RCOG OBSTETRICS EMQ’s

1. The structure that is initially seen on a scan in MCDA twins and may not be seen in a donor
twin following development of TTTS (Bladder)
2. The structure that is not seen after 25 weeks after development of duodenal atresia but
noted initially on scan (Stomach)
3. The condition known to have thin skin, easy bruisibility and hyper mobile joints (Ehler
Danlos Syndrome)
4. A 19 year old comes to the booking clinic at 12 weeks and reveals that she has family
history of a condition which has been reviewed by the cardiologist and reported normal.
Her father and grandmother are being followed up by the same cardiologist (Marfan’s )
5. A primigravida who is rhesus negative is reported to have high titres of anti-D at 20 weeks.
Her husband who is a paramedic wants to know her results. ( Do not give results to
husband unless wife’s permission – confidentiality)
6. You review a result of a pregnant women who has booked at 12 weeks and find that she is
positive for TPHA/VDRL consistent with syphills infection ( Reveal the results to women in
full/contents in full – as needs treatment and partner testing)call
7. A women of eastern European origin who does not speak or understand English is
accompanied by her friend in the clinic who translates for her. You have to reveal the
results of her booking blood tests ( Use language line/with or without friend in clinic)
8. Bradycardia down to 60bpm for approximately 2 minutes after siting epidural on CTG (
Continue observation of CTG/No intervention necessary)
9. A women who came in spontaneous labour at 39 weeks has progressed well with cervix 8
cms dilated on examination but CTG showing reduced variability for 60 minutes
(FBS/Observe closely)
10. A 30 weeks pregnant women is admitted on a medical ward with pneumonia. You are
called to attend the cardiac arrest. You reach there in 6 minutes and cardiac arrest team
leader tells you that she has PEA on monitor (Perimortem CS)
11. A 24 weeks pregnant women is admitted on the medical ward with pneumonia. You are
called to attend a cardiac arrest but you are literally operating in theatre. This being the
weekend your consultant has left after doing a ward round. You manage to reach the ward
in 35 minutes where this women has had cardiac arrest. The cardiac arrest team leader
informs you that the rythym on monitor is asystole. ( Stop the resuscitation/perimortem
CS not indicated- person is brain dead after >15 min of asystole)
12. You are busy attending emergency at 22:00hrs in A&E and mid wife calls you for an advise
about a women who is 28 weeks pregnant and came with non-specific symptoms and has
noted some bruises on her body. CTG is normal. ( Admit for observation- need to explore
about domestic abuse)
13. You are busy attending emergency at 22:00hrs in A&E and mid wife calls you for an advise
about a CTG on 32 weeks primigravida, which shows reduced variability for 20 minutes
with occasional early decelerations but no accelerations. ( Observe the CTG)
14. A pregnant women has booked at 18 weeks after coming from west Africa and is unsure
about varicella immunity. She thinks that she has had chicken pox as a child but the
serological test confirm that she in non-immune to varicella ( General advise about chicken
pox in pregnancy/ can she be given vaccine in pregnancy)
15. A 28 weeks pregnant School teacher has been exposed to a student who has been
dignosed with chicken pox. She has found this 5 days after the student was diagnosed to
have chicken pox. Her serological tests reveal that she is IgM and IgG negative. (Varicella
immunoglobulin ASAP)
16. A 30 weeks pregnant women known to be drug abuser using different illicit drugs presents
in A&E with severe abdominal pain and bleeding. She collapses while being treated. She
dies despite all the commendable efforts of the staff involved in her care. ( Inform the
coroner /likely postmortem/all maternal deaths should be reported to coroner)less than
24
17. A primigravida had an uneventful gestation and was admitted in spontaneous labour at
term. She made good progress in labour and reached full dilatation. Her second stage of
the labour was prolonged and delivery had to be expedited by forceps delivery. Her baby
was well until about 6 days when it became sick and later on died. (Refer the case to
coroner/ postmortem ?)
18. What type of suture material do you use for the repair of sphincter muscle in 3rd degree
tear (3 0 PDS)
19. What type of suture material do you use for repair of skin in second degree vaginal tear (2
0 vicryl rapide)
20. What type of suture material is used for B-lynch suture (Polyglyctin No 1?)half circle ,blunt
21. A women from Zambia gives birth to a baby weighing 2.5 kg. The neonate has been found
to have hepatosplenomegaly, palmer rash and blocked nose. What is the likely maternal
infection (Syphills)
22. A 23 year old women in her first pregnancy has been admitted in spontaneous labour at 34
weeks after SROM and is in established labourand GBS positive. She has a known allery to
penicillin (Clindamycin)
23. A 36 year old women has been admitted in labour at term. She is worried about her baby
being affected by GBS. Her last pregnancy was affected by GBS but her baby was found to
be normal and was discharged home without any problems. She has had swabs done in
this pregnancy which have been reported normal( No treatment required)
24. A 35 year old women has been admitted in labour after SROM at 38 weeks. She has
developed a temperature of 38.6 degrees. She has had past problems with kidneys and has
remained under the care of nephrologist. She has been advised against the use of
antibiotics like gentamicin in future which may worsen her kidney function (Use
benzyllpenicillin – not contraindicated)penicillin+metronidazole/amoxicillin -metronidazol
25. A 28 year old women has had uncomplicated pregnancy and has been admitted after
spontaneous labour at term. She has made good progress in her 1st stage and reached full
dilatation after 8 hours. Her CTG is noted to have persistent variable decelerations and
reduced variability. Delivery is deemed necessary for abnormal CTG and on examination
vertex is at spines in OP position (LSCS vs Trial ?)
26. A primigravida has been admitted in labour after SROM at tem. She has made good
progress and reached full dilatation in 8 hours. CTG is found to be abnormal and on
examination the presenting part is direct OA +2 below spines (Instrumental delivery in
room)
27. A 20 year old who is 18 weeks pregnant is killed by her partner (Incidental maternal death)
28. A 38 year old who has delivered 11 months ago died as a result of Osteosarcoma (Late
maternal death)
29. You are an educational supervisor and notice that the logbook of ST2 trainee contains
reflective practice record of a case in which you were also involved. You notice that trainee
has given lot of factual inaccuracies and portrayed himself highly in the case (Speak to the
trainee in private ?)
30. You notice that the logbook of your trainee is missing an OSAT about the procedure in
which he did not perform well with you. You also notice that it contains several OSATS of
the same procedure depicting satisfactory progress. (arrange team observations/Arrange
OSAT/Speak to trainee?)
31. A 24 year old has delivered after fertility treatment with bromocriptine for
marcoadenoma, which she will need to continue after delivery. How should she breast
feed (Normal on demand)
32. A 32 year old known HIV positive has delivered normally and wants to breastfeed. (Advise
against breastfeed)
33. A 30 year old who developed PTE in pregnancy and is now on warfarin postnatally. She is
worried about the breastfeeding ( Normal on demand)
34. A 38 year old is undergoing emergency LSCS due to failure to progress. A baby is delivered
with good apgars. Her uterus is atonic and not responding to syntocinin infusion,
ergometrine, 3 doses of carboprost. You ultimately put a B-Lynch suture to close the
uterus. Your anaesthetiest is worried about her observations which remain unstable with
BP 80/40 and Pulse of 120. Your mid wife checks between the legs and notices continuing
bleeding with heavy clots. (Hysterectomy)
35. A 30 year old known Jehovas Witness with advanced directive of not using any form of
blood products has a large fundal fibroid. She is undergoing LSCS for her first baby. She is
continuously bleeding from the placental site after delivery of baby. She has not
responded to syntocinon infusion, ergometrine, 3 units of carboprost and continues to
bleed from the placental site. Her partner has informed you that they plan to have more
babies. The anaesthetiest tells you that her observations are stable despite the continuing
bleeding. (Bakri balloon/Interventional radiology procedure/B-Lynch?)
36. A 14 weeks rhesus sensitized women with antibody titre of 16 IU (Repeat levels in 4
weeks)
37. A 26 weeks known rhesus sensitization in last pregnancy has antibody level of 1084IU
(MCA Doppler ?)
38. An 18 weeks known rhesus sensitization has normal anamoly scan ( Antibody titres in 4
weeks/ultrasound follow up ?)
39. A 28 weeks pregnant women has been found to have growth of fetus below 10th centile on
ultrasound. The scan also noted some form of renal anamoly and possibility of VSD
(Karyotyping)
40. A 26 weeks pregnant women has been found to have growth below 10th centile on a scan.
The scan also noted baby to have cleft lip. (Karyotyping?)
41. A 26 weeks who remains under peritoneal dialysis for her known kidney problems is found
to be anaemic. What causes her anemia (Lack of erythropoiten)
42. The cause of anaemia in women taking chloramphenicol (Bone marrow
suppression/Aplastic anaemia)
43. A 18 weeks pregnant develops anaemia after being admitted with cough and fever (
aplastic crisis ? – presumably viral infection eg with erythrovirus causes aplastic anaemia?)
44. A 26 year old women of Afro-carrbean origin is found to have anaemia and upon
investigations, the microscopic examination of blood film reveals presence of target cells
(Autosomal recessive disorder)
45. A 37 year old who is undergoing emergency caesarean section has developed very high
temperature with increasing heart rate and breathing rate after GA with the use of
succinylcholine (Autosomal dominant – Malignant hyperthermia )
46. A women who is bleeding excessively during the delivery has a known inherited bleeding
disorder due to factor VIII deficiency ( X-linked Recessive ?)
47. A women who has been induced at term and contracting about 5-6 in 10 is showing
progress of 1 cm in 4 hours from 4cms to 5 cms. The CTG reveals normal fetal heart
pattern but contracting 7 in 10. ( Reasses in 2 hrs/ Reasses in 4 hrs/ start syntocinon?)
48. A primip who is fully dilated with vertex in OA position below spines at +2 and CTG
showing deep atypical varaiable decelerations. (Prepare to deliver in Room)
49. Para 3 who is 9 cms dilated with direct OA and CTG showing abnormalities including late
decelarations for 30 minutes (FBS/Emergency LSCS?)
50. A twin 1 has had a normal delivery in DCDA pregnancy and after 20 minutes syntocinon
was started for the delivery of twin 2. The CTG appears abnormal and upon examination
twin 2 is in longitudinal lie with head at -1 station (Ventouse delivery/Breech
extraction/Emergency CS?)
51. A 25 year old who is 16 weeks pregnant is suspected to have suffered from toxoplasmosis
but upon testing is found to be negative for it. However, she has tested positive for IgM
B19 parvovirus (ultrasound screening?)
52. A women with history of PTE outside pregnancy has delivered baby by normal vaginal
delivery. Her BMI is 24 and there are no other risk factors for development of
thromboembolism (Heparin for 6 weeks postnatally?)
53. A healthy women has delivered baby by normal vaginal delivery. She is known to be
heterozygous for antithrombin 3 deficiency and has no other risk factors VTE. What post
natal thromboprophylaxis. (No prophylaxis required?)high dose
54. A 22 weeks women has just returned from Bangladesh after visiting her family. She has
started to feel tired and complains of fatigue all the time. She has come to know that one
of her second cousins has been diagnosed with tuberculosis. She has visited the clinic with
this information and has had Mantoux tuberculin test done, which shows an induration of
4mm.(No treatment/Repeat test? – 4mm negative) Index case sputum smear
55. A 25 weeks pregnant women has just returned from Bangladesh after visiting her family.
She has been ever since complaining of worsening tiredness and being generally unwell.
She has come to know that one of her close cousins has been diagnosed with tuberculosis.
She subsequently undergoes Mantoux tuberculin test which shows induration of 18mm.
(treatment with INH, Rifampicin, pyrinzamide and ethambutol under MDT ?)
56. A RCT for new drug in controlling hypertension has been used in 1000 pregnant women
and its outcome is compared with the control group of equal number of women. The
primary outcome measure of gestation at delivery in treatment group was 37 weeks
whereas in control group it was 36 weeks. The statistical tests applied revealed p-value of
> 0.05 (No benefit & no harm ?)
57. A RCT involving 1000 women for testing new drug for control of hypertension. During the
follow up a quarter of women in treatment group were lost out on follow up. The
statistical analysis of parameters compared with the control group showed a p-value of
<0.05 (Some benefit but some concerns?)atrition
58. A ST2 who is assisting you in difficult CS on Friday night sustains a needle stick injury ( Go
to A&E immediately)
59. A 31 weeks pregnant women who books late is found to be HIV positive with a viral load of
<50. (Start HAART treatment?)
60. A 26 weeks pregnant presents to triage with SROM. On examination ruptured membranes
is confirmed and with no contractions ( Steriods? Erythromycin?)
61. A women who is booked as low risk pregnancy is admitted in spontaneous labour at term.
She made good progress in 1st stage but remains undelivered with 3 hours of 2nd stage.
CTG is normal and head is at +1 station in OP position. (Rotational Ventouse? Rotational
Forceps)
62. A study done to assess the procedure of 3rd/4th degree tear repair in terms of suture
material used and grade of surgeon performing the procedure and comparing this practice
against the RCOG guidelines ( audit)
63. A mid wife who assessed the effect of water birth on the pain during the labour. What
type of study has been done ( retrospective Observational Study?)
64. What is the incidence of condition in children where the female partner is normal and
male partner is suffering from Duchenne’s Muscular dystrophy ( ? None)
65. What is the incidence of condition in children where the pregnant women’s father is
haemophillic but her partner is unaffected.
66. What is the incidence of condition in children in a women who is known to have Marfan’s
syndrome ( 1 in 2 )
67. A women who has progressed well in labour is now fully dilated with meconium stained
liquor. CTG is pathological and on examination head is at +2 in direct OA position (
Prepare to deliver in room)
68. A women who has progressed well in labour is now fully dilated and head is in OP position
at spines. The CTG shows baseline rate of 165 and persistent variable decelerations with all
the contractions. ( Deliver in theatre? FBS)
69. A women who is 4 days post natal is feeling depressed on the ward. She now reports that
the baby she delivered does not belong to her and is refusing to take care of baby. ( Admit
to mother and Baby unit?)
70. A pregnant women at 31 weeks has a growth scan after being reported by mid wife as
small for gestation. Her growth is on 10th centile with normal liquor and uterine artery
dopplers, however the baby is found to have ASD. ( Karyotype)
71. A rhesus negative women has attended the CMW appointment at 28 weeks for Anti-D. she
reports that her pregnancy has been uneventful except that she had a minor bleeding at 8
weeks of pregnancy. ( Routine Anti-D prophylaxis ? blood for anti-D )
72. A women who is 36 weeks pregnant is admitted to delivery suit with prolonged SROM. She
is known GBS positive in this pregnancy ( Benzyllpenicillin prophylaxis )IOL to equal more
than 37
73. A women who is 35 weeks pregnant is admitted with prolonged SROM to delivery suit. She
has a known allergy to benzyllpenicillin (clindamycin)
74. A bus driver who is 16 weeks pregnant with a BMI 42 collapsed after a days long shift. She
was being transferred to hospital but died on her way. (PE)
75. A 37 weeks pregnant women calls for advice. Her child has been found to have rash of 2-3
days duration and now diagnosed with chicken pox. She does not remember having had
chicken pox herself as a child. ( Antibody level check)
76. A 16 weeks pregnant women who is jehova’s witness has rung for advice. She is a school
teacher and has recently found that two of her pupils have been found to have slapped
cheek syndrome after developing initial rash. She has found that infection with this
condition in pregnancy can be dangerous to baby. ( antibody level check)
77. A women complains of severe headache for 8 hours every day. Her headache gets worst
on climbing the stairs ( cluster headache? Chronic daily headache)
78. A women who has got unilateral headache with features of photophobia and
phonophobia. Her headache always starts with feeling of being strange. When her
headache is worst it feels like a ‘hot poker has gone through her orbit’ ( cluster headace?
Migraine with aura?)
79. A women who is 2 weeks post natal is reporting to suffer from severe headache describing
it as the ‘worst headache of life’. She also has some photophobia and neck stiffness. (SAH)
80. A women who is para 1 was admitted in labour at term. She was examined 2 hours ago
and cervix was 8 cms dilated with vertex at spines. She has started to have some blood loss
 and on examination the cervix is 6 cms dilated with presenting part at 2 cms above spines
with no further contactions noticed and CTG become abnormal. ( Uterine rupture)
81. A 20,obese,smoker ,asthmatic weeks pregnant women has had flu-like illness and now
reports chest pain which worsens with breathing ( Pericarditis?)plural effusion
82. A diabetic,smoker,34 weeks pregnant has reported central chest pain with prostration.
She had reported SOB prior to this episode (MI)
83. A 8 weeks pregnant women has been referred by her GP for early antenatal booking. She
is known to be heterozygous for AT3 deficiency. ( Post natal thromboprophylaxis for 7 days
?)
84. A women who has progressed well in her 1st stage but her CTG has become pathological.
On examination her cervix is 8 cms dilated and FBS performed is abnormal. Delivery is
deemed necessary but the mother is compos mentos is refusing to undergo caesarean
section. ( CS can not be performed)
85. A women who is 14 weeks pregnant and suffered PE/DVT in past following road traffic
accident unrelated to estrogen. (Post natal LMWH for 6 weeks)
86. A women who is 16 weeks pregnant and known to be heterozygous for factor V leiden
mutation. She has had no history of VTE. (7 LMWH needed)
87. The maternal death at 26 weeks due to known heart disease ( Indirect maternal death)11
88. A women who developed dVT in pregnancy subsequently made adequate progress
towards recovery though had neurological deficit needing rehabilitation in hospital. She
developed severe infection 14 months after her delivery and died. ( Not classified as
maternal death)
89. A women who died after 8 months after delivery as a result of osteosarcoma ( Late
maternal death)
90. A women who is large for dates at 36 weeks has a growth scan showing polyhydramnios
with EFW of 5000 grams. Her antenatal OGTT was normal. What should be her mode of
delivery (Elective CS at term – options at 37 wks/38wks/term/induction at 41)
91. A women who is large for dates at 36 weeks has a growth scan showing polyhydramnios
with EFW of 4500 grams. Her last delivery was complicated with mild shoulder dystocia
but baby was delivered with no neurological problems. What should be her mode of
delivery? ( Re-scan in 2 weeks and review delivery plan,short trail of labour )
92. A women who is large for dates at 36 weeks has a growth scan showing polyhydramnios
with EFW of 4500 grams. Her last labour was complicated by delayed progress and she
underwent emergency CS for persistent OP presentation when her cervix was 6 cms
dilated. She is agreed to have planned VBAC. What should be the mode of delivery. (
Elective CS at term)
93. A primip who came in spontaneous labour at term has developed deep deceleration for
approximately 2 minutes following siting of epidural in 1st stage ( Reposition and watch
CTG for next 5 minutes )
94. A CTG in a women in 1st stage which has complete loss of variability for > 90 minutes (
Category 1 CS)
95. A women who has presented in triage few weeks after delivery with recurrence of
symmetrical joint pain in hands and knees. She had this condition present before
pregnancy and resolved completely during pregnancy. ( Rheumatoid Arthritis)
96. A baby is born with cataract and ASD. Her mother reveals that she developed minor rash
and flu-like illness with swollen neck lymph nodes during the 1st trimester of pregnancy
while her visit to India. ( Rubella)
97. A women who developed some symptoms of PET during last trimester and later on had
some complications in form of eye problems and arthritis. Her baby is found to have Anti-
Ro and Anti-La antibodies ( SLE)
98. A women of African origin has been booked for her first pregnancy. She has been found to
be anaemic. Most likely type of anaemia ( Haemoglobinopathy)
99. A women who is diagnosed and currently treated for pre-eclampsia. Her BP is 160/105
with protein of +++ on urine dipstick. She is found to be anaemic. ( Haemolytic )
100. A women is admitted in spontaneous labour at term with contractions of 4 :10. On
examination she is presenting as breech and found to be 8 cms dilated with intact
membranes and pulsating cord is felt behind the membranes. The only theatre in unit is
currently occupied and team in theatre have just delivered the baby ( Terbutaline ?)
101. A women who is rhesus negative has anti-D levels of 1011. Her partner is heterozygous
for rhesus negative blood group. ( MCA Doppler for PSV ? ffdna)
102. A rhesus sensitized women has anti-D levels of 0.2mu/L. Her partner is homozygous. (
Use mother’s blood for cell free DNA analysis ?)titer
103. A rhesus sensitized women has anti-D levels of 15. Her partner is homozygous. ( Repeat
levels in 4 weeks mca?)
104. A pregnant women non-immune to chicken pox, who recently visited a friend and had
coffee together, has now come to know that she has developed throco-lumbar shingles. (
Reassure- No VZV immunoglobulins needed ?)
105. A women who has delivered baby with Down’s syndrome. Her previous child was also
affected with down’s syndrome. ( Robertsonian translocation – genetics )
106. A young girl comes for pre-pregnancy counseling and wants to know the mode of
inheritance for her two brothers who are both wheel chair bound since early teenage. ( X-
linked )
107. A women has come to delivery suit with severe abdominal pain and contractions with
some vaginal bleeding. She is fully dilated and head is at spines, but there is no FH. (
Forceps delivery) real time scan
108. A women who is susceptible to chicken pox was given VZV immunoglobulin after her
son developed chicken pox. Four weeks later her other son has developed chicken pox. (
Repeat VZV immunoglobulin)