Obstetric Summaries

Question 1

CLASP

Answer 1

Prophylactic low dose aspirin in high risk women probably reduces risk of preeclampsia, but result wasn’t statistically significant, and does reduce risk of preterm birth.

Question 2

ACHOIS

Answer 2

Routine screening and treatment of GDM reduces serious perinatal outcomes including death

Question 3

MAGPIE

Answer 3

MgSo4 around time of delivery in preeclampsia reduces eclampsia by around half, and reduces placental abruption.

Question 4

HYPITAT

Answer 4

IOL >36 weeks gestation for gestational hypertension or mild pre-eclampsia reduces maternal adverse outcomes and severe HTN without adverse neonatal outcome.

Question 5

ACTORDS

Answer 5

Short term neonatal outcomes were improved with repeat weekly doses of corticosteroid prior to 32 weeks.

Question 6

ORACLE I

Answer 6

In PPROM <37/40, Erythromycin results in prolonged pregnancy and reduction in neonatal adverse outcomes. Augmentin increases risk of necrotising enterocolitis.

Question 7

ORACLE I - 7 year follow up

Answer 7

At 7 years of age there was no difference in outcomes for children of those treated with Erythromycin for PPROM.

Question 8

TRUFFLE

Answer 8

In IUGR <32/40, waiting until late ductus venosus changes to deliver did not increase hypoxia mediated deaths and neurodevelopment impairment is reduced, rather than delivery based on computerised CTG changes, although in practice a combination of both should be utilised as many of the DV group were delivered for reasons other than an abnormal DV.

Question 9

ARRIVE

Answer 9

Induction at 39 weeks of low-risk nulliparous women does not reduce risk of perinatal death or severe complications, but does reduce risk of caesarean delivery and development of hypertensive disorders compared to expectant management.

Question 10

TERMPROM

Answer 10

In Term PROM, IOL with oxytocin, IOL with vaginal prostaglandin, and expectant management all have similar rates of neonatal infection and cesarean section. Induction with oxytocin results in a lower risk of maternal infection than expectant management.

Question 11

WOMAN

Answer 11

In PPH, TXA given within 3 hours of delivery reduces risk of death secondary to atony by about one third, without increasing risk of thrombotic events or other complications.

Question 12

PPROMT

Answer 12

In PPROM close to Term, in the absence of infection or fetal compromise, expectant management with surveillance is appropriate, given immediate management does not reduce neonatal sepsis and increases risk of CS and RDS.

Question 13

HAPO

Answer 13

Increasing glucose levels at OGTT (not overtly diabetic range) are associated with increasing risk of adverse maternal and neonatal outcomes, eg shoulder dysotica, LGA, hypoglycaemia and C-section

Question 14

Doyle et al

Answer 14

Cochrane review, In pregnancies at high risk of preterm birth, in utero exposure to magnesium sulphate reduces the incidence of cerebral palsy and severe motor dysfunction in offspring

Question 15

Fonseca 2003

Answer 15

Vaginal progesterone significantly reduces rate of preterm birth in high risk pregnancies, namely previous preterm birth.

Question 16

Fonseca 2007

Answer 16

For asymptomatic singleton women with a cervix <15mm on second trimester USS, 200mg vaginal progesterone reduces risk of birth prior to 34 weeks gestation.

Question 17

Gyamfi-Bannerman et al

Answer 17

Antenatal betamethasone for women at risk of late preterm delivery 34-36+6 weeks significantly reduces rate of neonatal respiratory complications and need for respiratory support, but increases rate of hypoglycaemia.

Question 18

Term Breech Trial

Answer 18

Planned caesarean section in Term Breech presentation seemed to be significantly associated with reduced adverse neonatal outcomes and no increase in maternal adverse outcomes, although this trial has later come under scrutiny.

Question 19

Stutchfield et al (ASTECS)

Answer 19

Antenatal Steroids for Term Elective Caesarean Section reduces admission to SCBU for respiratory distress. The benefit of antenatal corticosteroids should be compared with the benefit of delaying delivery until 39 weeks.

Question 20

Twin Birth Study Collaborative Group

Answer 20

There is no reduction in morbidity or mortality of twins with planned caesarean over planned vaginal delivery if the first twin is cephalic. The second twin has increased risk regardless of mode of delivery.

Question 21

ORACLE II

Answer 21

Antibiotics should not be routinely prescribed for women in spontaneous PTL without evidence of clinical infection.

Question 22

ORACLE II - 7 year follow up

Answer 22

Antibiotics in preterm labour do not improve childhood outcomes