Sba 1 Obstetric Flashcards by Siba Kherbek

You see a 20-year-old G1P0 with a diagnosis of genital herpes in pregnancy. What is the
gestational age at which a primary infection occurs that the risk of transmission to the
baby is greatest?

Third trimester (34–40weeks)

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You admit a woman at 40weeks of gestation in labour with confirmed genital herpes.
Thisis thought to be a primary infection. Sheis offered an emergency CS that she refuses.
How will you manage this patient?

Commence her on intravenous aciclovir and also offer the neonate intravenous aciclovir

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An elective caesarean section is being performed on a 30-year-old Rhesus D negative
pregnant woman at 37weeks of gestation for placenta praevia (major). Arrangements
were made and she is receiving intraoperative cell salvage (ICS) transfusion. What would
be the plan with regard to Rhesus D prophylaxis in this woman assuming the baby’s
blood group is unknown?

Administer 1500IU anti-D Ig and then take a sample of maternal blood 30–45min after
ICS infusion

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What is the recommended regimen for anti-D prophylaxis for a 26-year-old Rhesus D
negative woman who is notsensitized?
A. 500IU Ig at 28weeks of gestation
B. 500IU Ig anti-D at 34weeks of gestation
C. 1000IU Ig anti-D at 28weeks gestation
D. 1500IU Ig anti-D at 28weeks gestation
E. 1500IU Ig anti-D at 28 and 34weeks of gestation

1500IU Ig anti-D at 28weeks gestation
OR : two-dose regimen of 500IU Ig given at 28 and 34weeks

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A 20-year-old RhD negative woman presents with bleeding at 11 weeks of gestation.
When will you consider administering anti-D Ig prophylaxis to this woman?
A. Shegoes on to have a complete miscarriage
B. Thebleeding is heavy but is stopping
C. Thebleeding is repetitive or associated with pain
D. Thebleeding is small and painless
E. If this is a threatened miscarriage and the bleeding is stopping

Thebleeding is repetitive or associated with pain

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A28-year-old primigravida was admitted with an undiagnosed breech and opted to try
for a vaginal delivery after counselling. What is the best indication that a cephalic-pelvic
disproportion is unlikely to happen?
A. Aclinically adequate pelvis
B. An estimated fetal weight that is less than 3800g
C. Afrank breech presentation
D. Good progress to full dilatation
E. Simultaneous easy passage of the fetal thighs and trunk through the pelvis

Simultaneous easy passage of the fetal thighs and trunk through the pelvis
* Afrank presentation is the best type of breech presentation for a successful vaginal birth followed
by a complete breech. Afootling or kneeling breech is a contraindication for a vaginal breech birth

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You have been called to the delivery of a 30-year-old primigravida who is pushing.
Thebaby is in the breech position. Themidwife is conducting the breech delivery and the
head of the baby is trapped behind the cervix, which is only 8 cm dilated. What action
will you take to deliver the head?

Incise the cervix at 3 and 7o’ clock positions
* Other options are symphysiotomy or CS, but these are only applicable where the cervix is fully dilated

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You have counselled a 30-year-old primigravida at 35weeks of gestation with a breech
presentation, and she agrees to an external cephalic version. You have scheduled this
procedure at 36weeks of gestation. What success rate will you give this woman?

38%–45%
* Multipara> nullipara

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What is the Lovset’s manoeuvre in breech vaginal delivery ?

rotation of the trunk of the foetus during a breech birth to facilitate delivery of the extended foetal arms and the shoulders

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Inthe conduct of a breech vaginal delivery, what manoeuvre should be used in delivering
the arms?

Lovset’s manoeuvre

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What is the Mauriceau–Smellie–Veit manoeuvre in breech vaginal delivery ?

suprapubic pressure by one obstetrician on the mother/uterus, while another obstetrician inserts left hand in vagina, palpating the fetal maxilla using the index and middle finger and gently pressing on the maxilla, bringing the neck to a moderate flexion.

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What is the Burns-Marshall technique in breech vaginal delivery ?

allowing the breech to ‘hang’ by its weight until the nape of the neck (or the ‘hair-line’) is visible

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What is the Bracht manoeuvre in breech vaginal delivery ?

After the arms are delivered, the infant is grasped by the hips and lifted with two hands toward the mother’s stomach

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Aschool teacher who is 10weeks pregnant reports contact with one of her pupils who has
chickenpox. When would you say this child was infectious?

48h before the rash appeared and until it crusted (usually after 5days)

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What advice would you give a 20-year-old woman from Nigeria at her booking visit at
12weeks of gestation who has a history of nothaving had chickenpox in the past?
A. To avoid contacts with anyone with chickenpox
B. To contact her GP if she has a rash
C. Reassure her as she is likely to have had the infection without knowing about it
D. To undertake serum screening for VZV immunoglobulin G (IgG)
E. To immediately inform a healthcare worker of a potential exposure to chickenpox

To undertake serum screening for VZV immunoglobulin G (IgG)

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Apregnant woman in her 24th week of gestation reports contact with a friend who previously has shingles/herpes zoster. What type of shingles poses the greatest risk to this
woman if she is susceptible ?

Ophthalmic shingles

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A29-year-old G3P1 delivered a full-term male infant 3days after she developed a chickenpox rash. Shewas commenced on oral aciclovir soon after the rash appeared. How will
you manage the baby?
A. Advise against breastfeeding for 4days
B. Administer VZIG IgG to the baby
C. Administer VZIG IgG to the baby with or without oral aciclovir
D. Educate the mother on the warning signs of varicella infection in the neonate and discharge

Administer VZIG IgG to the baby with or without oral aciclovir
* Breastfeeding is notcontraindicated in mothers who are on aciclovir.

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You are running an antenatal clinic for women with epilepsy with a neurologist and a
midwife. You are counselling a patient about the risk of epilepsy in pregnancy and the
importance of complying with the medications. What is the strongest risk factor for sudden unexpected death in epilepsy?

Uncontrolled tonic-clonic seizures

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What advice should be given to a 26-year-old woman suffering from epilepsy that has
been well controlled (with no seizures for the past 2years) on sodium valproate who has
attended for pre-conception counselling?

Change AED to the lowest effective and least teratogenic AED dose and commence on
folic acid 5mg/day for at least 3months before pregnancy
🚫 Not necessarily lamotrigine

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A26-year-old woman was admitted into the obstetrics unit at 20weeks of gestation feeling generally unwell and with diarrhoea. Shewas being treated as a case of gastroenteritis. Shefailed to respond to treatment on admission and on the third day deteriorated
rapidly and died. Apost-mortem showed that she had died from sepsis. What has been
identified as the most common aspect of substandard care in the management of pregnant women with sepsis that results in severe morbidity or mortality?
A. Delay in instituting appropriate antibiotic therapy
B. Failure to institute appropriate antibiotic therapy
C. Failure to institute appropriate resuscitative measures
D. Failure of recognition of signs of sepsis
E. Failure of recognition of symptoms of sepsis

Failure of recognition of signs of sepsis ( not 🚫 symptoms)

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Awoman died from genital sepsis that occurred at 30weeks of gestation. Whatis the
most common site of infection associated with septic shock in pregnancy?
A. Ascending genital tract
B. Gastrointestinal
C. Pharyngeal
D. Pulmonary
E. Urinary tract

Urinary tract
* Urinary tract infection and chorioamnionitis are common infections associated with septic shock in the pregnant patient

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A 26-year-old pregnant woman presents with very severe constant abdominal pain of
3days duration at 30weeks of gestation. Sheis examined and found to have abdominal
tenderness. Thereare no specific localized signs. Sheis tachycardic, but her blood pressure
is normal. Theuterus is irritable, but the fetal heart is normal on cardiotocography (CTG).
Urinalysis is negative for protein, glucose, and nitrites. Sheis administered pain killers, but
the pain has remained unchanged after 24h. What is the most likely cause of the pain?
A. Degenerating uterine fibroids
B. Genital tract sepsis
C. Ovarian torsion/haemorrhage
D. Placental abruption
E. Pyelonephritis

Genital tract sepsis

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What recommendation does NICE make about measuring the fetal heart rate in labour?
A. That CTGs should be discontinued after 30min where it has been normal
B. That CTGs should be performed on all women in suspected or established labour
C. That CTGs should be discontinued once they have been confirmed to be normal
D. That intermittent auscultation of the fetal heart should occur every 10–15min
E. To record accelerations and decelerations if heard

To record accelerations and decelerations if heard
* intermittent auscultation : every 15 to 30 minutes in active labor and every 5 minutes in the second stage of labor.
*

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Themidwife is admitting a woman into the alongside midwifery unit in your maternity
hospital. What feature in her initial assessment will warrant a transfer of this low-risk
woman to an obstetric unit?
A. Apulse of over 110beats/min on two occasions 30min apart
B. Asingle diastolic reading of 100mmHg or more or raised systolic BP of 150mmHg or more
C. Either raised diastolic BP of 90mmHg or more or raised systolic BP of 140mmHg or
more on 2consecutive readings taken 30min apart
D. Rupture of fetal membranes 12h before onset of established labour
E. Thepresence of single strands of meconium

Either raised diastolic BP of 90mmHg or more or raised systolic BP of 140mmHg or
more on 2consecutive readings taken 30min apart
* Apulse of over 120beats/min on two occasions 30min apart
* Asingle diastolic reading of 110mmHg or more or raised systolic BP of 160mmHg or more
* Rupture of fetal membranes 24h before onset of established labour
* Thepresence of significant meconium
* a temperature of 38°C or above on a
single reading or 37.5°C or above on 2consecutive readings 1h apart

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What are the fetal features in the initial assessment will warrant a transfer of a low-risk woman to an obstetric unit?

1- The fetal indications include any abnormal presentation, including cord presentation, transverse or oblique lie . 2- high (4/5–5/5 palpable) or free-floating head in a nulliparous . 3- suspected anhydramnios or polyhydramnios . 4- fetal heart rate below 110 bpm or above 160 bpm, a deceleration in FHR heard on intermittent auscultation . 5- reduced fetal movements in the last 24 h reported by the woman

You have admitted a primigravida at 41 weeks of gestation contracting regularly for the past 3 h. Fetal membranes are intact. This has been an uncomplicated pregnancy. What is the recommendation for monitoring the fetal heart rate as part of the initial assessment? A. Auscultate the fetal heart at the first contact with the woman in labour and at each further assessment B. Auscultate the fetal heart for a minimum of 30 s immediately after a contraction and record it as a single rate (record for at least 1 min) C. Give the woman the option of having a continuous or intermittent monitoring of the fetal heart D. Palpate the maternal pulse to differentiate between the maternal and fetal heart if the fetal heart rate is at a rate similar to maternal heart rate E. Perform a CTG on admission as low-risk women in suspected or established labour to first establish a normal heart rate

Auscultate the fetal heart at the first contact with the woman in labour and at each further assessment ( hourly) * for a minimum of 1 min immediately after a contraction * not performing a CTG on admission for low-risk women in suspected or established labour

A low-risk woman was admitted into the alongside midwifery unit in spontaneous labour at 42 weeks of gestation. She ruptured her membranes spontaneously at 6 cm dilatation, and there was liquor containing lumps of meconium. She was therefore transferred to the obstetrics unit. What precautions should be taken with this woman’s labour and birth?

Ensure availability of a healthcare worker trained in advanced neonatal life support at the time of birth * + ensure that healthcare professionals trained in fetal blood sampling ( not necessary taking sample)

A 25-year-old woman presents with absent fetal movements for 24 h. What would be the best method of diagnosing an intrauterine fetal death (IUFD) in this woman? A. A cardiotocography showing an absent fetal heartbeat B. Auscultation of the fetal heart with a sonicaid C. Doppler ultrasound scan D. Real-time ultrasound scan E. Real-time ultrasound with colour Doppler

Real-time ultrasound with colour Doppler

A 27-year-old woman who is known to be a group B haemolytic Streptococcus carrier has been diagnosed with an intrauterine fetal death at 34 weeks of gestation. She is being induced with prostaglandins and mifepristone. What management would you recommend for her group B haemolytic Streptococcus carrier status?

No antibiotics are indicated

The midwife referred an unaccompanied 30-year-old primigravida at 36 weeks of gestation because she could not hear the fetal heart with a sonicaid in the community. You have seen the patient and diagnosed an intrauterine fetal death. What would be the next step in her management?

Offer to call her partner or relative or friend

What will make you classify a 26-year-old female haemophilia carrier as obligate?

Her father is affected or she has an affected son and an affected relative in the maternal line

You see a 23-year-old woman and her 29-year-old partner who has haemophilia A. There is uncertainty as to the severity of his haemophilia. What is the main difference between the severe and the mild/moderate forms of haemophilia with regard to clinical manifestations?

Those with severe haemophilia bleed spontaneously into muscles and joints, while those with the mild/moderate forms may bleed following trauma or invasive procedures

A 26-year-old woman attends with her partner who has severe haemophilia A. She is now 7 weeks pregnant. What advice should they be given? 🤷🏻‍♀️🤷🏻‍♀️

Offer fetal sexing by free fetal DNA analysis from 9 weeks of gestation

A 22-year-old woman visits for her routine anomaly ultrasound scan at 20 weeks and informs the team that her partner has severe haemophilia B. The detailed scan is normal, and she is informed that the fetus is a male. What advice should be offered to this woman ? 🤷🏻‍♀️🤷🏻‍♀️

Prenatal diagnosis by means of amniocentesis in the third trimester * Ideally before 34 w

Approximately what proportion of twin pregnancies in the UK are monochorionic?

30 %

It is well recognized that monochorionic monoamniotic twin pregnancies have a higher perinatal loss rate than monochorionic diamniotic twin pregnancies. What gestations carry the greatest risk of perinatal loss?

Before 24 weeks of gestation

What type of vascular anastomoses in monochorionic twin pregnancies is most commonly associated with twin-to-twin transfusion syndrome (TTTS)?

Unilateral artery-vein anastomoses

What proportion of monochorionic pregnancies are complicated by TTTs ?

15 %

At what gestational age is TTTS most likely to develop in monochorionic twin pregnancies?

16 w * Uncommon after 26 w

A 20-year-old woman is seen at 30 weeks of gestation with generalized pruritus especially of the palms of the hands and soles of the feet. A diagnosis of obstetric cholestasis is suspected. How common is this complication of pregnancy in the UK?

7–8/1000 pregnancies

A 38-year-old G1P0 presents at 31 weeks of gestation with generalized pruritus that is not associated with a rash. The itching which is worse at night is on her palms and soles. Her stools have slowly become paler, but she is not jaundiced. You suspect obstetric cholestasis and request for a liver function test that includes bile acids. These come back as abnormal, thus confirming the diagnosis. How often should her liver function test be monitored?

Every 7 days

A 37-year-old woman who was diagnosed with obstetric cholestasis at 34 weeks of gestation had a spontaneous induced vaginal delivery at 36 weeks and 5 days. The bile acid levels then were 45 mmol/L. She has come back for follow-up at 8 weeks post-delivery. What should you tell her about the risk of recurrence?

Up to 90%

It has been recognized that various events during the intrapartum period are known to reduce the risk of operative vaginal delivery. What is the single most important factor that has been shown to help avoid operative vaginal delivery in a 29-year-old primigravida? A. Appropriate analgesia during labour B. Continuous support during labour C. Effective uterine contractions D. Ensuring adequate maternal hydration during labour E. Regular pelvic examination and monitoring of progress of labour

Continuous support during labour

A 32-year old primigravida went into spontaneous labour at 40 weeks of gestation. She has an epidural for pain relief. What is the effect of delaying pushing for 1–2 h on delivery?

Decreased risk of rotational operative interventions

You have examined a 28-year-old primigravida who went into spontaneous labour at 39 weeks of gestation following an uncomplicated pregnancy. She has been fully dilated for the past 3 h, and you feel that her labour should be expedited. The fetal head is 1/5 palpable per abdomen and there is caput at 2 cm below the spines. What is the level of the biparietal diameter in this baby?

At least 1 cm above the spines

A 35-year-old primigravida whose BMI is 37 kg/m2 had an uncomplicated pregnancy and went into spontaneous labour at 39+5 weeks of gestation. An epidural was sited for pain relief. She has been fully dilated for the past 3.5 h, actively pushed for 1.5 h, and now appears completely exhausted. You have been asked to perform an assisted vaginal delivery. What factor will increase the risk of her having a failed instrumental delivery? A. Estimated weight of 3600 g B. Her BMI C. Right occipito-anterior position D. Station at spines +1 and 0/5 vertex palpable per abdomen E. Two pluses of caput

Her BMI (< 30 ) * Estimated weight of > 4000g * occipito-posterior position * 1/5 vertex palpable per abdomen

A Foundation Year 2 doctor sustains a needle stick injury, while you were taking her through the suturing of an episiotomy in a woman who has just had a normal vaginal delivery. If this woman is HIV positive, what would be the estimated risk of this trainee acquiring the infection?

3 per 1000 injuries

A midwife in the unit was suturing an episiotomy of a woman who is known to be HIV positive and sustains a needle injury. Within which period of commencing PEP is it likely to be most effective?

Within 1 h of the exposure Not beyond 72 h * pep : post exposure prophylaxis: is the use of antiretroviral drugs after a single high-risk event to stop HIV seroconversion.

The rationale for post-exposure prophylaxis is that viral replication can be inhibited shortly following the exposure. Once the mucosal barrier has been breached, how long does it take the virus to be detected in blood?

Up to 120 h blood * Lymph nodes 72 h

A 35-year-old primigravida complained of a breast lump when she attended the antenatal clinic for her routine visit at 24 weeks of gestation. Further investigations have confirmed that this is indeed a malignancy. What is the impact of the pregnancy on the prognosis of the cancer?

It has no impact on prognosis

A 36-year-old woman who is 30 weeks pregnant has been referred by the midwife to the consultant-led antenatal clinic with a lump in her left breast. You have examined and found a discrete lump on the left breast with features suspicious of malignancy. What should be the most appropriate investigation to offer to this woman? A. Fine needle aspiration biopsy B. Fluid aspiration for cytology C. Mammography D. Ultrasound-guided biopsy E. Ultrasound scan

Ultrasound scan ( as a first step) * Then : Tissue diagnosis is performed with ultrasound-guided biopsy for histology rather than cytology as proliferative changes during pregnancy render cytology

What advice should a woman who had breast cancer and wishes to conceive after completing her course of tamoxifen but has been found on imaging to have suspicious metastases in the lungs be given?

To avoid pregnancy as life expectancy is limited and treatment of metastasis will be compromised

A 24-year-old woman is admitted at 30 weeks of gestation with regular uterine contractions. This is her first pregnancy and until now the pregnancy has been uncomplicated. She is examined, and the cervix is found to be soft with a closed os. A decision is taken to give her a course of corticosteroids and to commence her on the tocolytic nifedipine. What is the benefit of giving her nifedipine?

Prolongs the pregnancy by 2–7 days

A woman books for antenatal care at 8 weeks of gestation in her first pregnancy. What is the recommendation with regard to testing for blood group and antibodies? A. Test blood group and antibody at booking and then at 28 weeks of gestation B. Test blood group and antibody at booking and then antibody at 28 weeks C. Test blood group and antibody at booking, 28 and 36 weeks D. Test blood group and antibody at booking and then blood group at 28 weeks E. Test blood group and antibody at booking and 28 weeks and then antibody at 36 weeks

Test blood group and antibody at booking and then at 28 weeks of gestation

What is severe postpartum haemorrhage?

Blood loss of more than 2000 mL minor (500–1000 mL) or major (>1000 mL) Major ; subdivided into moderate (1001–2000 mL) and severe (>2000 mL).

What is the most common cause of primary postpartum haemorrhage?

Disorders of tone * Causes of PPH can be grouped under the ‘four Ts’, which include tone, tissue, thrombin and trauma.

A 35-year-old primigravida presents with a sudden onset of epigastric pain that is radiating to the back. Prior to this, she had been seen repeatedly with right hypochondrial pain. She is now 30 weeks pregnant. Her BP at the last antenatal clinic visit was normal. She is apyrexial, but tachycardic (pulse: 110 bpm) and hypotensive (BP = 80/50 mmHg). What is the most likely diagnosis? A. Abruptio placenta B. Hepatic rupture C. Pre-eclampsia D. Rupture of aortic aneurysm E. Splenic rupture

Hepatic rupture

An ST4 is performing an elective CS at 39 weeks of gestation with assistance by a FY2 on a G2P1. The indication for the CS is breech presentation. On opening the abdomen and exposing the uterus, she discovers that the lower segment is extremely vascular. The placenta had been localized to be anterior and not low on ultrasound scan at 20 weeks of gestation. What action should she take?

Call consultant before proceeding to make an incision on the uterus

What is the most important risk factor for postpartum sepsis? A. Asymptomatic bacteriuria B. Caesarean section C. Manual removal of the placenta D. Pre-labour rupture of fetal membranes E. Prolonged labour

Caesarean section

A couple are anxious about the risk of their baby being born with an inherited autosomal recessive condition. Their anxiety stems from the fact that their relative recently had a baby with an autosomal recessive condition. They want to know what the most common autosomal recessive condition worldwide is?

Beta-thalassaemia

They want to know what the most common autosomal recessive condition among Caucasians in Europe is?

cystic fibrosis.

You are counselling a patient about pre-implantation genetic diagnosis (PGD). They have been told that there is a risk of them having a baby with an autosomal recessive condition. What is a characteristic of an autosomal recessive condition? A. Both parents have to carry the abnormal gene for their children to be affected B. Half of the offspring will be affected by the condition C. They tend to be less severe and life-threatening D. The affected individual needs to have only one copy of abnormal gene for the disease to be expressed E. The risk to the offspring of an affected parent is 1:4

Both parents have to carry the abnormal gene for their children to be affected

A 27-year-old primigravida is admitted at 35 weeks of gestation with a blood pressure of 110/110 mmHg, severe proteinuria and brisk reflexes. She also has headaches and visual disturbances. She had a kidney transplant 2 years ago and was switched from an angiotensin-converting enzyme inhibitor (ACEi) in early pregnancy to labetalol. You have decided to commence her on magnesium sulphate (MgSO4) having sent a blood sample for an urgent renal function test because she has hardly voided in the last 6 h. What would be the regimen you will start with?

4 g loading dose followed by 0.5 g/h * The loading dose (4 g) should be given irrespective of the renal function but maintenance infusion levels should be halved in those with significant renal impairment and/or oliguria.

You are planning to induce a renal transplant recipient at 38 weeks of gestation. She has been taking 10 mg of prednisolone throughout pregnancy. Her renal function is stable and her BP is well controlled on labetalol. What additional precautions should you take in labour?

Commence her on intravenous hydrocortisone at a dose of 50–100 mg every 6–8 h * Women taking more than 7.5 mg prednisolone per day for more than 2 weeks during pregnancy require intravenous hydrocortisone (50–100 mg every 6–8 h) during labour and until they are able to tolerate oral medication.

A 25-year-old woman who had kidney transplant 2 years ago wishes to embark on pregnancy. Her graft function has been stable but she has significant proteinuria and is on an ACEi for the control of hypertension. What advice should she be given? A. Continue to ACEi until a positive pregnancy test and then reassess need for treatment and if required offer a non-teratogenic option B. Continue with ACEi until a positive pregnancy test, switch to a non-teratogenic option but recommence after 12–14 weeks C. Stop the ACEi D. Stop ACEi and recommence after 12 weeks of gestation E. Switch from the ACEi to another antihypertensive that is not teratogenic

Continue to ACEi until a positive pregnancy test and then reassess need for treatment and if required offer a non-teratogenic option * The non-proteinuria hypertensives can switch to alternative antihypertensives prior to pregnancy, but those with significant proteinuria may be reluctant to lose their renal protection for the unknown length of time it takes to successfully conceive

A 30-year-old woman has been diagnosed with acute kidney injury following an obstetric complication. What is the most common cause of acute kidney injury in obstetrics?

Pre-eclampsia ( 1.4 % of the cases ) HEIIP ( 14 % of the cases)

A 30-year-old G3P0 type I diabetic who has been on an insulin pump from 4 months before pregnancy is admitted for induction of labour at 38 weeks of gestation. What would be management plan once she is in established labour? A. Allow labour to progress without the need to monitor as the pump adjusts her insulin requirement B. Commence her on an insulin sliding scale C. Continue with the insulin pump but monitor blood glucose when appropriate D. Discontinue the insulin pump E. Increase the basal insulin dose and continue with the maintenance dose

Continue with the insulin pump but monitor blood glucose when appropriate

A 36-year-old woman who suffers from ulcerative colitis (UC) that was refractory to standard treatment was commenced on the biologic agent infliximab. She continued with this medication throughout the pregnancy. What is the main impact of this on the management of the mother and baby after delivery?

No live vaccines should be administered to the baby for the first 6 months ( Should ideally be discontinued at 32w of Pregnancy)

A 30-year-old woman who suffers from an active inflammatory bowel disease (IBD) reports that she is pregnant. She is currently taking sulfasalazine therapy. What is the likely course of the IBD in the pregnancy? A. It is likely to become more active during pregnancy B. It is likely to remain active C. It is likely to respond better to treatment than outside pregnancy D. The course tends to be fluctuating between remission and active disease E. There is a higher chance of remission

It is likely to remain active *( It's better to be in remission for 6 months before conception) * Rheumatoid arthritis 👉 There is a higher chance of remission * systemic lupus 👉 It is likely to become more active during pregnancy

What is the estimated detection rate for trisomy 21 when nuchal translucency, absence of the nasal bone, raised ductus venosus Doppler, tricuspid regurgitation and maternal serum biomarkers are combined at 11–13 weeks of gestation? A. 88% for a false positive rate of 5% B. 90% for a false positive rate of 5% C. 95% for a false positive rate of 3% D. 97% for a false positive rate of 3% E. 99% for a false positive rate of 5%

95% for a false positive rate of 3% * biochemistry (serum free-β-hCG and PAPP-A), + soft markers * Biochemistry alone 5% false positive

A 29-year-old woman with twins is seen for her combined first-trimester aneuploidy scan at 12 weeks of gestation. Why will the false positive rate of her test be twice as high as in singleton pregnancies? A. One of the twins is hydropic B. The twins are dichorionic C. The twins are monochorionic D. There is demise of one twin E. There is a significant difference in CRL measurements

The twins are monochorionic * In dichorionic twins, an individual risk is given for each fetus, but in monochorionic twins, the risk is calculated for each fetus and an average of the two is given for the whole pregnancy .

At what ferritin level should chelation be considered in a 30-year-old woman with a haemoglobinopathy who has had repeated blood transfusions and wishing to become pregnant?

>1000 µg/L * Chelation therapy may start after 10–20 transfusions or when the serum ferritin level exceeds 1000 µg/L

After approximately how many transfusions should chelation be considered in a 33-yearold woman with haemoglobinopathy who is desirous of starting a family?

10–20

Which hormone is responsible for reducing the water content of stools during pregnancy and thus making them harder? A. High circulating aldosterone B. High circulating oestrogen levels C. Motilin D. Renin E. Somatostatin

High circulating aldosterone

A 20-year-old woman is seen at 8 weeks of gestation complaining of chronic constipation since she missed her last period. Her bowels open twice a week and furthermore she strains for more than 25% of the time when she defaecates. She has been prescribed a hyperosmolar laxative. What is the most unwanted side effect of this medication for this woman?

Abdominal bloating and flatulence

A 30-year-old woman with three previous mid-trimester miscarriages has been referred for the assessment for an abdominal cerclage. What will be the indication for an abdominal cerclage in this patient? A. Previous failed McDonald suture B. Previous failed Shirodkar suture C. She has a short vaginal cervix D. She has had a previous cone biopsy E. The cervix is grossly disrupted

The cervix is grossly disrupted * or an absent vaginal cervix. A previously failed vaginal cerclage may be an indication .

A 29-year-old woman who has had two mid-trimester miscarriages had a transabdominal cerclage with a posterior knot at 11 weeks of gestation. She presents at 19 weeks of gestation with a brownish vaginal loss and disappearance of pregnancy signs of 3 days duration. An ultrasound scan confirms an intrauterine fetal death of 18 weeks of gestation. How best will she be managed? A. Hysterotomy and leave stitch in-situ B. Posterior colpotomy to remove stitch and offer suction evacuation C. Remove the stitch by laparotomy and induce delivery D. Remove the stitch by posterior colpotomy and induce delivery E. Remove the stitch laparoscopically and induce delivery

Remove the stitch by posterior colpotomy and induce delivery

You are seeing a 29-year-old woman in the clinic for counselling. She has had four mid-trimester miscarriages and the last two followed a failed vaginal cerclage (one a McDonald suture and the other a Shirodkar suture). When she was examined at her last clinic visit, there was very little vaginal cervix. She is now 6 weeks pregnant. What would be the approach to minimize the risk of miscarriage in this woman?

Offer a transabdominal cerclage at 10–11 weeks

A 30-year-old woman attends at 12 weeks for a nuchal translucency measurement as part screening for aneuploidy. What approximate detection rate for trisomy 21 using nuchal translucency alone will you quote to this woman?

77 % * 85%–90% for a combined first-trimester test using measurement of NT and placental protein markers, free β-hCG and pregnancy-associated plasma protein (PAPP-A) for a false positive rate of approximately 5%

A 33-year-old primigravida is seen for booking at 10 weeks gestation. Following counselling, she opts for the integrated test for aneuploidy. What is the main advantage of this test over the first-trimester screening test? A. It has a lower false-positive rate B. It has a higher detection rate for aneuploidy C. It is more cost-effective D. It has a better acceptance by patients E. It is less time-consuming

It has a lower false-positive rate *. integrated test : combines first-trimester maternal serum PAPP-A and fetal nuchal translucency with second-trimester quad screening

An ultrasound is performed at 14 weeks of gestation in a 27-year-old primigravida, and it shows a singleton viable pregnancy and an adnexal mass. What feature on this ultrasound scan will be helpful in distinguishing between an invasive and a benign cystic adnexa mass?

The presence of the ‘ovarian crescent sign’

A 24-year-old woman is seen at 18 weeks of gestation having been inadvertently treated by her GP with the tetracycline derivative doxycycline for a suspected infection in the first trimester. She is anxious about this treatment. What should she be told about the risk of this treatment to the pregnancy?

It is not associated with an increased risk as used in the first trimester * The tetracycline doxycycline is contraindicated beyond the 15th week of pregnancy as it causes tooth and bone discolouration and inhibits bone growth. Inadvertent use of tetracycline in the first trimester is not associated with an increased risk of congenital malformations

What is the most common adnexal cystic lesion diagnosed after 16 weeks of gestation? A. Corpus luteum cyst B. Follicular cyst C. Haemorrhagic cysts D. Luteoma of pregnancy E. Matured cystic teratoma

Matured cystic teratoma ( dermoid ) * < 6 cm asymptomatic 6-8 cm are prone to torsion

Approximately what percentage of women of child-bearing age is affected by epilepsy? A. 0.1%–0.5% B. 0.5%–1.0% C. 1.0%–1.5% D. 1.5%–2.0% E. 2.0%–2.5%

0.5%–1.0%

What is the effect of epilepsy on maternal mortality? A. It doubles the maternal mortality B. Increases it by up to 5 times C. Increases it by up to 10 times D. Increases it by up to 3 times E. Increases it by up to 6–7 times

Increases it by up to 10 times

A 25-year-old woman on high doses of sodium valproate reports that she has unexpectedly fallen pregnant. She is currently 8 weeks pregnant. What would be your next management plan? A. Commence her on high-dose folic acid (5 mg daily), stop the sodium valproate and commence on lamotrigine B. Commence on high-dose folic acid (5 mg daily), stop sodium valproate and commence on levetiracetam C. Commence on high-dose folic acid (5 mg daily), stop sodium valproate and commence on levetiracetam and refer for urgent neurological review D. Commence on high-dose folic acid (5 mg daily), stop sodium valproate and refer to neurologist for review E. Commence on high-dose folic acid (5 mg daily) and recommend continuation of sodium valproate but refer urgently to neurological review of medication

Commence on high-dose folic acid (5 mg daily) and recommend continuation of sodium valproate but refer urgently to neurological review of medication

A 20-year-old primigravida has been diagnosed with diabetes insipidus at 20 weeks of gestation. What is the most likely biochemical abnormality associated with this condition?

Hypernatraemia * Diabetes insipidus is the failure of the renal tubules to conserve water. If not corrected, this can lead to symptoms of polydipsia and dilute polyuria and can result in hypernatraemic dehydration

A 30-year-old pregnant woman has had a cardiac arrest and is undergoing cardiopulmonary resuscitation (CPR). When should a perimortem caesarean section be considered in this woman?

She is greater than 20 🙌weeks pregnant, and correctly performed CPR has failed to result in rapid return of spontaneous of circulation (ROSC) after 4 🙌 min

What is the ideal time within which a perimortem caesarean section should be completed in the interest of the mother from the cardiac arrest? A. 3 min after a cardiac arrest B. 4 min after a cardiac arrest C. 5 min after a cardiac arrest D. 6 min after a cardiac arrest E. 10 min after a cardiac arrest

5 min after a cardiac arrest

A 30-year-old woman has just had a cardiac arrest on the ward. You commenced CPR and need to instruct your assistant to deliver continuous oxygen by face mask. What is the recommended rate of delivery of oxygen to this woman? A. 1–2 litres per min B. 2–4 litres per min C. 4–6 litres per min D. 6–10 litres per min E. 10–15 litres per min

10–15 litres per min

A 23-year-old woman suffered a cardiac arrest and was brought into the A&E where CPR was initiated, and in the course of this a perimortem, CS was performed. Unfortunately the patient failed to respond to CPR and was pronounced dead 30 min after admission. What would be the next step in her management? A. Complete the perimortem CS and then inform the coroner and her relatives B. Leave all intravenous access ports, lines, intubation and other equipment including the CS in place and notify the coroner and relatives C. Remove the placenta and send for examination but do not complete the procedure until the coroner has been informed D. Inform the relatives and seek permission to inform the coroner after which the abdomen can be closed and the placenta sent for histological examination E. Inform the coroner and seek permission to complete the procedure and then inform the relatives

Leave all intravenous access ports, lines, intubation and other equipment including the CS in place and notify the coroner and relatives

A 35-year-old woman with phenylketonuria (PKU) is pregnant. When during pregnancy will the diagnosis of microcephaly be made?

When the HC measurement on USS is 5 SD or more below the gestational age * Microcephaly should be suspected if the HC falls 2 SD below the mean for gestational age. A definitive diagnosis can be made when the measurement is 5 or more SD below the mean for gestational age.

A 29-year-old woman presents at 24+6 weeks of gestation with mild contractions and intact fetal membranes. A speculum examination is performed and the cervical os is closed. What is the recommended management that is considered cost-effective? A. Commence on tocolysis and a course of corticosteroids B. Oncofetal fibronectin and corticosteroids C. Transabdominal cervical length measurement followed by a course of corticosteroids D. Translabial cervical length measurement followed by a course of corticosteroids E. Transvaginal cervical length measurement followed by a course of corticosteroid

Commence on tocolysis and a course of corticosteroids * Below 29+⁵ w no need to do tests or ultrasound for cervical measurement.. offer tocolysis & steroids instead

You have admitted a 30-year-old woman in her second pregnancy at 26+3 weeks of gestation with uterine contractions and intact fetal membranes. You suspect that she is in preterm labour. What would be the recommended management for this woman?

Corticosteroids and nifedipine

You are conducting an assisted vaginal breech delivery of a 32-year-old woman at 27 weeks of gestation, and this is complicated by head entrapment. What immediate action will you take to deal with this complication? A. Administer nifedipine B. Administer terbutaline subcutaneously C. Incise the cervix laterally D. Perform an episiotomy E. Proceed to a stat caesarean section

Incise the cervix laterally

Approximately what percentage of all live births are twins?

3 %

Approximately what percentage of twin pregnancies are delivered preterm (i.e. before 37 completed weeks of gestation)?

50% (1:2) * 34w-37w 👉 30% * < 34w 👉 20%

A 28-year-old woman attends to book for antenatal care at 10 weeks of gestation. A booking ultrasound scan shows a monochorionic diamniotic twin pregnancy. What would be the recommended test to predict the risk of spontaneous preterm birth in this woman?

A single cervical length measurement from 18 weeks of gestation

A 29-year-old woman presents at 22 weeks of gestation for routine antenatal assessment. A cervical length measurement is performed, and this is reported as 22 mm. What intervention has been shown to have the best benefit with respect to reducing the risk of preterm birth in this woman? A. Cervical cerclage B. The Arabin pessary C. The tocolytic nifedipine D. None E. Vaginal progesterone

None

What is the most common non-genital cause of sensorineural deafness in children?

Congenital cytomegalovirus (CMV) infection

A 30-year-old primigravida at 14 weeks of gestation was seen two days ago with myalgia, rhinitis and a mild temperature. She was investigated and found to have an infection with CMV. Assuming that this is a primary infection, what would be the estimated risk of vertical transmission in this pregnancy?

Up to 50% * Risk of congenital anomalies 40% - as herps

A 30-year-old woman has been diagnosed with a CMV infection at 16 weeks of gestation. She is known to have had a CMV infection in the past. What would be the vertical transmission rate for this woman?

1 -2 %

When will you summon a multidisciplinary team of senior staff to attend a woman with primary postpartum haemorrhage? A. She has lost in excess of 500 mL blood and bleeding is ongoing or she is in clinical shock B. She has lost in excess of 750 mL blood and bleeding is ongoing or she is in clinical shock C. She has lost in excess of 1000 mL blood and bleeding is ongoing or she is in clinical shock D. She has lost in excess of 1500 mL blood and bleeding is ongoing or she is in clinical shock E. She has lost in excess of 2000 mL blood and bleeding is ongoing or she is in clinical shock

She has lost in excess of 1000 mL blood and bleeding is ongoing or she is in clinical shock

When will you investigate a 19-year-old woman in her first pregnancy for anaemia? A. Her Hb is ≤110 g/L at 28 weeks of gestation B. Her Hb is ≤105 g/L at booking C. Her Hb is ≤100 g/L at 28 weeks of gestation D. Her Hb is <110 g/L at first contact in the first trimester E. Her Hb is <105 g/L at any time in pregnancy

Her Hb is <110 g/L at first contact in the first trimester

You are performing an elective caesarean section on a 33-year-old woman for breech presentation at 39 weeks of gestation. What would be the best prophylactic drug for the prevention of primary postpartum haemorrhage in this woman?

Intravenous oxytocin (5 IU, slowly) * IF vaginal delivery 👉 IM oxytocin 10 IU

A 28-year-old schoolteacher is attending for counselling about the risk of CMV as she plans to start a family. She is anxious about the risk of CMV to the pregnancy as this is a common infection in her school. What is the matrix to whose exposure she has the greatest risk of acquiring the infection?

Urine of an infected child * Or saliva

A 30-year-old woman has been diagnosed with primary CMV infection. An amniocentesis has been performed, and this confirms vertical transmission of the infection. What proportion of babies infected in utero are symptomatic at birth?

10%–25% ( 10 - 15 % )

You are about to see a couple in the pre-conception clinic for counselling about the risk of viral infections in pregnancy. When if infected is she at the greatest vertical transmission? A. Periconception (8 weeks before and up to 6 weeks after conception) B. Pre-gestation (12 months to 8 weeks before conception) C. The first trimester (up to 13 weeks) D. The second trimester E. The third trimester

The third trimester

A 25-year-old woman is seen for pre-pregnancy counselling. As a child, she underwent treatment for cancer, which involved chemotherapy with doxorubicin and radiotherapy to her chest and abdomen. What would be the essential screening test to perform prior to her embarking on a pregnancy? A. Chest X-ray B. Echocardiogram C. Liver function test D. Lung function test E. Renal function test

Echocardiogram

A 25-year-old woman had Hodgkin’s lymphoma and was treated with chemotherapy only. With respect to her cancer treatment, she is at a slightly increased risk of which pregnancy complication?

Preterm delivery * ( Radiation: stillbirth/ SGA)

A 29-year-old woman is diagnosed with postural tachycardia syndrome (PoTS) at 20 weeks of gestation. What conservative treatment would be considered for this patient in the first instance? A. Increase caffeine intake B. Increase fluid and salt intake C. Increase fluid intake D. Application of compression stockings E. Initiate aerobic exercises

Increase fluid and salt intake

A 37-year-old primigravida is admitted in established labour at 29+4 weeks of gestation. She has been prescribed magnesium sulphate for neuroprotection. What is the correct dose to be administered?

A single 4 g infusion IV over 30 min and then a 1 g infusion per hour until she delivers

A 27-year-old woman is diagnosed with monochorionic diamniotic twin pregnancy at an ultrasound scan performed at 10 weeks of gestation. At what gestational age should monitoring for twin to twin transfusion syndrome (TTTS) be started?

16 weeks

How common is a dural tap as a complication of epidural analgesia in labour?

0.5 - 2.5 % * approximately 50–60% of women experience postdural puncture headache

A 28-year-old woman is suspected to have severe sepsis following a normal vaginal delivery at 35 weeks of gestation. She had presented with spontaneous rupture of membranes 12 h before being induced. A blood test is performed as part investigation. What lactate level will influence your care of this patient?

4 mmol/L * With serum levels >4 mmol/L, an initial minimum of 20 mL/kg of crystalloid or equivalent should be administered. Vasopressors should be given for hypotension that does not respond to initial resuscitation

A primigravida who has had an uncomplicated pregnancy elects to have a home delivery after appropriate counselling. What will be her approximate risk of transfer to the hospital in labour as per NICE guidelines?

35% ( Indeed: 450/1000👉 45 % )

A 30-year-old woman is seen with vague generalized aches and feeling generally unwell. She had complained of a sore throat and body aches a few days before. She is a schoolteacher and reports that one of the children in her class has recently been diagnosed with parvovirus B19. A blood test is performed and shows a positive result for IgM but a negative result for IgG for parvovirus. She is 15 weeks pregnant. What is the risk of vertical transmission in this patient?

25%–35% * < 15w 👉 15%

An ultrasound scan is performed on a 23-year-old primigravida at 11 weeks of gestation. This shows herniation of the gut with the umbilical cord inserted at the centre of the hernia sac. What is the most likely diagnosis? A. Exomphalos/omphalocele B. Gastroschisis C. Omphalomesenteric duct remnants D. Physiological hernia E. Umbilical cord hernia

Exomphalos/omphalocele * most physiological hernias do not have the cord inserted at the centre of the hernia sac. * Ventral wall hernias are best diagnosed after 12 weeks of gestation when physiological hernias in most cases have resolved.

A 41-year-old woman attends at 13+4 weeks of gestation. What would you consider to be the most appropriate screening test for Down syndrome for her? A. Combined test (MA+NT+biochemistry) B. NT and biochemical test in the first and second trimesters C. NT measurement D. Triple test E. Quadruple test

Combined test (MA+NT+biochemistry) * MA 👉 detection rate: 30% MA + NT 👉 detection rate: 75-80% NT+combined test 👉 detection rate: 85% MA+NT+combined test 👉 detection rate: 85-95% , false positive rate 5%

You see a 30-year-old woman who is unsure of her dates. An ultrasound scan is performed, and the measurements are as follows: CRL = 90 mm, HC = 120 mm, BPD = 36 mm, FL = 20 mm, AC = 98 mm. What measurement should be used to determine her gestational age?

HC * CRL < 84 👉 determined by CRL

A 25-year-old Somalian woman who recently came to the UK admits genital cutting as a child. She is 26 weeks pregnant. You examine and find infibulation. What is the type of female genital mutilation (FGM) that this woman has?

FGM type 3 * Type 1 is partial or total removal of the clitoris and/or the prepuce (Clitoridectomy) * type 2 is partial or total removal of the clitoris and the labia minora * type 3 is narrowing of the vagina orifice with creation of a covering seal by cutting and appositioning the labia minora and/or the labia majora, with or without excision of the clitoris (infibulation) * type 4 is all other harmful procedures to the female genitalia for non-medical purposes, for example, pricking, piercing

A 30-year-old woman who has just had a normal vaginal delivery at term sustains a perineal tear that involves 50% of the external anal sphincter. You are called to suture this tear. How will you classify the degree of the tear?

3a degree * 1 degree: laceration of the vaginal epithelium or perineal body. 2 degree: primary muscle but not anal sphincter tear. 3 degree: 3a, <50% thickness of the external sphincter 3b, >50% of thickness of the external sphincter torn 3c, internal sphincter also torn 4 degree: tear with disruption of the anal epithelium

A 24-year-old primigravida goes into spontaneous labour at 39+6 weeks of gestation following an uncomplicated pregnancy. She progresses to 8 cm dilatation but fails to dilate any further. You have examined and found that the baby is in the deflexed occipitoposterior position. What will be diameter of the presenting part in this baby

Occipito-frontal

What will be diameter of the presenting part in each case : 1- fully flexed occipito-anterior presentation 2- deflexed vertex 3- brow presentation 4- face presentation

1- fully flexed occipito-anterior presentation 👉 sub-occipito bregmatic = 9.5 2- deflexed vertex 👉 occipito-frontal = 11.5 3- brow presentation 👉mento-vertical = 13.5 4- face presentation 👉 sub-mento bregmatic = 9.5

A 32-year-old woman in her second pregnancy was induced at 40 weeks because of gestational diabetes that is well controlled with metformin. She had prostaglandin gel and 3 h later had an artificial rupture of fetal membranes. Shortly after, she started contracting and progressed to full dilatation after 7 h. She remained fully dilated for 2 h and then started pushing. The head was delivered but was noticed to be receding (i.e. there was a turtleneck appearance). You were called and arrived after 2 min. What would be the next step to take in her management? A. Apply suprapubic pressure B. Insert your hand in the vagina and deliver the posterior arm C. Place her in all fours D. Perform an episiotomy and the attempt to deliver the shoulders E. Place her in the McRoberts position

Place her in the McRoberts position : which is successful in as many as 90% of cases. ( maternal pushing should be discouraged ) * If this fails, the next manoeuvre should be the application of supra-pubic pressure followed by internal manoeuvres

A primigravida is diagnosed with an intrauterine fetal death at 26 weeks of gestation. Following counselling, she books for induction of labour. What would be the appropriate dose of misoprostol and mifepristone to use to induce labour?

Mifepristone 200 mg, misoprostol 50 µg qd for a total of 5 doses * given six times hourly up to a maximum of five doses per course. * The vaginal route is the gold standard with the oral and sublingual routes reserved for those women at risk of malabsorption related to vaginal discharge or bleeding

A 36-year old woman who had breast cancer and has been free of any recurrence and has also just completed her five-year course of tamoxifen wishes to know when can she start trying to conceive?

After 3 months

You see a 31-year-old woman at 10 weeks of gestation for booking. She is on antituberculosis treatment. What is the most relevant monthly test you need to perform on this patient?

Liver function test

You suspect myocardial infarction in a pregnant woman at 24 weeks of gestation. An ECG is performed. What finding on the ECG would be highly suspicious (i.e. which is the most sensitive and specific change) of an acute myocardial infarction (AMI)?

ST elevation

A primigravida develops eczematous skin eruptions at 30 weeks of gestation. These are associated with itching and on examination are found to be located mainly within abdominal striae. What is the most likely diagnosis? A. Atopic eruption of pregnancy B. Eczema of pregnancy C. Obstetric cholestasis D. Pemphigoid gestationis E. Polymorphic eruption of pregnancy (PEP)

Polymorphic eruption of pregnancy (PEP) 👉( abdominal striae.) + sparing the belly button (umbilicus)

A primigravida is seen at 28 weeks of gestation for an ultrasound scan for suspected fetal growth restriction. This is confirmed on ultrasound scan measurement of the various biometric indices, and there is oligohydramnios and reduced end-diastolic flow (REDF) on umbilical artery Doppler. The baby is known to be a boy. What is the most likely cause of the oligohydramnios? A. Placenta insufficiency B. Polycythemia C. Posterior urethral valve D. Renal agenesis E. Renal hypoperfusion

Renal hypoperfusion

A 30-year-old lady who suffers from a major depressive disorder and has recently been admitted but is now well controlled on fluoxetine 40 mg has just found that she is pregnant. This is an unplanned pregnancy, and she is worried about the effects of the drug on the baby. What advice should she be given? A. Explain that the risk of malformation is low and recommend continuation of the medication B. Stop medication and replace it with a tricyclic antidepressant C. Stop medication and resume after delivery D. Stop medication and resume after the end of the first trimester E. Stop medication immediately

Explain that the risk of malformation is low and recommend continuation of the medication

A 25-year-old woman who is known to have beta-thalassaemia major has just delivered. She is on desferrioxamine. The mother plans to breastfeed and is worried about the effect of the drug on the baby. What should she be told ? A. Advise against breastfeeding B. Advise that breastfeeding is safe C. Change to another iron-chelating agent and allow her to breastfeed D. Recommend to continue medication and breastfeed as long as she understands the risk E. Stop the medication and breastfeed

Advise that breastfeeding is safe * Desferrioxamine is secreted in breast milk but is not orally absorbed and therefore not harmful

An elective caesarean section has been performed on a primigravida with a breech presentation at 39 weeks of gestation. Her weight is 110 kg. What is the dose of lowmolecular-weight heparin (Dalteparin) that you would give her as thromboprophylaxis?

7500 IU * 2500 IU for women who weigh <50 kg, 5000 IU for those weighing 50–90 kg, 7500 IU for those weighing 91–130 kg, 10,000 IU for those weighing 131–170 kg

A 29-year-old primigravida attends the clinic at 26 weeks of gestation to discuss postpartum thromboprophylaxis. She is homozygous for factor V Leiden. Her mother had a pregnancy-related thromboembolism. What would be the duration of thromboprophylaxis after her delivery? A. 10 days B. 14 days (2 weeks) C. 28 days (4 weeks) D. 42 days (6 weeks) E. 84 days (12 months) 30. What organism is known

42 days (6 weeks) * family history of VTE in her mother as well as being homozygous factor V Leiden

What organism is known to be the most common cause of sepsis in pregnancy? A. Escherichia coli B. Group B β haemolytic Streptococcus C. Pseudomonas D. Staphylococcus aureus E. Streptococcus pyogenes

Escherichia coli & Group A β haemolytic Streptococcus

You are the specialist registrar on call for the unit and are performing an emergency lower segment CS of a patient who has had one previous CS. An ultrasound scan performed at 20 weeks had ruled out placenta praevia. Upon opening the peritoneum, you find engorged bluish vessels on the lower uterine segment. What will be your course of action? A. Call for the consultant immediately and wait until he/she arrives B. Call for the consultant urgently but proceed with opening the lower segment C. Call for the consultant urgently but proceed with opening the upper segment D. Call the interventional radiologist and wait until catheters have been inserted E. Crossmatch blood and then proceed to open the uterus – lower segment

Call for the consultant urgently but proceed with opening the lower segment * this is emergency CS no time to wait the consultant or radiologist / classical CS associated with higher morbidity

You have been called to see a 30-year-old woman with ITP who has been fully dilated for over 3 h and pushing for the last one of these. You examine and find that the baby is in an occipito-posterior position and at the level of the ischial spines (station zero). What would be next step in the management of this patient? A. Emergency CS B. Kielland’s forceps delivery C. Manual rotation and forceps D. Neville-Barnes forceps delivery E. Ventouse delivery

Emergency CS 1- will reduce the risk of intracranial haemorrhage 2 - An instrumental delivery is likely to be a difficult as the baby’s head is still at the level of the spines.

You are about to see a 32-year-old woman in her third pregnancy at 12 weeks of gestation. Her last baby suffered from haemolytic disease of the fetus and newborn (HDFN). An antibody titre at this gestation is 8 IU. The father is heterozygous for RhD. What would be the next stage in her management? A. Chorionic villus sampling for fetal genotype B. ffDNA in maternal blood for fetal genotype C. Refer to fetal medicine for serial MCA Doppler monitoring D. Serial titres weekly E. Ultrasound scan for hydrops

ffDNA in maternal blood for fetal genotype * It is recommended that non-invasive fetal genotyping using maternal blood should be undertaken . This is possible for D, C, c, E, e and K

primigravida presents with a chickenpox rash 3 days after it was first noticed. She is now 18 weeks pregnant. How will she be managed? A. Arrange detailed scan with the fetal medicine unit after 5 weeks B. Arrange amniocentesis to exclude intrauterine infection C. Commence on aciclovir 400 mg tds for 5 days D. Reassure and discharge E. Ultrasound scan for anomaly in 3 weeks

Arrange detailed scan with the fetal medicine unit after 5 weeks * Oral aciclovir should be prescribed for pregnant women with chickenpox, if they present within 24 h of the onset of the rash . * referral to a fetal medicine specialist at 16–20 weeks or 5 weeks after infection

A 30-year-old G3P2 attends the VBAC clinic for counselling about mode of delivery. This is an uncomplicated pregnancy and she had indicated after her mid-trimester scan that she would like to try for a vaginal delivery. She had an emergency CS for her first pregnancy because of fetal distress and then had a uterine rupture in the second pregnancy intrapartum. The outcome at surgery was a live birth. What is the risk of uterine rupture that you will quote for this woman if she went for VBAC?

≥1:20 (5%) 👉 A previous uterine rupture is therefore considered a contraindication to VBAC

What is the risk of uterine rupture in Women who have had a previous CS and are embarking on VBAC ?

1:200 ( 0.5 % )

A 27-year-old woman is being counselled about VBAC. Her CS was an emergency at 8 cm dilation for an abnormal fetal heart rate on CTG. The baby had normal Apgar scores and pH at birth. She is now 34 weeks and the pregnancy is uncomplicated. What success rate for VBAC will you quote for her?

71-75% * After 2 CS = 62-75%

A 28-year-old who had a previous CS is being counselled about VBAC. What information from her past obstetrics history would give her the best chance of a successful VBAC? A. If she has had a previous vaginal delivery B. If the previous CS was an elective CS for breech presentation C. If the previous CS was for fetal distress in the late first state of labour D. If the previous CS was for labour dystocia at 8 cm or more dilatation E. If the previous CS was for labour dystocia at less than 8 cm dilatation

If she has had a previous vaginal delivery ( particularly previous VBAC )- single best predictor * A successful VBAC is more likely with a previous CS for fetal malpresentation compared with women with previous CS for either labour dystocia or fetal distress indications * A successful VBAC is more likely in women with a previous labour dystocia at 8 cm or more compared to less than 8 cm

A 32-year-old multiparous woman went into spontaneous labour at 40 weeks of gestation. Labour was progressing normally but at 8 cm dilatation, when fetal membranes ruptured spontaneously, she collapsed. What is the most likely cause of the collapse?

Amniotic fluid embolism ( 1.25-12.5/100,000) * AFE presents as collapse during labour or within 30 min of delivery

On what basis will you make a diagnosis of amniotic fluid embolism in a 30-year-old G2P1 who laboured spontaneously but had syntocinon augmentation at 5 cm dilatation? A. Bronchial lavage B. Clinical features C. Fetal squames in maternal circulation D. Fetal squames in the pulmonary trees E. Findings of a V/Q scan

Clinical features ( as there is no established accurate diagnostic test premortem. )

A 36-year-old woman is seen as an emergency at 34 weeks of gestation with central chest pain, which is mainly interscapular. She is found on examination to be breathless with a systolic hypertension (BP = 160/80 mmHg) and a wide pulse pressure. What is the most likely diagnosis in this woman? A. Cardiomyopathy B. Dissection of an aortic root aneurysm C. Dissection of the coronary artery D. Left ventricular failure E. Myocardial infarction

Dissection of an aortic root aneurysm

A 23-year-old primigravida whose pregnancy was complicated by gestational diabetes went into spontaneous labour at 40 weeks of gestation. She started pushing but had shoulder dystocia after delivery of the head of the baby. What factor is likely to increase the risk of brachial plexus injury (BPI) in the baby?

The weight of the baby

What is the most common cause of litigation related to shoulder dystocia in the UK?

Brachial plexus injury (BPI)

A 30-year-old woman whose labour was complicated by shoulder dystocia and brachial plexus injury has come back for debriefing. It is recognized that a significant number of these injuries are associated with substandard care. Approximately what proportion of these injuries are associated with substandard care?

45%–50%

A 42-year-old presents for booking at 10 weeks of gestation. She is a smoker (smoking 8–10 cigarettes per day). Her BMI is 28 kg/m2. What would be the plan for screening/ monitoring for SGA in this woman? A. Maternal serum-alpha protein at 14 weeks of gestation B. Maternal serum PAPP-A at 12 weeks of gestation C. Serial uterine and umbilical artery Doppler from 20–24 weeks of gestation D. Serial growth ultrasound scan and umbilical artery Doppler from 26–28 weeks of gestation E. Uterine artery Doppler at 20–24 weeks

Serial growth ultrasound scan and umbilical artery Doppler from 26–28 weeks of gestation * These women are at high enough risk, and uterine artery Doppler is therefore not very appropriate. * Age is a major risk factor 👉 1 major: serial growth ultrasound scan * Smoker < 11 is a minor risk factor 👉 1 minor : Uterine artery Doppler at 20–24 weeks * > 3 minor 👉 serial growth ultrasound scan

A 32-year-old G3P2 is referred at 28 weeks of gestation for ultrasound scan because of reduced fetal movements. Ultrasound measurements of both the head and abdominal circumference are below the 10th centile and the amniotic fluid index is 25 cm. The umbilical artery Doppler is normal. What single important investigation should be offered to this woman? A. Blood test for CMV and toxoplasmosis B. Middle cerebral artery Doppler C. Karyotyping D. Oral glucose tolerance test with 75 g glucose load E. Uterine artery Doppler

Karyotyping *SGA + polyhydramnios

When Karyotyping should be offered in SGA cases ?

1- severe SGA with structural abnormalities ( an EFW or AC <3rd centile ) 2- in those detected before 23 weeks of gestation especially of the uterine artery Doppler is normal. 3- in The presence of polyhydramnios, symmetrical SGA and normal umbilical artery Doppler

In the absence of group-specific blood, what should a 25-year-old woman who is having a major postpartum haemorrhage be transfused with? A. Blood group O, Rhesus (D) negative B. Blood group O, Rhesus (D) negative and CMV negative C. Blood group O, Rhesus (D) negative and K-negative D. Blood groups O, Rhesus (D) negative, K-negative and CMV negative E. Blood group O, Rhesus (D) negative, K-negative, CMV and CJD negative

Blood group O, Rhesus (D) negative and K-negative

A 27-year-old woman is on the list for an elective CS at 37 weeks of gestation for placenta praevia. She requests for intraoperative cell salvage. What are the components of intraoperative cell salvage? A. Blood collection and transfusion B. Blood collection, filtering and transfusion C. Blood collection, filtering, washing and transfusion D. Blood collection, filtering, washing and irradiation E. Blood collection, filtering, washing and treating prior to transfusion

Blood collection, filtering, washing and transfusion

You are managing a 24-year-old primigravida who has just had an emergency CS in the second stage and is bleeding heavily. She has lost in total about 1500 mL of blood and continues to bleed. Transfusion has commenced and her haemostatic test results are being awaited. What will be the indication for administering fresh frozen plasma (FFP) to this woman? A. Her fibrinogen level is less than 2 g/L B. Her haemostatic test results are unavailable C. Her platelets were low at the onset of labour D. She has had 4 units of red blood cells E. She is being transfused with fresh blood

She has had 4 units of red blood cells ( in the guidelines 6 units) * FFP should be guided by the aim of keeping PT & PTT ratios at less than 1.5 x normal. * Cryoprecipitate : guided by fibrinogen results, aiming to keep levels above 1.5 g/l

What is the estimated percentage reduction in venous thromboembolism (VTE) risk by low-molecular-weight heparin (LMWH) in medical and surgical patients, respectively?

60% and 70%

At what stage in pregnancy is the risk of VTE highest in a 33-year-old woman who is having her first baby and reports that her mother had a deep vein thrombosis (DVT) while on the combined hormonal contraceptive pill at the age of 35 years? A. In labour B. In the first trimester C. In the first three weeks postpartum D. In the second trimester E. In the third trimester

In the first three weeks postpartum

A 37-year-old mother of 3 who smokes 10 cigarettes per day books for antenatal care at 10 weeks of gestation. This was an IVF pregnancy. You have examined and found that her BMI is 29 kg/m2. What recommendation will you offer her about thromboprophylaxis? A. Commence on LMWH for 10 days after delivery B. Commence on LMWH from 28 weeks of gestation until 6 weeks post-delivery C. Commence on LMWH from 28 weeks until 10 days post-delivery D. Commence on LMWH now and until 10 days post-delivery E. Commence LMWH now and until 6 weeks post-delivery

Commence LMWH now and until 6 weeks post-delivery 4 risk factors: smoker+ age > 35 y + IVF + parity * ( BMI should be> 30 to be a risk factor)

You are booking a 26-year-old in her first pregnancy at 6 weeks of gestation. She was referred for advice on thromboprophylaxis because she had a DVT three years ago and was investigated and found to be heterozygous for factor V Leiden. The GP had stopped her warfarin and commenced her on 5000 IU of Fragmin daily. What would be your plan for her management? A. Commence on a higher dose (either 50%, 75% or full treatment dose) of LMWH until 6 weeks postpartum B. Commence on a higher dose (either 50%, 75% or full treatment dose) of LMWH until 12 weeks postpartum C. Commence on a higher dose (either 50%, 75% or full treatment dose) of LMWH until 6 weeks postpartum or until warfarin is re-commenced D. Continue with the LMWH until 6 weeks after delivery E. Continue with the standard dose of LMWH until 6 weeks postpartum or until warfarin is re-commenced

Continue with the standard dose of LMWH until 6 weeks postpartum or until warfarin is re-commenced * Women with a previous VTE associated with other heritable thrombophilic defects other than antithrombin III are at a lower risk of recurrence and can be managed with standard doses * High dose : recurrent DVt ot 2A : antphospholipid or antithrombin III or homozygous or 2 heterozygous ( compound)

What is the estimated prevalence of diagnosed pulmonary embolism in pregnancy in women with suspected PE?

2-6% ( 6%)

What is the estimated prevalence of diagnosed pulmonary embolism in pregnancy in women with suspected PE?

2-6% ( 6%)

A 30-year-old primigravida attends the Pregnancy Triage Unit with pain in her left leg. She is examined and DVT is suspected; the level of clinical suspicion is graded as high. She is commenced on therapeutic doses of dalteparin – an LMWH. A compression duplex ultrasound scan is performed and this is negative. What should be the next step in her management?

Stop the LMWH and repeat the ultrasound scan on days 3 and 7 to ensure that it is indeed not a DVT ( don't continue except for PE continue and repeat CT)

A 33-year-old G2P1 presents at 29 weeks of gestation with sudden onset chest pain and difficulties breathing. She also reports that she has had a swollen and painful left leg for the past one week. You suspect that she has a PE as well as a left DVT. She is commenced on therapeutic doses of LMWH pending confirmation of diagnosis. What would be the most appropriate investigation to perform in this woman? A. Chest X-ray B. Compression duplex ultrasound scan C. Computed tomography pulmonary angiogram (CTPA) D. Electrocardiogram (ECG) E. Ventilation-perfusion (V/Q) lung scan

Compression duplex ultrasound scan

A 40-year-old mother of three in her fourth pregnancy at 30 weeks of gestation is admitted into the emergency unit with a suspicion of PE. She has otherwise been asymptomatic and there are no symptoms of DVT. She is commenced on therapeutic doses of LMWH pending confirmatory tests. What should be next test to undertake in this woman?

Chest X-ray (CXR) followed by V/Q scan or CTPA

A 23-year-old woman presents with reduced fetal movements at 33 weeks gestation. The fetal heart could not be heard with a sonicaid; hence, she was referred for an ultrasound scan. The scan has confirmed an intrauterine fetal death (IUFD). Approximately what percentage of women presenting with an intrauterine fetal death have reduced fetal movements?

55%

A 19-year-old primigravida has been referred to the Maternity Triage with suspected reduced fetal movements at 35 weeks of gestation. You have taken a history from her and are assured that she does not have reduced fetal movements. This is an uncomplicated pregnancy. What will your management of this patient be? A. Check her BP and urine and then perform a cardiotocography and if all findings are normal, discharge her with a kick chart B. Check her BP and urine and then perform a cardiotocography and if all findings are normal, discharge her with the advice to contact the maternity unit if she has concerns C. Check her BP and urine, perform a cardiotocography and arrange an ultrasound scan and discharge if all findings are normal with the advice to contact the maternity unit if she has concerns D. Listen to the fetal heart and if normal, reassure and discharge her with the advice to contact the maternity unit if she has concerns E. Perform a cardiotocography and if normal, discharge her with the advice to contact the maternity unit if she has concerns

Listen to the fetal heart and if normal, reassure and discharge her with the advice to contact the maternity unit if she has concerns

. A 39-year-old woman is seen at 38 weeks of gestation with reduced fetal movements. Her BP is 150/95 mmHg and urinalysis is negative for protein. The fetal heartbeat is heard with a sonicaid and you arrange a cardiotocography, which shows normal baseline variability but no accelerations after 120 min. What will be your plan for this patient? A. Admit for monitoring of the fetus with daily CTGs B. Organize an ultrasound scan for biometry C. Organize an ultrasound scan for growth and Doppler of the umbilical artery D. Organize delivery E. Refer for biophysical profile assessment

Organize delivery

Test blood group and antibody at booking and then at 28 weeks of gestation

A patient is seen in the antenatal clinic at 12 weeks of gestation after having had her routine blood tests by the midwife in the community at 10 weeks of gestation. She is blood group O Rhesus D negative with red cell antibodies (titre of 2.4 IU/L). What would be the next logical step in the management of this patient? A. Assume that the baby is at risk of isoimmunization and monitor with serial antibody measurement B. Obtain a blood sample from the putative father to determine his genotype C. Offer an amniocentesis to determine baby’s blood group D. Offer non-invasive testing from maternal blood at around 16 weeks of gestation E. Perform a CVS at this gestation to determine blood group of the baby

Offer non-invasive testing from maternal blood at around 16 weeks of gestation ( To do fetal genotyping) * Avoid issues of non paternity * If anti K at around 20w

At what minimum level of anti-K antibody would a referral to a fetal medicine unit be necessary in a 27-year-old G3P2 who has had a previous caesarean section and a termination of pregnancy? She is currently at 16 weeks of gestation

Any level of antibody

What proportion of infants born with congenital CMV infection are born to women with pre-existing CMV immunity?

Two thirds * It avidity> 65% indicate past infection

You reviewed a 27-year-old G2P1 on the delivery suite at 27 weeks of gestation. She was admitted complaining of regular uterine contractions. Following counselling, she was started on a course of corticosteroids and magnesium sulphate (the latter for tocolysis). What is the advantage of giving her MgSO4? A. Reduces the risk of cerebral palsy in the baby B. Reduces the risk of having a preterm delivery C. Reduces the risk of her having eclampsia D. Reduces the risk of intracranial haemorrhage E. Reduces risk of ventricular haemorrhage

Reduces the risk of cerebral palsy in the baby

A 31-year-old G3P2 presents at 29 weeks of gestation with preterm premature rupture of fetal membranes. She is not having any contractions but complains of mild abdominal discomfort. You have confirmed rupture of membranes and sent some of the amniotic fluid for infection screen (culture). What proportion of women presenting with PPROM have positive amniotic fluid cultures? A. 15%–19% B. 20%–24% C. 25%–29% D. 30%–34% E. 35%–40%

30%–34%

A primigravida was diagnosed with breast cancer at 12 weeks of gestation. Following surgery, she was commenced on chemotherapy. She went into spontaneous labour at 36 weeks of gestation when on the last course of chemotherapy. She wishes to breastfeed. What advice will she be given?

To express the breast milk and discard for two weeks before breastfeeding

You are performing a routine laparoscopic tubal occlusion on the Gynaecology Day List of your unit. You have completed the procedure but during closure of the ports, your trainee pricks you with a needle. The patient is from a high-risk country, although she has not been tested for HIV. What would be the recommendation with respect to samples and testing on you? A. A baseline sample for testing, another follow-up for testing at 3 months and a third one at 6 months for testing B. Baseline sample for testing for HIV C. Baseline blood sample for storage and a follow-up sample for testing at 12 weeks D. Baseline sample for testing and another follow-up for testing E. Baseline sample for storage, a follow-up for testing and another at 6 months for testing

Baseline blood sample for storage and a follow-up sample for testing at 12 weeks

20-year-old woman is seen at 30 weeks gestation with generalized pruritus especially of the palms of the hands and soles of the feet. A diagnosis of obstetric cholestasis is suspected. How common is this complication of pregnancy in the UK

7–8/1000 pregnancies

A 33-year-old was induced at 37 weeks of gestation on account of obstetric cholestasis. What is the best time to perform a liver function test post-delivery to confirm that the liver function test result has returned to normal?

Six weeks

A woman is seen at 24 weeks gestation for follow-up. This is her second pregnancy – the first was a stillbirth at 29 weeks of gestation in a pregnancy complicated by obstetric cholestasis. She is interested in knowing how this pregnancy can be monitored to reduce the risk of a recurrence of the stillbirth. What is the best method of monitoring the baby from 26–28 weeks of gestation? A. Amniocentesis to check for lecithin-sphingomyelin ratio B. Cardiotocography C. No reliable method is available D. Transcervical amnioscopy for the identification of meconium-stained liquor E. Umbilical artery Doppler

No reliable method is available

What proportion of pregnant women is affected by nausea and vomiting in pregnancy?

Up to 80%

A 20-year-old woman is admitted with nausea and vomiting in pregnancy (NVP) at 7 weeks of gestation. What signs will make you diagnose hyperemesis gravidarum in this woman?

NVP with weight loss of more than 5% pre-pregnancy weight, dehydration and electrolyte imbalance

A 25-year-old is seen at 7 weeks of gestation in her first pregnancy with severe nausea and vomiting in pregnancy (NVP). Initial management has failed to stem the vomiting. Further investigations have been performed, including a thyroid function test. These have been reported as increased free thyroxine and suppressed thyroid-stimulating hormone. What should be the recommended management of this biochemical abnormality?

Treat the hyperemesis and not the abnormal thyroid function

What is the most likely electrolyte derangement in a woman admitted with hyperemesis gravidarum (HG)? A. Hyperkalaemia, hypernatraemia, hyperchloraemia and ketosis B. Hyperkalaemia, hypernatraemia, hypochloraemia and ketosis C. Hyperkalaemia, hyponatraemia, hypochloraemia and ketosis D. Hypokalaemia, hyponatraemia, hyperchloraemia and ketosis E. Hypokalaemia, hyponatraemia, hypochloraemia and ketosis

Hypokalaemia, hyponatraemia, hypochloraemia and ketosis

What is the estimated rate of mother-to-child transmission (MTCT) of HIV in women who are on combination antiretroviral therapy (cART) with undetectable viral load at the time of delivery in the UK?

0.1%–0.5%

A 30-year-old is offered HIV screening test at booking at 12 weeks of gestation but declines. What would be the next step in her management with respect to screening for HIV? A. Document in her notes and re-offer testing at her next antenatal visit at 16 weeks of gestation B. Document in her notes and re-offer testing at her 28 weeks antenatal visit C. Document in her notes and re-offer testing at her 36 weeks antenatal visit D. Document in her notes and offer rapid testing in labour E. Document in her notes and treat her as potentially positive and offer prophylactic ART to her newborn

Document in her notes and re-offer testing at her 28 weeks antenatal visit

When should a pregnant HIV-positive woman with a viral load of >30,000 HIV RNA copies/mL plasma who does not require treatment for herself commence cART? A. At the start of the second trimester B. At the start of the third trimester C. By the 12th week of gestation D. By the 16th week of gestation E. By the 24th week of gestation

At the start of the third trimester * If > 100,000 👉 now 30.000-100.000 👉 second trimester < 30.000👉 24w

A 40-year-old from Zimbabwe attends for her first antenatal visit at 16 weeks of gestation. She is counselled about the increased risk of aneuploidy and wishes to have an amniocentesis. What would be the most appropriate approach to this procedure? A. Defer the procedure until her HIV status is known B. Perform an HIV test and the amniocentesis but commence her on ART until the HIV results are back C. Perform an HIV test if she has no objection and then perform the amniocentesis D. Perform the procedure and manage depending on the outcome E. Offer rapid HIV test and proceed to perform amniocentesis if negative, and if positive, counsel against the procedure and perform an NIPT test

Defer the procedure until her HIV status is known

What should the recommendation be for a 37-year-old HIV-positive woman (diagnosed when she booked at 10 weeks of gestation) who has a high-risk combined trisomy 21 test at 12 weeks of gestation and wishes to have CVS? She has not been commenced on cART yet as she is only 12+4 weeks and her CD4 count is >500 cells/µL. A. Defer invasive testing until the viral load is <50 HIV RNA copies/mL plasma B. Measure HIV viral load and consider invasive testing if <50 HIV RNA copies/mL plasma C. Offer NIPT and only consider invasive testing if it is abnormal D. Perform the CVS but commence on cART E. Perform the procedure as the CD4 count is normal

Defer invasive testing until the viral load is <50 HIV RNA copies/mL plasma

A woman on cART has had a spontaneous vaginal delivery following induction of labour at 41+4 weeks’ gestation. What measures should be taken to reduce vertical transmission to the baby? A. Avoid breastfeeding B. Avoid breastfeeding and administer triple ART therapy for 4 weeks C. Avoid breastfeeding and administer triple ART for 6 weeks D. Avoid breastfeeding and commence the baby on zidovudine monotherapy E. Avoid breastfeeding and give the baby a 4-week course of zidovudine monotherapy

Avoid breastfeeding and give the baby a 4-week course of zidovudine monotherapy ( During 4 hours of delivery)

A 32-year-old G2P1 presents with lower abdominal pains, which are intermittent. She has not had any vaginal discharge or leakage of water per vaginam. She does not have any symptoms of urinary tract infection and is apyrexial. She is 28+2 weeks pregnant. What will be the next stage in her management? A. CTG for 30 min to determine the frequency of uterine contractions if any and the state of the fetus B. Nifedipine C. Oncofetal fibronectin D. Speculum examination followed by digital examination if indicated E. Ultrasound scan for cervical length

Speculum examination followed by digital examination if indicated

A 30-year-old primigravida attends for her anomaly ultrasound scan at 18 weeks of gestation, and the cervix is suspected to be short. A transvaginal ultrasound scan was performed, and the cervix measured 20 mm with a closed os. What would be the next logical step in the management of this patient? A. Commence on nifedipine B. Commence on vaginal progesterone C. Monitor the cervix weekly and consider a cerclage if its length is less than 15 mm D. Offer an interval cervical cerclage E. Reassure and offer routine antenatal care

Commence on vaginal progesterone * to women with no history of spontaneous preterm birth or mid-trimester loss in whom a transvaginal ultrasound scan has been carried out between 16+0 and 24+0 weeks of gestation that reveals a cervical length of less than 25 mm

Who should be offered screening for sickle cell disease and thalassaemia in the UK? A. All Afrocarribeans as early as possible B. All Afrocarribeans, Asians, middle-Europeans and Mediterranean as soon as possible C. All Asians, Afrocarribeans and Mediterranean as soon as possible D. All Asians as soon as possible E. All women as early as possible

All women as early as possible ( ideally by 10w)

An ultrasound has been performed on a primigravida at her booking visit. What is the crown-rump length (CRL) for measuring nuchal translucency (NT)? A. 40–80 mm B. 45–84 mm C. 45–90 mm D. 54–84 mm E. 60–85 mm

54–84 mm

A primigravida books for antenatal care at 10 weeks of gestation. What is the recommended number of antenatal visits she should have assuming that the pregnancy remains low risk?

10 visits

What is the best approach to assess gestational age for a woman booking with a CRL of 93 mm?

Head circumference

You have booked a 23-year-old rhesus (D) positive primigravida for antenatal care. When will you request for screening for atypical antibodies during her pregnancy?

At booking and 28 weeks

An anomaly ultrasound scan performed at 20 weeks of gestation on a primigravida shows a low-lying placenta. What action will you take on this patient? A. Admit her into the hospital from 32 weeks B. Admit her into the hospital from 34 weeks C. Perform a transvaginal ultrasound scan at 32 weeks to confirm praevia D. Repeat the transabdominal ultrasound scan at 32 weeks E. Request for a transvaginal ultrasound scan to confirm the diagnosis before making a management plan

Repeat the transabdominal ultrasound scan at 32 weeks Repeat not perform because: Only women whose placentas extend over the internal os should be offered another transabdominal scan at 32 weeks not only low lying

At what gestational age should an external cephalic version be attempted on a primigravida who is diagnosed with a breech presentation at 35 weeks of gestation?

37w * Where it is not possible to schedule an appointment for the version at 37 weeks, it should be scheduled at 36 weeks.

A 26-year-old haemophilia A carrier is about to have a CVS at 11 weeks of gestation on account of an abnormal nuchal translucency. What precaution if any should be undertaken prior to this procedure?

Check factor VIII levels ( should be more than 0.5) * More accurate: Check factor VIII and von Willebrand factor (vWF).

A 30-year-old haemophilia B carrier is now 36 weeks pregnant. What is the greatest risk to this woman in view of her carrier status? A. Increased risk of antepartum haemorrhage B. Increased risk of placental abruption C. Increased risk of neonatal intracranial and extracranial haemorrhage D. Increased risk of primary postpartum haemorrhage E. Increased risk of stillbirth

Increased risk of primary postpartum haemorrhage * coagulation factors may normalize during pregnancy in carriers, with an early fall in levels postnatally

A 22-year-old woman attends for her routine anomaly ultrasound scan at 20 weeks and informs the team that her partner has severe haemophilia B. The detail scan is normal and she is informed that the fetus is male. What advice should be offered to this woman? A. Planned elective CS at 39 weeks of gestation B. Prenatal diagnosis by means of amniocentesis as soon as possible C. Prenatal diagnosis by means of amniocentesis in the third trimester D. Prenatal diagnosis by means of cordocentesis (fetal blood sampling) E. Reassurance and support during the pregnancy

Reassurance and support during the pregnancy But if she is a carrier 👉 Prenatal diagnosis by means of amniocentesis in the third trimester ( after 34w)

When would you abandon an attempted ventouse delivery in a 20-year-old primigravida who had a delay in the second stage of labour? A. After a failed second application of the cup B. Delivery is not imminent following two contractions of a correctly applied instrument by an experience operator C. If the cup comes off after one failed pull D. If the cup comes off after the second application E. When there has been no evidence of progressive descent with moderate traction during each contraction

When there has been no evidence of progressive descent with moderate traction during each contraction

A 26-year-old primigravida is undergoing a trial of vaginal breech delivery. The breech is frank with an estimated birth weight of 3100 g. She progressed at a normal rate, but the cervix has remained at 7 cm for the past 3 h. The fetal heart rate is normal. What would be the next plan for her? A. Augment with oxytocinon and manage as for a cephalic presentation B. Augment with oxytocinon for 2 h and then re-assess C. Proceed to a caesarean section D. Re-examine in 2 h and if no progress, perform a CS E. Re-examine in 3–4 h and if no progress, perform a CS

Proceed to a caesarean section

What is the main risk of giving a high dose of oxytocin to a 30-year-old primigravida in the management of postpartum haemorrhage?

Hypotension

What is the estimated overall failure rate of the haemostatic suture in the management of primary postpartum haemorrhage?

25%

A 26-year-old G2P1 was induced at 37 weeks following prolonged rupture of fetal membranes. Labour was augmented with syntocinon following slow progress at 4 cm dilatation. She progressed to full dilatation and delivered 6 h after augmentation with syntocinon. Syntocinon (10 units) was given IM with the delivery of the anterior shoulder. The midwife has called you because since the delivery of the placenta, the patients has been bleeding and has lost a total of 600 mL blood. What will be the first step you will take in her management? A. Examine the placenta to see if it is complete B. Empty the bladder by inserting a Foley catheter C. Rub uterine contractions D. Secure an intravenous access with a 14 gauge cannula E. Send blood for cross-matching

Rub uterine contractions

Sba 1 Obstetric Flashcards

(211 cards)