Obstetrics - 2P Flashcards by Arianne DG

A 20-year-old woman at 5 weeks AOG by
amenorrhea, presents with vaginal spotting and
slight hypogastric pain. Pregnancy Test is
positive. On internal examination, cervix is
closed. So cervical and motion tenderness.
Uterus is not enlarged. No palpable adnexal
mass and tenderness. TVUS reveals thickened
endometrium with no signs of intrauterine or
extrauterine pregnancy. What is the next initial
step that you will do to this patient?

a. Request for CBC typing
b. Request for Serum B hCG
c. Request for Urinalysis
d. Request for repeat TVUS

b. Request for Serum B hCG

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(A 20-year-old woman at 5 weeks AOG by
amenorrhea, presents with vaginal spotting and
slight hypogastric pain. Pregnancy Test is
positive. On internal examination, cervix is
closed. So cervical and motion tenderness.
Uterus is not enlarged. No palpable adnexal
mass and tenderness. TVUS reveals thickened
endometrium with no signs of intrauterine or
extrauterine pregnancy.)

Same patient: If serum B progesterone will be
requested with a result of 15 ng/mL, which of the
following will be your working impression?
a. Pregnancy of unknown viability
b. Pregnancy of unknown location
c. Ectopic Pregnancy
d. Missed miscarriage

b. Pregnancy of unknown location

RATIONALE
a. Pregnancy of unknown viability (cases
of Intrauterine pregnancy but no signs of
embryo, no fetal cardiac activity)
c. Ectopic Pregnancy (no confirmation of
any extrauterine pregnancy)
d. Missed miscarriage (no signs of
intrauterine pregnancy)

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Same patient: If B hCG is more than 3500 
mIU/mL, repeat TVUS revealed trilaminar 
endometrium, what is the nearest possible 
diagnosis of this patient?
a. Ectopic Pregnancy
b. Threatened abortion 
c. Complete abortion 
d. Missed miscarriage

a. Ectopic Pregnancy

RATIONALE
b. Threatened abortion (should have 
gestational sac)
c. Complete abortion (still have elevated 
BhCG)
d. Missed miscarriage (should have 
embryo without cardiac activity)

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Same patient: What do you want to check with 
your chosen next initial step?
a. Signs of anemia
b. Check for UTI
c. Check for doubling time
d. Check if there are products of 
conception

c. Check for doubling time

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Patient presents for her first obstetrical visit at 8
weeks AOG by amenorrhea with complaints of
vaginal spotting. On internal exam, the cervical
os is closed without active bleeding. TVUS
revealed an intrauterine pregnancy with
gestational sac. What is your diagnosis?
a. Incomplete miscarriage
b. Missed miscarriage
c. Complete miscarriage
d. Threatened miscarriage

d. Threatened miscarriage

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(Patient presents for her first obstetrical visit at 8
weeks AOG by amenorrhea with complaints of
vaginal spotting. On internal exam, the cervical
os is closed without active bleeding. TVUS
revealed an intrauterine pregnancy with
gestational sac.)

Same patient: Repeat UTZ was done after 3
weeks revealing an embryonic pole of more than
5mm without fetal cardiac activity. What is your
diagnosis?
a. Incomplete miscarriage
b. Missed miscarriage
c. Complete miscarriage
d. Threatened miscarriage

Missed miscarriage

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Which of the following sonographic finding is
consistent with the American College of
Obstetrician and Gynecologist definition of early
pregnancy loss?
a. Absence of embryo with cardiac activity
more than or equal of 14 days after a
prior scan with gestational sac and with
yolk sac
b. CRL of more than 7mm and no
cardiac activity
c. Absence of embryo with cardiac activity
more than or equal to eleven days after
prior scan with gestational sac
d. All the choices are correct.

b. CRL of more than 7mm and no

cardiac activity

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A woman of 8 weeks of AOG by amenorrhea
presents to the ER complaining of abdominal
pain and fever. She has a temperature of 41 C,
BP of 80/50 mmHg, no rebound or guarding but
with cervical motion tenderness and generalized
malaise. She discloses that she had induced
abortion via catheterization done by an unskilled
attendant last night. You diagnosed her as a
septic miscarriage and treat her with broad
spectrum antibiotics. Which pathogenic
organism do you suspect given the severity of
her illness?
a. Group A Strep
b. Group B Strep
c. Mycoplasma hominis
d. E. coli

Group A Strep (Early causes – most

pathogenic)

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(A woman of 8 weeks of AOG by amenorrhea
presents to the ER complaining of abdominal
pain and fever. She has a temperature of 41 C,
BP of 80/50 mmHg, no rebound or guarding but
with cervical motion tenderness and generalized
malaise. She discloses that she had induced
abortion via catheterization done by an unskilled
attendant last night. You diagnosed her as a
septic miscarriage and treat her with broad
spectrum antibiotics.)

Same patient: What is your drug of choice for
this case?
a. Pen G 4 million units IV every 6 hours
b. Pen G 4 million units IV every 6 hours
+ Gentamycin 2mg/kg every 8 hours
c. Pen G 4 million units IV every 6 hours +
Gentamycin 2mg/kg every 8 hours +
Clindamycin every 8 hours
d. Imipenem

*Degree/severity: Moderate infection.

b. Pen G 4 million units IV every 6 hours
+ Gentamycin 2mg/kg every 8 hours

RATIONALE
a. Pen G 4 million units IV every 6 hours 
(mild pelvic infection)
c. Pen G 4 million units IV every 6 hours + 
Gentamycin 2mg/kg every 8 hours + 
Clindamycin every 8 hours (for cases of 
severe septicemia)
d. Imipenem (for cases of severe 
septicemia)

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What is the discriminatory B hCG level above
which failure to visualize an intrauterine
pregnancy likely indicates that a pregnancy is
likely not alive or ectopically located?
a. >500
b. > or =1000
c. > or =1500

c. > or =1500

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30-year-old G2P1 1001 presents at the OPD
complaining of pelvic pain and nausea. She is 6
weeks AOG by LMP. You requested for a TVUS
revealing no intrauterine pregnancy as well as
no adnexal mass and free fluid. B hCG was
done with a result of 3000 mIU/mL. What is the
best management strategy for this patient?
a. Exploratory laparotomy since she is
complaining of pelvic pain
b. No intervention. Just reassurance
c. Expectant management with 48 hours
follow-up
d. Request for blood test and start with
Methotrexate injection

c. Expectant management with 48 hours

follow-up

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What is the single best predictor of successful 
treatment with single dose methotrexate?
a. B hCG 
b. Progesterone levels
c. AOG
d. Size of the ectopic pregnancy

a. B hCG (used for monitoring ectopic

pregnancy

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A 23-year-old primigravid is diagnosed with right
ectopic pregnancy unruptured. She is
hemodynamically stable and managed medically
with single dose methotrexate. Her B hCG is
3153 mIU/mL on day 1. Following methotrexate
administration and 3256 mIU/mL on day 4 and
2548 mIU/mL on day 7. What is the most
appropriate course of action based on these
values?
a. Schedule the patient for laparoscopy
b. Repeat B hCG after 1 week
c. Administer second dose of methotrexate
d. No further intervention or follow up is
required

b. Repeat B hCG after 1 week (magic
value: 15 % reduction between day 4
and day 7)

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20-year-old primigravid with positive pregnancy
is diagnosed with a 2.5 cm right adnexal mass to
consider ectopic pregnancy by TVUS. Her B
hCG 1967 mIu/mL. Her hematocrit is 37% and
has small amount of free fluid in the cul de sac.
She strongly desires expectant management
rather than immediate treatment. Which aspect
of her history favors a successful resolution with
expectant management?
a. B hCG of less than 200 mIU/mL
b. Hematocrit level above 35%
c. Free fluid in the cul de sac
d. Ectopic pregnancy size < 3cm

d. Ectopic pregnancy size < 3cm

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What adjunctive treatment to decrease her
complications associated with cervical ectopic
pregnancy?
a. Uterine artery embolization
b. Folly catheter cervical tamponade
c. Potation Chloride injection
d. All the choices are correct

a. Uterine artery embolization

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Most common time in gestation for pregnancy 
loss to occur is?
a. Less than 10 weeks
b. 10-14 weeks
c. 14-20 weeks
d. 20-37 weeks

a. Less than 10 weeks

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Which of the following need NOT be performed
in a patient with recurrent pregnancy loss?
a. Extensive infection workup
b. Hysteroscopy
c. Lupus anticoagulant
d. Karyotyping of parents

a. Extensive infection workup

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The risk of pregnancy loss is high in women

a. With 2 or more prior pregnancy loss
b. Under the age of 35
c. With prior C section
d. With prior pregnancy loss

a. With 2 or more prior pregnancy loss

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The most common cause of sporadic pregnancy 
loss in the first trimester is?
a. Infection
b. Tobacco exposure
c. Genetic abnormalities
d. DM

c. Genetic abnormalities

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The most common trisomy in spontaneous 
abortion is?
a. Trisomy 21
b. Trisomy 18
c. Trisomy 13
d. Trisomy 16

d. Trisomy 16

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A female with recurrent abortion and isolated
prolonged aPTT is most likely associated with
a. Lupus anticoagulant
b. DIC
c. Von Willebrand disease
d. Hemophilia

a. Lupus anticoagulant

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All are causes of recurrent pregnancy loss 
EXCEPT:
a. APAS
b. Cervical incompetence
c. Bicornuate uterus
d. TORCH infections

d. TORCH infections

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Which of the following is false regarding 
complete miscarriage?
a. Uterus is smaller than the period of 
amenorrhea
b. Cervical os is open
c. Cervical os is closed
d. Both A and C

b. Cervical os is open

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Which of the following is not true for recurrent 
pregnancy loss?
a. Hysterosalphyngogram is the best 
method to rule out anatomical 
etiologies
b. Vaginal ultrasound may be used to 
detect anatomical defects
c. 3d vaginal ultrasound is superior to 2D 
ultrasound in detecting anatomical 
defects
d. Septate uterus is the most common 
anatomical cause of recurrent 
miscarriage

a. Hysterosalphyngogram is the best
method to rule out anatomical
etiologies

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Pregnant lady of history of RPL is diagnosed to have APAS. What would be the best treatment for her? a. Aspirin only b. Aspirin + heparin c. Aspirin + heparin + steroids d. Aspirin + steroids

b. Aspirin + heparin

``` Which of the following is not a widely accepted cause of RPL? a. Progesterone deficiency b. Uterine structural abnormalities c. APAS Syndrome d. Parenteral chromosomal abnormalities ```

a. Progesterone deficiency

``` Which of the following clinical scenarios is not an indication for APAS testing? a. History of severe pre-eclampsia requiring delivery at 38 weeks b. History of fetal loss at 16 weeks AOG c. History of three embryonic losses d. History of thromboembolism ```

a. History of severe pre-eclampsia | requiring delivery at 38 weeks

30-year-old G4P0 0030 12-to-13-week AOG. During prenatal check-up, OB history 3 abortions during the first and second trimester. Vital signs: BP 110/70 mmHg, PR 78 bpm, RR 20bpm and temperature of 37C. What laboratory should be requested? a. B2 glycoprotein 1, Russel Viper venom test and Anticardiolipin antibodies b. B2 glycoprotein 1, Russel Viper venom test, dsDNA

a. B2 glycoprotein 1, Russel Viper venom test and Anticardiolipin antibodies

29-year-old primigravid 10-11 weeks AOG with fever, body malaise and joint pain. Lab exam shows positive ANA and anti-dsDNA. What is the management? a. Aspirin and heparin b. Aspirin and prednisone c. Aspirin, heparin and prednisone d. Aspirin, heparin, prednisone and azathioprine

b. Aspirin and prednisone

``` What percentage of RPL is due to parental chromosomal abnormalities? a. 10-12% b. 8-9% c. 6-8% d. 2-4% ```

d. 2-4%

``` The relation of the long axis of the fetus to the mother is called? a. Presentation b. Position c. Fetal Lie d. Attitude ```

c. Fetal Lie

Dysfunctional labor due to fetal factors: When the fetal head is extended sharply, what type of presentation results?

b. Face

35-year-old G3P2 37 weeks. In early labor with estimated fetal weight of 2.5kg presents with face. What will be the best management of her delivery? a. Induction of labor b. Internal rotation to make mentum anterior position c. Caesarian section d. Observation to allow spontaneous rotation

d. Observation to allow spontaneous | rotation

34-year-old G2P2 38 weeks presented in the OBAS. In early labor with baby in transverse lie. At 4cm dilatation, the BOW spontaneously ruptured. Which of the following is the most distinct risk at this point? a. Shoulder dystocia b. Cord prolapses c. Uterine rupture d. Birth trauma

b. Cord prolapses

``` What is McRoberts maneuver to release shoulder dystocia? a. Rotation of the position shoulder to release the anterior shoulder b. Abduction of shoulders c. Sharp flexion of maternal thighs and knees and suprapubic pressure d. Rotation and extraction of anterior shoulder ```

c. Sharp flexion of maternal thighs and | knees and suprapubic pressure

``` Which of the following neonatal injuries may result from shoulder dystocia? a. Femoral fracture b. Skull fracture c. Asphyxia d. Intracranial hemorrhage ```

c. Asphyxia

Under what condition is external cephalic version is allowed in breech and transverse position? a. Multiparity b. Engaged presenting part c. Placenta previa d. Cephalopelvic disproportion

a. Multiparity

Fetal head after delivery retracts back and became wedged into the perineum. This is indicative of which of the following? a. Contracted midplane b. Poor maternal forces c. Too early anesthesia d. Shoulder dystocia

d. Shoulder dystocia

A G1P0 at term is in full cervical dilation after 6 hours of good labor with the baby’s head at station +1. After 2 hours, the baby’s head was at the pelvic floor with severe overlapping of the sutures. Which of the following is a distinct risk for the baby at this point? a. Cord Prolapse b. Cord compression c. Intracranial hemorrhage d. Sepsis

c. Intracranial hemorrhage

A 24-year-old primigravid after 6 hours of good labor became full dilated and fully effaced. After 4 1 and a half hours, the head was at station +2. She then complained of severe lower back ache in spite of diminished maternal contractions. Cervical lip was persistently present. After another hour, the head was crowning with a large caput. What is the most likely position of the head? a. Occiput anterior b. Face c. Occiput posterior d. Brow

c. Occiput posterior

The challenges of the Gaskin All-4’s maneuver for shoulder dystocia includes which of the following a. Time loss in patient repositioning b. Inability of the assistant to pull hard on the head c. Inability of the operator to rock the fetal shoulder from side to side d. Inability of the fetal head to replace into the pelvis

a. Time loss in patient repositioning

A 40-year-old G4P3 3003 was admitted because of watery vaginal discharge. Prenatal course was uneventful. There were no comorbidities. BMI is 25 kg/m2. Birthweight of previous babies were in the range 2600g. IE: fully dilated, station +3. Upon delivery of the fetal head, Turtle sign was noted. When this occurs, the problem of fetal size discrepancy is usually at the? a. Pelvic inlet b. Pelvic midplane c. Pelvic outlet d. Generalized contracted pelvis

a. Pelvic inlet

A 26-year-old G2P1 woman at 41 weeks AOG has been pushing for 3 hours without progress. Throughout this time, her vaginal examination has remained completely dilated, completely effaced and station 0. With the head persistently in the occiput posterior position. Which of the following statement accurately describe the situation? a. Occiput posterior position is frequently associated with a gynecoid pelvis b. Labor progress is normal if the patient does not have an epidural catheter for analgesia but is abnormal if epidural anesthesia is being used. c. The patient is best described as having a failure of descent d. Bony part of the fetal head is slightly on the body part of the pelvic inlet

c. The patient is best described as | having a failure of descent

A 21-year-old G4P3 38 weeks AOG. During her routine prenatal check-up, shows the following findings on Leopold’s maneuver 2: A large nodular mass on the right side and a hard round ballotable mobile mass on the left slightly upper portion of the abdomen. The fetal lie of the fetus is? a. Longitudinal b. Oblique c. Transverse d. Breech

b. Oblique

(A 21-year-old G4P3 38 weeks AOG. During her routine prenatal check-up, shows the following findings on Leopold’s maneuver 2: A large nodular mass on the right side and a hard round ballotable mobile mass on the left slightly upper portion of the abdomen. ) ``` Same patient: The presenting part of the above patient is most likely? a. Breech b. Acromion c. Vertex d. Mentum ```

b. Acromion

Dysfunctional Labor (Forces and Passages). 19- year-old G1P0at 40 weeks AOG came to the admitting section for hypogastric pain. Vital signs are normal with a fundic height of 31 cm. Fetal Heart tone of 150bpm and with an IE of 2- 3 cm dilated, 50% effaced, cephalic at station -1 with intact BOW. She was hooked on the fetal monitor which shows contractions occurring every 8-18 minutes apart. Mild to moderate in intensity lasting for 30 seconds. Clinical pelvimetry seems adequate. At what stage of labor is your patient coming to the admitting section? a. Latent Phase b. Active Phase c. Phase of maximum slope d. Deceleration phase

a. Latent Phase RATIONALE b. Active Phase (New update: now starts at 4cm)

(Dysfunctional Labor (Forces and Passages). 19- year-old G1P0at 40 weeks AOG came to the admitting section for hypogastric pain. Vital signs are normal with a fundic height of 31 cm. Fetal Heart tone of 150bpm and with an IE of 2- 3 cm dilated, 50% effaced, cephalic at station -1 with intact BOW. She was hooked on the fetal monitor which shows contractions occurring every 8-18 minutes apart. Mild to moderate in intensity lasting for 30 seconds. Clinical pelvimetry seems adequate. ) ``` Same patient: What is the acceptable limit at this stage of labor? a. Less than 14 hours b. Less than 20 hours c. More than 14 hours d. More than 20 hours ```

b. Less than 20 hours

(Dysfunctional Labor (Forces and Passages). 19- year-old G1P0at 40 weeks AOG came to the admitting section for hypogastric pain. Vital signs are normal with a fundic height of 31 cm. Fetal Heart tone of 150bpm and with an IE of 2- 3 cm dilated, 50% effaced, cephalic at station -1 with intact BOW. She was hooked on the fetal monitor which shows contractions occurring every 8-18 minutes apart. Mild to moderate in intensity lasting for 30 seconds. Clinical pelvimetry seems adequate.) ``` Same patient: What will be the treatment of choice? a. Immediate cesarian section b. Extend monitoring for another 2 hours c. Bedrest d. Sedation ```

c. Bedrest

(Dysfunctional Labor (Forces and Passages). 19- year-old G1P0at 40 weeks AOG came to the admitting section for hypogastric pain. Vital signs are normal with a fundic height of 31 cm. Fetal Heart tone of 150bpm and with an IE of 2- 3 cm dilated, 50% effaced, cephalic at station -1 with intact BOW. She was hooked on the fetal monitor which shows contractions occurring every 8-18 minutes apart. Mild to moderate in intensity lasting for 30 seconds. Clinical pelvimetry seems adequate.) Same patient: Which of the following items characterize the protracted active phase of dilation? a. If clinical pelvimetry is inadequate, cesarian delivery is preferred b. There is no dilation of 1cm per hour for nulliparas c. There is no dilation of 2cm per hour for multiparas d. Sedate the patient

a. If clinical pelvimetry is inadequate, | cesarian delivery is preferred

(Dysfunctional Labor (Forces and Passages). 19- year-old G1P0at 40 weeks AOG came to the admitting section for hypogastric pain. Vital signs are normal with a fundic height of 31 cm. Fetal Heart tone of 150bpm and with an IE of 2- 3 cm dilated, 50% effaced, cephalic at station -1 with intact BOW. She was hooked on the fetal monitor which shows contractions occurring every 8-18 minutes apart. Mild to moderate in intensity lasting for 30 seconds. Clinical pelvimetry seems adequate.) Same patient: Once the contraction becomes regular with increasing intensity with shortened interval, the patient requested for an epidural anesthesia. What will you explain to her in terms of the length of her labor? a. Epidural anesthesia has no effect on the latent phase of labor b. It lengthens the first and second stage of labor c. Though epidural anesthesia may lengthen labor, it does not slow down the fetal descent

b. It lengthens the first and second | stage of labor

c. 2 cm/hr

A 33-year-old G3P3 patient. 40-week AOG. came in for mild hypogastric pain. Vital signs within normal limit. Fundic height 33 cm. Good FHT. IE Cervix 4 cm dilated 50% effaced. Intact bag of water. Cephalic. Station -2. Patient delivered in less than 3 hours after the admission. Which is the statement being maternal complications? a. New born may fall to the floor b. Brachial palsy c. Intracranial hemorrhage d. Postpartum hemorrhage

d. Postpartum hemorrhage

A 33-year-old G3P3 patient. 40-week AOG. came in for mild hypogastric pain. Vital signs within normal limit. Fundic height 33 cm. Good FHT. IE Cervix 4 cm dilated 50% effaced. Intact bag of water. Cephalic. Station -2. Patient delivered in less than 3 hours after the admission. Which of the item is the fetal complication of rapid labor? a. Placenta abruption b. Cervicovaginal lacerations c. Brachial palsy d. Uterine atony

c. Brachial palsy

A 33-year-old G3P3 patient. 40-week AOG. came in for mild hypogastric pain. Vital signs within normal limit. Fundic height 33 cm. Good FHT. IE Cervix 4 cm dilated 50% effaced. Intact bag of water. Cephalic. Station -2. Patient delivered in less than 3 hours after the admission. Cervical dilation is facilitated by? a. Hydrostatic action of unruptured membrane b. Thickening of fundal area c. Formation of lower uterine segment d. Resistance of the passing segment of uterus

Hydrostatic action of unruptured | membrane

A 33-year-old G3P3 patient. 40-week AOG. came in for mild hypogastric pain. Vital signs within normal limit. Fundic height 33 cm. Good FHT. IE Cervix 4 cm dilated 50% effaced. Intact bag of water. Cephalic. Station -2. Patient delivered in less than 3 hours after the admission. What is a fetal effect of dystocia? a. Caput succedaneum b. Fetal drop c. Fistula formation d. Abruptio placenta

a. Caput succedaneum

``` 31-year-old G2P1 women at 40-week AOG progress in labor from 5 to 6 cm of cervical dilation over 3 hours. Which of the following best describe the labor? a. Prolonged latent phase b. Prolonged active phase c. Failure of active phase d. Protracted active phase ```

d. Protracted active phase

G1P0 39-week AOG in active labor for 14 hours. Uterine contractions 180 Montevideo units. IE cervix 5 cm dilated 60% effaced. Left occiput transverse. Station -1. Intact Bag of water. Clinical pelvimetry adequate. What is the abnormality? a. Power b. Passenger c. Passage d. Pelvis

a. Power

Which of the following statement true comparing Zhang vs Friedman’s curve? a. Friedman curve begin to flatten at 3 to 4 cm. b. In the zhang curve the active phase of labor begins at 6 cm. c. In the Friedman curve the active phase of labor begins at 6 cm. d. All of the above.

b. In the zhang curve the active phase | of labor begins at 6 cm.

26-years-old multigravida 40-week AOG. Presented to OB admission examination room with labor pains. She was admitted at 6 cm dilation. After 4 hours from time of admission IE was the same 6 cm. What other piece of information would you like to have to determine your next step? a. Estimated fetal weight b. If her contractions are adequate c. If her membrane is ruptured d. If she had any analgesia

b. If her contractions are adequate

Which of the following statements true regarding contractions at mid-pelvis? a. Causes transverse arrest of fetal head b. Less common than inlet contractions c. It can be inferred when there are parallel vaginal sidewalls d. It is suspected if interspinous diameter is less than 11 cm.

a. Causes transverse arrest of fetal | head

Postpartum hemorrhage n old definition to consider what would be the estimated blood loss to have for a cesarean section? a. < 550 ml b. > 600 ml c. > 1000 ml d. < 900 ml

c. > 1000 ml

32-year-old G2P1 1001 39-week AOG. Assisted vaginal delivery via outlet forceps extraction for 6 fetal malpresentation. What is the most common cause for postpartum hemorrhage for this patient? a. Uterine atony b. Cervical laceration c. Retained Product of conception d. Uterine subinvolutions

b. Cervical laceration

``` 62. Most common cause of postpartum hemorrhage is? a. Retained cotyledons b. Uterine overdistension c. Lower genital tract lacerations d. Uterine atony ```

d. Uterine atony

``` 41-year-old G7P6 6006 37-week AOG was admitted for labor pains. What anticipatory plans should you do for known asthmatic & hypertensive? a. Secure stock dose of Carboprost b. Secure stock dose of methergine c. Secure stock dose of dinoprostone d. Secure stock dose of carbetocil. ```

d. Secure stock dose of carbetocil.

35-year-old G2P2 2002 delivered via spontaneous vaginal delivery in a lying in. Referred to ER due to profuse vaginal bleeding on examination you noticed boggy and soft uterus. Crackles on bilateral lung fields. Patient is hypotensive and tachycardiac. What medication can probably give at lying in? a. Carboprost b. Oxytocin c. Methergine d. Carbetocil

b. Oxytocin

Which statement is incorrect about carbetocin? a. It is long-acting analog of oxytocin b. It has sustained action similar to that of methergine but without the side effect c. Comparative studies of IV carbetocin and IV infusion of oxytocin for the prevention of PPH have identified enhanced effectiveness d. It is more effective in preventing PPH compared to oxytocin.

c. Comparative studies of IV carbetocin and IV infusion of oxytocin for the prevention of PPH have identified enhanced effectiveness

32-year-old G2P2 2002 delivered via outlet forceps extraction. 3 hours after delivery. She referred for hypotension and tachycardia. On examination patient is pale and incoherent. She has soft abdomen with well contracted uterus. There was no vaginal bleeding. What is your diagnosis? a. Uterine atony b. Cervical laceration c. Hematoma d. Uterine rupture

c. Hematoma

Patient with fundally implanted placenta delivered vaginally. You applied vigorous cord traction without signs of placental separation. You noticed profuse vaginal bleeding and on examination the inverted uterus is protruding to the vulva. What is your diagnosis? a. Uterine inversion stage I b. Uterine inversion stage II c. Uterine inversion stage III d. Uterine inversion stage IV

c. Uterine inversion stage III

Patient delivered via outlet forceps extraction. Few hours after delivery, she complained deep pelvic pain associated with difficulty in urinating. On examination the patient is hypotensive, tachycardic and pale. She has fluctuating mass at paravaginal area. Which vessel is most likely involved? a. Cervical artery b. Vestibular branch of pudendal artery c. Descending branch of uterine artery d. Deep circumflex vessels of paravaginal triangle

c. Descending branch of uterine artery

A patient delivered in lying in clinic 5 days ago. She consulted ER for intermitted vaginal bleeding. Ultrasound finding shows thickened and heterogenous endometrium with noted fluid within endometrial canal. What is the best management for this patient? a. Give uterotonic b. Perform curettage c. Embolization d. Give broad spectrum antibiotics

d. Give broad spectrum antibiotics

(A patient delivered in lying in clinic 5 days ago. She consulted ER for intermitted vaginal bleeding. Ultrasound finding shows thickened and heterogenous endometrium with noted fluid within endometrial canal.) After placental delivery the uterus well contracted but continue bleeding persistently. So, what is the most appropriate approach to this patient? a. Inspect birth-canal b. Massage uterus c. Do a DNC d. Give antibiotics

a. Inspect birth-canal

30-year-old G6P5 5005 had profuse vaginal bleeding after vaginal delivery. On examination uterus noted to be boggy, what physiologic process is responsible for the bleeding in this patient? a. Failure to compress spinal artery b. Failure of decidua basalis to reepithelize c. Increase amount of coagulation factors d. Increase in the blood flow through uterine vessel

a. Failure to compress spinal artery

33-year-old G6P6 6006 referred to ER for introital mass after delivery of baby at home. On PE she is pale, hypotensive. You noted introital mass had placenta mass with an umbilical artery attached to it. Which of the following statement may be carried out? a. Use uterine relaxing agents before manipulation b. Immediate removal of placenta c. Immediate oxytocin infusion once venoclysis is available d. Give Prostaglandin infusion prior to any manipulation.

a. Use uterine relaxing agents before | manipulation

30-year-old postpartum patient complaint of severe hypogastric pain on PE. She was tachycardiac. BP 80/min. There was note of mass previously appreciated immediately after delivery. Hematoma to consider. What artery is most likely injured? a. Pudendal b. Uterine c. Hypogastric7 d. Ovarian

b. Uterine

``` Which of the following suitable treatment for uterine inversion? a. If recognized quickly fundal massage and uterotonic agents are initiated. b. Patient is evaluated for regional anesthesia. Large bore IV access is established. Rapid infusion is to begin while you wait for blood to arrive. c. Immediate recognition and call for assistant improve outcome d. All choices are correct. ```

c. Immediate recognition and call for | assistant improve outcome

``` This is fetal complication seen in placental abruption? a. Postpartum hemorrhage b. Hysterectomy c. Non-reassuring fetal status d. DIC ```

c. Non-reassuring fetal status

Which statement does not describe placental separation? a. It can cause fetal growth restriction. b. It can cause renal failure in mother. c. Oligohydramnios can be seen in traumatic abruption as a consequence d. It can be associated with maternal hypertension

c. Oligohydramnios can be seen in | traumatic abruption as a consequence

Consumptive coagulopathy can be characterized by which of the following items? a. Increase in D-dimer concentration b. Delay conversion of plasminogen to plasmin c. Decrease in fibrin degradation products. d. Does not lead to thrombophilia

a. Increase in D-dimer concentration

Following consideration is true in abruptio placenta? a. Vaginal delivery is allowed as long as mother is stable and fetus is died. b. Early amniotomy does not compress spinal arteries c. Small fetus with intact bag definitely dilates the cervix d. Uterotonic should not be used after delivery of dead fetus in abruptio.

a. Vaginal delivery is allowed as long as | mother is stable and fetus is died.

One of the following is true regarding placental migration? a. It does not occur since the villi are anchored at internal OS b. There is propensity to grow toward lower uterine segment c. Immigration is unlikely to occur if there is previous cesarean section d. Migration occurs at the first trimester

a. It does not occur since the villi are | anchored at internal OS

``` One of the demographic factors is not seen in placenta previa? a. Teen Pregnancy b. Multiparity c. Myoma d. Assisted Reproductive technology ```

d. Assisted Reproductive technology

Among the following statements, which is not a characteristics of placenta previa? a. After placenta delivery, bleeding from lower uterine segment is likely to occur b. Lower segment fails to constrict the blood vessels c. Symptoms starts by the occurrence of painful contractions d. There is no bleeding until labor ensues if the placenta implanted near at OS

c. Symptoms starts by the occurrence | of painful contractions

This is frequent histologic finding in morbidly adherent placenta? a. Syncytia-trophoblasts invasion of decidua basalis b. Cyto-trophoblasts invasion of myometrium c. Trophoblastic giant cell infiltrating the spinal arterioles d. Trophoblastic infiltration of decidua basalis

c. Trophoblastic giant cell infiltrating | the spinal arterioles

Which of the following statement characterize diagnosis of placenta previa? a. Standard ultrasound cannot adequately localize the placenta b. If there is suspicious of previa digital examination should be carried out immediately c. Internal examination should be done in a setup where immediate CS delivery can be done d. Placenta previa is unlikely if there is active bleeding in a patient with ultrasound finding of placenta covering internal OS

c. Internal examination should be done in a setup where immediate CS delivery can be done

``` Elective cesarean delivery for patient with morbidly adherent placenta at? a. 32-34 week b. 34-35 week c. 36-37 week d. 37-38 week ```

b. 34-35 week

``` Which of the following sonographic finding has highest positive and negative for placenta percreta? a. Abnormal placental villous lakes b. Thinning of retroplacental myometrium c. Retroplacental vessel invade the myometrium d. Loss of normal hypoechoic retroplacental zone ```

c. Retroplacental vessel invade the | myometrium

29-year-old G2P2 24-week with two previous CS delivery has an ultrasound findings of posterior placenta previa with numerous placental lakes suspicious of placental accrete. Which is the next best step for confirmation of diagnosis? a. Ultrasound at 28 weeks and 32 weeks b. Doppler ultrasound of placenta c. Do a transvaginal ultrasound d. Do an MRI

d. Do an MRI

``` Which among the different causes of hemorrhagic pregnancy associated with normally implanted placenta? a. Abruptio placenta b. Placenta previa c. Vasa previa d. Placenta accreta ```

a. Abruptio placenta

30-year-old G3P4 3003 underwent repeated CS. Placenta was implanted anteriorly near the scar. After delivery there was difficulty extracting placenta. Which layer is affected? a. Decidua capsularis b. Decidua parietalis c. Decidua basalis d. All of the above

c. Decidua basalis

30-year-old G2P1 36-week AOG was on her 10th hour of delivery and still at 4 cm. Resident decided to rupture bag of water and noticed profuse vaginal bleeding. What is the most likely cause? a. Placenta previa b. Vasa previa c. Uterine rupture d. Placenta abruption

b. Vasa previa

For which situation submission of placenta for pathologic examination is most informative and cost effective? a. Oligohydramnios complicating 3rd trimester b. Cholestasis complicating 3rd trimester c. After CS delivery for arrest of descent d. All of the choice are correct.

a. Oligohydramnios complicating 3rd | trimester

Which of the following scenario an indication for to screen for fetal maternal bleed? a. Marginal hematoma noted during routine pelvic ultrasound b. Retroplacental hematoma noted during 28-week ultrasound performed for lagging fundal height c. Sub-amniotic hematoma noted on visual inspection of placenta d. Chorioangioma noted during routine 28- week ultrasound

b. Retroplacental hematoma noted during 28-week ultrasound performed for lagging fundal height

Velamentous umbilical cord insertion variation most commonly associated with higher rate of which of the following? a. Uterine inversion b. Cord avulsion c. Early separation of placenta d. Single umbilical artery

b. Cord avulsion

A single umbilical cord cyst found during first trimester ultrasound performed for assessment of vaginal bleeding. No other remarkable findings noted during study. What is the most reasonable next step? a. Schedule follow-up ultrasound at 16- to-18-week AOG b. Ultrasound guided needle aspiration of cyst c. No alteration of routine care is indicated d. Counselling regarding increased risk of aneuploidy and offering chorionic villous sampling.

a. Schedule follow-up ultrasound at 16- | to-18-week AOG

b. Posterior placenta with accessory | lobe

28-year-old G2P1 20-week come in for fetal anatomic survey. No pregnancy complication noted. However, placenta was posteriorly located and there was note of blood vessels extending from the main placental disk crossing in a tubular structure that are within membrane. As a primary obstetrician of this patient which of the following you note on patient’s report? a. Schedule her delivery at 39-week in the absence of prior indications b. Closely examine placenta after delivery to check for completeness of placenta and do manual sweep of uterine cavity to check for retained products of placenta c. Follow with serial growth ultrasound d. All of the choice are correct

``` b. Closely examine placenta after delivery to check for completeness of placenta and do manual sweep of uterine cavity to check for retained products of placenta ```

32-year-old G2P1 at 38 weeks with prior cesarean delivery present for growth ultrasound. On ultrasound fetus is footling breech with appropriate growth for gestation age. An amniotic fluid index of 21 cm. No anomalies are seen. What is appropriate next step in her management? a. Counsel the patient about the findings and schedule her for repeat cesarean section b. Schedule a follow-up appointment at 1 week if undelivered c. Counsel the patient about the findings and do amniotomy d. All of the choices are reasonable option

a. Counsel the patient about the findings and schedule her for repeat cesarean section

23-year-old multigravida presents for routine fetal anatomic survey at 20-week AOG. Sonographic findings show well-circumscribed rounded predominately hypoechoic lying near the chorionic plate and protruding into the amniotic cavity. What modality is best use in narrowing the differential diagnosis of placental mass? a. MRI b. 3D ultrasound c. Placental biopsy d. Color doppler ultrasound

d. Color doppler ultrasound

23-year-old multigravida presents for routine fetal anatomic survey at 20-week AOG. Sonographic findings show well-circumscribed rounded predominately hypoechoic lying near the chorionic plate and protruding into the amniotic cavity. Which of the following will you not recommend? a. Submission of placental for pathologic examination b. Maternal serum AFP for open neural tube defect c. Serial Ultrasound for fetal growth and fluids d. Middle cerebral artery doppler of fetus

b. Maternal serum AFP for open neural | tube defect

``` With placenta abruption which condition preclude vaginal delivery? a. Intrauterine fetal demise and prior classical CS hysterotomy b. Term fetus at station 0, brisk vaginal bleeding and mild coagulopathy any station c. Intrauterine fetal demise and HSV ulcer on the maternal perineum d. All of the above. ```

a. Intrauterine fetal demise and prior | classical CS hysterotomy