Early pregnancy Flashcards
(45 cards)
You are performing a laparotomy for a ruptured right ectopic pregnancy in a 17 yo. A 10cm right ovarian cyst is noted. Left ovary appears normal. The most appropriate surgical procedure is:
A - R salpingo-oophorectomy
B - Aspiration of cyst only
C - R ovarian cystectomy
D - Cystectomy and wedge resection of L ovary
E - Oophorectomy with wedge resection of the L ovary
C - R ovarian cystectomy
O
A woman has two 23 week pregnancy losses due to a uterine septum. Which of the following is most appropriate advice?
A - metroplasty B - expectant management C - she will carry the next pregnancy longer D - against pregnancy E - hysteroscopic removal of septum
E - hysteroscopic removal of septum
I think B as similar worded RANZCOG Q says conservative/expectant - 2020 Cochrane review suggests septum resection may not improve pregnancy outcomes
Factors that are associated with incompetent cervix include each of the following EXCEPT
A - in utero DES exposure
B - cervical cone biopsy
C - Cervical infection
D- Cervical laceration
C - Cervical infection
O
Most common time for subseptate uterus to abort?
A - 8-14 weeks
B - 12-16 weeks
C - 14-18 weeks
D - 18-22 weeks
A - 8-14 weeks
44% risk of first trimester miscarriage
PTB 25% rate
Regarding ectopics:
A - continuing US and BHCG delays intervention and leads to greater risk of rupture
B - recurrence risk about 10%
C - better chance of subsequent live birth with salpingostomy vs salpingectomy
B - recurrence risk about 10%
- What is the MINIMUM MSD for the diagnosis of a blighted ovum (anembryonic pregnancy)
a. 15mm
b. 20mm
c. 25mm
d. 30mm
c. 25mm
O
Official answer used to be 20mm but criteria updated since
A patient who previously had a pregnancy terminated at 18 weeks for a neural tube defect consults you regarding the likelihood of recurrence of this condition. You advise her that the risk of recurrence is
a. 1/4
b. 1/25
c. 1/100
d. 1/250
b. 1/25
O
The risk of recurrence for isolated NTDs is approximately 5% with one affected sibling
With two affected siblings, the risk is approximately 10%
US: 5.5 per 10,000 live births
Chromosome mosaicism is detected at CVS performed for advanced maternal age. As a NEXT STEP you would recommend
a. A repeat of the CVS
b. An amniocentesis
c. Consideration of termination of pregnancy
d. No further action
b. An amniocentesis
O
Unable to exclude confined placental mosaicism
The MOST COMMON clinical presentation of women with a Hydatidiform mole is
a. Abnormal bleeding
b. Hyperemesis
c. Preeclampsia
d. Large for dates uterus
a. Abnormal bleeding
O
A 35yo G1P0 has a second trimester maternal serum screen (MSST2) arranged by her GP, which is increased risk for Down syndrome. What would you do FIRST?
a. Arrange CVS to karyotype
b. Arrange amniocentesis to karyotype
c. Arrange USS to check gestational age of fetus
d. Arrange a TOP
e. Arrange contact with a Down syndrome support group in case she wishes to continue the pregnancy
c. Arrange USS to check gestational age of fetus
O
MSS2
Quadruple test = oestradiol, inhibin A, AFP, HCG
Can be done 15-20 weeks
Sensitivity 75%, specificity 95%
A 20yo woman is seen in the first trimester at 10 weeks. Her last child was born with a closed spina bifida. Which is true?
a. The risk of NTD in this pregnancy is 10 percent
b. Chorionic villus sampling is indicated
c. Amniocentesis is indicated at 15 -16 weeks
d. She should start folic acid now
e. Ultrasound exam is indicated at 11-12 weeks
e. Ultrasound is indicated at 11-12 weeks
O
A 40yo primagravida books at 10 weeks. Which is MOST CORRECT
a. The chance of Down syndrome is 3%
b. The chance of any chromosomal abnormality at CVS is 4%
c. The chance of NTD is 1%
d. The chance of miscarriage following amniocentesis at 15 weeks is 2%
b. The chance of any chromosomal abnormality at CVS is 4%
Chance of NTD 2-4%
40y - 1 in 100 risk of Down syndrome
At routine AN screening, a woman from Nauru has a negative RPR and positive TPHA. The most likely explanation is
a. The patient has early syphilis
b. The patient has late latent syphilis
c. The result is false positive
d. The patient has been treated for syphilis in the past
d. The patient has been treated for syphilis in the past
You are called to the emergency room for a patient with severe abdominal pain, vaginal bleeding, hypotensive and tachycardic. She has bicornuate uterus, positive urine pregnancy test 2 weeks ago. USS shows empty uterus and large adnexal mass. You instruct the ER doctor to
a. Schedule patient for laparoscopy and probable linear salpingostomy
b. Order FBC and LFT in preparation for methotrexate
c. Not make any decisions until you arrive in half an hour
d. Begin scheduling laparoscopy with probable laparotomy
d. Begin scheduling laparoscopy with probable laparotomy
O
A woman had a CXR and was found to be 16 weeks pregnant. She asks about the evidence of potential harm from diagnostic radiography on the fetus. You tell her
a. There is no association with proven detrimental effects
b. There is a small increase in childhood malignancy
c. There is a small increase in fetal chromosomal damage
d. There is a small increase in growth restriction
b. There is a small increase in childhood malignancy
Very small potential risk
O
All of the following statements about partial molar pregnancy are true except
a. The karyotype is usually triploid
b. Beta HCG follow up is indicated after evacuation
c. Progression to choriocarcinoma doesn’t occur, although there may be persistent trophoblastic disease after evacuation
d. Early pre eclampsia is more common in patients with a partial mole than a normal pregnancy
c. Progression to choriocarcinoma doesn’t occur, although there may be persistent trophoblastic disease after evacuation
O
Which is the smallest fetal pole that a sonographer could be confident in diagnosing a missed miscarriage on transvaginal scan because of the absence of cardiac activity?
a. 7mm
b. 9mm
c. 11mm
d. 13mm
a. 7mm
O
The most common fetal chromosome abnormality observed in spontaneous miscarriages is
a. Autosomal trisomy
b. Triploidy
c. Sex chromosome abnormality
d. Chromosomal translocation
a. Autosomal trisomy
O
Which one of the following statements about spontaneous miscarriage is CORRECT?
A. The incidence of spontaneous abortion is increased in pregnancies if the woman is >40years old
B. Among chromosomally abnormal spontaneous abortuses, the most common chromosomal abnormality is triploidy
C. In utero exposure to diethylstilboestrol (DES) increases a woman’s risk of many pregnancy complications, but not spontaneous abortion
D. The karyotypic abnormalities in spontaneous abortuses are similar to those in liveborn neonates
E. Most spontaneous abortions occur between 12-16 completed weeks of pregnancy
F. Bacterial vaginosis is associated with an increased risk of first trimester miscarriage
A. The incidence of spontaneous abortion is increased in pregnancies if the woman is >40years old
O
Autosomal trisomy is the most common fetal chromosome abnormality observed in spontaneous miscarriages.
Autosomal trisomy 45%
Monosomy X 20-30%
Triploidy 15-20%
Tetraploidy 5%
A woman with hyperemesis in the first trimester of pregnancy has thyroid function tests which show reduced TSH, increased T4, and normal T3. This result is most likely to represent:
a. Hydatidiform mole causing thyrotoxicosis and hyperemesis
b. Thyrotoxic phase of autoimmune thyroiditis causing hyperemesis
c. Normal findings in early pregnancy
d. Graves disease (thyrotoxicosis) causing hyperemesis
c. Normal findings in early pregnancy
O
Which of the following carries the HIGHEST relative risk of ectopic pregnancy if the woman accidentally becomes pregnant?
A. Condoms
B. Diaphragm
C. Combination oral contraceptive pills
D. Progestogen-only pills
D. Progestogen-only pills
O
A 55yo woman seeks your advice regarding exposure to DES. She used DES for the first 4 months during both of her pregnancies. Her daughter is 30 and her son is 28. She is concerned about the risks to herself and her children. All of the following statements are true except:
a - her daughter’s fertility may be impaired due to uterine anomalies
b - the risk of her daughter developing clear cell adenocarcinoma of the vagina is 1%, and increases with time.
c - her daughter’s risk of cervical and vaginal dysplasia is doubled
d - her son has an increased risk of developmental genital tract abnormalities
e - the woman herself is probably at increased risk of breast cancer
b - the risk of her daughter developing clear cell adenocarcinoma of the vagina is 1%, and increases with time
O
The risk is present and historically thought higher in younger years, now thought risk is likely lifelong but not necessarily increasing with age.
Diethylstilboestrol (DES) is a synthetic oestrogen taken in 1940-80s to reduce risk of pregnancy complications (e.g. miscarriage). Interferes with reproductive and endocrine system.
Male offspring - increased risk of epipdidymal cysts, hypogonadism, undescended testes. No cancer risk (aside from separately if testes undescended). No infertility risk.
Female offspring - Significant uterine malformations - T shape. Higher rates of miscarriage but not birth defects. Higher amounts of cervical dysplasia but with appropriate monitoring, not squamous malignancy. Higher rates of vaginal and cervical clear cell adenocarcinoma.
DES users - Breast cancer risk increased by ~30%
https://ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women%27s%20Health/Statement%20and%20guidelines/Clinical-Obstetrics/Diethylstilboestrol-Exposure-in-Utero-(C-Obs-56)-Review-March-2021.pdf?ext=.pdf
A 34-year-old woman G7P0M5T1 presents for her first antenatal visit at 10 weeks with a viable singleton pregnancy. All her miscarriages were in the first trimester. She has a normal uterine configuration and is thrombophilia screen negative.
What would be the most appropriate initial preventative management for her recurrent miscarriages?
a. Cervical cerclage.
b. Maternal reassurance with intensive follow-up
c. Low dose aspirin
d. Low molecular weight heparin
b. Maternal reassurance with intensive follow-up
Wouldn’t give LDA or heparin without thrombophilia diagnosis
Evidence that maternal reassurance with intensive f/u improves LBR
Which of the following is most suggestive of an ectopic pregnancy?
a. Transabdominal ultrasound reveals no gestational sac; ß-hCG <4,000 mIU/mL
b. Transabdominal ultrasound reveals no gestational sac; ß-hCG >7,000 mIU/mL
c. Transvaginal ultrasound reveals no gestational sac; ß-hCG <600 mIU/mL
d. ß-hCG >7,000 mIU/mL, serum progesterone <40 mg/mL
b. Transabdominal ultrasound reveals no gestational sac; ß-hCG >7,000 mIU/mL
O
