Antenatal care

What is the level of growth discordance in MCDA twins that would prompt fetal medicine referral?

>25% fetal growth discordance

If one of the MCDA twins died, what is the chance of death and neurological complications in the second twin?

• death 15%

• neurological complications 26% (therefore do fetal brain MRI after 4 weeks)

When should screening for TTTS and fetal growth discordance start in MCDA?

TTTS - at 16/40

Fetal growth discordance - at 20/40

In MCDA what should the growth discordance be to diagnose fetal growth discordance?

More than 20%

According to last MBRRACE what is the maternal mortality rate overall vs black women?

overall 12.8 in 100,000

black 34 in 100,000

What is the incidence of placenta praevia?

If one prev CS?

1 in 200

1 in 160

What is the success rate of Bakri balloon in PPH?

75-80%

What is the cut off for cervical length in placenta praevia?

if <31mm x16 higher chance of EMCSW

What are the risks of placenta praevia?

MOH 21%

hysterectomy 11%

hysterectomy if prev CS 27%

bladder injury 6%

VTE 3%

What are the T and lambda signs?

T - monochorionic diamniotic

Lambda - dichorionic

What is the rule of cervical length management in multiple pregnancy and its management?

Measure of cervical length is offered once in multiple pregnancy at 16-20 weeks

if <25mm offer progesterone rather than stitch

What percentage of monochorionic twins will experience fetal growth restriction or TTS?

15% for both

What is the expected number of selective termination cases fetal medicine units should do for multiple pregnancy

15 cases pre year with 2 operators

When should patients with multiple pregnancies pregnancies have FBC checked?

booking

20-24/40

28/40

At what gestational age should women give up smoking to have the same effect as non smoker?

What is the maximum length of time a nicotine patch should be worn a day?

prior to 16/40

16 hours a day

What are the most common cause of death in pregnancy?

• direct early

• direct late

• indirect early

• indirect late

• direct early - VTE

• direct late - suicide

• indirect early - cardiac

• indirect late - malignancy

definition of maternal mortality rate vs maternal mortality ratio

maternal mortality rate - per 100,000

maternal mortality ratio - per 100,000 live births

What is the rate of compression to ventilation in neonatal resuscitation?

3 compressions to 1 ventilation

30 of these cycles in 1 minute

What are the side effects of neonatal steroids?

hypoglycaemia

reduced birth weight

psychosis

Difference in dexamethasone vs betamethasone dosing in antenatal care

dexamethasone - 12mg and 12mg 12 hours apart

betamethasone - 12mg and 12mg 24 hours apart

What is the appropriate follow up for a patient who refused IOL for post dates?

x2 weekly CTG

ultrasound for AFI

What is the incidence of breech?

3-5%

What is the mortality in vaginal breech vs CS vs SVD?

vaginal breech 2 in 1000

SVD 1 in 1000

CS 0.5 in 1000W

What is the rate of breech babies will turn to cephalic by term?

What is the rate ECV baby will turn back to breech?

8% and 3&

Still birth rate

2 in 1000 although some say 3

BMI for

• 1 point for antenatal VTE

• aspirin

• OGTT

• growth scans for obesity

• 1 point for antenatal VTE >30

• aspirin >35

• OGTT >30

• growth scans for obesity >35

Target Hb in pregnancy and post partum?

first trimester - 110

from 28/40 - 105

post partum - 100