Antenatal care Flashcards

1
Q

What should women be informed about the additional risk of miscarriage following amniocentesis or CVS?

A

It is likely to be below 0.5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the earliest gestation amniocentesis should be performed?

A

15 weeks gestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the earliest gestation CVS should be performed?

A

10 weeks gestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What should women be informed about the additional miscarriage risk for twin pregnancy following amniocentesis or CVS?

A

The additional risk is around 1%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What gestation is CVS usually performed between?

A

11+0 and 13+6 weeks gestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

1-2% of all CVS results will be affected by which confounding complication?

A

Confined placental mosaicism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

RCOG recommends those trained in CVS and Amniocentesis should carry out how many of these procedure per year as a minimum to maintain skills?

A

20

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Aside from miscarriage, what other risk is increased if amniocentesis is carried out prior to 15 weeks gestation?

A

Talipes equinovarus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What risks are increased with CVS before 10 weeks?

A

Oromandibular and limb defects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What complication is increased when amniocentesis is carried out in the third trimester?

A

Culture failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Corticosteroids should be offered to women between which gestations when imminent preterm birth is anticipated?

A

24+0 - 34+6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the two potential harmful side effects of antenatal corticosteroids for the neonate?

A

Neonatal hypoglycaemia and developmental delay

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the number needed to treat to prevent 1 neonatal death by giving antenatal corticosteroids between 22-34+6 weeks gestation?

A

38.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How should women with multiple pregnancy be counselled about the use of antenatal corticosteroids?

A

In line with the guidance for singleton pregnancy, however they should be advised of the uncertainties around their use in multiple pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the median latency of delivery after PPROM ?

A

7 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the change in blood oxygen saturation during a flight at cruising altitude?

A

SpO2 reduced by 10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What does the evidence show about risk of adverse pregnancy events with air travel?

A

There is no good data to suggest an increase in preterm labour, PPROM or abruption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What advice should be given to women about the maximum gestation to fly at?

A

36 weeks if no complications
32 weeks if any risk factors for preterm birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Which conditions are absolute contraindications to air flight?

A

Anaemia with Hb <75
Recent haemorrhage
Otitis media or sinusitis
Serious cardiac or respiratory disease
Recent sickle cell crisis
Recent GI surgery
A fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What advice should be given to pregnant women about antimalarial therapy?

A

Anti-malarials are safe in pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Which travel vaccines should be avoided in pregnant women?

A

Live vaccines such as the Yellow Fever vaccine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What percentage of babies born in the UK weigh more than 4,000g?

A

10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the Number Needed to Treat to prevent 1 fracture by using IOL in LGA?

A

60

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Antepartum haemorrhage is defined as vaginal bleeding after what gestation?

A

24 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

APH complicates what percentage of all pregnancies?

A

3-5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the definition of minor APH?

A

Blood loss less than 50mls which has settled

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the definition of major APH?

A

Blood loss of 50-1,000mls with no signs of clinical shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the definition of massive APH?

A

Blood loss greater than 1,000mls and or signs of clinical shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is the incidence of recurrent placental abruption?

A

4.4%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is the relative risk of placental abruption for women who have first trimester bleeding with an intrauterine haematoma?

A

Relative Risk 5.6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is the recurrence rate of placental abruption in women who have had two previous pregnancies complicated by abruption?

A

19-25%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Approximately what percentage of placental abruptions happen in “low risk” women?

A

70%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What should be avoided in placenta praevia?

A

Vaginal and rectal examinations
Penetrative sexual intercourse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What neonatal outcomes are associated with unexplained APH?

A

Increased risk of preterm birth
Increased rates of IOL
Increased neonatal admission
Increased rates of neonatal hyperbilirubinaema
Decreased birth weight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What should be considered in cases of APH associated with rupture of membranes?

A

Vasa praevia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What investigation should be performed for Rhesus negative women presenting with APH?

A

Kleihauer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is the sensitivity of ultrasound in identifying placental abruption?

A

24%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Antenatal corticosteroids are associated with a reduction in the risk of… (3)

A
  1. Neonatal death
  2. Respiratory distress syndrome
  3. Intraventricular haemorrhage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

How should antenatal care be changed in a low risk woman with APH from placental abruption or unexplained cause?

A
  1. The pregnancy should be reclassified as high risk
  2. Serial fetal growth scans should be performed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What action should be considered in active APH after 37 weeks?

A

IOL should be considered to avoid the risk of placental abruption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What advice should be given about fetal monitoring for women with APH?

A

Women with one episode of minor APH with no subsequent concerns about maternal or fetal wellbeing could have intermittent auscultation

Women with major or recurrent minor APH and those women with suspected abruption should have CEFM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What postnatal plan should be put in place for women with APH?

A

Recommend active management of the third stage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

How should anti-D be managed in Rh negative women with APH after 20 weeks?

A

500 units Anti-D should be given followed by Kleihauer - if >4mls leak then further anti-D is indicated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Serum lactate above which threshold is indicative of tissue hypoperfusion?

A

> =4mmol/l

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What are the two most common pathogens identified in pregnant women dying of sepsis?

A

Group A Strep and E.coli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What are the drawbacks of using Co-Amoxiclav to treat maternal sepsis?

A
  1. Does not cover MRSA or Pseudomonas
  2. May cause necrotising enterocolitis in the neonate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

When should haemoglobin be rechecked after initiating treatment for anaemia?

A

After 2 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

When should pregnant women be screened for anaemia?

A

At booking and at 28 weeks
Women with multiple pregnancy should have an additional FBC at 20-24 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

How often should women at high risk of needing blood transfusion (e.g. placenta praevia/accreta) have Group and Screen samples sent?

A

At least weekly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What dose of Anti-D should be given to Rhesus negative women who receive autologous cell salvage blood?

A

1,500 units

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

How often should FFP be transfused during major obstetric haemorrhage?

A

1 unit FFP should be transfused for every 6 units of Red Blood Cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

When is Cryoprecipitate indicated in major obstetric haemorrhage?

A
  1. Give the first dose of 2 5-unit pools early
  2. Give subsequent Cryoprecipitate to keep Fibrinogen levels above 1.5g/l
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What platelet level should trigger platelet infusion in major obstetric haemorrhage?

A

75 x 10^9

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What percentage of direct maternal deaths in the UK is caused by haemorrhage?

A

10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Which vitamin are obese women at high risk of being deficient in?

A

Vitamin D

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Above what BMI should women have a review for anaesthetic assessment in pregnancy?

A

> 40

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What is the guidance on assessment for GDM in women with obesity?

A

All women with BMI >30 should have a GTT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Above what BMI should serial growth scans be offered due to reduced utility of SFH?

A

> 35

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Above what depth of subcutaneous fat should women have the subcutaneous tissue space closed at Caesarean section?

A

2cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What are the BMI thresholds for class I, II and III obesity?

A

Class I 30-34.99
Class II 35-39.99
Class III >40.00

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What are pregnant women with obesity at increased risk of during pregnancy? (12 in total)

A
  1. Miscarriage
  2. GDM
  3. Pre-eclampsia
  4. VTE
  5. Induced labour
  6. dysfunctional or prolonged labour
  7. Caesarean section
  8. anaesthetic complications
  9. PPH
  10. Wound infections
  11. mortality
  12. Delayed initiation of breastfeeding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Weight loss between pregnancies reduces which risks?

A

Stillbirth
Hypertensive complications
Macrosomia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Which congenital malformation can arise in babies born to mothers who use Topiramate in pregnancy?

A

Cleft lip and palette

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What is the relative risk of pre-eclampsia in overweight, obese and severely obese women?

A

1.7
2.93
4.14

(Obese women are 3-4 times more likely to get pre-eclampsia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

What did the FaSTER trial demonstrate with relation to maternal obesity?

A

Lower sensitivity and higher false negative rate when screening for aneuploidy with ultrasound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What percentage of obese primparous women will have a vaginal birth following IOL?

A

60%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

how many antenatal appointments should low risk nulliparous and parous women have respectively?

A

Nulliparous women should have 10 antenatal appointments
Parous women should have 7 antenatal appointments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What advice should women be given about sleeping position after 28 weeks?

A

Women should be advised to avoid sleeping on their back after 28 weeks as this may increase the risk of stillbirth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

What advice should be given to women regarding caffeine intake in pregnancy?

A

Caffeine intake should be limited to 200mg per day to reduce risks of low birth weight in the baby

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Constipation affects up to what percentage of pregnancies?

A

38%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

What are the ROME III diagnostic criteria for constipation?

A
  1. At least 2 of:

a. straining for >25% of defecations
b. Lumpy or hard stools in at least 25% of defecations
c. Sensation of incomplete emptying for at least 25% of defecations
d. Sensation of anorectal obstruction/blockage for at least 25% of defecations
e. Manual maneouvres to facilitate at least 25% of defecations

  1. Loose stools are rarely present without the use of laxatives
  2. Insufficient criteria for irritable bowel syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Which promotility hormone is inhibited by increasing levels of progesterone in pregnancy, leading to constipation?

A

Motilin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

What is the role of the RAAS system in constipation?

A

Increased RAAS results in sodium and water reabsorption from the gut, reducing stool water content

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

What is the treatment of choice for chronic constipation in pregnancy?

A

Polythylene glycol (PEG, an osmotic laxative)

*Movicol is a polymer of PEG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Which laxatives should be avoided in the third trimester and why?

A

Stimulant laxatives should be avoided as they have been shown to cause uterine contractions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Why should Docusate sodium be avoided in pregnancy?

A

It can cause neonatal hypomagnesaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Which medication can be used in moderate to severe constipation associated with IBS-C and works by increasing c-GMP to decrease visceral pain?

A

Linaclotide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

How does ECV affect the outcome of labour?

A

Women should be informed that following successful ECV, there is a slightly increased rate of instrumental birth or Caesarean section compared to spontaneous cephalic labour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

When should ECV be offered?

A
  1. Typically from 37 weeks
  2. ECV can be offered to nulliparous women from 36 weeks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

How does 1 previous Caesarean affect risks of ECV?

A

The risks of ECV following 1 previous Caesarean are not increased compared to the unscarred uterus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

What can be given to improve the success rate of ECV?

A

Use of tocolysis with betamimetics (Terbutaline) improves the success rate of ECV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Breech presentation complicates what proportion of term deliveries?

A

3-4%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

What is the risk of emergency Caesarean within 24 hours of ECV?

A

0.5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

How does the risk of fetal mortality compare between vaginal breech, elective Caesarean and vaginal cephalic birth

A
  1. Vaginal breech - 2/1,000
  2. Caesarean - 0.5/1,000
  3. Vaginal cephalic - 1/1,000
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

What is the rate of emergency Caesarean section in women planning vaginal breech birth?

A

40%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Which factors increase the risks of vaginal breech birth (5)

A
  1. Hyperextended neck on ultrasound
  2. EFW >3.8Kg
  3. EFW <10th centile
  4. Footling presentation
  5. Evidence of antenatal fetal compromise
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Are induction and augmentation appropriate in vaginal breech birth?

A
  1. IOL is not recommended for vaginal breech birth
  2. Augmentation of slow progress should only be considered if contraction frequency is low in the presence of epidural anaesthesia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

How should a first twin in breech position be delivered?

A

Planned Caesarean section is recommended where the leading twin is breech

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

How should a second twin in breech position be delivered?

A

Routine Caesarean section for breech presentation of the second twin is not recommended

89
Q

What advice should be given about the Varicella vaccine and breastfeeding?

A

It is safe to breastfeed following Varicella vaccination

90
Q

How should pregnant women without previous exposure to chickenpox be managed following an exposure to chickenpox or shingles?

A

She should have a blood test to determine VZV immunity

91
Q

How should a women not immune to VZV be managed if she has had a significant exposure?

A

She should have PEP with Aciclovir from day 7 to day 14 post exposure

92
Q

When is VZIG effective following contact with Chickenpox or shingles?

A

Up to 10 days following exposure

93
Q

For what timespan should non-immune pregnant women who have been exposed to chickenpox be considered as potentially infectious?

A

From day 8-28 if they received VZIG or day 8-21 if they do not receive VZIG

94
Q

How soon after PEP with Aciclovir or VZIG can another course be prescribed if there is repeat exposure?

A

Aciclovir can be repeated after 7 days
VZIG can be repeated after 3 weeks

95
Q

What are the maternal risks of Varicella?

A

Increased risk of pneumonia, hepatitis and encephalitis

96
Q

What advice should women with chickenpox be given about avoiding susceptible individuals?

A

Avoid susceptible individuals until the lesions have crusted over (usually around 5 days)

97
Q

When should Aciclovir be prescribed for women with Chickenpox?

A

Within 24 hours of the onset of rash and if they are 20 weeks gestation or beyond

98
Q

What is the advice about VZIG for women with chickenpox?

A

VZIG has no therapeutic benefit once the rash has developed

99
Q

What fetal investigation should be offered for a pregnant woman who develops chicken pox and when should this happen?

A

Refer to fetal medicine for detailed ultrasound at 16-20 weeks or 5 weeks after infection
Amniocentesis has a good negative predictive value for fetal damage secondary to chickenpox and so should be offered

100
Q

How should pregnant women be managed following a chickenpox infection in the last 4 weeks of pregnancy?

A

Avoid planned delivery for at least 7 days following the onset of maternal rash
Inform a neonatologist of all babies born to mothers with chickenpox

101
Q

What are the characteristics of fetal varicella syndrome?

A

Skin scarring in a dermatomal distribution
eye defects
Hypoplasia of the limbs
Neurological abnormalities
(can happen following maternal infection up to 28 weeks)

102
Q

What are the high risk factors for pre-eclampsia?

A

Previous hypertensive disease in pregnancy
Chronic kidney disease
Autoimmune disease such as SLE or antiphospholipid syndrome
Type 1 or Type 2 diabetes
Chronic hypertension

103
Q

What are the moderate risk factors for pre-eclampsia?

A

Nulliparity
Age >=40
Pregnancy interval >10 years
BMI 35 or more at booking
FH pre-eclampsia
Multiple pregnancy

104
Q

What is the diagnostic threshold for pre-eclampsia using albumin-creatinine ratio

105
Q

What is the range of gestational ages for PLGF testing?

A

20-36+6 weeks

106
Q

How often should women with chronic hypertension be seen in ANC?

A

Weekly if hypertension is poorly controlled
Every 2-4 weeks if hypertension is well controlled

107
Q

How should BP be monitored postnatally in women with chronic hypertension?

A

Daily for the first 2 days
At least once between days 3 to 5
Review of antihypertensives at 2 weeks

108
Q

How often should women with gestational hypertension have BP measured?

A

Once or twice a week until BP is 135/85 or less

109
Q

How often should women with severe gestational hypertension have their BP meausred?

A

Every 15 to 30 minutes until BP is <160/110

110
Q

How often should urine dip be performed for protein in women with gestational hypertension?

A

Once to twice per week

111
Q

How often should urine dip be performed for protein in women with severe gestational hypertension?

A

Daily while admitted

112
Q

How often should PET bloods be performed in women with gestational hypertension?

113
Q

How often should fetal growth assessment be performed in women with gestational hypertension?

A

Every 2-4 weeks

114
Q

How often should blood pressure be monitored for women with pre-eclampsia?

A

Every 48 hours as outpatient
At least 4 times daily whilst admitted to hospital

115
Q

How often should women with pre-eclampsia have their bloods tested?

A

Twice weekly
3 times per week if severe hypertension

116
Q

How often should women with pre-eclampsia have fetal growth monitored?

A

Every 2 weeks

117
Q

What are the sequelae of pre-eclampsia which should prompt delivery prior to 37 weeks?

A

Poor BP control despite 3 agents
SpO2 <90%
Progressive deterioration in LFT, renal function or platelet count
Ongoing neurological features
Placental abruption
Reversed end-diastolic flow

118
Q

What is the name for the thin, continuous fibrinoid layer between anchoring villi and uterine decidual cells?

A

Nitabuch’s membrane

119
Q

What is the role of Methotrexate in PAS?

A

There is no role for Methotrexate in PAS in treatment of retained placental tissue as there are no rapidly dividing cells in the third trimester placenta

120
Q

What are the clinical criteria for diagnosis of FIGO grade 1 placenta accreta?

A

No separation with synthetic oxytocin or gentle cord traction

Attempts at manual removal result in heavy bleeding from placental site requiring mechanical or surgical procedures

At laparotomy or caesarean, there is no obvious distension over the placental bed, no neo-vascularity and no placental tissue seen invading through placental surface

121
Q

What are the clinical criteria for FIGO grade 2 PAS?

A

Abnormal macroscopic findings over the placental bed such as bluish/purple colouring or distension

Significant amounts of hypervascularity

No placental tissue seen invading through the placental surface

Dimple sign: gentle cord traction results in the uterus being pulled inwards without separation of the placenta

122
Q

What are the clinical criteria for FIGO grade 3a PAS?

A

Abnormal macroscopic findings on uterine serosal surface and placental tissue seen invading through the surface of the uterus

No invasion into any other organ - a clear surgical plane can be seen between the bladder and the uterus

123
Q

What are the clinical criteria for FIGO grade 3b PAS?

A

Placental villi are seen to be invading into the bladder but no other organs

A clear surgical plane cannot be seen between the bladder and the uterus

124
Q

Which ultrasonographic features of PAS have been seen in 98% of low-risk pregnancies with normal placentas?

A

Lacunae
Sub-placental hypervascularity
Irregular bladder wall

125
Q

Which ultrasonographic features of PAS are rarely seen unless there is PAS or UD?

A

Placental bulge
Bridging vessels
A myometrium <1mm thick
Loss of the retroplacental clear zone

126
Q

What is the risk of PAS in a woman with placenta praevia and 1 prior Caesarean?

127
Q

What is the risk of PAS in a woman with placenta praevia and 2 prior Caesareans?

128
Q

What is the risk of PAS in a woman with placenta praevia and 3 prior Caesareans?

129
Q

What is the risk of PAS in a woman with placenta praevia and 4 prior Caesareans?

130
Q

What was the overall maternal death rate in 2020-2022?

A

13.56 per 100,000

131
Q

What was the leading direct cause of maternal death in the most recent MBBRACE report?

A

Venous Thromboembolism

132
Q

How much higher are the odds of VTE in pregnant women with cancer?

A

7 times increased

133
Q

What is the success rate of planned VBAC?

134
Q

What is the success rate of planned VBAC for women with a previous vaginal birth?

135
Q

What are the changes in risk for induction/augmentation of labour in a woman pursuing a VBAC?

A

Women having IOL with VBAC have:

2-3 fold increase in risk of uterine rupture
1.5 times increased risk of Caesarean delivery

136
Q

How do risk rates for VBAC differ in a preterm woman?

A

Similar rates of successful VBAC but lower rate of uterine rupture in preterm

(i.e. prematurity is not a contraindication to VBAC)

137
Q

What is the risk of repeat uterine rupture for women labouring following previous uterine rupture?

138
Q

What percentage of women who plan elective repeat Caesarean will labour before 39 weeks?

139
Q

What thresholds should be used for diagnosis of anaemia in the first, second/third, and postpartum periods?

A

110 first trimester
105 second/third trimester
100 postpartum

140
Q

Group and screen samples used for transfusion in pregnancy should be no more than how old?

141
Q

Cell salvage should be used when blood loss is expected to be above what % of circulating volume?

142
Q

What is the lifetime risk of breast cancer in the UK?

143
Q

What percentage of breast cancer cases are diagnosed prior to age 45?

144
Q

What is the 5 year survival of breast cancer in women aged under 50?

145
Q

How does diagnosis of breast cancer differ in pregnant women?

A

They should have biopsy for histology, not cytology in pregnancy

146
Q

What investigations are used for staging of breast cancer in pregnancy if necessary?

A

Chest xray
Liver ultrasound

147
Q

Which chemotherapeutic agents used in breast cancer are safe in pregnancy?

A

Anthracyclines (Doxorubicin or Epirubicin)

148
Q

When should chemotherapy for breast cancer be used?

A

From second trimester onwards

149
Q

What advice should be given about use of Tamoxifen and Herceptin (Trastuzumab) for breast cancer in pregnancy?

A

They should not be used in pregnancy

150
Q

Birth should be aimed at least how long after administration of chemotherapy?

151
Q

What advice should be given about breastfeeding following Tamoxifen or Herceptin use?

A

Women taking Tamoxifen or Herceptin should not breastfeed

152
Q

How long prior to conceiving should women stop Tamoxifen?

A

At least 3 months

153
Q

Women with PPROM either in established labour or expected to have preterm birth within 24 hours should be offered MgSO4 up to what gestation?

A

29+6 weeks

154
Q

PPROM complicates roughly what percentage of pregnancies?

155
Q

PPROM is associated with roughly what percentage of preterm births? (range)

156
Q

What is the median latency from PPROM to birth?

157
Q

What typically happens to WCC following administration of antenatal corticosteroids?

A

WCC rises 24 hours after steroids and typically returns to normal after 3 days

159
Q

What is the alternative antibiotic of choice in PPROM for a woman who cannot have Erythromycin?

A

Penicillin

160
Q

What is the relative risk of chorioamnionitis when antibiotics are given in PPROM compared to no antibiotics?

A

RR 0.66
(i.e. a third reduction in rates of chorioamnionitis)

161
Q

What is the effect of antibiotics on the latent period following PPROM

A

29% reduction in labour within 48 hours
21% reduction in labour within 1 week

162
Q

What is the effect of corticosteroids on Respiratory Distress Syndrome following PPROM?

A

Antenatal corticosteroids reduce the rate of RDS following PPROM by 19%

163
Q

What is the effect of corticosteroids on Intraventricular haemorrhage following PPROM?

A

Antenatal corticosteroids reduce the rate of intraventricular haemorrhage by 51%

164
Q

When should MgSO4 be given in the context of PPROM?

A

Magnesium sulfate should be offered to women in established preterm labour or when birth is expected withing 24 hours between 24 and 29+6 weeks gestation

165
Q

Why is tocolysis not recommended in PPROM?

A

It increases the risk of chorioamnionitis without improving neonatal outcomes

166
Q

Hospital based care following PPROM should be offered to women with all three of which factors?

A

PPROM <26 weeks gestation
Non-cephalic presentation
Oligohydramnios

167
Q

What percentage of women who have PPROM will go on to have PTSD postnatally?

168
Q

At what gestation should women having PPROM after 24 weeks be planned to birth in the absence of GBS?

169
Q

What is the odds ratio of recurrent PPROM?

A

8.7
i.e. women with PPROM are 8 times more likely to have PPROM again in subsequent a pregnancy

170
Q

Weight loss between pregnancies reduces the risks of which complications?

A

Stillbirth
Hypertensive complications
Fetal macrosomia

171
Q

Which medication should obese women (BMI >30) be advised to take in early pregnancy?

A

Folic acid 5mg til 12 weeks

172
Q

What additional screening do women with BMI >30 require?

173
Q

BMI > what threshold is a moderate risk factor for pre-eclampsia?

174
Q

Women with BMI over what should have serial growth scans?

175
Q

Women with >= what depth of subcutaneous fat should have suturing of the subcutaneous tissue space?

176
Q

How long should women be advised to wait after bariatric surgery before trying to conceive?

A

12-18 months

177
Q

What percentage of the antenatal population are obese?

178
Q

How much more likely are women with obesity to develop gestational diabetes?

A

Women with obesity are 3 times more likely to develop gestational diabetes

179
Q

How much more likely are women with obesity to have a pulmonary embolism than healthy weight women?

A

Women with obesity are 15 times more likely to have a pulmonary embolism

180
Q

What percentage of obese women will have a successful VBAC?

181
Q

At what gestation should a history-indicated cervical cerclage be placed? (answer is a range)

A

11-14 weeks gestation

182
Q

What are the indications for history-indicated cerclage?

A

Women with singleton pregnancy with a history of 3 or more previous preterm births/second trimester losses

183
Q

What is the role of cervical cerclage in women with incidentally-identified cervical shortening?

A

Women should not be offered cervical cerclage for incidental cervical shortening in the absence of other risk factors for preterm birth

184
Q

When is cervical cerclage indicated in the context of ultrasound-identified cervical shortening?

A

When there is a history of one or more previous preterm births/second trimester losses

185
Q

What percentage of women with a history of previous preterm birth or second trimester pregnancy loss will reach 34 weeks gestation if they maintain a cervical length >25mm til 24 weeks gestation?

186
Q

Which are the high risk factors for preterm birth?

A

Previous preterm birth or second trimester loss beyond 16 weeks
Previous PPROM <34 weeks
Previous use of cerclage
Known uterine variant
Intrauterine adhesions
History of trachelectomy

187
Q

How should women at high risk for preterm birth be monitored?

A

Review by preterm birth specialist by 12 weeks
Cervical length scanning every 2-4 weeks from 16-24 weeks gestation

188
Q

What are the intermediate risk factors for preterm birth?

A

Previous Caesarean section at full dilatation
LLETZ >1cm depth
more than one LLETZ
cone biopsy

189
Q

How should women at intermediate risk for preterm birth be monitored?

A

Offer single cervical length scan between 18-22 weeks gestation

190
Q

What is the median delay in preterm birth in women who have rescue cervical cerclage performed?

191
Q

What are the contraindications to insertion of cervical cerclage?

A

Active preterm labour
Clinical evidence of chorioamnionitis
Continuing vaginal bleeding
PPROM
Evidence of fetal compromise
Lethal fetal defect
Fetal death

192
Q

What advice should be given on bed rest and abstinence from sexual intercourse for women who have had cervical cerclage?

A

Bed rest and abstinence from sexual intercourse should not be routinely recommended for women with cervical cerclage

193
Q

When should cervical cerclage be electively removed?

A

Between 36+1 and 37+0 weeks gestation

194
Q

How is labour managed for women with abdominally-sited cervical cerclage?

A

All women with abdominal cervical cerclage require Caesarean section

195
Q

Which legal framework covers the law surrounding FGM in England?

A

The Female Genital Mutilation Act 2003

196
Q

FGM must be reported to the police within what timeframe of its being identified?

197
Q

What is the role of clitoral reconstruction surgery in the context of FGM?

A

It should not be performed as there is high complication rate with inadequate results

198
Q

What additional antenatal screening assessment should be offered to women with FGM?

A

Hepatitis C serology

199
Q

Partial or total removal of the clitoris or prepuce constitutes which type of FGM?

200
Q

Partial or total removal of the clitoris and the labia minora, with or without removal of the labia majora constitutes which type of FGM?

201
Q

Narrowing of the vaginal orifice with creation of a covering seal by cutting and appositioning the labia minora and/or labia majora with or without excision of the clitoris constitutes which type of FGM?

202
Q

How many women and girls in England and Wales are thought to have had FGM?

203
Q

Which infections are more common in women who have had FGM? (2 of them)

A

Bacterial vaginosis
HSV2

204
Q

How should FGM be recorded?

A

FGM should be recorded in the HSCIC database in a non-anonymised fashion
The type of FGM should be recorded
Genital piercings must be included

205
Q

What percentage of neonatal HSV infections occur at the time of birth?

206
Q

What percentage of neonatal HSV infections occur in utero

207
Q

What is the mortality of neonatal HSV with CNS involvement, when antivirals are given?

208
Q

What percentage of neonatal HSV infections will present with disseminated disease?

209
Q

What is the mortality of disseminated neonatal HSV infection, when antivirals are given?

210
Q

What is the overall mortality of neonatal HSV infection?

211
Q

When is the most high risk time for neonatal HSV infection?

A

When there is primary infection in the third trimester within 6 weeks of delivery

212
Q

When should antiviral prophylaxis be started for most mothers with genital herpes?

213
Q

When should antiviral prophylaxis be started for mothers with genital herpes with risk factors for preterm birth?

214
Q

What is the workup of a pregnant woman presenting with suspected disseminated HSV infection?

A

Send samples for urgent HSV PCR and HSV IgG
Commence high dose IV Valaciclovir 10mg/Kg TDS
Inform neonatal team

215
Q

What treatment should be given for uncomplicated primary genital herpes simplex infection in pregnancy?

A

Aciclovir 400mg TDS 5 days
or
Valaciclovir 500mg BD 5 days

216
Q

How should mode of birth be decided in women with primary HSV infection in pregnancy before the 3rd trimester?

A

Vaginal birth can be considered if infection occurs at least 6 weeks prior to birth

217
Q

How should mode of birth be decided in women with primary HSV infection in pregnancy in the 3rd trimester?

A

They should be counselled to have Caesarean section

218
Q

What is the chance of neonatal herpes infection in a baby born to a mother with recurrent herpes lesions at the time of vaginal birth?

219
Q

How should episodes of recurrent genital herpes presenting in pregnancy be managed?

A

Supportive management with analgesia and topical lidocaine is appropriate for most