MRCOG Part 2 – Antenatal Care SBAs

Which of the following is not an indication for a Clause E termination of pregnancy?

A 30 year old woman is referred from screening with a higher chance combined screening result at 12 weeks gestation. The nuchal translucency is 6mm with a combined screening result of 1 in 5 for Trisomy 21 and 1 in 140 for Trisomy 13/18.  What is the next most appropriate investigation?

A 30 year old woman is referred from screening with a higher chance combined screening result at 12 weeks gestation. The nuchal translucency is 1.7mm with a combined screening result of 1 in 5 for Trisomy 21 and 1 in 140 for Trisomy 13/18.  She opts to have NIPT as she wants to avoid any increased risk of miscarriage.  The NIPT result is reported as higher chance for T21 and the woman wishes to confirm the result.  What is the next most appropriate investigation?

A 30 year old woman is referred from screening with a higher chance combined screening result at 12 weeks gestation. The nuchal translucency is 1.7mm with a combined screening result of 1 in 5 for Trisomy 21 and 1 in 140 for Trisomy 13/18.  She opts to have NIPT as she wants to avoid any increased risk of miscarriage.  The NIPT result is reported as lower chance.  What is the next most appropriate step?

A 30 year old woman is referred from screening with a higher chance combined screening result at 12 weeks gestation. The nuchal translucency is 1.7mm with a combined screening result of 1 in 5 for Trisomy 21 and 1 in 140 for Trisomy 13/18.  She opts to have NIPT as she wants to avoid any increased risk of miscarriage.  The NIPT result is reported as ‘no result’.  What is the next most appropriate investigation?

Which of the following is not an exclusion criteria for non-invasive prenatal testing?

Which of the following means the combined screening test cannot be offered?

What percentage of fetal hydrops is immune?

Which of the following is not a cause of fetal hydrops?

What is the procedure related risk of miscarriage from transabdominal chorionic villous sampling?

What is the procedure related risk of miscarriage from amniocentesis?

What threshold of nuchal translucency should trigger referral to a fetal medicine specialist?

What is the risk of confined placental mosaicism with CVS?

Which of the following is not a risk of amniocentesis?

From what gestation can amniocentesis be carried out?

A 22 year woman books for antenatal care at 8 weeks gestation. She and her partner are both sickle cell trait carriers and her booking bloods show HbsAG +ve, AntiHBc +ve, HBsAb -ve with viral load of 9log₁₀. She wishes to have prenatal diagnosis to ascertain the sickle cell status of her pregnancy. What is the most appropriate option?

Which of the following risk factors is associated with the highest risk of placental abruption?

A 19 year old primiparous woman presents with a postcoital antepartum haemorrhage of 20ml at 35 weeks gestation. On examination, maternal observations and CTG are normal.  Abdominal palpation is reassuring with no palpable contractions or tenderness. The fetus is in a breech presentation and the placenta is confirmed as anterior and high on bedside ultrasound scan.  She is Rhesus negative with ffDNA confirming a Rhesus negative fetus and her Hb is 118. On examination, there is a small cervical polypoid lesion extruding through the external cervical os.  What is the most appropriate management?

Which of these is not an indication for ultrasound surveillance of cervical length?

A 36 year old woman is referred to preterm birth clinic with a history of previous trachelectomy with abdominal cerclage in situ. It is her second pregnancy and her first child was delivered at 35 weeks gestation by emergency lower segment Caesarean section following preterm prelabour rupture of membranes. Unfortunately her dating scan at 12 weeks gestation confirms a missed miscarriage with CRL of 30mm.  What is the most appropriate management?

A 40 year old woman is seen in preterm birth clinic after a previous spontaneous mid-trimester loss at 21 weeks. The current pregnancy is an IVF pregnancy and her dating scan confirms a monochorionic diamniotic twin pregnancy.  She has not had any previous cervical surgery and is a non-smoker. She is very anxious about the risk of preterm birth and asks what can be done to reduce the risk.  What is the most appropriate management?

A 38 year old woman is seen in preterm birth clinic with a poor obstetric history as follows:

Para 1+2:

• 1^st pregnancy: spontaneous midtrimester loss at 18 weeks
• 2^nd pregnancy: spontaneous midtrimester loss at 19 weeks
• 3^rd pregnancy: ultrasound indicated vaginal cervical cerclage at 16 weeks, subsequent PPROM and emergency classical Caesarean section at 23 weeks gestation, neonatal death of baby at 2 days of age

She is currently 11 weeks pregnant and has had a normal dating scan with low risk combined screening.  What is the most appropriate management?

A 32 year old primiparous woman is referred from her dating scan at 12 weeks gestation with abnormal findings of a raised nuchal translucency of 5mm, a small omphalocele containing bowel and fused cerebral hemispheres and a single ventricle. What is the most likely diagnosis?

A 30 year old woman contacts the Maternity Assessment unit at 28 weeks gestation as she is concerned because her nephew has chicken pox and she was looking after him when the rash appeared. She is from Sri Lanka but thinks she may have had chicken pox herself as a child.  What is the most appropriate management?

A 30 year old woman woman contacts the Maternity Assessment unit at 28 weeks gestation as she is concerned because her husband has developed shingles around his left eye. She does not recall having had chicken pox herself as a child.  What is the most appropriate management?

A 30 year old woman woman contacts the Maternity Assessment unit at 28 weeks gestation as she is concerned because her nephew has developed a chicken pox rash in the last 24 hours.  She last saw him one week ago but she thinks she may have had chicken pox herself as a child.  What is the most appropriate management?

A 30 year old woman woman contacts the Maternity Assessment unit at 28 weeks gestation as she is concerned because her nephew has developed chicken pox yesterday and she was looking after him when the rash appeared.  Her community midwife has requested urgent serum serology for Varicella Zoster IgG from her antenatal booking bloods and the laboratory calls to report that the patient is non-immune. What is the most appropriate management?

A 30 year old woman contacts the Maternity Assessment unit at 28 weeks gestation as she is concerned because her nephew has developed chicken pox yesterday and she was looking after him when the rash appeared.  Her community midwife requests urgent serum serology for Varicella Zoster IgG from her antenatal booking bloods and the laboratory calls to report that the patient is immune. What is the most appropriate management?

A 30 year old woman woman contacts the Maternity Assessment unit at 20 weeks gestation as her nephew has recently had chicken pox and she has now developed a vesicular rash in the last 24 hours.  On examination, the rash is consistent with chicken pox but she is otherwise systemically well.  What is the most appropriate management?

A 30 year old woman woman contacts the Maternity Assessment unit at 28 weeks gestation as her nephew has recently had chicken pox and she has now developed a vesicular rash in the last 24 hours. On examination, the rash is consistent with chicken pox but she is otherwise systemically well.  She is noted to be a heavy smoker and reports that she has noticed a worsening cough over the last 24 hours.  What is the most appropriate management?

A 32 year old woman is booked for planned Caesarean section for breech presentation at 39 weeks gestation. She calls the Maternity Assessment Unit two days prior to her planned Caessarean date because she has developed a vesicular rash and has not had chicken pox previously.  She is seen by the on call obstetric registrar who confirms that the rash is consistent with chicken pox.  She is otherwise systemically well and has no concerning symptoms suggestive of severe Varicella illness. CTG is reassuring. What is the most appropriate management?

A 32 year old woman is booked for planned Caesarean section for breech presentation at 39 weeks gestation. She calls the Maternity Assessment Unit two days prior to her planned Caessarean date because she has developed a vesicular rash, has not had chicken pox previously and is concerned that her membranes have ruptured.  She is seen by the on call obstetric registrar who confirms that the rash is consistent with chicken pox. On speculum, there is obvious SROM but the cervix is closed and bedside ultrasound confirms persistent breech presentation.  She is otherwise systemically well and has no concerning symptoms suggestive of severe Varicella illness. The CTG is non-reassuring with repetitive decelerations in the absence of contractions. What is the most appropriate management?

A 32 year old woman has an emergency Caesarean section at 38+5 weeks gestation for presumed fetal compromise and breech presentation after confirmed SROM. She had active chicken pox at the time of delivery, with the onset of vesicular rash 48 hours prior to birth. What is the risk of varicella infection of the newborn?

A 32 year old primiparous woman is referred from her anomaly scan at 20 weeks gestation with abnormal findings of a raised nuchal fold of 10mm, suspected atrio-ventricular septal defect, absent nasal bone and short femurs. What is the most likely diagnosis?

A 35 year old woman reports itching of her hands and feet to her community midwife at 34 weeks gestation. On examination there is no evidence of rash or skin changes. Blood tests show ALT of 14 and bile acids of 14 micromol/L. What is the likely diagnosis?

A 35 year old woman reports itching of her hands and feet to her community midwife at 34 weeks gestation. On examination there is no evidence of rash or skin changes. Blood tests show ALT of 14 and bile acids of 14 micromol/L. What is the most appropriate management?

A 35 year old woman is diagnosed with severe intrahepatic cholestasis of pregnancy at 35 weeks gestation with ALT of 70 and bile acids of 120. Fetal growth is normal and there are no additional obstetric comorbidities. What is the most appropriate management?

A 35 year old woman has an uncomplicated spontaneous vaginal birth following induction of labour at 37 weeks for severe intrahepatic cholestasis of pregnancy. When should her liver function be rechecked postnatally?

A 35 year old woman reports itching of her hands and feet to her community midwife at 34 weeks gestation. On examination there is no evidence of rash or skin changes. Blood tests show ALT of 14 and bile acids of 21 micromol/L. She is very anxious about the risks of intrahepatic cholestasis and asks what complications she is at greater risk of.  Which of the following is she not at higher risk of with her diagnosis?

Which of the following vaccinations is indicated in pregnancy?

Which of the following vaccinations is contra-indicated in pregnancy?

Which of the following vaccinations may be recommended in pregnancy in certain situations?

A 30 year old woman attends her CMW for a routine antenatal appointment and is offereed a routine pertussis vaccination.  At what gestation should the pertussis vaccination be administered?

A 26 year old woman books for antenatal care with her community midwife at 8 weeks gestation.  She requests the meningococcal vaccination as she has been told that she is at high risk of meningococcal disease.  Which of the following is not considered high risk of meningococcal disease?

A 32 year old primiparous woman is referred from her anomaly scan at 20 weeks gestation with abnormal findings of a strawberry shaped head, congenital diaphragmatic hernia, spina bifida and bilateral talipes. What is the most likely diagnosis?

A 30 year old woman books for antenatal care with her community midwife and is noted to be seronegative for varicella.  She has never had chickenpox.  At what gestation should the varicella vaccination be administered?

Symphysio-fundal height is used to screen for fetal growth restriction in low risk obstetric populations.  How often should symphysio-fundal height be measured?

Symphysio-fundal height is used to screen for fetal growth restriction however certain groups of patients are unsuitable for fundal height measurement and require serial assessment of fetal growth by ultrasound.  Which of the following is not an indication for ultrasound assessment of fetal growth?

A 22 year old woman attends a booking antenatal appointment with her community midwife at 8 weeks gestation. She tells her midwife that she thinks she may have been ‘circumcised’ as a child and on examination, there is evidence of Type 1 FGM.  Which of the following countries has a very high prevalence of FGM?

A 22 year old Somalian woman attends a booking antenatal appointment with her community midwife at 8 weeks gestation. She tells her midwife that she thinks she may have been ‘circumcised’ as a child and on examination, there is evidence of Type 1 FGM.  Which of the following statements regarding FGM and UK law is incorrect?

A 29 year old woman visits her community midwife to book for routine antenatal care at 8 weeks gestation.  This is her second pregnancy and she is fit and well with no significant past medical or obstetric history.  She wishes to know how often she will need antenatal appointments.  What number of antenatal appointments are recommended for her?

A 29 year old woman attends her GP to book for routine antenatal care at 8 weeks gestation.  This is her first pregnancy and she is fit and well with no significant past medical or obstetric history.  She wishes to know how often she will need antenatal appointments.  What number of antenatal appointments are recommended for her?

A 26 year old primigravida contacts her community midwife at 30 weeks of gestation requesting a letter to give to the airline to allow her to travel as she is planning to travel abroad for a family event in Australia. She has been fit and well during this pregnancy, remaining under midewifery led antenatal care.  Which of the following statements regarding air travel in pregnancy is incorrect?

A 36 year old woman attends her local maternity assessment unit frequently in her first pregnancy with multiple symptoms that she is very concerned about despite reassurance. Her community midwife is concerned that she may be at risk of domestic abuse.  Which of the following is not associated with domestic abuse?

A 40 year old primiparous woman is referred from a routine growth scan at 32 weeks gestation with significant polyhydramnios. On scan, there is abnormal appearance of the abdomen with double bubble sign seen and severe polyhydramnios with deepest vertical pool of 17cm and AFI of 40.  What is the most appropriate investigation?

A 36 year old woman attends her GP to book for antenatal care.  She is concerned because she has a history of mental health illness and she wants to know how it will affect her pregnancy.  Which of the following is not a risk factor for postnatal psychosis?

A 26 year old woman attends her community midwife to book for routine antenatal care at 8 weeks gestation.  At the appointment, she is offered routine screening for a number of haematological conditions.  Which of the following haematological conditions is not routinely screened for in the UK at booking?

A 25 year old patient woman recently attended for her routine cervical smear and has received a letter telling her that her smear is abnormal and inviting her for coloscopy. However, she has just discovered that she is pregnant and her last menstrual period was 7 weeks ago.  The cervical smear report shows that high grade dyskaryosis present.  What is the most appropriate management plan?

A 35 year old woman contacts her community midwife as she has been asked to attend for her routine cervical smear but she is currently 11 weeks pregnant.  All her previous smears have been normal.  What is the most appropriate management plan?

A 25 year old woman recently attended for her routine cervical smear and has received a letter telling her that her smear is abnormal and inviting her for coloscopy. However, she has just discovered that she is pregnant and her last menstrual period was 7 weeks ago.  Her cervical smear result shows low grade dyskaryosis and HPV testing is positive.  What is the most appropriate management plan?

A 35 year woman attends her community midwife to book for routine antenatal care at 8 weeks gestation.  She describes herself as ‘prone to infections’ and wants to know what screening for infections is available in pregnancy.  Which of the following is routinely screened for in pregnancy?

A 25 year old woman attends her community midwife to book for antenatal care at 8 weeks gestation.  She has a history of intravenous drug use in the past and is worried as she has never been screened for blood-borne viruses.  Which of the following is not routinely screened for in pregnancy?

A 28 year old woman contacts her community midwife at 12 weeks gestation because she is concerned that she has read on the internet that pregnant women may become infected with toxoplamosis and she has recently had contact with a relative’s cat.  Which of the following statements regarding toxoplasmosis in pregnancy is incorrect?

A 30 year old woman attends her community midwife to book for antenatal care at 8 weeks gestation in her second pregnancy. She reports that she was told after her first pregnancy that she would need screening for gestational diabetes in any future pregnancies.  Which of the following is not a risk factor for gestational diabetes?

A 36 year old woman attends her community midwife to book for antenatal care at 8 weeks gestation.  She has a history of severe depression but has not taken medication for several years.  At the booking appointment, she appears well with normal interaction and affect.  What is the most appropriate tool to screen for depression?

A 30 year old primiparous woman is referred from her anomaly scan at 20 weeks. The scan report states that the estimated fetal weight is on 15^th centile with normal umbilical and uterine artery Dopplers, there is an enlarged fetal bladder measuring 20mm in diameter but the kidneys could not be visualised and there is anhydramnios. The woman denies any history of leaking vaginal fluid. What is the most likely diagnosis?

A 28 year old woman attends her local Maternity Assessment Unit at 26 weeks gestation in her second pregnancy.  She presents with a two day history of feeling generally unwell with a sore throat and abdominal pain.  Her child has also recently been unwell.  On examination, she has a widespread maculopapular rash.  Her observations are: pulse 130bpm, blood pressure 85/55, temperature 38C, respiratory rate 28, oxygen saturations 94% on RA.  What is the most likely causative organism?

A 28 year old woman is referred to hospital urgently by her GP with suspected sepsis at 26 weeks gestation in her second pregnancy. Which of the following clinical features are not suggestive of sepsis?

A 28 year old woman attends her local Maternity Assessment Unit at 26 weeks gestation in her second pregnancy.  She presents with a two day history of feeling generally unwell with a sore throat and abdominal pain.  Her child has also recently been unwell.  On examination, she has a widespread maculopapular rash.  Her observations are: pulse 130bpm, blood pressure 85/55, temperature 38C, respiratory rate 28, oxygen saturations 94% on RA.  What is the most appropriate investigation?

A 28 year old attends her local Maternity Assessment Unit at 26 weeks gestation in her second pregnancy. She presents with a two day history of feeling generally unwell with a sore throat and abdominal pain.  Her child has also recently been unwell.  On examination, she has a widespread maculopapular rash.  Her observations are: pulse 130bpm, blood pressure 60/30, temperature 38C, respiratory rate 28, oxygen saturations 94% on RA.  What is the most appropriate initial management?

A 28 year old woman attends her local Maternity Assessment Unit at 26 weeks gestation in her second pregnancy. She presents with a two day history of feeling generally unwell with a sore throat and abdominal pain.  Her child has also recently been unwell.  On examination, she has a widespread maculopapular rash.  Her observations are: pulse 130bpm, blood pressure 85/55, temperature 38C, respiratory rate 28, oxygen saturations 94% on RA.  On admission to hospital, she is treatment with broad spectrum intravenous antibiotics.  Which of the following would be the most appropriate choice of antibiotic?

A 28 year old woman is referred to hospital urgently by her GP at 26 weeks gestation in her second pregnancy with suspected bacterial sepsis. Blood cultures are taken and she is treated with broad spectrum antibiotics.  She is subsequently diagnosed with invasive Group A streptococcal infection.  Which of the following statements is incorrect regarding Group A streptococcal infection?

A 20 year old woman attends her local maternity assessment unit at 20 weeks gestation in her first pregnancy. She is very distressed because she has developed painful blisters on her labia which are consistent with genital herpes.  She denies any previous episodes in the past and has not previously been screened for sexually transmitted infections.  What is the most appropriate management plan?

A 20 year old woman attends her local maternity assessment unit at 39 weeks gestation in her first pregnancy. She is very distressed because she has developed painful blisters on her labia which are consistent with genital herpes.  She denies any previous episodes in the past and has not previously been screened for sexually transmitted infections.  What is the most appropriate management plan?

A 20 year old woman attends her local maternity assessment unit at 39 weeks gestation in her first pregnancy.  She has previously been diagnosed with genital herpes and has noticed that she has developed some lesions on the labia over the last few days.  What is the most appropriate management plan?

A 26 year old woman attends her community midwife to book for antenatal care at 8 weeks gestation.Her midwife recommends that she is vaccinated for Hepatitis B as she is in a high-risk category.  Which of the following is not considered to be at high risk of hepatitis B?

A 21 year old in her first pregnancy is referred with a higher chance combined screening result. What is the cut off for a higher chance screening result?

A 30 year old Nigerian woman attends antenatal clinic at 28 weeks of gestation in her first pregnancy.  She is planning to travel back to Nigeria to attend a family wedding but has lived in the UK for the last ten years.  She wishes to discuss malaria prevention.  Which of the following statements about malaria in pregnancy is incorrect?

A 28 year old woman presents at 36 weeks gestation in her third pregnancy as she has noticed pain and numbness in both her hands which is worse at night. On examination, there is normal tone and power but loss of sensation to the thumbs, index fingers and middle fingers bilaterally.  Upper arm reflexes and coordination are normal.  What is the affected nerve?

A routine full blood count at 28 weeks gestation in a low risk primigravida shows a haemoglobin of 90g/L with an MCV of 70. What is the most appropriate management?

Which of the following is not a risk factor for placental abruption?

Which of the following is not a risk factor for placenta praevia?

A 28 year old woman is referred for consultant led care in her fourth pregnancy. She has had three previous Caesarean sections and is noted to have a low-lying anterior placenta covering the internal cervical os at her anomaly scan at 20 weeks gestation.  She is asymptomatic and has not had any vaginal bleeding. What is the most appropriate management?

A 35 year old woman presents at 18 weeks gestation as she has noticed a lump in her right breast. On examination, she has a firm fixed irregular mass in the right breast, extending into the axilla.  What is the most appropriate management?

A 35 year old woman presents to her GP at 18 weeks gestation as she has noticed a lump in her right breast. On examination, she has a firm fixed irregular mass in the right breast, extending into the axilla.  She is referred urgently to a breast specialist and ultrasound guided biopsy confirms a diagnosis of breast cancer.  Which of the following is not contraindicated in pregnancy?

A 36 year old woman requests removal of her copper intrauterine contraceptive device as she wishes to try to conceive.  She has a previous history of breast cancer and asks for pre-conception advice.  Which of the following statements about pregnancy following breast cancer is correct?

A 24 year old primiparous woman attends for her dating scan which shows a singleton viable intra-uterine pregnancy with CRL of 90mm and head circumference of 110mm. She wishes to have screening for Down’s syndrome.  What is the most appropriate investigation?

A woman in her first pregnancy presents at 17 weeks gestation requesting cytomegalovirus (CMV) testing because her husband had been hospitalised with confirmed CMV illness. She tested positive for CMV IgM and IgG. Booking serum is IgM and IgG positive. What is the next most appropriate management?

A woman in her first pregnancy presents at 17 weeks gestation requesting cytomegalovirus (CMV) testing because her husband had been hospitalised with confirmed CMV illness. She tested positive for CMV IgM and IgG. Booking serum was tested and found to be CMV IgM and IgG negative.  What is the risk of congenital CMV?

Which of the following scenarios carries the highest risk of vertical cytomegalovirus (CMV) transmission?

A woman in her first pregnancy presents at 27 weeks gestation with itching and is noted to have abnormal liver function tests with ALT of 80 and bile acids of 12. As part of subsequent investigations, she is found to be positive for CMV IgM and IgG. Booking serum is subsequently tested and confirmed to be IgM and IgG positive with low avidity.  What is the likely diagnosis?

A woman in her first pregnancy presents at 27 weeks gestation with itching and is noted to have abnormal liver function tests with ALT of 80 and bile acids of 12. As part of subsequent investigations, she is found to be positive for CMV IgM and IgG. Booking serum is subsequently tested and confirmed to be IgM and IgG negative.  What is the likely diagnosis?

A woman in her first pregnancy presents at 17 weeks gestation requesting cytomegalovirus (CMV) testing because her husband had been hospitalised with confirmed CMV illness. She tested positive for CMV IgM and IgG. Booking serum was tested and found to be CMV IgM and IgG negative.  What is the next most appropriate management?

A woman in her first pregnancy presents at 17 weeks gestation requesting cytomegalovirus (CMV) testing because her husband had been hospitalised with confirmed CMV illness. She tested positive for CMV IgM and IgG. What is the next most appropriate management?

A woman is referred to fetal medicine from her anomaly scan at 20 weeks gestation with multiple fetal abnormalities. There is mild ventriculomegaly, bilateral facial clefts, severe growth restriction and short long bones.  She requests prenatal testing as she would consider termination of pregnancy if the baby was confirmed to have an underlying genetic condition. Amniocentesis is performed.  What is the next most appropriate investigation?

A woman is referred to fetal medicine from her anomaly scan at 20 weeks gestation with multiple fetal abnormalities. There is mild ventriculomegaly, bilateral facial clefts, severe growth restriction and short long bones.  She requests prenatal testing as she would consider termination of pregnancy if the baby was confirmed to have an underlying genetic condition. Amniocentesis is performed and confirms a normal karyotype and negative micro-array.  Prenatal exome sequencing is requested.  What is the chance of exome sequencing giving a diagnosis?

An 18 year old woman is referred to fetal medicine following her dating scan at 12 weeks gestation in her first pregnancy.  Ultrasound scan shows absence of cranial vault and cerebral hemispheres.  She opts for pregnancy termination and asks what the risk of recurrence is.  What is the risk of recurrence of this condition in a future pregnancy?

An 22 year old woman is referred to fetal medicine following her dating scan at 12 weeks gestation in her first pregnancy.  Ultrasound scan shows an occipital cranial bone defect with a large herniated fluid-filled cyst extruding posteriorly.  The kidneys appear multicystic and there is evidence of polydactyly. The couple are consanguineous second cousins. She opts for pregnancy termination and asks what the risk of recurrence is.  What is the risk of recurrence of this condition in a future pregnancy?

A 30 year old woman is referred to fetal medicine at 32 weeks gestation with a routine growth scan which shows a head circumference below the 1^st centile, having previously been normal at 20 weeks gestation.  What is the most appropriate next investigation?

An 18 year old woman is referred to fetal medicine following her dating scan at 12 weeks gestation in her first pregnancy with a raised nuchal translucency of 11mm.  Ultrasound scan shows bilateral symmetrical cystic structures located in the occipital-cervical region of the fetal neck with the nuchal ligament visible in the midline.  She opts for pregnancy continuation and invasive testing confirms a normal karyotype.  Subsequent scans show a growth restricted fetus below 5^th centile with evidence of pulmonary stenosis.  What is the likely diagnosis?

A 27 year old woman is referred to fetal medicine following her dating scan at 12 weeks gestation in her first pregnancy.  Ultrasound examination shows a paramedian abdominal wall defect with bowel extruding and normal umbilical cord insertion.  What is the risk of recurrence in a subsequent pregnancy?

A 28-year-old Gravida 2, Para 1 woman is referred for consultant led antenatal care at 12 weeks gestation. In her first pregnancy, her baby was diagnosed antenatally with a right-sided intraventricular haemorrhage at 32 weeks gestation causing severe ventriculomegaly. Her first child was born at 37 weeks by planned Caesarean section with a platelet count of 6 × 10⁹/L and required multiple platelet transfusions. Subsequent investigations confirm a diagnosis of fetal neonatal alloimmune thrombocytopenia (FNAIT) with high-titre maternal anti-HPA antibodies.  What HPA antigen is most commonly associated with FNAIT?

A 28-year-old Gravida 2, Para 1 woman is referred for consultant led antenatal care at 12 weeks gestation. In her first pregnancy, her baby was diagnosed antenatally with a right-sided intraventricular haemorrhage at 32 weeks gestation causing severe ventriculomegaly. Her first child was born at 37 weeks by planned Caesarean section with a platelet count of 6 × 10⁹/L and required multiple platelet transfusions. Subsequent investigations confirm a diagnosis of fetal neonatal alloimmune thrombocytopenia (FNAIT) with high-titre maternal anti-HPA-1a antibodies.  Maternal HPA testing confirmed that she has a HPA-1b-1b phenotype. Paternal HPA testing confirmed that her partner has a homozygous HPA-1a-1a phenotype.  What is the chance of the current pregnancy being affected by FNAIT?

A 28-year-old Gravida 2, Para 1 woman is referred for consultant led antenatal care at 12 weeks gestation. In her first pregnancy, her baby was diagnosed antenatally with a right-sided intraventricular haemorrhage at 32 weeks gestation causing severe ventriculomegaly. Her first child was born at 37 weeks by planned Caesarean section with a platelet count of 6 × 10⁹/L and required multiple platelet transfusions. Subsequent investigations confirm a diagnosis of fetal neonatal alloimmune thrombocytopenia (FNAIT) with high-titre maternal anti-HPA-1a antibodies.  Paternal HPA testing confirmed that her partner has a heterozygous HPA-1a-1b phenotype.  What is the chance of the current pregnancy being affected by FNAIT?

A 28-year-old Gravida 2, Para 1 woman is referred for consultant led antenatal care at 12 weeks gestation. In her first pregnancy, her baby was diagnosed antenatally with a right-sided intraventricular haemorrhage at 32 weeks gestation causing severe ventriculomegaly. Her first child was born at 37 weeks by planned Caesarean section with a platelet count of 6 × 10⁹/L and required multiple platelet transfusions. Subsequent investigations confirm a diagnosis of fetal neonatal alloimmune thrombocytopenia (FNAIT) with high-titre maternal anti-HPA-1a antibodies.  Maternal HPA testing confirmed that she has a HPA-1b-1b phenotype. Paternal HPA testing confirmed that her partner has a homozygous HPA-1a-1a phenotype.  What is the most appropriate management?

A 28-year-old Gravida 2, Para 1 woman is referred for consultant led antenatal care at 12 weeks gestation. In her first pregnancy, her baby was diagnosed antenatally with a right-sided intraventricular haemorrhage at 24 weeks gestation causing severe ventriculomegaly. Her first child was born at 37 weeks by planned Caesarean section with a platelet count of 6 × 10⁹/L and required multiple platelet transfusions. Subsequent investigations confirm a diagnosis of fetal neonatal alloimmune thrombocytopenia (FNAIT) with high-titre maternal anti-HPA-1a antibodies.  Maternal HPA testing confirmed that she has a HPA-1b-1b phenotype. Paternal HPA testing confirmed that her partner has a homozygous HPA-1a-1a phenotype.  What is the most appropriate management?

Which antibody is most commonly associated with severe haemolytic disease of the fetus and newborn (HDFN)?

What is the false negative rate for mass throughput RhD screening fetal genotyping by cell free fetal DNA (cffDNA)?

What percentage of RhD negative women do not require anti-D prophylaxis as they are carrying a RhD negative fetus?

Which of the following red cell antibodies do not cause haemolytic disease of the fetus and neonate (HDFN)?

Which of the following is not an indication for referral to a fetal medicine specialist?

A 30 year old woman is referred to fetal medicine in her second pregnancy at 24 weeks gestation.  She is known to have anti-D antibodies and fetal genotyping confirms that her fetus is predicted to be RhD positive. Her most recent titre shows anti-D concentration of 21IU/mL and ultrasound assessment shows a middle cerebral artery peak systolic velocity (MCA-PSV) of >1.5 MoMs.  She undergoes intra-uterine blood transfusion which confirms fetal anaemia with starting fetal Hb of 45. Which of the following is not a requirement for blood for intrauterine blood transfusion?

A 29 year old woman is referred to fetal medicine in her third pregnancy due to a history anti-D antibodies and severe haemolytic disease of the fetus and neonate (HDFN) in her second pregnancy which required multiple intra-uterine blood transfusions.  She is commenced on weekly intravenous immunoglobulin (IVIG) infusions from 12 weeks gestation as part of a clinical trial, with the aim of delaying the need for intra-uterine blood transfusion to a later gestation. Which of the following is the most common side effect of IVIG?

A 30 year old woman is referred to fetal medicine in her second pregnancy at 24 weeks gestation.  She is known to have anti-D antibodies and fetal genotyping confirms that her fetus is predicted to be RhD positive. Her most recent titre shows anti-D concentration of 21IU/mL and ultrasound assessment shows a middle cerebral artery peak systolic velocity (MCA-PSV) of >1.5 MoMs.  She undergoes intra-uterine blood transfusion which confirms fetal anaemia with starting fetal Hb of 45. Which of the following is not a recognised complication of intrauterine blood transfusion?