Antenatal Care Extra Questions Batch C
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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?CorrectIncorrect
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?CorrectIncorrect
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?CorrectIncorrect
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?CorrectIncorrect
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?CorrectIncorrect
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?CorrectIncorrect
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?CorrectIncorrect
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?CorrectIncorrect
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?CorrectIncorrect
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?CorrectIncorrect
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
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?
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>CorrectIncorrect
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?CorrectIncorrect
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?CorrectIncorrect
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?
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?
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?
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?
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?CorrectIncorrect
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?CorrectIncorrect
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?CorrectIncorrect
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?CorrectIncorrect
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?CorrectIncorrect
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?CorrectIncorrect
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?CorrectIncorrect
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?CorrectIncorrect
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?CorrectIncorrect
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?CorrectIncorrect
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?CorrectIncorrect
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?CorrectIncorrect
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?CorrectIncorrect