14 December 2023.
|
EMQ. Surrogacy |
|
|
48 |
EMQ. Clopidogrel |
|
49 |
EMQ. Jacob’s syndrome |
|
50 |
MCQ. Folic acid fortification of flour |
|
51 |
EMQ. Anti-D |
|
52 |
EMQ. The Term Breech Trial |
47. EMQ.
Surrogacy.
Surrogacy.
Pick the best choice from the option list for each scenario.
Abbreviations.
ART: assisted
reproductive technology
Bhatia: Bhatia K, Martindale E, Rustamov O &
Nysenbaum A: “Surrogate pregnancy: an essential
guide for clinicians”. TOG. 2009;11:49-54.
B&O: Burrell & O’Connor. TOG 2013.
“Surrogate pregnancy: ethical and medico-legal issues in modern obstetrics.” TOG. 2013;15:113-19.
CF: commissioning father
CM: commissioning mother
CPs: commissioning parents
Jones: Jones P et al: “Options for acquiring
motherhood in absolute uterinefactor infertility …”.
PO: parental order
SM: surrogate mother
Option List.
a)
CM
b)
CF
c)
CPs
d)
SM
e)
Chairman of the HFEA
f)
Senior judge at the Children and Family Court
g)
traditional surrogacy
h)
gestational surrogacy
i)
HFEA
j)
SSAEW
k)
RCOG Surrogacy Sub-Committee
l)
false
m)
true
n)
none of the above
Scenario 1. List the
different types of surrogacy.
Scenario 2. “Gestational” surrogacy has better
“take-home-baby” rates than “traditional” surrogacy.
Scenario 3. There are approximately 1,000 surrogate
pregnancies per annum in the UK. True/False
Scenario 4. Which national body regulates surrogacy in
England?
Scenario 5. Privately-arranged
surrogate pregnancies are illegal and those involved are liable to up to 2
years in prison. True/False
Scenario 6. List the risks of surrogacy.
Scenario 7. Obstetricians
are legally obliged to take the CPs’ wishes into consideration in managing
pregnancy complications or problems.
Scenario 8. The psychological outcomes of surrogacy are
fully understood. True/False.
Scenario 9. The psychological outcomes of surrogacy are
more severe after traditional surrogacy.
True/False
Scenario 10. Who has the
right to arrange TOP if the fetus is found to have a major congenital
abnormality?
Scenario 11. A SM decides
at 10 weeks that she does not wish to be pregnant and arranges to have a TOP.
The CPs. hear about this and object strongly. To whom should they apply to have
the TOP blocked?
Scenario 12. A woman has
hysterectomy and BSO to deal with extensive endometriosis at the age of 30. She
marries two years later and her sister offers to act as surrogate. She
undergoes IVF and 4 embryos are created. One is transferred and a successful
pregnancy ensues. The baby is adopted by the woman and her husband. The 3
remaining embryos were frozen. Four years later the woman falls out with her
sister, but finds another surrogate and wishes to proceed with another
pregnancy. The sister says she does not want her eggs to be used and that the
frozen embryos should not be transferred. Does the sister have the legal right
to block the use of the embryos? Yes / No.
Scenario 13. A girl born
from donor sperm reaches the age of 16 and wishes to know the identity of her
genetic father. Does she have the right to this information? Yes / No.
Scenario 14. A girl born
from donor sperm reaches the age of 18 and wins a place at Oxford University to
read medicine. Does she have the legal right to get the donor to contribute to
her fees?
Yes / No.
Scenario 15. A PO is
active from the moment it is completed and signed by the relevant parties.
True/False
Scenario 16. A SM can
change her mind at any time and keep the child, even if the egg was not hers.
True/False
Scenario 17. The CPs can change their mind, leaving the SM
as the legal mother. True/False
Scenario 18. A SM’s husband is the legal father until
adoption is completed or a PO comes into force.
True/False
Scenario 19. A lesbian
couple in a stable, co-habiting relationship can be CPs and become the legal
parents of the child of a SM. True/False
Scenario 20. CPs are
likely to get faster legal status as the legal parents through application for
a PO rather than applying for adoption. True/False
Scenario 21. Surrogacy
can involve fertility treatment followed by pregnancy care. It is best if the
clinician
responsible for the fertility treatment also provides the pregnancy care. True/False
CPD TOG 2009.11.1. Bhatia
et al. Surrogate pregnancy: an essential guide for clinicians
With regard to surrogacy,
1. counselling is generally not needed if it
is an uncomplicated altruistic act. True/False
2. the technique of artificial insemination
used in traditional surrogacy usually takes place at home. True/False.
3. there are reliable statistical data on the
true incidence and nature of surrogacy … True/False
4. a parental order has the same effect as
adoption, but follows a quicker route. True/False
In gestational surrogacy
5. the success rate is higher than with
traditional surrogacy. True/False
6. it is recommended that the surrogate mother
should not be over the age of 40 years. True/False
In traditional surrogacy
7. an oocyte from the surrogate mother and the
sperm of the commissioning father are used. True/False
8. surrogacy is regulated by the Human Fertilisation
and Embryology Act 1990. True/False
9. where a health professional is involved in
the treatment, surrogacy can only be practised in centres licensed by the HFEA.
True/False
10. if the commissioning parents change their
minds about taking the child, the surrogate mother and her partner (if she has
one) will be legally responsible for the child. True/False 11. there must be no payment to a surrogate
mother apart from reasonable expenses. True
12. the surrogate parents give their consent,
which can be given from 2 weeks following the birth. True/False
13. the baby is genetically related to both of
the commissioning parents. True/False
14. one or both of the commissioning parents are
living in the UK and the baby is living with them. True/False
15. the application is made within 3 months of
the birth of the baby. True/False
With regard to the health risks to the surrogate mother,
16. the available literature shows that surrogate
mothers experience higher than average postpartum depression rates. True/False
17. there is reasonable evidence to indicate that
obstetric risks are the same as for any other pregnancy derived by IVF with the
same number of fetuses. True/False
Whilst caring for a surrogate mother during pregnancy,
18. in any situation of conflict or disagreement,
an obstetrician’s legal duty of care lies with the surrogate mother and child,
rather than the commissioning parents. True/False
19. the commissioning parents have the right to
make decisions about the child immediately after delivery in the case of a
premature birth or unexpected birth of a baby in poor condition. True/False
With regard to surrogacy,
20. in approximately 2 out of 50 arrangements, the
surrogate mother refuses to give up the child. True
TOG questions. See B&O in Abbreviations.
With regard to different types of surrogacy,
1. the practice of ‘straight surrogacy’
produces a child who has no genetic link to the surrogate mother. True/False
When medical interventions in pregnancy (such as
amniocentesis) are recommended,
2. a doctor should obtain consent from both the
commissioning parents and the surrogate if the baby is the genetic child of the
commissioning mother. True/False
3. In 2013, professional medical bodies are
totally opposed to surrogacy arrangements in the UK. True/False
After delivery,
4. the community healthcare visitor should only
visit a baby if it resides with the surrogate mother. True/False
If the surrogate mother has a miscarriage,
5. the doctor may be asked to provide
evidence to support this. True/False
Commissioning parents,
6. previously knew the surrogate mother in
about 10% of cases. True/False
7. are free to consent to medical treatment for
the baby while waiting for parental responsibility to be granted, provided that
the child resides with them. True/False
With regard to the surrogacy contract,
8. it is legally enforceable and therefore the
involvement of the Trust’s legal team is unnecessary. True/False
With regard to current legislation surrounding the
practice of surrogacy in the UK,
9. the introduction of The Human Fertilisation
and Embryology Act 1990 makes it likely that there will be more cases of
surrogacy in the future. True/False
10. if the surrogate or a foreign commissioning
parent domiciles in the UK, then UK laws apply regardless of where conception occurred.
True/False
11. organisations and agencies involved are
legally allowed to operate in the UK, and can charge membership fees provided
that they operate on a non-profit basis. True/False
12. if a surrogate mother feels emotional and unsure
about handing over the baby to the intended parents after birth, since she has
already accepted payment from the intended parents she is bound by the terms of
her contract and must continue with the arrangement. True/False
13. advertising the availability of surrogate
service is illegal in the UK. True/False
Regarding parental responsibility,
14. the court will grant a parental order if the
commissioning couple are either married or cohabitees and both are >16 years
old. True/False
15. a parental order can only be granted to a
same-sex couple if they have been together for at least 10 years. True/False
16. the commissioning couple should apply for
parental responsibility within 6 months after the birth of the child. True/False
With regard to the surrogate mother,
17. if she changes her mind about handing over the
baby after birth, it is possible that she may be able to retain legal custody
of the child if she has a genetic link to the child. True/False
18. if her husband was unaware that his wife underwent
artificial insemination and became pregnant as a surrogate, he is still the
legal father of the child. True/False
If a woman has donated an egg,
19. she is legally considered to be the mother of the
child. True/False
The commissioning mother,
20. will be entitled to normal maternity rights
with her employer if she has a genetic link to the child. True/False
TOG questions from Jones. TOG 2021;23:138-47
Concerning surrogacy in the UK,
5. the surrogate is the child’s legal mother
at birth, regardless of the origin of the gametes that created the embryo. True/False
6. surrogacy arrangements ensure that in the event
that the child is born with disability, the intended parents cannot renege on the
agreement. True/False
7. undergoing the process internationally bypasses
UK legislation, thereby negating the need to arrange a parental order. True/False
8. there are no major differences in psychological
development between children born from this and those born to non-surrogates. True/False
9. the outcomes in surrogate mothers are
mostly positive. True/False
48. EMQ.
Clopidogrel.
Abbreviations.
Question
1. What type of drug is clopidogrel?
Option list.
|
A |
antibiotic |
|
B |
antidepressant |
|
C |
antihypertensive |
|
D |
antipsychotic |
|
E |
biologic |
|
F |
direct-acting oral anticoagulant |
|
G |
diuretic |
|
H |
immunomodulator |
|
I |
parenteral anticoagulant |
|
J |
platelet inhibitor |
|
K |
none of the above |
Question
2. What is the main mode of action of clopidogrel?
Option list.
|
A |
irreversible binding to the platelet P2Y12 ADP receptor causing
impaired platelet aggregation |
|
B |
inhibition of clotting factor II |
|
C |
inhibition of clotting factor VIII |
|
F |
inhibition of the renin-angiotensin system |
|
D |
inhibition of vitamin K metabolism |
|
G |
selective serotonin uptake inhibition |
|
H |
peripheral vasodilation |
|
I |
none of the above |
Option list.
|
A |
acupuncture should be substituted for the surgery |
|
B |
diazepam should be added post-operatively |
|
C |
the surgery can go ahead after anaesthetic review |
|
D |
the surgery can go ahead, but careful blood pressure
monitoring is essential |
|
E |
the drug should be discontinued at least 10 days before
surgery |
|
F |
none of the above. |
Question 4.
Which of the
following statements is most appropriate in relation to emergency surgery for
patients taking clopidogrel?
Option list. Use
the list for the previous question.
Question
5. What is the advice about the use of clopidogrel in
pregnancy?
Option list.
|
A |
it is contraindicated because of an increased risk of
APH |
|
B |
it is contraindicated because of an increased risk of
bleeding after miscarriage |
|
C |
it is contraindicated because of an increased risk of
fetal abnormality |
|
D |
it is contraindicated because of an increased risk of
PPH |
|
E |
it is contraindicated because there is insufficient
data about its safety |
|
F |
none of the above |
Question
6. What is the advice about the use of clopidogrel during
breastfeeding?
Option list.
|
A |
it is contraindicated because of an increased risk of
postnatal depression |
|
B |
it is contraindicated because of an increased risk of
PPH |
|
C |
it is contraindicated because of an increased risk of
pulmonary embolism |
|
D |
it is contraindicated because of an increased risk of
posterior reversible encephalopathy syndrome |
|
E |
it is contraindicated because there is insufficient
data about its safety |
|
F |
none of the above |
49. EMQ.
Jacob’s syndrome.
Abbreviations.
ADHD: Attention-Deficit, Hyperactivity Disorder
ASD: autistic spectrum disorder.
Question 1.
What is the
approximate incidence of Jacob’s syndrome in newborn females?
Option list. There is none – just give a figure.
Question 2.
What is the
approximate incidence of Jacob’s syndrome in newborn males?
Option list. There is none – just give a figure.
Question 3.
What type of
disorder is Jacob’s syndrome?
Option list.
|
A |
autosomal dominant |
|
B |
autosomal recessive |
|
C |
autosomal trisomy |
|
D |
sex chromosome trisomy |
|
E |
X-linked dominant |
|
F |
X-linked recessive |
|
G |
trinucleotide repeat |
Question
4. What proportion of cases of Jacob’s syndrome are believed
to go undiagnosed?
Question
5. Which, if any, of the following are true of the Jacob’s
phenotype?
Option list.
|
A |
ataxia |
|
B |
clinodactyly |
|
C |
hypertelorism |
|
D |
hypotonia |
|
E |
macrocephaly |
|
F |
microcephaly |
|
G |
macroorchidism |
|
H |
microorchidism |
|
I |
premature ovarian failure |
|
J |
short stature |
|
K |
tall stature |
|
L |
tremor |
Question
6. Which, if any, of the following are more common in Jacob’s
syndrome.
Option list.
|
A |
ADHD |
|
B |
ASD |
|
C |
aggressive behaviour |
|
D |
asthma |
|
E |
criminal behaviour |
|
F |
diabetes |
|
G |
epilepsy |
|
H |
hypogonadotrophic
hypogonadism |
|
I |
hypertension |
|
J |
infertility |
|
K |
low IQ |
|
L |
schizophrenia |
50. MCQ.
Folic acid fortification of flour.
Abbreviations.
FFF: fortification of flour with
folic acid.
NTD: neural tube defect.
Scenario 1.
What is the incidence of NTD in the UK?
Scenario 2.
What is the risk of an affected sibling for the woman who becomes
pregnant after having a baby with NTD?
Scenario
3.
Which foods contain significant amounts of folic acid?
Scenario 4.
What percentage of folic acid is destroyed by cooking / food
storage?
Scenario 5.
How many people in the UK are estimated to have a folate-deficient
diet?
Scenario 6.
What is the significance of the MTHFR (Methylenetetrahydrofolate reductase gene)?
Scenario 7.
What is the significance of the Meckel-Gruber syndrome to this
issue?
Scenario 8.
By what gestation has the neural tube closed?
Scenario 9.
What proportion of pregnant women have taken folic acid
preconceptually?
Scenario 10.
What dose and duration of folic acid is advised for routine
periconceptual use?
Scenario 11.
List the women to whom a higher dose should be offered.
Scenario 12.
How effective is periconceptual folic acid consumption in reducing
NTD risk in the low-risk population?
Scenario 13.
How effective is periconceptual folic acid consumption in reducing
NTD risk in women who have had an affected baby?
Scenario 14.
What is the risk of NTD recurrence for a woman who has had two
affected babies?
Scenario 15.
What is the risk of NTD in Ireland?
Scenario 16. What is
the significance of the name “Bukowski” in relation to folic acid?
Scenario 17.
What effect does periconceptual folic acid have on the risk of
stillbirth?
Scenario 18.
What effect does periconceptual folic acid have on the risk of
autistic spectrum disorder?
Scenario 19.
What effect does periconceptual folic acid have on maternal
haemoglobin levels?
Scenario 20.
What recommendations have been made by the RCOG to improve folic
acid levels in pregnancy?
Scenario 21.
Which names are of importance in the history of folic acid and
NTD?
Scenario 22.
What neurological condition has been thought potentially
problematic with folic acid supplementation?
51. EMQ.
Anti-D.
cffDNA: cell-free, fetal DNA.
DAT: direct anti-globulin test.
FDIU: fetal death in utero.
Ig: immunoglobulin.
ICS: intra-operative cell salvage.
i.m: intra-muscular
RAADP: routine antenatal anti-D prophylaxis.
TOP: termination
of pregnancy.
Scenarios.
There is no option list for many
questions to force good technique!
Question 1.
What proportion of
the Caucasian population in the UK has Rh-ve blood group?
Question 2.
What proportion of
the Rh+ve Caucasian population is homozygous for RhD?
Question 3.
What is the chance
of a Rh-ve woman with a Rh+ve partner having a Rh-ve child?
Question 4.
When was routine
postnatal anti-D prophylaxis introduced in the UK?
Question 5.
Where does anti-D for prophylactic use come
from?
Question 6.
How many deaths
per 100,000 births were due to RhAI up to 1969?
Question 7.
How many deaths
per 100,000 births were due to RhAI in 1990?
Question 8.
Anti-D was in
short supply in 1969. Which non-sensitised, Rh-ve primigravidae with Rh+ve
babies were not be given anti-D as a matter of policy?
Question 9.
List the possible
reasons that a Rh-ve mother with a Rh+ve baby who does not receive anti-D might
not become sensitised?
Question 10.
What is the UK
policy for the administration of anti-D after a term pregnancy?
Question 11.
What is the
alternative name of the Kleihauer test?
Question 12.
What does the
Kleihauer test do?
Question 13.
How does the
Kleihauer test work and what buzz words should you remember?
Question 14.
When should a
Kleihauer test be done after vaginal delivery?
Question 15.
What blood
specimen should be sent to the laboratory for a Kleihauer test?
Question 16.
What steps should
be taken to prevent sensitisation in the woman whose blood group is RhDu
and whose baby is Rh+ve?
Question 17.
The Kleihauer test is of value
in helping to decide if antenatal vaginal bleeding or abdominal pain are due to
placental abruption, with a +ve test confirming FMH and making abruption highly
probable.
True/False?
Question 18.
When should anti-D
be offered?
Question 19.
When should a
Kleihauer test be considered?
Question 20.
How often does the
word “considered” feature in the GTG? The GTG
has been archived, but I left this question to illustrate the point about
‘offered’ and ‘considered’.
Question 21.
A Rh-ve woman
miscarries a Rh+ve fetus at 18 week’s gestation. What should be done about
Rhesus prophylaxis?
Question 22.
A Rh-ve woman
miscarries a Rh+ve fetus at 20 week’s gestation. What should be done about
Rhesus prophylaxis?
Question 23.
Which potentially
sensitising events are mentioned in the GTG?
Question 24.
What factors are listed in the GTG as
particularly likely to be linked to FMH > 4 ml?
Question 25.
A woman has recurrent bleeding from 20
weeks. What should be done about Rh prophylaxis?
Question 26.
What are the key messages about giving
RAADP?
Question 27.
Which of the
following statements, if any, is true of Rhesus negative volunteers given what
should be a sensitising dose of Rh D?
|
A |
all will produce anti-D |
|
B |
95% will produce anti-D |
|
C |
90 % will produce anti-D |
|
D |
80 % will produce anti-D |
|
E |
none of the above |
Question 28.
When a Rh-ve woman
develops antibodies after a pregnancy, in what percentage of cases is the
sensitising event identified?
|
A |
10% |
|
B |
20% |
|
C |
30% |
|
D |
40% |
|
E |
<50% |
Question 29.
Which, if any, of
the following statements is associated with an increased risk of significant
Rhesus alloimmunisation.
|
A |
anti-D occurring after a 1st. pregnancy |
|
B |
anti-D occurring after a 2nd. pregnancy |
|
C |
anti-D occurring after a 3rd. pregnancy |
|
D |
anti-D occurring after a 4th. pregnancy |
|
E |
anti-D occurring after multiple pregnancy |
Question 30.
A woman has FMH
> 4ml. An appropriate additional dose of anti-D Ig is administered i.m.
after taking advice from the consultant haematologist. When should a follow-up
test be done to ensure that the fetal cells have been eliminated from the
maternal circulation?
Question 31.
A woman has FMH
> 4ml. An appropriate dose of anti-D Ig is administered i.v. after taking
advice from the consultant haematologist. When should a follow-up test be done
to ensure that the fetal cells have been eliminated from the maternal
circulation?
Question 32.
A woman has a potentially sensitising event at <12
weeks. Which, if any, of the following investigations should be done?
|
A |
cffDNA |
|
B |
DAT |
|
C |
Kleihauer or equivalent test for feto-maternal
haemorrhage |
|
D |
maternal blood group & antibody screen for anti-D |
|
E |
none of the above |
Question 33.
A woman has a
potentially sensitising event at 16 weeks.
Which, if any, of the following investigations should be
done?
|
A |
cffDNA |
|
B |
DAT |
|
C |
Kleihauer or equivalent test for feto-maternal
haemorrhage |
|
D |
maternal blood group & antibody screen for anti-D |
|
E |
none of the above |
Question 34.
A woman has a
potentially sensitising event at 22 weeks.
Which, if any, of the following investigations should be
done?
|
A |
cffDNA |
|
B |
DAT |
|
C |
Kleihauer or equivalent test for feto-maternal
haemorrhage |
|
D |
maternal blood group & antibody screen for anti-D |
|
E |
none of the above |
Question 35.
A woman has a
potentially sensitising event at 32 weeks.
Which, if any, of the following investigations should be
done?
|
A |
cffDNA |
|
B |
DAT |
|
C |
Kleihauer or equivalent test for feto-maternal
haemorrhage |
|
D |
maternal blood group & antibody screen for anti-D |
|
E |
none of the above |
Question 36.
A woman has a
potentially sensitising event. The laboratory is uncertain about her Rhesus
group and declares the test to be indeterminate. How should the situation be
dealt with?
|
A |
treat her as Rhesus -ve until a definitive result is
available |
|
B |
treat her as Rh+ve until a definitive result is available |
|
C |
treat her as Rh Du until a definitive result
is available |
|
D |
refer her to a fetal medicine expert |
|
E |
none of the above |
Question 37.
A woman has a
complete miscarriage at 10 weeks confirmed by ultrasound scan. Which, if any,
of the following investigations would be appropriate?
|
A |
cffDNA |
|
B |
DAT |
|
C |
Kleihauer or equivalent test for feto-maternal
haemorrhage |
|
D |
maternal blood group & antibody screen for anti-D |
|
E |
none of the above |
Question 38.
A primigravida has
a threatened miscarriage at 10 weeks. An ultrasound scan shows a viable intrauterine
pregnancy. Which, if any, of the following investigations would be appropriate?
|
A |
antibody screen |
|
B |
cffDNA |
|
C |
DAT |
|
D |
Kleihauer test |
|
E |
maternal blood group |
Question 39.
A Rh-ve woman has
a painless APH at 30 weeks. An ultrasound scan shows a viable intrauterine
pregnancy. Which, if any, of the following investigations would be appropriate?
|
A |
antibody screen |
|
B |
cffDNA |
|
C |
DAT |
|
D |
Kleihauer test |
|
E |
maternal blood group |
Question 40.
A Rh-ve woman has
a molar pregnancy identified and evacuated using suction at 10 weeks gestation.
Which of the following statements, if any, is true?
|
A |
complete molar pregnancies have no fetal tissue so cannot
be involved in Rh sensitisation |
|
B |
incomplete molar pregnancies have fetal tissue and can be
involved in Rh sensitisation |
|
C |
molar pregnancies have significant potential for
triggering Rh sensitisation |
|
D |
molar pregnancies generate potentials < 24 volts so
cannot be involved in Rh sensitisation |
|
E |
none of the above |
Question 41.
A Rh-ve woman has a FDIU at 37 weeks. She
declines intervention. Which, if any, of the following investigations should be
offered?
|
A |
DAT |
|
B |
Kleihauer or equivalent test for feto-maternal
haemorrhage |
|
C |
maternal blood group & antibody screen for anti-D |
|
D |
placental biopsy |
|
E |
none of the above |
Question 42.
A Rh-ve woman has a FDIU at 37 weeks. She
declines intervention and goes into labour at 40 weeks. She has a normal
delivery but required manual removal of the placenta.
Which of the
following statements, if any, are true about Rhesus prophylaxis?
Option list.
|
A |
FMH estimation is important in relation to the FDIU |
|
B |
FMH estimation is important in relation to the mode of
delivery & complications |
|
C |
FMH is minimal after FDIU and Rh D prophylaxis is
irrelevant |
|
D |
FMH may have been the cause of the FDIU |
|
E |
None of the above and I am really fed up with this topic. |
Question 43.
A woman develops
evidence of sudden-onset “fetal distress” in labour, C section is performed and
an anaemic baby is delivered. FMH is suspected to be the cause of the “fetal
distress” and the anaemia. When should samples of maternal blood be collected
for testing for FMH?
|
A |
When the decision for C section was taken |
|
B |
At the time of delivery |
|
C |
30 – 120 minutes after the likely time of the FMH |
|
D |
4 hours after the likely time of the FMH |
|
E |
all of the above |
|
F |
none of the above |
Question 44.
A Rh-ve mother has
C. section during which ICS is used. The baby’s blood group is Rh+ve. What is
the minimum recommended dose of anti-D after return of the salvaged fetal red
cells?
|
A |
250 IU |
|
B |
500 IU |
|
C |
1,000 IU |
|
D |
1,500 IU |
|
E |
2,000 IU |
|
None of the
above. |
Question 45.
Which, if any, of
the following statements is true about current use of cffDNA for determination
of the fetal Rhesus blood group in the
NHS?
|
A |
it is recommended
for all Rh-ve women |
|
B |
it is recommended
for consideration prior to RAADP use |
|
C |
it is recommended
for all Rh-ve women prior to RAADP use |
|
D |
it is recommended
for all Rh+ve women prior to RAADP use |
|
E |
it is not yet
approved for use |
|
F |
none of the above |
52. EMQ.
The Term Breech Trial.
Abbreviations.
Cs: Caesarean section.
ECV: external cephalic version.
VB: vaginal birth.
VBD: vaginal breech delivery.
Question 1.
What is the approximate incidence of breech
presentation at 28 weeks?
|
3% |
|
|
B |
5% |
|
C |
7% |
|
D |
10% |
|
E |
12% |
|
F |
15% |
|
G |
20% |
Question
2.
What is the
approximate incidence of breech presentation at 32 weeks?
Option list. Use that from Q1.
Question
3.
What is the
approximate incidence of breech presentation at 36 weeks?
Question
4.
What is the
approximate incidence of breech presentation at 40 weeks?
Question
5.
What is the
approximate incidence of breech presentation at 40 weeks after
successful ECV at 36 weeks?
Don’t get bogged down looking for trick questions. You could argue that to be
successful, ECV would need to ensure that all babies were cephalic at T, but
the simplest meaning is that the baby was successfully turned at 36 weeks.
|
A |
1% |
|
B |
2% |
|
C |
3% |
|
D |
4% |
|
E |
5% |
Question
6.
What is the
approximate incidence of cord prolapse with breech presentation in term
labour?
|
1% |
|
|
B |
3% |
|
C |
5% |
|
D |
7% |
|
E |
10% |
|
F |
12% |
|
G |
15% |
|
H |
20% |
|
I |
none of the
above |
Question
7.
Which, if any, of
the following are included in the RCOG’s PIF about the risks
associated with Cs?
|
damage to
bowel |
|
|
B |
damage to
bladder |
|
C |
damage to
ureter |
|
D |
damage to
partner from fainting / falling |
|
E |
endometriosis |
|
F |
gestational trophoblastic
disease |
|
G |
hysterectomy |
|
H |
miscarriage |
|
I |
placental
accreta |
|
J |
placenta
previa |
|
K |
postnatal
depression |
|
L |
PPH |
|
M |
scar
dehiscence |
|
N |
scar
herniation |
|
O |
scar pregnancy |
|
P |
stillbirth |
|
Q |
thromboembolism |
Question 8.
What are the 3 key
questions in the RCOG’s PIF that patients are advised to ask?
Question
9.
Which, if any, of
the following were in the main conclusions of the Term Breech Trial?
|
stillbirths
were significantly fewer with planned C section |
|
|
B |
neonatal
mortality was reduced significantly by planned C section |
|
C |
neonatal
morbidity was reduced significantly by planned C section |
|
D |
serious
neonatal morbidity was reduced significantly by planned C section |
|
E |
perinatal
mortality was reduced significantly by planned C section |
|
F |
perinatal
morbidity was reduced significantly by planned C section |
|
G |
serious perinatal
morbidity was reduced significantly by planned C section |
|
H |
none of the
above |
Question
10. Which, if any, of the following were in the main
conclusions of the follow up at 2 years
of the children in the Term
Breech Trial?
|
neonatal
mortality was reduced significantly by planned C section |
|
|
B |
neonatal morbidity
was reduced significantly by planned C section |
|
C |
planned C
section reduced the risk of child death up to 2 years |
|
D |
planned C
section reduced the risk of child morbidity up to 2 years |
|
E |
planned C
section improved child neurodevelopment at 2 years of age |
|
F |
none of the
above |
Question
11. Which, if any, of the following were included in the
conclusions of the Premoda Trial?
|
A |
fetal mortality was reduced by planned cs |
|
B |
neonatal mortality was reduced by planned cs |
|
C |
neonatal morbidity was reduced by planned cs |
|
D |
surgeons’ sleep patterns were improved planned cs |
|
E |
Cs should be offered as superior to planned vaginal
delivery even in expert centres |
|
F |
VBD is a safe option in centres where it is commonly
practised and strict criteria are met |
Question
12. Which, if any, of the following are listed as
contraindications to VBD in GTG20a.
|
A |
maternal height < 1.6 metres |
|
B |
maternal BMI > 30 |
|
C |
gestation < 36 weeks |
|
D |
failed ECV at 36 weeks |
|
E |
reversion to breech presentation after successful ECV
at 36 weeks |
|
F |
estimated fetal weight > 3.5 kg. |
|
G |
estimated fetal weight <25th. centile. |
|
H |
hyperextended fetal neck |
|
I |
footling presentation |
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