Obstetric Emergencies.
Where do ectopic pregnancies most often implant?
The vast majority implant in the Fallopian tubes, mainly at the Ampullary end.
What is the expected rise in BHCG in the first 4 weeks of pregnancy?
A decrease in BHCG almost certainly means a miscarriage.
A full term mother begins to deliver in the ED but the baby is stuck (shoulder dystocia). What is the first manoeuvre you should try?
The McRoberts manoeuvre is where you assist to get the woman to hyperflex her legs against her abdomen. This creates 1-2cm of extra room and allows delivery of the baby in up to 90% of cases. The Zavanelli manoeuvre is a last ditch attempt to push the babys head back up the vagina and then do a Caesarian section.
In the "developed world" the rate of maternal deaths is 12 in 100000 live births. Which country has 1360 in 100000 live births?
Interestingly the USA has a maternal mortality rate of 23.8 per 100,000 which put them the highest of 49 developed countries.
Who recently over turned "Roe vs Wade".
Roe vs Wade was a landmark 1971 decision that legalised abortion in the USA. It has recently been overturned by a Conservative dominated Supreme Court.
What is the biggest cause of maternal death worldwide?
The use of tranexamic acid in developing countries has made an improvement in the deaths from post partum haemorrhage in the last few years.
Which medication is most effective to treat eclamptic seizures?
MgSO4 is the drug of choice to both prevent seizures in patients with pre eclampsia and treat those who present with a seizure (eclampsia).
HELLP syndrome can occur in up to 1% of pregnancies in the third trimester. What does HELLP stand for?
HELLP syndrome is a life threatening condition usually associated with pre eclampsia.
Which of the following statements about eclampsia is incorrect?
It is a life threatening condition for both mother and baby. You will need to use MgS04 to treat the seizure and prevent further seizures. Labetalol IV 20 to 40mg is the initial drug of choice to treat the elevated BP. If not available IV Hydrallazine is a reasonable drug to start with. Technically of course you could be BHCG negative if the seizure occurs post partum.
The "Wandering womb" has been used over the centuries to explain many female maladies. Which of the following treatments has not been recommended at some stage in history?
I think lute playing would simply annoy any organ.