DOI: 10.1111/tog.

12868 2023;25:153–6
The Obstetrician & Gynaecologist
CPD
http://onlinetog.org

CPD questions for volume 25 issue 2

CPD credits can be claimed for the following questions Regarding physiological changes seen in healthy
online via the TOG CPD submission system in the RCOG pregnant women,
CPD ePortfolio. You must be a registered CPD participant of
9. serum levels of troponin are not raised. ThFh
the RCOG CPD programme (available in the UK and
10. the ejection fraction is reduced. ThFh
worldwide) in order to submit your answers.
Completion of TOG true/false questions can be claimed as Regarding assessment of a pregnant woman for ACS,
a Specific Learning Event. Participants can claim two credits
11. echocardiography is able to assess specific
per set of questions if at least 70% of questions have been
ventricular regional walls for signs
answered correctly. CPD participants are advised to consider
of dysfunction. ThFh
whether the articles are still relevant for their CPD, in
12. rapid angiographic assessment is routinely
particular if there are more recent articles on the same topic
available 24 hours-a-day, 365 days-a-year
available and if clinical guidelines have been updated
within the UK. ThFh
since publication.
13. radial approach at angiography is preferred to
Please direct all questions or problems to the CPD Office.
a femoral approach. ThFh
Tel: +44 (0)20 7772 6307 or email: [email protected].
14. fetal shielding with a lead apron has been
The blue symbol denotes which source the questions refer
shown to reduce radiation exposure
to including the RCOG journals, TOG and BJOG, and RCOG
from angiography. ThFh
guidance, such as Green-top Guidelines (GTGs) and
15. angiographic iodinated contrast has been
Scientific Impact Papers (SIPs). All of the above sources are
shown to be teratogenic. ThFh
available to RCOG Members and Fellows via the RCOG
website. RCOG Members, Fellows and Associates have full Regarding management of ACS in pregnancy,
access to TOG content via the Wiley Online Library app
16. use of bare metal stents at primary percutaneous
(available for iOS and Android).
coronary intervention (PCI) is preferred. ThFh
17. thrombolysis carries a significant risk of
TOG Acute coronary syndromes in preterm birth. ThFh
pregnancy: a literature review 18. conservative management of spontaneous
coronary artery dissection is
Regarding acute coronary syndromes (ACS) in
not recommended. ThFh
pregnancy,
19. data exists showing that clopidogrel is safe to
1. they occur more commonly in the early use in pregnant women. ThFh
postpartum period compared with the 20. conception should be delayed by at least 12
antenatal period. ThFh months after an acute episode. ThFh
2. NSTEMI (non-ST elevation MI) is the
commonest subtype of presentation. ThFh
TOG Non-immune hydrops fetalis: a
3. spontaneous coronary artery dissection is the
practical guide for obstetricians
commonest cause. ThFh
With regard to hydrops fetalis,
Electrocardiogram (ECG) changes in a normal
1. cases secondary to extra-cardiac anomalies
pregnancy include,
usually present in the first trimester. ThFh
4. sinus tachycardia. ThFh 2. when identified in the first trimester, the cause
5. left axis deviation. ThFh is most likely to be non-immune. ThFh
6. ST-depression. ThFh 3. diagnostic testing is essential to determine the
7. T-wave inversion in leads II, III and aVF. ThFh cause of the non-immune type prior to
8. right bundle branch block. ThFh termination of pregnancy. ThFh

ª 2023 Royal College of Obstetricians and Gynaecologists. 153

Regarding fetal therapy for hydrops, 2. about 10% of fetuses with structural anomalies
have an underlying genetic or
4. investigating the underlying cause is a pre-
chromosomal problem. ThFh
requisite to treatment. ThFh
3. in the presence of a structural anomaly, up to
5. shunt insertion for chylothorax leads to
40% of chromosomal problems are detectable
regression in the majority of cases. ThFh
on quantitative fluorescence-polymerase chain
6. amnioreduction is associated with a reduction
reaction (QF-PCR), karyotyping and
in the risk of preterm delivery in those
chromosomal microarray. ThFh
complicated by severe polyhydramnios. ThFh
With regard to the causes of non-immune hydrops fetalis, Regarding sequencing techniques in prenatal testing,

7. fetal infections are responsible for about 25% 4. QF-PCR is used for detecting
of cases presenting in the second trimester. ThFh common aneuploidies. ThFh
8. genetic causes account for up to 1:4 cases in 5. chromosomal microarray is able to
the third trimester. ThFh detect microdeletions. ThFh
6. fluorescence in-situ hybridisation (FISH) is
With regard to maternal mirror syndrome, able to detect common aneuploidies. ThFh
9. it occurs in most cases of 7. non-invasive prenatal diagnosis is used for
non-immune hydrops. ThFh identifying aneuploidy. ThFh
10. it is clinically indistinguishable from When a patient has been identified as having a fetus with
pre-eclampsia. ThFh structural abnormalities,
11. the underlying pathophysiology is
clearly understood. ThFh 8. if these are multiple and fetal DNA for QF-
12. affected women typically PCR and chromosomal microarray are
have haemoconcentration. ThFh normal, the woman should be referred to
13. its development is considered an important genetics clinic. ThFh
trigger for termination of pregnancy/and or 9. exome sequencing is indicated following a
delivery on maternal ground. ThFh multidisciplinary team review. ThFh

With regard to genetic causes of non-immune With regard to tissues for DNA,
hydrops fetalis,
10. those being sent for genetic analysis should be
14. they are responsible for most cases. ThFh placed in formalin. ThFh
15. the phenotype is typically stable 11. when proband DNA cannot be obtained
throughout pregnancy. ThFh following fetal demise, biparental blood samples
16. the most common are the RASopathies. ThFh should be used for molecular autopsy by proxy. T h F h
17. most are inherited. ThFh
18. exome sequencing is the With regard to QF-PCR,
primary investigation. ThFh 12. it has a better detection rate than FISH for
Regarding multidisciplinary team management for common aneuplodies. ThFh
non-immune hydrops fetalis, 13. where an abnormality is detected,
chromosomal microarray is recommended to
19. first-line investigation results should be help exclude ’free trisomy’. ThFh
completed by the local team before referral to
the tertiary centre. ThFh Exome sequencing,
20. parallel planning should be included in the 14. is carried out in England as directed by the
parental counselling. ThFh NHS Genomic Medicine Service. ThFh
15. focuses on the genome which codes
TOG Prenatal genomic testing for for proteins. ThFh
ultrasound detected fetal structural 16. has the potential to identify a maternal carrier
anomalies status of BRCA. ThFh
17. has an advantage over whole genome
With regard to congenital anomalies in the UK, sequencing in that it allows greater in-
1. they occur in about 3–5% of pregnancies. ThFh depth coverage. ThFh

154 ª 2023 Royal College of Obstetricians and Gynaecologists.

18. ideally should be undertaken only after the 12. necrosis of the bladder is a complication of
fetus has had a normal QF-PCR and UAE treatment of ectopic pregnancy. ThFh
chromosomal microarray result. ThFh 13. occlusion of vessels is a treatment option for
19. is the test of choice for a fetus with those with heterotopic ectopic pregnancy. ThFh
presumed achondroplasia. ThFh 14. angiography is the gold standard for diagnosis
of uterine arteriovenous malformations. ThFh
With regard to noninvasive prenatal diagnosis,
Regarding the management of thrombosis,
20. it was initially trialled to identify rhesus
negative babies with rhesus negative mothers. ThFh 15. a temporary IVC filter is a treatment
option for recurrent venous
thromboembolism (VTE) despite
TOG The clinical applications of adequate anticoagulation. ThFh
interventional radiology techniques in 16. a temporary IVC filter is not recommended
obstetrics and gynaecology for the management of VTE in the peri-
partum period. ThFh
Regarding uterine artery embolisation (UAE) for fibroids,
17. thrombolytic therapy is indicated mainly in
1. the presence of an intrauterine device increases the event of life-threatening pulmonary
the risk of post-operative infection. ThFh embolism with haemodynamic compromise. ThFh
2. the Royal College of Obstetricians and
With regard to interventional radiography in the
Gynaecologists and the Royal College of
management of infertility,
Radiologists recommend that GnRH
analogues are discontinued prior to 18. when used for fallopian tube recanalisation,
the procedure. ThFh the procedure success rate is about 100%. ThFh
3. post-operative complications associated with the 19. a confirmatory salpingogram is not
procedure tend to occur within 24–48 hours. ThFh necessary following fallopian
4. pre-operative MRI has been shown to help to tube recanalisation. ThFh
identify ovarian-uterine anastomoses. ThFh 20. those who have had successful recanalisation
are advised to start trying to conceive after
With regard to UAE for adenomyosis,
4–6 weeks. ThFh
5. it has been shown to improve symptom
related quality of life scores. ThFh
6. there is robust evidence of improvements in TOG Consenting, competence and
symptoms persisting up to and beyond 3 years. ThFh confidentiality in paediatric adolescent
7. complications are similar to those for gynaecology
fibroid embolisation. ThFh
For consent to be valid,
With regard to the role of interventional radiology (IR) in
1. it must be voluntary. ThFh
the management of postpartum haemorrhage,
2. the person does not necessarily need the
8. evidence suggests that balloon occlusion of the capacity to consent. ThFh
uterine arteries reduces the need 3. it must be informed. ThFh
for hysterectomy. ThFh
While assessing the best interest of the adolescent, the
9. surgical ligation of vessels is preferred to IR
healthcare professional must consider the views of,
techniques in the presence of a
large haematoma. ThFh 4. the adolescent. ThFh
10. vesico-vaginal fistula is an 5. the parent or persons with
established complication. ThFh parental responsibility. ThFh
6. others close to the adolescent. ThFh
Regarding the use of IR in the management of early
7. neighbours. ThFh
pregnancy and benign gynaecological complications,
Those allowed to give consent for a young person who
11. it is considered an alternative to hysterectomy
lacks capacity are,
in those with gestational trophoblastic
neoplasia complicated by life- 8. siblings. ThFh
threatening bleeding. ThFh 9. court. ThFh

ª 2023 Royal College of Obstetricians and Gynaecologists. 155

10. a named doctor for child protection. ThFh Situations when breaching confidentiality without consent
11. teachers. ThFh is allowed include,
12. an individual or local authority with
16. when it is for the public interest. ThFh
parental responsibility. ThFh
17. when it is for the best interest of the adolescent
and the adolescent lacks the maturity to take
The advantages for sharing information include,
the decision. ThFh
13. avoiding the young person being asked the 18. when it is required by law. ThFh
same question repeatedly. ThFh
When it comes to parents refusing blood products for their
14. helping the parents/family to stop the
children based on religious grounds,
young person from engaging in
risky behaviour. ThFh 19. the child’s best interest is paramount. ThFh
15. helping young people and protecting them 20. the views of parents/those with parental
from harm. ThFh responsibility are usually not considered. ThFh

156 ª 2023 Royal College of Obstetricians and Gynaecologists.