MRCOG part 2

Risk of postpartum psychosis with hx of bipolar

50%, 1 in 2

Incidence of early onset GBS in the newborn

0.57

Increase in maternal mortality in multiple pregnancy

2.5x

Risk of adverse outcome to baby in low risk pregnancies having a home birth in the UK

9 per 1000

Risk of reversion to breech after successful ECV at 36 weeks

5%

Risk of uterine perforation during ERPC

5 in 1000

Risk of simple hyperplasia without atypia progressing to endometrial cancer

1%

Approx 4% for complex hyperplasia

Overall risk of hyperplasia without atypia → 5%

What is the increased risk of CS in IOL vs SOL

1.5x

Normal Hb in 1st Trimester

>110

What percentage of births in the UK are instrumental deliveries?

10%.

What is the approximate rate of episiotomy in a vacuum-assisted delivery?

50–60%.

What is the approximate rate of episiotomy in a forceps delivery?

>90%.

What percentage of instrumental deliveries without episiotomy result in a significant vulvo-vaginal tear?

17-38%.

The rate of Obstetric Anal Sphincter Injury (OASI) in a vacuum-assisted delivery is _____.

1–4%.

What is the risk of Obstetric Anal Sphincter Injury (OASI) associated with a forceps delivery?

8–12%.

What is the risk of postpartum haemorrhage (PPH) following both vacuum and forceps deliveries?

10–40%.

Cephalhaematoma is a perinatal outcome predominantly associated with vacuum delivery, with an incidence of _____.

1–12%.

What is the incidence of facial or scalp lacerations in both vacuum and forceps deliveries?

10%.

What is the overall incidence of Obstetric Anal Sphincter Injury (OASI) in the UK?

3%.

How does the UK incidence of OASI differ between primiparous and multiparous women?

6% in primiparous women

2% in multiparous women.

By what factor does a ventouse (vacuum) delivery increase the risk of OASI?

It doubles the risk (2X).

By what factor do nulliparity and forceps delivery each increase the risk of OASI?

They each increase the risk by a factor of six (6X).

How is the increased risk of OASI from a forceps delivery (6X) modified by performing an episiotomy?

6x to 1.3x

What percentage of women who sustain an OASI are asymptomatic after one year?

60-80%.

What is the maximum safe dose of lignocaine with adrenaline when used as a local anaesthetic?

7 mg/kg.

What is the maximum safe dose of lignocaine without adrenaline when used as a local anaesthetic?

3 mg/kg.

What is the incidence of cord prolapse?

0.5%.

A breech presentation increases the risk of cord prolapse by a factor of _____.

two (2X).

What is the perinatal mortality rate associated with cord prolapse?

1%.

In maternal collapse, what percentage of normal cardiac output is achieved with CPR?

30%.

From 20 weeks of gestation, aortocaval compression significantly reduces cardiac output by up to _____.

90% (leaving only 10%).

If there is no response to correctly performed CPR, after how many minute should a perimortem CS be commenced and delivery

CS after 4 minutes of collapse

Delivery after 5 minutes of collapse

What is the standard intramuscular dose of adrenaline for treating anaphylaxis in an adult?

500 micrograms (0.5 ml) of 1:1000 adrenaline solution.

What is the intravenous bolus dose of adrenaline used in maternal collapse/anaphylaxis?

50 micrograms (0.5 ml of 1:10,000 solution).

What is the incidence of placental abruption?

0.5%.

What percentage of placental abruption cases occur in pregnancies considered low-risk?

70%.

What is the recurrence risk of placental abruption after one previous abruption?

10%.

After two previous placental abruptions, the recurrence risk increases to _____.

25%.

What is the incidence of vasa praevia?

1 in 1,200 to 1 in 5,000 pregnancies.

Even with urgent caesarean delivery, what is the minimum fetal mortality rate in cases of vasa praevia?

At least 60%.

For an asymptomatic woman with a prenatal diagnosis of vasa praevia, when is a planned caesarean delivery considered reasonable?

At 34–36 weeks of gestation.

Vasa praevia is more common in pregnancies conceived via _____.

In vitro fertilisation (IVF).

What is the incidence of Preterm Prelabour Rupture of Membranes (P-PROM)?

3%.

Following P-PROM, the risk of neonatal infections increases to _____, compared to 0.5% in normal labour.

1%.

What percentage of women with P-PROM will go into labour within 24 hours?

60%.

What is the UK guidance on offering antenatal corticosteroids for gestations between 24+0 and 33+6 weeks?

Offer corticosteroids.

What is the UK guidance on antenatal corticosteroids for gestations between 34+0 and 35+6 weeks?

Consider corticosteroids.

For gestations between 23+0 and 23+6 weeks, what is the UK guidance on antenatal corticosteroids?

Discuss the use of corticosteroids.

What is the incidence of stillbirth (SB) in the UK?

0.5% (5 per 1000 births).

What proportion of stillbirths are classified as unexplained?

50%.

What percentage of stillbirths are associated with the baby being small for gestational age (SGA)?

33%.

Following an intrauterine death, what percentage of women will deliver spontaneously within 3 weeks?

85%.

What is the risk of developing Disseminated Intravascular Coagulation (DIC) within 4 weeks of an intrauterine death?

10%.

The risk of developing Disseminated Intravascular Coagulation (DIC) rises to _____ after 4 weeks following an intrauterine death.

30%.

What is the risk of nerve entrapment after one caesarean section using a Pfannenstiel incision?

Less than 1%.

According to the TOG source, what is the overall rate of nerve injuries associated with gynaecological surgery?

3.7%.

In vertical transmission of Hepatitis B, what is the risk if the mother is e-antigen positive?

90%.

In vertical transmission of Hepatitis B, the risk is _____ if the mother is e-antigen negative.

10%.

If an infant is infected with Hepatitis B at birth, what is the likelihood they will become a chronic carrier?

90%.

By what percentage does the combination of vaccination and immunoglobulin reduce the vertical transmission of Hepatitis B?

By more than 90%.

What is the incidence of obstetric cholestasis in multi-ethnic populations?

0.7% of pregnancies.

The incidence of obstetric cholestasis is _____ in women of Indian-Asian or Pakistani-Asian origin.

1.2%–1.5%.

What is the incidence of early miscarriage (before 12 weeks)?

20%.

What is the incidence of late miscarriage (between 12 and 24 weeks)?

1-2%.

Recurrent miscarriage, defined as three or more consecutive miscarriages, affects what percentage of couples?

1%.

What is the approximate risk of a subsequent miscarriage after a woman has had three previous miscarriages?

40%.

Parental genetic factors are responsible for what percentage of recurrent miscarriages?

2%.

What is the risk of miscarriage for a woman under the age of 30?

10%.

The risk of miscarriage for a woman aged 40 is _____.

50%.

For a woman over the age of 45, the risk of miscarriage is _____.

90%.

What is the incidence of ectopic pregnancy?

11 per 1000 pregnancies (1.1%).

In women with fertility-reducing factors, what is the future pregnancy rate after a salpingotomy for an ectopic pregnancy?

75%.

In women with fertility-reducing factors, what is the future pregnancy rate after a salpingectomy for an ectopic pregnancy?

40%.

For women without fertility-reducing factors, what is the future pregnancy rate after either a salpingotomy or salpingectomy?

90% in both groups.

What is the recommended daily dose of folic acid for a pregnant woman with a BMI greater than 30?

5mg (until 12 weeks).

At what gestation should an Oral Glucose Tolerance Test (OGTT) be offered to a pregnant woman with a BMI over 30?

Between 24-28 weeks.

A BMI greater than _____ is considered a moderate risk factor for pre-eclampsia, warranting consideration of low-dose aspirin.

35

What is the overall rate of serious risk (to major vessels, bladder, uterus, or bowel) in laparoscopy?

2 per 1000 procedures.

What percentage of bowel injuries that occur during laparoscopy are not diagnosed at the time of surgery?

15%.

What proportion of major complications in laparoscopy are related to the entry technique?

50%.

In a patient with a previous midline incision, what is the risk of umbilical adhesions?

50%.

Following a previous suprapubic incision (e.g., Pfannenstiel), the risk of umbilical adhesions is _____.

25%.

What is the risk of uterine perforation during a surgical evacuation of retained products of conception?

1 in 1000.

What is the rate of serious complications overall for a hysterectomy?

4 per 100 (4%).

The risk of haemorrhage and blood transfusion during a hysterectomy is _____.

2 per 100 (2%).

What is the risk of urinary tract injury during a hysterectomy?

7 per 1000.

What is the prevalence of endometriosis in the general population?

2-10%.

Among women with pelvic pain, what percentage are found to have endometriosis?

90%.

What is the risk of an unsuspected uterine sarcoma during surgery for a presumed benign fibroid in women under 50?

2.5 per 1000.

In post-menopausal women, what is the risk of an unsuspected uterine sarcoma at the time of surgery for a presumed benign fibroid?

6 per 1000.

What is the risk of permanent amenorrhoea following Uterine Artery Embolisation (UAE)?

1.5–7% overall, but it is markedly dependent on the patient’s age.

What percentage of patients who undergo Uterine Artery Embolisation (UAE) require an urgent hysterectomy, usually due to infection?

1%.

Over 20 years, what is the risk of endometrial hyperplasia without atypia progressing to carcinoma?

Less than 5%.

What percentage of cases of endometrial hyperplasia without atypia will spontaneously regress?

Over 80%.

Atypical endometrial hyperplasia (AH) carries a _____ risk of progressing to malignancy over 20 years.

25%.

In women diagnosed with atypical endometrial hyperplasia (AH), what percentage may have a concomitant carcinoma already present?

Up to 40%.

What is the lifetime risk of ovarian cancer for a carrier of the BRCA 1 gene mutation?

40%.

What is the lifetime risk of breast cancer for a carrier of either the BRCA 1 or BRCA 2 gene mutation?

80%.

For a carrier of the BRCA 2 gene mutation, the lifetime risk of ovarian cancer is _____.

20%.

HNPCC (Lynch Syndrome Type II) carries a 12% lifetime risk of ovarian cancer and is also associated with which other gynaecological cancer?

Endometrial cancer.