FCPS OBG Part 2 Written – Antenatal Care

1. A 35-year-old para 2 has been admitted for post-dates induction of labour at 41+4 weeks of gestation. Her first baby was a normal vaginal delivery and her second baby was born by elective caesarean section for breech presentation. The cervix was 2 cm dilated and the vertex at spines –1. On artificial rupture of the membranes the liquor was clear. An oxytocin infusion was commenced and an epidural sited. Two hours later she complains of sudden severe constant pain. The previously reassuring cardiotocograph shows atypical decelerations ; then there is difficulty picking up the fetal heartbeat. On vaginal examination the cervix is 5 cm dilated, the vertex is not in the pelvis and the liquor is blood stained with clots What is the best next management step?

2. A 35-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 . Her pulse is 106/minute, BP 116/72 mm hg CTG is reassuring. What is the most appropriate management option for this woman ?

3. You are asked to review a 28-year-old primiparous woman who was brought by ambulance with heavy vaginal bleeding at 32 weeks of gestation. Her total blood loss has been estimated to be around 2 litres 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?

4. A 37-year-old primiparous woman presented with small antepartum haemorrhage and tightenings at 34+3 weeks of gestation. Ultrasound examination at 32 weeks of gestation showed a low-lying placenta. CTG trace is reassuring. Tocograph shows regular uterine activity. What would be the next step in her management?

5. A 29-year-old G2P1 with a booking BMI of 35 had a placental abruption and an emergency caesarean section at 37 weeks of gestation in her previous pregnancy. She is currently on low dose aspirin 75 mg in the current pregnancy. The previous fetal weight at birth was 1814 g at 37 weeks. You are about to see her following a 20 week anomaly scan in antenatal clinic. What is the most appropriate antenatal care in her current pregnancy?