Submitted by: Shabnam Naz
figure for memorization in exam
refrences gtg and nice guidelines
1. 24% of successful IVF procedures result in multiple pregnancies.
2. Multiple births currently account for 3% of live births.
3. Around one-third of twin pregnancies in the UK have a monochorionic placenta.
4. About 300 000 children with SCD are born each year;two-thirds of these births are in Africa.’In the UK, it is estimated that there are 12 000–15 000 affected individuals and over 300 infants born with SCD in the UK each year who are diagnosed as part of the neonatal screening programme.
5. Major congenital abnormalities are 4.9% more common in multiple pregnancies than in singleton pregnancies.
6. about 60%-70 % of twin pregnancies result in spontaneous birth before 37 weeks 0 days.
7. about 75% of triplet pregnancies result in spontaneous birth before 35 weeks 0 days.
8. 10% of twin births take place before 32 weeks of gestation.
9. TTTS complicates 10–15% of MC pregnancies;
10. TTTS accounts for about 20% of stillbirths in multiple pregnancies.
11. Rarely (in approximately 5% of cases), the transfusion may reverse during pregnancy, with the donor fetus demonstrating features of a recipient fetus and vice versa.
12. Intrauterine size discordance is significant when it is > 25% it occurs in 10% of monochorionic pregnancies.
13. Sensitivity and specificity of u/s for chorionicity
At < 14 weeks: 90%’ 99.5%
After 14 weeks 88%’ 94.7 %
14. 3% of MC placentas have two placental masses (bipartite), so these are not necessarily dichorionic.
15. The prospective risk of unexplained stillbirth after 32 weeks in MCDA twins is 1/23 (4.35%)
16. reported incidence of vasa previa varies between one in 2000 and one in 6000 pregnancies in IVF it is 1 in 300
17. Sensitivity and specificity of different ultrasound modalities in diagnosing placenta accreta are : grey scale 95%, 76%, Doppler 92%’ 68%’ three dimensional power Doppler 100%, 85%
18. 27% and 50% of women having SCD have a painful crisis during pregnancy and 7-20 % develop ACS
19. Diabetes in pregnancy affects 5% of women 87.5% have gastational diabetes which may or may not resolve after delivery.
7.5% have type I diabetes. 5% have type II Diabetes.
20>10% of all preterm births are due to hypertensive disorders.
21> 5% of all stillbirth are due to hypertensive disorders.
22> 20–25% of preterm births and 14–19% of term births in women with pre-eclampsia being less than the tenth centile of birth weight for gestation.
23> More than 70 000 babies are born with thalassaemia worldwide each year.
24> and there are 100 million individuals who are asymptomatic thalassaemia carriers.
25>Passage of meconium is more common in preterm obstetric cholestasis pregnancies than in term obstetric cholestasis pregnancies (25% compared with 12%)
26> caesarean section rates in obstetric cholestasis is 10-36%
27> Postpartum haemorrhage in obstetric cholestasis with rates of 2-22%is reported
28> The overall incidence of OASIS in the UK is 2.9% (range 0–8%), with an incidence of 6.1% in primiparae compared with 1.7% in multiparae.
28..Risk of anal sphincter injury in women undergoing VBAC is 5% and birthweight is the strongest predictor of this.
29>Published randomised controlled trials have reported residual EAS defects in 19–36% overall following repair.
30>The risk of sustaining a further third- or fourth-degree tear after a subsequent delivery is 5–7%.
31> Operative vaginal delivery rates have remained stable at between 10% and 13% in the UK.
31>>The rate of instrumental delivery in women undergoing VBAC is also increased up to 39%.
32>There is a wide variation in the reported incidence of shoulder dystocia between 0.58% and 0.70%.
33> the incidence of postpartum hemorrhage with shoulder dystocia (11%) And third and fourth degree tear 3.8%.
34> plexus injury (BPI) is one of the most important fetal complications of shoulder dystocia, complicating 2.3% to 16% of such deliveries. The majority resolve without permanent injury. Fewer than 10% result in permanent dysfunction.
35> rate of shoulder dystocia in women with prior history of shoulder dystocia is 10 times higher with reccurence rate of 1-25%.
36>Delivery of the posterior arm is associated with humeral fractures with a reported incidence between 2% and 12%
37>threatened miscarriage increases the risk of placental abruption from 1.0% to 1.4%
38>number of previous LSCS and risk of placenta previa
One previous caesarean section OR 2.2 ,Two previous caesarean sections OR 4.1 Three previous caesarean sections OR 22.4
39> The incidence of thrombotic complications in a review of 272 women with PPH who had received rFVIIa was reported to be 2.5%.
40> the chances of successful planned VBAC are 72–75%
41>up to 10% of women scheduled for ERCS go into labour before the 39th, also 10% of women scheduled for planned LSCS for breech presentation go into labour.
42>Maternal death from uterine rupture in planned VBAC occurs in 4/100,000 cases in the developed world; this estimate is based on information from case reports.
42>> with ERCS risk of maternal death is 13/100000.
43>planned VBAC compared with ERCS carries around 1% additional risk of either blood transfusion or endometritis.
44> planned VBAC is associated with a 10/10,000 (1/1000) 0.1% risk of antepartum stillbirth beyond 39 weeks of gestation and a 4/10,000 (0.4/1000)0.04% risk of delivery related perinatal death if conducted in a large centre,The risk of perinatal death arising from uterine rupture during VBAC was reported as 4.5% in a Dutch population study
44>> delivery related perinatal death with ERCS Is 1/10000(0.01%)
45> planned VBAC carries an 8/10,000 (0.8/1000)0.08%risk of the infant developing hypoxic ischaemic encephalopathy.
>cerebral palsy following term birth is rare (approximately 10/10,000) (1/1000)and only 10% of cases are thought to be related to intrapartum events.
46>baby will have respiratory problems after birth: rates are 2–3% with planned VBAC and 3–4% with ERCS.
46>>ERCS compared with planned VBAC increased the risks of respiratory distress syndrome (0.5% versus less than 0.05%).
47>elective LSCS increases respiratory morbidity 11.4%, 6.2% and 1.5% at 37, 38 and 39 weeks of gestation, respectively.
48> single course of corticosteroids reduces 50% of respiratory morbidity if given to women going for ELSCS prior to 39th weeks.
49> Women with placenta Previa risk of accreta increases with increasing number of previous
Caesarean sections as follows:1>3%. 2>11%. 3>40%. 4>61%. 5>67%
50>likelihood of successful trial of VBAC for pregnancies with infants weighing 4000 g or more is 55–67%.
51>An abnormal cardiotocograph (CTG) is the most consistent finding in uterine rupture and is present in 55–87% of these events.
52>prostaglandin induction compared with non-prostaglandin induction incurred a nonsignificantly higher risk of uterine rupture (140/10,000 versus 89/10,000.
53>prostaglandin induction compared with non-prostaglandin induction carries higher risk of perinatal death from uterine rupture 11.2/10,000 versus 4.5/10,000.
54>perinatal death in women with an unscarred uterus induced by prostaglandin is 6/10’000
55> risks of uterine rupture/10,000 planned VBAC deliveries are 102, 87 and 36/10,000 for induced, augmented and spontaneous labour groups.
56>rates of caesarean section in women undergoing planned VBAC are 33%, 26% and 19% for induced, augmented and spontaneous labour groups, respectively.
57>the risk of serious neonatal infection is 1%, rather than 0.5% for women with intact membranes
58>60% of women with prelabour rupture of the membranes will go into labour within 24 hours, and 90% by 48 hours.
59>In uncomplicated malaria, fatality rates are low: approximately 0.1% for P. falciparum. In severe malaria, particularly in pregnancy, fatality rates are high (15–20% in nonpregnant women compared with 50% in pregnancy).
60>The reported prevalence of congenital malaria varies from 8% to 33%
61>ranging from 2.2% to as high as 26%.9–14 The prevalence of PCOS when diagnosed by the Rotterdam criteria was over twice that found when
62>The prevalence of gestational diabetes mellitus is twice as high among women with PCOS compared to control women.
63>Insulin resistance is present in around 65–80% of women with PCOS, independent of obesity is and is further exacerbated by excess weight.
64>women with PCOS have a 2.89-fold (95% CI 1.52–5.48) increased risk for endometrial cancer.
65>The reported incidence of thrombosis with OHSS ranges between 0.7% and 10%
66>Approximately 5% of women experience severe premenstrual symptoms .
67>Up to 10% of women will have some form of surgery during their lifetime for the presence of an ovarian mass.
68>The overall incidence of a symptomatic ovarian cyst in a premenopausal female being malignant is approximately 1:1000 increasing to 3:1000 at the age of 50.
69>Although up to 20% of borderline ovarian tumours appear as simple cysts on ultrasonography the majority of such tumours will have suspicious ultrasonographic finding.
70>ca 125 is only raised in 50% of early stage disease.
71>RMI I sensitivity 78% specificity 87% in premenopausal women for RMI of 200
72>Using IOTA rules the reported sensitivity was 95%, specificity 91%, positive likelihood ratio of 10.37 and negative likelihood ratio of 0.06.
73>The recurrence rates after laparoscopic needle aspiration of simple cysts range from 53% to as high as 83%.
74>Chemical peritonitis due to spillage of dermoid cyst contents has been reported in different series to occur in less than 0.2% of cases
75>Serum CA125 is well established, being raised in over 80% of ovarian cancer cases
76> In post menopausal women if a cut-off of 30u/ml is used, the test has a sensitivity of 80% and specificity of 75%.
77> Ultrasound is also well established, achieving a sensitivity of 90% and specificity of 73% when using a morphology index.
78>Using a cut off point of RMI of 250 in post menopausal women and sensitivity of 70% and specificity of 90% can be achieved.
79> 12-17% percent of women undergoing excision of VIN have clinically unrecognised invasion diagnosed on histology.
80>Survival from cervical cancer is stage dependent, with an overall 5-year survival of approximately 60%. Other prognostic indicators are the tumour type, tumour bulk, age and performance status of the individual patient.
81>. Cure rates of exenteration in cervical cancer is 30–50% have been reported but the operation has a mortality of approximately 2–4%.
82>The need for chemotherapy following a complete mole is 15% and 0.5 % after a partial mole .
83>the development of postpartum GTN requiring chemotherapy occurs at a rate of 1/50 000
84>Antiphospholipid antibodies are present in 15% of women with recurrent miscarriage, prevalence of antiphospholipid antibodies in general population is < 2%.
85>In approximately 2–5% of couples with recurrent miscarriage, one of the partners carries a balanced structural chromosomal anomaly:most commonly a balanced reciprocal or Robertsonian translocation.
86>There are approximately 100–200 pregnancies in women with SCD per year in the UK;
87> risk of massive haemorrhage is approximately 12 times more likely with placenta praevia.
88>In general, maternal mortality associated with multiple births is 2.5 times that for singleton births.
89>Heritable thrombophilia is found in 20-50% of pregnancy-related VTE.
90>cross-reactivity rate to different heparin preparations is 33.3%”
91>Most cases of pharyngitis are viral, but approximately 10% of cases in adults are attributable to GAS.
92>primary VZV infection in pregnancy is uncommon; it is estimated to complicate 3 in every 1000 pregnancies.
93>The incidence of pneumonia complicating varicella in pregnancy has been quoted at 10-14%.
94>If maternal infection occurs 1–4 weeks before delivery, up to 50% of babies are infected and approximately 23% develop clinical varicella, despite high titres of passively acquired maternal antibody.
95> ECV carries 0.5% immediate emergency caesarean section rate and no excess perinatal morbidity and perinatal mortality.
96>the risk of serious neonatal infection is 1%, rather than 0.5% for women with intact membranes.
97>Complications following LSCS;
1. Postpartum haemarhage > 1000ml 4-8%.
2. Stress urinary incontinence 4%.
3. UTI, endometritis, wound infection 8%.
4. urinary tract injury 1/1000
98> risk of GTN developing after confirmed therapeutic termination, rate is estimated to be 1/20 000.
99>. There are approximately 100–200 pregnancies in women with SCD per year in the UK; pregnancy outcome in this group is currently being assessed by the UK Obstetric Surveillance System
100>. Alloimmunisation (the formation of antibodies to red cell antigens) is common in SCD, occurring in 18–36% of patients.
101. There are approximately 1000 individuals affected by thalassaemia major or intermedia syndromes in the UK.
102. Alloimmunity occurs in 16.5% of individuals with thalassaemia.
103. A study from one region of the UK reported that 1 in 20 (5%) women with severe pre-eclampsia or eclampsia were admitted to intensive care.
104. Breech presentation complicates 3–4% of all term deliveries
105.ECV may not be performed because breech is not diagnosed in about 25%
106.The likelihood of achieving a spontaneous vaginal delivery is approximately 80% even for women who have required more complex operative vaginal deliveries in theatre.
107. A customised EFW < 10th centile is predictive of a SGA neonate (sensitivity 68%, specificity 89%
108.One small study suggested that, in severely SGA fetuses, the rate of aneuploidy was 20% in fetuses presenting before 23 weeks of gestation, irrespective of the presence of structural anomalies, compared with 0% in fetuses presenting between 23–29 weeks of gestation.
109. Women should be reassured % of .pregnancies affected by single episode of RFM are unaffected.
110.women who have experienced a previous uterine rupture are reported to have a higher risk (5% or higher) of recurrent uterine rupture with labour. Hence previous uterine rupture is considered a contraindication to VBAC.
111 women with one, two, or three or more previous caesarean deliveries experience a 1%, 1.7% or 2.8% risk respectively of placenta praevia in subsequent pregnancies.
112. Placenta accreta occurs in 11–14% of women with placenta praevia and one prior caesarean delivery and in 23–40% of women with placenta praevia and two prior caesarean deliveries.
113. In women with placenta praevia and five or more prior caesarean deliveries, the incidence of placenta accreta is up to 67%.. .
114. observational studies, have shown similar rates of VBAC success with two previous caesarean births (VBAC success rates of 62–75%) and single prior caesarean birth(72-75%).
114. The rates of hysterectomy (56/10 000 0.5% compared with 19/10 000) 0.2% and transfusion (1.99% compared with 1.21%) were increased in women undergoing VBAC after two previous caesarean births compared with one previous caesarean birth.
115. The rates of hysterectomy (56/10 000 compared with 19/10 000) and transfusion (1.99% compared with 1.21%) were increased in women undergoing VBAC after two previous caesarean births compared with one previous caesarean birth.
116. Abnormal cardiotocography (CTG) is the most consistent finding in uterine rupture and is present in 66–76% of these events.
117. Most uterine ruptures (more than 90%) occur during labour (the peak incidence being at 4–5 cm cervical dilatation), with around 18% occurring in the second stage of labour and 8% being identified post vaginal delivery.
118. The risk of uterine rupture in an unscarred uterus is extremely rare at 2 per 10 000 (0.02%) and in ERCS the risk is 2 per 10 000 (0.02%) also.
119. It is important to note that scar dehiscence may be asymptomatic in up to 48% of women.
120.classic triad of a complete uterine rupture (pain, vaginal bleeding, fetal heart rate abnormalities) may present in less than 10% of cases.
121. In the NICHD study,18 prostaglandin induction compared with nonprostaglandin induction (e.g. amniotomy or intracervical Foley catheter) was associated with a higher uterine rupture risk (87 per 10 000 [0.87%] versus 29 per 10 000 [0.29%]) and a higher risk of perinatal death due to uterine rupture (11.2 per 10 000 [0.11%] versus 4.5 per 10 000
122. At least 80% of women tested will have VZV IgG and can be reassured.
123. The incidence of pneumonia complicating varicella in pregnancy has been quoted at 1014%.
124. Pooled data from nine cohort studies detected 13 cases of FVS following 1423 cases of maternal chickenpox occurring before 20 weeks of gestation: an incidence of 0.91%The risk appears to be lower in the first trimester (0.55%)
125. If maternal infection occurs 1–4 weeks before delivery, up to 50% of babies are infected and approximately 23% develop clinical varicella.
126. In uncomplicated malaria, fatality rates are low: approximately 0.1% for P. falciparum. In severe malaria, particularly in pregnancy, fatality rates are high (15–20% in nonpregnant women compared with 50% in pregnancy).
127. The reported prevalence of congenital malaria varies from 8% to 33%.
128. warfarin embryopathy (hypoplasia of nasal bridge, congenital heart defects, ventriculomegaly, agenesis of the corpus callosum, stippled epiphyses) in approximately 5% of fetuses exposed between 6 and 12 weeks of gestation.
129. The sensitivity of serial compression ultrasonography with Doppler imaging was 94.1% and the negative predictive value was 99.5%
130. lower risk of LMWH compared with unfractionated heparin for heparin-induced osteoporosis; the overall risk of this complication on systematic review was 0.04% (compared with 2% for unfractionated heparin) when used for treatment rather than prophylaxis.
131. cross-reactivity rate to different heparin preparations is 33.3% for delayed type hypersensitivit
132. warfarin is 99% bound to serum proteins which results in minimal transfer to breast milk.
133.The overall incidence of cord prolapse ranges from 0.1–0.6%.In the case of breech presentation, the incidence is higher at 1%.
133. In breech vaginal delivery with nonfrank presentations risk of cord prolapse is 5.6%.
134. Neonates born alive after cord prolapse are highly likely to require resuscitation, as evidenced by a high rate of low Apgar scores: 21% at 1 minute and 7% at 5 minutes.1
135. in presence of significant meconium baby should be kept in observation, Perform these observations at 1 and 2 hours of age and then 2-hourly until 12 hours of age.
136. If there has been non-significant meconium, observe the baby at 1 and 2 hours of age in all birth settings.
137. Closely observe any baby born to a woman with prelabour rupture of the membranes (more than 24 hours before the onset of established labour) at term for the first 12 hours of life (at 1 hour, 2 hours, 6 hours and 12 hours) in all settings.
138. Keloid scarring has been reported in up to 3% of women with FGM
139. As many as 33% of IVF cycles have been reported to be associated with mild forms of OHSS
140. More severe OHSS has been reported in 3.1–8.0% of IVF cycles.
141. Approximately 5% of women experience severe premenstrual symptoms
142. up to 20% of borderline ovarian tumours appear as simple cysts on ultrasonography the majority of such tumours will have suspicious ultrasonographic finding.
143. The recurrence rates after laparoscopic needle aspiration of simple cysts range from 53% to as high as 84%.
144. breast cancer affects almost 5000 women of reproductive age in the UK annually.
145. when breast cancer is diagnosed in women aged 30 years or less, 10–20% of cases may be associated with pregnancy or occur within 1 year postpartum.
146The prognosis of breast cancer is improving,with 5-year survival around 80% for the under 50s age group; however,the survival rate may be lower in very young women.
147. overall survival for ovarian cancer is 35%.
148. The overall 5-year survival for cervical cancer is approximately 60%
148. Overall 5 year survival of GTN is 93%.( stage I =97%’ stageII=86%,stageIII=83% stage IV=61%)
152.Fewer than 10% ofwomendiagnosedwith breast cancer subsequently become pregnant.
153.Amenorrhoeais reported in 20–70% of premenopausal womenwithbreastcancer,69 but the rate ranges from less than 5% in women under 30 years of age to 50% in women aged 36–40 years
154. is now well established that HPV is found in over 95% of cervical cancers.
155. The two most common high-risk HPV viruses for development of cervical cancer are HPV-16 and HPV-18, which account for approximately 70% of squamous cell cancers.
156. PHVP has been reported to follow 11.6% of hysterectomies performed for prolapse and 1.8% for other benign diseases.6 A large study from Austria estimated the frequency of PHVP requiring surgical repair to be between 6% and 8%.
157. After ASC At 24 months’ follow-up, the vaginal vault was well supported in 99.2%, with 89.2% showing stage 0 vaginal vault prolapse and 10% showing stage I prolapse that did not require revision surgery
158. A systematic review of observational studies reported long-term success rates of 78–100%.
159.Mesh erosion was observed in 2–11%, Serious complications such as bowel injury, sacral myelitis and severe bleeding have an estimated incidence of 2% (range 0–8%).
160. in SSF One concern is the high incidence (8–30%) of postoperative anterior compartment prolapse and SUI.
161. use of TVM in treatment of PHVP objective success rates of 87–95% with short-term follow-up (6–18 months). Mesh erosion occurred in 4.6–10.7% and reoperation rates were 0.4–6.0%.
162. Lichen sclerosus accounts for at least 25% of the women seen in dedicated vulval clinics, with estimates of incidence quoted as one in 300 to one in 1000 of all patients referred to dermatology departments.
163. On excision, 19–22% of cases of VIN have unrecognised invasion detected.
164. In case of VIN Rported risk of progression to cancer varies widely,but appears to be in the order of 40–60%.
165. Women treated surgically forVIN still have a residual risk of developing invasive cancer in the order of 4%.
166 In PID the positive predictive value of a clinical diagnosis is 65-90% compared to laparoscopic diagnosis.
167. The absence of endocervical or vaginal pus cells has a good negative predictive value (95%) for a diagnosis of PID but their presence is non-specific (poor positive predictive value – 17%
168. The fetal C, c, E, e and K genotype can also be detected using this method (with an accuracy of fetal RhC/c and RhE/e genotype estimations from maternal blood between 96–98%, which compares well with the reported accuracy of fetal RhD of > 95%).
169. MCA PSV monitoring is predictive of moderate or severe fetal anaemia with 100% sensitivity and a false positive rate of 12%.
170. The risk of fetal loss following an FBS is 1–3%, but is higher if the fetus is hydropic.
171. risk of Reccurence GDM is 24-84% especially if women required insulin during pregnancy
172.Karyotyping is important as about 6% of stillborn babies will have a chromosomal abnormality.
173. preclamsia affects 5-10% of pregnancies, sever Preclamsia affects 1-2% of pregnancies and Eclampsia occours in 1 in 2000 pregnancies 0.05%
174. Macrosomia occurs in 10-12% of Women with GDM.
175. Asymptomatic Bactriurea complicates 2-5% of pregnancies, if left untreated, 30-40% women develop pyelonephritis, PTL.
176. when iron deficiency is suspected, serum ferritin should be measured using cutoff of 30 ug/lit?
177. Overall 15% of women are RH negative.
178. In approximately 1.5% of women placenta will cover cervical ps at 20 week scan, but in only
0.14 % of women will have placenta Previa at delivery
179. ECV Complications: 5.7 % will develop transient CTG Abnormalties, persistent CTG
Abnormalties 0.3%, placental abruption 1/1000(0.1%)
180. women with SCD IN POSTPARTUM The risk of sickle cell crisis remains increased: in one study it occurred in 25% of women and was more common following general anaesthesia
181. Women having their first labour have 20% chance of emergency LSCS , so all women in antenatal period should be given information regarding LSCS as around 1 in 5 women will need caesarean delivery.
182. Women undergoing VBAC have 25% chance of me LSCS
183. Risk of VTE is 0.1 in ERSC
184. Creatinine value falls from 62 to 44 um/lit, while urea falls from 4.3 to 3.2 mm/lit as GFR increases as early as 6 weeks of pregnancy
185. risk of meconium passage increases linearly with a 19.7% increase for each 10 micromoles/litre increase in total bile acid concentration.
186. Transabdominal cerclage has incidence (3.4% versus 0%) of serious operative complications (bleeding requiring transfusion, injury to bladder/bowel/uterine artery, anaesthetic .
187. complications with cervical cerclage including bladder damage, cervical trauma, membrane rupture and bleeding are reported but are raresia problems)
188. The incidence of intra-amniotic infection in ultrasound-indicated cerclage is about 1–2%.
189. The rate of ectopic pregnancy is 11 per 1000 pregnancies, with a maternal mortality of 0.2 per 1000 estimated ectopic pregnancies
190. Inform women having a salpingotomy that up to 1 in 5 women may need further treatment.
This treatment may include methotrexate and/or a salpingectomy.
191. The mortality rate in vasa Previa is around 60% although significantly improved survival rates of up to 97% have been reported where the diagnosis is made antenatally.
192. TVS HAS sensitivity 88%’ specificity 98.8%, positive predictive value 93.3%, negative predictive value 97.6% and false negative rate 2.33%).for diagnosis of placenta Previa.
193. Sensitivity of MRI in diagnosis of placenta accreta is 80% and specificity is 65%.
194.As gestation advances vasa praevia can resolve in up to 15% of cases.
195. Incidence of velamentus cord insertion in general population is 1% and bi lobed placenta and succenturate lobe is 1.7%p
196. APH complicates 3-5% of pregnancies.
197. 20% of all preterm deliveries are in association with APH.
198. 70% cases of placental abruption occur in low risk pregnancies.
199. Obstetric haemorrhage remains a major cause of maternal mortality in the UK and is now the third leading cause of direct maternal deaths, accounting for approximately 10% of direct deaths.
200. antenatal use of iron, with or without folic acid, showed a 50% reduction in the risk of anaemia in the third trimester or at delivery.