formative and wb

Question 1

young woman with BMI 18.5, she is pregnant and her baby is smaller than the 3rd centile for gestational age. She has had herpes in the past and was treated for chlamydia. What is the most likely cause of her baby being small?

Answer 1

Given the facts:

History of HSV and chlamydia are less likely to be direct causes here.
BMI is 18.5: while at the low end of normal, it alone is unlikely to cause severe FGR (<3rd centile).
No mention of pre-eclampsia or hypertensive disease.
In practice, the most common cause of FGR in a structurally normal fetus is placental insufficiency.

➡️ Most likely cause: placental insufficiency.

If congenital infection screening was done and is negative, this is even more likely.

Question 2

blood marker for a hyatidiform mole turned cancer

Answer 2

hCG levels are the gold standard for diagnosis, monitoring, and assessing the persistence or malignant transformation of a molar pregnancy.
Persistent elevated hCG levels after evacuation of a molar pregnancy indicate gestational trophoblastic neoplasia (GTN).

Question 3

is oxygen used in delivery

Answer 3

Indications:

Maternal hypoxia: If the mother shows clinical signs of hypoxia (e.g., cyanosis, low oxygen saturation).
Not routinely recommended just for non-reassuring CTG unless there is evidence of maternal hypoxia or another clinical need. NICE advises against routine oxygen use solely to improve fetal status.

Question 4

oxytocin indications in labour

Answer 4

Indications:

Delayed progress in labour:
In the first stage: If cervical dilatation is <2 cm in 4 hours in active labour.
In the second stage: If there is delayed descent after 1 hour of active pushing in nulliparous women (or 0.5 hours in multiparous women).
To correct uterine inertia (ineffective contractions).
Caution:
If CTG is abnormal, oxytocin should be used with care and only after correcting reversible causes of fetal compromise.

Question 5

FBC - fetal scalp blood sampling indications

Answer 5

Indications:

When the CTG is suspicious or pathological and there is uncertainty about fetal wellbeing.
Cervix must be ≥3 cm dilated and membranes ruptured.
Contraindications (where FBS should NOT be done):
Maternal infection (HIV, Hepatitis B/C, herpes).
Known bleeding disorders or fetal bleeding disorders (e.g., hemophilia).
Non-vertex presentations.
NICE recommends avoiding FBS if there is an acute event (e.g., cord prolapse, prolonged deceleration).

Question 6

electrode monitoring indications

Answer 6

Fetal Scalp Electrode Monitoring (FSE)
Indications:

Poor-quality external CTG: Difficulty in obtaining a reliable external fetal heart rate trace (e.g., maternal obesity, excessive maternal/fetal movements).
When continuous internal monitoring is needed for high-risk pregnancies.
To differentiate between maternal and fetal heart rate when the external trace is confusing.
Requires:
Cervix ≥2 cm dilated and ruptured membranes.
Contraindications:

Same as for FBS (infection risk, bleeding disorders).

Question 7

main risk if a mother contracts chickenpox at 38 weeks

Answer 7

Key points from NICE and RCOG (Green-top Guideline No. 13):

Greatest risk: When maternal chickenpox occurs from 7 days before to 2 days after delivery.
At 38 weeks, if the mother develops chickenpox and delivers within this high-risk window, the newborn may not receive protective maternal antibodies in time.
This puts the neonate at risk of:
Severe disseminated varicella (neonatal varicella infection)—potentially life-threatening.
🔑 Immediate management implications:

If the mother is within 7 days pre-delivery to 2 days post-delivery:
The newborn should receive Varicella-Zoster Immunoglobulin (VZIG) (or intravenous immunoglobulin if VZIG unavailable) as soon as possible after birth.
If the neonate develops signs of infection, intravenous acyclovir is required.
If more than 7 days elapse between the maternal rash and delivery, the baby is usually protected by maternal antibodies.

Question 8

combined smoking and alcohol effect on FBC

Answer 8

Question 9

individual effects of smoking and alcohol on

Answer 9

Question 10

placental abruption presentation

Answer 10

The classic presentation of placental abruption typically includes:

Severe abdominal pain,
Vaginal bleeding (which may or may not be present),
Uterine tenderness/rigidity,
Fetal heart rate abnormalities (indicating fetal distress),
Signs of maternal shock (if hemorrhage is significant).

Question 11

vasa praevia vs placental abruption

Answer 11

Placental Abruption typically presents with painful abdominal bleeding, uterine rigidity, and fetal distress due to impaired placental function. It requires emergency management and can result in significant maternal and fetal morbidity and mortality, especially in severe cases.
Vasa Previa is a condition where fetal vessels are located near or across the cervix and are at risk of rupture during labor, leading to bright red vaginal bleeding and severe fetal bradycardia if rupture occurs. Immediate cesarean delivery is required to prevent fetal exsanguination.

Question 12

vasa praevia causes

Answer 12

Velamentous cord insertion
- Low-lying placenta
- Multiple pregnancies (twins/triplets)
- In vitro fertilization (IVF)

Question 13

causes of placental abruption

Answer 13

Trauma (e.g., abdominal injury)
- Hypertension
- Smoking
- Cocaine use
- Previous abruption
- Preeclampsia
- Advanced maternal age

Question 14

fill out this table for placental abruption vs vasa praevia

Answer 14

Question 15

fill out this table for placental abruption vs vasa praevia

Answer 15

Question 16

what is a marginal bleed

Answer 16

A marginal bleed refers to bleeding near the edge of the placenta, often seen as a sign of minor placental separation or vascular issues with the placenta. While mild marginal bleeds may resolve on their own, close monitoring is required to assess the risk of progression to a more serious condition, such as placental abruption.

Question 17

obstetric cholestasis implications for mother

Answer 17

pruritis, elevated LFTs, fatigue, gallstones, coagulopathy (affects Vit K absorption), liver failure,

PPH, preterm labour, higher risk of pre eclampsia,

Question 18

management of obstetric cholestasis

Answer 18

Question 19

obstetric cholestasis fetal implications

Answer 19

stillbirth, preterm birth, meconium stained liquor, fetal distress, IUGR

Question 20

placental abruption maternal outcomes - immediate complications name 6

Answer 20

and death

Question 21

3 long term outcomes of placental abruption

Answer 21

Question 22

management of meconium stained liqor

Answer 22

Question 23

postnatal monitoring after meconium stained amniotic fluid

Answer 23

Question 24

lab findings in ICP

Answer 24

Question 25

fibroids RF

Answer 25

Question 26

surgical options for endometriosis

Answer 26

Question 27

C sec risks immediate and long term for mother and baby

Answer 27

Question 28

what cancer is likely if adnexal mass with mixed appearance some cystic some not

Answer 28

germ cell, sex cord stromal, mets

Question 29

surgical options in ovarian cancer

Answer 29

Question 30

routine blood tests at visit

Answer 30

FBC for screening for anaemia, blood group and rhesus D, serology (HIV), sickle cell test for haemaglobinopathies, rubella and Hba1c not done routinely, nor is b HCG

Question 31

screening tests for Down syndrome available

Answer 31

At 11-14 weeks you can have the combined test - this tests for high bHCG and low PAPPA as well as looking at nuchal thickness of USS to see if under 7mm * 14-20 weeks you can have the triple test (low AFP, high oestriol and high bHCG) or quadruple (also inhibin) * You can have a NIPT blood test if high risk that looks at foetal cells in blood

Question 32

Describe the physiological changes in the cardiovascular system in pregnancy.

Answer 32

blood volume increases from 6-8 weeks gestation, increase in plasma volum cardiac output increases due to increased stroke volume, decreased systemic vascular resistance bp reduces diastolic

Question 33

PPROM confirmation

Answer 33

speculum look for pool of fluid in post fornix nitrazine test - turns black actim PROM test Fibronectin test

Question 34

What are maternal and fetal risks of pre-labour rupture of membranes?

Answer 34

maternal = increased infection risk and placental abruption fetal = chorioamnionitis, foetal restriction deformities, foetal distress, cord compression, premature birth, neonatal death

Question 35

management of ROM at 38 weeks

Answer 35

discuss risks to pregnancy, especially infection after 18-24hours, most mothers go into spontaneous labour after SROM 1) wait for 24 hours provided initial assessment is normal (temp, abdo palpation, speculum, CTG). Can augment with prostin or oxytocin, monitor fetus for distress 2) wait til 72 hours and no more as risk increases if induced after that, IV antibiotics will be required and FHR monitoring in labour 3) Have induction of labour there and then (risks of intervention increase but fetal infection risk decreases)

Question 36

GBS treatment during labour

Answer 36

Clindamycin if penicillin allergic. If not then benzylpenicillin