EBCOG Part 1-Maternal Medicine-Day 4(EMQ)

A. Start IV prophylactic unfractionated heparin (UFH)
B. Change to prophylactic IV UFH
C. Change to heparinoid danaparoid sodium
D. Change to LMWH
E. Start prophylactic LMWH
F. Start dalteparin
G. Monitor anti-Xa levels
H. Remove catheter 3 hrs after giving heparin
I. Remove catheter 8 hrs after giving last dose of heparin
J. Remove catheter 12 hrs after giving last dose of heparin
K. Remove catheter 24 hrs after giving last dose of heparin
L. Withhold heparin for 12 hrs before giving spinal anaesthesia
M. Withhold heparin 24 hrs before giving SA
N. Withhold heparin for 24 hrs before giving EA
O. Withhold heparin for 48 hrs before giving EA.

1.43 year old,P3,presents to EPAU at 12 weeks of gestation with mild vaginal bleeding.She gives h/o unprovoked DVT 1 year prior to this pregnancy & was treated with warfarin for 6 mths.Currently the GP has started her on LDA in view of a previous h/o pre-eclampsia.

2. 40 year old P2,presents to obstetric day assessment unit at 28 weeks of gestation with reduced fetal movements.CTG is normal.Her notes say she had DVT at 20 weeks of gestation during her current pregnancy & she is on 80 mg LMWH twice daily.Her booking blood results were normal.However her recent blood test reveals a platelet count of 60 X 109/1.

3.P1,30 yrs old delivered 8 hrs ago.she gives h/o previous thrombophilia.she delivered by CS & had a massive PPH & her current Hb is 8 g/dl.The midwife informs you about minimal soakage of the CS wound dressing.

4. 33 year old P3,is seen by the SHO in the postnatal ward.She had a CS for failure to progress & is on epidural for pain relief for the past 4 hrs following the CS.The midwife has just given her the first dose of prophylactic LMWH postnatally.

5. A 38 year old,G3P2,is admitted for an elective CS for breech presentation.She had a pulmonary embolism during this pregnancy & has been on a therapeutic dose of LMWH for the past 3 mths.She took her last dose just before coming into the ward.

A.Acquired autoimmune disorder associated with vascular thrombotic events, pregnancy failure and clinical manifestations involving other organs, such as the heart, skin and central nervous system
B.During pregnancy, the risks are mostly cardiovascular (especially, that of aortic dissection)
C.Most likely to occur during pregnancy or in the immediate postpartum period with differential diagnosis including PET/HELLP/ AFLP/TTP 
D.Fetal manifestations of passively acquired autoimmunity
E.Approximately 80–90% of patients may be rheumatoid factor-positive
F.Risk of postpartum haemorrhage due to poor uterine tone and arterial fragility
G,Vasospasm compromising perfusion of peripheral areas of circulation, especially fingers and toes can result in severe pain due to ischaemia
H.Involvement in the form of oesophageal constriction is the most common clinical feature
I.none of the above


6.Neonatal lupus

7.Lupus flare

8. Rheumatoid arthritis

9. Scleroderma

10.Ehlers-Danlos syndrome

11.APLS

12.Marfan syndrome

13.Raynaud’s phenomenon