Antenatal Care – SBA

1. A 24 primiparous patient with a spontaneous conception is seen in a booking antenatal clinic at 14 weeks gestation. Her BMI is 26 and she smokes 10 cigarettes a day. Her combined test gave a low risk for Down syndrome, however the PAPPA level was noted to be 0.3 MoM. What fetal growth surveillance would be most appropriate, according to the RCOG green Top Guideline No. 31 (Investigation and Management of the Small for Gestational Age Fetus)?

2. Mrs. Tina , Primigravida with 34 weeks in ANC clinic with partner for antenatal care . She makes very little eye contact, and on asking history ,partner answers most questions what is most appropriateNext step?

3. All the following are autosomal dominant diseases except

4. 42yr old primigravida with BMI of 27 conceived following Assisted reproduction, underwent SGA assessment of the fetus. The fetal growth was plotted on the graph and is given below

The uterine artery Doppler showed the following appearance.

The most appropriate management for her is.

5. A 30 year old G3P2L2 at 30 weeks was diagnosed to have a fetus with EFW which when plotted on the graph was <5th percentile. The umbilical artery Doppler revealed the following appearance.

The most appropriate management option for the woman is

6. This is a linked question to Q5. The woman in Q5 was further followed up and at 3 weeks showed the Doppler waveform as given below. What is the most appropriate action?

7. Mrs., rosy A 20 -year-old school teacher has come to see you in antenatal clinic. She is at 10 weeks of gestation in her first pregnancy. Her partner is known to have glucose 6-phosphatase deficiency. She is otherwise fit and healthy. She has been tested negative for the condition.
What is the risk of her child being a carrier for the same condition?

8. Mrs. X, a 30-year-old woman books in the antenatal clinic at 12 weeks of gestation with a BMI of 42.This is her first baby and she is normally fit and well with no significant family history.With regard to her BMI, which complication of pregnancy is the highest risk compared to women with a normal BMI?

9. Ms.X is 32weeks pregnant with uncomplicated triplet pregnancy. She is asking when she can be delivered.The recommended gestational age to offer delivery to an uncomplicated triplet pregnancy is:

10. Mr. and MRS. Alexander are here for preconceptional counselling.Both of them are carriers of most common mutation, ΔF508. They want to know chances of them having normal child

11. Mrs.X,28 years old woman who is 36 weeks pregnant in her second pregnancy comes to the labour ward because of upper abdominal pain and slight vaginal bleeding. Her first pregnancy ended in Caesarean section because of placental abruption. She has a normal blood pressure (BP) and a reactive non-stress test. What are her chances of having another placental abruption?

12. Ms. X, 28 years old woman had an open spina bifida lesion closed in the early neonatal period and subsequently she relies on a wheelchair for mobility and intermittent self-catheterisation. She is seeking your advice about the chance of her having a baby similarly affected by a neural tube defect.

13. Ms.Sweetie, 32 year old conceived by IVF pregnancy .She got dating scan done just now .You counselled her regarding twin to twin transfusion syndrome . MCDA twin pregnancy monitoring to detect TTTS starts at which week?

14. FGM Is traditional cultural practice in many African and Egyptian countries.
According to UK epidemiology, how, many girls aged under 15 years have undergone this as part of tradition?

15. Which of the  following country has highest Percentage of girls and women aged 15–49  who has undergone FGM?

16. FGM Is traditional cultural practice in many countries of the world.
Which of the  following country has least  Percentage of girls and women aged 15–49  who has undergone FGM?

17. The lower  urinary tract symptoms  are common in women with which type of FGM?

18. Keloid scarring has been reported in up to what %of women in women undergoing FGM ?

19. Document maternal history of FGM in the personal child health record prior to postnatal discharge. This personal child health record is called

20. All are true regarding FGM except

21. Which of the following statement is true regarding Defibulation

22. Ms.Halima . 17 year old presented with recurrent Urinary tract infection .on Sensitive  enquiry  she accepts that she has undergone FGM . On examination , only difference she has a Genital piercing .This type of FGM

23. Fibrinogen deficiency may be associated with bleeding, but quantitative and qualitative deficiency can also be associated with thrombosis and pregnancy loss. In the neonate, afibrinogenaemia has been associated with ICH and umbilical bleeding. Which of the following statements is false:

24.There is evidence of better overall obstetric outcome after bariatric surgery compared with women with class III obesity who are managed conservatively. Pregnancy can exacerbate nutritional deficiencies that predate pregnancy. Which of the following  is the commonest  vitamin deficiencies in women can occur post bariatric surgery:

25.  A woman presents for booking in the first trimester, she is taking lithium for her mental health.How often should her serum lithium levels be checked?

26. A woman has a brother affected by haemophilia A and comes to see you to discuss the implications of this as she is planning a pregnancy. During the discussion she asks what is the chance of her brother having a son who is a carrier?

27. 24 years old Primigravida at 30 weeks presented with continuous pain in abdomen with vaginal bleeding, around 250ml.She smokes 20 cigarettes per day.She has repeated episodes of spotting in this pregnancy. During examination she is quiet and scared.

On examination-

BMI is19kg/M2

Pulse -84Bpm

Bp-100/70mm of Hg

Bruises present over back and legs and, on her abdomen, as well

She has a black left eye

P/A- uterus, 30weeks, tense and hard

Cephalic presentation

Speculum examination – os-2cm dilated dark brownish bleeding +

What is the most important cause of abruption you suspect in this woman ?

28. When doing ultrasound for monochorionic twin gestation, there is discordance in amniotic volume. Bladder of twin 1 is not visible as well as reversed flow in ductus venous. Which Quintero staging of Twin to Twin transfusion syndrome is this ?

29. Leslie, 42 years old is at 21 weeks of gestation and 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 should be done?

30. Among those receiving gynaecological treatment, what is the reported incidence of domestic violence in the United Kingdom?

31. Clinical audit is a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change. There are five principal steps, commonly referred to as the audit cycle. What is the first step of audit ?

32. In all of the following women, Aspirin is started from 12 weeks of pregnancy till birth, except:

33. year old women G2P1L1 is referred by the GP to the antenatal clinic at 12 weeks of pregnancy with twin gestation. Her previous pregnancy was complicated by gestational hypertension . Her booking BP is 136/86, BMI is 33kg/m2. she is a smoker who smokes 12 cigarettes per day. Which of the following is considered as a significant (high) risk factor for the development of pre-eclampsia as her pregnancy progresses

34. What is the advisable minimum waiting period to conceive following bariatric surgery?

35. A 30-year-old woman with a previous history of caesarean section and multiple uterine fibroids had a repeat elective caesarean section due to breech presentation. She had massive postpartum haemorrhage (PPH) secondary to uterine atony with an estimated blood loss of 3 L. She is RhD-negative and had transfusion of the group specific packed red cells, reinfusion of the salvaged red cells from the cell saver and also fresh frozen plasma (FFP), cryoprecipitate and platelets. The cord blood group was confirmed as RhD-negative.

Anti-D prophylaxis should be administered in which one of the options, if she had the following blood products transfused?

36. 36 year old woman who was diagnosed to have pre-eclampsia at 39+ weeks but was not on antihypertensives. She delivered a male baby vaginally with no complications. Postnatally, on the D1, her blood pressure was 146/96 mm hg. She does not have any signs of blurring of vision, visual scotoma, vomiting , epigastric tenderness. What is you management for her blood pressure?

37. In which of the circumstances during the antihypertensive treatment do we give a volume expansion?

38. 35 year old woman who had severe pre-eclampsia and was delivered at 37 weeks due to symptoms of imminent eclampsia. The labour proceeded well with no complications. The postnatal bloodpressure was 152/104 mm of Hg. The best anti-hypertensive management is

39. The following are all major risk factors, for SGA except

40. All the following are autosomal dominant diseases except

41. Cryoprecipitate includes all except

42. Mrs. Tina, A 30-year-old woman attends the Antenatal Assessment Unit at 18 weeks of gestation .she presents with a few days’ history of flu-like symptoms. She gives of trip to Travel history She reveals that she returned to the UK last week from a two week trip to Caribbean island .

What is the most appropriate next step in her management?

43. Ms, X, A 30-year-old pregnant woman who is at 28 weeks of gestation presents to the Day Assessment Unit complaining of flu-like symptoms.fever with chills . She tells you that she recently went on holiday to Kenya.

What is the most appropriate test for the diagnosis of malaria?

44. Mrs.x presented to you in clinic at 8 weeks , as she is exposed to child who has developed rash similar to slapped cheek appearance . On follow up at 16 weeks shows Fetal Hydrops. Doppler indicates fetalanemia

45. Mrs. Sabina ,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

46. 17 year old woman from Eritrea has come to the Antenatal clinic at 24 weeks of gestation. She has migrated from her country to UK recently. On exploring sensitively, she said that she has undergone FGM . The most important action would be

47. 20 year old has presented to the labour room with complaints of reduced fetal movements at 39 weeks of gestation. She had a similar complaint a week back and after necessary investigations was reassured and sent home which is quite remote with difficulty in accessing health care. She is a smoker. Examination reveals an adequately grown fetus and CTG is reassuring. Ultrasound revealed appropriately grown fetus and adequate liquor with normal umbilical Doppler. What is the most appropriate action?

48. 36 year old woman Rh negative has presented to the labour room at 32 weeks with complaints of loss of fetal movements since two days. Ultrasound done revealed IUFD. All the statements regarding IUFD and Rh negative pregnancy are true except:

49. Bernard Soulier Syndrome is associated with significant risk of primary and secondary PPH, and wound haematoma. Which of the following statement is true?

50. DDAVP is a useful modality to manage many bleeding conditions and may be used by intravenous, subcutaneous or intranasal route. It is not helpful in all of the following conditions except: