Early Pregnancy Extra Questions Batch B – MCQ

1. A 25-year-old woman is referred to the clinic. She has a pituitary macroprolactinoma and has been treated with bromocriptine for a year. Her prolactin levels have been normal for the past six months. She is now 11 weeks pregnant and was advised to continue this medication. She is worried about any risks if she continues this medication while pregnant. What will you tell her?

2. A woman attends her first ultrasound scan in pregnancy. What is the maximum crown rump length (CRL) that is accurate for dating before you measure gestational age by head circumference (HC)

3. At what gestational age is chorionic villus sampling (CVS) usually performed?

4. A woman is currently being treated for acne with oral retinoids and finds herself pregnant in the first trimester. What is her chance of miscarrying?

5. A 30-year-old woman visits her GP at 8 weeks gestation in her second pregnancy with mild symptoms of nausea and vomiting of pregnancy (NVP). She had severe NVP in her first pregnancy requiring hospital admission and is concerned that her symptoms will worsen. What is the most appropriate advice from her GP?

6. What percentage of pregnant women with hyperemesis gravidarum in early pregnancy experience transient hyperthyroidism?

7. A woman has undergone surgical management of miscarriage and a partial molar pregnancy has been confirmed. Referral to a specialist centre is advised. Where are the three specialist referral centres in the United Kingdom?

8. A woman has undergone surgical management of miscarriage and the histology confirms Gestational Trophoblastic Disease (GTD). What is the expected incidence of GTD in the United Kingdom?

9. A woman has been diagnosed with high-risk gestational trophoblastic neoplasia (GTN) and is about to receive multiagent chemotherapy. What is the expected cure rate?

10. A woman has attended the gynaecology clinic to discuss a diagnosis of a molar pregnancy. What is the definitive method of diagnosis?

11. A woman underwent medical management of miscarriage but no specimen was sent for histological analysis. What would be the advice to the patient following this procedure?

12. During a routine surgical evacuation of miscarriage when should oxytocic agents be used?

13. A woman has had surgical management of miscarriage and a molar pregnancy has been confirmed. Which immunohistochemistry marker is useful for distinguishing between partial and complete molar pregnancies?

15. A woman has had surgical management of miscarriage and a molar pregnancy has been confirmed. Which immunohistochemistry marker is useful for distinguishing between partial and complete molar pregnancies?

15. A woman has had an ultrasound scan and the possibility of a molar pregnancy with a co-existing twin has been raised by the sonographer. The woman has been referred to a regional fetal medicine centre for further investigations. What would be the most appropriate investigation?

16. A 25-year-old woman attends the Early Pregnancy Unit with vomiting and bleeding. An ultrasound scan is performed, which is strongly suggestive of a molar pregnancy. What is the optimal method of uterine evacuation?

17. A woman has had an ultrasound scan and the possibility of a molar pregnancy with a co-existing twin has been raised by the sonographer. The woman has been referred to a regional fetal medicine centre for further investigations. What would be the most appropriate investigation?

18. A 30-year-old woman attends the preconception counselling clinic. She has completed follow-up with the regional trophoblastic screening centre following a partial molar pregnancy. She is keen to try and conceive again, but wishes to know the risk of a further molar pregnancy. What would you tell her the risk is?

19. A woman attends the early pregnancy unit having experienced her second successive miscarriage. She has been researching miscarriage on the internet and has read that most miscarriages are due to genetic problems. What percentage of first-trimester miscarriages are due to chromosomal abnormalities?

20. What is the age-related risk of miscarriage in women under 20 years of age?

21. A woman attends the miscarriage clinic having experienced her third consecutive first-trimester loss. Which investigations should be undertaken?

22. Which B vitamin has been shown to be effective in the reduction of nausea and vomiting of pregnancy (NVP)?

23. A 30-year-old woman attends the early pregnancy unit with a positive pregnancy test and some lower abdominal pain. Her last menstrual period was approximately 8 weeks ago, but her menstrual cycle is irregular. A transvaginal ultrasound scan is organised, which demonstrates an intrauterine gestation sac with fetal pole and yolk sac, but no fetal heartbeat is identified. The crown-rump length (CRL) is 6mm. What is the correct course of action?

24. A woman who has had a left salpingectomy previously for ectopic pregnancy has now been diagnosed with an ectopic pregnancy in the right fallopian tube. A laparoscopy is performed and the surgeon opts for a salpingotomy as the woman still wishes to become pregnant. What is the possibility that she will require further treatment (methotrexate or salpingectomy)

25. A woman attends the early pregnancy unit and has a confirmed diagnosis of miscarriage. She is fit and well, and all observations are normal. What is the recommended first line management?

26. A woman who has blood group A Rh negative undergoes a laparoscopic salpingectomy for a ruptured ectopic pregnancy. What anti-D rhesus prophylaxis is required?

27. A woman underwent a surgical evacuation of the uterus following a failed intrauterine pregnancy. The products of conception were sent for histological analysis and a diagnosis of complete molar pregnancy was made. The woman was referred to the regional trophoblastic disease centre for follow-up, and subsequently required treatment with single-agent chemotherapy. She returns to clinic after completion of treatment as she wishes to conceive again. How long should she wait?

28. A woman attends for her first trimester dating scan at 12 weeks gestation and all appears well. Both fetal heart and fetal movements are seen. What is the chance that she will miscarry before 24 weeks of gestation?

29. What investigation is indicated for women following a second-trimester miscarriage, which is not indicated in recurrent first-trimester loss?

30. A healthy 30-year-old woman with recurrent first-trimester miscarriage attends the clinic for investigation and all tests recommended in the RCOG guideline are reported as normal. The woman is a member of an internet support group for miscarriage and has heard from other members that there may be other adjunctive treatments that can be used. What treatment would you recommend?