Vol 19 Issue 3 Flashcards
A 17-year-old girl is receiving her antenatal care in your unit having booked at 12 weeks of gestation. What in her history will make you suspect child sexual exploitation?
A -Failure to disclose the father of the child
B - Failure to stop smoking despite counselling
C - Lack of proper means of supporting herself and the child
D - Repeated presentations in the pregnancy
E - The fact that she is pregnant
Repeated presentations in the pregnancy
Girls may present to antenatal services or repeatedly seek emergency contraception or termination of pregnancy. Frequent presentations to services should raise suspicion of child sexual exploitation.
What action should be taken if there are concerns about child sexual exploitation involving a 17-year-old girl who is attending the antenatal clinic?
A - Arrange a multi-agency consultation to assess the risk and then manage accordingly
B - Contact the GP and seek further information as she may already be known to be at risk
C - Inform the police and remove her from her home to avoid the risk of this continuing
D - Inform social services immediately
E - Raise these concerns with the child and share the information following local safeguarding protocols
Raise these concerns with the child and share the information following local safeguarding protocols
If a clinician has any concerns (even in the absence of a clear disclosure from a child) it is imperative that they raise these concerns with the child and share the information by following local safeguarding protocols. Confidentiality is key to encouraging children to access healthcare when they need it and so any potential breach of confidentiality (disclosure of the information without the child’s consent) needs to be formally considered as part of this process.
It has been documented that healthcare workers are reluctant to ask, or feel uncomfortable asking patients about domestic violence. Several reasons have been cited for this. What is the most unlikely reason for this?
A - Anxiety about the potential impact of mismanagement on their GMC license
B - Feeling inadequately informed to manage cases
C - Feeling of lack of confidence in managing cases
D - Feeling uncomfortable bringing up the subject
E - Lacking confidence in enquiring about it
Anxiety about the potential impact of mismanagement on their GMC license
Domestic violence is an important public health issue that many members of the medical profession feel uncomfortable or inadequately informed to manage. Healthcare professionals have cited reasons including a lack of confidence in enquiring about potential domestic violence underpinning their reluctance to ask patients about potential domestic violence.
How does the incidence of domestic violence in pregnancy compare to that of gestational diabetes mellitus (GDM) in the UK?
A - That of DV is half that of GDM
B - That of DV is ten times that of GDM
C - That of DV is three to four times that of GDM
D - That of DV is more than ten times that of GDM
E - They are similar
That of DV is more than ten times that of GDM
The incidence of gestational diabetes mellitus in the UK is 0.05% compared to 4-12% for domestic violence. The incidence of DV is therefore 80−240 times that of gestational diabetes.
A 30-year-old G2P1 is seen at 41+0 weeks to plan and book induction of labour on account of her dates. She is known to be a group B haemolytic streptococcus carrier. What would be the next logical step to take in her management?
A - Book for induction of labour and perform an ARM on admission
B - Book for induction of labour with prostaglandin E vaginal pessary
C - Book for induction of labour with prostaglandin tablets (oral)
D - Book for induction of labour with syntocinon
E - Offer membrane sweep and give a date for induction of labour
Offer membrane sweep and give a date for induction of labour
According to NICE, prior to formal IOL, women should be offered a vaginal examination for membrane sweeping as an adjunct to formal induction. Several studies have reported that membrane sweeping/stripping is associated with higher rates of spontaneous vaginal delivery, shorter induction-to-delivery interval, reduced likelihood of post-term pregnancy, and a decreased need for IOL. The STRIP-G study revealed that membrane sweeping was a safe procedure in women who were found to be carriers of group B haemolytic streptococcus.
Titrated oxytocin is now the commonest adjunct used for induction of labour and maintaining uterine contractions. What is the mechanism of action of this uterotonic?
A - Increasing prostaglandin release from the chorioamniotic membrane
B - Increase release of interleukin 6 and 8 from the amniochoriodecidual space
C - Binding to the oxytocin receptors in the uterus resulting in myometrial contraction
D - Acting directing on the cervix causing it to be soft and to dilate
E - Acting on receptors on the nipples, uterus and cervix to cause contractions, cervical dilatation and effacement
Binding to the oxytocin receptors in the uterus resulting in myometrial contraction
Oxytocin is a naturally occurring peptide from the posterior hypothalamus, which acts on oxytocin receptors in the uterus with no direct effects on the cervix.
How soon after delivery is cffDNA cleared from the maternal circulation?
A - Hours after delivery B - 48 hours after delivery C - 7 days after delivery D - One month after delivery E - 90−120 days (life span of red cells) after delivery
Hours after delivery
cffDNA is cleared from the maternal circulation hours after delivery making it specific to that pregnancy. This is in contrast to free fetal cells that last in the circulation for weeks and may therefore cross pregnancies.
What is the threshold percentage of cffDNA that is required in maternal circulation before an NIPT could be undertaken?
A - 3% B - 4% C - 5% D - 10% E - 20%
4%
What is the potential impact of early twin demise on the result of NIPT?
A - It increases the reliability of the test compared to if both twins are alive
B - The effect of the demised fetus’ cffDNA on the NIPT is unknown
C - The demise demised fetus’ is cleared from the maternal circulation within hours and therefore should not affect the result
D - It is advisable to delay testing for at least 24 hours to allow the demised fetus’ cffDNA to be cleared from the maternal circulation
E - There is a tendency for the result to generate a false negative test based on the levels of the demised fetus’ cffDNA
The effect of the demised fetus’ cffDNA on the NIPT is unknown
