Maternal Medicine ( Platinum ) – SBA

1. 30 years old Primigravida at 34+ weeks presented with severe itching including the palms and soles and is worse at night. Her liver function tests were normal, and emollients did not give her relief. Your consultant starts her on ursodeoxycholic acid(UDCA) and antihistamines. All the statements are false regarding obstetric cholestasis (OC) except,

2. A 34 year-old woman is 16 weeks pregnant in her third pregnancy. Her blood pressure is 155/105 mmHg; 4 weeks earlier, it was 160/102 mmHg. Her urine dipstick shows + protein. Her spot urinary protein/creatinine ratio is 40mg/mmol. Which one of the following is considered the most likely diagnosis?

3. 40 year old primigravida has just identified that she is pregnant at 34 days of amenorrhoea. She is a known chronic hypertensive on captopril. What is the most appropriate management?

4. 31 year old P1L1 was delivered 6 weeks before at 28 weeks of gestation due to severe pre-eclampsia and HELLP syndrome. During her postnatal review, her BP is found to be normal and she was on anti-hypertensives for 2 weeks following delivery. She is very anxious that she may develop pre-eclampsia again in the subsequent pregnancy. What is the risk of recurrence of pre-eclampsia in her subsequent pregnancy?

5. 32 year old woman has presented with obstetric cholestasis at 35 weeks of gestation. She was put on menandiol sodium phosphate of 10 mg daily in view of prolonged prothrombin time. Which of the following complications is likely to happen to the neonate in this scenario?

6. A 35 year old woman with severe pre-eclampsia has had an emergency caesarean section at 32 weeks gestation because of severe IUGR. She became hypotensive and tachycardic and was returned to theatre where 2l of blood was evacuated from the abdomen and hysterectomy was performed. One week later, she developed sudden onset of severe chest pain and breathlessness and dies despite resuscitation. What is the diagnosis?

7. A healthy 23 year old woman has been referred to the antenatal clinic at 10 weeks gestation in her second pregnancy. Her first pregnancy was complicated by intra-uterine foetal death at 41 weeks gestation and she developed DVT after delivery. Following full investigation, she was found to have APAS. Her mother and sister both suffer from essential hypertension. Her BMI is 27 kg/m2 and her BP is 120/85 mmHg. Urine analysis showed no abnormalities. How will you manage the patient in this pregnancy?

8. A 27-year-old para 1 comes to your clinic requesting contraception. She mentions that her maternal aunt had deep vein thrombosis (DVT) and is on warfarin. She is worried that if she takes hormonal contraception, she will also develop DVT. Which of the following advice regarding DVT is incorrect?

9. Which of the following is the primary diagnostic test for DVT in pregnancy?

10. A woman with an uncomplicated pregnancy of 26 weeks gestation is about to go on a long haul flight to visit relatives in America, from India. She has a BMI of 37, is a smoker and she will be returning to the UK at 30 weeks gestation. Select the best advice regarding thromboembolism prevention in her case.

11. All of the following about LMWH are true compared to UFH except:

12. What is the risk of VTE in pregnancy after IVF with OHSS?

13. A 37-year-old para1 attends the delivery suite with periodic abdominal pain at 34 weeks’ gestation. She has diabetes and is on insulin. On examination there is a closed cervix and a positive fetal fibronectin test. What is the most appropriate management plan?

14. A 30-year-old lady who had a stillbirth in her previous pregnancy has been found to have undiagnosed diabetes. She is currently on oral hypoglycaemic agents, with good glycaemic control, and attends for pre-pregnancy counselling. What is the appropriate next step?

15. A 20-year-old woman books into the antenatal clinic at 10 weeks of gestation. She is fit and well but is noted to have an increased body mass index (BMI) but no other risk factors for diabetes. What BMI and above should be offered screening for diabetes?

16. A 36 -year-old Pakistani lady has delivered her fourth baby normally. She is a known Type 2 diabetic for 5 years and was taking Metformin and isophane insulin in pregnancy for glycaemic control. The woman is planning to breast feed.
What advice should be given with regard to a hypoglycaemic agent in the postnatal period?

17. Ms Lily is 37 weeks pregnant. She has been diagnosed with gestational diabetes, which is well controlled by diet alone. Her 36-week growth scan shows a normally grown foetus with normal liquor and Doppler. She was screened for GDM in view of her ethnicity alone. Her pregnancy has been uneventful so far. Up to when can Ms Lily be offered elective birth if she remains undelivered?

18. A 29-year-old woman is 24 weeks pregnant. She has long-standing type 1 diabetes mellitus. Her 20-week foetal anatomy ultrasound showed no structural foetal abnormalities. However, she is concerned about whether her diabetes may cause congenital foetal anomalies in her unborn child.
Of the options listed below, which SINGLE action addresses her anxiety?

19. A para 1 who delivered 2 week ago, was diagnosed to have GDM (diet controlled), and her plasma glucose levels have now returned to normal.What follow-up should she have postpartum?

20. A woman who is Rhesus-negative undergoes a laparoscopic salpingectomy for an ectopic pregnancy at eight weeks gestation. What dose of anti-D immunoglobulin should she receive immediately after the operation?

21. You are asked to review the blood results of a 32-year-old woman at 28 weeks gestation in her second pregnancy. Which one of the following antibodies has significant risk of causing fetal anaemia?

22. Which of the following is true regarding anti-D prophylaxis in pregnancy?

23. You are following up a 22-week pregnant woman in the antenatal clinic. Her epileptic fits are well controlled on medications. What is the most common cause of maternal death secondary to epilepsy?

24. Pregnant women with epilepsy have the highest risk of breakthrough seizures during:

25. 17 year old female has recently been diagnosed with epilepsy. She currently takes the oral contraceptive microgynon. Which of the following anti-epileptic medications is likely to make her contraception less effective?