Obs T1

Question 1

Failed early pregnancy: Criteria?

Answer 1

CRL >7mm with no heartbeat, MSD >25 with no embryo

Question 2

Failed early pregnancy: Concerning features?

Answer 2

CRL <7mm with no heartbeat, MSD 16-24mm with no embryo, abnormal appearing yolk/gestational sac, empty amnion sign, double bleb sign

Question 3

Failed early pregnancy: What CRL should FHR be visible?

Answer 3

> 5mm (6 weeks)

Question 4

Failed early pregnancy: How do you differentiate a pseudogestational sac from an IUP?

Answer 4

Pseudosac has irregular margins, beaked edges, may be filled with debris, located centrally in the endometrial cavity, displaces the anterior/posterior endometrial cavity surfaces. If a double decidual layer is present, it is compatible with IUP.

Question 5

Gestational trophoplastic disease: Types?

Answer 5

Complete, incomplete, invasive (increased myometrial vascularity), PSTT, choriocarcinoma

Question 6

Gestational trophoplastic disease: Karyotype?

Answer 6

Complete (46XX, two sperms and empty egg), incomplete (69XXY, two sperms and normal egg)

Question 7

Gestational trophoblastic disease: Prognosis?

Answer 7

Complete (15% risk of invasive mole, 2.5% risk of choriocarcinoma), partial (1-4% risk of invasive mole, no risk of choriocarcinoma)

Question 8

Gestational trophoplastic disease: Management?

Answer 8

Correlate with bHCG, O&G referral for D&C, weekly bHCG monitoring until normalised (will be >100,000), molar registry. CT CAP and MR brain if suspect choriocarcinoma.

Question 9

RPOC: Findings?

Answer 9

Endometrial thickness >10mm, variable vascularity

Question 10

RPOC: Ddx?

Answer 10

Endometritis (vascularity at myometrium), haematoma (avascular), GTD (bunch of grapes, very high bhcg), AVM (strong myometrial vascularity), dehiscence.

Question 11

What are the ultrasound signs of ectopic including heterotopic pregnancies?

Answer 11

Tube: Tubal ring/bagel sign, blob sign, ring of fire sign

Uterus: pseudogestational sac

Interstitial: endomyometrial mantle (abnormally eccentric gestational sac) <5mm highly suspicious + interstitial line sign
> DDx eccentric gestational sac

These signs indicate various characteristics of ectopic pregnancies on ultrasound.

Question 12

What is the primary location for ectopic pregnancies?

Answer 12

95% tubal, with 70% in ampulla, interstitial, scar, cervical, ovarian, abdominal

Ectopic pregnancies can occur in various locations, but the majority are tubal.

Question 13

What is the incidence of heterotopic pregnancy?

Answer 13

1 in 5000 due to IVF, previously 1 in 30,000

Heterotopic pregnancies are rare and have increased incidence with assisted reproductive technologies.

Question 14

What are the risk factors for ectopic pregnancies?

Answer 14

PID, scarring (appendicitis, diverticulitis, surgery), IUD

These factors increase the likelihood of ectopic pregnancies due to anatomical changes or infections.

Question 15

What bHCG level should show an intrauterine gestational sac?

Answer 15

3000

Ectopic pregnancies typically have lower bHCG levels for gestational age.

Question 16

What is the implication of haemoperitoneum in the context of ectopic pregnancy?

Answer 16

Concerning for rupture but can represent spillage from haematosalpinx or blood from another source

Haemoperitoneum may indicate a serious complication but can also have other explanations.

Question 17

What are the management options for ectopic pregnancies?

Answer 17

Review in real time, medical (methotrexate/potassium), and/or surgical

Management depends on the specifics of the case, including the patient’s condition and the type of ectopic pregnancy.

Question 18

What are the criteria for using methotrexate in ectopic pregnancies?

Answer 18

Size <3cm, no heartbeat, no rupture, bHCG <3000 (some say <6000)

These criteria help determine if methotrexate is a safe and effective treatment option.

Question 19

What are the complications associated with caesarean scar pregnancy?

Answer 19

Placenta accreta, uterine rupture, hysterectomy, premature labour

These complications can arise due to the abnormal implantation of the placenta in a previous caesarean section scar.

Question 20

What is the correct technique for measuring nuchal translucency?

Answer 20

Age 11-13 weeks, sagittal view (tip of nose/nasal bone present), 75% FOV, neutral neck, amnion separate to skin, inner to inner margins of widest part

Correct measurement technique is crucial for accurate assessment.

Question 21

What is considered an abnormal measurement for nuchal translucency?

Answer 21

> 3mm

An abnormal measurement can indicate potential issues with fetal development.

Question 22

What are the associations of abnormal nuchal translucency measurements?

Answer 22

• Trisomies
• Turner syndrome
• Noonan syndrome
• Congenital heart disease
• Congenital diaphragmatic hernia (CDH)
• Omphalocele
• Skeletal dysplasia
• VACTERL association
• Parvovirus B19
• Miscarriage

These associations highlight the importance of further investigation.

Question 23

What is the next step if nuchal translucency measurement is high risk?

Answer 23

Correlate with maternal age, antenatal screening bloods; if high risk, patient needs genetic counselling and referral to tertiary hospital for karyotyping options (amniocentesis, CVS)

Follow-up is essential for managing potential risks.

Question 24

What antenatal screening tests are offered in relation to nuchal translucency?

Answer 24

Combined first trimester screen
* Serum PAPP-A
* Free bHCG
* Nuchal translucency (11w0d-13w6d)
+ Maternal age

• NIPT (measures fetal DNA) - fetal cell free DNA

These tests help assess the risk of chromosomal abnormalities.

Question 25

What are the true diagnostic tests for genetic abnormalities?

Answer 25

* Chorionic villus sampling (placenta biopsy) * Amniocentesis (aspiration of amniotic fluid) ## Footnote These tests provide definitive results regarding genetic conditions.

Question 26

What is the prognosis/complication associated with acrania/anencephaly?

Answer 26

Progress to anencephaly (acrania-anencephaly sequence) ## Footnote This condition is often lethal and requires careful management.

Question 27

What is the management approach for acrania/anencephaly?

Answer 27

Referral to O&G; not compatible with life; consider termination; karyotyping not required as not associated with aneuploidy ## Footnote Management focuses on ethical considerations and patient support.

Question 28

How would you counsel a patient regarding acrania/anencephaly?

Answer 28

* Explain it is a lethal abnormality (no brain) * Refer to O&G * Discuss termination options * Advise high dose folate (4mg/day) and early ultrasound for future pregnancies due to increased risk of recurrence (2-3%) ## Footnote Counseling must be sensitive and supportive, addressing both medical and emotional aspects.

Question 29

What are the differential diagnoses for physiological gut herniation?

Answer 29

* Gastroschisis * Omphalocele ## Footnote Distinguishing these conditions is important for management and outcomes.

Question 30

What is the physiology behind physiological gut herniation?

Answer 30

* Bowel grows faster than abdominal cavity * Herniates into base of umbilical cord at 8 weeks * Midgut rotates 90 degrees anticlockwise * Returns to abdominal cavity at 10-11 weeks * Rotates 180 degrees anticlockwise ## Footnote Understanding the normal development process is crucial for identifying abnormalities.