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ABOG OB/GYN Qualifying Exam study materials
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ABOG OB/GYN Qualifying Exam practice questions

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Question 1Obstetrics

A 28-year-old G2P1 at 39 weeks presents in active labor with a category III fetal heart rate tracing showing recurrent late decelerations with minimal variability. Which of the following is the most appropriate initial management?

  1. Immediate cesarean delivery without intrauterine resuscitation
  2. Administration of a tocolytic and continued observation
  3. Maternal repositioning, oxygen, and discontinuation of oxytocin Correct answer.
  4. Artificial rupture of membranes to improve contraction pattern

Explanation

Category III tracings reflect abnormal fetal acid-base status and require prompt intrauterine resuscitation (position change, oxygen, stopping oxytocin, treating hypotension) while preparing for delivery if no improvement. Immediate cesarean without any resuscitative effort is not the first step unless the tracing does not respond.

Question 2Obstetrics

Which organism is the most common cause of early-onset neonatal sepsis in term infants born to colonized mothers in the United States?

  1. Staphylococcus aureus
  2. Escherichia coli
  3. Listeria monocytogenes
  4. Group B Streptococcus Correct answer.

Explanation

Group B Streptococcus (Streptococcus agalactiae) is the leading cause of early-onset neonatal sepsis, which is why universal antepartum screening and intrapartum prophylaxis are performed. E. coli is more prominent in preterm infants.

Question 3Obstetrics

A 32-year-old G1P0 at 10 weeks gestation has a blood pressure of 158/104 mmHg confirmed on repeat measurement. Which of the following is the most likely diagnosis?

  1. Chronic hypertension Correct answer.
  2. White coat hypertension
  3. Gestational hypertension
  4. Preeclampsia without severe features

Explanation

Hypertension documented before 20 weeks gestation is classified as chronic hypertension. Gestational hypertension and preeclampsia are defined by onset at or after 20 weeks.

Question 4Obstetrics

Which of the following best describes the mechanism of action of magnesium sulfate in the prevention and treatment of eclamptic seizures?

  1. It blocks cerebral NMDA receptors and causes vasodilation Correct answer.
  2. It acts primarily as a cerebral vasoconstrictor
  3. It enhances presynaptic acetylcholine release
  4. It raises the seizure threshold by increasing serum calcium

Explanation

Magnesium sulfate is thought to prevent seizures through cerebral vasodilation and antagonism of NMDA receptors, reducing neuronal excitability. It does not act primarily as a vasoconstrictor or by altering calcium.

Question 5Obstetrics

A patient at 34 weeks gestation presents with painless bright red vaginal bleeding. Her uterus is soft and nontender, and fetal heart tones are reassuring. Which diagnosis should be highest on the differential?

  1. Placental abruption
  2. Uterine rupture
  3. Placenta previa Correct answer.
  4. Vasa previa

Explanation

Painless bright red bleeding with a soft, nontender uterus is the classic presentation of placenta previa. Abruption typically presents with painful bleeding and a tender, hypertonic uterus.

Question 6Obstetrics

A 30-year-old G1P0 at 39 weeks has a prolonged second stage with arrest of descent. Which of the following is the most common cause of arrest of descent in this setting?

  1. Hypotonic uterine dysfunction
  2. Cervical dystocia
  3. Occiput posterior position
  4. Cephalopelvic disproportion Correct answer.

Explanation

Arrest of descent in the second stage is most often due to cephalopelvic disproportion or a macrosomic fetus that cannot negotiate the pelvis. Positional abnormalities and uterine dysfunction contribute but are less frequently the primary cause of true arrest.

Question 7Obstetrics

Which of the following is the most reliable method for confirming rupture of membranes when the diagnosis is uncertain?

  1. Detection of insulin-like growth factor binding protein-1 or placental alpha microglobulin-1 Correct answer.
  2. Ferning pattern on dried fluid
  3. Nitrazine paper color change
  4. Pooling of fluid on speculum examination

Explanation

Biomarker tests such as IGFBP-1 and PAMG-1 have high sensitivity and specificity and are useful when standard bedside tests are equivocal. Pooling, nitrazine, and ferning are helpful but less reliable.

Question 8Obstetrics

A 24-year-old G1P0 at 8 weeks gestation presents with cramping and vaginal bleeding. Her cervix is closed and no tissue is seen at the os. Which of the following is the most likely diagnosis?

  1. Complete abortion
  2. Inevitable abortion
  3. Incomplete abortion
  4. Threatened abortion Correct answer.

Explanation

A threatened abortion is characterized by vaginal bleeding in early pregnancy with a closed cervix. An inevitable abortion involves cervical dilation, and incomplete abortion involves passage of some tissue.

Question 9Obstetrics

A patient at 28 weeks gestation has a fundal height of 24 cm. Which of the following is the most appropriate next step in evaluation?

  1. Maternal serum screening for aneuploidy
  2. Immediate amniocentesis
  3. Reassurance and return in 4 weeks
  4. Ultrasound assessment of fetal growth and amniotic fluid Correct answer.

Explanation

A fundal height that lags by more than 3 cm should prompt ultrasound evaluation for fetal growth restriction, oligohydramnios, or dating errors. Reassurance alone would risk missing growth restriction.

Question 10Obstetrics

Which of the following findings on a fetal ultrasound at 20 weeks is most suggestive of an open neural tube defect?

  1. Mild pyelectasis
  2. Echogenic intracardiac focus
  3. Choroid plexus cyst
  4. Lemon sign with banana-shaped cerebellum Correct answer.

Explanation

The lemon sign (frontal bone scalloping) and banana sign (Arnold-Chiari malformation with cerebellar displacement) are classic sonographic markers of open spina bifida. The other findings are soft markers of aneuploidy.

Question 11Obstetrics

A 36-year-old G3P2 at 38 weeks has a blood pressure of 162/110 mmHg with 3+ proteinuria and a platelet count of 92,000. Which of the following is the most appropriate management?

  1. Expectant management until 39 weeks
  2. Immediate delivery with no further intervention
  3. Outpatient blood pressure monitoring
  4. Magnesium sulfate for seizure prophylaxis and antihypertensives Correct answer.

Explanation

Preeclampsia with severe features at 38 weeks requires magnesium sulfate for seizure prophylaxis and treatment of severe hypertension, followed by delivery. Delivery is indicated but must be accompanied by stabilization.

Question 12Obstetrics

Which of the following is the most common cause of postpartum hemorrhage?

  1. Uterine atony Correct answer.
  2. Genital tract laceration
  3. Retained placenta
  4. Coagulopathy

Explanation

Uterine atony accounts for the majority of postpartum hemorrhage cases. The other causes-lacerations, retained tissue, and coagulopathy-are less common.

Question 13Obstetrics

A patient with a prior classical cesarean delivery at 36 weeks presents in labor with sudden severe abdominal pain and fetal bradycardia. Which of the following is the most likely diagnosis?

  1. Uterine leiomyoma degeneration
  2. Umbilical cord prolapse
  3. Uterine rupture Correct answer.
  4. Placental abruption

Explanation

Sudden severe abdominal pain with fetal bradycardia in a patient with a prior classical cesarean scar is highly suggestive of uterine rupture. Classical scars carry a substantially higher rupture risk than low transverse scars.

Question 14Obstetrics

Which of the following is the most appropriate antibiotic regimen for intrapartum prophylaxis in a patient with a penicillin allergy that is not severe (no anaphylaxis)?

  1. Vancomycin alone
  2. Erythromycin
  3. Clindamycin alone
  4. Cefazolin Correct answer.

Explanation

For patients with a non-severe penicillin allergy, a cephalosporin such as cefazolin is appropriate for GBS prophylaxis. Clindamycin and vancomycin are reserved for severe allergy with susceptibility testing.

Question 15Obstetrics

A 25-year-old G1P0 at 12 weeks has a TSH of 6.5 mIU/L with a normal free T4. Which of the following is the most appropriate management?

  1. Initiate levothyroxine Correct answer.
  2. Initiate methimazole
  3. No treatment; recheck in the third trimester
  4. Radioactive iodine ablation

Explanation

Overt hypothyroidism in pregnancy, indicated by an elevated TSH with normal or low free T4, warrants levothyroxine therapy. Untreated maternal hypothyroidism is associated with adverse neurodevelopmental outcomes.

Question 16Obstetrics

Which of the following is the recommended gestational age window for screening for gestational diabetes with the two-step approach?

  1. 24 to 28 weeks Correct answer.
  2. 20 to 24 weeks
  3. 16 to 20 weeks
  4. 32 to 36 weeks

Explanation

Universal screening for gestational diabetes is recommended between 24 and 28 weeks gestation. Earlier screening may be considered for patients with risk factors.

Question 17Obstetrics

A patient at 33 weeks gestation presents with regular painful contractions and cervical dilation of 3 cm. Which of the following interventions has been shown to reduce neonatal respiratory distress syndrome in this setting?

  1. Antibiotic prophylaxis alone
  2. Tocolytic therapy alone
  3. Progesterone supplementation
  4. Antenatal corticosteroids Correct answer.

Explanation

Antenatal corticosteroids given between 24 and 34 weeks reduce the incidence and severity of respiratory distress syndrome and other neonatal morbidities. Tocolytics delay delivery but do not directly mature the fetal lungs.

Question 18Obstetrics

A 22-year-old G2P1 at 36 weeks has a fetus in breech presentation confirmed by ultrasound. Which of the following is the most appropriate counseling regarding external cephalic version?

  1. It eliminates the need for delivery planning
  2. It is typically performed at or after 37 weeks Correct answer.
  3. It is contraindicated in all patients with a prior cesarean
  4. It should be performed before 34 weeks

Explanation

External cephalic version is generally performed at or after 37 weeks in candidates without contraindications, balancing success rates against the risk of precipitating delivery. It does not guarantee vaginal delivery and requires monitoring.

Question 19Obstetrics

Which of the following is the most common cause of spontaneous preterm birth?

  1. Intra-amniotic infection Correct answer.
  2. Cervical insufficiency
  3. Uterine anomaly
  4. Multiple gestation

Explanation

Intra-amniotic infection and inflammation are among the most common identifiable causes of spontaneous preterm labor and birth. Cervical insufficiency and uterine anomalies are less common contributors.

Question 20Obstetrics

A patient at 18 weeks gestation reports a two-day history of fever, myalgia, and diarrhea after eating soft cheese. Which of the following is the most appropriate initial management?

  1. Reassurance and return if symptoms worsen
  2. Blood cultures and empiric antibiotics Correct answer.
  3. Amniocentesis for culture
  4. Maternal serum alpha-fetoprotein

Explanation

Listeriosis should be suspected with a compatible exposure and systemic symptoms, and treatment with ampicillin-based therapy is initiated after blood cultures. Prompt treatment reduces the risk of fetal infection.

Question 21Obstetrics

Which of the following is the most appropriate initial management of a patient at 34 weeks with preterm premature rupture of membranes and no evidence of infection?

  1. Expectant management with corticosteroids and antibiotics Correct answer.
  2. Immediate delivery regardless of status
  3. Tocolysis until 39 weeks
  4. Amnioinfusion

Explanation

In PPROM before 34 to 37 weeks without infection, expectant management with antenatal corticosteroids and latency antibiotics improves neonatal outcomes. Delivery is reserved for infection, abruption, or nonreassuring fetal status.

Question 22Obstetrics

A 40-year-old G4P3 at 41 weeks has a Bishop score of 4. Which of the following is the most appropriate method for cervical ripening?

  1. Misoprostol or a mechanical dilator Correct answer.
  2. Amniotomy alone
  3. Immediate high-dose oxytocin
  4. Expectant management for 2 more weeks

Explanation

An unfavorable cervix (Bishop score ≤6) benefits from ripening with prostaglandins such as misoprostol or mechanical methods before induction. High-dose oxytocin alone is less effective with an unfavorable cervix.

Question 23Obstetrics

Which of the following is the most accurate statement about the risk of recurrence of preeclampsia in a subsequent pregnancy after a prior affected pregnancy?

  1. Recurrence is negligible
  2. Recurrence depends only on fetal sex
  3. Recurrence occurs in over 80 percent of cases
  4. Recurrence occurs in about 15 to 20 percent of cases Correct answer.

Explanation

Recurrence of preeclampsia in a subsequent pregnancy occurs in approximately 15 to 20 percent of cases, with higher risk if the prior episode was severe or early onset. Fetal sex is not the sole determinant.

Question 24Obstetrics

A patient at 30 weeks gestation has a biophysical profile score of 4 with absent amniotic fluid. Which of the following is the most appropriate next step?

  1. Immediate delivery or further fetal assessment Correct answer.
  2. Maternal hydration and recheck in 48 hours
  3. Reassurance and routine follow-up
  4. Repeat the biophysical profile in one week

Explanation

A biophysical profile of 4 or less, particularly with oligohydramnios, indicates fetal compromise and warrants immediate further assessment and likely delivery. Delay risks fetal demise.

Question 25Obstetrics

Which of the following is the most common cause of maternal mortality in the United States?

  1. Sepsis
  2. Hemorrhage
  3. Hypertensive disorders
  4. Cardiovascular disease Correct answer.

Explanation

Cardiovascular disease is a leading cause of pregnancy-related mortality in the United States. Hemorrhage, hypertensive disorders, and sepsis are also important contributors but are less common overall.

Question 26Obstetrics

A 28-year-old G2P1 at 10 weeks gestation presents with a 2-day history of vaginal spotting and mild pelvic cramping. Her cervix is closed on speculum exam. Ultrasound shows an intrauterine gestational sac with a fetal pole measuring 7 weeks and no cardiac activity. Which of the following is the most appropriate management?

  1. Methotrexate administration
  2. Expectant management with repeat ultrasound in 1 week Correct answer.
  3. Immediate dilation and curettage
  4. Serial beta-hCG measurements every 48 hours

Explanation

For a pregnancy with a fetal pole measuring less than 7 mm and no cardiac activity, the diagnosis of pregnancy loss is not definitive; expectant management with a repeat ultrasound in 1 week is recommended to confirm viability. Immediate intervention is reserved for definitive evidence of pregnancy loss or maternal instability.

Question 27Obstetrics

A 32-year-old G3P2 at 36 weeks gestation has a singleton fetus in breech presentation confirmed by ultrasound. She has no other complications. Which of the following is the most appropriate management?

  1. Plan vaginal breech delivery
  2. Attempt external cephalic version at 37 weeks Correct answer.
  3. Schedule cesarean delivery at 39 weeks
  4. Perform immediate cesarean delivery

Explanation

External cephalic version is recommended for breech presentation at term (≥37 weeks) in patients without contraindications, as it increases the likelihood of vaginal delivery and reduces cesarean rates. Cesarean delivery is reserved for failed version or contraindications.

Question 28Obstetrics

A 30-year-old G1P0 at 14 weeks gestation presents with a 1-day history of fever, malaise, and a vesicular rash on her abdomen. She reports no prior history of varicella or vaccination. Which of the following is the most appropriate management?

  1. Intravenous acyclovir and varicella-zoster immune globulin Correct answer.
  2. Reassurance and supportive care only
  3. Varicella vaccine administration
  4. Oral acyclovir and follow-up in 1 week

Explanation

Pregnant women with varicella are at increased risk of severe disease and complications; intravenous acyclovir is recommended for severe or progressive disease, and varicella-zoster immune globulin may be considered. The combination is appropriate for a pregnant patient with active varicella.

Question 29Obstetrics

A 26-year-old G2P1 at 20 weeks gestation has a routine anatomy ultrasound that shows a short cervix measuring 20 mm. She has no history of preterm birth. Which of the following is the most appropriate management?

  1. Vaginal progesterone Correct answer.
  2. Bed rest
  3. Serial cervical length measurements
  4. Cerclage placement

Explanation

Vaginal progesterone is recommended for women with a singleton pregnancy and a short cervix (≤25 mm) without a history of preterm birth, as it reduces the risk of preterm birth. Cerclage is generally reserved for women with a history of preterm birth and a short cervix.

Question 30Obstetrics

A 35-year-old G1P0 at 28 weeks gestation has a 1-hour glucose challenge test result of 180 mg/dL. Which of the following is the most appropriate next step?

  1. Initiate insulin therapy
  2. Repeat the 1-hour glucose challenge test
  3. Perform a 3-hour oral glucose tolerance test Correct answer.
  4. Recommend dietary modification only

Explanation

A 1-hour glucose challenge test result ≥140 mg/dL (or ≥135 mg/dL in some practices) is an indication for a 3-hour oral glucose tolerance test to diagnose gestational diabetes. Treatment is not initiated without confirmation by the diagnostic test.

Question 31Obstetrics

A 30-year-old G1P0 at 38 weeks gestation presents with a blood pressure of 158/102 mmHg and 2+ proteinuria. She has no symptoms. Which of the following is the most appropriate management?

  1. Admit for observation and repeat blood pressure in 4 hours
  2. Discharge with instructions to return if symptoms worsen
  3. Start labetalol and plan delivery at 37 weeks Correct answer.
  4. Admit, start magnesium sulfate, and plan delivery after 34 weeks

Explanation

This patient has gestational hypertension with proteinuria, consistent with preeclampsia without severe features. Antihypertensive therapy is indicated for sustained blood pressure ≥160/110 mmHg or ≥150/100 mmHg in some protocols, and delivery is recommended at 37 weeks. Labetalol is a first-line antihypertensive.

Question 32Obstetrics

A 24-year-old G1P0 at 39 weeks gestation has spontaneous rupture of membranes and is group B streptococcus (GBS) positive. She has no allergies. Which of the following is the most appropriate intrapartum antibiotic prophylaxis?

  1. Ampicillin
  2. Clindamycin
  3. Penicillin G Correct answer.
  4. Cefazolin

Explanation

Penicillin G is the preferred agent for intrapartum GBS prophylaxis in patients without penicillin allergy. Ampicillin is an acceptable alternative but penicillin G is first-line.

Question 33Obstetrics

A 32-year-old G2P1 at 32 weeks gestation presents with a blood pressure of 168/112 mmHg and a platelet count of 88,000/µL. She has a headache and visual disturbances. Which of the following is the most appropriate initial management?

  1. Corticosteroids and expectant management
  2. Immediate cesarean delivery
  3. Magnesium sulfate and antihypertensive therapy Correct answer.
  4. Hydralazine alone

Explanation

This patient has severe preeclampsia with severe features (severe hypertension, thrombocytopenia, and cerebral symptoms). Initial management includes magnesium sulfate for seizure prophylaxis and antihypertensive therapy to control blood pressure, followed by delivery after maternal stabilization.

Question 34Obstetrics

A 28-year-old G1P0 at 18 weeks gestation presents with a 2-day history of fever, myalgia, and diarrhea after eating unpasteurized cheese. Which of the following is the most appropriate treatment?

  1. Intravenous immunoglobulin
  2. Trimethoprim-sulfamethoxazole
  3. Ampicillin Correct answer.
  4. No treatment; supportive care only

Explanation

Listeria monocytogenes infection is suggested by the history of unpasteurized cheese consumption and flu-like symptoms. Ampicillin (often with gentamicin) is the treatment of choice for listeriosis in pregnancy.

Question 35Obstetrics

A 40-year-old G4P3 at 41 weeks gestation has a Bishop score of 4. Which of the following is the most appropriate method for cervical ripening?

  1. Oxytocin infusion
  2. Dilation and curettage
  3. Misoprostol Correct answer.
  4. Amniotomy

Explanation

Misoprostol is a prostaglandin E1 analog used for cervical ripening when the Bishop score is unfavorable (≤6). Oxytocin and amniotomy are less effective for ripening and are typically used when the cervix is favorable.

Question 36Obstetrics

A 30-year-old G2P1 at 30 weeks gestation has a biophysical profile score of 4 with absent amniotic fluid. Which of the following is the most appropriate next step?

  1. Repeat biophysical profile in 24 hours
  2. Maternal hydration and repeat ultrasound in 2 hours
  3. Initiate antenatal corticosteroids and repeat biophysical profile in 48 hours
  4. Immediate delivery Correct answer.

Explanation

A biophysical profile score of 4 or less with oligohydramnios is an abnormal result indicating fetal compromise. Delivery is generally recommended, especially at ≥30 weeks, after appropriate counseling and administration of corticosteroids if time permits.

Question 37Obstetrics

A 35-year-old G3P2 at 36 weeks gestation has a fetus in transverse lie. Which of the following is the most appropriate management?

  1. Cesarean delivery Correct answer.
  2. External cephalic version
  3. Expectant management until 39 weeks
  4. Vaginal delivery

Explanation

Transverse lie at term is an indication for cesarean delivery because vaginal delivery is not possible and carries high risk. External cephalic version is not typically attempted for transverse lie.

Question 38Obstetrics

A 28-year-old G2P1 at 34 weeks gestation presents with preterm premature rupture of membranes (PPROM). She has no contractions and no signs of infection. Which of the following is the most appropriate initial management?

  1. Antibiotics and antenatal corticosteroids Correct answer.
  2. Amniocentesis for fetal lung maturity
  3. Tocolytic therapy
  4. Immediate induction of labor

Explanation

For PPROM at 34 weeks without infection or labor, expectant management with antibiotics (to prolong latency and reduce infection) and antenatal corticosteroids (for fetal lung maturity) is recommended. Delivery is considered at 34 weeks or later depending on institutional protocols.

Question 39Obstetrics

A 30-year-old G1P0 at 12 weeks gestation has a TSH of 6.5 mIU/L and a normal free T4. Which of the following is the most appropriate management?

  1. Radioactive iodine
  2. No treatment; repeat TSH in 4 weeks
  3. Methimazole
  4. Levothyroxine Correct answer.

Explanation

Subclinical hypothyroidism in pregnancy (TSH >2.5-3.0 mIU/L with normal free T4) is treated with levothyroxine to reduce the risk of adverse pregnancy outcomes. Treatment is especially indicated when TSH is >4.0 mIU/L or thyroid peroxidase antibodies are positive.

Question 40Obstetrics

A 25-year-old G1P0 at 39 weeks gestation has a prolonged second stage with arrest of descent. Which of the following is the most common cause?

  1. Occiput posterior position
  2. Epidural analgesia
  3. Cephalopelvic disproportion Correct answer.
  4. Uterine inertia

Explanation

Cephalopelvic disproportion (CPD) is a common cause of arrest of descent in the second stage, often due to a mismatch between fetal size and maternal pelvis. Other causes include malposition and ineffective uterine contractions.

Question 41Obstetrics

A 24-year-old G1P0 at 8 weeks gestation presents with cramping and vaginal bleeding. Her cervix is closed and no tissue is passed. Ultrasound shows an empty uterus with a beta-hCG of 1500 mIU/mL. Which of the following is the most appropriate next step?

  1. Progesterone supplementation
  2. Repeat beta-hCG in 48 hours Correct answer.
  3. Dilation and curettage
  4. Methotrexate

Explanation

With an empty uterus and a beta-hCG below the discriminatory zone (typically 1500-3500 mIU/mL), the pregnancy is of unknown location. Serial beta-hCG measurements are needed to determine if the pregnancy is viable, failing, or ectopic.

Question 42Obstetrics

A 36-year-old G3P2 at 38 weeks gestation has a blood pressure of 162/110 mmHg with 3+ proteinuria and a platelet count of 92,000/µL. Which of the following is the most appropriate management?

  1. Magnesium sulfate and delivery Correct answer.
  2. Oral nifedipine alone
  3. Expectant management until 39 weeks
  4. Corticosteroids and discharge

Explanation

This patient has severe preeclampsia (severe hypertension and thrombocytopenia). Magnesium sulfate is indicated for seizure prophylaxis, and delivery is recommended after maternal stabilization, regardless of gestational age.

Question 43Obstetrics

A 28-year-old G1P0 at 28 weeks gestation has a fundal height of 24 cm. Which of the following is the most appropriate next step in management?

  1. Repeat fundal height in 2 weeks
  2. Oral glucose tolerance test
  3. Biophysical profile
  4. Ultrasound for fetal growth Correct answer.

Explanation

A fundal height that is 4 cm less than expected (24 cm at 28 weeks) suggests fetal growth restriction or oligohydramnios. Ultrasound is indicated to assess fetal growth and amniotic fluid volume.

Question 44Obstetrics

A 32-year-old G2P1 at 36 weeks gestation has a fetus in breech presentation confirmed by ultrasound. She has no other complications. Which of the following is the most appropriate management?

  1. Immediate cesarean delivery
  2. Expectant management until 39 weeks
  3. External cephalic version at 37 weeks Correct answer.
  4. Vaginal breech delivery

Explanation

External cephalic version is recommended at 37 weeks for breech presentation in patients without contraindications to increase the chance of vaginal delivery.

Question 45Obstetrics

Which of the following is the most accurate statement about the risk of recurrence of preeclampsia in a subsequent pregnancy?

  1. The risk is higher if the first pregnancy was complicated by preterm delivery
  2. The risk is approximately 10-20% Correct answer.
  3. The risk is less than 5%
  4. The risk is approximately 50%

Explanation

The recurrence risk of preeclampsia is generally quoted as 10-20% in subsequent pregnancies, though it is higher if the first pregnancy was severe or delivered preterm. The other options are inaccurate.

Question 46Obstetrics

Which fetal heart rate pattern is most characteristic of a healthy, oxygenated fetus and is classified as category I by the three-tier system?

  1. Baseline 150 bpm with recurrent late decelerations
  2. Sinusoidal pattern with a baseline of 130 bpm
  3. Baseline 140 bpm with moderate variability and no decelerations Correct answer.
  4. Baseline 100 bpm with minimal variability

Explanation

Category I tracings are strongly predictive of normal fetal acid-base status and require a baseline of 110-160 bpm, moderate variability, and absent late or variable decelerations. Any tracing with a sinusoidal pattern, minimal variability, or recurrent decelerations falls outside category I.

Question 47Obstetrics

A 27-year-old G1P0 at 11 weeks gestation has a hemoglobin of 10.8 g/dL with a mean corpuscular volume of 72 fL and a ferritin of 8 ng/mL. Which of the following is the most appropriate management?

  1. Immediate packed red blood cell transfusion
  2. Oral iron supplementation with recheck of hemoglobin in 4 weeks Correct answer.
  3. Reassurance alone, since this hemoglobin is normal for pregnancy
  4. Vitamin B12 and folate supplementation

Explanation

Microcytosis with a low ferritin confirms iron deficiency anemia, which in pregnancy is treated first-line with oral iron and a follow-up hemoglobin to assess response. Transfusion is reserved for severe or symptomatic anemia, and B12/folate treat macrocytic anemia.

Question 48Obstetrics

A 33-year-old G2P1 at 34 weeks gestation has a blood pressure of 150/95 mmHg, 1+ proteinuria, and a normal platelet count with normal liver enzymes. Which of the following best describes this condition?

  1. Preeclampsia with severe features
  2. Preeclampsia without severe features Correct answer.
  3. Chronic hypertension
  4. Gestational hypertension

Explanation

New-onset hypertension after 20 weeks with proteinuria defines preeclampsia, and this case lacks any severe features such as blood pressure of 160/110 mmHg or higher, thrombocytopenia, or elevated liver enzymes. Gestational hypertension requires the absence of proteinuria, and chronic hypertension predates 20 weeks.

Question 49Obstetrics

A 29-year-old G2P1 at 39 weeks gestation has spontaneous rupture of membranes and, after 6 hours, a temperature of 38.6°C with maternal tachycardia and fetal tachycardia. Which of the following is the most appropriate next step in management?

  1. Perform an immediate cesarean delivery regardless of fetal status
  2. Obtain a repeat temperature in 2 hours before intervening
  3. Administer acetaminophen and continue expectant management
  4. Begin broad-spectrum intravenous antibiotics and proceed with delivery Correct answer.

Explanation

Intrapartum fever with ruptured membranes and maternal and fetal tachycardia indicates intraamniotic infection, which is treated with broad-spectrum IV antibiotics plus prompt delivery. Delaying treatment increases maternal and neonatal morbidity, while cesarean delivery is reserved for obstetric indications.

Question 50Obstetrics

A 31-year-old G3P2 at 37 weeks gestation with a prior classical cesarean delivery presents in active labor with strong contractions. She reports sudden tearing abdominal pain, and fetal heart tracing shows prolonged deceleration to 70 bpm. Which of the following is the most appropriate immediate management?

  1. Amnioinfusion to relieve the prolonged deceleration
  2. Emergent laparotomy with cesarean delivery and uterine repair Correct answer.
  3. Administration of epidural analgesia and observation
  4. Tocolytic therapy and continuous monitoring for improvement

Explanation

Sudden tearing pain with fetal bradycardia in a patient with a prior classical incision strongly suggests uterine rupture, which requires immediate laparotomy and delivery. Tocolytic therapy, amnioinfusion, or observation would dangerously delay definitive treatment.