Antenatal care NICE guidelines

1. All of the following women are at high risk of vitamin D deficiency and need daily vitamin D supplementation except

A. African -Caribbean origin
B. Saudi Arabia origin
C. European white skinned women
D. Indian origin
E. Obese women

2. All are true regarding antenatal care of low risk woman except

A. Women, their partners and their families should always be treated with kindness, respect and dignity
B. For sickle cell diseases and thalassaemia should be offered to all women as early as possible in pregnancy (ideally by 10 weeks)
C. At 34weeks appointment, options for management of prolonged pregnancy should be discussed with woman
D. Woman who is nulliparous with an uncomplicated pregnancy, a schedule of 10 appointments should be adequate
E. For a woman who is parous with an uncomplicated pregnancy, a schedule of 7 appointments should be adequate

3. Regarding gestational age assessment of pregnancy

A. New Pregnant women should be offered an early ultrasound scan between 11 weeks 0 days and 13 weeks 6 days to determine gestational age and to detect multiple pregnancies
B. This will ensure consistency of gestational age assessment and increase the incidence of induction of labour for prolonged pregnancy
C. Crown–rump length measurement should be not used to determine gestational age
D. If the crown–rump length is above 84 mm, the gestational age should be estimated using head circumference
E. All women need not be offered early scan

4. Regarding antenatal care in women all are true except

A. The majority of women can be reassured that it is safe to continue working during pregnancy.
B. The recommended dose is 5mg of folic acid per day to reduce neural tube defects in low risk woman
C. Iron supplementation should not be offered routinely to all pregnant women
D. Pregnant women should be informed that vitamin A supplementation (intake above 700 micrograms) might be teratogenic and should therefore be avoided.
E. Pregnant women should be informed to avoid liver and liver products may also contain high levels of vitamin A.

5. All are true regarding information on how to reduce the risk of listeriosis in pregnancy except

A. Drinking only pasteurised or UHT milk
B. Can eat ripened soft cheese such as Camembert, Brie and blue-veined cheese
C. Can eat hard cheeses, such as Cheddar, or cottage cheese and processed cheese
D. Not eating pâté (of any sort, including vegetable)
E. Not eating uncooked or undercooked ready-prepared meals.

6. 24 year old African Caribbean origin Tina, scuba diving trainer by profession, is at 10weeks of gestation, she is here for her booking visit. All the following statements regarding her profession, effect on pregnancy are true except

A. She needs to start daily vitamin D supplementation
B. Need to prescribe 400mcg folic acid if she is not on it already
C. Continuing a moderate course of exercise during pregnancy is not associated with adverse outcomes
D. Can continue to train for scuba diving as it’s moderate exercise and it’s safe
E. Needs to provide Pregnancy book for her for further information.

7. All are true regarding alcohol and smoking advise during pregnancy except

A. Avoid drinking alcohol in the first 3 months of pregnancy if possible because it may be associated with an increased risk of miscarriage.
B. Binge drinking during pregnancy may be harmful to the unborn baby.
C. Consider visiting pregnant women who want to quit smoking at home if it is difficult for them to attend specialist service
D. Women using nicotine patches need not remove them before going to bed.
E. Woman should be informed about the specific risks of smoking during pregnancy such as the risk of having a baby with low birthweight and preterm birth

8. Regarding Clinical examination of pregnant women, all are true except

A. Maternal weight and height should be measured at the booking appointment, and the woman's body mass index should be calculated (weight [kg]/height[m]2).
B. Repeated weighing during pregnancy for all woman at each antenatal visit
C. Routine breast examination during antenatal care is not recommended for the promotion of postnatal breastfeeding.
D. Routine antenatal pelvic examination is not recommended.
E. In Female genital mutilation-Antenatal examination will allow planning of intrapartum care.

9. Regarding screening of anaemia in pregnancy all are true except

A. All Pregnant women should be offered screening for anaemia.
B. Screening should take place early in pregnancy (at the booking appointment) and at 28 weeks when other blood screening tests are being performed.
C. Screening In early pregnancy allows enough time for treatment if anaemia is detected.
D. Haemoglobin levels outside the normal UK range for pregnancy (that is, 11 .5 g/ 100 ml at first contact and 10g/100 ml at 28 weeks)
E. Anaemia should be investigated, and iron supplementation considered if indicated.

10. Regarding Screening for haemoglobinopathies all are false except

A. Sickle cell diseases and thalassaemia should be offered to all women as early as possible in pregnancy (ideally by 14 weeks).
B. If prevalence of sickle cell disease is high ,all pregnant women should be offered screening for haemoglobinopathies using the Family Origin Questionnaire.
C. Where prevalence of sickle cell disease is low , laboratory screening (preferably high-performance liquid chromatography) should be offered to all pregnant women to identify carrier
D. If the mean corpuscular haemoglobin is more than 27 picograms, laboratory screening (preferably high-performance liquid chromatography) should be offered.
E. If the woman is identified as a carrier of a clinically significant haemoglobinopathy then the father of the baby should be offered counselling and appropriate screening without delay.

11. Maria Dumba, 24 year old is here for booking visit. She is worried as at her place, 2 out of 1000 babies are affected with sickle cell disease. What is the best test you recommend for her?

A. If no risk factors identified in her history, no further tests required
B. High-performance liquid chromatography
C. Using Family Origin Questionnaire she can be recognized high or low risk
D. Mean corpuscular haemoglobin
E. Screen partner

12. All are true regarding screening of structural anomalies except

A. If meningomyelocele, detected during the anomaly scan women should be informed of the findings to enable them to make an informed choice of continuing pregnancy or termination
B. Fetal echocardiography involving the four-chamber view of the fetal heart and outflow tracts is recommended as part of the routine anomaly scan.
C. Detection rates vary by the type of fetal anomaly, the woman's body mass index and the position of the unborn baby at the time of the scan.
D. Anomaly scans are normally done between 18 weeks 0 days and 20 weeks 6 days.
E. Routine screening for cardiac anomalies using nuchal translucency is recommended.

13. All are true regarding booking appointment except

A. Ideally occur by 10weeks
B. BMI Needs to be calculated
C. Vaginal swab for Group B streptococcus needs to be taken.
D. It can take place at local surgery or at home by community midwife depending on accessibility
E. No routine iron supplementation

14. Nervous 42-year-old woman presents to your antenatal clinic. She is anxious that she is here for combined screening. She is now 11weeks pregnant and is very concerned about her age. What results needed for further referral for invasive testing

A. Increased. αFP, decreased PAPP-A, and decreased hCGand increased nuchal translucency
B. Decreased αFP, decreased PAPP-A, and decreased hCG and increased nuchal translucency
C. Decreased αFP, increased inhibin B, increased hCG and increased estriol
D. Decreased Unconjugated estriol, decraesed AFP, increased hCG and increased inhibin A
E. Increased hCG, decreased PAPP-A, and increased nuchal translucency

15. Leslie, 42 year old at 21 weeks of gestation, is here for anomaly scan. She missed her first trimester and second trimester down syndrome screening as she was not in UK and was on vacation. According to NICE what’s the cut off for nuchal fold thickness beyond which referral to fetal medicine specialist for further tests is required.

A. 3mm
B. 2.7mm
C. 5mm
D. 6mm
E. None of the above

16. Leslie, 42 year old at 21 weeks of gestation is here for anomaly scan. She missed her first trimester and second trimester down syndrome screening as she was not in UK and she was on vacation. When do you have to refer to fetal medicine for further testing?

A. Increased nuchal fold (6 millimetres or above)
B. Presence of echogenic bowel and echogenic foci in heart
C. Both A and B must be present
D. Either A or B needs prompt referral
E. Her age needs prompt referral for further testing.

17. 30-year-old Rebecca is pregnant with her second baby. She has had previous normal vaginal delivery with her midwife with no complications. She is seen at her booking visit with her midwife and has bloods taken for antenatal screening. Which of these is the most appropriate set of blood investigations for her?

A. Hepatitis C, HIV, syphilis and toxoplasmosis
B. Syphilis, hepatitis B and HIV
C. HIV, hepatitis c, rubella and group B streptococcus
D. Rubella, hepatitis B, HIVand syphilis
E. HIV, cytomegalovirus, rubella and hepatitis B

18. Reshma, 26 year old, Indian origin is here for her booking visit. She is into her second pregnancy, previous pregnancy complicated by macrosomia with gestational diabetes. Her BMI is 27kg/m2 . All are independent risk factors for development of gestational diabetes in her except

A. Indian origin
B. Overweight
C. Previous macrosomia
D. History of gestational diabetes
E. All above options are correct

19. 33 year old Rachel, is in her second pregnancy. This is an IVF pregnancy with twin gestation, her first baby is now 11 year old. She is here for booking visit. All are true regarding measurement of Blood pressure except

A. Remove tight clothing,
B. Ensure arm is relaxed and supported at heart level
C. Use cuff of appropriate size
D. Inflate cuff to 20–30 mmHg above palpated systolic blood pressure lower column slowly by 2 mmHg per second or per beat. Read blood pressure to the nearest 2 mmHg
E. Measure diastolic blood pressure as sound get muffled -phase IV

20. 36year-old, Katie, multiparous woman in her fourth pregnancy attends antenatal clinic at 42 weeks of gestation. This is low risk pregnancy. She had three previous normal vaginal deliveries, all of which were induced. This time she is adamant that she does not want induction of labour. But she is willing for membrane sweeping. What is the most appropriate form of monitoring for her?

A. Twice-weekly CTG and ultrasound estimation of maximum amniotic pool depth
B. Twice-weekly CTG and ultrasound estimation of amniotic fluid index
C. Daily assessment with CTG and umbilical artery Doppler
D. Daily CTG, umbilical artery Doppler and ultrasound estimation of maximum amniotic pool depth
E. Twice-weekly CTG and umbilical artery Doppler

Antenatal care NICE guidelines

Antenatal care NICE guidelines

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