1) 223. A 23-year-old woman presents with ongoing pruritus that has worsened from

12 weeks of pregnancy.

Her blood results are:

Albumin 32 g/l

Serum alkaline phosphatase 320 U/l

Serum ALT 35 U/l

Serum bilirubin 20 μmol/l

γ-Glutamyl transferase 40 U/l

Anti-nuclear antibodies Negative

Anti-mitochondrial antibodies Positive

Anti-smooth muscle antibodies Negative

Lupus anticoagulant Negative

2) 125. What is the primary reason that serological screening for hepatitis B is routinely

offered to all pregnant women?

3) A 30-year-old woman, who is 36 weeks pregnant, is seen in antenatal clinic. This is

her fi rst pregnancy. She is HIV positive. She has been fully compliant with her

HAART (highly active antiretroviral therapy) throughout her pregnancy. Her latest

serum viral load is <50 copies/mL. Apart from HIV, her pregnancy has been uncom- plicated, and she has an appropriately grown cephalic presentation fetus. She is concerned about vertical transmission of HIV and is keen to avoid surgery if possi- ble. Which one of the following is recommended management and advice?

4) 127. A 27-year-old multiparous woman had spontaneous rupture of membranes at

37 weeks of gestation. She is a carrier of group B Streptococcus (GBS) as detected

on a vaginal swab in the second trimester.

What is the most appropriate management?

5) 214. A 27-year-old woman is reviewed in the antenatal clinic at 36 weeks in her

first pregnancy. She has HIV and is on highly active antiretroviral treatment

(HAART). What is the threshold parameter for which delivery by elective

caesarean section would be recommended?

6) A 26-year-old primigravida, 26 weeks gestation has chronic hepatitis B infection.

She is on Tenofovir for treatment of the HBV infection. She is HbeAg negative and

the viral load is 104 IU/ml.

Which of the following statements is true regarding her medical condition?

7) 222. A 34-year-old woman starts to develop severe pruritus on her limbs and trunk

at 34 weeks of gestation. On examination, there is evidence of scratching but

no rash. She is afebrile and her urine is dark. LFTs are abnormal with an alanine

transaminase (ALT) level of 451 U/l with normal bile acids. Standard liver

serological screening is normal.

8) Which of the following statements is false regarding hepatitis C infection in

pregnancy?

9) 131. A woman who is 36 weeks pregnant attends the maternity day assessment unit

with decreased fetal movements. She has no other symptoms. The CTG and

clinical observations are all normal. A dipstick test of a urine sample reveals 1+

proteinuria. The sample is sent for culture and sensitivity. The result is as follows:

The automated urine microscopy results are:

White blood cells >100 (× 106

/l)

Red blood cells >40–100 (× 106

/l)

Squamous epithelial cells ≥20 (× 106

/l)

The culture results are:

Organism count 104

–105

/ml

Organism Group B Streptococcus

Antibiotic sensitivity Erythromycin, nitrofurantoin, penicillin

What is the correct management?

117. 10) A 33-year-old woman has just had her second normal vaginal delivery. She is

a known group B Streptococcus (GBS) carrier, and received the loading dose

of benzylpenicillin 30 minutes prior to delivery. She is otherwise low risk

obstetrically and the baby was born in good condition.

What initial management of the neonate would be recommended

11) Ms XY is 30/40 weeks pregnant. Her recent MSU sample confi rms the presence of

signifi cant GBS bacteriuria (>105 CFU/ml) sensitive to cephalexin. However, she is

asymptomatic for a UTI. Which of the following treatment options are best suited to

her?

12) The commonest pathogen causing ascending genital tract infection following deliv-

ery of any type (miscarriage/abortion, termination, caesarean section, vaginal deliv-

ery) is:

13) Which antibiotics should be given to prevent early onset neonatal GBS disease to

women who have accepted intrapartum antibiotic prophylaxis (IAP) and are allergic

 to benzylpenicillin?

14) What is false about immunisation and antibiotic prophylaxis in women at risk of

transfusion related infections?

15) 213. An HIV-positive woman who presented late for antenatal care at 34 weeks of

gestation is now in labour. What would be the threshold parameter for offering

intrapartum intravenous zidovudine therapy?

215. 16) An HIV-positive woman presents with spontaneous rupture of membranes at

term. What is the threshold parameter to recommend induction of labour

17) 221. A 30-year-old woman in her third pregnancy arrives unbooked from Mumbai

at 28 weeks of gestation. She begins to feel unwell at 32 weeks of gestation and

develops jaundice, severe fatigue and nausea. She rapidly develops fulminant

hepatic failure and encephalopathy. She is transferred to a liver unit, but dies,

despite intensive therapy.