Title OB HEPATITIS July 2025 (for distribution).pdf ✅

20th OBGYN ORAL EXAM REVIEW ORAL SIMULATION 1 University of the Philippines-Manila, College of Medicine Philippine General Hospital Department of Obstetrics and Gynecology ORAL SIMULATION EXAM JULY 2025 EXAMINER’S COPY (HEPATITIS IN PREGNANCY) Name of Examinee: Name of Examiner: LK is a 28-year-old G1P0 at 26 weeks gestation who presents for her first prenatal visit. She recently relocated from the province without prior consultations. She reports generally good health, denies intravenous drug use, and has no known history of liver disease or jaundice. She works at a salon, and is the 4th of 6 siblings. Her partner is a tricycle driver who has had 3 previous relationships. She lives with her partner and 2 younger siblings. ANSWER/ POINT SCORE What initial tests will you request for this patient? (2 POINTS) Give at least 8 (0.25pts each) 1) CBC 2) Urine CS 3) Blood typing with Rh 4) 75g OGTT 5) Pelvic ultrasound / Congenital anomaly scan 6) HbsAG 7) HIV screening 8) RPR / VDRL 9) Rubella IgG 10) Papsmear
20th OBGYN ORAL EXAM REVIEW ORAL SIMULATION 2 Initial prenatal labs reveal the following: CBC: Hgb 120 Hct 0.36 WBC 8900 Platelet 264 Urine CS: E.coli 10,000 CFU/ml Blood type A+ 75g OGTT: 89-125-115 HIV Screening: Non reactive HbsAg: Reactive RPR: Non reactive CAS: PU 25 weeks by sonar aging, breech, 650g placenta anterior gr 1-2 high lying, adequate AFI, no gross anomalies seen Patient came back at 29 weeks for follow-up, and labs reveal the following Hepatitis B serology results: • HBsAg (Hepatitis B surface antigen): Positive • Anti-HBs (Hepatitis B surface antibody): Negative • Anti-HBc total (Hepatitis B core antibody, total): Positive • HBeAg (Hepatitis B e-antigen): Positive • HBV DNA quantitative PCR: 2.5 x 107 IU/mL SCORE What is the initial diagnosis? (1 POINT) ANSWER: ● G1P0 Pregnancy uterine 26 weeks age of gestation, breech not in labor, (0.5 pt) ● Hepatitis B virus infection, unknown infectivity (0.5pt) What other diagnostics will you request for? Give at least 8 (0.25 pt each) (2 POINTS) GIVE AT LEAST 8 (0.25 POINT EACH) ● HBeAg ● Anti-HBs ● Anti-HBc ● Anti HCV ● HBV DNA PCR (viral load) ● AST ● ALT ● Bilirubin ● whole abdominal ultrasound
20th OBGYN ORAL EXAM REVIEW ORAL SIMULATION 3 Further workup reveals normal liver transaminases (ALT, AST), normal bilirubin, and no signs of decompensated liver disease. SCORE What is your impression? (2 POINTS) G1P0 Pregnancy Uterine 29 weeks AOG, Breech not in labor Chronic Hepatitis B virus infection, high infectivity. How will you manage this patient? (0.625 POINT) (0.125 each) • Advise antiviral treatment with Tenofovir • Monitor liver function tests • Monitor creatinine levels • Advise household screening • Administer Hepatitis B vaccine and immunoglobulin to the baby within 12h of birth How will you advise this patient regarding mode of delivery and breastfeeding? (1.5 POINTS) (0.75 pt each) Patient may undergo vaginal delivery unless there are obstetric indications such as malpresentation. Patient may breastfeed for as long as there are no cuts or breaks in the skin around the nipple/areola TOTAL: 9