Antenatal Care Extra Questions Batch C

1. A community midwife requests advice with regard to induction of labour for a woman who is currently 40 weeks gestation. She has had 2 previous vaginal deliveries at 38 and 39 weeks. The pregnancy has been uncomplicated. What would you advise?

A. To arrange induction as soon as possible
B. To arrange induction between 41–42 weeks and discuss membrane sweep
C. To arrange induction with amniotomy at 41 weeks
D. To continue expectant management even after 42 weeks with fetal surveillance until labour commences
E. To observe for 10 days and call again if the mother had not delivered

2. A gravida 2 Para 1, booked for low-risk midwifery care presents at 38 weeks with diminished fetal movements for 48 hours. The fetal heart rate was undetectable and sadly, intrauterine fetal death was confirmed with an ultrasound scan. The mother would prefer to go home and return 24 hours later for induction after arranging childcare for her other child. Her blood group is B RhD negative. What would you advise?

A. Advise 200mg of mifepristone and then allow to go home
B. Advise a Kleihauer test and administer anti-RhD gammaglobulin and allow to go home
C. Advise Kleihauer test to detect feto-maternal haemorrhage and allow to go home
D. Advise against going home
E. Allow her to go home

3. A British born primigravida with an uncomplicated pregnancy at 22 weeks gestation, needs to travel to sub-Saharan Africa for a family emergency and is expected to spend up to a month in Nigeria. She wishes to know about the risk of contracting malaria. What is her risk during a 1-month stay without chemoprophylaxis?

A. 1:5000
B. 1:2500
C. 1:500
D. 1:50
E. 1:20

4. A primigraavida is seen in the antenatal clinic. A routine mid trimester anomaly scan at 20 weeks reveals an anterior placenta covering the os. What is the most appropriate management?

A. Arrange a colour flow doppler scan
B. Arrange an MRI as soon as possible
C. Arrange a transvaginal scan immediately as itwill reclassify unto 60% of the cases
D. Reassure the mother and arrange a repeat scan for placental localisation at 36 weeks
E. Reassure the mother that there is no need for any further investigations as the placenta will migrate upward as the pregnancy progresses

5. A gravida 3 Para 2 is diagnosed with an anterior placenta reaching to the os at 20 weeks. She has had 2 previous caesarean sections. What further investigation would you arrange?

A. Colour flow Doppler scan at 32 weeks
B. MRI scan at 36 weeks
C. No further investigations
D. Transvaginal scan at 32 weeks
E. Ultrasound scan at 36 weeks for placental localisation

6. A 29-year-old primigravida with a low-risk pregnancy attends the obstetric assessment unit with generalised pruritus at 34 weeks. What is the most important investigation to establish a diagnosis of obstetric cholestasis?

A. Bile acids and liver function tests
B. Bile acids and liver function tests with pregnancy specific reference ranges
C. Coagulation status of the mother
D. Presenting symptoms of the mother
E. Ultrasound estimation of fetal weight

7. A multiparous woman is admitted to a delivery suite at 37 weeks gestation. She has been feeling unwell for the last 48 hours. She gives history of flu-like symptoms with cough, abdominal pain and watery vaginal discharge. Her temperature is 38, pulse 110per minute, Respiratory rate 24perminute. You have made a diagnosis of sepsis and antibiotics have been commenced after blood culture. Her serum lactate is 4 mmol/l. What would be recommended for immediate intravenous fluid resuscitation?

A. Colloid 500 ml
B. Crystalloid 1000 ml
C. Crystalloid 20ml/kg body weight
D. Crystalloid 40 ml/kg body weight
E. CVP line and fluid as required

8. A primigravida aged 37 is seen at booking. This is a pregnancy following assisted conception. Her BMI is 19 and the ultrasound scan has confirmed a singleton fetus appropriate for the period of gestation. What is the recommended investigation to identify fetus at risk of SGA age?

A. 2-weekly liquor volume and uterine artery Doppler from 26 weeks
B. 3-weekly serial ultrasound scan for growth and estimated fetal weight from 28 week onwards
C. Detailed anomaly scan to be performed by a fetal medicine specialist at 20 weeks to look for fetal echogenic bowel
D. Growth scans at 28 and 34 weeks
E. Uterine artery Doppler at 20–24 weeks

9. A 40-year-old primigravida is seen in the antenatal clinic with a twin pregnancy conceived through IVF. Gestation is 11+6 days and the ultrasound scan has confirmed DCDA twins appropriate for the gestation with normal nuchal thickening. What is the appropriate monitoring to detect growth discordance?

A. Growth scans at 28 and 34 weeks
B. Serial growth scans every 2 weeks from 20 weeks
C. Serial growth scans with fetal weight estimation every 2 weeks from 16 weeks
D. Serial growth scans with fetal weight estimation every 3–4 weeks from 20 weeks
E. Symphysio-fundal measurement

A 38-year-old gravida 3 Para 2 is admitted at 32 week gestation feeling unwell. She has been gradually becoming more anxious through the day with cough and chest pain, which was worse during inspiration. Observations are as follows:

Temperature 37.2 ∘C, Pulse 110 per minute, BP 98/60, RR 24 per minute and blood gases reveal mild respiratory alkalosis.
What is the most appropriate management plan?

A. Perform an urgent chest X-ray and electrocardiogram and commence the patient on therapeutic unfractionated heparin infusion
B. Perform an urgent chest X-ray and electrocardiogram and commence the patient on therapeutic low molecular weight heparin
C. Request a ventilation-perfusion scan to rule out pulmonary embolism
D. Request an urgent computed tomography pulmonary angiogram to rule out pulmonary embolism
E. Take blood cultures and start the patient on intravenous antibiotics

11. A 37-year-old primigravida weighing 102 kg (BMI 40 kg/m2) is seen in an antenatal clinic for booking. She conceived via assisted conception following a long period of subfertility. Ultrasound has confirmed a dichorionic diamniotic twin pregnancy of 11+5 days gestation. What is the best practice with regard to reducing maternal risk of

venous thromboembolism?

A. Advise compression stockings and mobilisation throughout pregnancy
B. Commence 75mg of Aspirin per day and advice good hydration and mobilisation
C. Consider and advise low molecular weight heparin – Enoxaparin 40mg per day throughout pregnancy
D. Consider and advise low molecular weight heparin – Enoxaparin 60mg per day throughout pregnancy
E. Consider and advise unfractionated heparin daily throughout pregnancy

12. You are seeing a patient at antenatal clinic at 16 weeks’ gestation to make a plan for her antenatal care. T e midwife wants to know if the woman has any major risk factors for an SGA fetus. Which of the following is a major risk factor for this?

Options

A. BMI of 19
B. Chronic hypertension
C. PAPP-A > 4 MoM on combined screening.
D. Preeclampsia in a previous pregnancy
E. Smoking 10 cigarettes per day.

13. You see a 34-year-old para 1 with a BMI of 29 in your antenatal clinic. She is at 10 weeks’ gestation with a confirmed intrauterine pregnancy and is taking folic acid 400 mcg daily. In her last pregnancy, 3 years ago, she developed preeclampsia at 37 weeks’ gestation. She was induced and spontaneously delivered a healthy female at 37+2 weighing 2990 g. She has no additional risk factors. <strong>Which of the following would be the best initial antenatal management plan?</strong>

A. Aspirin 75 mg from 18 weeks’ gestation until delivery, serial symphysis fundal height at each antenatal visit plotted on a customized growth chart, uterine artery Doppler at 20 to 24 weeks’ gestation and, if this is normal, scan for fetal size and UA Doppler in the third trimester
B. Aspirin 75 mg from 12 weeks’ gestation until delivery and serial symphysis fundal height at each antenatal visit plotted on a customized growth chart.
C. Aspirin 75 mg from 12 weeks’ gestation until delivery, serial symphysis fundal height at each antenatal visit plotted on a customized growth chart, serial ultrasound measurement of fetal size and assessment of fetal well-being with UA Doppler from 26 to 28 weeks’ gestation.
D. Aspirin 75 mg from 12 weeks’ gestation until delivery, serial symphysis fundal height at each antenatal visit plotted on a customized growth chart, uterine artery Doppler at 20 to 24 weeks’ gestation and, if this is normal, scan for fetal size and UA Doppler in third trimester.
E. Aspirin 75 mg from 12 weeks’ gestation until 34 weeks’ gestation and serial symphysis fundal height at each antenatal visit plotted on a customized growth chart.

14. A 35-year-old para 1 at 32 weeks’ gestation is being monitored for an SGA fetus, her midwife plotted symphysis fundal height on a customized growth chart suggested static growth. Her antenatal care has previously been uneventful other than a course of steroids at 26+3 weeks’ gestation during an admission for threatened preterm labour. Her first delivery was 3 years ago at 39 weeks with the delivery of a healthy male infant weighing 2950 g. She has had tuberculosis as a child living in India, but is otherwise fit and well. Ultrasound scan today reveals the fetal abdominal circumference to be around the 7th centile on a customized chart, with an UA pulsatility index greater than 2 standard deviations from the mean for gestational age. End diastolic flow is present.

What would be the best initial follow-up plan for her?

A. Course of antenatal steroids, daily UA Doppler and weekly abdominal circumference or estimated fetal weight
B. Course of antenatal steroids, twice weekly UA Doppler and weekly abdominal circumference or estimated fetal weight
C. Course of antenatal steroids, twice weekly C G, weekly UA Doppler and weekly abdominal circumference or estimated fetal weight.
D. twice weekly C G, weekly UA Doppler and weekly abdominal circumference or estimated fetal weight.
E. twice weekly UA Doppler with once weekly abdominal circumference or estimated fetal weight.

15. A 25-year-old para 0 with a twin pregnancy has just had a 24-week ultrasound scan at the antenatal clinic. T e report shows twin 1 with a DVP of liquor measuring 1.4 cm and twin 2 with a DVP of 10.8 cm. Her 12-week scan report says ‘ sign clearly seen’. What is the most likely diagnosis?

A. Chromosomal abnormality twin 1.
B. Cytomegalovirus
C. Discordant fetal growth
D. win reversed arterial perfusion
E. win-to-twin transfusion syndrome.

16. A 28-year-old para 1 (SVD 3 years ago) who is RhD negative is found to have an anti-D level of 6 IU/ml at a routine 28-week red cell antibody screen. T e father is homozygous RhD positive. She is o ered weekly ultrasound scans to detect fetal anaemia. What would be the indication for referral to fetal medicine centre for consideration of intrauterine transfusion?

Options

A. Ductus venosus Doppler resistance index greater than 1.5 multiples of the median or other signs of fetal anaemia
B. Middle cerebral artery Doppler peak systolic velocities greater than 1.5 multiples of the median or other signs of fetal anaemia
C. Middle cerebral artery Doppler pulsatility index greater than 1.5 multiples of the median or other signs of fetal anaemia.
D. Umbilical artery Doppler peak systolic velocities greater than 1.5 multiples of the median or other signs of fetal anaemia.
E. Umbilical artery Doppler pulsatility index greater than 1.5 multiples of the median or other signs of fetal anaemia

17. A 19-year-old para 0 is found to have anti-K antibodies at a titre of 8 IU/ml a er her 28-week routine antibody screen. She thinks the baby was conceived while on holiday abroad and has no contact with the father. What is the next step in her management?

Options

A. Amniocentesis.
B. Cordocentesis.
C. Free fetal DNA.
D. Repeat antibody titre in 2 weeks
E. Repeat antibody titre in 4 weeks.

18. A 41-year-old para 2 has multiple fetal anomalies found at a routine 20-week anomaly ultrasound scan. An amniocentesis is performed and trisomy 13 is diagnosed. A er counselling, she opts for medical termination of pregnancy, which is performed at 21+3 weeks’ gestation. She is found to be Rh negative. A Kleihauer test con rms a fetal maternal haemorrhage of 4 ml. What total dose of anti-D immunoglobulin is required?

Options

A. 250 IU.
B. 500 IU.
C. 625 IU.
D. 750 IU.
E. 1000 IU.

19. A 31-year-old para 1 homeless heroin misuser with unknown dates books late and is found to be at approximately 28 weeks’ gestation on ultrasound. She is also found to be Rh negative and receives routine antenatal anti-D immunoglobulin (Ig) prophylaxis of 500 IU, with a plan for a further 500 IU at approximately 34 weeks’ gestation. One week a er her initial anti-D Ig injection, now at around 30 weeks’ gestation, she has an episode of a small amount of postcoital spotting. T e cervix is healthy and closed, and the placenta is not low.

What is the best management with regards to anti-D?

Options

A. Anti-D Ig 500 IU now, Kleihauer test, no further routine antenatal anti-D prophylaxis
B. Anti-D Ig 500 IU now, Kleihauer test, then routine 500 IU at 34 weeks as planned
C. Anti-D Ig 500 IU now, Kleihauer test, then anti-D 500 IU at 35 weeks’ gestation.
D. Kleihauer test now. If fetal maternal haemorrhage less than 4 ml, no anti-D now but routine anti-D Ig at 34 weeks’ gestation
E. Kleihauer test now. If fetal maternal haemorrhage less than 8 ml, no anti-D now but routine anti-D Ig at 34 weeks.

20. A 32-year-old para 0 is seen for antenatal booking at 10 weeks’ gestation. She is a keen outdoor activity enthusiast and asks you about a list of activities she is thinking of doing on her holidays while pregnant.
Which of her planned activities is it most important to strongly advise her against?

A. Mountain biking.
B. Open-water swimming.
C. Scuba diving.
D. Skiing.
E. Snorkelling.

21. A 39-year-old para 0 who is 12+2 by last menstrual period attends for dating scan. She is keen to have screening for aneuploidy. T e CRL is found to be 89 mm. What would be the best management with regard to dating the pregnancy and screening for Down syndrome?

A. Date the pregnancy using biparietal diameter and arrange quadruple test for Down syndrome screening.
B. Date the pregnancy using CRL, measure the nuchal translucency and use the combined test to screen for Down, Edward’s and Patau’s syndromes.
C. Date the pregnancy using head circumference and arrange quadruple test for Down syndrome screening
D. Date the pregnancy using head circumference, measure nuchal translucency and use the combined test to screen for Down, Edward’s and Patau’s syndromes
E. Date the pregnancy using head circumference, o er amniocentesis to screen for Down, Edward’s and Patau’s syndromes.

22. A 32-year-old para 0 undergoes IVF outside the UK and has a trichorionic triamniotic triplet pregnancy. She is concerned about how she will cope with her pregnancy towards her due date and asks the latest she is likely to be delivered by. When should women with trichorionic triamniotic triplets be o ered elective delivery, in the absence of prior complications or labour?

A. From 32+0 weeks’ gestation, after a course of antenatal corticosteroids.
B. From 35+0 weeks’ gestation.
C. From 35+0 weeks’ gestation, after a course of antenatal corticosteroids
D. From 36+0 weeks’ gestation, after a course of antenatal corticosteroids.
E. From 36+0 weeks’ gestation.

23. You are asked to update a guideline for your unit on antenatal and postnatal care of women suffering from domestic violence. Approximately what percentage of women receiving antenatal or postnatal care in the UK reports a history of domestic violence?

A. 5%.
B. 8%.
C. 20%
D. 35%.
E. 40%.

24. A 29-year-old primigravida is found to be breech at a 36-week midwife antenatal clinic. This is confirmed on ultrasound scan. She declines ECV and you book a planned caesarean section for 39 weeks’ gestation. What are the chances of the baby spontaneously turning to cephalic?

A. 5%.
B. 8%.
C. 10%.
D. 12%.
E. 15%.

25. You see a couple for preconceptual counselling. They are both fit and well with no medical history. The woman’s father (now deceased) had haemophilia A. What are the chances of the couple having a child affected by haemophilia A?

A. 12.5%.
B. 25%.
C. 50%.
D. 75%.
E. 100%.

26. A 29-year-old para 0 at 36+0 weeks’ gestation is referred by a community midwife with a BP of 148/97 mm Hg and 2+ proteinuria at a routine antenatal check. On arrival at hospital her BP is 146/95 mm Hg and repeat is 149/93. The protein : creatinine ratio (PCR) is 37 mg/mmol, but renal function, full blood count, transaminases and bilirubin are normal. T e C G is also normal. What would be the best initial management plan?

A. Admit, BP four times per day, ultrasound fetal size, liquor volume and UA Doppler.
B. Admit, BP four times per day, ultrasound fetal size, liquor volume and UA Doppler and commence antihypertensive treatment
C. Admit, BP four times per day, ultrasound fetal size, liquor volume and UA Doppler and commence course of antenatal steroids.
D. Admit, BP four times per day, ultrasound fetal size, liquor volume and UA Doppler, daily repeat blood tests and urine PCR.
E. Ultrasound fetal size, liquor volume and UA Doppler, allow home to return in 2 days for C G and repeat blood tests, BP and urine PCR.

27. You are asked to update your unit guidelines on antenatal aspirin. Which of the following patients should have aspirin 75 mg daily from 12 weeks’ gestation?

A. 23-year-old primigravida with a BMI of 36 at booking.
B. 32-year-old para 1 whose mother developed preeclampsia at 27 weeks’ gestation.
C. 34-year-old para 1 with a BMI of 34 at booking who developed gestational diabetes in her previous pregnancy
D. 39-year-old para 1 (previous unexplained stillbirth at 36 weeks’ gestation).
E. 39-year-old para 1 (who delivered an SGA baby at 35 weeks, 12 years ago).

28. A 25-year-old primigravida develops severe preeclampsia at 27 weeks’ gestation and is delivered by emergency caesarean section. She is concerned about her future pregnancies. What is the chance of her developing preeclampsia in her next pregnancy?

A. 16%.
B. 25%.
C. 30%.
D. 40%.
E. 55%.

29. A 32-year-old nulliparous woman attends for preconception counselling. She had a laparoscopic gastric band procedure 3 months ago. What is the minimum amount of time pregnancy should be delayed after bariatric surgery?

A. 6 months.
B. 9 months.
C. 12 months.
D. 18 months
E. 24 months

30. A 32-year-old primigravida at 33+6 weeks’ gestation has been under close surveillance a er a diagnosis of an SGA fetus. She attends for ultrasound in the morning clinic. Fetal abdominal circumference remains less than the 10th centile, DVP of liquor measures 1.2 cm and the UA Doppler shows reversed end diastolic ow. T e C G is normal. A course of antenatal corticosteroids was completed 2 days ago. She had a large breakfast 4 hours ago. T e labour ward is busy, an elective caesarean section has just been commenced, but you have access to open an emergency second operating theatre. She is keen for a vaginal delivery. What would be the best management plan you would advise for her?

A. Commence induction on the antenatal ward.
B. Commence induction on the labour ward under close surveillance
C. Deliver by caesarean section today.
D. Deliver by category 1 caesarean section
E. Repeat ultrasound and umbilical Doppler twice weekly, aiming to deliver at 37 weeks.

32. A primigravida at 20 weeks’ gestation attends obstetric triage feeling short of breath. She has a monochorionic diamniotic twin pregnancy. She has not attended for antenatal care since her dating scan at 14 weeks’ gestation where chorionicity was confirmed, after which she separated from her partner. Chest examination is unremarkable, but her SFH is 32 cm. An ultrasound scan is performed, revealing that both twins are alive. win 1 has polyhydramnios with a DVP of liquor measuring 9.5 cm and bladder visible. win 2 has oligohydramnios with a DVP of liquor measuring 0.5 cm. Despite an hour of scanning, it is not possible to identify a bladder in twin 2. Both twins have end diastolic ow present on UA Doppler. A diagnosis of suspect twin–twin transfusion syndrome is made. What Quintero stage would this be classified as?

A. I.
B. II.
C. III
D. IV.
E. V.

32. A 28-year-old primigravida with monochorionic diamniotic twin comes for her regular ultrasound and antenatal clinic appointment at 24 weeks. win 2 has no fetal heart present and Spalding’s sign is present. win 1 has a fundal height with normal size, liquor volume, UA Doppler and a visible bladder with plenty of fetal movement. An ultrasound 2 weeks ago had been normal. Her BP is normal and there is no proteinuria. After a single fetal death in a monochorionic diamniotic twin pregnancy, what is the overall rate of survival for the co-twin?

A. 68%.
B. 72%.
C. 88%.
D. 93%.
E. 97%.

Antenatal Care Extra Questions Batch C

Antenatal Care Extra Questions Batch C

Quiz Summary

Information

Results

Results

Categories

1. Question

2. Question

3. Question

4. Question

5. Question

6. Question

7. Question

8. Question

9. Question

10. Question

11. Question

12. Question

13. Question

14. Question

15. Question

16. Question

17. Question

18. Question

19. Question

20. Question

21. Question

22. Question

23. Question

24. Question

25. Question

26. Question

27. Question

28. Question

29. Question

30. Question

31. Question

32. Question