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Options for Questions 1-1

A Revise EDD

Fetal movement chart

Fetal umbilical artery Doppler

D Reassure

Daily day assessment unit visits

Maternal thrombophilia screen

G Biophysical profile

H Amniocentesis for karyotype

Immediate induction of labour

K Fetal growth scans every 2-4 weeks L

Maternal glucose tolerance test

Induction of labour at term

Instrunctions:For each of the case histories described below, choose the single most
appropriate management from the above list of options. Each option may be used
once, more than once, or not at all.
Explanation
A healthy 35 year old primigravida is referred to the antenatal
clinic because the fetus is thought to be small for dates at 34
weeks gestation. She had a dating scan at 9 weeks and a
Question 1
normal anomaly scan at 22 weeks. Ultrasound scan shows
abdominal and head circumferences below the third centile
with normal amniotic fluid volume.

Options for Questions 2-2


Discuss benefits of vaginal breech
delivery

A Offer external cephalic version

Maternal MRI pelvimetry

D Breech extraction

Review at 36-37 weeks gestation

Ultrasound scan for estimated fetal


weight

H Stabilising induction of labour

Caesarean section at 39 weeks

Ultrasound scan for placental site

Detailed anomaly scan to exclude


congenital anomalies

Admit for assessment

Caesarean section at 37-38 weeks

Instrunctions:For each of the case histories described below, choose the single most
appropriate management from the above list of options. Each option may be used
once, more than once, or not at all.
Explanation
Question 2 A healthy 23 year old primigravida attends for a routine
antenatal clinic visit at 34 weeks gestation, Her pregnancy has
been uncomplicated but the fetus is identified to be in a breech

presentation.

Options for Questions 3-3


Discuss benefits of vaginal breech
delivery

A Offer external cephalic version

Maternal MRI pelvimetry

D Breech extraction

Review at 36-37 weeks gestation

Ultrasound scan for estimated fetal


weight

H Stabilising induction of labour

Caesarean section at 39 weeks

Ultrasound scan for placental site

Detailed anomaly scan to exclude


congenital anomalies

Admit for assessment

Caesarean section at 37-38 weeks

Instrunctions:For each of the case histories described below, choose the single most
appropriate management from the above list of options. Each option may be used
once, more than once, or not at all.
Explanation
A healthy 37 year old primigravida is referred to the antenatal
clinic at 37 weeks gestation because of a breech presentation.
Question 3
The placenta is fundal and the uterine size is appropriate for
gestation age.

Options for Questions 4-4


A

Can be delivered in a midwifery-led


B
unit

Can have a home birth

Should deliver in a consultant-led


unit

Should have venous access in the


second stage of labour

Should have an anaesthetist at ST3


level or above available

Should have an obstetrician at ST3


level or above available

Consultant obstetrician should be


immediately available

Consultant anaesthetist should be


immediately available

Should have an anaesthetist at ST6


level or above available

Should be delivered in a tertiary


centre

Should have venous access in the


third stage of labour

Should have blood cross-matched


during labour

Instrunctions:For each scenario described below, choose the single most appropriate
plan for labour from the above list of options. Each option may be used once, more
than once, or not at all.
Explanation
A 35 year old woman has attended the consultant antenatal
clinic at 36 weeks gestation to discuss her birth plan. Her BMI
Question 4
was 42 at booking and 45 at 36 weeks. Her pregnancy is
otherwise uncomplicated

Options for Questions 5-5


Prophylactic antibiotics if vaginal
operative delivery

A Prophylactic antibiotics in labour

Venous access early in labour

D Blood grouped & saved in labour

Blood cross-matched in labour

Active management of the third


stage of labour

Fetal monitoring using scalp


electrode

Venous access in the second stage


of labour

Venous access in the third stage of


labour

Prophylactic oxytocin infusion after


delivery of the placenta

Prophylactic rectal misoprostol


after delivery of the placenta

Prophylactic low molecular weight


heparin in labour

Instrunctions:For each scenario described below, choose the single most appropriate
intervention from the above list of options. Each option may be used once, more than
once, or not at all.
Explanation
A 30 year old primigravida presents in spontaneous labour at
38 weeks gestation. Her BMI was 43 at 37 weeks gestation
Question 5
and her pregnancy has been uncomplicated. Her cervix is fully
effaced and 2cm dilated.

Options for Questions 6-6


A Thrombophilia screen

Stop heparin

Stop warfarin

D Advise against pregnancy

Convert warfarin to low molecular


weight heparin

Convert low molecular weight


heparin to warfarin

Screen for
antiphospholipidantibodies

Close observation for additional


risk factors

Graduated elastic compression


stockings

Low molecular weight heparin as


soon as possible

Low molecular weight heparin


from 12 weeks

Warfarin as soon as possible

Instrunctions:For each scenario described below, choose the single most appropriate
antenatal management from the above list of options. Each option may be used once,
more than once, or not at all.
Explanation
A 37 year old woman attends the antenatal clinic at 12 weeks
Question 6 gestation in her first pregnancy. She is wheelchair bound
because of spina bifida and her BMI is 42

Options for Questions 7-7


A Thrombophilia screen

Stop heparin

Offer termination of pregnancy

Low molecular weight heparin for 7


days post-partum

Low molecular weight heparin for 6


F
weeks post-partum

Close observation for additional


G
risk factors

Screen for antiphospholipid


antibodies

Close observation for additional


H risk factors + low molecular weight
heparin for 7 days post-partum

Close observation for additional


risk factors + low molecular weight J
heparin for 6 weeks post-partum

Graduated elastic compression


stockings

Low molecular weight heparin


antenatally + 6 weeks post-partum

Low molecular weight heparin


antenatally + 7 days post-partum

M Warfarin from 12 weeks


Instrunctions:For each scenario described below, choose the single most appropriate
management from the above list of options. Each option may be used once, more than
once, or not at all.
Explanation
A 32 year old woman attends the antenatal clinic at 20 weeks
gestation. She is known to be a carrier of the factor V Leiden
Question 7
mutation but has never had a thromboembolic event. Her BMI
is 29

Options for Questions 8-8

A Offer termination of pregnancy

Prophylactic dose low molecular


weight heparin

High (12 hourly) prophylactic dose


low molecular weight heparin

Screen for antiphospholipid


antibodies

Thrombophilia screen

Close observation for additional


risk factors

Graduated elastic compression


stockings

Prophylactic dose low molecular


weight heparin if admitted

Therapeutic dose low molecular


weight heparin if admitted

High prophylactic dose low


molecular weight heparin if
admitted

Therapeutic dose low molecular


weight heparin

K Warfarin from 12 weeks gestation


M

Prophylactic dose low molecular


weight heparin + low dose aspirin

Instrunctions:For each scenario described below, choose the single most appropriate
antenatal management from the above list of options. Each option may be used once,
more than once, or not at all.
Explanation
A 33 year old woman attends the antenatal clinic at 12 weeks
gestation. She is known to be a carrier of the Factor V Leiden
Question 8
mutation and suffered a pulmonary embolus 3 weeks after
caesarean section in her last pregnancy

Options for Questions 9-10


A

Low molecular weight heparin for


3-5 days

Low molecular weight heparin for 6


Low molecular weight heparin for 3
D
weeks
months

Graduated compression stockings

G Unfractionated heparin

Low molecular weight heparin for 7


days

Low dose aspirin

Lower prophylactic dose of


enoxaparin

Lower peophylactic dose of


tinzaparin

High prophylactic dose of


enoxaparin

High prophylactic dose of


tinzaparin

Therapeutic dose of tinzaparin

M Therapeutic dose of enoxaparin

Low molecular weight heparin for 7


days 6 weeks

Instrunctions:For each scenario described below, choose the single most appropriate
antenatal management from the above list of options. Each option may be used once,
more than once, or not at all.
Explanation
A 23 year old woman has a grade III caesarean section for
Question 9 breech presentation in labour. Her BMI is 25 and the operation
has been uncomplicated with an estimated blood loss of 750ml
Question
10

A 38 year old woman has a normal vaginal delivery following


a 10 hour labour. Her BMI is 39.