EMQ Flashcards
A group of trainees meet together on the labour ward with the duty consultant on a Monday morning to discuss the noteworthy cases during which the consultant relates various experiences, situations and advice to the trainees
A: Appraisal B: Bloom’s taxonomy of learning C: Criterion-referenced standard setting D: Educational supervision E: Experiential learning F: Formative assessments G: Life-long adult learning H: Linear equating standard setting I: Norm-referenced standard setting J: Pendleton’s rules for feedback K: Quality assurance in education L: Reflective practice M: Reliability N: Summative assessments O: Transformative learning P: Validity Q: Vicarious learning
The correct answer is vicarious learning.
vɪˈkɛːrɪəs,vʌɪˈkɛːrɪəs/:
feeling is experienced by watching, listening to, or reading about other people doing something, rather than by doing it yourself.
These questions test the basic principles of teaching, learning, assessment and appraisal. For a useful article and reference see: Duthie SJ, Garden AS. The teacher, the learner and the method. The Obstetrician & Gynaecologist 2010;12:273–80.
A consultant has just performed an online learning exercise on her Trust’s clinical governance issues as a pre-requisite for her consultant appraisal. The Trust has determined that every consultant must score 15 or more out of 25 before the assessment can be signed off by the appraiser
A: Appraisal B: Bloom’s taxonomy of learning C: Criterion-referenced standard setting D: Educational supervision E: Experiential learning F: Formative assessments G: Life-long adult learning H: Linear equating standard setting I: Norm-referenced standard setting J: Pendleton’s rules for feedback K: Quality assurance in education L: Reflective practice M: Reliability N: Summative assessments O: Transformative learning P: Validity Q: Vicarious learning
The answer is norm-referenced standard setting.
A specialist trainee in obstetrics and gynaecology must become a member of the Royal College of Obstetricians and Gynaecologists before progressing to advanced training
A: Appraisal B: Bloom’s taxonomy of learning C: Criterion-referenced standard setting D: Educational supervision E: Experiential learning F: Formative assessments G: Life-long adult learning H: Linear equating standard setting I: Norm-referenced standard setting J: Pendleton’s rules for feedback K: Quality assurance in education L: Reflective practice M: Reliability N: Summative assessments O: Transformative learning P: Validity Q: Vicarious learning
The answer is summative assessments.
An ST1 trainee describes to his clinical supervisor how he managed a postpartum haemorrhage by himself for the first time and now feels much more confident about dealing with this complication, more than after doing a skills drills on the subject
A: Appraisal B: Bloom’s taxonomy of learning C: Criterion-referenced standard setting D: Educational supervision E: Experiential learning F: Formative assessments G: Life-long adult learning H: Linear equating standard setting I: Norm-referenced standard setting J: Pendleton’s rules for feedback K: Quality assurance in education L: Reflective practice M: Reliability N: Summative assessments O: Transformative learning P: Validity Q: Vicarious learning
The correct answer is experiential learning.
An ST7 advanced trainee presents a case-based discussion to her educational supervisor who realises that the trainee has only superficial knowledge with knowledge deficits on the subjects discussed. The supervisor recommends some targeted reading to address the identified educational needs. They meet together a few weeks later and the trainee describes how reading around the subject has enabled a lot of the concepts to fall into place to enhance her clinical practice as a specialist obstetrician and gynaecologist. The trainee also describes that she now understands the need for in-depth learning to be an expert in the field
A: Appraisal B: Bloom’s taxonomy of learning C: Criterion-referenced standard setting D: Educational supervision E: Experiential learning F: Formative assessments G: Life-long adult learning H: Linear equating standard setting I: Norm-referenced standard setting J: Pendleton’s rules for feedback K: Quality assurance in education L: Reflective practice M: Reliability N: Summative assessments O: Transformative learning P: Validity Q: Vicarious learning
The answer is transformative learning.
A few trainees were asked to submit some questions for a local MRCOG Part 2 course. Most of the questions were gratefully accepted and incorporated into the course by the organiser; two questions were rejected because they were deemed to be outside the scope of the MRCOG Part 2 syllabus
A: Appraisal B: Bloom’s taxonomy of learning C: Criterion-referenced standard setting D: Educational supervision E: Experiential learning F: Formative assessments G: Life-long adult learning H: Linear equating standard setting I: Norm-referenced standard setting J: Pendleton’s rules for feedback K: Quality assurance in education L: Reflective practice M: Reliability N: Summative assessments O: Transformative learning P: Validity Q: Vicarious learning
Correct
The answer is validity.
A 29-year-old woman, P2, has had a rapid birth of a healthy male infant at term with extensive perineal trauma. In theatre, a fourth-degree tear is diagnosed and the anorectal mucosa has been sutured and the external and internal anal sphincters now need to be sutured
A: Coated vicryl® / Braided polyglactin / Half circle, round bodied / 3-0
B: Coated vicryl® / Braided polyglactin / J needle, round bodied, heavy / 2-0
C: Coated vicryl® / Braided polyglactin / Half circle, round bodied / 0
D: Dermabond® / Topical skin adhesive / None
E: Endoloop® ligature / Braided polyglactin / None / 0
F: Mersilene® / Polyester fibre / Blunt point, half circle, double / 5 mm
G: Monocryl® / Monofilament: polypropylene / Half circle, round bodied / 1
H: Nylon / Monofilament / Straight cutting / 0
I: PDS / Monofilament: polydioxanone / Half circle, round bodied / 3-0
J: PDS / Monofilament: polydioxanone, looped / Blunt, taperpoint, half circle, heavy / 0
K: Prolene® / Monofilament: polypropylene / Curved double / 6-0
L: Prolene® / Monofilament: polypropylene / Curved, reverse cutting / 4-0
M: Stainless steel wire / Multifilament / Tapercut, round bodied / 2 mm
N: Steristrips® / Skin adhesive strips / None
O: Vicryl Rapide® / Braided polyglactin / Tapercut, half circle / 2-0
The answer is coated vicryl® / braided polyglactin / half circle, round-bodied / 3-0.
A 27-year-old woman has had two second-trimester miscarriages and has had a diagnosis of cervical weakness. She is now 14 weeks pregnant and is going to have a cervical cerclage procedure in an attempt to gain a successful outcome for this pregnancy
A: Coated vicryl® / Braided polyglactin / Half circle, round bodied / 3-0
B: Coated vicryl® / Braided polyglactin / J needle, round bodied, heavy / 2-0
C: Coated vicryl® / Braided polyglactin / Half circle, round bodied / 0
D: Dermabond® / Topical skin adhesive / None
E: Endoloop® ligature / Braided polyglactin / None / 0
F: Mersilene® / Polyester fibre / Blunt point, half circle, double / 5 mm
G: Monocryl® / Monofilament: polypropylene / Half circle, round bodied / 1
H: Nylon / Monofilament / Straight cutting / 0
I: PDS / Monofilament: polydioxanone / Half circle, round bodied / 3-0
J: PDS / Monofilament: polydioxanone, looped / Blunt, taperpoint, half circle, heavy / 0
K: Prolene® / Monofilament: polypropylene / Curved double / 6-0
L: Prolene® / Monofilament: polypropylene / Curved, reverse cutting / 4-0
M: Stainless steel wire / Multifilament / Tapercut, round bodied / 2 mm
N: Steristrips® / Skin adhesive strips / None
O: Vicryl Rapide® / Braided polyglactin / Tapercut, half circle / 2-0
The answer is Mersilene® / polyester fibre / blunt point, half circle, double / 5 mm.
A 37-year-old woman, P4 and with a BMI of 32, has undergone a laparotomy using a midline sub-umbilical incision to remove an abdominal mass which was confirmed as a benign enlarged fibroid uterus; now the plan is to close the peritoneum and rectus sheath
A: Coated vicryl® / Braided polyglactin / Half circle, round bodied / 3-0
B: Coated vicryl® / Braided polyglactin / J needle, round bodied, heavy / 2-0
C: Coated vicryl® / Braided polyglactin / Half circle, round bodied / 0
D: Dermabond® / Topical skin adhesive / None
E: Endoloop® ligature / Braided polyglactin / None / 0
F: Mersilene® / Polyester fibre / Blunt point, half circle, double / 5 mm
G: Monocryl® / Monofilament: polypropylene / Half circle, round bodied / 1
H: Nylon / Monofilament / Straight cutting / 0
I: PDS / Monofilament: polydioxanone / Half circle, round bodied / 3-0
J: PDS / Monofilament: polydioxanone, looped / Blunt, taperpoint, half circle, heavy / 0
K: Prolene® / Monofilament: polypropylene / Curved double / 6-0
L: Prolene® / Monofilament: polypropylene / Curved, reverse cutting / 4-0
M: Stainless steel wire / Multifilament / Tapercut, round bodied / 2 mm
N: Steristrips® / Skin adhesive strips / None
O: Vicryl Rapide® / Braided polyglactin / Tapercut, half circle / 2-0
The answer is PDS / monofilament: polydioxanone, looped / blunt, taperpoint, half circle, heavy /0.
A 39-year-old woman in her first pregnancy has a rotational forceps delivery with an episiotomy in theatre with effective epidural analgesia after a prolonged labour. Inspection of the lower genital tract reveals damage above the episiotomy incision and a 2-cm ‘button-hole’ defect in the vagina that includes the anorectal mucosa is identified and now has to be sutured
A: Coated vicryl® / Braided polyglactin / Half circle, round bodied / 3-0
B: Coated vicryl® / Braided polyglactin / J needle, round bodied, heavy / 2-0
C: Coated vicryl® / Braided polyglactin / Half circle, round bodied / 0
D: Dermabond® / Topical skin adhesive / None
E: Endoloop® ligature / Braided polyglactin / None / 0
F: Mersilene® / Polyester fibre / Blunt point, half circle, double / 5 mm
G: Monocryl® / Monofilament: polypropylene / Half circle, round bodied / 1
H: Nylon / Monofilament / Straight cutting / 0
I: PDS / Monofilament: polydioxanone / Half circle, round bodied / 3-0
J: PDS / Monofilament: polydioxanone, looped / Blunt, taperpoint, half circle, heavy / 0
K: Prolene® / Monofilament: polypropylene / Curved double / 6-0
L: Prolene® / Monofilament: polypropylene / Curved, reverse cutting / 4-0
M: Stainless steel wire / Multifilament / Tapercut, round bodied / 2 mm
N: Steristrips® / Skin adhesive strips / None
O: Vicryl Rapide® / Braided polyglactin / Tapercut, half circle / 2-0
The answer is Coated vicryl® / braided polyglactin / half circle, round bodies / 3-0.
Royal College of Obstetricians and Gynaecologists. Management of Third- and Fourth-degree Perineal Tears. Green-top Guideline 29. London: RCOG; 2015.
The anatomical structure that is divided when a midline episiotomy is performed
A: Anal canal mucosa B: Arcus tendinous fascia pelvis C: Bulbospongiosis D: Coccygeus E: Deep transverse perineal muscle F: External anal sphincter G: Iliococcygeus H: Ischiorectal fossa I: Perineal body or central perineal tendon J: Pubocervical fascia and pubovesical ligaments K: Pubococcygeus L: Puborectalis M: Rectovaginal endopelvic fascia N: Sacrospinous ligaments O: Sacrotuberous ligaments P: Superficial transverse perineal muscle Q: Transverse cervical ligaments R: Uterosacral ligaments
The correct answer is perineal body or central perineal tendon. Applied pelvic anatomy is essential knowledge for obstetricians and gynaecologists.
The anatomical structure that is supported after a transvaginal tape is inserted in the surgical treatment of genuine stress incontinence
A: Anal canal mucosa B: Arcus tendinous fascia pelvis C: Bulbospongiosis D: Coccygeus E: Deep transverse perineal muscle F: External anal sphincter G: Iliococcygeus H: Ischiorectal fossa I: Perineal body or central perineal tendon J: Pubocervical fascia and pubovesical ligaments K: Pubococcygeus L: Puborectalis M: Rectovaginal endopelvic fascia N: Sacrospinous ligaments O: Sacrotuberous ligaments P: Superficial transverse perineal muscle Q: Transverse cervical ligaments R: Uterosacral ligaments
The correct answer is pubocervical fascia and pubovesical ligaments.
The anatomical structure used to support the vaginal vault in the surgical treatment of third degree utero-vaginal prolapse
A: Anal canal mucosa B: Arcus tendinous fascia pelvis C: Bulbospongiosis D: Coccygeus E: Deep transverse perineal muscle F: External anal sphincter G: Iliococcygeus H: Ischiorectal fossa I: Perineal body or central perineal tendon J: Pubocervical fascia and pubovesical ligaments K: Pubococcygeus L: Puborectalis M: Rectovaginal endopelvic fascia N: Sacrospinous ligaments O: Sacrotuberous ligaments P: Superficial transverse perineal muscle Q: Transverse cervical ligaments R: Uterosacral ligaments
The correct answer is sacrospinous ligaments.
The anatomical structure normally included in the first major pedicle that is divided and secured during a vaginal hysterectomy and after the vagina and bladder have been reflected off the cervix and surrounding tissues and the peritoneum of the pouch of Douglas has been divided and opened
A: Anal canal mucosa B: Arcus tendinous fascia pelvis C: Bulbospongiosis D: Coccygeus E: Deep transverse perineal muscle F: External anal sphincter G: Iliococcygeus H: Ischiorectal fossa I: Perineal body or central perineal tendon J: Pubocervical fascia and pubovesical ligaments K: Pubococcygeus L: Puborectalis M: Rectovaginal endopelvic fascia N: Sacrospinous ligaments O: Sacrotuberous ligaments P: Superficial transverse perineal muscle Q: Transverse cervical ligaments R: Uterosacral ligaments
The correct answer is uterosacral ligaments.
During an abdominal total hysterectomy: the anatomical structure normally included in the clamping of the paracervical tissues after the uterine artery have been secured and divided and before the vaginal angle and the surrounding tissue is secured and sutured
A: Anal canal mucosa B: Arcus tendinous fascia pelvis C: Bulbospongiosis D: Coccygeus E: Deep transverse perineal muscle F: External anal sphincter G: Iliococcygeus H: Ischiorectal fossa I: Perineal body or central perineal tendon J: Pubocervical fascia and pubovesical ligaments K: Pubococcygeus L: Puborectalis M: Rectovaginal endopelvic fascia N: Sacrospinous ligaments O: Sacrotuberous ligaments P: Superficial transverse perineal muscle Q: Transverse cervical ligaments R: Uterosacral ligaments
The answer is transverse cervical ligaments.
The anatomical structure that is reconstructed during the surgical repair of a rectocele
A: Anal canal mucosa B: Arcus tendinous fascia pelvis C: Bulbospongiosis D: Coccygeus E: Deep transverse perineal muscle F: External anal sphincter G: Iliococcygeus H: Ischiorectal fossa I: Perineal body or central perineal tendon J: Pubocervical fascia and pubovesical ligaments K: Pubococcygeus L: Puborectalis M: Rectovaginal endopelvic fascia N: Sacrospinous ligaments O: Sacrotuberous ligaments P: Superficial transverse perineal muscle Q: Transverse cervical ligaments R: Uterosacral ligaments
The correct answer is rectovaginal endopelvic fascia.
May be divided when opening the peritoneum during a laparotomy and is also known as the urachus.
A: Anterior division of the internal iliac B: Ascending cervical branch of vaginal artery C: Deep circumflex D: Inferior epigastric E: Internal iliac F: Internal pudendal G: Lateral sacral H: Middle rectal I: Obturator J: Ovarian K: Posterior division of the internal iliac L: Superior gluteal M: Umbilical N: Uterine O: Vaginal
The answer is umbilical. Knowledge of the blood supply to the pelvis and anterior abdominal wall is essential. Radiopaedia.org has a useful mnemonic to help you remember the branches of the internal iliac artery.
May become thrombosed in the puerperium and is a rare cause of acute localised abdominal pain
A: Anterior division of the internal iliac B: Ascending cervical branch of vaginal artery C: Deep circumflex D: Inferior epigastric E: Internal iliac F: Internal pudendal G: Lateral sacral H: Middle rectal I: Obturator J: Ovarian K: Posterior division of the internal iliac L: Superior gluteal M: Umbilical N: Uterine O: Vaginal
The answer is ovarian.
Occasionally may need to be ligated in cases of acute pelvic or obstetric haemorrhage
A: Anterior division of the internal iliac B: Ascending cervical branch of vaginal artery C: Deep circumflex D: Inferior epigastric E: Internal iliac F: Internal pudendal G: Lateral sacral H: Middle rectal I: Obturator J: Ovarian K: Posterior division of the internal iliac L: Superior gluteal M: Umbilical N: Uterine O: Vaginal
The answer is anterior division of the internal iliac. Note that the answer is ‘anterior division of the internal iliac’ rather than ‘internal iliac’ in order to avoid postoperative ischaemic pain in the buttock when the posterior division is occluded.
Needs to be secured when closing the anterior vagina during a total hysterectomy
A: Anterior division of the internal iliac B: Ascending cervical branch of vaginal artery C: Deep circumflex D: Inferior epigastric E: Internal iliac F: Internal pudendal G: Lateral sacral H: Middle rectal I: Obturator J: Ovarian K: Posterior division of the internal iliac L: Superior gluteal M: Umbilical N: Uterine O: Vaginal
The answer is ascending cervical branch of vaginal artery.
Biophysical blood flow analyses (Doppler) may be used in the second trimester of pregnancy to assess possible perinatal outcomes
A: Anterior division of the internal iliac B: Ascending cervical branch of vaginal artery C: Deep circumflex D: Inferior epigastric E: Internal iliac F: Internal pudendal G: Lateral sacral H: Middle rectal I: Obturator J: Ovarian K: Posterior division of the internal iliac L: Superior gluteal M: Umbilical N: Uterine O: Vaginal
The answer is uterine.
May be damaged when injecting local anaesthetic during a regional block for instrumental deliveries
A: Anterior division of the internal iliac B: Ascending cervical branch of vaginal artery C: Deep circumflex D: Inferior epigastric E: Internal iliac F: Internal pudendal G: Lateral sacral H: Middle rectal I: Obturator J: Ovarian K: Posterior division of the internal iliac L: Superior gluteal M: Umbilical N: Uterine O: Vaginal
The answer is internal pudendal.
Occlusion has been shown to be an effective treatment for women with leiomyomata (fibroids)
A: Anterior division of the internal iliac B: Ascending cervical branch of vaginal artery C: Deep circumflex D: Inferior epigastric E: Internal iliac F: Internal pudendal G: Lateral sacral H: Middle rectal I: Obturator J: Ovarian K: Posterior division of the internal iliac L: Superior gluteal M: Umbilical N: Uterine O: Vaginal
The answer is uterine.
May be damaged during insertion of a second access port during laparoscopy and sometimes results in either a sub-rectus haematoma or postoperative haemorrhage
A: Anterior division of the internal iliac B: Ascending cervical branch of vaginal artery C: Deep circumflex D: Inferior epigastric E: Internal iliac F: Internal pudendal G: Lateral sacral H: Middle rectal I: Obturator J: Ovarian K: Posterior division of the internal iliac L: Superior gluteal M: Umbilical N: Uterine O: Vaginal
The answer is inferior epigastric.
Biophysical blood flow analyses (Doppler) may be used in the third trimester of pregnancy to assess possible perinatal outcomes
A: Anterior division of the internal iliac B: Ascending cervical branch of vaginal artery C: Deep circumflex D: Inferior epigastric E: Internal iliac F: Internal pudendal G: Lateral sacral H: Middle rectal I: Obturator J: Ovarian K: Posterior division of the internal iliac L: Superior gluteal M: Umbilical N: Uterine O: Vaginal
The answer is umbilical.
Initial suturing during a surgical repair of a right mediolateral episiotomy will prevent postpartum haemorrhage
A: Anterior division of the internal iliac B: Ascending cervical branch of vaginal artery C: Deep circumflex D: Inferior epigastric E: Internal iliac F: Internal pudendal G: Lateral sacral H: Middle rectal I: Obturator J: Ovarian K: Posterior division of the internal iliac L: Superior gluteal M: Umbilical N: Uterine O: Vaginal
The answer is vaginal.
A 48-year-old woman had an abdominal total hysterectomy and bilateral salpingo-oophorectomy to remove an ovarian tumour and is seen on the ward round on day 2. She had a poor night with abdominal pain and bloating and has just started vomiting. On examination: she looks pale and sweaty; the abdomen is distended with minimal bowel sounds and generalised tenderness; temperature is 36.8°C; pulse rate is 110 bpm; BP is 120/65 mmHg; respiratory rate is 14 breaths/min; BMI is 36
A: Acute renal failure B: Allergic reaction C: Bowel perforation D: Chest infection E: Cerebrovascular accident F: Deep vein thrombosis G: Delirium tremens H: Intra-abdominal haemorrhage I: Myocardial infarction J: Paralytic ileus K: Pulmonary atelectasis L: Pulmonary embolism M: Small bowel obstruction N: Subcutaneous haematoma O: Sub-rectus haematoma P: Septic shock Q: Urinary tract infection R: Vaginal vault haematoma S: Wound dehiscence T: Wound infection
The correct answer is paralytic ileus. This is a classic post-operative ward round diagnosis after a proper examination of the cardiovascular and respiratory systems.
A 25-year-old woman underwent an uncomplicated laparoscopy and dye test to investigate primary subfertility. There was some minimal-stage endometriosis, which was diathermised, and the fallopian tubes were patent. Eight hours after the operation the woman is experiencing a lot of pain requiring opiate analgesia. The abdomen is very tender around the secondary port site in the left iliac fossa; is slightly distended; oozing blood-stain fluid, despite a pressure dressing. Observations: pulse rate is 110 bpm; BP is 140/75 mmHg; temperature is 36.5°C; respiratory rate is 18 breaths/min
A: Acute renal failure B: Allergic reaction C: Bowel perforation D: Chest infection E: Cerebrovascular accident F: Deep vein thrombosis G: Delirium tremens H: Intra-abdominal haemorrhage I: Myocardial infarction J: Paralytic ileus K: Pulmonary atelectasis L: Pulmonary embolism M: Small bowel obstruction N: Subcutaneous haematoma O: Sub-rectus haematoma P: Septic shock Q: Urinary tract infection R: Vaginal vault haematoma S: Wound dehiscence T: Wound infection
The answer is sub-rectus haematoma. See explanation to question 1.
A 38-year-old woman, P4, has just arrived back on the gynaecology ward after an uncomplicated surgical management of miscarriage to stop uterine haemorrhage following a spontaneous miscarriage at 14 weeks of gestation. The estimated blood loss was recorded as 800 ml and haemostasis was achieved satisfactorily with intravenous oxytocics, and has been maintained. She is taking daily thyroxine 150 microgram and prenisolone 10 mg for arthritis and had no known allergies and is a non-smoker. She becomes acutely unwell and on examination: she looks unwell with cold extremities and is drowsy; abdomen is soft and non-tender with no masses or rashes; vaginal examination is normal with no vaginal bleeding. Observations: pulse rate is 120 bpm; BP is 90/50 mmHg; temperature is 35.7°C; respiratory rate is 26 breaths/min
A: Acute renal failure B: Allergic reaction C: Bowel perforation D: Chest infection E: Cerebrovascular accident F: Deep vein thrombosis G: Delirium tremens H: Intra-abdominal haemorrhage I: Myocardial infarction J: Paralytic ileus K: Pulmonary atelectasis L: Pulmonary embolism M: Small bowel obstruction N: Subcutaneous haematoma O: Sub-rectus haematoma P: Septic shock Q: Urinary tract infection R: Vaginal vault haematoma S: Wound dehiscence T: Wound infection
The correct answer is septic shock. See explanation to question 1.
A 42-year-old woman had a vaginal hysterectomy on the afternoon list the day before and is seen on the Day 1 ward round. She looks pale and feels unwell and faint and complains of difficulty getting her breath and pains in her chest and shoulders. There is no vaginal bleeding and the urine catheter sample is clear but she has passed only 100 ml overnight despite receiving more than a litre of normal saline overnight. The abdomen is slightly distended and tender; bowel sounds are present. Observations: pulse rate is 105 bpm; BP is 120/50 mmHg; temperature is 36.7°C; respiratory rate is 25 breaths/min
A: Acute renal failure B: Allergic reaction C: Bowel perforation D: Chest infection E: Cerebrovascular accident F: Deep vein thrombosis G: Delirium tremens H: Intra-abdominal haemorrhage I: Myocardial infarction J: Paralytic ileus K: Pulmonary atelectasis L: Pulmonary embolism M: Small bowel obstruction N: Subcutaneous haematoma O: Sub-rectus haematoma P: Septic shock Q: Urinary tract infection R: Vaginal vault haematoma S: Wound dehiscence T: Wound infection
The correct answer is intra-abdominal haemorrhage. See explanation to question 1.
A 75-year-old woman, with a BMI of 24 and who is a non-smoker, had a laparotomy through a mid-line surgical incision for an abdominal and pelvic mass 3 days ago and the tumour was deemed to be inoperable. She has developed some central and right-sided chest pain and is feeling unwell and breathless and has become restless. On examination: abdomen is soft and non-tender; wound satisfactory; chest dull to percussion both bases and poor air entry with some crepitations that clear with coughing. Observations: pulse rate is 96 bpm; BP is 110/60 mmHg; temperature is 38.7°C; respiratory rate is 21 breaths/min A: Acute renal failure B: Allergic reaction C: Bowel perforation D: Chest infection E: Cerebrovascular accident F: Deep vein thrombosis G: Delirium tremens H: Intra-abdominal haemorrhage I: Myocardial infarction J: Paralytic ileus K: Pulmonary atelectasis L: Pulmonary embolism M: Small bowel obstruction N: Subcutaneous haematoma O: Sub-rectus haematoma P: Septic shock Q: Urinary tract infection R: Vaginal vault haematoma S: Wound dehiscence T: Wound infection
The correct answer is chest infection. See explanation to question 1.
A 70-year-old woman, P1, with a BMI of 34 and type 2 diabetes and who is a smoker (15 cigarettes a day) had an uncomplicated laparoscopic hysterectomy and bilateral salpingo-oophorectomy two days ago to treat endometrial cancer. She has developed some central and right-sided chest pain and is feeling unwell and breathless and has become restless. On examination: she looks pale and moderately distressed; abdomen is soft and non-tender; wounds satisfactory; chest percussion and breath sounds are normal; lower limbs normal and mobile. Observations: pulse rate is 102 bpm; BP is 140/750 mmHg; temperature is 36.7°C; respiratory rate is 22 breaths/min A: Acute renal failure B: Allergic reaction C: Bowel perforation D: Chest infection E: Cerebrovascular accident F: Deep vein thrombosis G: Delirium tremens H: Intra-abdominal haemorrhage I: Myocardial infarction J: Paralytic ileus K: Pulmonary atelectasis L: Pulmonary embolism M: Small bowel obstruction N: Subcutaneous haematoma O: Sub-rectus haematoma P: Septic shock Q: Urinary tract infection R: Vaginal vault haematoma S: Wound dehiscence T: Wound infection
The correct answer is pulmonary embolism. See explanation to question 1.
A 31-year-old nulliparous woman is referred with a long history of frequency, passing urine as much as every 30–60 minutes during the day and associated with pain and irritation. There is very occasional nocturia and she also suffers from intermittent lower abdominal pains. Her LMP was 2 weeks ago and her periods are irregular and heavy coming every 5–7 weeks. She is not sexually active and smokes 5–10 cigarettes a day. The GP has taken several urine samples for culture and they have all been negative. On examination: BP is 120/65 mmHg, BMI is 24; abdominal and vaginal examination is normal apart from some vague suprapubic, vaginal and urethral tenderness. Urine analysis is normal; full blood count is normal; thyroid and renal function are normal
A: Atonic bladder B: Bladder calculus C: Bladder diverticulum D: Bladder tumour E: Chronic cystitis F: Detrusor over-activity G: Endometriosis of the bladder H: Overactive bladder I: Overflow incontinence J: Painful bladder syndrome K: Sensory urgency L: Tuberculosis of the renal tract M: Urethral syndrome N: Urinary tract infection O: Urodynamic stress incontinence P: Uterine tumour Q: Vesicovaginal fistula
The answer is urethral syndrome. History taking is essential in gynaecology.
Urethral syndrome is also known as symptomatic abacteriuria. It has many of the same symptoms as urethritis, which is an infection and inflammation of the urethra. These symptoms include abdominal pain and frequent, painful urination. Both conditions cause irritation to your urethra. Urethritis usually develops because of a bacteria or virus, but urethral syndrome often has no clear cause.
A 35-year-old woman, P4, complains about many years of urinary urgency, frequency and occasional incontinence. She is a teacher and describes an almost constant sensation of needing to pass urine and finds it impossible to wait for the break between classes to void. The episodes of incontinence are associated with increasing urgency but are rare. Gynaecological examination is normal. A bladder diary shows frequency 12 times/day; functional bladder capacity 300 ml; average voided volume 150 ml. Cystometry shows: no incontinence; the first desire to void occurs at 100 ml; strong desire at 300 ml; no observed increase in bladder pressure during filling
A: Atonic bladder B: Bladder calculus C: Bladder diverticulum D: Bladder tumour E: Chronic cystitis F: Detrusor over-activity G: Endometriosis of the bladder H: Overactive bladder I: Overflow incontinence J: Painful bladder syndrome K: Sensory urgency L: Tuberculosis of the renal tract M: Urethral syndrome N: Urinary tract infection O: Urodynamic stress incontinence P: Uterine tumour Q: Vesicovaginal fistula
The correct answer is sensory urgency.
Sensory urgency describes patients complaining of urinary urgency but without demonstrable detrusor instability. The International Continence Society [1] has defined urgency as a strong desire to void accompanied by fear of leakage or fear of pain, which may be associated with two types of detrusor dysfunction: urgency with overactive detrusor dysfunction is motor urgency, whereas urgency with detrusor hypersensitivity is sensory urgency. The problem remains of defining what exactly is meant by detrusor hypersensitivity but many authors have investigated patients with urinary urgency unaccompanied by objective evidence of detrusor instability and a number of terms have been used — primary vesical sensory urgency [2], urge syndrome [3] and sensory urge incontinence
A 27-year-old woman had an emergency caesarean section for an obstructed labour after an unsuccessful trial of forceps in theatre with epidural analgesia. Since the operation, which was 3 days ago, she has been having problems with passing urine and has leaked urine with minimal sensation to void. There is no recorded damage or surgical difficulties with the bladder in the operation notes. She now has an indwelling catheter with intermittent spigot and release every 4 hours. The urine draining is clear with adequate urine output
A: Atonic bladder B: Bladder calculus C: Bladder diverticulum D: Bladder tumour E: Chronic cystitis F: Detrusor over-activity G: Endometriosis of the bladder H: Overactive bladder I: Overflow incontinence J: Painful bladder syndrome K: Sensory urgency L: Tuberculosis of the renal tract M: Urethral syndrome N: Urinary tract infection O: Urodynamic stress incontinence P: Uterine tumour Q: Vesicovaginal fistula
The answer is atonic bladder.
A 72-year-old nulliparous woman is referred with intermittent episodes of what is thought to be vaginal bleeding for the last 6 months mainly when she is on the toilet. She has urinary frequency and nocturia twice or three times a night and occasional leaks of urine. She has type 2 diabetes and suffers from hypertension, and takes medications for both conditions. She smokes 20 cigarettes a day and occasionally leaks urine when coughing. On examination: BP is 150/90 mmHg; BMI is 34; abdominal palpation is normal; vaginal examination shows an atrophic vaginal, normal cervix and pelvis with no blood seen. Urine analysis shows: protein 2+; blood 3+; glucose 3+; an ultrasound scan of the kidneys, bladder, uterus and ovaries is normal
A: Atonic bladder B: Bladder calculus C: Bladder diverticulum D: Bladder tumour E: Chronic cystitis F: Detrusor over-activity G: Endometriosis of the bladder H: Overactive bladder I: Overflow incontinence J: Painful bladder syndrome K: Sensory urgency L: Tuberculosis of the renal tract M: Urethral syndrome N: Urinary tract infection O: Urodynamic stress incontinence P: Uterine tumour Q: Vesicovaginal fistula
The answer is bladder tumour.
A 59-year-old woman, P2, is referred with urinary leakage when coughing, sneezing, lifting, bending and changing position and she has had to wear incontinence pads. On examination her BMI is 30 and there is evidence of lower genital tract atrophy; there is no demonstrable stress incontinence. Filling cystometry shows: an early first desire to void at 75 ml; urgency at 140 ml associated with high pressure detrusor contraction, which reached 40 cm/H20 and resulted in completed bladder emptying
A: Atonic bladder B: Bladder calculus C: Bladder diverticulum D: Bladder tumour E: Chronic cystitis F: Detrusor over-activity G: Endometriosis of the bladder H: Overactive bladder I: Overflow incontinence J: Painful bladder syndrome K: Sensory urgency L: Tuberculosis of the renal tract M: Urethral syndrome N: Urinary tract infection O: Urodynamic stress incontinence P: Uterine tumour Q: Vesicovaginal fistula
The answer is detrusor over-activity. This a urodynamic diagnosis while over-active bladder is a clinical diagnosis.
A 33-year-old woman, P1, is referred with a long history of urinary frequency and urgency and annoying nocturia that is depriving her of sleep. It is not associated with leaks or bed-wetting but there is lower abdominal pain when she empties her bladder. These symptoms are much worse during menstruation and there is also some deep pain experienced during sexual intercourse. Three months ago she had a Mirena® intrauterine device inserted by her GP for contraception and she confirms that her symptoms have improved to some extent on the basis that she is now amenorrhoeic. On examination: BP is 135/70 mmHg; BMI is 28; abdominal palpation is normal with some suprapubic tenderness; vaginal examination is normal with some vague tenderness in the posterior and anterior fornices. Several urine cultures have been negative and an ultrasound scan of the kidneys, bladder, uterus and ovaries is normal A: Atonic bladder B: Bladder calculus C: Bladder diverticulum D: Bladder tumour E: Chronic cystitis F: Detrusor over-activity G: Endometriosis of the bladder H: Overactive bladder I: Overflow incontinence J: Painful bladder syndrome K: Sensory urgency L: Tuberculosis of the renal tract M: Urethral syndrome N: Urinary tract infection O: Urodynamic stress incontinence P: Uterine tumour Q: Vesicovaginal fistula
The answer is painful bladder syndrome. See question 1 to see how the clinical history of painful bladder syndrome differs from the urethral syndrome.
A 29-year-old woman, P2+1 is referred with irregular vaginal bleeding since she had an uncomplicated termination of pregnancy 3 months ago. On examination – BMI: 19; she looks pale and unwell; the abdomen is soft and not tender; the vaginal examination revealed a bulky uterus, normal closed cervix; no pelvic masses; a small red friable lesion of 2 cm in the left periurethral space
A: B-cell lymphoma of the ovary B: Carcinomatosis C: Cervical carcinoma D: Choriocarcinoma E: Endodermal sinus tumour F: Endometrial adenocarcinoma G: Krukenberg tumour H: Malignant dermoid teratoma I: Malignant melanoma J: Mixed mesodermal tumour K: Mucinous cystadenocarcinoma L: Ovarian endometroid carcinoma M: Pelvic actinomycotic granulomata N: Squamous cell carcinoma O: Tubo-ovarian abscess P: Uterine sarcoma
The answer is choriocarcinoma. Presentations of advanced gynaecological tumours are self-explanatory but you can discuss these with your local trainee-friendly gynaecological oncologist if you would like further information.
A healthy 23-year-old woman, P0+1, presents to her GP with pelvic pain. Ultrasound examination of the pelvis shows an 8 cm diameter, solid mass arising from the left ovary, there is no free fluid, and the right ovary and uterus are normal. She had an uncomplicated termination of pregnancy 6 months ago. Her periods have been normal and she has a Mirena® IUS for contraception. There is no relevant past medical or surgical history and her family history is unremarkable. The following blood results were obtained:
• liver function tests: normal
• full blood count: normal
• urea, creatinine and electrolytes: normal
• hCG < 5 IU/l
• AFP: 24 600 U/ml
• CA125: 27 U/ml
A: B-cell lymphoma of the ovary B: Carcinomatosis C: Cervical carcinoma D: Choriocarcinoma E: Endodermal sinus tumour F: Endometrial adenocarcinoma G: Krukenberg tumour H: Malignant dermoid teratoma I: Malignant melanoma J: Mixed mesodermal tumour K: Mucinous cystadenocarcinoma L: Ovarian endometroid carcinoma M: Pelvic actinomycotic granulomata N: Squamous cell carcinoma O: Tubo-ovarian abscess P: Uterine sarcoma
The answer is endodermal sinus tumour.
A 69-year-old P4 woman is referred by her GP with increasing drowsiness and confusion. Abdominal examination is normal and there is no lymphadenopathy; rectal examination reveals a firm fixed pelvic mass. Blood tests reveal that she is uraemic.
A: B-cell lymphoma of the ovary B: Carcinomatosis C: Cervical carcinoma D: Choriocarcinoma E: Endodermal sinus tumour F: Endometrial adenocarcinoma G: Krukenberg tumour H: Malignant dermoid teratoma I: Malignant melanoma J: Mixed mesodermal tumour K: Mucinous cystadenocarcinoma L: Ovarian endometroid carcinoma M: Pelvic actinomycotic granulomata N: Squamous cell carcinoma O: Tubo-ovarian abscess P: Uterine sarcoma
The answer is cervical carcinoma.
A 42-year-old woman, P3, is admitted to the intensive care unit in status epilepticus. She has not suffered from epilepsy in the past. She smokes 25 cigarettes a day and otherwise is in good health. She has been sterilised. While she was being catheterised the nurse noticed a small dark-brown raised lesion near the uretheral orifice on the left labia about 1 cm in diameter and with bilateral inguinal lymphadenopathy
A: B-cell lymphoma of the ovary B: Carcinomatosis C: Cervical carcinoma D: Choriocarcinoma E: Endodermal sinus tumour F: Endometrial adenocarcinoma G: Krukenberg tumour H: Malignant dermoid teratoma I: Malignant melanoma J: Mixed mesodermal tumour K: Mucinous cystadenocarcinoma L: Ovarian endometroid carcinoma M: Pelvic actinomycotic granulomata N: Squamous cell carcinoma O: Tubo-ovarian abscess P: Uterine sarcoma
The answer is malignant melanoma.
A 64-year-old woman is admitted with a bowel obstruction. She has a 2-day history of abdominal pain and vomiting. She has a past medical history of irritable bowel syndrome, diverticulosis and breast cancer, which was treated successfully over 5 years ago. During the laparotomy the surgeon confirms a diverticular abscess and obstruction of the sigmoid colon. He calls for a gynaecologist to give an opinion about bilateral ovarian enlargement up to about 6–7 cm, solid with nodules covering the surfaces
A: B-cell lymphoma of the ovary B: Carcinomatosis C: Cervical carcinoma D: Choriocarcinoma E: Endodermal sinus tumour F: Endometrial adenocarcinoma G: Krukenberg tumour H: Malignant dermoid teratoma I: Malignant melanoma J: Mixed mesodermal tumour K: Mucinous cystadenocarcinoma L: Ovarian endometroid carcinoma M: Pelvic actinomycotic granulomata N: Squamous cell carcinoma O: Tubo-ovarian abscess P: Uterine sarcoma
The answer is Krukenberg tumour.
A 59-year-old woman, P2, is referred with vague abdominal pains, malaise, heart burn and weight loss. An ultrasound scan shows bilateral enlarged (9–10-cm diameter each) ovaries with multiple cysts, a normal uterus, no free fluid; normal liver and kidneys. There is a family history of bowel cancer and she has been on combined HRT since the menopause. Blood results:
• liver function tests: normal
• full blood count: normal
• urea, creatinine and electrolytes: normal
• hCG < 5 IU/l
• AFP: 19 U/ml
• CA125: 251 U/ml
A: B-cell lymphoma of the ovary B: Carcinomatosis C: Cervical carcinoma D: Choriocarcinoma E: Endodermal sinus tumour F: Endometrial adenocarcinoma G: Krukenberg tumour H: Malignant dermoid teratoma I: Malignant melanoma J: Mixed mesodermal tumour K: Mucinous cystadenocarcinoma L: Ovarian endometroid carcinoma M: Pelvic actinomycotic granulomata N: Squamous cell carcinoma O: Tubo-ovarian abscess P: Uterine sarcoma
The answer is mucinous cystadenocarcinoma.
A couple are referred to the fertility service because the 24-year-old male partner has developed testicular cancer that will require orchidectomy followed by chemotherapy. They wish to have his semen stored for artificial insemination of his wife if he were to become azoospermic in the future
A: Abandon operative procedure and reschedule
B: Defer the operative procedure
C: Fraser competence must be demonstrable before obtaining consent
D: Obtain legal advice on individuals who withhold consent for treatment
E: Obtain legal advice on interpretation on the Abortion Act 1967
F: Obtain legal advice on interpretation on the Human Fertilisation and Embryology Act 1990 and the Code of Practice of Human Fertilisation and Embryology Authority Act 2009
G: Obtain legal advice on interpretation on the Mental Capacity Act 2005
H: Parental consent must be obtained before proceeding
I: Paternal consent must be obtained before proceeding
J: Perform additional procedure without explicit consent to do so
K: Proceed without consent in order to save the fetus’ life
L: Proceed without consent in order to save the woman’s life
M: Respect the rights of the putative father of the fetus to withhold consent
N: Respect the rights of the unborn fetus and proceed to delivery
O: Respect the rights of the woman to withhold consent for treatment
P: Specific consent is unnecessary
Q: Verbal consent alone is acceptable
R: Verbal consent with witness and case note documentation
S: Written consent must be obtained
The answer is written consent must be obtained.
Royal College of Obstetricians and Gynaecologists. Obtaining Valid Consent. Clinical Governance Advice 6. London: RCOG; 2015.
A 13-year-old girl requires a hymenotomy to treat her cryptamenorrhoea
A: Abandon operative procedure and reschedule
B: Defer the operative procedure
C: Fraser competence must be demonstrable before obtaining consent
D: Obtain legal advice on individuals who withhold consent for treatment
E: Obtain legal advice on interpretation on the Abortion Act 1967
F: Obtain legal advice on interpretation on the Human Fertilisation and Embryology Act 1990 and the Code of Practice of Human Fertilisation and Embryology Authority Act 2009
G: Obtain legal advice on interpretation on the Mental Capacity Act 2005
H: Parental consent must be obtained before proceeding
I: Paternal consent must be obtained before proceeding
J: Perform additional procedure without explicit consent to do so
K: Proceed without consent in order to save the fetus’ life
L: Proceed without consent in order to save the woman’s life
M: Respect the rights of the putative father of the fetus to withhold consent
N: Respect the rights of the unborn fetus and proceed to delivery
O: Respect the rights of the woman to withhold consent for treatment
P: Specific consent is unnecessary
Q: Verbal consent alone is acceptable
R: Verbal consent with witness and case note documentation
S: Written consent must be obtained
The answer is parental consent must be obtained before proceeding.
A 14-year-old girl attends the gynaecology clinic requesting a termination of pregnancy. Her last period was 10 weeks ago. She does not want her parents to know
A: Abandon operative procedure and reschedule
B: Defer the operative procedure
C: Fraser competence must be demonstrable before obtaining consent
D: Obtain legal advice on individuals who withhold consent for treatment
E: Obtain legal advice on interpretation on the Abortion Act 1967
F: Obtain legal advice on interpretation on the Human Fertilisation and Embryology Act 1990 and the Code of Practice of Human Fertilisation and Embryology Authority Act 2009
G: Obtain legal advice on interpretation on the Mental Capacity Act 2005
H: Parental consent must be obtained before proceeding
I: Paternal consent must be obtained before proceeding
J: Perform additional procedure without explicit consent to do so
K: Proceed without consent in order to save the fetus’ life
L: Proceed without consent in order to save the woman’s life
M: Respect the rights of the putative father of the fetus to withhold consent
N: Respect the rights of the unborn fetus and proceed to delivery
O: Respect the rights of the woman to withhold consent for treatment
P: Specific consent is unnecessary
Q: Verbal consent alone is acceptable
R: Verbal consent with witness and case note documentation
S: Written consent must be obtained
The answer is Fraser competence must be demonstrable before obtaining consent.
A 19-year-old woman suffering from Down syndrome is referred to the gynaecology clinic with an abdominal mass that needs an exploratory laparotomy. She is an orphan and lives in a residential care home and is accompanied to the clinic by one of the home’s healthcare assistants. She has a low IQ
A: Abandon operative procedure and reschedule
B: Defer the operative procedure
C: Fraser competence must be demonstrable before obtaining consent
D: Obtain legal advice on individuals who withhold consent for treatment
E: Obtain legal advice on interpretation on the Abortion Act 1967
F: Obtain legal advice on interpretation on the Human Fertilisation and Embryology Act 1990 and the Code of Practice of Human Fertilisation and Embryology Authority Act 2009
G: Obtain legal advice on interpretation on the Mental Capacity Act 2005
H: Parental consent must be obtained before proceeding
I: Paternal consent must be obtained before proceeding
J: Perform additional procedure without explicit consent to do so
K: Proceed without consent in order to save the fetus’ life
L: Proceed without consent in order to save the woman’s life
M: Respect the rights of the putative father of the fetus to withhold consent
N: Respect the rights of the unborn fetus and proceed to delivery
O: Respect the rights of the woman to withhold consent for treatment
P: Specific consent is unnecessary
Q: Verbal consent alone is acceptable
R: Verbal consent with witness and case note documentation
S: Written consent must be obtained
The answer is obtain legal advice on interpretation on the Mental Capacity Act 2005.
An 18-year-old woman is to be seen by the consultant gynaecologist who is accompanied by a medical student as a part of his clinical attachment
A: Abandon operative procedure and reschedule
B: Defer the operative procedure
C: Fraser competence must be demonstrable before obtaining consent
D: Obtain legal advice on individuals who withhold consent for treatment
E: Obtain legal advice on interpretation on the Abortion Act 1967
F: Obtain legal advice on interpretation on the Human Fertilisation and Embryology Act 1990 and the Code of Practice of Human Fertilisation and Embryology Authority Act 2009
G: Obtain legal advice on interpretation on the Mental Capacity Act 2005
H: Parental consent must be obtained before proceeding
I: Paternal consent must be obtained before proceeding
J: Perform additional procedure without explicit consent to do so
K: Proceed without consent in order to save the fetus’ life
L: Proceed without consent in order to save the woman’s life
M: Respect the rights of the putative father of the fetus to withhold consent
N: Respect the rights of the unborn fetus and proceed to delivery
O: Respect the rights of the woman to withhold consent for treatment
P: Specific consent is unnecessary
Q: Verbal consent alone is acceptable
R: Verbal consent with witness and case note documentation
S: Written consent must be obtained
The answer is verbal consent alone is acceptable.
A 39-year-old woman, P4, has attended the day case surgical unit for a surgical termination of pregnancy and insertion of a Mirena® IUS for which she consented for a week before in the outpatient clinic. She now appears somewhat upset and reticent about undergoing the procedure
A: Abandon operative procedure and reschedule
B: Defer the operative procedure
C: Fraser competence must be demonstrable before obtaining consent
D: Obtain legal advice on individuals who withhold consent for treatment
E: Obtain legal advice on interpretation on the Abortion Act 1967
F: Obtain legal advice on interpretation on the Human Fertilisation and Embryology Act 1990 and the Code of Practice of Human Fertilisation and Embryology Authority Act 2009
G: Obtain legal advice on interpretation on the Mental Capacity Act 2005
H: Parental consent must be obtained before proceeding
I: Paternal consent must be obtained before proceeding
J: Perform additional procedure without explicit consent to do so
K: Proceed without consent in order to save the fetus’ life
L: Proceed without consent in order to save the woman’s life
M: Respect the rights of the putative father of the fetus to withhold consent
N: Respect the rights of the unborn fetus and proceed to delivery
O: Respect the rights of the woman to withhold consent for treatment
P: Specific consent is unnecessary
Q: Verbal consent alone is acceptable
R: Verbal consent with witness and case note documentation
S: Written consent must be obtained
The answer is defer the operative procedure.
A 41-year-old woman is seen at 20 weeks of gestation in her first pregnancy. The anomaly scan was normal and Down syndrome screening was low risk. She is a nonsmoker and has no relevant past medical, surgical or family history. Clinical examination reveals, BP: 120/70 mmHg; BMI: 23; cardiovascular and respiratory systems normal. Blood group is O Rhesus negative, no red cell antibodies detected; full blood count normal
- you are the most senior obstetrician at a consultant-led hospital antenatal clinic and you must determine the gestation for the next review in the clinic and the action required at that visit from the option list. All other antenatal visits will be performed by the community midwife.
A: 20 weeks of gestation; review with results of the fetal anomaly scan and full blood count
B: 22 weeks of gestation; review results of recent glucose tolerance test
C: 28 weeks of gestation; perform an ultrasound scan to measure fetal biometry, full blood count and red cell antibody detection test
D: 28 weeks of gestation; perform full blood count, red cell antibody detection test and review results of the recent glucose tolerance test
E: 30 weeks of gestation; review with results of full blood count
F: 30 weeks of gestation; review with results of full blood count and recent glucose tolerance test
G: 32 weeks of gestation; perform an ultrasound scan for placental localisation
H: 32 weeks of gestation; perform an ultrasound scan to measure fetal biometry
I: 36 weeks of gestation; arrange an elective caesarean section at 39 weeks of gestation
J: 36 weeks of gestation; with a possible induction of labour at 38–40 weeks of gestation
K: 39 weeks of gestation; arrange an elective caesarean section at 41 weeks of gestation
L: 39 weeks of gestation; arrange induction of labour at or about term if all is normal with the pregnancy
M: 41 weeks of gestation; perform cervical assessment and membrane sweep and arrange induction of labour at term + 12 days
N: 41 weeks of gestation; to assess whether a vaginal birth is still a realistic and achievable option
The answer is 39 weekof gestation; arrange induction of labour at or about term if all is normal with the pregnancy.
Royal College of Obstetricians and Gynaecologists. Induction of Labour at Term in Older Mothers. Scientific Impact Paper No 34. London; RCOG; 2013.
