15 August 2024.
Role-players: 1.
Website 2.
|
28 |
Role-play.
1 |
|
29 |
Role-play.
2 |
|
30 |
EMQ. The
MAGPIE trial |
|
31 |
SBA.
Advanced
maternal age |
28 & 29. I’ll email the candidates’ instructions shortly
before the tutorial. I don’t want any
preparation!
30 & 31. Answer without preparation as
exam practice, using ‘intelligent guessing’ for things you don’t know. It will
help cement facts in long-term memory; just reading stuff is said to lead to
only 5% retention. The discussion in the tutorial and the answers on Dropbox
will give you all you need to know and save you time reading up on this topic.
30. The MAGPIE trial .
This was one of the seminal trials that changed practice
and you should know the basics.
Question 1.
Which of the following is true of the Magpie
trial?
|
A |
it
compared MgSO4 with placebo in the management of eclampsia /
severe PET |
|
B |
it
compared MgSO4 with lytic cocktail in the management of eclampsia
/ severe PET |
|
C |
it
compared MgSO4 with phenytoin in the management of eclampsia /
severe PET |
|
D |
it
compared MgSO4 with alcohol in the management of threatened
premature labour |
|
E |
it
compared MgSO4 with atosiban in the management of threatened
premature labour |
|
F |
it
compared MgSO4 with ritodrine in the management of threatened
premature labour |
|
G |
it
compared MgSO4 with dexamethasone in the prevention of cerebral
palsy due to extreme prematurity |
|
H |
it
compared MgSO4 with placebo in the prevention of cerebral palsy
due to extreme prematurity |
|
I |
none
of the above |
Question 2.
Which if any of the following are true of
the Magpie trial?
|
A |
it involved ~ 1,000 women |
|
B |
it involved ~ 10,000 women |
|
C |
it involved ~ 20,000 women |
|
C |
it involved > 20,000 women |
|
D |
it involved ~ 30 hospitals |
|
E |
it involved ~ 50 hospitals |
|
F |
it involved ~ 80 hospitals |
|
G |
it involved > 150 hospitals |
|
H |
it involved 5 countries |
|
I |
it involved 10 countries |
|
J |
it involved 20 countries |
|
K |
it involved 30 countries |
|
L |
it involved 50 countries |
|
M |
it involved >50 countries |
Question 3.
Which if any of the following are true?
|
A |
almost 50% of the women were in Africa |
|
B |
almost 50% of the women were in America |
|
C |
almost 50% of the women were in Asia |
|
D |
almost 50% of the women were in Australia
/ New Zealand |
|
E |
almost 50% of the women were in Europe |
Question 4.
Which, if any, of the following is true of
the Magpie trial?
|
A |
cerebral palsy rates at 2 years were ↓ by
the use of MgSO4 in babies born < 34 weeks |
|
B |
cerebral palsy rates at 2 years were
unchanged by the use of MgSO4
in babies born < 34 week |
|
C |
eclampsia rates were reduced by about half
by the use of MgSO4 |
|
D |
eclampsia rates were reduced by about half
by the use of MgSO4 but only in underdeveloped countries |
|
E |
maternal mortality was significantly ↓ by
the use of MgSO4 |
|
F |
maternal mortality was significantly ↓ by
the use of MgSO4, but only in underdeveloped countries |
|
G |
premature delivery was significantly ↓ by
the use of MgSO4 |
|
H |
perinatal mortality from prematurity was
significantly ↓ by the use of MgSO4 |
31. Advanced maternal
age.
An important topic for the exam and real life.
Abbreviations.
Howell: Howell A et al: “Very advanced maternal age”. TOG.2021;23:38-47.
This SBA is being developed. Exam questions are likely to
come from the CPD questions for “Howell”
– see above - which are open-access and reproduced below. I’ll add some SBA’s
when I have time.
Don’t do any reading – just answer as you would in the exam, using ‘intelligent
guessing’ when you are not sure. You will get the correct answers in the
tutorial and the written answer.
Pregnancy following conception via assisted reproductive technologies
in women of advanced maternal age.
1. is
significantly more likely to result in a live birth if a donor embryo rather
than an autologous embryo is used. False/True
2. is
associated with a two-fold increase in the risk of developing pre-eclampsia in comparison
to a pregnancy following spontaneous conception. False/True
3. is
an indication for aspirin (150 mg) from 12 weeks of gestation until delivery to
decrease the risk of pre-eclampsia and small-for-gestational-age. False/True
With regard
to early pregnancy in women of very advanced maternal age,
4. there
is an overall 53% risk of miscarriage. False/True
5. the
overall risk of ectopic pregnancy in those aged 44 years or more is twice that
in younger women. False/True
6. there
is evidence that women aged 40 years and above are twice as likely to need a
blood transfusion during an admission for an ectopic pregnancy in comparison to
younger women. False/True
Women of very
advanced maternal age are more likely than younger women to be,
7. multiparous.
False/True
8. overweight
or obese. False/True
Multiple
pregnancy rates in women of very advanced maternal age,
9. have
been consistently higher than in any her age group due to multiple embryos being
transferred during assisted reproductive technology. False/True
With regard
to medical complications in women of very advanced maternal age,
10. studies
have shown that they are three to six times more likely to develop gestational hypertension
than younger women. False/True
11. the
most significant risk factor for developing pre-eclampsia is obesity. False/True
Venous thromboembolism
risk in women of very advanced maternal age,
12. is
increased in the first trimester following assisted reproductive technology. False/True
13. should
be first assessed at 28 weeks’ gestation. False/True
Regarding
placental complications, women of very advanced maternal age,
14. are
three times more likely to have placenta praevia than younger women. False/True
15. have
a similar risk of placental abruption as younger women. False/True
Regarding
postpartum haemorrhage,
16. it
complicates one in four pregnancies in women of very advanced maternal age. False/True
17. women
of very advanced maternal age are almost twice as likely to need blood products
than younger women. False/True
Women of very
advanced maternal age,
18. are
33.5 times more likely to be admitted to intensive care than younger women. False/True
Regarding
trisomy,
19. the
risk of having a child with T21 is 1:35 at the age of 45. False/True
20. if
a cut off of 1 in 150 is used as a screen positive result, one in four women of
very advanced maternal age will screen positive. False/True
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