By Catherine Nelson-Piercy

Recognition of the significance of maternal medication is now mirrored within the content material of the MRCOG examination, middle education and better education in either obstetrics and drugs. This booklet ways obstetric medication from the viewpoint of actual sufferers and medical eventualities in addition to version solutions to examination questions. The ebook can be helpful for trainees and experts who are looking to ‘test themselves’.

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E) Most cases of tuberculosis (TB) in pregnancy are associated with HIV infection. Answers (a) (b) (c) (d) (e) T F F F F 34 OBSTETRIC MEDICINE: A PROBLEM-BASED APPROACH Explanation (a) The prevalence of TB in UK is rising. In most UK populations, TB is typically found in recently arrived immigrants from the Asian subcontinent or Africa. (b) Symptoms are often atypical or reported late, and the diagnosis can be challenging. Nonspecific abdominal or back pain, lymphadenopathy and respiratory symptoms should be considered seriously, especially in high-risk women.

A multiparous woman on an obstetric high-dependency unit, who presented with breathlessness 2 weeks after delivery by Caesarean section. Echocardiogram confirms the diagnosis of peripartum cardiomyopathy. 3. A 30 year old primiparous woman with a bioprosthetic aortic-valve replacement 20 years previously presents with breathlessness at 30 weeks’ gestation. 4. A 33 year old American is referred at 16 weeks’ gestation with a history of palpitations. She brings the results of previous investigations, which include an echocardiogram showing posterior movement of one mitral valve cusp during systole.

Haematuria would favour a diagnosis of SLE. 4. New-onset hypertension in the third trimester with new-onset proteinuria is most likely to be pre-eclampsia. 5. Pre-existing hypertension with renal impairment and proteinuria points to a diagnosis of underlying renal disease. This is most likely to be because of reflux nephropathy. SLE is also possible. 2 HEART SOUNDS AND MURMURS The following women are all found to have a heart murmur or added sound. Choose the most likely auscultatory abnormality from the list below: (a) (b) (c) (d) (e) (f) (g) Early diastolic murmur Mid-systolic click Ejection systolic murmur Pan-systolic murmur Late-systolic murmur Third heart sound Opening snap 2.

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