Birth Matters Flashcards
Regarding Postpartum Haemorrhage one of the following is true:
a) Over estimation of blood loss is a common problem
b) A pre-existing coagulation disorder is a common cause of postpartum haemorrhage
c) A history of Postpartum Haemorrhage in a previous pregnancy is not considered a contraindication to home birth
d) Antibiotics should be given for up to 24 hours after an evacuation of retained placental remnants in a haemodynamically stable patient
e) Prostaglandin F2alpha(Carboprost) is not recommended in postpartum haemorrhage
d) Antibiotics should be given for up to 24 hours after an evacuation of retained placental remnants in a haemodynamically stable patient
A 28-year-old primigravida at 39 weeks gestation presents to Delivery Suite with a history of ruptured membranes for 6 hours without contractions. On examination she is afebrile, the fundus is appropriate for term, there is a singleton fetus with a cephalic presentation and the head is engaged. On speculum examination there is obvious clear liquor draining and the cervix cannot be adequately visualised. A CTG is normal. Which of the following statements about management is correct.
a) If the woman wants to wait for the onset of spontaneous contractions, a sterile vaginal examination should be performed to exclude cord prolapse first
b) Induction of labour with prostaglandins is associated with less analgesic use and lower rates of neonatal infections compared to oxytocin use
c) Induction of labour with oxytocin or prostaglandins is associated with a reduced risk of maternal and neonatal infection compared to expectant management
d) If the baby is not delivered in 12 hours time, intravenous erythromycin should be started to minimise the risk of Group B strep infection
e) If expectant management is chosen, the woman should remain in hospital for regular fetal and maternal monitoring
c) Induction of labour with oxytocin or prostaglandins is associated with a reduced risk of maternal and neonatal infection compared to expectant management
A 32-year-old primigravida is found to have a breech presentation at a routine antenatal clinic visit at 36 weeks gestation. Which one of the following statements about management is correct?
a) The risk of placental abruption with external cephalic version is about 5%
b) External cephalic version is successful in 20 to 35% of cases
c) She should be offered external cephalic version at 39 to 40 weeks if the presentation remains breech
d) Given the reduction in perinatal mortality in the elective section arm of the Term Breech Trial, she should be offered an elective caesarean section now
e) An ultrasound should be arranged to check fetal anatomy, growth, position of the fetal legs and exclude extension of the fetal neck
e) An ultrasound should be arranged to check fetal anatomy, growth, position of the fetal legs and exclude extension of the fetal neck
A 29-year-old primigravida who is 36 weeks pregnant wishes to discuss the pros and cons of epidural analgesia during labour.Which of the following statements is correct?
a) Epidural analgesia is associated with a two-fold increase in her chance of a caesarean section
b) Epidural analgesia is associated with an increase in operative vaginal delivery rate
c) Epidural analgesia is more likely to result in depression of the newborn at birth than pethidine
d) It is possible to increase the chances of a normal vaginal delivery in the presence of epidural analgesia by allowing active second stage to last up to 4 hours
e) Epidural analgesia increases the chance of long term back problems
b) Epidural analgesia is associated with an increase in operative vaginal delivery rate
A 31 year old primigravida who is 36 weeks pregnant wishes to discuss the pros and cons of episiotomy versus a perineal tear should her perineum be at risk of tearing during delivery of the fetal head. Which of the following statements is correct?
a) Use of an episiotomy in this situation is associated with lower rates of posterior perineal trauma
b) The risk of episiotomy and perineal trauma can be reduced by the use of perineal massage in the weeks preceding delivery
c) Irrespective of how perineal trauma occurs, less analgesia is required when the perineal skin is closed with interrupted sutures
d) Avoiding an episiotomy in this situation is associated with less anterior perineal trauma
e) Irrespective of how perineal trauma occurs, chromic catgut sutures are preferred to synthetic sutures as they dissolve more rapidly and have less risk of requiring removal weeks after delivery
b) The risk of episiotomy and perineal trauma can be reduced by the use of perineal massage in the weeks preceding delivery
A 33-year-old G4P3 woman had a polycose screen at 28 weeks of 9.1mmol/L. A glucose tolerance test showed a fasting glucose of 5.0mmol/L and a 2 hour result of 8.9mmol/L. The delivery was complicated by shoulder dystocia, and a third degree perineal tear. The birthweight of the baby was 4.1kg. What testing would best exclude a diagnosis of Type II diabetes:
a) A fasting blood glucose >5.0mmol/L in the puerperium
b) A normal neonatal blood glucose estimation
c) Persistent glycosuria
d) A glucose tolerance test at 6 weeks postpartum
e) A glucose tolerance test before hospital discharge
d) A glucose tolerance test at 6 weeks postpartum
With regard to preterm delivery, which statement is correct?
a) Evidence of infection can be identified in more than half of spontaneous preterm births at less than 30 weeks
b) Antenatal corticosteroids are of no benefit for babies born between 32 and 34 weeks
c) Caesarean section has been shown to reduce perinatal mortality in breech babies at <32 weeks’ gestation
d) Smoking cessation early in pregnancy has no impact on preterm delivery
e) Spontaneous preterm labour accounts for about one third of all preterm births
a) Evidence of infection can be identified in more than half of spontaneous preterm births at less than 30 weeks
Regarding Breech Presentation which of the following is correct:
a) ECV can be safely recommended to women with a previous caesarean section who have a breech presentation at 36 weeks gestation
b) Risk of death or neurodevelopmental delay at 2 years of age is similar in babies delivered after a planned breech vaginal delivery or planned caesarean section
c) A woman with an undiagnosed breech presenting in advanced labour should have an epidural inserted
d) Caesarean section should be recommended to women with an undiagnosed breech who present in labour at 34 weeks gestation
e) The majority of babies with a breech presentation at term will have a fetal abnormality
b) Risk of death or neurodevelopmental delay at 2 years of age is similar in babies delivered after a planned breech vaginal delivery or planned caesarean section
Regarding Post Term Pregnancy, which of the following is INCORRECT:
a) Prolonged pregnancy is associated with an increased risk of neonatal, postnatal and childhood mortality up to the age of 2yrs
b) Current evidence favours induction of labour from 41 weeks gestation
c) Reassuring fetal CTGs are usually indicative of fetal wellbeing for a week
d) Meconium staining is seen in 25% pregnancies past 42 weeks
e) Early ultrasound estimation of gestational age reduces induction of labour for prolonged pregnancy
c) Reassuring fetal CTGs are usually indicative of fetal wellbeing for a week
In post term pregnancy (>41 weeks) which statement if CORRECT?
a) Sweeping the membranes reduces the rate of Caesarean section
b) Oligohydramnios is an indication for induction that week
c) It is usual for fetal movements to slow down after term
d) Induction of labour is associated with increased Caesarean section compared with expectant management
e) Induction of labour is recommended to reduce the risk of stillbirth
e) Induction of labour is recommended to reduce the risk of stillbirth
A 37-year-old woman is found to have twins on an 11-week scan. Which of the following statements is true:
a) Dizygotic twins increase with increasing maternal age due to increased splitting of the early embryo
b) Monochorionic monoamniotic twinning occurs when the embryo splits around 7 days post conception
c) Ultrasound assessment of chorionicity in the first trimester is not sufficiently reliable to use clinically
d) Dizygotic twinning rates have not changed in the past 10 years
e) She does not have an increased risk of fetal abnormality
b) Monochorionic monoamniotic twinning occurs when the embryo splits around 7 days post conception
A 23y G2P0 woman comes to see you at antenatal clinic at 18 weeks gestation. She requests an elective Caesarean Section as she is frightened of the pain of labour, and doesn’t want to be incontinent after a vaginal birth. All of the below are true except:
a) Elective Caesarean Section is associated with an increased risk of antepartum stillbirth in a subsequent pregnancy
b) Elective Caesarean Section protects against the risk of urinary incontinence
c) Vaginal delivery is associated with increased risk of utero-vaginal prolapse
d) Spontaneous vaginal delivery increases the risk of faecal incontinence
e) Epidural analgesia will help her cope with the labour pain, but will increase her risk of instrumental delivery
d) Spontaneous vaginal delivery increases the risk of faecal incontinence
A healthy 35y G3P1 with normal BMI presents for discussion about Vaginal Birth After Caesarean Section (VBAC). Her last delivery was an elective CS for breech presentation at term. She is 32 weeks pregnant with a singleton pregnancy. All of the following are true except:
a) Her chance of a successful VBAC is ~30%
b) Her risk of uterine rupture in labour is 35 per 10,000 women
c) Her risk of uterine rupture after induction of labour with prostaglandins is 240 in 10,000 women
d) She has an increased risk of postpartum haemorrhage
e) An abnormal fetal heart rate pattern is often the first clinical sign of uterine rupture.
a) Her chance of a successful VBAC is ~30%
A 28y G2P1 who has previously had a normal vaginal birth at term, presents at 34 weeks gestation with a dichorionic twin pregnancy. The first twin is cephalic and the second twin is breech. You advise her:
a) She should have an elective Caesarean section at 38 weeks
b) “Locked twins” is possible in this situation
c) Delivery by 38 weeks is advised to reduce the risk of adverse infant outcome
d) The second twin will need to undergo external cephalic version (ECV) after the birth of the first twin
e) Elective Caesarean section protects against the development of cerebral palsy in twin pregnancies
c) Delivery by 38 weeks is advised to reduce the risk of adverse infant outcome
A 40 year old woman presents to your rooms with a twin pregnancy at 12 weeks gestation. With regards to screening/diagnosis of Down syndrome, which of the following is the best answer?
a) The risk of having a baby with Down syndrome is higher if the pregnancy is monochorionic than if it is dichorionic
b) In a dichorionic pregnancy, the risk of her having a baby with Down syndrome at term is ~ 1 in 50.
c) Amniocentesis in a twin pregnancy at 16 weeks carries a procedure-related risk of miscarriage of 10%
d) Nuchal translucency as part of first trimester aneuploidy screening is not a valid test in monochorionic twin pregnancies.
e) CVS is not an option for prenatal diagnosis in twin pregnancies
b) In a dichorionic pregnancy, the risk of her having a baby with Down syndrome at term is ~ 1 in 50.
