ABOG Maternal-Fetal Medicine common mistakes
ABOG Maternal-Fetal Medicine · Understand the traps and how to avoid them.
Committing to a single diagnosis (e.g., preeclampsia) and stopping the workup once the most familiar condition fits, without systematically excluding the mimics listed in the stem (TTP, HUS, acute fatty liver, lupus flare, sepsis).
Pattern recognition drives fast answers under time pressure, and the first plausible diagnosis anchors subsequent reasoning; candidates underweight 'atypical' features that were deliberately included to signal an alternative.
What to do instead
Before selecting, explicitly name two alternative diagnoses and state one feature in the stem that argues for or against each; if a listed feature is incompatible with the leading diagnosis, treat it as a trigger to reopen the differential rather than explain it away.
Reading a fetal ultrasound question as a request for the descriptive finding rather than the next management step (or vice versa), and answering the wrong question.
Stems are long and imaging findings are salient, so candidates fixate on interpreting the image description and miss the actual interrogative at the end of the stem.
What to do instead
Read the final sentence of the stem first, classify the task as 'diagnose,' 'next step,' or 'counsel,' then read the body; re-read the last line before committing to the answer.
Choosing the most aggressive or most definitive intervention (immediate delivery, cesarean, fetal surgery) when the stem describes a stable patient in whom expectant management or a diagnostic step is indicated.
Exam writers exploit a 'do something' bias; candidates equate decisiveness with correctness and fear that a conservative option reflects missed urgency.
What to do instead
Stratify by stability: if the stem gives reassuring maternal and fetal status without a time-critical trigger, prefer the option that gains information or buys time; reserve delivery for stated deterioration, non-reassuring testing, or a gestational threshold that makes expectant management unsafe.
Selecting a management option that is correct in general but wrong for the gestational age given (e.g., recommending a treatment or delivery threshold that ignores the stated preterm or previable gestational age).
Candidates retrieve the adult or term-pregnancy version of a management rule and fail to re-anchor it to the gestational age printed in the stem.
What to do instead
Before answering, write down the gestational age and viability status from the stem and screen every option against it; eliminate any option whose threshold or indication does not apply at that gestational age.
Misapplying or miscomputing screening and diagnostic test performance-confusing sensitivity with positive predictive value, or interpreting a screening result as diagnostic without accounting for prevalence.
These concepts are learned as formulas and recalled as labels; under time pressure candidates substitute the intuitively 'stronger' sounding metric.
What to do instead
For any test question, sketch a 2x2 table with the stated prevalence and test characteristics before reading the options; answer from the table, not from memory of which metric sounds best.
Treating a statistically significant result in a small trial as practice-changing, or accepting a study's conclusion without checking whether the outcome was a validated clinical endpoint versus a surrogate.
Question stems present abstracts in the affirmative voice; candidates evaluate plausibility of the conclusion rather than the design, and surrogate endpoints feel clinically meaningful.
What to do instead
Apply a fixed checklist to every research-methods item: randomization and allocation concealment, sample size and power, primary versus secondary outcomes, composite endpoint components, and whether the outcome matters to patients; downgrade conclusions that rest only on surrogates or subgroup analyses.
Answering infectious-disease questions from drug familiarity rather than matching the antimicrobial to the pathogen, gestational age, and maternal allergy or organ function stated in the stem.
Candidates default to the antibiotic they have seen used most often and skip the contraindication screen, especially for teratogenicity and renal dosing.
What to do instead
Name the organism and the pregnancy-safety category explicitly before reading options, then eliminate any agent that is contraindicated at that gestational age or inconsistent with the stated allergy, renal function, or resistance pattern.
Managing a maternal emergency without first addressing the airway, breathing, and circulation, or applying a pregnancy-specific resuscitation modification incorrectly (e.g., delaying defibrillation, omitting left uterine displacement).
Obstetric training emphasizes the fetal and uterine perspective, so candidates reach for delivery or tocolysis before stabilization, and physiologic changes of pregnancy are over-applied.
What to do instead
Run a standard ABC sequence first and state the pregnancy-specific adjustments separately (left uterine displacement, early airway control for reduced functional residual capacity, no change to defibrillation energy); only then consider perimortem delivery timing.
Choosing an anesthetic or analgesic plan without integrating the obstetric context-contraindications from thrombocytopenia, coagulopathy, infection at the site, or the need for an emergent versus elective mode of delivery.
Candidates answer from the drug's general safety profile and neglect the coagulation and timing data embedded in the stem.
What to do instead
Before selecting, extract platelet count, coagulation status, infection, and urgency from the stem, then eliminate neuraxial or general options that those data exclude; if urgency precludes neuraxial placement, say so explicitly.
Handling ethics and professionalism items by choosing the option that protects the clinician or institution (documenting refusal, deferring to the family, following protocol without discussion) rather than the option that preserves informed consent and patient autonomy.
Candidates import defensive practice habits and conflate 'what would avoid liability' with 'what is ethically correct,' and they underweight the need to counsel rather than simply comply or refuse.
What to do instead
For ethics items, rank options by whether they support informed, non-coerced patient decision-making and transparent disclosure; prefer the option that involves counseling and shared documentation over one that transfers the decision to the clinician, family, or a policy alone.