Pregnancy

Question 1

Define Small for gestational age (SGA).

Answer 1

An infant with a birth weight <10th centile for its gestational age.

Question 2

Define Fetal growth restriction (FGR).

Answer 2

When a pathological process has restricted genetic growth potential. This can present with features of fetal compromise including reduced liquor volume (LV) or abnormal doppler studies.

Question 3

Define constitutionally small foetuses.

Answer 3

Identified by small size at all stages but growth following the centiles. No pathology is present.

Question 4

Name 2 different types of growth restriction.

Answer 4

1. Placenta mediated

2. Non-placenta mediated

Question 5

Describe the role of head circumference (HC) and abdominal circumference (AC) in the diagnosis of the cause of growth restriction .

Answer 5

A symmetrically small fetus is more likely to be constitutionally small whilst an asymmetrically small fetus is more likely to be caused by placental insufficiency.

Question 6

Describe the impact on placental insufficiency on the amniotic fluid volume.

Answer 6

Placental insufficiency can result in impaired fetal kidney function which will result in reduced amniotic fluid volume.

Question 7

What medication should women that are high risk for pre-eclampsia be started on at 16 weeks gestation?

Answer 7

75mg of aspirin

Question 8

What should be given If delivery is being considered between 24 and 35+6 weeks gestation?

Answer 8

Antenatal steroids

Question 9

What is Red blood cell isoimmunisation?

Answer 9

The production of antibodies in response to an isoantigen present on an erythrocyte.the production of antibodies in response to an isoantigen present on an erythrocyte.

Question 10

What antibodies are produced when the mother’s immune system is sensitised to antigens on fetal erythrocytes?

Answer 10

IgG

Question 11

What is the result of Rhesus D isoimmunisation?

Answer 11

This causes the fetal immune system to attack and destroy its own RBCs, leading to fetal anaemia. This is termed haemolytic disease of the newborn (HDN)

Question 12

If sensitising events occur what can be administered to prevent maternal isoimmunisation?

Answer 12

Anti- D immunoglobulin

Question 13

What blood tests should be considered following a sensitising event?

Answer 13

1. Maternal blood group antibody screen

2. Feto-materal haemorrhage (FMH) test

Question 14

Describe the red blood cell isoimmunisation screening programme in the UK.

Answer 14

In the UK, all pregnant women have a maternal blood group (ABO and RhD typing), and an antibody screen performed at the booking visit (8-12 weeks gestation). This is repeated at 28 weeks.

Question 15

When should women who test RhD- be offered routine antenatal anti-D prophylaxis?

Answer 15

(500 IU) at 28 and 34 weeks gestation. Some centres give a single (larger) dose at 34 weeks.

Question 16

What are the complications of prolonged pregnancy?

Answer 16

Due to the increased potential for placental insufficiency, there is also a higher risk of fetal acidaemia and meconium aspiration in labour, and the need for instrumental or caesarean delivery.

The reduced oxygen and nutrient transfer due to placental degradation can deplete fetal glycogen stores, resulting in neonatal hypoglycaemia.

Question 17

Describe the appearance of babies born in prolonged pregnancies.

Answer 17

Vernix on a newborn. Prolonged pregnancy babies are typically born with less vernix and drier skin.

Question 18

When is the most reliable period of dating for foetal age?

Answer 18

Dating is recommended between 11+0 and 13+6 weeks gestation during the first trimester scan. This is most reliable as the fetus rarely shows signs of being constitutionally large or small until a later stage of gestation.

Question 19

Describe the NICE management of prolonged pregnancy.

Answer 19

Membrane sweeps – can be offered from 40+0 weeks in nulliparous and 41+0 weeks in parous women.

Induction of labour – usually offered between 41+0 and 42+0 weeks gestation.
See here for more information.

Question 20

Define miscarriage.

Answer 20

A loss of a pregnancy at less than 24 weeks’ gestation

Question 21

Name some risk factors of miscarriage.

Answer 21

Maternal Age >30-35 (largely due to an increase in chromosomal abnormalities)
Previous miscarriage
Obesity
Chromosomal abnormalities (maternal or paternal)
Smoking
Uterine anomalies
Previous uterine surgery
Anti-phospholipid syndrome
Coagulopathies

Question 22

Describe how a women a woman experiencing a miscarriage would present.

Answer 22

The main presenting symptom of miscarriage is vaginal bleeding. This may include passing clots or products of conception.

Question 23

How is the definitive diagnosis of a miscarriage confirmed?

Answer 23

transvaginal USS

Question 24

Under what CRL and no fetal heart beat would result in a diagnosis of inconclusive miscarriage and a repeat scan required in 7 days?

Answer 24

7mm

Question 25

If a fetal pole is not visible, but intrauterine pregnancy is confirmed with a gestational sac and yolk sac, the management depends on what?

Answer 25

mean sac diameter (MSD)

Question 26

What diagnosis can be made if the MSD is >25mm?

Answer 26

Failed pregnancy

Question 27

During a miscarriage, regardless of treatment type, if the patient is Rhesus negative and is greater than 12 weeks gestation, what is required?

Answer 27

anti-D prophylaxis

Question 28

Describe the 3 methods of management for miscarriages.

Answer 28

1. Conservative
2. Medical: vaginal misoprostol (prostaglandin analogue) to stimulate cervical ripening and myometrial contractions. It is usually preceded by mifepristone 24-48 hours prior to administration.
3. Surgical: Surgical management involves a manual vacuum aspiration with local anaesthetic if <12 weeks, or evacuation of retained products of conception (ERPC).

Question 29

Name the 6 types of miscarriages.

Answer 29

1. Threatened
2. Inevitable
3. Missed
4. Incomplete
5. Complete

Question 30

What is the definition of recurrent miscarriage?

Answer 30

the occurrence of three or more consecutive pregnancies that end in miscarriage of the fetus before 24 weeks of gestation

Question 31

Name a syndrome that, if left with no pharmacological interventions, result in the live birth rate being as low as 10%

Answer 31

Antiphospholipid Syndrome

Question 32

Name the 2 main genetic factors contributing to the risk of recurrent miscarriage.

Answer 32

1. Parental chromosomal rearrangements

2. Embryonic chromosomal abnormalities

Question 33

Name 3 endocrine factors contributing to the risk of recurrent miscarriage.

Answer 33

1. Diabetes
2. Thyroid disease
3. PCOS

Question 34

Name 3 anatomical factors contributing to the risk of recurrent miscarriage.

Answer 34

1. Uterine malformations
2. Cervical weakness
3. Acquired uterine abnormalities

Question 35

Name 3 risk factors for recurrent miscarriage.

Answer 35

1. Advancing maternal age
2. Number of previous miscarriages
3. Lifestyle

Question 36

Define ectopic pregnancy.

Answer 36

Any pregnancy which is implanted at a site outside of the uterine cavity