2

Multiple-choice questions:
Paper 2
1

Downs syndrome:
a has a birth prevalence in the region of 1.4 per 1000
in England and Wales
b can be diagnosed using serum
screening c can be found in mosaic form
d is associated with oligohydramnios
e is associated with a higher rate of miscarriage than
in pregnancies with a normal karyotype.

Concerning post-coital contraception.

a The progesterone-only pill can be used.
b Oral methods should be administered within 24 hours.
c It is available as an over the counter preparation.
d The intrauterine device has a role.
e Follow-up of individuals who have used postcoital contraception is not worthwhile.

Urinary tract infection in pregnancy:

a is associated with preterm labour b
is commonly due to staphylococci
c acute pyelonephritis is associated with intrauterine
growth retardation
d is more common with a transverse
lie e may present with vomiting.

20

MCQs PAPER 2: QUESTIONS

Rubella in pregnancy:
a means screening pregnant women by sampling for
rubella antibodies is advised
b is associated with recurrent miscarriage
c is associated with the greatest incidence of congenital
malformations when the infection occurs during the
second trimester
d is indicated by a rising titre of rubella-specific IgM
levels following recent infection
e is associated with a neural tube defect in the fetus.

Congenital abnormalities are associated with the

following maternal infections:
a hepatitis B
b toxoplasmosis
c cytomegalovirus
d group B streptococcus
e parvovirus.

Concerning thalassaemia in pregnancy.

a Thalassaemia minor may be suspected on a blood film.
b It most commonly occurs in women of African origin.
c The carrier rate in the UK is approximately 1 in 10 000.
d A woman with -thalassaemia minor can be reassured that
the baby will be healthy.
e Thalassaemia trait increases the likelihood of pre-eclampsia.

LHRH analogues:
a can be used to treat endometriosis
b rarely cause side effects
c can be administered orally d
are inexpensive preparations
e act principally at the uterine level.

21

OBSTETRICS AND GYNAECOLOGY FOR FINALS, DRCOG AND MRCOG

Concerning intermenstrual bleeding (IMB).

a
IMB occurs in about 10% of normal
menstrual cycles.
b Laparoscopy should be included as part
of the investigation. c A luteal phase
progesterone is essential.
d IMB may be associated with ovulation.
e
IMB is a feature of cervical intraepithelial neoplasia.

Risks of combined oral contraceptive (COC)

pill usage include: a increased incidence of
endometrial carcinoma
b
pelvic
inflammatory
disease
c
benign
ovarian cysts
d hypotension
e increased risk of ovarian carcinoma.

10

Rotational delivery:
a may be preceded by a labour during
which back pain is a prominent
feature
b can be achieved using a silastic ventouse
cup
c can be safely attempted when two-fifths
of the fetal head is palpable per
abdomen
d can correct a deep transverse arrest
e should be attempted with a fetal pH of
7.12.

11

In pregnancy, ultrasound:
a can diagnose fetal ascites
b anomaly scanning is usually carried
out in the second trimester of
pregnancy
c can establish fetal maturity at
34 weeks gestation d can
diagnose a cleft lip

e is able to identify the fertilised ovum prior

to implantation.
12

The following are known

to be teratogenic: a
alcohol
b
m
e
t
h
y
l
d
o
p
a
c
w
a
r
f
a
r
i
n
d
a
mi
no
gl
yc
os
id
es
e
ph

en
yt
oi
n.

22

MCQs PAPER 2: QUESTIONS

13

Fallopian tube occlusion:

a may be caused by chlamydial infection
b is a common finding in pelvic endometriosis
c when caused by infection most commonly ascends from
the lower genital tract
d may follow appendicitis
e can be assessed using transvaginal ultrasound.

14

Gonorrhoea:
a may cause blindness in the baby of an infected
mother b is diagnosed by taking a high vaginal swab
c may cause perihepatitis
d may cause penile discharge
e is caused by a Gram-positive diplococcus.

15

The following instructions are appropriate when advising on

the use of the diaphragm.
a Always use a spermicide.
b Sterilise the diaphragm prior to insertion.
c The diaphragm cannot be used at the same time as the
sheath. d Refitting the diaphragm is required after childbirth.
e The diaphragm must be left in place for at least six
hours following intercourse.

16

Concerning sickle cell disorders in pregnancy.

a Sickle cell disorders are most common in women of
Asian origin.
b A sickle cell crisis can be precipitated in conditions
of heightened oxygen tension.
c Sickle cell disorders are associated with an increased
incidence of hypertension during pregnancy.
d Sickle cell disease results from a variant on the alpha
globin chain.
e Partner screening is recommended during the
second trimester.

23

OBSTETRICS AND GYNAECOLOGY FOR FINALS, DRCOG AND MRCOG

17

Urodynamic investigations:
a are unnecessary in the patient who
complains of stress incontinence
b
can be conducted before excluding
urinary infection
c cystometry measures the pressure/volume
relationship of the bladder during filling
and voiding
d could usefully include ultrasonography
e
if normal, should show a bladder
capacity of 250 mL.

18

The perinatal mortality rate:

a is usually expressed at the rate per
thousand total births over one year
b is attributable to congenital malformations
in 50% of cases c in England and Wales is
higher in those whose mother was
born in Pakistan than in those whose
mother was born in the West Indies
d falls with social class
e is lowest in mothers aged between 18
and 20 years.

19

Tocolysis to suppress preterm labour:

a ideally should be continued for 12 hours
b carries the risk of maternal
pulmonary oedema if sympathomimetics are used
c is usually initiated with oral therapy
d may be employed beyond 34
weeks
gestation
e
is
exclusively a role for sympathomimetics.

20

Ovarian masses:
a are malignant in the
presence of ascites b
include
benign
teratomas
c
of germ cell origin may secrete
hormones

d may be confused with developmental

abnormalities of the renal tract
e if malignant can be reliably staged preoperatively.

24

MCQs PAPER 2: QUESTIONS

21

Concerning lactation.
a Lactation is successfully suppressed by demand
feeding to empty the engorged breasts.
b Colostrum is secreted for seven days after the
birth. c Bromocryptine promotes milk production.
d Lactation will fall with Sheehans syndrome.
e The staphylococcus organism is associated with
puerperal mastitis.

22

When massive post-partum haemorrhage occurs:

a an anaesthetist is essential to assist in the management of
the patient
b initial cross-matching of three units of blood is
sufficient c bimanual uterine compression has a role
d uncross-matched O Rhesus-positive blood may be given in
an emergency
e bilateral uterine artery ligation may be necessary.

23

Secondary post-partum haemorrhage:

a is abnormal bleeding that occurs 12 hours postpartum b may be due to infection
c cannot be controlled by uterine contracting
agents d occurs following 5% of births
e can usually be diagnosed by ultrasound examination of
the pelvic organs.

24

Regarding resuscitation of the newborn.

a Resuscitation in some form is required in approximately
one-third of babies.
b The Apgar score is recorded at delivery.
c Resuscitation will be required if the fetal heart rate
is persistently 90 beats a minute.
d Meconium seen in the posterior pharynx and larynx is
an indication for intubation.
e Naloxone can be given safely to all infants.

25

OBSTETRICS AND GYNAECOLOGY FOR FINALS, DRCOG AND MRCOG

25

Concerning maternal cardiac disease in

pregnancy.
a A classification system exists to determine
the mortality risk. b Involvement of the aorta in
Marfans syndrome increases the
mortality.
c The fetus has an increased risk of
congenital heart disease. d Mitral stenosis is
an infrequent complication following

rheumatic heart disease.

Women with primary pulmonary
hypertension should be advised
against pregnancy.

26

Appropriate
maternal
investigations
following a term stillbirth would include:
a
glycosylate
d
haemoglobi
n
b
a
Kleihauer
blood test
c a platelet count
d blood pressure measurement
e antinuclear antibody estimation.

27

Placental abruption:
a
may
have
no
associated
vaginal
bleeding
b
is
an
indication for delivery
c has a higher incidence with
maternal cocaine abuse d may be
identified
using
ultrasound
to
demonstrate
retroplacental clot
e can be readily distinguished from acute
appendicitis.

28

The ventouse method:

a may employ a metal cup

b
has increased in popularity with
electronic pumps
c can be used safely in the absence of
criteria necessary for a forceps delivery
d requires the patient to be in the lithotomy
position
e may be performed in conjunction with a
pudendal block.
29

26

A high fetal head at

term in a primipara: a
can be caused by
placenta praevia
b can be caused by a lower-segment
uterine fibroid

MCQs PAPER 2: QUESTIONS

c
d
e
30

27

is associated with incorrect pregnancy dating

is an indication for a Caesarean section
has a higher incidence in patients of African origin.

Fetal well-being in the third trimester can be usefully

assessed by:
a serial assessment of symphyseal fundal height
b ultrasound measurement of crownrump length
c ultrasound measurement of amniotic fluid
volume d measuring serum alpha-fetoprotein
e measuring serum oestradiol levels.

OBSTETRICS AND GYNAECOLOGY FOR FINALS, DRCOG AND MRCOG

Answers: MCQs Paper 2

1 a T This

figure translates into

approximately 970 affected births
annually.
b F The serum screening only gives a
risk for the likely incidence of Downs
syndrome being present at term in an
individual pregnancy. Diagnosis
requires karyotyping.
c T
Mosaicism accounts for 12% of
Downs cases.
d F Polyhydramnios is found in
association
with
duodenal
atresia.
e T Fetal wastage is more
common with all types of
chromosomal
abnormalities.

2 a F The

POP is not used in this context, as

its principal mechanism of action is
thickening of cervical mucus and
prevention of sperm penetration.
b F It should be administered within 72
hours.
c T
Post-coital
contraception
is
available for purchase over the
counter.
d T Following adequate counselling
the intrauterine contraceptive
device may be fitted within five days
of the episode of unprotected
intercourse.
e F Follow-up can detect method
failures
and
ensure
adequate
contraceptive measures are being
taken.

3 a T Uterine

activity can be precipitated by

urinary infection and should always
be screened for and treated in the
patient who presents with

d
e

28

symptoms and/or signs of preterm

labour.
F This organism is unusual; the
most common bacterium found is
Escherichia coli.
T This association, together with
the risks of preterm labour and
delivery, is the indication for
hospitalisation and intravenous
antibiotic therapy to treat acute
pyelonephritis.
F There is no known, statistically
proven association with fetal lie.
T A variety of non-specific
symptoms may be present, such as
nausea,
vomiting,
fever
and
abdominal pain.

MCQs PAPER 2: ANSWERS

4 a T Such

screening provides valuable baseline information.

Additionally, all women who lack rubella antibodies
should be identified and offered postnatal vaccination.
F A pregnancy during which primary rubella
infection is contracted has a higher incidence of
miscarriage.
Thereafter rubella immunity is developed and protects a
subsequent pregnancy from this complication.
F First-trimester infection has the most devastating
consequences, with in excess of 80% of fetuses affected.
T Detection of rising IgM titres is used for diagnostic
purposes. Rubella-specific IgM is demonstrable for up
to eight weeks after the onset of the rash.
F A variety of defects, including cataracts,
chorioretinitis, microphthalmia, glaucoma, deafness,
microcephaly and mental retardation but not neural
tube defects, are associated with congenital rubella
infection.

5 a F There

6 a T Red

is no known association. However, infants born

to hepatitis B surface-antigen-positive women
should be given hepatitis B immunoglobulin and
active immunisation shortly after delivery.
T Toxoplasmosis infection is associated with fetal
intracranial calcification, microcephaly, hydrocephaly
and hepatosplenomegaly.
T Cytomegalovirus can result in
hepatosplenomegaly, microcephaly,
hyperbilirubinaemia, petechiae and
thrombocytopenia.
F Group B streptococcus is a common normal
maternal vaginal commensal. It does not cause fetal
abnormality. It can cause overwhelming neonatal
infections, but this is rare.
F Parvovirus B19 infection is a known cause of nonimmune hydrops fetalis. This is not a congenital
abnormality.
blood cells of sufferers are small, with a low mean cell
volume and low mean cell haemoglobin.
F Thalassaemia has a worldwide distribution
but is concentrated in a broad band
encompassing the Mediterranean and Middle

East.

29

OBSTETRICS AND GYNAECOLOGY FOR FINALS, DRCOG AND MRCOG

cT The carrier rate of approximately 1 in

10 000 in the UK can be compared
with a carrier rate of 1 in 7 in Cyprus.
d F Depending on the carrier status
of the mothers partner, the fetus
may have a normal haemoglobin,
thalassaemia minor or
thalassaemia major. Therefore, no
such reassurance can be given.
F There is no known association.

7 a T LHRH

analogues have proved to be

successful therapy for endometriosis
in a number of controlled trials.
F Side effects similar to those
experienced by women during the
menopause are commonly
experienced by women in receipt of
LHRH analogue treatment.
F The polypeptide structure of the
LHRH analogues makes them
inappropriate for oral administration.
Parenteral routes, including the nasal
route, injection and depot
preparations, have been developed.
F Costs of these preparations
are in excess of 80 per
month.
F LHRH analogues act by initial
stimulation, followed by downregulation
of
pituitary
gonadotrophin secretion.

a F IMB is uncommon in the normal

menstrual cycle.
b F
Hysteroscopy is the more useful
investigation.
c F The establishment of ovulation is
not essential in the management of
patients with IMB, but it may be
helpful if progestogens are to be
considered in the adequately
assessed anovulatory patient.
8

T Regular mid-cycle spotting and

pain (mittelschmerz) are noted by
some women at the time of
ovulation.
F
Pre-invasive cervical disease does
not cause IMB.

a F The COC has a protective effect in

the order of 50%.
b F The incidence of PID is lower
in women who use the COC as
a method of contraception,
compared with women who
have unprotected intercourse.
c F The incidence of benign ovarian cysts
is lower.
d F
COC usage is associated with
hypertension.
e F The COC has a protective effect;
most studies indicate a reduction in
excess of 50%.
9

30

MCQs PAPER 2: ANSWERS

10 a T Back

F
d
e

11

pain is common in labours with an occipito-posterior

position of the fetal head.
T The ventouse has increased in popularity for achieving
safe rotational vaginal delivery. Clinicians often prefer the
metal cup for rotations, feeling the failure rate is lower.
None of the head should be palpable per abdomen.
T Rotation to the occipito-anterior position can
permit vaginal delivery.
F In the presence of fetal distress, delivery should
be by Caesarean section.

a T Fluid can clearly be seen around the fetal liver and bowel.
b T Most commonly this examination is now
conducted around 20 weeks of gestational age.
c F Fetal maturity cannot be reliably
determined ultrasonographically in the
third trimester.
d T Early diagnosis of cleft lip can be useful
information to forewarn the parents and paediatric
surgeons.
e F Pregnancies can only be detected following implantation.

12 a T Widespread

cT

T
e

abnormalities, including those of the fetal

alcohol syndrome with growth retardation, central
nervous system abnormalities, microcephaly,
microphthalmia and poorly developed philtrum,
have been described.
F Methyldopa has been used safely during
pregnancy for many years to control hypertension.
There have been occasional case reports of
microcephaly.
Warfarin is known to cause intracerebral haemorrhage,
nasal hypoplasia and stippling of the epiphyses.
Aminoglycosides are known to be ototoxic.
T Phenytoin can cause fetal hydantoin syndrome.
Various craniofacial and digital abnormalities, together
with more major anomalies (cardiac defects, cleft lip
and palate), have been associated with maternal
phenytoin ingestion during pregnancy.

31

OBSTETRICS AND GYNAECOLOGY FOR FINALS, DRCOG AND MRCOG

13 a T Chlamydial

infection, which may be

asymptomatic, can cause considerable
tubal damage. It is more common than
gonorrhoea as the infection responsible.
F Tubal occlusion is surprisingly
uncommon even in the presence of
moderately
severe
pelvic
endometriosis.
T The mechanism, however, by which
infection ascends through the cervical
canal and reaches the fallopian tubes is
still unknown.
T Appendicitis can result in tubal
damage, both from the local pelvic
inflammatory reaction and the
associated surgery.
F A hydrosalpinx may be seen
ultrasonographically, but occlusion of
normal calibre tube and fimbrial end
clubbing cannot be diagnosed by this
means.

14 a T Gonococcal

ophthalmia neonatorum can

lead to severe conjunctivitis, keratitis
and blindness if not promptly treated.
b F Endocervical and urethral swabs
are required. In some circumstances
throat and rectal swabs should be
considered.
c
T Systemic manifestations, perihepatitis
and septicaemia can all be caused by
gonococcal infection.
d T The majority of gonococcalinfected men develop a urethritis,
dysuria and urethral discharge.
F
Gonococcus is a Gram-negative
intracellular diplococcus.

15 a T The

efficacy of the diaphragm as a

method of contraception is
reduced if this advice is ignored.
F The diaphragm should be
clean, but sterility is not required.

32

F Safer sexual practices are to be

encouraged and there is no reason
why two barrier methods should not
be used together.
T It is important to advise refitting
after each child is born and when there
has been a significant weight change
in the user.

MCQs PAPER 2: ANSWERS

T Removal before six hours has elapsed following

intercourse diminishes the efficacy of the diaphragm
method of contraception. If further intercourse takes place
before this time, the spermicide should be replenished.

16 a F African

and West Indian populations have the highest

incidence.
F Lowered oxygen tension, acidosis,
infection and dehydration may precipitate a
crisis.
T Regular screening for hypertension/pre-eclampsia,
urinary tract infection and reduced fetal growth is
recommended in women with sickle cell disease.
F Sickle cell disease results from an amino acid
substitution of glutamine for valine on the beta globin
chain.
F Earlier (pre-pregnancy or first trimester)
diagnosis is recommended so that the couple can
be advised on the possible risk of a serious
haemoglobin defect in their offspring and
subsequently counselled about prenatal diagnostic
options.

17 a F Studies

have shown that a significant proportion of

women with stress incontinence have detrusor
instability and therefore this investigation is
worthwhile to prevent inappropriate intervention.
F Urinary infection may be responsible for some or
even all of a patients symptoms and therefore if
should always be excluded before conducting timeconsuming and invasive investigations.
T Cystometry is indicated in the investigation of
patients with multiple symptoms, a voiding disorder,
previous unsuccessful incontinence surgery or a
neuropathic bladder disorder.
T Ultrasound is a means of assessing postmicturition residual urinary volume and the bladder
neck.
F Capacity (taken as a strong desire to void)
should be greater than 400 mL.

33

OBSTETRICS AND GYNAECOLOGY FOR FINALS, DRCOG AND MRCOG

18 a T The

F
e

perinatal mortality rate is the number of

perinatal deaths divided by the total
births (born live and still) expressed as a
proportion of 1000 total births occurring
in the same location during the same
period.
F Twenty per cent of deaths are
attributable
to
congenital
malformations.
T Mothers from Pakistan also have a
higher perinatal mortality rate than
those from India and Bangladesh.
Perinatal mortality rises with social class.
F Perinatal mortality is lowest in
those mothers aged between 20
and 29 years.

19 a F Labour

should be suppressed for 2448

hours to gain maximum benefit from the
steroids used to enhance fetal lung
development.
T Maternal pulmonary oedema is a
particular risk with the sympathomimetics and warrants careful
attention to the patients fluid balance.
F Intravenous therapy is almost
universally administered initially, the role of
oral tocolysis remaining controversial.
T Although permitting delivery is the
usual management when gestation
has reached 34 weeks, tocolysis may
temporarily suppress labour, enabling
in utero transfer to a unit with more
sophisticated obstetric and neonatal
facilities.
F Atosiban, magnesium sulphate,
indomethacin and nifedipine are some
of the alternative pharmacological
agents that have been investigated.

20 a F Ascites

can occur with benign ovarian

tumours and parasitic fibroids. Meigs
syndrome describes ascites and

pleural effusion in association with a

benign ovarian fibroma.
b
T Teratomas (also known as dermoids)
are most common in young women and
are bilateral in about 12% of cases.
c
T Both -fetoprotein and human
chorionic gonadotrophin may be
produced.
d T A palpable pelvic kidney can simulate an
ovarian mass.
e
F Careful surgical staging is
essential
to
determine
the
appropriate
subsequent
management.
34

MCQs PAPER 2: ANSWERS

21

a F Such measures promote milk production. Non-feeding,

simple analgesia and a good supportive bra are
usually adequate measures.
b F Colostrum is secreted for approximately the first two
days post-partum; the change to milk occurs on the
third and fourth day.
c
F Bromocryptine inhibits the release of prolactin
from the pituitary and is therefore useful for the
suppression of lactation.
d
T Sheehans syndrome or necrosis of the anterior
pituitary following severe post-partum haemorrhage is
now fortunately very rare. If the patient survives, there
is
a failure of lactation due to the lack of prolactin and
manifestations of the other endocrine deficiencies.
e
T Mastitis is associated with milk stasis, nipple trauma
and poor nursing technique. Pathogenic bacteria enter
and are most commonly of the staphylococcal type.

22 a T The

F
c

anaesthetist is an essential member of the team and

will normally manage the patients fluid balance, in
addition to inserting central intravenous access lines.
A minimum of six units of blood should be cross-matched.
T Uterine atony resulting in dramatic bleeding may be
controlled by forcibly compressing the uterus between a
hand on the abdomen and a hand inserted per vaginum.
Uncross-matched O Rhesus-negative blood can be
used unless the patient is known to have blood
group antibodies.
T Uterine haemorrhage that cannot be controlled by local
or pharmacological means necessitates surgery. Uterine
artery ligation may be sufficient to avoid hysterectomy.

23 a F Secondary

post-partum haemorrhage is defined as

abnormal bleeding that occurs between 24 hours and
six weeks post-partum.
b T Infection is a common cause.
c
F Uterine relaxation and atony can occur in the
few days following delivery. It may respond to
oxytocin,
ergometrine or prostaglandin therapy. The possibility of
retained products, however, should be borne in mind.

35

OBSTETRICS AND GYNAECOLOGY FOR FINALS, DRCOG AND MRCOG

d
e

F
Secondary
post-partum
haemorrhage occurs after 1% of births.
F Ultrasonically, it may be difficult to
distinguish retained products from blood
clot and it may not be diagnostic.

24 a T Although

some form of resuscitation is

required in about a third of babies,
active resuscitation, such as assisted
ventilation, is required by less than 5%.
b F The Apgar score is recorded at
1, 5 and sometimes 10 minutes
after delivery.
c
T Recognition of the need for
resuscitation should be prompt (in the
first minute) if there is no regular
respiration, if the heart rate is below 100
beats/minute or if the Apgar score
remains below 7.
d T Gentle suction should be applied to
the endotracheal tube until no further
meconium is obtained, changing the tube
should it become blocked during the
process.
e F Care should be taken in the infant of a
mother who
is a known opiate addict. Use may
precipitate acute withdrawal in the
neonate.

25 a T The

New York Heart Association

Classification is based on the physical
abilities of the mother and is divided into
four classes. Nearly 90% are in the
milder categories of 1 and 2; those with
class 3 and 4 account for only 10% of
heart disease in pregnancy but account
for 85% of cardiac-caused deaths.
T Involvement of the aorta in Marfans
syndrome increases the mortality from
515% to 2550%.
T The fetus has a greater risk of
congenital heart disease when the

d
e

36

abnormality is present on the maternal

side rather than the paternal one.
There is also an increased incidence
of prematurity and intrauterine growth
retardation.
F Mitral stenosis is the more frequent
rheumatic valvular disorder (90%).
T Primary pulmonary hypertension is
associated with sudden death; the raised
cardiac output and decreased peripheral
resistance of normal pregnancy
increases the risk to an unacceptable
50%.

MCQs PAPER 2: ANSWERS

26 a T Maternal

d
e

glycosylated haemoglobin is required for the

detection of diabetes mellitus, as glycaemia control
may have returned to within normal limits post-partum.
T A Kleihauer blood test is an acid-stained film of
maternal blood to establish the presence of fetal red
blood cells and quantitate the volume of feto-maternal
transfusion.
T An increasing incidence of consumptive
coagulopathy develops with time following fetal
demise and therefore should be checked in a woman
with a retained dead fetus in utero.
T Hypertensive disease of all aetiologies increases
perinatal mortality.
T Systemic lupus erythematosus is associated
with an increased pregnancy loss in all
trimesters.

27 a T So-called

concealed abruptions constitute 2035% of

cases.
F In cases of mild abruption, particularly with the
preterm fetus, provided the fetal condition is monitored,
expectant management should be considered.
T Maternal cocaine abuse is associated with a
higher incidence of placental abruption and
increased risks of growth retardation and preterm
labour.
T The diagnosis of placental abruption is
principally a clinical one, but in the presence of a
large clot it may be identified as a hyperechogenic
area on ultrasound examination.
F The diagnosis of appendicitis in pregnancy is
notoriously difficult and can be confused with
concealed placental abruption.

28 a T Pliable

silastic cups are increasing in popularity and replacing

the metal cups, as they are simpler to assemble.

c
d

T Electronic pumps produce a rapid onset and

reliably controlled vacuum and are therefore
preferred to the hand-pump devices.
F The criteria for the ventouse method and forceps
should be the same.
T The patient should be in the lithotomy position,
similar to a forceps delivery.

37

OBSTETRICS AND GYNAECOLOGY FOR FINALS, DRCOG AND MRCOG

e T A pudendal block may be adequate with perineal

infiltration of local anaesthetic for the lift-out procedures.
29

a T A placenta which significantly encroaches into the lower

segment prevents engagement of the fetal head.
b T Any tumour which obstructs
the lower segment can prevent
descent of the fetal head.
c T The preterm infant would not be
expected to have engaged in the
pelvis and therefore the dating of the
pregnancy should be checked. The
widespread use of early ultrasound
has assisted in the more accurate
assessment of pregnancy gestation.
d F Significant numbers will experience
descent of the head into the pelvis
during labour and successful vaginal
delivery and therefore routine
Caesarean section cannot be
justified. The possibility of
cephalopelvic disproportion should,
however, be borne in mind.
eT African races commonly have a pelvic
inlet with a higher angle of inclination
than Caucasian women and therefore
the head may fail to engage before
the onset of labour.

30 a T Serial

assessments of symphysial fundal

height are useful at picking up growth
restriction, although ideally these
measurements should be done by
the same person.
b F Crownrump length is used in the first
trimester.
c T Reduced amniotic fluid is
associated with impaired fetal
renal function.
d F Serum alpha-fetoprotein levels
are not useful in the third trimester.
e F Oestriol levels have been used
in the past but oestradiol levels are

unhelpful.

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