Scientific Impact Papers

Question 1

What are the limits in gestation for flying by most airlines?

Answer 1

36/40
If risk of preterm labour e.g. multiple pregnancy - 32/40
Most need a letter >28/40 to say no anticipated complications and confirmation of EDD

Question 2

What is the increase in VTE risk for long haul flights?

Answer 2

3 fold

18% for each 2 hours flight time

Question 3

What is the advice re: DVT and flying?

Answer 3

Hydration, TEDs, mobilise

If other riskes e.g. prev DVT, obese etc consider LMWH for day of travel and several days after

Question 4

What is the rate of neural tube defects in the UK?

Answer 4

1.5/1000

Question 5

What proportion of women are estimated to be taking folic acid preconceptually?

Answer 5

1/3

Question 6

What is the population coverage of the cervical screening programme in the UK?

Answer 6

77-80% (only 63% 25-29)

Question 7

When was HPV immunisation introduced to the UK?

Answer 7

2008 for 12-13 yo - bilvalent 16/18 vax - Cervarix

2012 - quadrivalent - 6/11/16/18 - Gardasil

Question 8

What % of IVF births are multiple pregnancies?

Answer 8

Approx 25%

Question 9

What is the increase in relative risk for preterm birth following IVF?

Answer 9

x2 (23% of IVF twins>natural)

Question 10

What in the relative risk of LBW/SGA for singleton IVF pregnancy?

Answer 10

RR 1.6

Question 11

What is the increase in risk of congenital abnormalities with IVF?

Answer 11

30-40% but absolute risk is low

3-5% are diagnosed after birth

Question 12

What is the increase in perinatal mortalitlity with IVF?

Answer 12

Results inconsistent but approx 70% compared with natural conceptions
Higher with PGD/screening compared to standard ICSi

Question 13

What is the increased probability of live birth with D5 blastocyst vs D2 cleavage stage embryo selection?

Answer 13

40%

Question 14

What % of women with PCOS are overweight?

Answer 14

40-50%

Question 15

How does metformin work in PCOS?

Answer 15

• Inhibits production of hepatic glucose
• Enhances cellular insulin sensitivity
• ?Direct effect on ovarian function

No good data for metformin; best reserved for patients with glucose intolerance or T2DM

Question 16

How much additional blood is there in a baby’s cord at term?

Answer 16

80-100ml

Question 17

In what % of CVS samples are abnormal cell lines in the placenta not present in the fetus (ie mosaicism)?

Answer 17

1%

Question 18

What % of fetal energy requirements is provided by glucose?

Answer 18

75%

Question 19

What % of the general population have a folate deficiency?

Answer 19

5%

Question 20

What are the obstetric complications of treatment to the cervix for CIN?

Answer 20

Cold-knife, laser, LLETZ - increased risk LBW, PTB if >10mm depth - similar to risk if previous PTD history
Cold-knife conisation also increased risk CS
LLETZ - PPROM
Consider TVUS serially but ?no improvement in outcome

Question 21

What is the miscarriage rate at 35-39?

And 40-44?

Answer 21

35-39 = 24%
40-44 = 51%

Question 22

Where is Inhibin B produced?

Answer 22

Small antral follicles secondary to FSH

Question 23

What is the chance of a pregnancy from a vitrified oocyte?

Answer 23

4%

Effect of prolonged vitrification unknown

Question 24

What is the incidence of cerebral palsy at:

• 22-27/40
• 28-31/40
• 32-36/40?

Answer 24

• 22-27/40 = 15%
• 28-31/40 = 6%
• 32-36/40 = 0.7%

50% considered perinatal in origin

Question 25

What was found to be the odds ratio for cerebral palsy when MgSO4 was given for PET/tocolysis?

Answer 25

0.14

Question 26

What is the most common lesion seen in cases of cerebral palsy and what pathological process is important? How does MgSO4 help?

Answer 26

Periventricular white matter injury
NMDA receptors on oligodendrocytes important in the glial injury process
MgSO4 acts as Ca2+ antagonist - ?reverses hypoxic injury

Question 27

What is the relative risk for cerebral palsy and gross motor dysfunction with MgSO4 given to women at risk of PTL as per the Cochrane review?

Answer 27

CP - 0.68

Gross motor dysfunction - 0.61

Question 28

At what gestation should MgSO4 be considered for neuroprotection?

Answer 28

<30/40

Question 29

What % of maternities in 2006-8 were in women >35? and >40?

Answer 29

> 35 - 20%

>40 - 3.6%

Question 30

What is the rate of stillbirth in 25-29 yo and in >=40?

Answer 30

25-29 - 4.6/1000 maternities
>=40 - 7.6/1000

x2 in Afrocaribbean across all age groups

Question 31

What is the estimate for how many stillbirths could be prevented if all women aged 40 or above had IOL at 39/40 (or 40?)

Answer 31

39/40 - 17

40/40 - 7

Question 32

How many cervical, endometrial, and ovarian cancers are diagnosed in those <45 every year?

Answer 32

Cx - 1000
Endo - 120
Ovarian - >500

Question 33

What is the rate of recurrence following radical vaginal trachelectomy?

Answer 33

4.2 - 5.6%

Question 34

How many pregnancies have congenital CMV infection?

Answer 34

0.2-2.2%

Question 35

What are transmission rates of CMV with 1)primary infection 2)re-activation

Answer 35

1) 30-40% (13% asymptomatic at birth)
1st trimester = 30%
3rd trimester = 47%
2) 1-2%

Question 36

CMV diagnosis

Answer 36

Maternal 
1) CMV IgG +ve when previously -ve
2) CMV IgM +ve, IgG low avidity 
Fetal
Amniocentesis after 20/40 PCR for CMV