1. Down’s syndrome (trisomy 21) is
(a) Trisomy 21 is the most common chromosomal abnormality among live births.
(b) It usually occurs as a result of a balanced chromosomal translocation in the parents.
(c) One hundred per cent of affected infants have cardiac defects.
(d) The fetal heart is always abnormal.
2. Hypertensive disorders in pregnancy: which of the following is true?
(a) ‘Significant’ proteinuria is e”0.3 g/24 h.
(b) When blood pressure is >140/90 mmHg prior to 20 weeks’ pregnancy induced hypertension is the likely diagnosis.
(c) A protein : creatinine ratio >10 mg/nmol is considered significant
(d) None of these
3. Which is the risk factor for pre-eclampsia?
(b) Advanced maternal age
(d) None of these
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4. Which one of the following is a typical biochemical and haematological abnormality in Pre-eclampsia?
(a) Reduced haemoglobin
(b) Rise in platelets as part of the acute systemic response
(c) Low uric acid
(d) Impaired renal and liver function
5. The current indications for screening for gestational diabetes is
(a) Previous history of IUGR
(b) Persistent glycosuria
(c) Family history of PCOS
6. Aetiological factors in spontaneous preterm labour is
(a) Delivery before 34 weeks occurs in 20% of twins
(b) Spontaneous preterm labour is more common in the presence of fetal compromise.
(c) Uterine abnormalities such as fibroids or müllerian abnormalities are a cause of first-trimester miscarriage, but not preterm delivery.
(d) Cervical surgery and recurrent terminations of pregnancy protect against preterm delivery
7. The following statements refer to prediction and prevention of preterm labour—which is true?
(a) Strategies for prevention of preterm birth, in those at high risk, are commenced from 23 weeks
(b) A cervical suture should only be inserted if the cervical length on transvaginal sonography (TVS) is short
(c) Antibiotics throughout pregnancy prevent preterm labour.
(d) Cervical length on TVS is a sensitive method for prediction of delivery before 28 weeks
8. Investigations and management of preterm labour: which one of the following is true?
(a) Fetal fibronectin as a test for preterm labour is highly specific
(b) WBC count and CRP estimation are indicated
(c) Steroids reduce perinatal mortality by promoting pulmonary maturity.
(d) Caesarean section reduces the incidence of respiratory distress syndrome (RDS) in the neonate.
9. Preterm prelabour rupture of membranes (PPROM) , which statement is appropriate
(a) PPROM occurs before one-third of preterm deliveries
(b) Infection of the placenta (chorioamnionitis) or cord (funisitis) is uncommon.
(c) If there is evidence of chorioamnionitis delivery may be delayed to give antibiotics
(d) Induction should not be performed until term
10. Common causes of antepartum haemorrhage (APH, bleeding from the genital tract from 24 weeks gestation) include which of the following?
(a) Vasa praevia
(b) Uterine rupture
(c) Placental abruption
(d) None of these
11. The statement appropriate for Placenta praevia:
(a) Placenta praevia complicates about 0.4% of pregnancies at term.
(b) Placenta praevia cannot be diagnosed with ultrasound
(c) The majority of ‘low-lying’ placentas diagnosed at 20 weeks will remain so at term
(d) The patient should be routinely managed under in-patient care with delay of delivery until the patient labours, at which time an emergency Caesarean section will be performed
12. Methods used in identification of high-risk pregnancy:
(a) Use of history as a screening tool in identification of high-risk pregnancy is very sensitive
(b) Use of history as a screening tool in identification of high-risk pregnancy is specific.
(c) The uterine circulation normally develops a very high resistance in normal pregnancy
(d) Low levels of pregnancy-associated plasma protein A (PAPP-A) increase the risk of IUGR, pre-eclampsia and stillbirth
13. The prolonged pregnancy: which of the following is true?
(a) A pregnancy is prolonged if e”40 weeks’ gestation is completed.
(b) Perinatal mortality and morbidity starts increasing between 41 and 42 weeks.
(c) Although stillbirth is increased post dates, neonatal illness, encephalopathy and meconium passage and a clinical diagnosis of fetal distress are less common.
(d) Routine dating scans increase the incidence of induction for post dates.
14. In Breech presentation the following is true?
(a) Fetal abnormality is more common in a breech baby
(b) Caesarean delivery is no safer for the term breech baby than vaginal breech birth.
(c) In breech presentation, labour is longer
(d) Breech presentation occurs in 10% of term deliverie
15. The finding related to Types of multiple pregnancy is
(a) Dichorionic twins result from division at 9–13 days
(b) Division before day 3 leads to twins with a shared placenta but separate amnions, MCDA.
(c) All dichorionic twins are non-identical.
(d) Monochorionic twins are always identical.
16. The complications of multiple pregnanc is :
(a) First trimester miscarriage is more common in multiple pregnancy, but late miscarriage is not
(b) In twin–twin transfusion syndrome, with optimal treatment, survival of both twins occurs in 85%.
(c) Childhood handicap is more common with twins.
(d) In the majority of pregnancies, the presenting twin is breech
17. True features of malpresentation include
(a) Labour is often slower and more painful in occipito-anterior position, with back ache and an early urge to push
(b) Extension of the fetal head on the neck, resulting in a large (13 cm) presenting diameter (brow), will still normally deliver vaginally
(c) Vaginal delivery with a face presentation is possible only in the mento-anterior position
(d) Malpresentation is more common in nulliparous women
18. The Induction of labour: which one of the following is false?
(a) Hyperstimulation is more common with misoprostol than prostaglandin E2 (PGE2).
(b) Cervical ‘sweeping’ from/ after 40 weeks reduces the chance of induction and postdates pregnancy.
(c) Absolute contraindications include acute fetal compromise, abnormal lie, placenta praevia or pelvic obstruction such as a pelvic mass or pelvic deformity causing cephalo-pelvic disproportion
(d) The risk of cord prolapse is decreased with induction of labour.
19. Labour/vaginal delivery after a previous Caesarean section (VBAC), which staement is correct:
(a) If vaginal delivery is attempted about 30% of women will deliver vaginally after one Caesarean section.
(b) Emergency Caesarean section is as safe as elective Caesarean
(c) Fetal risks are increased with VBAC.
(d) Caesarean section is less likely in women who have had a previous elective Caesarean section
20. Prelabour, term rupture of the membranes: which of the following is true?
(a) The incidence of membrane rupture before the onset of labour after 37 weeks is 50%.
(b) Risk of neonatal infection is reduced by vaginal examinations, the presence of group B streptococcus and increased duration of membrane rupture
(c) Induction of labour does not increase the risk of Caesarean section, and is associated with a lower chance of maternal infection.
(d) Erythromycin should be prescribed