Obesity – Maternal medicine Module part2

Obesity - Maternal medicine Module part2

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A woman with a BMI of 42 seen in antenatal clinic at 37 weeks. A plan is being made for
induction of labour at 39/40 weeks.

A) Birth injury, stillbirth

B) Difficult fetal monitoring, need for fetal scalp electrode

C) Macrosomia, stillbirth

D) Need for continuous electronic fetal monitoring

E) Preterm labour, macrosomia

F) SGA, preterm birth

G) Stillbirth, no guidance for monitoring available

A woman with a BMI of 35 who, at 36/40 week scan, shows estimated fetal weight of greater
than the 98th centile.

A) Birth injury, stillbirth

B) Difficult fetal monitoring, need for fetal scalp electrode

C) Macrosomia, stillbirth

D) Need for continuous electronic fetal monitoring

E) Preterm labour, macrosomia

F) SGA, preterm birth

G) Stillbirth, no guidance for monitoring available

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.

3) 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

4) Not true about obesity and pregnancy

A) Anti‐obesity or weight loss drugs are not recommended for use in pregnancy.

B) Pregnant women with a booking BMI 40 kg/m2 or greater should be referred to an obstetric anaesthetist for consideration of antenatal assessment.

C) All pregnant women with a booking BMI 35 kg/m2 or greater should be screened for gestational diabetes

D) Women with more than one moderate risk factor (BMI of 35 kg/m2 or greater, first pregnancy, maternal age of more than 40 years, family history of pre‐eclampsia and multiple pregnancy) may benefit from taking 150 mg aspirin daily from 12 weeks of gestation until birth of the baby.

E) Women with a BMI greater than 35 kg/m2 are more likely to have inaccurate SFH measurements and should be referred for serial assessment of fetal size using ultrasound.

are at increased risk of mental health problems and should therefore be screened for these in
pregnancy

A) BMI 30 or more

B) BMI 40 or more

C) BMI 35 or more

Regarding folic acid supplementation in pregnancy for women having BMI 30 kg/m2 or greater,
true statement is

A) 400 microgram of folic acid daily is advised starting one month before pregnancy and continue in first trimester

B) Folic acid supplementation 5 mg/day should start at least 1 month before conception and continuing during the first trimester of pregnancy.

C) Folic acid supplementation 5 mg/day should start at least 1 month before conception and continuing during the first trimester of pregnancy

D) Folic acid supplementation 5 mg/day should start at least 3 month before conception and continue throughout the pregnancy.

E) 400 microgram of folic acid daily is advised starting ine month before pregnancy and continue in first trimester

A woman with a BMI of 30 seen for her anomaly scan at 20/40 weeks. She had a gastric band
procedure 2 years previous and lost 20% of her bodyweight.

A) Birth injury, stillbirth

B) Difficult fetal monitoring, need for fetal scalp electrode

C) Macrosomia, stillbirth

D) Need for continuous electronic fetal monitoring

E) Preterm labour, macrosomia

F) SGA, preterm birth

G) Stillbirth, no guidance for monitoring available

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.

8) 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

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.

9) 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.

10)

During antenatal consultations, women with a BMI greater than 30 should be informed of which
of the following antenatal risks:

A) Gestational diabetes, hypertension, fetal macrosomia, preterm birth

B) Gestational diabetes, small-for-gestational-age fetus, preterm birth, stillbirth

C) Gestational diabetes, small-for-gestational-age fetus, stillbirth

D) Gestational diabetes, thromboembolism, hypertension, fetal macrosomia, stillbirth

E) Thromboembolism, hypertension, fetal macrosomia, preterm birth

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.

11) 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

12)

A 30 years old woman books in the antenatal clinic at 12 week of gestation with a BMI of 40.This
is her first pregnancy and she is fit and well with no family history of note. With regard to her BMI
which complication of pregnancy is the highest risk compared to women with a normal BMI ?

A) emergency c . section

B) gestational diabetes

C) postpartum haemmorage

D) still birth

E) venous thromboembolism

13) A woman with a BMI of 40 booking at 12/40 weeks in her first pregnancy

A) Birth injury, stillbirth

B) Difficult fetal monitoring, need for fetal scalp electrode

C) Macrosomia, stillbirth

D) Need for continuous electronic fetal monitoring

E) Preterm labour, macrosomia

F) SGA, preterm birth

G) Stillbirth, no guidance for monitoring available

14)

likely to have inaccurate SFH measurements and should be referred for serial assessment of fetal
size using ultrasound.

A) BMI 30 or more

B) BMI 40 or more

C) BMI 35 or more

15) All are true regarding pregnancy following bariatric surgery except;

A) There is reduced incidence of GDM after bariatric surgery

B) These pregnancies should be managed in consultant led care

C) A minimum waiting period of 12–18 months after bariatric surgery is recommended before conception

D) Glucose tolerance test should be done to screen foe GDM

E) Regular blood tests may be required following malabsorptive surgeries to diagnose micronutritional deficincies.

16)

should have venous access established early in labour and consideration should be given to the
siting of a second cannula.

A) BMI 30 or more

B) BMI 40 or more

C) BMI 35 or more

17)

A woman with a BMI of 37 is 41 weeks pregnant. The baby has demonstrated normal growth on
scans and she declines induction of labour.

A) Birth injury, stillbirth

B) Difficult fetal monitoring, need for fetal scalp electrode

C) Macrosomia, stillbirth

D) Need for continuous electronic fetal monitoring

E) Preterm labour, macrosomia

F) SGA, preterm birth

G) Stillbirth, no guidance for monitoring available

18) should be referred to an obstetric anaesthetist for consideration of antenatal assessment.

A) BMI 30 or more

B) BMI 40 or more

C) BMI 35 or more

19)

A 31-year-old primigravida with BMI of 40 attends her community midwife at 8 weeks of
gestation for her booking visit. What information should she be given on her options regarding
screening for chromosomal anomalies?

A) First-trimester combined screening is not recommended due to the inaccuracy of nuchal translucency measurements so she should have second-trimester (quadruple) screening instead.

B) First-trimester combined screening will be offered, but if there are difficulties obtaining a nuchal translucency measurement she may require a transvaginal ultrasound

C) Her weight has no impact on the accuracy of screening for chromosomal anomalies

D) Non-invasive prenatal testing (NIPT) is offered first line as the higher free-fetal DNA fraction in maternal plasma means the result is more accurate.

E) She should not have a screening test as the risks of amniocentesis are so high that she would not be able to have one even if she had a high-risk result

20)

should have a moving and handling risk assessment carried out in the third trimester of
pregnancy to determine any requirements for labour and birth.

A) BMI 30 or more

B) BMI 40 or more

C) BMI 35 or more

21) With regard to reproduction in obese woman; which of the following statement is correct;

A) Pregnancies have similar degrees of risk of obstetric complications as in non-obese women

B) Infertility is mainly explained by its relation to pcos

C) They have a higher risk of aneuploid miscarriage than those of normal weight

D) The effect of obesity on ART outcomes could be only explained by abnormal oocyte quality

E) Fertilization rate of oocytes from ART are lesser to those of non-obese women

A 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.

22) 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

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