Week 16 - Antenatal care

Question1

With respect to the diagnosis and classification of small for gestational age (SGA) fetuses

A.    SGA is estimated fetal weight below the 10^th centile

B.    Severe SGA is estimated fetal weight below the 5^th centile on customized growth chart

C.   Severe SGA is abdominal circumference below the 10^th centile on customized growth chart

D.   SGA is estimated fetal weight below the 5^th centile on customized growth chart

E.    Severe SGA is estimated fetal weight below the 3^rd centile on customized growth chart          

Question2

What proportion of small for gestational age fetuses are constitutionally small?

A.    5%

B.    10%

C.   25%

D.   40%

E.    Over 50%         

Question3

Which one is a major risk factor for small for gestational age fetus?

A.    Maternal age over 35 years

B.    Smoking

C.   Previous stillbirth         

D.   Type 1 diabetes

E.    Previous placental abruption

Question4

Major risk factors for small for gestational age (SGA) fetus include

A.    Maternal age over 40 years, smoking and use of cocaine in pregnancy

B.    Previous stillbirth, maternal age over 35 years and pre-existing diabetes mellitus

C.   Chronic hypertension, anti-phospholipid antibodies and smoking

D.   Renal impairment, maternal SGA and previous stillbirth          

E.    Previous placental abruption, previous still birth and smoking

Question5

Which one is a major risk factor for small for gestational age fetus?

A.    Echogenic bowel     

B.    Choroid plexus cyst

C.   First trimester Beta HCG > 2.5 MoM

D.   First trimester PAPP-A > 0.4 MoM

E.    Fetal renal pelvic dilatation

Question6

Which one is not a major risk factor for SGA?

A.    Factor V Leiden mutation carrier              

B.    Antiphospholipid syndrome

C.   Diabetes with vascular disease

D.   Smoking 12 cigarettes per day

E.    Bleeding in early pregnancy similar to a period

Question7

Assessment of risk factors for small for gestational age fetus should occur

A.    At booking

B.    At booking and at 11-14 weeks

C.   At booking and at 16 weeks

D.   At booking and at 20-24 weeks                                  

E.    At booking, 16 and 28 weeks

Question8

Which one is an indication for uterine artery Dopplers at 20-24 weeks gestation?

A.    35 year old woman with a previous SGA baby

B.    40 year old woman with previous severe pre-eclampsia and BMI of 35

C.   18 year old woman who smokes 15 cigarettes a day and has a BMI of 19

D.   37 year old woman with an BMI of 18 and smokes 5-10 cigarettes per day      

E.    37 year old woman with previous placental abruption and BMI of 22

Question9

Which one is an indication for serial fetal growth scans

A.    Women with BMI over 30

B.    Women with BMI over 35                           

C.   Women with BMI over 40

D.   Women with BMI over 30 who smoke cigarettes

E.    Women with BMI over 40 who have one or more additional risk factors for small for gestational age fetus

Question10

A 33 year old woman has been assessed for risk factors for small for gestational age fetus. As a result, she has uterine artery Dopplers performed and they are reported as normal. She has no other risk factors.

A.    Reassure and return to low-risk midwifery care

B.    Repeat uterine artery Dopplers 4-6 later

C.   Growth scan and umbilical artery Doppler at 32 weeks                      

D.   Growth scan and umbilical artery Doppler at 28, 32 and 36 weeks

E.    Induction of labour at 40 weeks

Question11

With respect to screening for small for gestational age fetus, first trimester uterine artery Dopplers

A.    Have low specificity and low sensitivity

B.    High specificity and high negative predictive value                  

C.   High sensitivity but low negative predictive value

D.   Low negative predictive value and low specificity

E.    High positive predictive value but low negative predictive value

Question12

Which one is not adjusted for in developing customized fetal growth charts?

A.    Maternal age                                    

B.    Maternal height

C.   Maternal weight

D.   Parity

E.    Maternal ethnic origin

Question13

With respect to the management of small for gestational age (SGA) fetuses, karyotype should be offered

A.    To all women with severe SGA

B.    To women with severe SGA before 28 weeks gestation

C.   To women with severe SGA and normal uterine artery Dopplers

D.   To women with severe SGA before 23 weeks gestation                     

E.     To women with severe SGA and normal umbilical artery Dopplers

Question14

The commonest abnormality detected in fetuses following karyotype for severe SGA before 26 weeks gestation is

A.    Trisomy 13

B.    Trisomy 21

C.   Triploidy                     

D.   Trisomy 18

E.    45X0

Question15

A 33 year old woman attends for growth scan at 28 weeks gestation because she is at increased risk of having a small for gestational age fetus. Ultrasound scan shows an estimated fetal weight on the 2^nd centile with normal umbilical artery Dopplers and normal liquor volume. Anomaly scan at 19 weeks was normal.

A.    Repeat growth scan in 1 week and umbilical artery Dopplers in 3-4 days

B.    Test for cytomegalovirus and toxoplasmosis and repeat growth scan in 2 weeks                                   

C.   Offer karyotype, test for cytomegalovirus and toxoplasmosis and repeat growth scan in 2 weeks

D.   Uterine artery Dopplers, offer aspirin 75 mg daily and repeat growth scan in 2 weeks

E.    Middle cerebral artery and ductus venosus Dopplers within 7 days

Question16

Infections are responsible for what proportion of small for gestational age fetuses?

A.    Less than 1%

B.    1-2%

C.   4-5%                          

D.   8-12%

E.    15-18%

Question17

To reduce the morbidity associated with small for gestational age (SGA) fetuses

A.    Aspirin should be offered from 12 weeks gestation to women at increased risk of SGA

B.    Magnesium sulphate should be considered if delivery is planned before 34 weeks

C.   Magnesium sulphate should be considered if delivery is planned before 32 weeks                               

D.   Corticosteroids should be offered if induction of labour is planned before 37 weeks

E.    Caesarean section should be recommended if delivery is planned before 37 weeks

Question18

A 23 year old woman has a growth scan at 30 weeks gestation because of suspected small for gestational age fetus. The estimated fetal weight is on the 7^th centile on customized chart with normal umbilical artery Dopplers and normal liquor volume.

A.    Repeat umbilical artery Dopplers within 7 days

B.    Repeat umbilical artery Dopplers in 7 days

C.   Repeat umbilical artery Dopplers within 14 days

D.   Repeat umbilical artery Dopplers in 14 days                

E.    Repeat umbilical artery Dopplers in 7 days if uterine artery Dopplers were abnormal

Question19

A 23 year old woman has a growth scan at 30 weeks gestation because of suspected small for gestational age fetus. The estimated fetal weight is on the 7^th centile on customized chart with raised umbilical artery Doppler PI but positive end-diastolic frequencies and normal liquor volume.

A.    Offer uterine artery Dopplers

B.    Recommend delivery at 32 weeks

C.   Recommend delivery at 34 weeks

D.   Repeat umbilical artery Dopplers twice a week                        

E.    Repeat umbilical artery Dopplers daily and administer corticosteroids

Question20

A 23 year old woman has a growth scan at 30 weeks gestation because of suspected small for gestational age fetus. The estimated fetal weight is on the 7^th centile on customized chart with raised umbilical artery Doppler PI with absent end-diastolic frequencies and reduced liquor volume.

A.    Recommend delivery by caesarean section

B.    Recommend delivery by caesarean section after corticosteroids

C.   Umbilical artery Dopplers twice a week

D.   Umbilical artery Dopplers daily                

E.    Biophysical profile daily

1a) 2e) 3b) 4c) 5a) 6a) 7a) 8a) 9b) 10a) 11e) 12b) 13d) 14c) 15b) 16c) 17a) 18c) 19d) 20d

A,C,C,A,A,AD,B,E,C,C,E,D,C,B,C,D,C,D,D

 1-E     2-E     3- D 4-D     5-A    6-A      7-D     8-B     9-A     10-C

11-A    12-A    13-D     14-C     15-C     16-C     17- D   18-C    19-D    20-D

1 A 2E  3C   4D  5A   6A   7A   8B   9E   10C   11B   12A   13C  14C   15B   16C   17A   18D   19D   20D

ANSWERS

1)   E

2)   E

3)   C

4)   D

5)   A

6)   A

7)   D

8)   D

9)   B

10)                  C

11)                  B

12)                  A

13)                  D

14)                  C

15)                  B

16)                  C

17)                  C

18)                  D

19)                  D

20)                  D