PassMRCOG - Early pregnancy

Question 1

What is the sensitivity and specificity of TV US for diagnosis of ectopic pregnancy

Answer 1

Sensitivity is 87-99%
Specificity 94-99.9%

Question 2

Incidence of ectopic pregnancy in the UK?

Answer 2

11,000 per year
11 in 1000 pregnancies

Question 3

Maternal mortality of ectopic pregnancy in the UK?

Answer 3

2 per 1000

Question 4

How many ectopics are non tubal?

Answer 4

3-5%

Question 5

Most common locations of tubal pregnancies

Answer 5

Ampullary 70-80%
Isthmus 12%
Fibrial 5-11%
Cornual/interstitial portion of tube 2%

Question 6

What percentage of appropriately selected women with require 2 or more doses of methotrexate?

Answer 6

14% (range 3-27%)

Question 7

What percentage of women treated with methotrexate will require surgical intervention

Answer 7

<10%

Question 8

What is the recurrence rate of ectopic pregnancy - regardless of treatment modality

Answer 8

18.5%
recurrence rate is the same regardless of treatment modality

Question 9

Which US feature might help differentiate miscarriage from a cervical ectopic

Answer 9

Sliding sign
Pressure is applied to the cervix with the probe, with a miscarriage the gestational sac slides against the cervical canal whereas it does not with an implanted cervical ectopic.

Question 10

What is the “interstitial line sign”?

Answer 10

A thin echogenic line that extends from the uterine cavity to the periphery of the interstitial sac.
Sensitivity 80%
Specificity 98% for diagnosis of interstitial ectopic

Question 11

What are the ultrasound criteria from diagnosing an interstitial ectopic?

Answer 11

Empty uterine cavity,
Visualisation of gestational sac within interstitial part of the tube in all planes
The interstitial line sign

Question 12

What is the ultrasound criteria for diagnosing a cervical ectopic

Answer 12

Empty uterine cavity
Barrel-Shaped cervix
Gestational sac below the level of internal cervical os
Absence of the sliding sign
Colour doppler shows blood flow around the gestation sac.

Question 13

Between which gestations is the fetal anomaly scan offered?

Answer 13

18 - 20+6 weeks

Question 14

Amniocentesis should be performed after ____ weeks of gestation?

Answer 14

15 weeks
Before 14 weeks amniocentesis has a higher fetal loss rate and increased incidence of talipes and respiratory morbidity.
Risk of pregnancy loss is likely to be below 0.5%

Question 15

What is the rate of spontaneous abortion amongst pregnant woman infected with Rubella in the first trimeter?

Answer 15

20%

Question 16

What proportion of fetuses are affected by congenital rubella syndrome when rubella is contracted in or before the 11th week?

Answer 16

90%

20% when contracted in the 11-16th weeks

No cases reports of CRS after 20 weeks

Question 17

What proportion of fetuses are affected by congenital rubella syndrome when rubella is contracted between 11-16 weeks?

Answer 17

20%

90% if before 11 weeks

No cases reports of CRS after 20 weeks.

Question 18

What is the incubation period of Rubella?

Answer 18

11-23 days
Average 14 days