Antenatal Care Platinum Extra Questions

1. A 32-year-old woman is seen for preconception counselling. She has a history of breast cancer and has just completed a course of tamoxifen.
How long should she wait before she can try to conceive?

2. A 38-year-old woman is seen in antenatal clinic at 12 weeks of gestation. She has a body mass index (BMI) of 37 kg/m2 and does not regularly undertake exercise. What would the recommendation be with regard to starting exercise in pregnancy in order to control her weight?

3. A 27-year-old woman attends for her pregnancy dating scan. She is unsure of the date of her last menstrual period. The following fetal measurements are obtained:

Which of these measurements should be used to date the pregnancy?

4. A 42-year-old woman is seen in the booking clinic in her first pregnancy. She has a history of chronic hypertension and is taking methyldopa. She is white Caucasian with a BMI of 24 kg/m2.
What daily dose of vitamin D should be recommended for her throughout this pregnancy?

5. With regard to the routine anomaly scan in pregnancy, what threshold of nuchal-fold measurement should trigger a referral to a fetal medicine specialist?

6. In an uncomplicated pregnancy, how often should auscultation of the fetal heart be performed by the midwifery team?

7. A 37-year-old pregnant woman is seen in the clinic at 42 weeks of gestation. She declines an offer of induction of labour, wanting to keep things ‘as natural as possible’.
What management should be offered?

8. A 26-year-old woman is seen for her antenatal booking appointment. She was in a road traffic accident 10 years ago and has a spinal cord transection at the level of T11 and is paraplegic. What additional complication is she at risk of when compared with women with lower spinal cord injuries?

9. A woman is seen at 24 weeks of gestation in the joint obstetric and mental health clinic with a psychiatrist. She has been referred by the community midwife because of the woman’s concerns after watching her sister give birth. She recounts her sister having a very traumatic forceps delivery followed by a massive haemorrhage, describing ‘blood everywhere’. She is diagnosed with severe anxiety and post- traumatic stress disorder (PTSD). She is requesting an elective caesarean section.
What intervention would be most appropriate?

10. A 32-year-old woman is seen in the antenatal clinic. She is 16 weeks pregnant and is planning to go to Tanzania for a safari in 4 weeks. She enquires about malaria prophylaxis.
What would be the primary recommendation?

11. A woman with a monochorionic diamniotic (MCDA) twin pregnancy at 25 weeks of gestation has been diagnosed with severe twin-to-twin transfusion syndrome (TTTS) and has been referred to the regional centre.
What is the recommended first- line management, assuming no contraindications to any treatment?

12. A woman presents to the obstetric triage unit with reduced fetal movements at 27 weeks of gestation. She has a monochorionic twin pregnancy. A CTG is performed. It is normal in the presenting twin but shows a bradycardia in twin 2. Both twins have a cephalic presentation. Preparations are made for emergency delivery, but during this time in the antenatal ward, the fetal heart of twin 2 stops. An ultrasound examination confirms the absence of a fetal heartbeat in twin 2.
What is the most appropriate action?

13. A woman is referred from the antenatal clinic with reduced fetal movements at 29 weeks of gestation. Computerised CTG (cCTG) is normal with a short-term variation (STV) of 8 ms. Ultrasound shows an estimated fetal weight plotting below the 10th centile, with reversed end- diastolic flow in the umbilical artery. Middle cerebral artery (MCA) Doppler and ductus venosus Doppler are normal. She was given a course of steroids 2 weeks previously for a threatened preterm labour. What is the recommended management?

14. A 28-year-old woman in her first pregnancy is in the antenatal clinic at 12 weeks of gestation. She has a history of female genital mutilation (FGM). On examination, she has type 3 FGM, and the vaginal orifice admits one finger only. What would be the recommended management?

15. What is the most common adverse obstetric problem in a pregnancy complicated by unexplained antepartum haemorrhage?

16. Which obstetric complication has a significantly increased likelihood in women
who have undergone bariatric surgery?

17. What is the incidence of vasa praevia in women who have had successful in vitro fertilisation (IVF) treatment?

18. A woman at 36 weeks of gestation has prelabour rupture of membranes. She has a temperature of 40°C and is hypotensive with a systolic blood pressure of 5 mmHg. She has a diffuse macular rash and gives a history of vomiting and diarrhoea. Blood tests reveal a significantly raised creatinine level, and her bilirubin level is also raised.
What single additional feature would confirm a diagnosis of staphylococcal toxic shock?

19. A woman is seen in antenatal clinic at 39 weeks. It is her first pregnancy and she is concerned about continuing the pregnancy beyond her estimated date of delivery. She is asking about a membrane sweep.
When should a first membrane sweep be offered for this woman?

20. What is the earliest gestational age at which amniocentesis can be performed?

21. A 29-year-old woman at 33 weeks of gestation presents with a 24- hour history of symptoms suggestive of preterm prelabour rupture of membranes (PPROM).
Which initial test should be performed to confirm a diagnosis of PPROM?

22. A 33-year-old woman has just had her second normal vaginal delivery. She is a known group B Streptococcus (GBS) carrier, and received the loading dose
of benzylpenicillin 30 minutes prior to delivery. She is otherwise low risk obstetrically and the baby was born in good condition.
What initial management of the neonate would be recommended?

23. A 40-year-old woman in her first pregnancy attends antenatal clinic for advice at 10 weeks of gestation. She is fit and healthy and has no significant past medical history. She asks whether it is safe to drink alcohol in pregnancy. Her preferred drink is red wine.
What would be the recommended upper limit of amount of wine that she could drink in this pregnancy?

24. A new screening test is being assessed in a university antenatal clinic looking at the ability of a raised serum level of substance X to detect Down’s syndrome in women over 45 years of age. One hundred women are entered into the trial and 12 test positive for raised serum levels of substance X. Of these 12, eight are subsequently found to have babies with Down’s syndrome. From the 100 women, there are ten cases of Down’s syndrome in total.
What is the sensitivity of elevated substance X to detect Down’s syndrome in these women?

25. Which three classes of antihypertensive drugs appear to be associated with an increased risk of congenital malformations?

26. For any potentially sensitising event, rhesus D- negative, previously non- sensitised women should receive a minimum dose of 500 IU anti- D immunoglobulin (Ig) intramuscularly within 72 hours of the event, regardless of whether the woman has already received routine antenatal anti- D Ig prophylaxis at 28 weeks. Any additional dose of anti- D Ig needed is guided by a test of maternal blood for fetomaternal haemorrhage.
The dose calculation is based on which formula?

27. A 28-year-old woman in her second pregnancy has a booking blood test at 14 weeks of gestation that shows the presence of anti- K antibody at a titre of 1 in 16.
What is the most appropriate action?

28. What is the optimum method of screening for chromosomal abnormality in a monochorionic twin pregnancy at 13 weeks of gestation?

29. At her booking visit with a midwife, a 27-year-old woman is offered haemoglobinopathy screening using the Family Origin Questionnaire. She is deemed to be at low risk.
What value of mean corpuscular haemoglobin would trigger laboratory screening?

30. What is the primary reason that serological screening for hepatitis B is routinely offered to all pregnant women?

31. A high level of vitamin A intake in the first trimester of pregnancy may be harmful to the fetus and poses a risk of teratogenicity.
What is the recommended upper limit of daily intake of vitamin A in early pregnancy?

32. A 27-year-old multiparous woman had spontaneous rupture of membranes at 37 weeks of gestation. She is a carrier of group B Streptococcus (GBS) as detected on a vaginal swab in the second trimester.
What is the most appropriate management?

33. The rate of survival for babies born at the extremes of prematurity (between 22 and 26 weeks) has improved in recent years.
What is the current rate of overall survival for extreme preterm births?

34. Babies born preterm have a much higher risk of suffering from disabilities compared with those born at term.
What is the most common major long- term consequence of prematurity?

36. The risk of preterm birth is considerably higher in multiple pregnancies than in singleton pregnancies.
What proportion of twin births take place before 32 weeks of gestation?

36. A woman who is 36 weeks pregnant attends the maternity day assessment unit with decreased fetal movements. She has no other symptoms. The CTG and clinical observations are all normal. A dipstick test of a urine sample reveals 1+ proteinuria. The sample is sent for culture and sensitivity. The result is as follows:

What is the correct management?

37. From which gestational age is cell – free fetal DNA present in reliably measurable levels for aneuploidy screening?

38. A woman is found to have an adnexal cyst at her 20- week anomaly scan. What is the most common type of adnexal cystic lesion diagnosed at this gestation?

39. What proportion of terminations of pregnancy in the UK are carried out for fetal abnormality?

40. After adjusting for confounding factors, which obstetric factors are associated with partner abuse during pregnancy?