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MRCOG PART 2 SBAs and EMQs

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Week 2 - antenatal care

Week 2 - antenatal care Posted by PAUL A.

Question1

A healthy 33 year old woman books for her second pregnancy at 10 weeks gestation. In her first pregnancy, she had an emergency caesarean section because of failed induction of labour at 42 weeks. The procedure was uncomplicated and the baby weighed 3950 g. Counselling regarding mode of delivery in this pregnancy

A.    Should be conducted at the booking visit

B.    Should be conducted at the 11-14 weeks visit

C.   Should be conducted after the 18-20 weeks anomaly scan              

D.   Should be conducted by 36 weeks gestation

E.    Should have been conducted before discharge after the previous caesarean section

 

Question2

A healthy 33 year old woman books for her second pregnancy at 10 weeks gestation. In her first pregnancy, she had an emergency caesarean section because of failed induction of labour at 42 weeks. The procedure was uncomplicated and the baby weighed 3950 g. With respect to counselling regarding mode of delivery in this pregnancy

A.    Counselling should be provided by an obstetrician

B.    Counselling should be provided by an obstetrician if the woman wants a planned vaginal birth

C.   An obstetrician should be involved in counselling if the woman wants a planned vaginal birth

D.   An obstetrician should be involved in counselling if the woman wants a planned caesarean section            

E.    Counselling can be provided by a midwife but the final decision on mode of delivery should be made by an obstetrician

 

Question3

A healthy 35 year old woman attends the antenatal clinic at 20 weeks gestation in her second pregnancy. In her first pregnancy, she had an elective caesarean section because of breech presentation. The procedure was uncomplicated and the baby weighed 4250 g. Following counselling, planned caesarean section is booked for 39 weeks gestation. The chances of the woman presenting in labour before the planned caesarean section date are

A.    1-2%

B.    3-4%

C.   5-6%

D.   7-8%

E.    9-10%                        

 

Question4

Which one is a contra-indication to planned vaginal birth after one previous caesarean section?

A.    Previous caesarean section before 30 weeks

B.    Previous uterine rupture                

C.   Induction of labour required at 37 weeks because of pre-eclampsia

D.   Left lateral uterine angle extension at previous caesarean section

E.    Previous caesarean section for failed forceps delivery with a direct occipito-anterior position

 

Question5

A healthy 29 year old nulliparous woman is referred to the antenatal clinic at 20 weeks gestation. She had hysteroscopic resection of uterine septum performed 3 years ago following recurrent first trimester miscarriages. Anomaly scan has been reported as normal. With respects to options for birth, she should be informed that

A.    Planned vaginal birth is contra-indicated after hysteroscopic resection

B.    The risk of uterine rypture is at least 1 in 20 following hysteroscopic resection

C.   Uterine rupture is rare after hysteroscopic resection               

D.   The risk of uterine rupture is similar to that after one previous caesarean section (1 in 200)

E.    Uterine rupture following hysteroscopic resection is more likely to cause fetal death 

 

Question6

You have just completed a caesarean section performed because of unstable lie. Due to difficulties encountered, an inverted T uterine incision was required. You are writing the discharge letter and need to make recommendations for future pregnancies.

A.    Planned vaginal birth if the woman waits at least 2 years before conceiving

B.    Planned caesarean section should be recommended for future pregnancies

C.   Planned vaginal birth can be offered as risk of uterine rupture is not increased compared to one previous caesarean section

D.   The woman should be referred for detailed counselling by a consultant obstetrician                 

E.    Planned caesarean section should be recommended at 37-38 weeks because of increased risk of uterine rupture

 

Question7

A healthy 33 year old woman attends the antenatal clinic at 20 weeks in her third pregnancy. She had a caesarean section in her first pregnancy because of a breech presentation. In her second pregnancy, she had a spontaneous vaginal birth. She would like to discuss options for giving birth in this pregnancy. The likelihood of successful planes vaginal birth is

A.    62-68%

B.    72-75%

C.   76-80%

D.   80-84%

E.    85-90%                      

 

Question8

A healthy 33 year old woman attends the antenatal clinic at 20 weeks in her third pregnancy. She had a caesarean section in her first pregnancy because of a breech presentation. In her second pregnancy, she had a spontaneous vaginal birth. She would like to discuss options for giving birth in this pregnancy. The risk of uterine rupture associated with planned vaginal birth is

A.    About 1 in 200

B.    Lower than 1 in 200                        

C.   Higher than 1 in 200

D.   Lower than 1 in 1000

E.    About 1 in 5000

 

Question9

 

The likelihood of successful planned vaginal birth is an important consideration for women with one previous caesarean section. Which group has the highest likelihood of successful planned vaginal birth?

 

A.    Women with previous caesarean section for fetal compromise

 

B.    Women with previous caesarean section for breech presentation              

 

C.   Women with previous caesarean section for failed induction of labour

 

D.   Women with previous caesarean section for non-progressive first stage of labour

 

E.    Women with caesarean section for unsuccessful vaginal operative delivery

 

Question10

 

The likelihood of successful planned vaginal birth is an important consideration for women with one previous caesarean section. Which group has the highest likelihood of successful planned vaginal birth?

 

A.    White women in their 30s with previous caesarean section for mal-presentation            

 

B.    Asian women in their 30s with previous caesarean section for non-progressive first stage

 

C.   White women in their 30s with previous caesarean section for non-progressive first stage

 

D.   African women in their 30s with previous caesarean section for mal-presentation

 

E.    African women in their 30s with previous caesarean section for unsuccessful vaginal operative delivery

 

Question11

A 36 year old woman attends the antenatal clinic at 40 weeks gestation in her second pregnancy. In her first pregnancy, she had an emergency caesarean section because of non-progressive first stage of labour. Her BMI at booking was 36 kg/m2. She wishes to have a planned vaginal birth and is considering the option of induction of labour at 41 weeks. The likelihood of successful planned vaginal birth if her labour is induced is

A.    About 70%

B.    About 60%

C.   About 50%

D.   About 40%                

E.    About 30%

 

Question12

A 36 year old woman attends the antenatal clinic at 20 weeks gestation in her second pregnancy. In her first pregnancy, she had an emergency caesarean section because unsuccessful vaginal operative delivery. Her BMI at booking was 30 kg/m2. The risk of uterine rupture associated with planned vaginal birth is

A.    1 in 1000

B.    1 in 500

C.   1 in 300

D.   1 in 200                                 

E.    1 in 100

 

Question14

In women planning a vaginal birth after one previous caesarean section, which one is not associated with an increased risk of uterine rupture?

A.    Inter-pregnancy interval less than 12 months               

B.    Maternal age over 40 years

C.   Post-dates pregnancy

D.   BMI over 30 kg/m2

E.    Fetal macrosomia

 

Question15

A 36 year old woman attends the antenatal clinic at 20 weeks gestation in her second pregnancy. In her first pregnancy, she had an emergency caesarean section because of unsuccessful vaginal operative delivery. Her BMI at booking was 30 kg/m2. During discussion on mode of delivery, the woman wishes to know what would happen if she suffers uterine rupture. The risk of perinatal death arising from uterine rupture during planes vaginal birth is

A.    About 1 in 1000

B.    About 1 in 500

C.   About 1 in 100

D.   About 1 in 10                        

E.    About 1 in 20

 

Question16

Hypoxic ischaemic encephalopathy (HIE) is a recognised complication of planned vaginal birth. The risk of HIE during planned vaginal birth after caesarean section is

A.    About 1 in 10,000

B.    About 1 in 1000                    

C.   About 1 in 500

D.   About 1 in 250

E.    About 1 in 100

 

Question17

A healthy 26 year old woman attends the antenatal clinic at 24 weeks gestation in her second pregnancy. In her first pregnancy, she had an emergency caesarean section because of breech presentation. Her BMI at booking was 23 kg/m2. During discussion on mode of delivery, the woman should be informed that

A.    The risk of hysterectomy is higher with planned caesarean section compared to planned vaginal birth

B.    The risk of venous thrombo-embolism is not significantly different with planned caesarean section compared to planned vaginal birth                

C.   The risk of endometritis associated with planned caesarean section if 4 times the risk associated with planned vaginal birth

D.   She is more likely to need a blood transfusion if she has a planned vaginal birth compared to planned caesarean section

E.    The risk of hysterectomy is higher with planned vaginal birth compared to planned caesarean section

 

Question18

A healthy 36 year old woman attends the antenatal clinic at 18 weeks gestation in her second pregnancy. In her first pregnancy, she had an emergency caesarean section because of placenta previa. During discussion on mode of delivery, the woman should be informed that

A.    Maternal mortality is significantly higher after planned caesarean section compared to planned vaginal birth

B.    Planned caesarean section is associated with a 5-6 fold increase in the risk of transient tachypnoea of the new-born compared to planned vaginal birth

C.   Planned vaginal birth is associated with a lower risk of stillbirth compared to planned caesarean section

D.   The risk of respiratory distress syndrome associated with planned caesarean section is about 5 in 1000               

E.    The risk of respiratory distress syndrome associated with planned vaginal birth is about 5 in 1000

 

Question19

 

In women opting for planned vaginal birth after one previous caesarean section, the absolute risk of delivery-related perinatal death is

 

A.    1 in 200

 

B.     1 in 500

C.     1 in 1000

D.     1 in 2500                                 

E.     1 in 10,000

 

Question20

A healthy 36 year old woman attends the antenatal clinic at 18 weeks gestation in her second pregnancy. In her first pregnancy, she had an emergency caesarean section because of placenta previa. During discussion on mode of delivery, the woman should be informed that if vaginal birth is planned

A.    There is a 1 in 10 risk that she would require a forceps or ventouse delivery

B.    There is a 1 in 20 risk that she would suffer an anal sphincter injury                      

C.   There is at least a 5 in 10 risk that she would require a forceps or ventouse delivery

D.   There is a 1 – 2 in 100 risk that she would suffer an anal sphincter injury

E.    There is no significant difference in the risk of short-term urinary incontinence compared to planned caesarean section 

 

Question21

In women with one previous caesarean section, the risk of placenta previa in a subsequent pregnancy is

 

A.    0.1%

B.    1.0%                           

C.   3.5%

D.   5.5%

E.    7%

 

 

ANTENATAL CARE Posted by Anitha D.

1 D 2 A 3E 4 B 5C 6D 7B  8B 9A 10A 11C 12A 14B 15E 16A 17D 18D 19E 20E 21B

ANC Posted by rasheeda B.

1d  2a  3e  4b  5c  6d  7e  8b  9b  10a  11d  12d  14a  15e  16a  17b  18d  19e  20b  21b

 

Posted by shah M.
A Low molecular weight heparin from 8 weeks B Aspirin from 12 weeks
C Low molecular weight heparin and aspirin from 12 weeks D Low molecular weight heparin from 8 weeks + aspirin from 12 weeks
E Aspirin from 12 weeks + low molecular weight heparin from 28 weeks    

 

Explanation
Question 14 A 23 year old woman with sickle cell disease attends the antenatal clinic at 8 weeks gestation in her first pregnancy. She has a history of painful crises every 6 months, is up-to-date with all immunization and is taking prophylactic penicillin. She is also taking folic acid 5 mg daily. BP = 133/69, urine analysis is normal. She has a viable intra-uterine pregnancy on scan.
 

SCD comes in intermediate risk,so why the answer is D not E sir?

Posted by Farrukh G.
Explanation
Question 14 A 23 year old woman with sickle cell disease attends the antenatal clinic at 8 weeks gestation in her first pregnancy. She has a history of painful crises every 6 months, is up-to-date with all immunization and is taking prophylactic penicillin. She is also taking folic acid 5 mg daily. BP = 133/69, urine analysis is normal. She has a viable intra-uterine pregnancy on scan.
 

SCD comes in intermediate risk,so why the answer is D not E sir?

 

See notes / RCOG guidelines

 

Intermediate risk – consider antenatal prophylaxis with LMWH

  • Hospital admission
  • Single previous VTE related to major surgery
  • High-risk thrombophilia + no VTE (antithrombin deficiency, protein C or S deficiency, compound or homozygous for low-risk thrombophilia)
  • Medical comorbidities e.g. cancer, heart failure, active SLE, IBD or inflammatory polyarthro-pathy, nephrotic syndrome, type I DM with nephropathy, sickle cell disease, current IVDU
  • Any surgical procedure e.g. appendicectomy
  • OHSS (first trimester only)

 

IT DOES NOT SAY CONSIDER FROM 28 WEEKS - The scoring system in the RCOG guidelines is inaccurate.

ANSWERS Posted by PAUL A.

Answers

 

1)   C

2)   D

3)   E

4)   B

5)   C

6)   D

7)   E

8)   B

9)   B

10)                  A

11)                  D

12)                  D

13)                   

14)                  A

15)                  D

16)                  B

17)                  B

18)                  D

19)                  D

20)                  B

21) B

Doubts Posted by shah M.

Sir I have some very basic doubts,,,

1.In trial of VBAC ,if Ctg abnormlity  occurs ,should we go for FBS or straight to CS taking impending rupture as a possibility 

2.How to find out baseline foetal heart rate from Ctg tracing as single FHR need to b taken instead of a range?

3.how to assess the strength or amplitude of uterine contraction from Ctg trace ,to decide upon need for oxytocin?

4.For location of pregnancy,serum progesterone  used or not?

Thanks

Regards

Posted by PAUL A.
Doubts Posted by shah M.
Tue Nov 17, 2015 09:43 am

Sir I have some very basic doubts,,,

1.In trial of VBAC ,if Ctg abnormlity  occurs ,should we go for FBS or straight to CS taking impending rupture as a possibility 

2.How to find out baseline foetal heart rate from Ctg tracing as single FHR need to b taken instead of a range?

3.how to assess the strength or amplitude of uterine contraction from Ctg trace ,to decide upon need for oxytocin?

4.For location of pregnancy,serum progesterone  used or not?

Thanks

Regards

Please start a new discussion for new issues.

1.In trial of VBAC ,if Ctg abnormlity  occurs ,should we go for FBS or straight to CS taking impending rupture as a possibility 

 

Depends on nature of abnormality and presence / absence of other features - this has to be based on clinical judgement.

 

2.How to find out baseline foetal heart rate from Ctg tracing as single FHR need to b taken instead of a range?

 

You do not need a single FHR- you need to decide if it is above / below 100, 160, 180... It does not matter if it is 145 or 148.

 

 

3.how to assess the strength or amplitude of uterine contraction from Ctg trace ,to decide upon need for oxytocin?

 

You cannot assess strength of contractions from CTG and guidelines for oxytocin use do not require this assessment. You can only assess frequency from CTG and use clinical assessment to determine duration. This plus other clinical findings should inform your decision on use of oxytocin

 

4.For location of pregnancy,serum progesterone  used or not?

 

Can be used but you need to be aware of specificity / sensitivity. Ultrasound + HCG better

Posted by AMBREEN G.

FROM WHERE I GOT THE CORRECT ANSWER