OBESITY -ANS module part2

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1) 111. Which obstetric complication has a significantly increased likelihood in women

who have undergone bariatric surgery?

A) Delivery by caesarean section

B) Gestational diabetes

C) Large-for-gestational-age fetus

D) Pre-eclampsia

E) Small-for-gestational-age (SGA) fetus

2) Retake quiz

A 29-year-old para 1 with a booking BMI of 42 (121 kg) attends at 39+1 weeks of gestation with a history of regular contractions and spontaneous rupture of the membranes.

Her first baby was born three years ago by emergency caesarean section for suspected fetal compromise when the cervix was 7 cm dilated.

In this pregnancy, the antenatal course has been uncomplicated and she is aiming for a vaginal birth. On examination, the cervix is 5 cm dilated and the liquor is clear.

What would be the most appropriate management?

A) Intravenous access, continuous EFM, inform anaesthetist and theatre staff of admission, consider epidural analgesia and syntocinon

B) Intravenous access, continuous EFM, inform anaesthetist and theatre staff of admission, consider epidural analgesia, review by a senior obstetrician at the ward round

C) Intravenous access, continuous EFM, inform paediatrician of admission, consider epidural analgesia, review by a senior obstetrician at the ward round

D) Intravenous access, continuous EFM, inform anaesthetist and theatre staff of admission, consider epidural analgesia, inform paediatrician of admission

E) Mobilise and allow labour to progress with intermittent auscultation of the fetal heartbeat

3) A 32-year-old primigravida woman books at 12 weeks gestation with a BMI of 55. What

management would you advocate?

A) Active management of the third stage

B) .Recommend elective caesarean section for women with extreme obesity (BMI > 50)

C) Recommend epidural analgesia early in labour

D) Regular cervical length assessment due to the increased risk of preterm labour

E) Routine episiotomy

4) A 28-year-old woman with a BMI of 40 at booking and weighing 120 kg, had a Neville Barnes forceps birth with an episiotomy and is requesting an early discharge. She had an uncomplicated pregnancy and does not like staying in hospital.

How would you advise this woman?

A) You advise against early discharge as she is a high-risk patient

B) You agree for the woman to go home and arrange for her to have a test for glucose tolerance 6 weeks after birth

C) You agree for the woman to go home on antibiotics for a week to avoid infection of the episiotomy

D) You agree for the woman to go home with 60 mg of enoxaparin for 10 days

E) You agree for the woman to go home with 80 mg of enoxaparin for 10 days

5) 17) You see a couple in the Gynaecology clinic with subfertility of 18

months' duration. The woman, who is generally healthy, has a BMI of 24

kg/m2 and is ovulating normally as evidenced by 21-day progesterone

test. The man, who is a smoker, has a BMI of 44 kg/m2

.What is the likely

impact of his high BMI on their fertility?

A) Alters lipid content of seminal plasma 2.

B) Associated with hypothermia of the testicles

C) Causes erectile dysfunction

D) Increases libido

E) Production of immature spermatozoa

6) 54) What is the main difference between an obese and a non-obese

woman undergoing IVF/ICSI with respect to live birth rates after their

first ART cycle?

A) Women with a BMI of > 30 kg/M2 have up to 20% lower risk of having a live birth compared to those with BMI< 30 kg/M2

B) Women with a BMI of > 30kg/M2 have up to 30% lower risk of having a live birth compared to those with BMI< 30kg/M2

C) Women with a BMI of > 30kg/M2 have up to 50% lower risk of having a live birth compared to those with BMI< 30kg/M2

D) Women with a BMI of > 30kg/M2 have up to 60% lower risk of having a live birth compared to those with BMI< 30kg/M2

E) Women with a BMI of > 30kg/M2 have up to 70% lower risk of having a live birth compared to those with BMI< 30kg/M2

7) MMD25

Regarding pregnancy outcome after bariatric surgery in obese reproductive age

women, which of the following is true?

A) Pregnancy should be delayed for at least 2 years following bariatric surgery.

B) Dumping syndrome following bariatric surgery can be provoked by 75 g GTT.

C) Ideal gestational weight gain (GWG) for pregnancies following bariatric sur- gery is 8–10 k.g.

D) Pregnant women need not take supplements of folic acid, vitamin B12 and iron.

E) There is increased risk of preterm deliveries and congenital anomalies.

8) A 20-year-old para 1 is seen for booking at 12 weeks gestation. In her first pregnancy she had a spontaneous vaginal birth at 38 weeks. She has a BMI of 33 (weight 85 kg) and smokes 10 cigarettes per day. She is otherwise fit and well and is not on any medication other than folic acid 5 mg which was prescribed by her GP.

What would be the most appropriate management for her pregnancy?

A) Continue folic acid, add vitamin D 10 microgram and aspirin 75 mg once daily. Arrange glucose tolerance test at 26–28 weeks.

B) Continue folic acid, add vitamin D 10 microgram and aspirin 75 mg once daily. Arrange glucose tolerance test at 16–18 weeks, if this is normal repeat at 28 weeks.

C) Stop folic acid, start aspirin 75 mg once daily. Arrange glucose tolerance at 26–28 weeks. Offer induction of labour at 39 weeks.

D) Stop folic acid. Arrange glucose tolerance test at 26–28 weeks.

E) Stop folic acid, start vitamin D 10 microgram once daily. Arrange glucose tolerance test at 26–28 weeks.

9) 36/40 weeks pregnant woman in her second pregnancy, and with a BMI of 41 at booking, presents in the antenatal clinic to discuss the mode of birth. Her scan today shows a normal size baby. She had an emergency Caesarean section 3 years ago with her first baby at full dilatation with no subsequent complications.

What would be the most appropriate advice at this point in her management?

A) An elective caesarean section at 39 weeks of gestation with a consultant anaesthetist and consultant obstetrician present in theatre

B) A membrane sweep at 40 weeks and an induction of labour at T12

C) A planned induction of labour at 38 weeks of gestation to prevent neonatal birth injury

D) A repeat scan at 38 weeks of gestation to assess the weight of the baby and then decide the mode of birth based on the EFW

E) Discuss the pros and cons of a VBAC and encourage a vaginal birth

10) 55) What would be the recommended duration of physical activity for a

30 year old obese (body mass index of 33 kg/M2) woman who is trying

to conceive?

A) 1. Moderate intensity for at least 30−40 minutes on four or more occasions each week

B) 2. Moderate intensity for at least 30−40 minutes on five or more occasions each week

C) 3. Moderate intensity for at least 60−90 minutes daily four or more occasions each week

D) 4. Moderate intensity for at least 60−90 minutes on five or more occasions each week

11) A 22-year-old primigravida attends for post-dates induction of labour at 41+5 weeks of gestation. At booking her BMI was 32 (weight 95 kg). There is no significant past medical history and she has been well antenatally.

Following induction with prostaglandins and syntocinon she had a normal vaginal birth, although the placenta was not delivered for 50 minutes. The blood loss was estimated to be 1300 ml.

What is the most appropriate postnatal thromboprophylaxis method for this woman?

A) 5 days of low molecular weight heparin

B) 10 days of low molecular weight heparin

C) 6 weeks of low molecular weight heparin

D) Graduated compression stockings

E) Graduated compression stockings and 7 days of low molecular weight heparin

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