Postpartum Problems Extra questions Batch B – MCQ

1. A healthy 34-year-old low-risk primigravida is referred to the obstetric antenatal clinic by her midwife at the woman’s request to discuss the management of the third stage of labour. Her antenatal group has advised her to have physiological management of the third stage of

labour to improve bonding with her baby. T ey suggest that, as long as she delivers in a quiet room, her own endogenous oxytocin will work well and, as she is ‘low risk’; her chance of postpartum haemorrhage will be no higher than if she were to have an active management of the third stage. T e woman asks you for your advice and rationale for this regarding management of her third stage of labour.

Which is the best advice?

2. A 32-year-old low-risk primigravida presents with contractions at 26+0 weeks’ gestation. On examination the cervix is 5 cm dilated. She is admitted, steroids are given and a magnesium sulphate infusion is commenced. She is anxious and is keen to know a very approximate prognosis for her fetus. Approximately what percentage of live births at 26 weeks’ gestation will go on to survive without disability?

3. A 33-year-old primigravida with asthma delivers a live infant at term. T ere was no meconium. T e infant makes no spontaneous attempt at breathing and is oppy. It is dried, covered and assessed. Five in ation breaths are performed. T ere is good chest movement on in ation. T e neonate is then reassessed: there is a heart rate of around 50 bpm although still no breathing. Senior assistance is summoned and en route.

What is the next immediate step?

4. A 34-year-old primigravida has a water birth. T ere is signi cant perineal trauma. On examination the external anal sphincter is completely severed, as is the internal anal sphincter, although the rectal mucosa is intact.

Whatclassi cationofperinealtearisthis?

5. A 35-year-old now para 1 attends for perineal review a er an episiotomy wound infection 1 week postdelivery. All has healed well. She has had di culties with a variety of contraceptive methods she has tried over a number of years and is keen to rely on lactational amenorrhoea. She asks about its e cacy. If a mother is amenorrhoeic, is less than 6 months postnatal and is exclusively breast ,howe effective is lactational amenorrhea as a method of contraception?

6. A 25-year-old para 5 is due to get a LNG-IUS inserted 4 weeks post caesarean section. She defaults the appointment due to child care, but attends 3 weeks later (7 weeks postnatally). She is formula feeding her infant. She remains amenorrhoeic and had sexual intercourse with her husband 2 weeks previously, but has not since because it was too uncomfortable. A pregnancy test is negative. She is very keen for contraception, ideally with LNG-IUS, but does not want a progesterone implant. What would be the best management?

7. A 37-year-old para 1 had signi cant gestational hypertension in her last few weeks of antenatal care. Postnatally the BP has not been under control despite maximum dose labetalol. She su ered intolerable side effects from nifedipine and is therefore commenced on an ACE inhibitor. She is breast feeding and is keen for something safe for her infant.

Which of these ACE inhibitors has the most infant safety data in breast feeding?