named because affected babies make high-pitched cries that sound like those of a cat. Affected individuals have wide-set eyes, a small head and jaw, and are moderately to severely mentally retarded and very short.
· Wolf-Hirschhorn syndrome, which is caused by partial deletion of the short arm of chromosome 4. It is characterized by severe growth retardation and severe to profound mental retardation.
· Down's syndrome, usually is caused by an extra copy of chromosome 21 (trisomy 21). Characteristics include decreased muscle tone, stockier build, asymmetrical skull, slanting eyes and mild to moderate mental retardation.[41]
· Edwards syndrome, which is the second-most-common trisomy; Down syndrome is the most common. It is a trisomy of chromosome 18. Symptoms include mental and motor retardation and numerous congenital anomalies causing serious health problems. Ninety percent die in infancy; however, those that live past their first birthday usually are quite healthy thereafter. They have a characteristic clenched hands and overlapping fingers.
· Patau syndrome, also called D-Syndrome or trisomy-13. Symptoms are somewhat similar to those of trisomy-18, but they do not have the characteristic hand shape.
· Jacobsen syndrome, also called the terminal 11q deletion disorder. This is a very rare disorder. Those affected have normal intelligence or mild mental retardation, with poor expressive language skills. Most have a bleeding disorder called Paris-Trousseau syndrome.
· Klinefelter's syndrome (XXY). Men with Klinefelter syndrome are usually sterile, and tend to have longer arms and legs and to be taller than their peers. Boys with the syndrome are often shy and quiet, and have a higher incidence of speech delay and dyslexia. During puberty, without testosterone treatment, some of them may develop gynecomastia.
· Turner syndrome (X instead of XX or XY). In Turner syndrome, female sexual characteristics are present but underdeveloped. People with Turner syndrome often have a short stature, low hairline, abnormal eye features and bone development and a "caved-in" appearance to the chest.
· XYY syndrome. XYY boys are usually taller than their siblings. Like XXY boys and XXX girls, they are somewhat more likely to have learning difficulties.
· Triple-X syndrome (XXX). XXX girls tend to be tall and thin. They have a higher incidence of dyslexia.
9. What are the obstetrics procedures used for prenatal diagnosis?
· observation of fetus’s movements
· auscultation of FHR
· US
· KTG
· amniocentesis – amniotic fluid sampling
· CVS (chorionic villi sampling)
· Cordocentesis and FBS (fetal blood sampling)
· PAPPA test (Pregnancy-associated plasma protein A, pappalysin 1)
10. What are the main duties of a mid-wife?
* antepartum care and education, preparation for childbirth, brestfeeding and parenthood
* risk assessment, prevention and reduction
* physiological management of spontaneous normal vaginal birth
* postpartum care to mother and baby, including of medical help
* maintenance of all necessary equipment and supplies
* preparing documentation
11. What are the types of HT-definition?
· Essential hypertension indicates that no specific medical cause can be found to explain a patient's condition.
· Secondary hypertension indicates that the high blood pressure is a result of another condition, such as kidney disease or tumours.
· Gestational hypertension or pregnancy-induced hypertension is defined as the development of new arterial hypertension in a pregnant woman after 20 weeks gestation. Hypertension can arise before week 20 if the woman has multiple fetuses or a hydatidiform mole. There is no specific treatment, but is monitored closely to rapidly identify pre-eclampsia and its life-threatening complications (HELLP syndrome and eclampsia). Treatment options are limited, as many antihypertensives may negatively affect the fetus; methyldopa, hydralazine and labetalol are most commonly used for severe pregnancy hypertension.
12. How can you define IUGR?
IUGR – intra uterine growth restriction. It means that fetus does not grow properly. The growth is slower. Baby is small for gestational age.
13. Give examples and describe placental pathologies.
· Placenta accreta - an invasion of the myometrium which does not penetrate the entire thickness of the muscle
· Placenta increta occurs when the placenta further extends into the myometrium
· Placenta percreta, the worst form of the condition, is when the placenta penetrates the entire myometrium to the uterine serosa (invades through entire uterine wall). This variant can lead to the placenta attaching to other organs such as the rectum or bladder
· Placenta peaevia:
· Type I or low lying: The placenta encroaches the lower segment of the uterus but does not infringe on the cervical internal orficle.
· Type II or marginal: The placenta touches, but does not cover, the top of the cervix.
· Type III or partial: The placenta partially covers the top of the cervix.
· Type IV or complete: The placenta completely covers the top of the cervix.
· Placental abruption (also known as abruptio placentae) is a complication of pregnancy, wherein the placental lining has separated from the uterus of the mother. It is the most common cause of late pregnancy bleeding.
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