Options for Questions 1-1ARevise EDDBFetal movement chart

CFetal umbilical artery DopplerDReassure

EDaily day assessment unit visitsFMaternal thrombophilia screen

GBiophysical profileHAmniocentesis for karyotype

IInduction of labour at termJImmediate induction of labour

KFetal growth scans every 2-4 weeksLMaternal glucose tolerance test

Instrunctions:For each of the case histories described below, choose the single most appropriate management from the above list of options. Each option may be used once, more than once, or not at all.

ExplanationQuestion 1A healthy 35 year old primigravida is referred to the antenatal clinic because the fetus is thought to be small for dates at 34 weeks gestation. She had a dating scan at 9 weeks and a normal anomaly scan at 22 weeks. Ultrasound scan shows abdominal and head circumferences below the third centile with normal amniotic fluid volume.

Options for Questions 2-2AOffer external cephalic versionBDiscuss benefits of vaginal breech delivery

CMaternal MRI pelvimetryDBreech extraction

EReview at 36-37 weeks gestationFCaesarean section at 37-38 weeks

GUltrasound scan for estimated fetal weightHStabilising induction of labour

ICaesarean section at 39 weeksJUltrasound scan for placental site

KDetailed anomaly scan to exclude congenital anomaliesLAdmit for assessment

Instrunctions:For each of the case histories described below, choose the single most appropriate management from the above list of options. Each option may be used once, more than once, or not at all.

ExplanationQuestion 2A healthy 23 year old primigravida attends for a routine antenatal clinic visit at 34 weeks gestation, Her pregnancy has been uncomplicated but the fetus is identified to be in a breech presentation.

Options for Questions 3-3AOffer external cephalic versionBDiscuss benefits of vaginal breech delivery

CMaternal MRI pelvimetryDBreech extraction

EReview at 36-37 weeks gestationFCaesarean section at 37-38 weeks

GUltrasound scan for estimated fetal weightHStabilising induction of labour

ICaesarean section at 39 weeksJUltrasound scan for placental site

KDetailed anomaly scan to exclude congenital anomaliesLAdmit for assessment

Instrunctions:For each of the case histories described below, choose the single most appropriate management from the above list of options. Each option may be used once, more than once, or not at all.

ExplanationQuestion 3A healthy 37 year old primigravida is referred to the antenatal clinic at 37 weeks gestation because of a breech presentation. The placenta is fundal and the uterine size is appropriate for gestation age.

Options for Questions 4-4ACan be delivered in a midwifery-led unitBCan have a home birth

CShould deliver in a consultant-led unitDShould have venous access in the second stage of labour

EShould have an anaesthetist at ST3 level or above availableFShould have an obstetrician at ST3 level or above available

GConsultant obstetrician should be immediately availableHConsultant anaesthetist should be immediately available

IShould have an anaesthetist at ST6 level or above availableJShould be delivered in a tertiary centre

KShould have venous access in the third stage of labourLShould have blood cross-matched during labour

Instrunctions:For each scenario described below, choose the single most appropriate plan for labour from the above list of options. Each option may be used once, more than once, or not at all.

ExplanationQuestion 4A 35 year old woman has attended the consultant antenatal clinic at 36 weeks gestation to discuss her birth plan. Her BMI was 42 at booking and 45 at 36 weeks. Her pregnancy is otherwise uncomplicated

Options for Questions 5-5AProphylactic antibiotics in labourBProphylactic antibiotics if vaginal operative delivery

CVenous access early in labourDBlood grouped & saved in labour

EBlood cross-matched in labourFActive management of the third stage of labour

GFetal monitoring using scalp electrodeHVenous access in the second stage of labour

IVenous access in the third stage of labourJProphylactic oxytocin infusion after delivery of the placenta

KProphylactic rectal misoprostol after delivery of the placentaLProphylactic low molecular weight heparin in labour

Instrunctions:For each scenario described below, choose the single most appropriate intervention from the above list of options. Each option may be used once, more than once, or not at all.

ExplanationQuestion 5A 30 year old primigravida presents in spontaneous labour at 38 weeks gestation. Her BMI was 43 at 37 weeks gestation and her pregnancy has been uncomplicated. Her cervix is fully effaced and 2cm dilated.

Options for Questions 6-6AThrombophilia screenBStop heparin

CStop warfarinDAdvise against pregnancy

EConvert warfarin to low molecular weight heparinFConvert low molecular weight heparin to warfarin

GScreen for antiphospholipidantibodiesHClose observation for additional risk factors

IGraduated elastic compression stockingsJLow molecular weight heparin as soon as possible

KLow molecular weight heparin from 12 weeksLWarfarin as soon as possible

Instrunctions:For each scenario described below, choose the single most appropriate antenatal management from the above list of options. Each option may be used once, more than once, or not at all.

ExplanationQuestion 6A 37 year old woman attends the antenatal clinic at 12 weeks gestation in her first pregnancy. She is wheelchair bound because of spina bifida and her BMI is 42

Options for Questions 7-7AThrombophilia screenBStop heparin

COffer termination of pregnancyDLow molecular weight heparin for 7 days post-partum

ELow molecular weight heparin for 6 weeks post-partumFScreen for antiphospholipid antibodies

GClose observation for additional risk factorsHClose observation for additional risk factors + low molecular weight heparin for 7 days post-partum

IClose observation for additional risk factors + low molecular weight heparin for 6 weeks post-partumJGraduated elastic compression stockings

KLow molecular weight heparin antenatally + 6 weeks post-partumLLow molecular weight heparin antenatally + 7 days post-partum

MWarfarin from 12 weeks

Instrunctions:For each scenario described below, choose the single most appropriate management from the above list of options. Each option may be used once, more than once, or not at all.

ExplanationQuestion 7A 32 year old woman attends the antenatal clinic at 20 weeks gestation. She is known to be a carrier of the factor V Leiden mutation but has never had a thromboembolic event. Her BMI is 29

Options for Questions 8-8AOffer termination of pregnancyBProphylactic dose low molecular weight heparin

CHigh (12 hourly) prophylactic dose low molecular weight heparinDScreen for antiphospholipid antibodies

EThrombophilia screenFClose observation for additional risk factors

GGraduated elastic compression stockingsHProphylactic dose low molecular weight heparin if admitted

ITherapeutic dose low molecular weight heparin if admittedJHigh prophylactic dose low molecular weight heparin if admitted

KWarfarin from 12 weeks gestationLTherapeutic dose low molecular weight heparin

MProphylactic dose low molecular weight heparin + low dose aspirin

Instrunctions:For each scenario described below, choose the single most appropriate antenatal management from the above list of options. Each option may be used once, more than once, or not at all.

ExplanationQuestion 8A 33 year old woman attends the antenatal clinic at 12 weeks gestation. She is known to be a carrier of the Factor V Leiden mutation and suffered a pulmonary embolus 3 weeks after caesarean section in her last pregnancy

Options for Questions 9-10ALow molecular weight heparin for 3-5 daysBLow molecular weight heparin for 7 days

CLow molecular weight heparin for 6 weeksDLow molecular weight heparin for 3 months

EGraduated compression stockingsFLow dose aspirin

GUnfractionated heparinHLower prophylactic dose of enoxaparin

ILower peophylactic dose of tinzaparinJHigh prophylactic dose of enoxaparin

KHigh prophylactic dose of tinzaparinLTherapeutic dose of tinzaparin

MTherapeutic dose of enoxaparinNLow molecular weight heparin for 7 days 6 weeks

Instrunctions:For each scenario described below, choose the single most appropriate antenatal management from the above list of options. Each option may be used once, more than once, or not at all.

ExplanationQuestion 9A 23 year old woman has a grade III caesarean section for breech presentation in labour. Her BMI is 25 and the operation has been uncomplicated with an estimated blood loss of 750ml

Question 10A 38 year old woman has a normal vaginal delivery following a 10 hour labour. Her BMI is 39.