Options for question 1
A) She should be started on long-term heparin therapy
B) She should be started on long-term aspirin therapy
C) If untreated, her risk of miscarriage in a future pregnancy is lower than in a woman with unexplained recurrent miscarriage
D) IVF with pre-implantation genetic diagnosis should be considered if she has a fourth consecutive miscarriage
E) Aspirin started when her pregnancy test becomes positive is an appropriate treatment
F) Low molecular weight heparin started when her pregnancy test becomes positive is the most appropriate treatment
G) Unfractionated heparin started when her pregnancy test becomes positive is the most appropriate treatment
H) Aspirin plus unfractionated heparin is the most appropriate treatment
For the scenario 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.
1) A healthy 34 year old woman with three consecutive first trimester miscarriages has been confirmed to have positive anti-phospholipid antibodies
Options for questions 2-4
A) Aspirin 75mg
B) Aspirin 150mg
C) Unfractionated heparin
D) Refer for genetic counselling
E) Low molecular weight heparin
F) Warfarin
G) Aspirin + low molecular weight heparin
H) Aspirin plus unfractionated heparin
I) Oral corticosteroids
J) No additional treatment
K) Metformin
L) Vaginal progesterone pesseries
M) Human chorionic gonadotrophin injections
For the scenarios 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.
2) A healthy 35 year old woman has suffered three consecutive first trimester miscarriages. Investigations confirm that she has positive anti-cardiolipin antibodies
3) A 30 year old woman is known to have the polycystic ovary syndrome. Her BMI is 34 kg/m2 and she has conceived spontaneously. However, she has suffered three consecutive first trimester miscarriages. Full investigations for recurrent miscarriage have been negative.
4) A healthy 32 year old woman has suffered three consecutive first trimester miscarriages. Cytogenetic analysis of products of conception showed 46XX / 47XXX karyotype. All other investigations for recurrent miscarriage are negative
5) With respect to fetal movements (T/F)
A) Fetal movements are usually first perceived at 16-18 weeks gestation
B) Multiparous women typically perceive fetal movements at earlier gestations than primiparous women
C) The frequency of fetal movements increases between 20 and 32 weeks gestation
D) The frequency of fetal movements decreases between 36 and 40 weeks gestation
E) At term, normal fetuses make an average of 10 movements per hour
F) Women perceive more fetal movements in the evening than in the morning
G) Women perceive more fetal movements when standing compared to lying down
6) A healthy 32 year old woman telephones the maternity assessment unit at 19:00. She is 35 weeks pregnant and has just returned from work. She is unsure whether she has felt fetal movements during the day. Which one of the options below is the most appropriate management?
A) The woman should be advised to contact her community midwife immediately
B) The maternity assessment unit should contact the woman’s community midwife and ask her to visit the woman as soon as possible
C) The woman should be asked to attend the maternity assessment unit at 08:00 the next morning if she has not felt fetal movements
D) The woman should be advised to lie on her left side for 2 hours and attend if she does not feel 10 or more movements during this period
E) The woman should be advised to lie on her left side for 2 hours and attend if she does not feel any movements during this period
F) The woman should be reassured
G) The woman should be asked to attend the maternity unit immediately
7) A healthy 32 year old primigravida attends the maternity assessment unit at 36 weeks gestation because of reduced fetal movements for 24 hours. While on the unit, she perceives normal fetal movements. She has no other risk factors, BP = 110/80 mmHg and fundal height is appropriate for gestation age. Fetal heart rate is 138 / minute using a hand-held Doppler device. (T/F)
A) CTG is recommended
B) She should be reassured and asked to re-attend if fetal movements are reduced again
C) Induction of labour should be recommended at 40 weeks if her pregnancy remains uncomplicated
D) Ultrasound scan is recommended to assess liquor volume
E) The woman should be given a Count to Ten kick chart
8) With respect to cardiac disease in pregnancy in the UK (T/F)
A) Maternal mortality from cardiac disease has fallen over the last 10 years
B) Pregnancy is associated with a reduction in the risk of myocardial infarction
C) Myocardial infarction in pregnancy typically presents in the first and second trimesters
D) 1 in 3 women who suffer myocardial infarction in pregnancy will die
E) Aortic stenosis is the commonest lesion in pregnant women with rheumatic heart disease
9) With respect to uterine rupture in the UK (T/F)
A) The overall incidence of uterine rupture is 2 per 1,000 maternities
B) There is a linear relationship between number of previous caesarean sections and risk of uterine rupture
C) Compared to women with one previous caesarean section, the risk of uterine rupture is not significantly increased until after 4 caesarean sections
D) Perinatal mortality rate is not significantly higher in women who suffer a uterine rupture compared to the general population
E) Abdominal pain is the commonest clinical feature that is noted prior to the diagnosis of uterine rupture
F) Uterine rupture is associated with a mortality rate of 5-10%
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