EBCOG Part 1 2 Weeks Crash Course Labour and Delivery and Postpartum problems Day 2

A. Do nothing
B. FFP 12-15ml/kg
C. Platelet transfusion
D. Cryoprecipitate
E. Packed red cell transfusion
F. O negative Kell negative blood
G. Protamine sulphate
H. Fibrinogen concentrate
I. recombinant factor VIIA


Each of the following Options describes various woman presenting with postpartum haemorrhage.For each patient select the single most appropriate management option from the list


1.Mrs.Anna , 34 year dole multiparous delivered normally had a Major atonic postpartum haemorrhage of 1200 ml ,bleeding stopped with Bakri ballon tamponade now bleeding settled and she is hemodynamically stable , 4th unit blood ongoing
Her Hb is 75g/L
Platelet count is 52 x10 9/L
Prothrombin time is more than 1.5times Normal
Fibrinogen is 1.8g dl

2.Mrs.Swati Patel delivered by forceps delivery had traumatic Postpartum haemorrhage  recognised late as had posterior fornix tear, quantified blood loss is 1500ml .no uterine atony. bleeding still present,

She is tachycardic and hypotensive

Started with packed red blood cells

Prothrombin time is 35seconds

APTT 50 seconds

What is next best blood product to be given .

3.A woman has a massive PPH and receives a transfusion of 18 units of red blood cells, 12 units of fresh frozen plasma, 5 units of platelets and 3 units of cryoprecipitate.

Her results are as follows

 Blood markers are

pH >7.2

platelet count 60

 APPT -45 seconds

 PT -20 seconds

At the time of hysterectomy .consultant decided to give this blood product

A. Amoxicillin
B. Benzylpenicillin
C. Cefuroxime
D. Clarithromycin
E. Clindamycin
F. Co-amoxiclav
G. Erythromycin
H. Gentamicin
I. Meropenem
J. Metronidazole
K. Piperacillin
L. Vancomycin
For each of the following clinical scenarios, select the single most appropriate choice of antibiotic based on the information provided. Each option may be chosen once, more than once or not at all.

4. A 26-year-old woman is diagnosed with severe pyelonephritis 2 days after a caesarean section. Culture of a midstream urine sample grows an extended- spectrum β-lactamase (ESBL)-producing organism. She has no known allergies, and is given a single dose of gentamicin. What antibiotic should also be commenced?

5.A 24-year-old woman is 6 days postpartum. She complains of having had a sore throat for the last 2 days, and culture of a throat swab has confirmed the presence of group A Streptococcus. It is suspected that she is developing toxic shock syndrome. Which antibiotic should be used in order to switch off exotoxin production?

6.A 32-year-old woman develops sepsis 2 days after a caesarean section. She is a nurse and is known to carry methicillin-resistant Staphylococcus aureus (MRSA). Which antibiotic should be used to ensure that MRSA is treated effectively?

A. Caesarean section under general anaesthetic
B. Caesarean section under spinal anaesthetic
C. Consider aspirin and prophylactic LMWH during antennal period
D. Consider prophylactic LMWH for 10 days after delivery
E. Prophylactic high dose LMWH during antennal period and 6 weeks postpartum
F. Thrombophilia testing is recommended


7.A 21-year-old woman at 1 day post normal delivery developed acute shortness of breath, tachypnoea, tachycardia, hypotension and chest pain. A CT angiogram pulmonary reported a massive pulmonary embolism occluding the right pulmonary trunk with very little blood supply to the right lung. This patient underwent an open embolectomy of the pulmonary artery. At discharge, what would you advise?

8.A 31-year-old primigravida presents with a known antithrombin deficiency and a history of previous thromboembolic event. She attends the antenatal clinic at 10 weeks gestation for booking. How should she be managed?

9.A 28-year-old P0+4 has a history of recurrent spontaneous early miscarriages. Her older sister had thromboses during pregnancy. She attends the early pregnancy unit with amenorrhoea of 6 weeks' duration with vaginal spotting. What would be the next step in her management?

10.A 32-year-old woman with a BMI of 42 had a normal vaginal delivery.

11.A 26-year-old gravida 2, para 1 is on prophylactic LMWH for protein S deficiency. She had developed deep vein thrombosis in her last pregnancy 3 years ago. She self administers LMWH at midday every day. She attends the maternity assessment unit at 36+3 weeks at 4 p.m. with painful contractions and is found to be 1 cm dilated. At 5 p.m. the obstetric team decide to deliver her by caesarean section for suspicious cardiotocograph (CTG).

A. vaginal delivery 39 wks ,
B.episiotomy
C.episiotomy at time labour
D.Episiotomy prior to crowning
E.offer .Elective LSCS at 39 weeks
F.Emergency LSCS
G.Allow vagianl dleivery

The following scenarios deal with women who had third degree tear. Choose the appropriate management options

12.Ms. Suzy, second gravida at 36 weeks with first delivery complicated by Third degree tear. Endoanal ultrasound shows defect
advised for her

13.Ms. Ruby in her third pregnancy at 34 weeks ,she Has had fecal incontinence following her second delivery

14.Post 3rd degree repair never had follow up also having some incontinence directly came in labour 4-5 cms

A.Safer to deliver by cesarean section to reduce cardiovascular risks
B.Substitute the drug for a safe antihypertensive (methyl dopa/labetalol/nifedepine). Add aspirin 75 mg once viable pregnancy is confirmed
C.High maternal morbidity and mortality risk; and hence multidisciplinary care and hence discussion on the option of medical TOP
D.Commence aspirin 75 mg once daily, LMWH prophylactic dosage from 1st trimester
E.High maternal morbidity and mortality risk; and hence multidisciplinary care and hence discussion on the option of medical TOP
F.Needs GTT testing and steroid cover in labour
G.General measures to help in symptom control such as minimise exposure to cold, avoiding precipitating factors such as smoking and treatment with vasodilators such as nifedepine
H.Check for maternal Anti Ro/La Ab,
Each of the following scenarios describes a pregnant woman who has come to you for antenatal care with an underlying medical problem.

Choose the single most appropriate option for obstetric management.



15.26-year-old Jane is currently 6 weeks pregnant in her first pregnancy with lupus nephritis, and is taking captopril for treatment of her underlying kidney problem.

16.30-year-old Alison, P1, is currently 16 weeks pregnant. Her previous child COngenital heart bloom  needing pacemaker insertion.

17.Ms.Freya is 10 weeks pregnant had is known to have APLS, on a background of lupus, with previous recurrent miscarriage.

18.Mrs Kaur is a P2 38-year-old with scleroderma. She is currently 10 weeks pregnant ,but has severe pulmonary hypertension requiring her to be on positive pressure oxygen.

19.Lola is 16 weeks pregnant with a flare-up of psoriatic arthritis. She is on high-dose prednisolone.

20.Lucy is a primi at 18 weeks pregnant, and is known to have Raynaud's disease. She was previously on an illioprost infusion, but stopped after getting pregnant. She complains of severe pain and ulcers on her fingers and toes.

21.Carla is a P2 at 37 weeks of pregnancy, with Marfan disease. When a routine imaging is performed, an aortic root is noted to have increased in dimension from 3.5 mm to 7.0 mm.

A. Close surveillance and LMWH postnatally for 6weeks
B. Prophylactic antenatal LMWH plus postnatal for6weeks
C. Prophylactic antenatal enoxaparin sodium plus postnatal enoxaparin sodium for 3-5 days
D. Prophylactic LMWH in the first trimester
E. High prophylactic dose of antenatal enoxaparin sodium plus postnatal for 6 weeks
F. Conservative management
G. Start Prophylactic LMWH from 28 from now and PP for 6 weeks
H. Post partum LMWH for 10 days
I. Start Prophylactic LMWH from now and PP for 6 weeks
J. Only intermittent pneumatic compression
K. Early mobilisation, hydration



Above options show the various management options of VTE prophylaxis .
Please choose the appropriate option form above options .each option. And be chosen once more than once


22. G2P1 35-year-old, BMI of 32 kg/m2 is seen in the antenatal clinic for booking. She has conceived following a long period of subfertility through assisted conception. Ultra- sound scan had confirmed a di-chorionic, di-amniotic twin pregnancy. Admitted at 32 weeks with pre-ecclampsia. What is recommended as the best practice with regard to reducing maternal risk of VTE ?

23.Ms XY is 28-year-old G1 with a BMI of 55. She presents to the consultant-led ANC at 28 weeks with a fetal growth scan, which is normal. She is otherwise fit and well. She takes routine pregnancy supplements. In terms of VTE prophylaxis, which of the following is best suited to her?

24.A 25-year-old woman presents at 12 weeks gestation. Four years earlier she presented with a deep vein thrombosis after fracturing her femur and undergoing a major orthopaedic operation. Her thrombophilia screen result is negative, she has no family history of thrombosis and she has a body mass index of 23 kg/m. What thromboprophylaxis should be offered to this woman?

25.Ms XY is 28-year-old G1 with a BMI of 30. She presents to the consultant-led ANC at 28 weeks with a fetal growth scan, which is normal. She is otherwise fit and well. She takes routine pregnancy supplements. In terms of VTE prophylaxis, which of the following is best suited to her?