EBCOG Part 1 – 2 Weeks Crash Course Early pregnancy, preconception care, Maternal Medicine Day 3

1.A 28 year old woman with a BMI of 25 kg/m²books into the antenatal clinic at 12 weeks.2 years ago she had a confirmed iliofemoral thrombosis in her left leg after major knee surgery.What will be your advise regarding thromboprophylaxis in this pregnancy & postpartum?

2.You see a 36 year old woman with a BMI of 38 kg/m² in your day assessment unit.She is 32 weeks into her 4^th ongoing pregnancy & describes sudden onset shortness of breath with no cough or chest pain.She does,however have right leg pain & swelling.Physical exam shows a pulse rate of 100 bpm,BP-110/70 mmHg,temp-37 ֯c & RR of 18/min.Chest auscultation is unremarkable.You suspect PE & start LMWH.What is your next most appropriate step?

3.A 24 year old woman with 12 weeks pregnancy presents with confirmed venous thromboembolism.Whatwould you advise her regarding her treatment?​

4.A 28 year old woman with a BMI of 25 kg/m² books into the antenatal clinic at 12 weeks.Two years previously she had a confirmed unprovoked iliofemoral thrombosis in her left leg.What will be your advise regarding thromboprophylaxis during this pregnancy & the postpartum period?

5. Mrs Anne is a primiwho is 30 weeks pregnant.Shepresents to A&E with acute onset of shortness of breath & chest pain.She has just travelled via a long haul flight(12 hr) to the UK.She has been commenced on therapeutic LMWH-dalteparin pending investigations to rule out a PE.Her booking weight is 66 kg & she currently weighs 76 kg.What is the correct dose of dalteparin she should receive?​

6.A 20 year old woman , a known epileptic, attends the antenatal clinic for preconceptual counselling. she has been seizure free for 2 years . Which of the following medications would you advise her against  because of the risk of congenital malformations ?

7.The ST1 in the department has joined newly & is doing his first duty in the labour suite.There is a primi who is a known epileptic in active labour.She is in considerable pain & is demanding something for pain relief.Which opiate should be avoided as analgesia in labour for pregnant women with epilepsy ?

8.A 26 year old woman with epilepsy has just given birth .Her seizures are well controlled with carbamazepine monotherapy .She wishes to have a discussion about postnatal contraception .Which hormonal methods of contraception Would be considered reliable in this situation ?

9.26 year old obese woman at 34 weeks pregnancy presented to triage with h/o waking up with headache that has been gradually worsening.The headache is associated with nausea,an episode of omiting,intermittent tingling in left arm & blurring of vision in left eye.She has a h/o headaches ,but they have not been so intense.
Findings are
BMI-40
BP- 130/80 mmHg
pulse-78 bpm
RR-13 /min
temp-37.2 C

10.A 25 years old obese woman who is 3 days postnatal is rushed into A & E following a seizure.She has a h/o gradual onset of headache for 2 days with phoptophobia.On exam she is unable to move the left side of her body ,has difficulty in speaking & slight disorientation.on exam-BMI -42 BP-140/90 mmHg,p-100,saturation-98% on air,temp-38.6C,chest –clear,CVS-normal heart sounds,CNS-left upper & lower limb decrease in power,weak reflexes & variable sensory loss.urine dipstick-blood+++ & leucocytes+.What is the most likely diagnosis?

11.A 36-year-old woman is seen in the booking clinic. She has a history of inflammatory bowel disease and is taking mesalazine 4 g/day and folic acid 5 mg/day. What is the main fetal risk if she continues this treatment?

12.A32-year-old woman G2P0+1 who suffers from inflammatory bowel disease (IBD) and which has been active, reports that she is pregnant. She is currently taking sulfasalazine therapy & is complaint with her medications. What is the likely course of the IBD in the pregnancy?

13.A 27-year-old woman in her 1st pregnancy who has been receiving treatment for inflammatory bowel disease (IBD) is now 36 weeks pregnant. Her IBD has been in remission since she was placed on 40 mg prednisolone daily before few months. What precaution must be taken when she goes into labour?

14.Sickle cell disease (SCD) is the most common inherited condition worldwide.The recommended daily dose of folic acid for pregnant women with sickle cell disease is

15.A 26 year old woman with SCD is admitted at 18 weeks with symptoms of chest pain,tachypnoea ,cough and shortness of breath .chest xray shows a new infiltrate throughout the lung fields .What is the most likely diagnosis ?

16.A 28 year old primi with SCD attends the preconceptional clinic for advise as she wishes to start her family.Her husbands hemoglobinopathy screen was HbAA.You have reviewed her vaccination history & noted she had hemophilus influenza type b,conjugated meningococcal C vaccine,pneumococcal vaccine & HepB vaccines previously(5 yrs ago)& influenza vaccine 8 mths ago.Which one of the vaccines would you recommend her to have preconceptually?

17.A 25 year old woman with transfusion dependent beta thalassemia has been trying to conceive & undergoing ovulation induction?Which one of the statements is true with regards to young women with beta thalassemia major?

18.A 27 year old Asian woman in her first pregnancy is known to have thalassemia major.She is 28 weeks pregnant.She comes to the emergency department with shortness of breath that has rapidly deteriorated.Despite resuscitation,she died within 20 minutes.What is the most likely cause of death?

19.A 23 year old woman with Beta Thalasemia major attends the antenatal clinic at 8 weeks of gestation.Cardiac function tests performed 12 weeks ago were normal.She has had a splenectomy.Her current blood test results are Hb-105g/L,Platelets-650x/L,Se.fructose-275 mmol/L.What antenatal thromboprophylaxis would be recommended ?

20.An 18 year old primi from West Africa is admitted at 30 weeks gestation with severe pain in her hips.A diagnosis of acute painful sickle cell crisis has been made.What is the most important immediate management?

21.A 28 year old woman with beta Thalasemia major is planning her pregnancy.Of the following preconceptional tests that should be offered ,which one need not be done routinely?

22.A 28 year old P1 with SLE presents for a growth scan at 28 weeks gestation.FetalHeart was 80-90 bpm & a fetalECHO confirmed  a 2nd degree congenital heart block.which one of the following autoantibodies is asso with CHB in women with SLE?​

23.A 26 year old woman consults you because she is contemplating a pregnancy.Shehas RA & is taking methotrexate.Youradvise regarding MTX & pregnancy is​

24.A couple attend for pre-pregnancy counselling owing to the woman’s medical history of systemic lupus erythematosus (SLE). She was diagnosed 5 years ago when she had been investigated for severe fatigue, skin rashes, cold fingers and achy joints. She is known to have SLE with high-titre antinuclear factor and double-stranded DNA-antibodies. Renal biopsy has shown stage 4 lupus nephritis. For the last 2 years, the woman has been in good health, taking prednisolone 7.5 mg, hydroxycholoroquine 200 mg, candesartan 32 mg, ferrous sulphate 200 mg and Adcal D3 one tablet daily.Which of her medications needs to be altered before or during pregnancy?

25.A 27-year-old woman was diagnosed with rheumatoid arthritis 6 months after the birth of her first child. She was started on sulfasalazine and has taken this for several years, with good control of her symptoms. However, she stopped the medication during her subsequent pregnancy and found that her hands and feet were not painful or stiff any more.What would be the best initial treatment for her if she experiences a postpartum flare of her rheumatoid symptoms (e.g. painful, swollen wrists and fingers), such that she is unable to care for her newborn child?