Obstetrics and Gynaecology Flashcards

A pregnant woman at 16 weeks gestation has a quadruple screen showing elevated AFP, low oestradiol, elevated beta-hCG, and elevated inhibin A. What is the most likely associated condition?

Answer: Down syndrome (trisomy 21)

In the quadruple screen for Down syndrome: AFP is low, unconjugated oestriol (uE3) is low, beta-hCG is elevated, and inhibin A is elevated. Note: In neural tube defects, AFP is elevated. The pattern described most closely matches Down syndrome screening with the elevated hCG and inhibin A being key markers.

A woman at 38 weeks gestation presents in labour. On vaginal examination, the umbilical cord is palpated below the presenting part. CTG shows variable decelerations. What is the immediate management?

Answer: Emergency caesarean section with cord elevation

Cord prolapse is an obstetric emergency. Immediate management includes elevating the presenting part manually to relieve cord compression, filling the bladder to elevate the fetal head, and emergency caesarean section. The patient should be placed in knee-chest or Trendelenburg position.

A 25-year-old woman presents with primary amenorrhoea, absent breast development, and a karyotype of 46,XY. Ultrasound shows absent uterus and testes in the inguinal canals. What is the most likely diagnosis?

Answer: Complete androgen insensitivity syndrome

Complete androgen insensitivity syndrome (CAIS) presents in 46,XY individuals as phenotypically female with primary amenorrhoea, absent breast development or breast development without pubic hair, absent uterus, and inguinal/abdominal testes due to complete resistance to androgens.

A diabetic mother delivers a macrosomic baby. During delivery, the fetal head delivers but the shoulders do not. What is this obstetric emergency called?

Answer: Shoulder dystocia

Shoulder dystocia occurs when the fetal shoulders become impacted behind the maternal symphysis pubis after delivery of the head. It is more common with fetal macrosomia and maternal diabetes. The McRoberts manoeuvre is the first-line intervention.

A 20-year-old woman presents with hirsutism, acne, oligomenorrhoea, and a BMI of 32. Ultrasound shows polycystic ovaries. What is the first-line management for menstrual irregularity?

Answer: Combined oral contraceptive pill

Combined oral contraceptive pills (COCPs) are first-line for managing menstrual irregularity and hyperandrogenism (hirsutism, acne) in PCOS when fertility is not desired. They regulate cycles, reduce androgens, and protect the endometrium from hyperplasia.

What is the most common type of ovarian cyst in women of reproductive age?

Answer: Functional (follicular) cyst

Functional (follicular) cysts are the most common ovarian cysts in reproductive-age women. They result from failure of a dominant follicle to rupture or regress. Most resolve spontaneously within 2-3 menstrual cycles without intervention.