The characteristics of the mucinous cystic adenoma of the ovaries is the presence of a large tumour which is multicystic and the penetration of the peritoneum into the cavities forming septas. The serous tumours can only be differentiated on the bases of the contents.

Urodynamics is a broad term that comprises cytometry, urethral pressure measurement, leak point pressure, pressure flow studies, EMG and videourodynamics. They assess the function of the bladder and urethra as a functional unit. This may provide information such as the site of bladder outlet obstruction, overactivity of the detrusor and sphincter weakness. In muscular terms the detrusor and sphincter muscles are being assessed.

Ovulation in the menstrual cycle usually occurs over 4 days. There is an increase in basal body temperature at the time of ovulation due to the effect of progesterone.

A high Day 21 progesterone level indicates ovulation and the release of an egg.

Dysmenorrhea is described as painful menstruation. The symptoms start at the time of ovulation and persist till menstruation.

Barr body is an inactive and non functioning X chromosome found in female somatic cells and is presents with a rim around the nucleus

Varicella or chickenpox, is a highly contagious disease caused by primary infection with varicella-zoster virus (VZV) which can result in maternal mortality or serious morbidity. The virus which remains dormant in the sensory nerve root ganglia following a primary infection can get reactivated to cause a vesicular erythematous skin rash along the dermatomal distribution known as herpes zoster, ‘zoster’ or ‘shingles’. Though rare the risk of acquiring infection from an immunocompetent individual with herpes zoster in non-exposed sites like thoracolumbar regions can also occur. As the viral shedding will be greater, a disseminated zoster or exposed zoster (e.g. ophthalmic) in an individual or localised zoster in an immunosuppressed patient should be considered very infectious.

In industrialised countries, over 85 % of women in childbearing age are immune to varicella zoster virus (VZV), however, women from tropical and subtropical areas are more susceptible to chickenpox in pregnancy as they are more likely to be seronegative for VZV IgG. Up to 10% cases of VZV in pregnancy are complicated with Varicella pneumonia, whereas perinatal varicella/ chickenpox carries a 20 to 30 % risk of transmitting infection to the neonate. Studies on maternal varicella infection from 12-28 weeks gestation suggests a 1.4% risk of fetal varicella syndrome (FVS) whose subsequent abnormalities include:
– Skin scarring (78%)
– Eye abnormalities (60%)
– Limb abnormalities (68%)
– Prematurity and low birthweight (50%)
– Cortical atrophy, intellectual disability (46%)
– Poor sphincter control (32%)
– Early death (29%)

In the case mentioned above, patient had developed chickenpox rashes in her 2nd trimester and presented to you at day 2 of illness. Her varicella IgM came back positive along with a negative IgG indicating that she is not being immunized and that she is currently having active varicella infection. The best management in this case will be to reassured and allowed patient to be monitored at home. As there is no underlying lung disease, she is not immunocompromised and she is a non-smoker, so antiviral therapy is not required.

Generally, for pregnant women with chickenpox if they present within 24 hours of onset of rash and are in 20+0 weeks of gestation or beyond oral aciclovir should be prescribed. However, the use of acyclovir before 20+0 weeks should be considered carefully as Aciclovir is rated category B3 (Pregnancy and Breastfeeding, eTG, January 2003, ISSN 1447-1868) and should only be prescribed if its potential benefits outweigh the potential risks caused to the fetus, with informed consent in pregnant women who present within 24 hours of onset of varicella rash. If the patient is immunocompromised or if there are respiratory symptoms, a haemorrhagic rash or persistent fever for more than six days it is advisable to use intravenous acyclovir. On the other hand, to prevent secondary bacterial infection of the lesions, symptomatic treatment and hygiene should also be advised and unless there is significant superimposed bacterial infection antibiotics are not required.

If the pregnant woman has had a significant exposure to chickenpox or shingles, and is not immune to VZV , she should be offered VZIG as soon as possible or at the very latest within 10 days of the exposure. However, since Varicella zoster immunoglobulins (VZIG) has no therapeutic benefit in already developed cases of chickenpox, it should not be given to the context patient who have already developed active rashes of chickenpox with serology showing positive IgM positive and negative IgG indicating primary infection.

At least five weeks after primary infection a detailed fetal ultrasound must be done checking for any anomalies and ultrasounds should be repeated until delivery; and consider a fetal MRI if any abnormalities are found. In cases were if ultrasound is found to be normal, VZV fetal serology and amniocentesis are not useful and is not routinely advised.

During pregnancy cardiac output increases by 30 to 50%. As a result, the resting pulse speeds up from a normal of about 70 bpm to 80 or 90 bpm.

The genitofemoral nerves takes its origin from the L1 and L2 spinal segments.

Labour induction is indicated as no fetal movements have been felt for 24 hours, with a normal cardiotocograph (CTG) and the pregnancy is at near/full term with a favourable cervix.

Amniotic fluid volume assessment would have been indicated 24 hours earlier as, if it was low, induction would have been indicated then, despite a normal CTG.

Ultrasound examination of the foetus is not indicated as it is necessary to expedite delivery.

Carrying out another CTG, with or without oxytocin challenge, is not indicated, although MG monitoring during induced labour would be mandatory.

Delivery immediately by Caesarean section is not indicated unless the lack of fetal movements is due to fetal hypoxia. This can result in fetal distress during labour, necessitating an emergency Caesarean section if the cervix is not fully dilated.

In pregnancy, term refers to the gestational period from 37 0 to 41 6 weeks. Preterm births occur between 24 0 and 36 6 weeks. 60% of the women will go into labour with in 24 hours in PPROM. After 24 hours have past without any contraction and the gestation age is more than 34 week than prostaglandins can be used to augment labour.

Breech presentation refers to the foetus in the longitudinal lie with the buttocks or lower extremity entering the pelvis first.

The current recommendation for the breech presentation at term includes offering external cephalic version (ECV) to those patients that meet criteria, and for those whom are not candidates or decline external cephalic version, a planned caesarean section for delivery sometime after 39 weeks.

The testicular artery arises from the aorta and supplies the testis and the epididymis. The testis is supplied by 3 arteries.: Testicular artery, cremasteric artery that arises from the inferior hypogastric artery and the artery to the vas deferens from the internal iliac artery.

Evidence is not yet of sufficient quality for there to be evidence-based guidelines or recommendations. Having excluded other causes:

Reassure patients that breakthrough bleeding is a common side-effect of CHC and usually resolves after three cycles of use.
Advise women who smoke that stopping smoking may improve cycle control.
If bleeding persists after three cycles, consider changing formulation:
Increase dose of oestrogen, particularly if on a 20-microgram ethinylestradiol (EE) preparation

All other options are not acceptable.

A sample for fetal blood pH can be taken during the labour. The mother should be lying in a left lateral position.

Atosiban is a modified form of oxytocin that is administered by intravenous infusion for 2–48 hours.

Although a dilatation and curettage (D&C) is frequently recommended as part of a woman’s menorrhagia examination.
D&C is not indicated in a woman who had a normal hysteroscopy and laparoscopy only two years ago, and who experienced comparable symptoms when not taking the OCP in the past, especially after the age of 40.
The Filshie clips should not be removed because they will not improve the symptoms.

Although an endometrial ablation or possibly a hysterectomy may be required in the future to address the symptoms, the first line of treatment should be a nonsteroidal anti-inflammatory drug (NSAID), which will reduce the loss in up to half of the women treated.

Turner syndrome, a condition that affects only females, results when one of the X chromosomes (sex chromosomes) is missing or partially missing. Turner syndrome can cause a variety of medical and developmental problems, including short height, failure of the ovaries to develop and heart defects. Streak ovaries are a form of ovarian dysgenesis and are associated with Turner syndrome. Occasionally they may be functional and secondary sexual characteristics may develop.

Prolactin is necessary for the secretion of milk by the cells of the alveoli. The level of prolactin in the blood increases markedly during pregnancy, and stimulates the growth and development of the mammary tissue, in preparation for the production of milk. However, milk is not secreted then, because progesterone and oestrogen, the hormones of pregnancy, block this action of prolactin. After delivery, levels of progesterone and oestrogen fall rapidly, prolactin is no longer blocked, and milk secretion begins.

Fetal ultrasound scanning is considered an essential part of routine antenatal care with first trimester scans recommended for confirming viability, accurate estimation of gestational age and determining the number of foetuses. Fetal crown-rump length (CRL) is measured in early pregnancy primarily to determine the gestation age (GA) of a foetus and is most reliable between 9+0 to 13+6 weeks’ gestation, but not beyond.

This woman has experienced a septic abortion. Therefore the first step is commencement of intensive antibiotic treatment as soon as cervical swabs have been taken.

The next step is evacuation of the uterus. Curettage can be performed after a few hours, to extract any remaining infected products of conception from the uterine cavity.

The choice of antibiotics depends on the most likely microorganism involved. Therefore, prior to commencing any other procedure, it is vital to take cervical swabs for microscopic examination to guide further antibiotic therapy (correct answer).

If curettage is performed immediately there is a risk that the infection would spread.

However, if Clostridium welchii infection is suspected from the cervical smear (particularly if encapsulation of the microorganisms is present), then curettage should be performed immediately along with commencing antibiotic treatment.

Curettage can be delayed for up to 12-24 hours if other microorganisms are suspected; unless a significant increase in bleeding occurs.

Ergometrine is not essential as an immediate treatment measure as the patient is not bleeding heavily and reports that her bleeding has decreased. However, ergometrine is commonly given when curettage is performed.

First stage of the labour starts with the contractions of the uterus. With time, the no. of contractions, its duration and intensity increases. It ends once the cervix is fully dilated.