DRCOG – Module 5 – Peripartum & Neonate – SBA Questions

A 40 year old woman is prescribed low molecular weight heparin (LMWH) thromboprophylaxis after an emergency Caesarean section in labour with epidural anaesthesia. The epidural catheter has been removed. When can LMWH be given?

A 38 year old woman is brought into her GP surgery by her partner. She delivered her first baby 18 days ago but has started acting strangely. She is no longer feeding her baby, believes that her baby does not belong to her and has accused her partner of swapping her baby. What is the most likely diagnosis?

A 24 year old primiparous woman has a spontaneous vaginal delivery at term. She previously had a deep vein thrombosis after a period of immobilisation following an ankle fracture.  Her BMI is 19 and her postpartum weight is 49kg. What is the most appropriate option for postpartum thromboprophylaxis?

A 35 year old woman with known triple positive antiphospholipid syndrome has an intrauterine fetal death of a severely growth restricted baby at 24 weeks gestation complicated by severe pre-eclampsia.She has previously had multiple pulmonary emboli and a central venous sinus thrombosis.  She has an induction of labour and a vaginal delivery. What is the most appropriate option for postpartum thromboprophylaxis?

A postpartum woman reports abdominal pain and increased lochia that smells offensive. She had an emergency Caesarean section one day ago ago following induction of labour for prolonged rupture of membranes at term and her baby required antibiotics for suspected infection after birth. On examination she has a pulse rate of 110 bpm, a temperature of 38.2° and has lower abdominal tenderness. Her Caesarean wound is healing well and appears clean. High vaginal swabs confirm the presence of anaerobes. What is the most appropriate management?

A woman presents on Day 4 postpartum feeling unwell with a productive cough. She had an emergency Caesarean section under general anaesthetic for placental abruption at 35 weeks gestation.  Her booking BMI was 43 and she was known to have gestational diabetes which required treatment with insulin during the pregnancy. She has a history of anaphylaxis to penicillin. On examination, crepitations are auscultated at the right lung base. She has a normal blood pressure and temperature of 38.8°C, a respiratory rate of 24 breaths per minute and a pulse rate of 95 beats per minute. What is the most appropriate management?

A 32-year-old primigravida presents 10 days postpartum with a painful, swollen left breast. She reports fever and malaise for 4 days and has been on oral flucloxacillin for 48 hours without improvement. On examination, the left breast is erythematous, warm, and tender and she has pyrexia of 38.9C with maternal heart rate of 110bpm. What is the most appropriate management?

A 28-year-old woman presents five days postpartum after a normal vaginal delivery. She complains of severe sore throat, fever, and generalized body aches. She is breastfeeding and reports no complications during delivery but mentions being in contact with her 6-year-old child who recently had a sore throat. On examination, she is pyrexial and has an erythematous pharynx with tonsillar exudate and cervical lymphadenopathy. What is the most appropriate management?

A 24 year old has a spontaneous vaginal delivery at term. Antenatally she had a history of recurrent urinary tract infections and was on rotating antibiotic prophylaxis. She is admitted on Day 6 postpartum with a history of abdominal pain, diarrhoea and vomiting.  On examination, she is pyrexial with a temperature of 39.4C, heart rate of 140bpm and blood pressure of 70/30.  Blood cultures are positive for a gram-negative rod, resistant to multiple antibiotics. What is the most appropriate management?

A 41 year old woman conceives by IVF treatment and is diagnosed at 18 weeks with preterm prelabour rupture of membranes. She is counselled about the risks of infection and opts to continue with the pregnancy.  She presents at 21 weeks in spontaneous labour and rapidly miscarries.  Postpartum, she develops severe septic shock and requires admission to intensive care for inotropic support.  CT Abdomen/Pelvis shows evidence of retained placental tissue and multiple gas locules within the uterus and myometrium with evidence of surrounding necrosis. What is the most likely causative organism?

A 28-year-old woman presents five days postpartum after a normal vaginal delivery. She complains of severe sore throat, fever, and generalized body aches. She is breastfeeding and reports no complications during delivery but mentions being in contact with her 6-year-old child who recently had a sore throat. On examination, she is pyrexial and has an erythematous pharynx with tonsillar exudate and cervical lymphadenopathy. What is the most likely causative organism?

A woman in her second pregnancy opts to have a planned Caesarean birth. Her first child was born by forceps complicated by shoulder dystocia and the baby sustained a brachial plexus injury which required surgery and extensive physiotherapy.  She has a booking BMI of 39 and develops gestational diabetes during pregnancy which requires insulin treatment.  She is readmitted on Day 6 postpartum with extensive erythema around the Caesarean section wound which spreads rapidly.  She has excruciating pain over the wound requiring intravenous morphine and the pain is elicited beyond the margins of the superficial erythema.  She is treated with broad spectrum antibiotics and requires multiple debridement procedures over the following two weeks. What is the most likely causative organism?

A 32-year-old primigravida presents 10 days postpartum with a painful, swollen left breast. She reports fever and malaise for 4 days and has been on oral flucloxacillin for 48 hours without improvement. On examination, the left breast is erythematous, warm, and tender and she has pyrexia of 38.9C with maternal heart rate of 110bpm. What is the most likely causative organism?

A woman presents on Day 4 postpartum feeling unwell with a productive cough. She had an emergency Caesarean section under general anaesthetic for placental abruption at 35 weeks gestation.  Her booking BMI was 43 and she was known to have gestational diabetes which required treatment with insulin during the pregnancy. On examination, crepitations are auscultated at the right lung base. She has a normal blood pressure and temperature of 38.8°C, a respiratory rate of 24 breaths per minute and a pulse rate of 95 beats per minute. What is the most likely causative organism?

A 24 year old has a spontaneous vaginal delivery at term. Antenatally she had a history of recurrent urinary tract infections and was on rotating antibiotic prophylaxis. She is admitted on Day 6 postpartum with a history of abdominal pain, diarrhoea and vomiting.  On examination, she is pyrexial with a temperature of 39.4C, heart rate of 140bpm and blood pressure of 70/30.  Blood cultures are positive for a gram-negative rod, resistant to multiple antibiotics. What is the most likely causative organism?

A postpartum woman reports abdominal pain and increased lochia that smells offensive. She had an emergency Caesarean section one day ago ago following induction of labour for prolonged rupture of membranes at term and her baby required antibiotics for suspected infection after birth. On examination she has a pulse rate of 110 bpm, a temperature of 38.2° and has lower abdominal tenderness. Her Caesarean wound is healing well and appears clean. What is the most likely causative organism?

A 31 year old woman presents in spontaneous labour at term and has an epidural sited for pain relief. She has a rotational forceps birth in theatre complicated by a postpartum haemorrhage of 1000ml. In the postnatal period, she develops severe lower back pain which is not relieved by opiate analgesia and on Day 4 after birth, she develops lower limb weakness and urinary retention associated with pyrexia. What is the most likely causative organism?

A 38 year old black African woman has an induction of labour at 37 weeks for Type 2 diabetes and gestational hypertension medicated with oral nifedipine 10mg BD. She has a spontaneous vaginal birth and her blood pressure on Day 1 and Day 2 postnatally is normal. She is reviewed in the community on Day 5 and noted to have a blood pressure of 155/98 mmHg.   She is otherwise clinically well and is asymptomatic. She is not breastfeeding and does not plan to start. What is the most appropriate treatment option?

A 38 year old primiparous black African woman has an induction of labour at term for gestational hypertension medicated with oral labetalol 200mg TDS. She has a forceps birth and her blood pressure on Day 1 and Day 2 postnatally is normal. She is reviewed in the community on Day 5 and noted to have a blood pressure of 155/98 mmHg.   She is otherwise clinically well and is asymptomatic. She is breastfeeding exclusively. What is the most appropriate treatment option?

A 38 year old primiparous woman has an induction of labour at term for gestational hypertension medicated with oral labetalol 200mg TDS. She has a forceps birth and her blood pressure on Day 1 and Day 2 postnatally is normal. She is reviewed in the community on Day 5 and noted to have a blood pressure of 155/98 mmHg.   She is otherwise clinically well and is asymptomatic. She is breastfeeding exclusively. What is the most appropriate treatment option?

A 26 year old woman has an emergency Caesarean section for presumed fetal compromise at 38 weeks. She was noted to have new onset gestational hypertension in labour and requires oral labetalol 200mg BD for blood pressure control intrapartum but is normotensive postnatally.  She is discharged from hospital on Day 2 postpartum. When should she next be seen for measurement of her blood pressure?

How much pressure should anti-embolism stockings exert?

What management should be advised for the partner of a mother being treated for Group A streptococcal infection in the puerperium?

What management should be advised for the baby of a mother being treated for Group A streptococcal infection in the puerperium?

Which of the following is not a cause of primary postpartum haemorrhage?

Which of the following is not a known cause of secondary postpartum haemorrhage?

What is the definition of secondary postpartum haemorrhage?

What percentage of neonates are at risk of developing Ophthalmia Neonatorum when born vaginally to mothers with current Chlamydia trachomatis infection?

What proportion of women infected with Chlamydia Trachomatis at the time of delivery will develop a puerperal infection?

A 28-year-old breastfeeding woman presents with recurrent mastitis. What investigation is most appropriate to determine the underlying cause?

A 29-year-old woman presents with mastitis. Her symptoms include fever, unilateral breast pain, and erythema. She asks whether she can continue breastfeeding. What is the most appropriate advice?

A 32-year-old primigravida presents 10 days postpartum with a painful, swollen left breast. She reports fever and malaise for 4 days and has been on oral flucloxacillin for 48 hours without improvement. On examination, the left breast is erythematous, warm, and tender and she has pyrexia of 38.9C with maternal heart rate of 110bom. What is the next most appropriate management step?

A 32-year-old primigravida presents 10 days postpartum with a painful, swollen left breast. She reports fever and malaise for 2 days. On examination, the left breast is erythematous, warm, and tender. What is the next most appropriate management step?

A 30 year old primiparous woman has an uncomplicated vaginal birth at 41 weeks. At booking, she was found to be RhD negative and cell free fetal DNA testing confirmed that the fetus was expected to be Rhesus positive. After birth, cord blood RhD typing confirms that the baby is RhD positive.  What is the most appropriate management option?

A 28 year old woman in her second pregnancy is found at booking to be RhD negative with anti D antibodies. Antenatal ultrasound surveillance confirms a raised MCA PSV at 36 weeks gestation and she has an induction of labour at 37 weeks with a spontaneous vaginal birth. What is the most appropriate initial management plan?

Which of the following is the most likely cause of conjugated hyperbilirubinemia in a neonate?

Which of the following types of neonatal jaundice is considered pathological?

What is the prevalence of neonatal jaundice in the first week of life in preterm babies?

Which of the following organisms is most likely to be responsible for fatal invasive infection following pregnancy?

Which of the following increases a woman’s risk of developing postpartum sepsis?

Which of the following does not increase a woman’s risk of developing postpartum sepsis?

What is the prevalence of neonatal jaundice in the first week of life in term babies?

What is the first-line pharmacological treatment for closing a patent ductus arteriosus (PDA) in a preterm neonate?

Which of the following is the most common cause of apnoea in preterm neonates?

Which of the following interventions has the most evidence for reducing the risk of intraventricular haemorrhage (IVH) in preterm neonates?

Which of the following conditions is not routinely screened for in the UK using the newborn blood spot screening test?

Which of the following conditions is not routinely screened for in the UK using the newborn blood spot screening test?

A multiparous woman had an induction of labour for suspected large for gestational age at 39 weeks gestation. The baby was born by spontaneous vaginal delivery complicated by shoulder dystocia which required internal manoevres and delivery of the posterior arm and birthweight was 4.8kg. After birth, the baby is noted to have asymmetric Moro reflex and palpable crepitus in the upper thorax. What is the most likely diagnosis?

A multiparous woman had an induction of labour for dichorionic twins at 37 weeks gestation. The first twin was born cephalic by spontaneous vaginal delivery but the second twin was delivered by vaginal breech birth which was complicated by nuchal arms and required breech extraction.  After birth, the second twin is noted to have weakness of the right arm, with the forearm extended and internally rotated. Grasp reflex is intact. What is the most likely diagnosis?

A primiparous woman has a Ventouse birth at 41 weeks gestation for prolonged second stage of labour with occiput posterior fetal position. The vacuum cup detaches twice during the delivery during rotation. The baby weighs 3.98kg at birth and has Apgar scores were 3, 4 and 7 at 1, 5 and 10 minutes respectively requiring resuscitation and admission to the neonatal unit. At 12 hours of age, the infant is noted to diffuse swelling of the scalp that crosses suture lines and progresses rapidly. What is the most likely diagnosis?

A primiparous woman has a Ventouse birth at 40 weeks gestation for prolonged second stage of labour and the baby weighs 4.3kg at birth. The infant presents on Day 2 of life with a soft, fluctuant swelling over the parietal region that does not cross suture lines. What is the most likely diagnosis?

A primiparous woman presents in spontaneous labout at 41 weeks gestation and rapidly has a spontaneous vaginal delivery. The baby is born in poor condition with no respiratory effort and a heart rate of 90 beats per minute despite drying and stimulation and requires inflation breaths for resuscitation.  Pre-ductal oxygen saturations (SpO₂) are commenced for further monitoring.  What is an acceptable pre-ductal SpO₂ at 3 minutes of age?

During neonatal resuscitation, chest compressions are indicated in which of the following scenarios?

A primiparous woman presents in spontaneous labout at 41 weeks gestation and rapidly has a spontaneous vaginal delivery. The baby is born in poor condition with no respiratory effort and a heart rate of 90 beats per minute despite drying and stimulation.  What is the most appropriate next step in neonatal resuscitation?

What is the correct ratio of chest compressions to ventilations during neonatal resuscitation?

A woman has an emergency Caesarean section for presumed fetal compromise and the baby is born in poor condition. At  birth and one minute of age, the baby has a heart rate of 120bpm but makes no respiratory effort and is pale and does not move spontaneously or in response to stimulation.  At five minutes of age after successful resuscitation, the baby has a heart rate of 150bpm, is pink and moving and is crying weakly both spontaneously and in response to stimulation.  What Apgar scoring should be documented in the postnatal notes?

A 24 year old primigravid woman is being induced for gestational diabetes. She has an artificial rupture of membranes and is commenced on oxytocin.  Over the next 14 hours, she makes adequate progress to 7cm dilated when she is noted to be pyrexial with a temperature of 39.5C, maternal tachycardia of 120bpm and obvious rigors.  The fetal baseline heart rate is 160bpm but there are no other CTG abnormalities.  What is the most appropriate management?

A woman attends in early labour and suddenly collapses with significant frank vaginal bleeding. Despite cardiopulmonary resuscitation and perimortem Caesarean section, she sadly dies.  Post-mortem examination confirms the presence of fetal squamous cells in the pulmonary vasculature.  What is the cause of death?

You are the on call SHO for Labour ward and attend an emergency buzzer for maternal collapse. On entering the room, the midwife informs you that the woman delivered her ten minutes ago and controlled cord traction to deliver the placenta was attempted but that the woman suddenly became very hypotensive and collapsed.  On examination, the placenta is visible at the vaginal introitus and but there does not appear to be significant vaginal bleeding.  What is the likely diagnosis?

A woman has an emergency Caesarean section for placental abruption and has a massive postpartum haemorrhage of 3 litres. Emergency blood products are requested for immediate transfusion. Which of the following specifications is not required for emergency blood products issued for obstetric patients?

Which of the following is not a cause of disseminated intravascular coagulation in labour?

A woman has an emergency Caesarean section for placental abruption and has a massive postpartum haemorrhage of 3 litres. She is transfused 4 units of packed red cells but bleeding is ongoing so the anaesthetist requests additional blood products while awaiting the most recent coagulation test results.  What is the next most appropriate blood product to give?

Which of the following is not an indication for intrapartum antibiotic prophylaxis in labour?

Which of the following drugs is not used in the management of preterm labour?

A woman has a primary post-partum haemorrhage and receives intramuscular ergometrine.  Which of the following is a contra-indication to ergometrine?

A woman has a vaginal delivery with a physiological third stage. The placenta is not delivered after 60 minutes following the birth of the baby but there is no active bleeding. What is the most appropriate management?

A woman has a vaginal delivery with an active third stage but retains her placenta. How long should be allowed before diagnosing retained placenta in this scenario?

Which of the following does not reduce the risk of obstetric anal sphincter injury?

Which of the following statements about third and fourth degree tears is incorrect?

Which of the following is not a risk factor for third or fourth degree perineal tears?

A woman has a vaginal delivery and sustains a perineal tear. On examination, the injury affects the skin and perineal muscles and more than 50% of the external anal sphincter is torn.  What classification of perineal tear is this?

Which of the following risks is not reduced by planned Caesarean section?

Which of the following is not an indication for planned Caesarean section?

You are on call for Labour Ward and attend an emergency buzzer for shoulder dystocia. What is the first management that should be undertaken?

Which of the following statements about shoulder dystocia is incorrect?

Which of the following complications is not associated with shoulder dystocia?

Which of the following is not a factor associated with shoulder dystocia?

Which of the following is not a factor associated with shoulder dystocia?

Which of the following is not a risk factor for postpartum haemorrhage?

What is the most common cause of postpartum haemorrhage?

A woman with a previous Caesarean section is admitted in early labour.  Which of the following is not a sign or symptoms of uterine scar rupture?

A woman with a previous Caesarean section is admitted in early labour. Which of the following is not recommended for women having a vaginal birth after Caesarean section (VBAC)?

A woman with a previous Caesarean section is admitted in early labour.  Which of the following is associated with a lower chance of successful vaginal birth after previous Caesarean?

Which of the following statements about home birth is incorrect?

You are on call for Labour Ward and you are called to review a 26 primigravid woman in early labour at term who is noted to be hypertensive.  On examination, her blood pressure is 170/118 and urinanalyis shows 4+ proteinuria.  As you are assessing her, she has a tonic-clonic seizure and loses consciousness.  What is the most appropriate initial management?

You are on call for Labour Ward and you are called to review a 26 primigravid woman in early labour at term who is noted to be hypertensive.  She has no known drug allergies but has a past medical history of severe asthma.  On examination, her blood pressure is 170/118 and urinanalyis shows 4+ proteinuria.  What is the most appropriate management?

You are the on call SHO for Labour Ward and you are called to review a 26 primigravid woman in early labour at term who is noted to be hypertensive.On examination, her blood pressure is 170/118 and urinanalyis shows 4+ proteinuria.  Urgent biochemistry shows the following results:

What is the likely diagnosis?

You are on call for Labour Ward and attend an emergency buzzer.  On entering the room, the midwife states that she has just performed an artificial rupture of membranes and there has been a cord prolapse.  Which of the following is not a risk factor for cord prolapse?

A woman in established labour requests an epidural.  Which of the following is a contraindication to epidural anaesthesia?

A woman in established labour has an epidural sited and complains of a sudden severe headache which is worse on sitting up and relieved by lying down.  On examination all her observations are within normal limits and upper limb and cranial nerve examination is normal.  What is the likely diagnosis?

A woman in established labour requests an epidural for pain relief.  Which of the following statements about epidural anaesthesia is incorrect?

You are on call on the labour ward and are asked to assist the obstetric registrar with fetal blood sampling.  Which of the following statements regarding fetal blood sampling is incorrect?

You are assisting with a Caesarean section for abnormal cardiotocography with suspected fetal compromise.  Which of the following features is abnormal on cardiotocography?

You are on call for the labour ward and are asked to insert an intravenous cannula for a woman in labour.  Which of the following is not an indication for intravenous access in labour?

Which of the following is not an indication for continuous electronic fetal monitoring using cardiotocography during labour?

Which of the following is not an increased risk during induction of labour?

A 42 year old primigravid woman is booked for induction of labour at 40 weeks gestation.  Which of the following methods are not used for induction of labour?

Which of the following is not an indication for induction of labour?

You are the SHO on labour ward when the emergency  buzzer sounds and you attend with your registrar.   The midwife has just performed an artificial rupture of membranes (ARM) on a woman having an induction of labour and there is  frank vaginal bleeding and the CTG shows a prolonged fetal bradycardia.  What is the likely diagnosis?

A woman presents in early labour with frank vaginal bleeding. Which of the following is not a cause of bleeding in labour?

A woman presents in early labour with severe constant abdominal pain and approximately 500ml of frank vaginal bleeding.  The CTG is abnormal and a Caesarean section is performed which confirms a placental abruption.  Which of the following is not a risk factor for placental abruption?

Which of the following is not a symptom or sign of placental abruption?

A woman is admitted in early labour and has a BMI of 46. Which of the following statements regarding the management of labour in obese women is incorrect?