Obstetrics and Gynaecology

Fifth Edition

Lawrence Impey, Tim Child

Extended Matching Questions (EMQs)

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Chapter 24

1. Choose the likely diagnosis in the scenarios described below. Each option may be used once, more than once or not at all.

Possible Answers

A Abruption E Placenta praevia
B Bleeding of undetermined origin F Uterine rupture
C Cervical ectropion G Vasa praevia
D Cervical pathology

For each of the questions below, select the answer which is most appropriate. Each option can be used once, more than once or not at all.

a.) A woman, para 1, with a previous caesarean, is augmented in labour, at term, with Syntocinon. She has had a pinkish loss since her membranes were ruptured, but her loss becomes more brisk, her urine is bloody and for the last 30 minutes she has complained of pain between contractions across her lower abdomen. The CTG is abnormal.

b.) A woman, para 2, presents at 31 weeks with painless PV bleeding. She has had multiple episodes of minor bleeding since 24 weeks, but did not attend hospital. She reports the bleeding to be period-type loss, but more fresh in colour. She left home in a rush and does not have her notes with her. She cannot remember the result of her 20-week scan, but comments that she has another scan booked for 32 weeks.

c.) A 20-a-day smoker presents at 34 weeks with generalized abdominal pain, PV bleeding and contractions. On palpation, her uterus feels hard and is tender. Suddenly, the patient becomes very unwell and collapses.

d.) A woman is induced for postdates pregnancy. She has been well in pregnancy to date and the only history of note was a low-lying placenta at 20 weeks, which was reported at 34 weeks to have moved away. Following rupture of the membranes, there is heavy PV loss and immediate, profound fetal bradycardia on the CTG.