EBCOG PART 1 – ANTENATAL CARE – DAY 1

A.Offer Magnesium sulphate infusion
B.Admission at 34 weeks, offer steroid and Cesarean at 36weeks if asymptomatic
C.offer steroids
D.Admission at 36 weeks for elective Cesarean if asymptomatic
E.Incision type doesn’t affect outcome of baby
F.Do a vaginal examination.
G.Admission at 32 weeks, offer course of steroids and deliver at 34-36 weeks if asymptomatic
H.Novasure endometrial ablation
I.Verticals skin incision and or curvilinear uterine incision
J.consultant led care unit
K.Pfannesteil skin and curvilinear uterine incision
L.Wait and watch
M.vertical skin and or vertical uterine incision.
N.category 1cesarean section .

Each of the following   Options describes various woman presenting with Antepartum Haemorrhage  For each patient select the single most appropriate  management option  from the list 

1.A 24year old woman immigrant of Asian origin ,in her second pregnancy. first delivery by cesarean section.This pregnancy she is diagnosed to have grade 2 placenta Previa , planned for elective CS at 37 weeks as she was asymptomatic . Now she is 35weeks 2days .presented with spotting.

2. A 32 year old woman ,  presented with heavy bleeding . She is now 27 weeks pregnant with transverse lie  , she was resuscitated with 6units of packed  red blood cells and 4units of FFP.she is immediately shifted to OT, what is the best surgical approach

3. A 30 year old  primigravida, conceived by IVF,  anomaly scan shows vessel running between placenta and succenturiate   lobe ,Best plan for her delivery .

4. A 35-year-old para 2 has been admitted for post-dates induction of labour at 41+4 weeks of gestation. Her first baby was a normal vaginal delivery and her second baby was born by elective caesarean section for breech presentation. On the initial examination, the cervix was 2 cm dilated and the vertex at spines –1. On artificial rupture of the membranes the liquor was clear. An oxytocin infusion was commenced and an epidural sited. Three hours later she complains of sudden severe constant pain. The previously reassuring cardiotocograph shows atypical decelerations with slow recovery; then there is difficulty picking up the fetal heartbeat. On vaginal examination the cervix is 5 cm dilated, the vertex is not in the pelvis and the liquor is blood stained with clots.

A.28-30 weeks
B.30-32 weeks
C.32-34 weeks
D.34-36 weeks
E.30 weeks
F.32 weeks
G.34 weeks 
H.36 weeks 
I.Normal delivery at 32 weeks
J.Cesarean delivery at 32 weeks
K.Normal delivery at 34-36 weeks
L.Cesarean delivery at 34-36 weeks.
M.None of the above

Mrs, suzi, primigravida conceived by ART technique ,is here at 26 weeks of gestation. , She got delayed for an anomaly scan as she was on vacation.  Her anomaly scan was done at 26 weeks and the image is shown as below .

While counselling she asks  following questions .please choose the options from above list , each option can be chosen once, more than once or none at all.

5. When she has to be admitted to hospital

6.when she has to receive a prophylactic dose of steroid as she is at risk of preterm delivery ?

7. If she remains asymptomatic , when she can deliver