Question 1
With respect to the risk factors for venous thrombo-embolism (VTE)
(a) Admission to hospital during pregnancy is associated with a 3-4 fold increase in VTE risk
(b) Obesity (BMI 30 or more) is associated with a higher risk of pulmonary embolism than deep vein thrombosis
(c) Age over 35 is associated with a 3-4 fold increase in risk of VTE
(d) IVF singleton pregnancies are not associated with an increased risk of VTE
(e) In pregnant women admitted to hospital, the increased risk of VTE has disappeared by 28 days after discharge
Question2
A 33 year old woman attends the antenatal clinic at 8 weeks gestation in her first pregnancy. She developed deep vein thrombosis at the age of 18 years and is known to have anti-thrombin deficiency. BMI = 22 kg/m2, BP = 112/56 mmHg and urine analysis is normal.
(a) Standard prophylactic dose of LMW heparin from 8 weeks
(b) Standard prophylactic dose of LMW heparin until 12 weeks then increase to therapeutic dose
(c) 50-75% therapeutic dose of LMW heparin
(d) Standard prophylactic dose of LMW heparin from 28 weeks
(e) Aspirin from 12 weeks + prophylactic LMW heparin from 28 weeks
Question3
A 33 year old woman has been admitted to the antenatal ward at 28 weeks gestation. She is known to have anti-thrombin deficiency and has been on low molecular weight heparin. She presented with a painful swollen left leg and left deep vein thrombosis has been diagnosed. You have been asked to check her anti-Xa levels. The blood sample should be taken
(a) Before her morning dose of heparin
(b) 1 hour after her morning dose of heparin
(c) 2 hours after her morning dose of heparin
(d) 3 hours after her morning dose of heparin
(e) 4 hours after her morning dose of heparin
Question4
A 33 year old woman attends the antenatal clinic at 7 weeks gestation. She has a history of anti-phospholipid syndrome and had been taking warfarin before pregnancy. This was changed to a prophylactic dose of low molecular weight heparin (LMWH) at 6 weeks gestation. Her BMI is 27 kg/m2, BP = 98/52 mmHg and urine analysis is normal.
(a) Add aspirin 75 mg daily from 12 weeks
(b) Increase LMWH dose to 50% therapeutic dose
(c) Increase LMWH dose to 50% therapeutic dose + aspirin 75 mg daily from 12 weeks
(d) Increase LMWH dose to 50% therapeutic dose + aspirin 75 mg daily from 12 weeks + serial growth scans
(e) Increase LMWH does to 75% therapeutic dose + aspirin 75 mg daily from 12 weeks + uterine artery Dopplers at 22-24 weeks
Question5
A 32 year old woman attends the antenatal clinic at 7 weeks gestation in her first pregnancy. She has a history of 2 un-provoked DVTs and thrombophilia screen has been negative. Her BMI = 25 kg/m2, BP = 120/68 mmHg and urine analysis is normal. There is no family history of VTE.
(a) Prophylactic LMW heparin
(b) Prophylactic LMW heparin from 28 weeks
(c) Prophylactic LMW heparin + serial growth scans
(d) 50% therapeutic LMW heparin + serial growth scans
(e) 50% therapeutic LMW heparin
Question6
A 23 year old woman attends the antenatal clinic at 8 weeks gestation in her first pregnancy. She suffered deep vein thrombosis at the age of 18 years following a long-haul flight. Her BMI = 23 kg/m2 and she has no other risk factors.
(a) Manage as low-risk pregnancy
(b) Prophylactic LMW heparin from 12 weeks
(c) Prophylactic LMW heparin from 8 weeks
(d) Prophylactic LMW heparin from 28 weeks
(e) Prophylactic LMW heparin for 6 weeks post-partum
Question7
A 36 year old woman attends the antenatal clinic at 8 weeks gestation in her first pregnancy. She developed a DVT 10 years ago after a fractured pelvis. BMI = 34 kg/m2, BP = 125/67 mmHg. With specific reference to thromboprophylaxis
(a) Low molecular weight heparin from 28 weeks
(b) Avoid dehydration and keep mobile
(c) Low molecular weight heparin for 6 weeks post-partum
(d) Low molecular weight heparin for 6 weeks post-partum if caesarean section
(e) Low molecular weight heparin from 8 weeks
Question8
A healthy 33 year old woman attends the antenatal clinic at 12 weeks gestation. She suffered deep vein thrombosis at the age of 18 years while taking the combined oral contraceptive pill. Her mother and sister have suffered deep vein thrombosis and pulmonary embolism respectively. She does not know if they have been tested for thrombophilias. BMI = 25 kg/m2, BP = 98/56 mmHg and urine analysis is normal.
(a) Manage as low risk for VTE
(b) Low molecular weight heparin from 12 weeks
(c) Test for Protein C, S and anti-thrombin deficiency
(d) Test for anti-thrombin deficiency
(e) Low molecular weight heparin from 28 weeks
Question9
A healthy 23 year old woman attends the antenatal clinic at 8 weeks gestation. She is known to have anti-thrombin deficiency following multiple episodes of pulmonary embolism in her sister. She has no personal history of thrombo-embolism. BMI = 22 kg/m2, BP = 112/56 mmHg.
(a) Prophylactic LMW heparin from 8 weeks
(b) Prophylactic LMW heparin from 28 weeks
(c) 50% therapeutic LMW heparin from 12 weeks
(d) 50% therapeutic LMW heparin from 28 weeks
(e) 50% therapeutic LMW heparin from 8 weeks
Question10
A healthy 33 year old woman attends the antenatal clinic at 8 weeks gestation. She is known to have protein C deficiency following multiple episodes of pulmonary embolism in her sister. She has no personal history of thrombo-embolism. BMI = 22 kg/m2, BP = 112/56 mmHg.
(a) Prophylactic LMW heparin from 8 weeks
(b) Prophylactic LMW heparin from 28 weeks
(c) 50% therapeutic LMW heparin from 12 weeks
(d) 50% therapeutic LMW heparin from 28 weeks
(e) 50% therapeutic LMW heparin from 8 weeks
Question11
A healthy 27 year old woman attends the antenatal clinic at 8 weeks gestation. She is known to have protein S deficiency following multiple episodes of pulmonary embolism in her sister. She has no personal history of thrombo-embolism. BMI = 28 kg/m2, BP = 122/66 mmHg.
(a) Prophylactic LMW heparin from 8 weeks
(b) Prophylactic LMW heparin from 28 weeks
(c) 50% therapeutic LMW heparin from 12 weeks
(d) 50% therapeutic LMW heparin from 28 weeks
(e) 50% therapeutic LMW heparin from 8 weeks
Question12
A healthy 23 year old woman attends the antenatal clinic at 8 weeks gestation. She is known to be a carrier of the factor V Leiden mutation following deep vein thrombosis in her sister. She has no personal history of thrombo-embolism. BMI = 25 kg/m2, BP = 112/56 mmHg.
(a) Prophylactic LMW heparin from 8 weeks
(b) Prophylactic LMW heparin from 28 weeks
(c) 50% therapeutic LMW heparin from 12 weeks
(d) 50% therapeutic LMW heparin from 28 weeks
(e) Manage as low risk during antenatal period
Question13
A healthy 23 year old woman attends the antenatal clinic at 12 weeks gestation in her first pregnancy. Her sister suffered pulmonary embolism during pregnancy. BMI = 22 kg/m2, BP = 112/54 mmHg and urine analysis is negative.
(a) Consider testing for thrombophilia
(b) Manage as low risk during antenatal period
(c) Low molecular weight heparin from 12 weeks
(d) Low molecular weight heparin from 28 weeks
(e) Low molecular weight heparin for 6 weeks post-partum
Question14
A 34 year old woman telephones for advice about her treatment with low molecular weight heparin. She has a history of deep vein thrombosis associated with protein C deficiency and has been on a prophylactic dose of low molecular weight heparin (LMWH). She is due to have a planned caesarean section in 3 days time. She usually injects LMWH in the morning.
(a) Omit LMWH the day before caesarean section
(b) Omit LMWH on the morning of planned caesarean section
(c) Inject LMWH as normal and attend for caesarean section
(d) Change time of injection to evening and inject normal dose on the day before caesarean section
(e) Omit LMWH 2 days before caesarean section
Question15
A 35 year old woman attends the antenatal clinic at 37 weeks gestation. She developed deep vein thrombosis at 32 weeks and is on a therapeutic dose of low molecular weight heparin (LMWH). Elective caesarean section is planned for 38 weeks because of breech presentation. She normally injects LMWH in the morning.
(a) Omit LMWH on the morning of caesarean section
(b) Omit LMWH from the morning before the day of planned caesarean section
(c) Administer prophylactic dose of LMWH on the morning of caesarean section
(d) Change to prophylactic dose of LMWH from 37 weeks
(e) Ensure dose of LMWH is administered at least 12 hours before caesarean section
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