Q) Incidence of cord prolapse in breech? It's 0.1-0.

6 overall
But 1% in breech
Q)GBS in a previous pregnancy, irrespective of carrier status
this pregnancy?
Explain to women that the likelihood of maternal GBS
carriage in this pregnancy is 50%. Discuss the options of
IAP, or bacteriological testing in late pregnancy and then
offer of IAP if still positive.
If performed, bacteriological testing should ideally be
carried out at 35–37 weeks of gestation or 3–5 weeks prior
to the anticipated delivery date, e.g. 32–34 weeks of
gestation for women with twins

Prev h/o of PPH carries a recurrence risk of about 20–25%.

Injury during c/s Bladder 0.1 %
Ureter 0.03 % Bowel 0.05 %
FIGURES GUIDELINES MRCOG EXAM

••Figures from past exams

••Figures from guidelines & Consent Advise
INCIDENCES/FIGURES:Sep.2015
1. UAE was done for a 30 yrs old woman. % of those
who will require re-intervention?
[25%](<40yr 25%,40-50yr 10%).
2. Abroutpio recurrence %
[4.4% after one time ,19-25% after 2 previous
abruptions]
3. OASI incidence
•The overall incidence in the UK is 2.9% (range 0–8%),
•Incidence is 6.1% in primiparae , •1.7% in multiparae.
•The reported rate of OASIS (in singleton, term,
cephalic, vaginal first births) in England is 5.9%
4. Risk of miscarriage after 3 consecutive miscarriages is
[40%].
•RM affects 1% of couples
trying to conceive.
•APL antibodies are present in 15% of women with RM.
•The prevalence of APL antibodies in women with a low-
risk obstetric history is less than
2%.
• In women with RM a/w APL antibodies, the LB rate in
pregnancies with no pharmacological
intervention is 10%.
•Aspirin plus unfractionated heparin compared with
aspirin alone significantly reduces the miscarriage
rate by 54% .
Age related risk of miscarriage
12–19 years, 13%;
20–24 years, 11%;
25–29 years, 12%;
30–34 years, 15%;
35–39 years,25%;
40–44 years,51%;
and ≥45 years,93%.
•Advanced paternal age has also been identified as a
risk factor for miscarriage.The risk of miscarriage
is highest among couples where the woman is ≥35
years of age and the man ≥40 years of age.
•In 2–5% of couples with recurrent miscarriage, one of
the partners carries a balanced structural
chromosomal anomaly.
•In couples with RM, chromosomal abnormalities of the
embryo account for 30–57% of further
miscarriages.
•Prevalence of uterine anomalies in RM range between
1.8% and 37.6%.
•Translocation carriers have a higher (50–70%) chance
of a healthy LB in future untreated pregnancies
following natural conception than is currently achieved
after PGD/IVF (approximately 30%).
•In unexplained RM prognosis for a successful future
pregnancy with supportive care alone is in the
region of 75%.
5. What range is coded as very rare
•[<1/10,000]
6. In what percent of polyhydramnios no cause can be
found? (unexplained)
[ 50-60%,……].
•Incidence of PHA varies between 0.2 and 3.9%.
7. Risk of recurrence of shoulder dystocia above
population in a woman with P/H of Sh.dystocia.
[In folds: 10]
8. % of Ureteric injuries that can be identified during
laparoscopy (intra-operatively):
[1:3] one third.(half for bladder).
9. Incidence of post dural tab/puncture; or duration of
puncture headache?
[?0.5-2.5%, 7-10d]
•Postdural puncture headache:
- Puncture of the dura occurs in 0.5–2.5% of epidurals
- If accidental dural puncture occurs with an epidural
needle there is a 70–80% chance of a postdural
puncture headache
Figures guidelines,CA,exams.txt[09/12/2017 22:14:46]
-The headache is usually in the fronto-occipital regions
and radiates to the neck.
- It is characteristically worse on standing and typically
develops 24–48 hours post-puncture
-Conservative management includes hydration and
simple analgesics
- Untreated, the headache typically lasts for 7–10 days
but can last up to 6 weeks
- Epidural blood patch has a 60–90% cure rate
10. Incidence of moderate to severe OHSS [3-8%]
•In IVF cycles mild OHSS affect around one-third of
cycles,while the combined incidence of moderate
or severe OHSS varies from 3.1% to 8%.
11. Risk of ovarian cancer in BRCA-1 carrier
[?40%]
• The estimated risk of ovarian cancer is 35–46% for
BRCA1 mutation carriers and
13–23% for BRCA2 mutation carriers.
•BRCA mutations may account for up to 90% of
hereditary ovarian cancers.
•The lifetime risk of ovarian cancer in the general
population is 1.4%.
•The strongest known risk factor is a family history of
the disease, which is present in about 10–15%
of women with ovarian cancer.
•Women with a single family member affected by
epithelial ovarian cancer have a 4–5% risk, while
those with two affected relatives have a 7% risk of
developing the disease. In contrast, women with
hereditary ovarian cancer syndromes defined as having
at least two first-degree relatives with epithelial
ovarian cancer, have a life-time probability as high as
13–50% for developing epithelial ovarian cancer.
•There is a 4–8% chance of detecting an occult
malignancy at the time of rrBSO. Over the age of 45
the risk rises to approximately 20%.
12. Pt with P/H of severe pre-eclampsia <28 wks, what
is the chance of recurrence?
[1:2 (or 55%)]
13. Incidence of twins after successful IVF cycle?
[25% (1:4)]
14. what percentage of couples will succeed to conceive
within the 1st yr?
[>80%]
15. Laproscopy ,serious complications
[2:1000]
16. A woman with atypical endometrial hyperplasia is
planned for TAH. What is the risk of finding a
concomitant cancer?
[?40- 50%,…].
•The incidence of coexisting endometrial carcinoma
ranges 6.4–43% in women undergoing
hysterectomy for atypical hyperplasia.
17. What is the incidence of OAB among the elderly
ladies??
{?15%}-(13-16%).
••The risk of ureteric or bladder damage during an
abdominal hysterectomy for menorrhagia
--7/1000
••The recurrence risk of ectopic pregnancy
--18.5%
••The chance of fetal laceration during a caesarean
delivery
--1-2%
••The risk of bowel injury at laparoscopy
--0.4/1000
0.2/1000 for vessel injury
••The risk of miscarriage after amniocentesis
--1% additional risk
••The risk of getting HIV from a blood transfusion
--1/2 millions pt overall , 1/1 not on ttt
••The risk of failure of a female sterilisation
--2-5/1000
••Failure rate of vasectomy
--1/2000
••Death following laparos.tubal occlusion
--1/12,000
Figures guidelines,CA,exams.txt[09/12/2017 22:14:46]
••Laparotomy following laparos.tubal occlusion
--3/1000
##C/S for placenta praevia:
••em.hysterectomy
--11/100
••need for further laparotomy
--75/1000
••VTE
--3/100
••bladder or ureteric injury
--6/100
••massive obst.haemorrhage
--21/100
••future p.pravia
--23/1000
••if p.praevia & previous c/s
--em.hysterectomy 27/100
##OVD
••3rd & 4th degree tear
--with vacuum. 1-4/100
--with forceps. 8-12/100
••extensive/significant vaginal/vulval tear
--1/10. with vacuum
--1/5. with forceps
••subgaleal haematoma
--3-6/1000
••ICH
--5-15/10,000
••PPH
--1-4/10
••cephalhaematoma
--1-12/100
••facial or scalp laceration
--1/10
••neonatal jaundice
--5-15/100
••retinal haemorrhage
--17-38/100
••episiotomy
--5-6/10 for vacuum
--9/10 for forceps
##Laparoscopy for managing tubal ectopic:
••serious complications from diag.laparoscopy
--2/1000
••death from complications
--3-8/-100,000
••persistent triphoblast following salpingotomy
--4-8/100
##Repair of 3rd & 4th degree tear
••faecal urgency. 26/100
••perin.pain & dyspareunia
--9/100
••wound infection 8/100
##Vaginal surgery for prolapse:
••damage to bladder/UT
--2/1000
••damage to bowel
Figures guidelines,CA,exams.txt[09/12/2017 22:14:46]
--5/1000
••excessive bleeding requiring transfusion or return to
theatre
--2/100
••pelvic abscess. 3/1000
••risk of death within 6 wks
--37/100,1000
••intraoperative blood transfusion. 2/100
##Caesarean section:
••em.hysterectomy. 7-8/1000
••need for further surgery at later date(include
curettage)
--5/1000
••admission to ICU. 9/1000
••VTE. 4-16/10,000
••bladder injury. 1/1000
••ureteric injury. 3/10,000
••death. 1/12,000
••uterine rupture in future pregnancies/deliveries
--2-7/1000
••antepartum stillbirth
--1-4/1000
••future placenta praevia & p.accreta. 4-8/1000
••persistent wound & abdominal discomfort in 1st few
months.
--9/100
••subsequent repeat C/S. 1/4
••readmission to hospital
--5/100
••haemorrhage. 5/1000
••infection. 6/100
••fetal laceration. 1-2/100
##Abdominal hysterectomy for benign conditions:
••overall risk of serious complications. 4/100
••damage to bladder & or ureter
--7/1000
••damage to bowel. 4/10,000
••haemorrhage requiring BT
--23/1000
••return to theatre(bleeding,dehiscence,etc)
--7/1000
••pelvic abscess/infection
--2/1000
•• VTE. 4/1000
••death within 6 wks
--32/100,000
##Diagnostic laparoscopy:
••serious complications. 2/1000
••risk of death. 3-8/100,000
##Amniocentesis:
••success at 1st attempt in
--94% of procedures
••blood stained sample in
--0.8% of procedures
••miscarriage rate
--1% over the norm
••chorioamnionitis/severe sepsis
--<1/1000
##Surgical evacuation ERPC:
••perforation. 1/200
Figures guidelines,CA,exams.txt[09/12/2017 22:14:46]
••haemorrhage. 1-2/1000
••pelvic infection. 3/100
••RPOC. 5/100
••perforation for Ashermans
--0.7-1.8%
••TOP. ~~0.4-0.52%
••hysteroscopy for PMB
--0.2-2%
VBAC
••A 28 years old pregnant para 1 had previous CS for
failure to progress 18 months ago.She was opted
for vaginal birth at 39 weeks & induction was
planned.Her BMI is 30.5 kg/m2.
Her chance of successful vaginal birth will be:
1- 72-75%
2- 85-90%
3- 40%
4- 25-30%
5- 60%
•Ans.3
40%
•gtg ((Induced labour, no previous vaginal delivery, BMI
greater than 30 and previous caesarean for
labour dystocia are associated with an increased risk of
unsuccessful VBAC. If all of these factors are
present, successful VBAC is achieved in 40% of cases.))
••What is the success rat of VBAC you quote for women
with the following previous birth
characteristics:
1-One previous c/s.72-75%
2-One previous VD.85-90%
3-Two previous c/s.62-75%(71)
4-Previous c/s for labour dystocia.64%
5-Previous c/s for malpresentation.84%
6-Previous c/s for fetal distress.73%
7-Previous c/s for unsuccessful instrumental
delivery.61.3%
••Risk of Uterine Rupture with:
1-planned VBAC.
20-50/10,000 or 1/200
2-ERCS(2/10,000)
3-induced or augmented labour compared to spont
VBAC.
--2-3 fold increased risk of rupture &
--1.5 fold incr risk of c/s
--with PG(87/10,000)
--with non-PG(eg amniotomy)(29/10,000)
4-preterm VBAC(34/10,000)
5-unscarred uterus(2/10,000)
6-2 previous scars(1.36%)
7-classical cs 200-900/10,000
8-previous rupture recurrence > 5% ie >500/10,000
••Mat.&Fetal O.C in VBAC
--blood transfusion 2/100
--MMR 4/100,000
--anal sphincter injury 5/100
--instrum.delivery up to 39%
--transient resp.morbidity 2-3/100
--AP-SB 10/10,000
--HIE 8/10,000
--delivery-related PND 4/10,000
••For ERCS
Figures guidelines,CA,exams.txt[09/12/2017 22:14:46]
--blood transfusion 1/100
--MMR 13/100,000
--transient resp.morbidity 4-6/100
--HIE < 1/10,000
••Other Incidences
--ERCS to be conducted after 39 weeks
--antibiotics to be given before skin incision(cefuroxime,
metronidazole)
--upto 10% sched.for ERCS go into labour spont.
--dehiscence is asymp.in upto 48%
--abn.CTG in 66-76%
-->90% ruptured during labour (peak 4-5 cm cx
dilatation)
--18% in 2nd stage & 8% identified post vag.delivery
--50% red.of resp.morbidity if giving steroids to women
having el cs beyond 37 wks
--overall c/s rate 25.5%
-em 14.8%
-el 10.7%
--Risk of PP
-after 1 prev.cs 1%
-after 2 prev.cs 1.7%
-after 3 or more prev.cs 2.8%
--Risc of accreta on top of PP
-pp+1 scar 11-14%
-pp+2 scars 23-40%
-pp+3 scars 61%
-pp+4 ,5 or more scars 67%
•• The risk of abnormally invasive placentation (without
PP)1increases from
--0.31% with one prior caesarean section
(<1% for 1 &2 )
to 2.33% with four .
(2% for 3 & 4)
(6.7% for 5 scars)
••Exam figures2
••1. Risk of postpartum psychosis for a pregnant woman
with bipolar disorders.
D. 1:4 [25%]
••2. The incidence of EOGBS in UK without
implementing the screening program. A. 0.5:1000
••3. Risk of adverse outcome to the baby if a low risk
primi opted for home delivery.
D. 9:1000
••4. The increase in maternal mortality in multiple
pregnancy in comparison to singleton
B. 2.5 folds. .
••5. Risk of spontaneous re-version after successful ECV
at 36 wks in a PG. A. <5%
#Success rates of ECV .
•Overall success levels for multiparous women (60%)
•for nulliparous women (40%).
•Spontaneous version from breech to cephalic at term
occurs in only 8% of primigravid
women after 36 weeks of gestation.
•Where ECV at term has been unsuccessful, only 3–7%
of babies will spontaneously turn to cephalic
presentation. •Spontaneous reversion to breech after a
successful ECV is rare, occurring in only 3%.
••6. Risk of progression of simple hyperplasia to
carcinoma? A. 1%
••7. Risk of perforation after surgical evacuation [?early
pregnancy].
E. 5:1000
••8. A 40yrs old woman who is found to be BRCA1
carrier has opted for risk reducing BSO. What is the
chance of finding an occult malignancy during this
surgery? [Figures may not be accurate]
4-8%.Risk is 20% if>45yr
••9. % of response of post dural puncture headache to
blood patch
D. 60-90%. [?60-80%]
••10. lactate threshold used in the management of
sepsis [some said it is Anti-D level & referral ]
Figures guidelines,CA,exams.txt[09/12/2017 22:14:46]
B. 2.
D. 4.
••11. The value from the options that would apply for
"very common"
C. >10%.
••12. Minimum number of days required for the heart
beat to appear by TVS. A. 35.
B. 37.
C. 39.
D. 41 [?42]
E. 47
••Gs 28-31
FP 35
YS 36-40
FH 41
••13. Risk of neonatal infection If the mother got 1ry
HSV infection at term & delivered virginally:
D. 40%
••14. A ?22 yrs old woman is found to be BRCA1 carrier.
What is her lifetime risk for developing ovarian
cancer?
D. 50%
••15. A lady has chronic pelvic pain that worsens during
menstruation. What is the chance that she has
endometriosis?
E. 50%