Options for Questions 31-33
A Administer anti-D 250IU B Administer anti-D 500IU
C Administer anti-D 250IU plus Kleihauer test D Administer anti-D 500IU plus Kleihauer test
E Administer anti-D 500IU if Kleihauer test is positive F Administer routine antenatal prophylactic anti-D
G Measure anti-D antibody titre H Amniocentesis and measure OD450
I Fetal blood sampling J Elective delivery at 37-38 weeks
K Elective delivery at 34 weeks L Paternal Rhesus D zygosity
M Anti-D not needed N Fetal middle cerebral artery peak systolic velocity
Instructions: For each of the case histories described below, choose the single most appropriate management from the above list of options. Each option may be used once, more than once, or not at all.
Question 31 A 24 year old Rhesus negative un-sensitised woman presents with painless vaginal bleeding at 8 weeks gestation. Ultrasound scan shows a viable 8 weeks intra-uterine pregnancy. Your answer: MCorrect answer: M
Question 32 A 34 year old mother of 4 children presents at 10 weeks gestation with fresh vaginal bleeding with clots. An ultrasound scan preformed 2 weeks earlier had shown a viable 8 weeks intra-uterine pregnancy. Repeat ultrasound scan now shows an empty uterus with thickened endometrium and no adnexal masses. The woman is Rhesus negative with no red cell antibodies. Your answer: MCorrect answer: M
Question 33 A 23 year old Rhesus negative un-sensitised woman has an evacuation of retained products of conception for an 8 weeks missed miscarriage. Your answer: CCorrect answer: A