TOG online SBA resource, Vol.

20 Issue 2
SBA 1
Total Attempts: 1
What, according to National Institute for Health and Care Excellence guidance, would be
the most appropriate intervention to offer a 28-year-old who presents at 25+6 weeks of
gestation with threatened preterm labour?

A-Cervical phosphorylated insulin-like growth factor binding globulin protein-1

B-Corticosteroids and tocolysis

C-Placental alpha macroglobulin-1

D-Translabial ultrasound to measure the cervical length

E-Vaginal fetal fibronectin

Correct answer:

B-Corticosteroids and tocolysis

Based on cost-effectiveness, the recent National Institute of Health and Care Excellence (NICE)
pathway on preterm birth and labour proposes that tests to help diagnosed labour in women with
pregnancies below 29+6 weeks of gestation are not used after this gestation but rather these
women should be administered corticosteroids and tocolysis.
David AL, Soe A. Extreme prematurity and perinatal management. The Obstetrician &
Gynaecologist2018;20:109–17
SBA 2
Total Attempts: 1
When should antenatal corticosteroids be administered for neonatal benefit in women
presenting with threatened or established preterm labour?

A-20+0–34+6 weeks of gestation

B-22+0–34+6 weeks of gestation

C-24+0–34+6 weeks of gestation

D-22+0–34+0 weeks of gestation

C-24+0–36+0 weeks of gestation

Correct answer:

C-24+0–34+6 weeks of gestation

All women requiring or at a high risk of preterm delivery between 24+0 and 34+6 weeks of
gestation should receive antenatal corticosteroids. These should also be considered for women at
the threshold of viability (22+0–25+6 weeks of gestation) who are at risk of preterm birth.
David AL, Soe A. Extreme prematurity and perinatal management. The Obstetrician &
Gynaecologist2018;20:109–17

SBA 3
Total Attempts: 1
What changes in heart rate from lying to an upright position are essential to make a
diagnosis of postural tachycardia syndrome (PoTS)?

A-A persistent increase in heart rate of >10 bpm

B-A persistent increase in heart rate of >20 bpm

C-A persistent increase in heart rate of >30 bpm

D-A persistent increase in heart rate of >40 bpm

E-A persistent increase in heart rate of >50 bpm

Correct answer:

C-A persistent increase in heart rate of >30 bpm

For a diagnosis of PoTS, there has to be a persistent increase in heart rate of > 30 bpm when
changing from lying to upright position in the absence of orthostatic hypotension. In severe
cases, the standing heart rate is persistently >120 bpm.
Bhatia M, Kavi L, Nelson‐Piercy C. Postural tachycardia syndrome and pregnancy. The
Obstetrician & Gynaecologist2018;20:119–23.

SBA 4
Total Attempts: 1
A 29-year-old is diagnosed with postural tachycardia syndrome (PoTS) at 20 weeks of
gestation. What conservative treatment would be considered for this patient in the first
instance?

A-Application of compression stockings

B-Increase caffeine intake

C-Increase fluid intake

D-Increase fluid and salt intake

E-Initiate aerobic exercises

Correct answer:

D-Increase fluid and salt intake

The initial mainstay of conservative management for PoTS is increased fluid (2-3 l/day) and salt
intake (up to 10–12 g/day), which is aimed at increasing the circulating plasma volume and
improving clinical symptoms. Other conservative strategies include physical manoeuvres such as
making a fist, bending forward, placing a foot on a chair and pumping calves before standing.
Compression stockings have been used effectively but caffeine intake should be limited as it may
promote hypovolaemia by increasing diuresis.
Bhatia M, Kavi L, Nelson‐Piercy C. Postural tachycardia syndrome and pregnancy. The
Obstetrician & Gynaecologist2018;20:119–23.

SBA 5
Total Attempts: 1
A woman has just reported that she has been assaulted sexually by someone she knows.
What would be the immediate needs of the woman?

A-A thorough assessment to gather evidence

B-Emergency contraception and screening for STIs

C-Her protection and need for a place of safety

D-Involvement of the social worker and organisations she can relate to

E-Psychological support and counselling

Correct answer:

C-Her protection and need for a place of safety

The immediate needs of a woman reporting sexual assault, particularly if the alleged perpetrator
is someone she knows, will be her protection and the need for a place of safety. This is best
achieved by involving the police who can liaise with other agencies such as social services and
the housing department.
Long L, Butler B. Sexual assault. The Obstetrician & Gynaecologist 2018;20:87–93.

SBA 6
Total Attempts: 1
There is a suspicion that a serious sexual assault on a 30-year-old bar woman was drug
facilitated. Up to when after the assault can a blood sample be taken for forensic tests?

A-1 day
B-2 days

C-3 days

D-4 days

E-5 days

Correct answer:

C-3 days
In general, vaginal swabs can be taken up to 7 days after vaginal penetration, 3 days after anal
penetration and 2 days after oral penetration. A toxicology screen will be sent from a blood
within three days of the assault and from urine within 14 days of the assault if a drug-facilitated
sexual assault is suspected.
Long L, Butler B. Sexual assault. The Obstetrician & Gynaecologist 2018;20:87–93.

SBA 7
Total Attempts: 1
A diagnosis of Fowler’s syndrome (FS) is made in a 25-year-old student with polycystic
ovary syndrome. What treatment is most effective in restoring voiding in this patient?

A-Anticholinergics

B-Botulinum toxin

C-Intermittent self-catheterisation

D-Physiotherapy

E-Sacral neuromodulation

Correct answer:

E-Sacral neuromodulation

The only treatment that has been found to restore voiding in women with FS is sacral
neuromodulation. Injection of botulinum into the urethral sphincter have been shown to be
effective in managing urinary retention resulting from this condition.
Panicker JN, Pakzad M, Fowler CJ. Fowler's syndrome: a primary disorder of urethral sphincter
relaxation. The Obstetrician & Gynaecologist 2018;20:95–100.

SBA 8
Total Attempts: 1
You suspect that a 20-year-old who presents with urinary retention suffers from Fowler’s
syndrome (FS). What test will you perform to confirm the diagnosis?

A-A maximum urethral resting value of 80 mmHg

B-Concentric needle EMG of the striated urethral sphincter

C-Demonstration of painful withdrawal of a urethral catheter

D-Frequency and volume charts (voiding diary)

E-Routine cystometry

Correct answer:

B-Concentric needle EMG of the striated urethral sphincter

The maximum urethral closure pressure is typically found to have a measured resting value in
excess of 100 cm of water in women with FS. Routine cystometry will demonstrate a large
bladder capacity without the usual sensations during the filing phase and filling is often stopped
by the urodynamicist at 500 ml on grounds of safety, although the women’s actual functional
capacity is much greater. Concentric needle EMG of the striated urethral sphincter is the test
used to make a diagnosis.
Panicker JN, Pakzad M, Fowler CJ. Fowler's syndrome: a primary disorder of urethral sphincter
relaxation. The Obstetrician & Gynaecologist 2018;20:95–100.