PassMRCOG - Antenatal care

Question 1

What is the incidence of early onset neonatal GBS disease in term infants with no risk factors?

Answer 1

0.2/1000 births

Overall incidence 0.57/1000

Question 2

What is the incidence of early onset neonatal GBS disease in term infant if GBS in previous pregnancy

Answer 2

If GBS in previous pregnancy incidence is 0.9/1000

Question 3

What is the incidence of early onset neonatal GBS disease in term infant if GBS in current pregnancy

Answer 3

2.3/1000

Question 4

What is the incidence of early onset neonatal GBS disease if there is intrapartum pyrexia?

Answer 4

5.3/1000

Question 5

Incidence of polyhydramnios

Answer 5

1%

Question 6

Causes of polyhydramnios

Answer 6

Idiopathic 60%
Maternal - Diabetes or CHF - 25%
Fetal - CNS, GI and cervicothoracic abnormalities 15%

Question 7

What constitutes mild, moderate and severe polyhydramnios on AFI

Answer 7

Mild 25-29.9cm
Moderate 30-34.9cm
Severe >35cm

Question 8

Absolute risk VTE in pregnancy

Answer 8

1-2/1000

Question 9

How long should a women avoid trying to conceive after travelling to an area affected by Zika?

Answer 9

2 months if only she travelled and not her male partner.
3 months if her partner was also possibly exposed/travelled.

Question 10

What is the still birth rate with severe ICP and what is the background stillbirth rate?

Answer 10

Severe ICP - 3.44%
Background rate - 0.29%

Question 11

Diabetes insipidus. What is the typical biochemical findings?

Answer 11

Hypernatraemia
Blood osmolality >285
Urine osmolality <300

Question 12

What is the incidence of gestational diabetes insipidus?

Answer 12

2-4 per 100,000

Question 13

What is the typical clinical course of gestational diabetes insipidus?

Answer 13

It usually arises in the third trimester and remits spontaneously 4-6 weeks postpartum.
Conditions causing hepatic dysfunction such as HELLP may cause DI to develop.

Question 14

How might diabetes insipidus present clinically?

Answer 14

True polydipsia (>3L oral intake) and dilute polyuria >3L a day

Question 15

What are the contraindications to cabergoline

Answer 15

Pre-eclampsia
Cardiac valvulopathy
History of pericardial, pulmonary or retroperitoneal fibrotic disorders
History of puerperal psychosis
Hypersensitivity to ergot alkaloids

Question 16

In sepsis, MAP should be maintained above what level with vasopressors?

Answer 16

> 65mmHg

Question 17

In sepsis aim for a CVP greater than

Answer 17

8mmHg

Question 18

What are the risks of vertical transmission of parvovirus in pregnancy by gestation?

Answer 18

<15 weeks gestation - 15%
15-20 weeks - 25%
Term - 70%

Question 19

Incidence of placental abruption

Answer 19

1 in 200 pregnancies

Question 20

Recurrence rates of placental abruption

Answer 20

4.4% if one previous affected pregnancy
19-25% if 2 previous affected pregnancies

Question 21

Which anti-TNF drug is considered “safe” throughout all trimesters

Answer 21

Certolizumab
It is not actively transported across the placenta and thus doesn’t accumulate to the same extent as transport is reliant on slow diffusion.
Rituximab is mono-clonal antibody that depletes B-cell. should be discontinued 6 months before conceiving.

Question 22

What is the most common solid benign liver lesion?

Answer 22

Hepatic hemangioma.

Present in ~10% of healthy individuals.
Well circumscribed and hyperechoic.
Rarely rupture
Grow slowly.
Arise from vascular endothelial cells
Typically asymptomatic.

Question 23

What is the first line treatment for active TB in pregnancy

Answer 23

Isoniazid, Rifampicin, ethambutol, pyrazinamide

Isoniazid can cause neuropathy - supplement Vit B6 pyridoxine

Question 24

What is first line treatment for latent TB in pregnancy?

Answer 24

Isoniazid and Rifampicin

Isoniazid can cause neuropathy - supplement Vit B6 pyridoxine

Question 25

Anti D antibodies. Above which level should patients be referred to FMU.

Answer 25

> 4

Question 26

Anti-C antibodies. Above which level should patients be referred to FMU.

Answer 26

> 7.5
or if Anti E also detected

Question 27

Anti K antibodies. Above which level should patients be referred to FMU.

Answer 27

Refer if detected at any level

Question 28

Anti-E antibodies. Above which level should patients be referred to FMU.

Answer 28

Refer if Anti-C Ab also detected.

Question 29

What percentage of monochorionic twin pregnancies are complicated by TTTS

Answer 29

10-15%

Question 30

Cystic fibrosis and pregnancy.
What is proportion of live births?

Answer 30

70-90%

The prematurity rate is ~25%,
Higher rates of spont PTB.
Pre-existing and GDM are more common.

Question 31

What is dermatographia arterfacta?

Answer 31

A complication sometimes encountered in ICP.
When the skin is stroked it develops a raised pink line.

Question 32

What is the mechanism by which gestational diabetes insipidus arises?

Answer 32

Typically cause by a transient deficiency Of ADH during pregnancy or postpartum.
Usually as a result of increased vasopressinase activity.

Vassopressinase activity is increased for two reasons:
1) increase in placental vasopressinase production - esp in multiple pregnancy
2) Decreased hepatic degradation of placental vasopressinase.

Question 33

Individuals with rubella are usually infectious from ________ before symptoms appear to _____ after the onset of the rash.

Answer 33

Infectious for 1 week before symptoms appear to 4 days after the onset of the rash.

Question 34

A spinal cord injury above which level is associated with a higher frequency of breech or transverse lie.

Answer 34

An injury above T10.

Question 35

What is the most common cause of an acute surgical abdomen in pregnancy?

Answer 35

Appendicitis
Most commonly presents in 2nd trimester.

Question 36

What is the risk of fetal loss in simple appendicitis, appendicitis with peritonitis and with appendicitis with a perforated appendix?

Answer 36

In simple appendicitis - 1.5%
Appendicitis with peritonitis - 6%
Fetal loss with perforated appendix 36%