EBCOG PART 1 – ANTENATAL CARE – DAY 1 (SBA)

1.Which of the following infective organism is likely to have the following characteristic and fetal sequelae: Unpasteurised milk, soft cheese; IUFD, neonatal sepsis, neonatal abscesses.

2.What is the incidence of this most serious complication if she waits for four or more weeks?

3.A 24-year-old woman presents in clinic at 12weeks gestation with monochorionic twins. Upon discussing  the risks associated with monochorionic twins, she asks you how common twin-to-twin transfusion syndrome  is. What is your answer?

4.Antepartum haemorrhage  (APH) is defined 

5.APH is a leading cause of perinatal and maternal mortality worldwide& complicates what % of pregnancies ?

6.26 year old is into her 10th week of pregnancy. This is her 4th pregnancy . Last 2 deliveries were complicated by abruption. she had to undergo Emergency cesarean section for same reason. Now she is asking about chances of recurrence in this pregnancy as well 

7.A 23-year-old P1 has undergone an induction of labour at 41 weeks + 6 days in her first pregnancy. The antenatal care was complicated with an admission to hospital with a small painful antepartum haemorrhage at 34 weeks of gestation. The symptoms settled spontaneously and all investigations and monitoring were normal; her blood group is AB Rh positive. Now she has come with bleeding started at home an hour back . Pulse 120bpm ,  blood pressure -90/50mm of Hg , per Abdomen -tense , tender  Fetal cardiac activity noted , Quantified blood loss till now is 500ml  How do you classify  severity of  haemorrhage ?

8.approximately what % of cases of placental abruption occur in low-risk pregnancies?

9.A 23-year-old P1 has undergone an induction of labour at 41 weeks + 6 days in her first pregnancy. The antenatal care was complicated with an admission to hospital with a small painful antepartum haemorrhage at 34 weeks of gestation. The symptoms settled spontaneously and all investigations and monitoring were normal; her blood group is AB Rh positive. Now she has come with bleeding started at home an hour back. ultrasound detection of retroplacental clot can happen in 

10.what percentage of pregnancies with abruption can have abnormal CTG?

11.A 23-year-old P1 has undergone an induction of labour at 41 weeks + 6 days in her first pregnancy. The antenatal care was complicated with an admission to hospital with a small painful antepartum haemorrhage at 34 weeks of gestation. The symptoms settled spontaneously and all investigations and monitoring were normal; her blood group is AB Rh positive. Now she has come with bleeding started at home an hour back . Pulse 120bpm ,  blood pressure -90/50mm of Hg ,  per Abdomen -tense , tender  Fetal cardiac activity noted ,

Ctg is as follows 

Quantified blood loss till now is 500ml  Per vaginal examination- cervix-soft ,2cm   dilated , bleeding ++membranes -present 

What’s your  definitive step in management ?

12.A 23-year-old P1 has undergone an induction of  labour at 41 weeks + 6 days in her first pregnancy. The antenatal care was complicated with an admission  to hospital with a small painful antepartum  haemorrhage at 34 weeks of gestation. The symptoms  settled spontaneously and all investigations and  monitoring were normal; her blood group is AB Rh  positive.Now she is here for induction of labour .

CTG is as follows 

Baby’s growth  is appropriate for gestational age .Regarding her monitoring of baby in labour 

13.A 23-year-old P1 has undergone an induction of labour at 41 weeks + 6 days in her first pregnancy. The antenatal care was complicated with an admission to hospital with a small painful antepartum haemorrhage at 34 weeks of gestation. The symptoms settled spontaneously and all investigations and monitoring were normal; her blood group is AB Rh negative . Now she has come with bleeding started at home an hour back . Pulse 120bpm ,  blood pressure -90/50mm of Hg , per Abdomen -tense , tender  Fetal cardiac activity noted , Quantified blood loss till now is 500ml  After her delivery ,   Baby is A Rh negative .  which statement regarding Anti -D is correct ?

14.Mrs.X, grand multiparous ,underwent emergency cesarean section category 1 for massive abruption ,she received massive blood transfusion,  for atonic postpartum Haemorrhage . what is the recommended dose of fresh frozen plasma to be administered to prevent coagulation problems?

15. You are asked to review a ms. Angle , 28-year-old primiparous woman who was brought by ambulance with heavy vaginal bleeding at 34 weeks of gestation. Her total blood loss has been estimated to be around 1.5 and an ultrasound scan reveals massive abruption with no fetal heart rate. Immediate blood transfusion has been started and you notice bleeding from the venepuncture site. Results of the coagulation test are not available. What other blood products should be started while awaiting the results of coagulation studies?

16.Mr &Mrs.adama were her in antenatal clinic,a5 32 weeks for placental location. As she has low lying placenta in early scan. Her USg image is enclosed. what your diagnosis ?

 17.prenatal diagnosis  of vas previa is most effective around

18.Acooridng to UK obstetric surveillance system of births antenatal detection of vasa previa was done in 

19.The routine screening of vas previa appears to be little benefit in attempting to identify cases of vasa praevia in the mid trimester scan .what percentage of  vasa praevia cases have one or more identifiable prenatal risk factors?

20. The image shown below is one of the risk factor for vasa previa which is seen in 

 21.Identify type 1vas previa in image below ?

22. The fetal mortality rate in undiagnosed vasa previa even with urgency cesarean section is

23.In prenatal diagnosed vasa previa, survival rate of baby is 

24.All of the following are risk factor aor vasa previa except 

25.Benckiser’s haemorrhage is 

26.What the total fetal blood volume at term?

27.Mrs. Rasheeda , 32 year old  IVF pregnancy is here for confirmation scan at 32weeks . As her anomaly scan showed low lying placenta .Now she has type 3 placenta previa . Which of the following labelled image indicates the same ?

28.For pregnancies greater than 16 weeks of gestation, the placenta should be reported as ‘low lying’ when the placental edge is 

29. The estimated incidence of placenta praevia at term is

30. Mrs, Ranjitha , 32 year old p1 previous cesarean delivery for fetal distress is here for routine anomaly scan .you see this in scan what would u advise her ?

31.Mrs, Ragini  , 32 year old p1 with  previous Normal Delivery is here for routine anomaly scan .you see singleton preganncy with  low lying placenta  in present scan and  you talk to her regarding placental migration .This happens in —-% cases before term.

32. Mrs, Rosy  , 32 year old p1  with monochorionic Twins with  previous Normal Delivery is here for routine anomaly scan .you see singleton pregnancy with  low lying placenta  in present scan and  you talk to her regarding placental migration .This happens in majority of cases by 

33.The risk of an emergent bleed associated with placenta praevia has been reported to be ———% by 37 weeks gestation. 

34.The risk of massive haemorrhage together with the possibility of needing a blood transfusion has been estimated to be approximately ——- times more likely in caesarean section for placenta praevia than in caesarean delivery for other indications

35.Mrs, Ranjitha , 32 year old p3 with three previous cesarean delivery .she  Had a follow up scan at 32 weeks which shows grade 4 placenta previa .Her chances of having accreta are

36.placenta accreta spectrum remains undiagnosed before delivery 

36.A 39-year-old primigravida presents with a history of painless bleeding at 31+6 weeks of gestation. This is the first episode of bleeding during this pregnancy. At home, the blood soaked through her clothes and ran down her legs then filled two sanitary towels. By the time she arrives at the hospital, the bleeding seems to be settling. On the 20 week scan the placenta was covering the os and she has another ultrasound appointment in four days’ time.

Maternal observations are:

pulse of 106 beats per minute

blood pressure 116/72 mmHg

respiratory rate 18 breaths per minute

temperature 36.7°C

saturations 100% on room air.

The cardiotocograph is reassuring.

What is the most appropriate management option for this woman?

38. With regards to SLE disease flare:
A Pregnancy decreases the likelihood of disease flare
B Flare is more likely to occur if there has been active disease more than 12 months prior to getting pregnant
C Flare is less likely to occur in the immediate postpartum period
D Kidney involvement (nephropathy) may manifest for the first time during pregnancy
E Prophylactic steroids given during pregnancy prevent the disease flare-up

39. The following haematological and laboratory findings are associated with disease activity in SLE during pregnancy:

A Megaloblastic anaemia
B Decreased erythrocyte sedimentation rate (ESR)
C Increased in complement levels
D Increase in C-reactive protein levels
E Thrombocythemia

40. The following antiepileptic drugs and anomalies are correctly matched:
A Sodium valproate – cleft palate
B Carbamazepine – neural tube defect
C Phenytoin – neural tube defect
D Lamotrigine – isolated cleft palate
E Phenytoin – cardiac defects