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UKOM SpOG practice questions

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Question 1Obstetrics: Antenatal Care and Normal Pregnancy

At what gestational age, measured from the first day of the last menstrual period, is a pregnancy conventionally considered to reach term?

  1. From 34+0 to 36+6 weeks
  2. From 37+0 to 41+6 weeks Correct answer.
  3. From 39+0 to 40+6 weeks
  4. From 42+0 weeks onward

Explanation

Term is conventionally defined as the period from 37+0 to 41+6 weeks of gestation calculated from the first day of the last menstrual period. Deliveries before 37+0 weeks are preterm, and those from 42+0 weeks are post-term. Subcategories (early term, full term, late term) refine this range but do not change its outer limits.

Question 2Obstetrics: Antenatal Care and Normal Pregnancy

A woman at 10 weeks of gestation reports mild nausea and vomiting but is tolerating fluids and has no weight loss. Which initial management is most appropriate?

  1. Immediate hospital admission for intravenous fluids
  2. Elective caesarean section planning
  3. Reassurance, dietary advice and outpatient antiemetic therapy Correct answer.
  4. Routine termination counselling

Explanation

Mild nausea and vomiting of pregnancy that does not impair hydration or nutrition is managed in the community with reassurance, small frequent bland meals, avoidance of triggers, and an antiemetic such as doxylamine-pyridoxine if needed. Admission and intravenous rehydration are reserved for hyperemesis gravidarum with dehydration, ketosis, or weight loss.

Question 3Obstetrics: Antenatal Care and Normal Pregnancy

Which supplement is recommended routinely for all pregnant women in the UK to reduce the risk of fetal neural tube defects?

  1. Vitamin A 10,000 IU daily
  2. Iron 200 mg daily from the first trimester
  3. Calcium 1 g daily throughout pregnancy
  4. Folic acid 400 micrograms daily before conception and until 12 weeks Correct answer.

Explanation

Periconceptual folic acid 400 micrograms daily, started before conception and continued to 12 weeks, reduces the incidence of neural tube defects. A higher dose of 5 mg is used for women with additional risk factors such as previous affected pregnancy, diabetes, or obesity. Iron and calcium are not given routinely to all women, and high-dose vitamin A is teratogenic.

Question 4Obstetrics: Antenatal Care and Normal Pregnancy

A woman books at 8 weeks. Which routine investigation is offered at the booking visit as part of standard UK antenatal care?

  1. Routine thyroid ultrasound
  2. First-trimester amniocentesis
  3. Full blood count and blood group with antibody screen Correct answer.
  4. Routine oral glucose tolerance test for all women

Explanation

Booking bloods include full blood count, blood group and red cell antibodies, rubella immunity, syphilis, hepatitis B, HIV, and haemoglobinopathy screening where indicated. A glucose tolerance test is offered only to women with risk factors for gestational diabetes, and invasive testing is not routine.

Question 5Obstetrics: Antenatal Care and Normal Pregnancy

At what gestation is the routine fetal anomaly ultrasound scan normally offered in the UK?

  1. 11+0 to 13+6 weeks
  2. 18+0 to 20+6 weeks Correct answer.
  3. 30+0 to 32+0 weeks
  4. 24+0 to 28+0 weeks

Explanation

The mid-trimester anomaly scan is offered between 18+0 and 20+6 weeks, when fetal anatomy is well visualised and before the limit for legal termination in most circumstances. The 11+0 to 13+6 week scan is the dating and combined screening scan, not the anomaly scan.

Question 6Obstetrics: Antenatal Care and Normal Pregnancy

A nulliparous woman at 30 weeks reports regular painful tightenings and low back pain. What is the most appropriate next step?

  1. Reassure her that back pain is always musculoskeletal
  2. Prescribe a course of antibiotics
  3. Advise her to wait until 37 weeks for routine review
  4. Arrange urgent assessment of uterine activity and cervical change Correct answer.

Explanation

Regular painful contractions with back pain before 37 weeks raise suspicion of threatened preterm labour and require urgent assessment, including fetal monitoring and cervical assessment. Delay until term review risks missing preterm labour and its complications. Antibiotics are not indicated without evidence of infection.

Question 7Obstetrics: Antenatal Care and Normal Pregnancy

A woman at 26 weeks has a haemoglobin of 95 g/L with a mean corpuscular volume of 72 fL. Which is the most likely cause?

  1. Anaemia of chronic disease
  2. Folate deficiency
  3. Thalassaemia trait
  4. Iron deficiency anaemia Correct answer.

Explanation

Microcytic anaemia with a low MCV in pregnancy is most commonly due to iron deficiency, which is common because of increased iron requirements. Ferritin should be checked, and iron therapy started. Thalassaemia trait is possible but less likely without a family history or ethnic risk, and folate deficiency causes macrocytosis.

Question 8Obstetrics: Antenatal Care and Normal Pregnancy

A woman at 34 weeks has a fundal height of 30 cm. Which action is most appropriate?

  1. Immediately induce labour
  2. Reassure her that fundal height is imprecise and review at term
  3. Arrange ultrasound assessment of fetal growth and liquor volume Correct answer.
  4. Repeat the fundal height in 6 weeks

Explanation

A fundal height that is 3 cm or more below the gestation-specific expected value warrants ultrasound biometry and assessment of amniotic fluid to exclude fetal growth restriction. Immediate delivery is not indicated at 34 weeks without further evidence of compromise, and delaying reassessment risks missing growth restriction.

Question 9Obstetrics: Antenatal Care and Normal Pregnancy

Which finding on the 20-week anomaly scan is a soft marker for fetal aneuploidy rather than a structural anomaly?

  1. Holoprosencephaly
  2. Echogenic intracardiac focus Correct answer.
  3. Diaphragmatic hernia
  4. Bilateral renal agenesis

Explanation

An echogenic intracardiac focus is a common soft marker associated with an increased risk of trisomy 21 but is usually a normal variant. Structural anomalies such as holoprosencephaly, diaphragmatic hernia, and renal agenesis are major malformations requiring detailed counselling and further investigation.

Question 10Obstetrics: Antenatal Care and Normal Pregnancy

A woman with a previous caesarean section is considering a vaginal birth after caesarean. Which factor most strongly increases the risk of uterine rupture?

  1. Spontaneous onset of labour
  2. Maternal age under 30
  3. Induction of labour with a single agent Correct answer.
  4. Previous vaginal delivery

Explanation

Induction of labour, particularly with prostaglandins or multiple agents, increases the risk of uterine rupture in women with a previous caesarean. Previous vaginal delivery and spontaneous labour are associated with higher success rates and lower rupture risk. Maternal age under 30 is not a recognised major risk factor.

Question 11Obstetrics: Antenatal Care and Normal Pregnancy

A woman at 28 weeks has a random plasma glucose of 11.1 mmol/L. Which diagnosis is most likely?

  1. Pre-existing type 1 diabetes
  2. Renal glycosuria
  3. Transient hyperglycaemia of pregnancy
  4. Gestational diabetes mellitus Correct answer.

Explanation

A random plasma glucose of 11.1 mmol/L or more, with symptoms or confirmed on repeat, meets criteria for gestational diabetes when first recognised in pregnancy. Pre-existing diabetes would usually have been diagnosed before conception or at booking. Renal glycosuria does not cause hyperglycaemia.

Question 12Obstetrics: Antenatal Care and Normal Pregnancy

Which vaccine is routinely recommended in the UK during pregnancy to protect the newborn against pertussis?

  1. Live attenuated varicella vaccine
  2. Oral polio vaccine
  3. Live attenuated measles-mumps-rubella vaccine
  4. Tetanus-diphtheria-inactivated poliomyelitis-pertussis (Tdap) vaccine Correct answer.

Explanation

The combined Tdap vaccine is offered in each pregnancy, usually from 16 weeks, to provide passive antibody protection against pertussis in the first months of life. Live vaccines such as MMR and varicella are contraindicated in pregnancy. Oral polio vaccine is not used in the UK schedule.

Question 13Obstetrics: Antenatal Care and Normal Pregnancy

A woman at 36 weeks has a singleton breech presentation confirmed by ultrasound. Which management option is appropriate to offer?

  1. Immediate caesarean section at 36 weeks
  2. Await spontaneous version after 40 weeks
  3. Induction of labour at 37 weeks
  4. External cephalic version Correct answer.

Explanation

External cephalic version is offered from 36 to 37 weeks for a singleton breech without contraindications, with a success rate of around 50 percent. Immediate caesarean at 36 weeks is premature, and induction of labour is not recommended for breech. Spontaneous version becomes less likely after 37 weeks.

Question 14Obstetrics: Antenatal Care and Normal Pregnancy

A woman at 32 weeks has a blood pressure of 150/95 mmHg on two occasions with 2+ proteinuria. Which diagnosis is most likely?

  1. Chronic hypertension
  2. White-coat hypertension
  3. Gestational hypertension
  4. Pre-eclampsia Correct answer.

Explanation

New hypertension after 20 weeks with significant proteinuria defines pre-eclampsia. Gestational hypertension lacks proteinuria, chronic hypertension predates pregnancy or is present before 20 weeks, and white-coat hypertension is not associated with proteinuria.

Question 15Obstetrics: Antenatal Care and Normal Pregnancy

Which prophylactic measure is recommended for a woman at high risk of pre-eclampsia, such as one with previous pre-eclampsia?

  1. Aspirin 75 to 150 mg daily from 12 weeks Correct answer.
  2. Routine calcium supplementation at 2 g daily
  3. Prophylactic magnesium sulphate infusion
  4. Low molecular weight heparin from the first trimester

Explanation

Low-dose aspirin, usually 75 to 150 mg daily, started from 12 weeks, is recommended for women at high risk of pre-eclampsia. Heparin, high-dose calcium, and prophylactic magnesium are not routine preventive measures; magnesium is used for treatment and seizure prophylaxis in established severe disease.

Question 16Obstetrics: Antenatal Care and Normal Pregnancy

A woman at 12 weeks has a body mass index of 38. Which additional antenatal recommendation applies?

  1. Recommend routine thromboprophylaxis from the first trimester
  2. Offer a 5 mg folic acid dose and a glucose tolerance test Correct answer.
  3. Advise weight loss of 10 kg during pregnancy
  4. Offer a routine 20-week scan only

Explanation

A body mass index of 30 or more is associated with an increased risk of neural tube defects and gestational diabetes, so a higher folic acid dose of 5 mg and an oral glucose tolerance test are recommended. Weight loss during pregnancy is not advised, and routine thromboprophylaxis depends on additional risk assessment.

Question 17Obstetrics: Antenatal Care and Normal Pregnancy

A woman at 16 weeks reports a two-week history of intense generalised itching without a rash, worse at night. Which condition should be excluded first?

  1. Candidal infection
  2. Intrahepatic cholestasis of pregnancy Correct answer.
  3. Atopic eczema
  4. Pruritic urticarial papules and plaques of pregnancy

Explanation

Generalised itching without a primary rash, particularly worse at night, suggests intrahepatic cholestasis of pregnancy, which requires bile acid and liver function testing. Pruritic urticarial papules and plaques of pregnancy and eczema produce visible skin lesions, and candidiasis causes localised vulvovaginal symptoms.

Question 18Obstetrics: Antenatal Care and Normal Pregnancy

A woman at 38 weeks has a singleton cephalic fetus and spontaneous rupture of membranes with clear liquor but no contractions after 4 hours. Which management is recommended?

  1. Give prophylactic antibiotics and discharge home
  2. Perform immediate caesarean section
  3. Offer induction of labour with oxytocin or prostaglandin Correct answer.
  4. Await spontaneous labour for up to 72 hours

Explanation

For a term woman with ruptured membranes and no labour after 4 hours, induction of labour is recommended to reduce the risk of maternal and neonatal infection. Prolonged expectant management increases infection risk, and caesarean section is not indicated for uncomplicated rupture with a cephalic fetus.

Question 19Obstetrics: Antenatal Care and Normal Pregnancy

A woman at 34 weeks presents with painless vaginal bleeding and a soft uterus. Which is the most appropriate initial step?

  1. Admit for assessment and avoid digital vaginal examination Correct answer.
  2. Perform a speculum and digital examination in clinic
  3. Arrange outpatient ultrasound in one week
  4. Advise bed rest at home

Explanation

Painless vaginal bleeding in the third trimester suggests placenta praevia, and digital vaginal examination can provoke catastrophic haemorrhage. The woman should be admitted for maternal and fetal assessment and ultrasound localisation of the placenta. Outpatient review or bed rest alone is unsafe.

Question 20Obstetrics: Antenatal Care and Normal Pregnancy

A woman at 24 weeks has a cervix measuring 20 mm on transvaginal ultrasound and a history of previous preterm birth. Which intervention reduces the risk of preterm delivery?

  1. Routine cervical cerclage for all women
  2. Elective delivery at 34 weeks
  3. Vaginal progesterone Correct answer.
  4. Routine tocolysis from 24 weeks

Explanation

A short cervix with a history of preterm birth identifies a woman at high risk, and vaginal progesterone reduces the risk of preterm delivery. Cerclage is considered in selected cases but is not routine for all, and elective early delivery or long-term tocolysis is not appropriate.

Question 21Obstetric Complications and High-Risk Pregnancy

A 30-year-old woman at 34 weeks' gestation has a blood pressure of 158/108 mmHg on two occasions four hours apart, 3+ proteinuria on dipstick, and a platelet count of 88 × 10⁹/L. Which classification best fits this presentation?

  1. HELLP syndrome without hypertension
  2. Severe pre-eclampsia Correct answer.
  3. Gestational hypertension without proteinuria
  4. Chronic hypertension with superimposed pre-eclampsia

Explanation

Pre-eclampsia is diagnosed when new hypertension after 20 weeks is accompanied by proteinuria or other maternal organ dysfunction. Severe features here include systolic ≥160 mmHg, diastolic ≥110 mmHg and thrombocytopenia below 100 × 10⁹/L. The combination therefore meets criteria for pre-eclampsia with severe features.

Question 22Obstetric Complications and High-Risk Pregnancy

Which single measurement is used to define chronic hypertension in pregnancy when the diagnosis is made during gestation?

  1. Blood pressure ≥140/90 mmHg before 20 weeks' gestation Correct answer.
  2. Blood pressure ≥160/110 mmHg persisting for 24 hours postpartum
  3. Blood pressure ≥150/100 mmHg at any point after delivery
  4. Blood pressure ≥130/80 mmHg in the first trimester

Explanation

Chronic hypertension is defined as blood pressure of at least 140/90 mmHg present before 20 weeks' gestation, present before pregnancy, or persisting beyond 12 weeks postpartum. A first-trimester threshold of 130/80 mmHg does not define the condition.

Question 23Obstetric Complications and High-Risk Pregnancy

A woman with pre-eclampsia is given magnesium sulphate for seizure prophylaxis. Which clinical sign is the earliest indicator of magnesium toxicity and should prompt reassessment?

  1. Loss of the deep tendon reflexes Correct answer.
  2. Urine output of 100 mL per hour
  3. Respiratory rate of 18 breaths per minute
  4. Serum magnesium of 2.0 mmol/L

Explanation

Magnesium toxicity progresses from loss of deep tendon reflexes, to respiratory depression, to cardiac arrest. Reflexes disappear at roughly 3.5–5 mmol/L, before respiratory compromise. Monitoring reflexes, respiratory rate and urine output is therefore standard practice during infusion.

Question 24Obstetric Complications and High-Risk Pregnancy

A woman at 33 weeks' gestation presents with painless vaginal bleeding. Ultrasound shows the placenta covering the internal cervical os. Which initial management step is most appropriate?

  1. Immediate amniotomy to decompress the uterus
  2. Corticosteroids, anti-D if Rh-negative, and avoidance of vaginal examination Correct answer.
  3. Digital vaginal examination to assess dilatation
  4. Immediate caesarean delivery regardless of maternal or fetal condition

Explanation

In suspected placenta praevia, digital vaginal examination can provoke catastrophic haemorrhage and is contraindicated until praevia is excluded. Initial management is expectant, with antenatal corticosteroids, anti-D immunoglobulin for Rh-negative women, and preparation for controlled delivery. Immediate delivery is reserved for maternal instability or non-reassuring fetal status.

Question 25Obstetric Complications and High-Risk Pregnancy

Which finding is most characteristic of placental abruption rather than placenta praevia?

  1. Bleeding occurring only after rupture of membranes
  2. Bleeding associated with a fundal placenta on ultrasound
  3. Painful bleeding with a tense, tender uterus Correct answer.
  4. Painless bright-red bleeding with a soft uterus

Explanation

Abruption typically produces painful bleeding with a hard, tender uterus because blood dissects into the myometrium. Praevia more often causes painless bleeding with a relaxed uterus. Concealed abruption may show little external bleeding despite significant retroplacental loss.

Question 26Obstetric Complications and High-Risk Pregnancy

A woman at 36 weeks' gestation with gestational diabetes has an estimated fetal weight on the 95th centile. Which fetal complication is most strongly associated with this finding?

  1. Fetal growth restriction
  2. Oligohydramnios
  3. Neural tube defect
  4. Shoulder dystocia Correct answer.

Explanation

Maternal hyperglycaemia drives fetal hyperinsulinaemia, producing macrosomia with disproportionate truncal growth. The resulting shoulder dystocia risk at delivery is the classic intrapartum concern. Careful counselling about delivery mode and anticipation of dystocia at delivery are therefore essential.

Question 27Obstetric Complications and High-Risk Pregnancy

A woman with type 1 diabetes is planning pregnancy. Which preconception measure most reduces the risk of congenital malformation?

  1. Reducing insulin doses to avoid first-trimester hypoglycaemia
  2. Tight glycaemic control targeting HbA1c below 6.5% before conception Correct answer.
  3. Switching to an oral hypoglycaemic agent before conception
  4. Starting folic acid 5 mg daily from confirmation of pregnancy

Explanation

Congenital malformations in pre-gestational diabetes are related to periconceptional glycaemia, so optimisation of HbA1c before conception is the key intervention. High-dose folic acid should also be started before conception, not after pregnancy is confirmed. Oral agents and insulin reduction are not standard preconception strategies.

Question 28Obstetric Complications and High-Risk Pregnancy

Which parameter is used to diagnose gestational diabetes on a 75 g oral glucose tolerance test at 24–28 weeks?

  1. Fasting plasma glucose ≥7.0 mmol/L
  2. Random glucose ≥11.1 mmol/L
  3. Two-hour glucose ≥7.8 mmol/L
  4. Fasting plasma glucose ≥5.1 mmol/L Correct answer.

Explanation

The diagnostic thresholds on a 75 g OGTT are fasting ≥5.1 mmol/L, one-hour ≥10.0 mmol/L, or two-hour ≥8.5 mmol/L, with any single value being sufficient. A fasting value of 7.0 mmol/L suggests overt diabetes rather than gestational diabetes. The two-hour threshold of 7.8 mmol/L belongs to older criteria.

Question 29Obstetric Complications and High-Risk Pregnancy

A woman at 31 weeks' gestation reports reduced fetal movements. Cardiotocography shows a sinusoidal pattern. Which interpretation is most appropriate?

  1. A sign of fetal anaemia requiring urgent assessment Correct answer.
  2. A normal variant requiring no further action
  3. An artefact of maternal obesity
  4. A pattern typical of uterine hyperstimulation

Explanation

A true sinusoidal pattern is a smooth, undulating baseline without accelerations and is strongly associated with fetal anaemia, often from fetomaternal haemorrhage. It warrants urgent evaluation, including fetal middle cerebral artery Doppler and consideration of delivery. It is not a normal variant and must not be dismissed.

Question 30Obstetric Complications and High-Risk Pregnancy

Which finding on cardiotocography most strongly suggests fetal hypoxaemia requiring intrauterine resuscitation?

  1. Baseline rate of 140 beats per minute
  2. Recurrent late decelerations Correct answer.
  3. Baseline variability of 10 beats per minute
  4. Fetal heart rate accelerations with movement

Explanation

Late decelerations reflect uteroplacental insufficiency and, when recurrent, indicate fetal hypoxaemia. Initial management includes maternal left lateral positioning, oxygen if hypoxic, fluid bolus and stopping oxytocin. Variability of 10 beats per minute and accelerations are reassuring features.

Question 31Obstetric Complications and High-Risk Pregnancy

A woman at 28 weeks' gestation has a cervical length of 18 mm on transvaginal ultrasound with a history of one previous preterm birth. Which intervention most reduces the risk of preterm delivery?

  1. Routine bed rest until term
  2. Elective caesarean section at 34 weeks
  3. Vaginal progesterone Correct answer.
  4. Cervical cerclage in all such women

Explanation

In women with a short cervix, vaginal progesterone reduces the incidence of preterm birth and neonatal morbidity. Cerclage is reserved for selected cases, such as a history of preterm birth with a short cervix or recurrent second-trimester loss. Bed rest and elective early caesarean are not effective preventive strategies.

Question 32Obstetric Complications and High-Risk Pregnancy

Which organism is most commonly implicated in preterm prelabour rupture of membranes?

  1. Candida albicans
  2. Herpes simplex virus
  3. Treponema pallidum
  4. Group B streptococcus Correct answer.

Explanation

Ascending genital tract infection is the leading mechanism of preterm prelabour rupture of membranes, and group B streptococcus is among the most frequently isolated organisms. This underpins the use of intrapartum antibiotic prophylaxis. Candida, treponema and herpes are not the dominant causes.

Question 33Obstetric Complications and High-Risk Pregnancy

A woman at 26 weeks' gestation with preterm prelabour rupture of membranes is stable with no signs of chorioamnionitis. Which management is most appropriate?

  1. Amnioinfusion to restore fluid volume
  2. Expectant management with antibiotics and antenatal corticosteroids Correct answer.
  3. Digital cervical examination every four hours
  4. Immediate caesarean delivery

Explanation

In preterm prelabour rupture of membranes before viability or at early gestation, expectant management with antibiotics and corticosteroids improves outcomes when there is no infection or fetal compromise. Digital examinations increase infection risk and are avoided. Delivery is indicated for chorioamnionitis or non-reassuring fetal status.

Question 34Obstetric Complications and High-Risk Pregnancy

Which statement about rhesus D alloimmunisation is correct?

  1. Sensitisation usually occurs in the first pregnancy
  2. Anti-D prophylaxis is indicated after potentially sensitising events such as amniocentesis Correct answer.
  3. Anti-D immunoglobulin is given to Rh-positive women after delivery
  4. Anti-D immunoglobulin crosses the placenta and treats fetal anaemia

Explanation

Anti-D immunoglobulin is given to Rh-negative women after sensitising events such as amniocentesis, external cephalic version, antepartum haemorrhage or delivery. It works by clearing fetal red cells before an immune response develops. It does not cross the placenta to treat established fetal anaemia.

Question 35Obstetric Complications and High-Risk Pregnancy

A woman with known red cell alloimmunisation has rising maternal antibody titres. Which investigation best assesses the severity of fetal anaemia?

  1. Middle cerebral artery peak systolic velocity on Doppler Correct answer.
  2. Amniotic fluid index measurement
  3. Maternal haemoglobin concentration
  4. Umbilical artery pulsatility index

Explanation

Middle cerebral artery peak systolic velocity rises with fetal anaemia because of reduced blood viscosity and increased cardiac output. It is the main non-invasive tool for guiding the need for intrauterine transfusion. Amniotic fluid index, maternal haemoglobin and umbilical artery Doppler do not directly assess anaemia.

Question 36Obstetric Complications and High-Risk Pregnancy

A woman at 38 weeks' gestation has a fetus in the transverse lie. Which management is most appropriate?

  1. Awaiting spontaneous version until 42 weeks
  2. Trial of vaginal delivery
  3. Induction of labour with oxytocin
  4. External cephalic version followed by reassessment Correct answer.

Explanation

Persistent transverse lie at term precludes vaginal delivery because of the risk of cord prolapse and obstructed labour. External cephalic version may be attempted if membranes are intact and there are no contraindications, followed by reassessment of presentation. If version fails, caesarean delivery is required.

Question 37Obstetric Complications and High-Risk Pregnancy

Which finding is most consistent with hyperemesis gravidarum rather than ordinary nausea and vomiting of pregnancy?

  1. Weight loss exceeding 5% with ketonuria and electrolyte disturbance Correct answer.
  2. Occasional vomiting relieved by dietary changes
  3. Morning nausea only, resolving by midday
  4. Nausea confined to the first trimester without weight loss

Explanation

Hyperemesis gravidarum is distinguished by persistent vomiting with significant weight loss, dehydration, ketonuria and electrolyte or acid-base disturbance. Ordinary nausea and vomiting of pregnancy is self-limiting and does not cause metabolic derangement. Assessment for thyroid function and other causes is also relevant.

Question 38Obstetric Complications and High-Risk Pregnancy

A woman at 34 weeks' gestation presents with a small amount of painless vaginal bleeding and a fundal placenta on ultrasound. Which diagnosis should be considered next?

  1. Placental abruption
  2. Vasa praevia Correct answer.
  3. Placenta praevia
  4. Uterine rupture

Explanation

Vasa praevia involves unprotected fetal vessels crossing the membranes over the cervix and can cause painless bleeding with fetal compromise, often after membrane rupture. A fundal placenta does not exclude it, particularly with a velamentous cord insertion or succenturiate lobe. Placenta praevia is excluded by the fundal location.

Question 39Obstetric Complications and High-Risk Pregnancy

Which condition is most strongly associated with an increased risk of venous thromboembolism in pregnancy?

  1. Asymptomatic bacteriuria
  2. Gestational diabetes
  3. Previous venous thromboembolism Correct answer.
  4. Mild gestational thrombocytopenia

Explanation

A personal history of venous thromboembolism is one of the strongest risk factors for recurrence during pregnancy and the puerperium. Thromboprophylaxis is considered based on this and other risk factors. Gestational thrombocytopenia, gestational diabetes and asymptomatic bacteriuria are not major thrombotic risk factors.

Question 40Obstetric Complications and High-Risk Pregnancy

A woman at 30 weeks' gestation with a history of pulmonary embolism is being managed with low molecular weight heparin. Which statement about anticoagulation in pregnancy is correct?

  1. Low molecular weight heparin is preferred because it does not cross the placenta Correct answer.
  2. Direct oral anticoagulants are safe in the first trimester
  3. Warfarin is the preferred agent throughout pregnancy
  4. Heparin must be stopped at 24 weeks to avoid bleeding

Explanation

Low molecular weight heparin does not cross the placenta and is therefore the preferred anticoagulant in pregnancy. Warfarin crosses the placenta and causes embryopathy, while direct oral anticoagulants are contraindicated. Anticoagulation is continued through pregnancy and adjusted around delivery.

Question 41Obstetric Complications and High-Risk Pregnancy

A woman at 32 weeks' gestation has a blood pressure of 165/115 mmHg with headache and visual disturbance. Which antihypertensive is most appropriate for acute control?

  1. Intravenous labetalol Correct answer.
  2. Oral enalapril
  3. Oral ramipril
  4. Oral spironolactone

Explanation

Intravenous labetalol is a first-line agent for acute severe hypertension in pregnancy, alongside hydralazine and nifedipine. ACE inhibitors such as ramipril and enalapril are contraindicated because of fetal renal toxicity. Spironolactone is not used for acute blood pressure control.

Question 42Obstetric Complications and High-Risk Pregnancy

A woman at 39 weeks' gestation has a prolonged second stage and develops a sudden severe abdominal pain, loss of station and fetal bradycardia. Which diagnosis is most likely?

  1. Uterine hyperstimulation
  2. Uterine rupture Correct answer.
  3. Placental abruption
  4. Cord prolapse

Explanation

Sudden severe pain, loss of station and fetal bradycardia during labour suggest uterine rupture, particularly after previous caesarean or with obstructed labour. Placental abruption causes pain and bleeding but not loss of station. Cord prolapse causes bradycardia without the pain and station loss.

Question 43Obstetric Complications and High-Risk Pregnancy

A woman at 37 weeks' gestation has a fetus with an estimated weight below the 3rd centile and an umbilical artery pulsatility index above the 95th centile. Which management is most appropriate?

  1. Expectant management until 42 weeks
  2. Maternal oxygen therapy to improve growth
  3. Immediate elective caesarean at 37 weeks for all such fetuses
  4. Close surveillance with delivery planned based on Doppler and fetal status Correct answer.

Explanation

Fetal growth restriction with abnormal umbilical artery Doppler indicates placental insufficiency and requires close surveillance, including ductus venosus Doppler and cardiotocography. Timing of delivery balances prematurity against stillbirth risk, with delivery usually before term if Doppler worsens. Maternal oxygen does not improve growth.

Question 44Obstetric Complications and High-Risk Pregnancy

Which mechanism best explains the increased oxygen affinity of fetal haemoglobin compared with adult haemoglobin?

  1. Fetal haemoglobin is present in smaller quantities
  2. Fetal haemoglobin has a lower haematocrit
  3. Fetal haemoglobin has a higher P50 than adult haemoglobin
  4. Fetal haemoglobin binds 2,3-DPG less avidly Correct answer.

Explanation

Fetal haemoglobin binds 2,3-diphosphoglycerate less avidly than adult haemoglobin, shifting its dissociation curve to the left. This increases oxygen affinity and facilitates placental oxygen uptake. A left-shifted curve means a lower P50, not a higher one.

Question 45Obstetric Complications and High-Risk Pregnancy

A woman at 24 weeks' gestation has a history of two second-trimester pregnancy losses with painless cervical dilatation. Which diagnosis and management are most appropriate?

  1. Preterm labour; give tocolysis only
  2. Chorioamnionitis; start antibiotics only
  3. Cervical insufficiency; consider cerclage Correct answer.
  4. Placenta praevia; plan caesarean

Explanation

Recurrent painless second-trimester losses with cervical dilatation suggest cervical insufficiency, for which cerclage may be considered. Cerclage is most beneficial in women with a history of recurrent loss and a short cervix. Antibiotics alone and tocolysis alone do not address the structural cause.

Question 46Obstetric Complications and High-Risk Pregnancy

A woman at 33 weeks' gestation is admitted with a blood pressure of 168/112 mmHg and 3+ proteinuria. Her platelet count is 88 × 10⁹/L, ALT is 210 U/L and she reports right upper quadrant pain. Which diagnosis best fits this picture?

  1. Acute fatty liver of pregnancy
  2. HELLP syndrome Correct answer.
  3. Gestational thrombocytopenia with superimposed cholecystitis
  4. Severe pre-eclampsia with haemolysis and thrombocytopenia

Explanation

HELLP is defined by haemolysis, elevated liver enzymes and low platelets, and the combination of thrombocytopenia below 100 × 10⁹/L, markedly raised transaminases and right upper quadrant pain in a hypertensive pregnant woman is its classic presentation. It is a severe variant on the pre-eclampsia spectrum and mandates delivery once the mother is stabilised.

Question 47Obstetric Complications and High-Risk Pregnancy

A woman at 30 weeks' gestation has a blood pressure of 158/104 mmHg confirmed on two readings four hours apart, with no symptoms and normal blood count and liver enzymes. Which classification applies?

  1. Pre-eclampsia without severe features
  2. Severe pre-eclampsia
  3. Gestational hypertension Correct answer.
  4. Chronic hypertension

Explanation

New hypertension arising after 20 weeks without proteinuria or evidence of maternal organ dysfunction is classified as gestational hypertension. It is a provisional label, because a proportion of these women later develop proteinuria or laboratory abnormalities and convert to pre-eclampsia.

Question 48Obstetric Complications and High-Risk Pregnancy

A woman at 29 weeks' gestation presents with a painful, tense uterus, dark vaginal loss and a fundal uterine tenderness; ultrasound shows a normally sited placenta with a retroplacental clot. Which complication is most likely to follow if this is managed expectantly?

  1. Uterine rupture
  2. Disseminated intravascular coagulation Correct answer.
  3. Placenta accreta spectrum
  4. Gestational trophoblastic disease

Explanation

This is placental abruption, and concealed haemorrhage with placental separation can trigger consumptive coagulopathy through release of thromboplastin into the maternal circulation. Coagulation studies and fibrinogen should therefore be checked and repeated, because fibrinogen falls early in abruption-associated DIC.

Question 49Obstetric Complications and High-Risk Pregnancy

A woman at 35 weeks' gestation with monochorionic diamniotic twins has a deepest vertical pocket of 12 cm in one sac and 1.5 cm in the other, with a distended bladder in the larger sac. Which diagnosis is most likely?

  1. Twin reversed arterial perfusion sequence
  2. Acute peripartum polyhydramnios of one twin
  3. Selective fetal growth restriction
  4. Twin-to-twin transfusion syndrome Correct answer.

Explanation

The combination of polyhydramnios in one sac and oligohydramnios in the other in a monochorionic pregnancy is the diagnostic criterion for twin-to-twin transfusion syndrome, driven by unbalanced placental vascular anastomoses. Staging and treatment, usually fetoscopic laser ablation, depend on the gestational age and severity.

Question 50Obstetric Complications and High-Risk Pregnancy

A woman at 20 weeks' gestation has a history of a previous unexplained stillbirth at 36 weeks. Which antenatal surveillance strategy is most appropriate in this pregnancy?

  1. Weekly cardiotocography from 24 weeks until delivery
  2. Serial growth scans from 28 weeks with delivery planned by 39 weeks Correct answer.
  3. Delivery by elective caesarean at 34 weeks
  4. No additional surveillance beyond routine antenatal care

Explanation

A previous unexplained stillbirth is a recognised risk factor for recurrence and for fetal growth restriction, so serial growth assessment in the third trimester with avoidance of post-term delivery is recommended. The exact schedule is individualised, but the key elements are growth surveillance and delivery before 39 weeks rather than intensive early monitoring.