Knowledge from PACES

Question 1

What is the diagnostic investigation for Bartholin’s cyst/ abscess?

Answer 1

Clinical diagnosis

Question 2

When is biopsy considered for Bartholin’s cyst/ abscess?

Answer 2

If the patient is >40 to exclude malignancy

Question 3

What is the follow up for women who have a major risk factor for SGA?

Answer 3

Serial USS for fetal size with umbilical artery Doppler from 26-28 weeks (at least every 2 weeks, if doppler is abnormal monitor twice a week)

And serial measurements of SFH from 24 weeks

Question 4

When are women referred for serial foetal size assessment?

Answer 4

Single SFH reading <10%

Question 5

When is karyotyping offered in SGA?

Answer 5

<23 weeks gestation

Question 6

What is recommended delivery for SGA if doppler is abnormal?

Answer 6

No later than 37 weeks

Question 7

What is recommended delivery for SGA if doppler is normal?

Answer 7

At 37 weeks (IOL)

Question 8

How is SGA diagnosed?

Answer 8

Clinical (SFH)
USS - serial, abdominal circumference most important fetal growth parameter (sensitivity 70-90%)

Question 9

What is uterine notching?

Answer 9

High resistance of placental circulation on uterine artery doppler - high risk of IUGR

Question 10

What is low birth weight, very low birth weight and SGA?

Answer 10

• LBW: <2500g
• VLBW: <1500g
• SGA: <10%

Question 11

How many foetal movements are normal per hour?

Answer 11

16-45

Interval >50-75 mins in between movements is worrying

Question 12

When do foetal movements develop?

Answer 12

Between 18-20 weeks

Increase in frequency and then plateau at 32 weeks (should never decrease in frequency)

70% of pregnancies with reduced foetal movements are uncomplicated

Question 13

What are the risk factors for still birth?

Answer 13

Maternal:
- Smoking
- Obesity
- Hypertension
- Pre-eclampsia
- Extremes of maternal age
- PMH of reduced foetal movements
- Primiparity
- Obesity
- Placental insufficiency

Foetal:
- Congenital conditions

Socioeconomic:
- Poor access to healthcare

Question 14

What are the risk factors for taking low dose aspirin from 12-36 weeks of pregnancy?

Answer 14

High risk factors (only need one):

C - CKD
A - Autoimmune conditions (SLE/APL syndrome)
T - T1/2DM
C - Chronic hypertension
H - Hypertension in previous pregnancy

Low risk factors (>=2)

F - First pregnancy
A - Age >40
T - Ten year interval between pregnancies
B - BMI >35
M - Multiple pregnancies
F - Family hx PET