Intrapartum Care for Women with Existing Medical Conditions or Obstetric Complications and their Babies

1. Ms. Mariam Ahmed, primigravida, now 36 pregnancy in active labour. she was here to pay a visit to her sister as she delivered recently. She has been booked at her home country. You are suspecting mitral valve stenosis on examination. All are true regarding her except –

2. Ms. Fatima, 24-year-old is in her first pregnancy, is on warfarin for her mechanical mitral valve. Otherwise her pregnancy has been uneventful. She is now 34 weeks pregnant. Her cardiologist has advised to switch to LMWH if needed. Her consultant has decided to deliver her by 38 weeks. What is the ideal time to switch over to LMWH?

3. Ms. Fatima, 24-year-old is in her first pregnancy, and she is on warfarin for her mechanical aortic valve. Otherwise her pregnancy has been uneventful. She is now 33 weeks pregnant. Her cardiologist has advised to switch to LMWH if needed. Her consultant has decided to deliver her by 36 weeks because of IUGR. What is the ideal time to switch over to LMWH?

4. Ms. Fatima, 24-year-old is in her first pregnancy, she is on warfarin for her mechanical aortic valve. Otherwise her pregnancy has been uneventful. She is now 33 weeks pregnant. Her cardiologist has advised to switch to LMWH if needed. Her consultant has decided to deliver her by 36 weeks because of IUGR. Her labour was induced. All are true regarding managing anticoagulation except-

5. 34-year-old Mrs Hasina is 38 weeks pregnant with mechanical aortic valve and previous cesarean section. It was done for Cepahlo pelvic disproportion. She is on therapeutic low-molecular weight heparin as she had an episode of Deep vein thrombosis at 8weeks gestation. After discussion with MDT, she is for elective cesarean section after 2 days at 09: 00hrs.She is on therapeutic low-molecular weight heparin. All are true regarding advise of Anticoagulation except –

6. Mrs Hasina, 34-year-old is 38 weeks pregnant. With mechanical aortic valve, she is on therapeutic low-molecular weight heparin as she has a history of episode of Deep vein thrombosis at 10 weeks gestation. After discussion with MDT, she is for induction of labour today at 10:00hrs. She is on therapeutic low-molecular weight heparin. After admission now she is on un fractionated heparin. Her birth should be as close as to how many hours after stopping the infusion.

7. Ms. Fatima, 37weeks of pregnancy, she is on low-molecular weight heparin. Admitted in active labour. Her delivery time should be aimed for how many hours after last dose of low-molecular weight heparin.

8. Ms. Salma, 24-year-old is in her first pregnancy, she is on warfarin for her mechanical aortic valve. She is admitted with active labour at 19:00hrs. All are true regrading intrapartum care except –

9. Ms. Salma, 24-year-old is in her first pregnancy, she is on warfarin for her mechanical aortic valve. She is admitted with active labour at 19:00hrs. She delivered by vacuum at 06:00hrs next day. Regrading her postpartum review –

10. All of the following woman needs to be offered Elective cesarean birth, except

11. For the women with following heart disease, intrapartum fluid balance is critical to cardiac function. Except –

12. Ms Tina, 26year old, is been diagnosed with hypertrophied cardiomyopathy. She is been admitted with active labour. You are worried about her developing heart failure. All of the following signs are suggestive of Heart failure except-

13. Ms. Sweetly, 28year old, is been diagnosed with hypertrophied cardiomyopathy. She is been admitted with active labour. She complains off easy fatiguability, breathlessness. She developed pale, sweaty, agitated with cool peripheries with tachycardia, hypotension. You suspect cardiac failure. All are the initial investigation to confirm heart failure except

14. Mrs. Patel, primigravida was started with prophylactic low-molecular-weight heparin at 30 weeks as her VTE assessment score was more than 3. Now she is 38 weeks admitted in active labour at 09:00hrs and she is requesting for epidural analgesia, she has taken last dose of heparin yesterday at 22:00hrs. All are true except-

15. Ms. Richa, 24-year-old is primigravida, 38weeks in active labor, she is mosaic Turner syndrome conceived by IVF. she has a coarctation of aorta with size is 27 cm/m². First line of uterotonic is –

16. A 40-year-old, Mrs Raksha, is primigravida with 39 weeks pregnancy. She is known case of mild intermittent asthma on inhalational steroids. All are true regarding Intrapartum Care of her except-