I85PREP
⌘ K
ABPS Family Medicine Obstetrics study materials
ABPS Family Medicine Obstetrics study resources

ABPS Family Medicine Obstetrics practice questions

One question at a time. Build your ABPS Family Medicine Obstetrics understanding.

First 50 of 200 questions. Each one lists the choices, the correct answer, and an explanation. The checker at the top of this page saves progress in this browser when it is available.

Continue in the practice tool above to load more questions, 50 at a time.

Question 1Maternal-Fetal Medicine and High-Risk Obstetric Care

A 28-year-old G2P1 at 11 weeks gestation has a blood pressure of 148/96 mmHg on two occasions four hours apart, with no proteinuria and no prior hypertension. Which diagnosis best fits?

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

Explanation

Hypertension detected before 20 weeks gestation is classified as chronic hypertension, regardless of whether it predates the pregnancy. Gestational hypertension is defined by new hypertension arising after 20 weeks. Preeclampsia requires proteinuria or maternal organ dysfunction in addition to hypertension after 20 weeks.

Question 2Maternal-Fetal Medicine and High-Risk Obstetric Care

A 34-year-old G1 at 30 weeks has new blood pressure of 158/112 mmHg and a platelet count of 88,000/µL with normal liver enzymes and no proteinuria. Which is the most appropriate initial management?

  1. Magnesium sulfate seizure prophylaxis and delivery planning Correct answer.
  2. Oral labetalol with reassessment in 48 hours
  3. Antihypertensive therapy alone with outpatient follow-up
  4. Expectant management with weekly labs

Explanation

Thrombocytopenia below 100,000/µL with severe-range blood pressure constitutes preeclampsia with severe features even without proteinuria. Severe features mandate magnesium sulfate for seizure prophylaxis and planning for delivery, generally after 34 weeks or sooner if maternal/fetal status deteriorates. Expectant outpatient management is unsafe with severe features.

Question 3Maternal-Fetal Medicine and High-Risk Obstetric Care

Which medication is first-line for acute blood pressure control in a pregnant patient with severe hypertension (≥160/110 mmHg) in the antepartum period?

  1. Enalapril
  2. Losartan
  3. Intravenous labetalol Correct answer.
  4. Atenolol

Explanation

Intravenous labetalol, intravenous hydralazine, and oral immediate-release nifedipine are the recommended first-line agents for acute severe hypertension in pregnancy. ACE inhibitors and angiotensin receptor blockers are contraindicated in pregnancy due to fetal renal and teratogenic effects. Atenolol is associated with fetal growth restriction and is avoided.

Question 4Maternal-Fetal Medicine and High-Risk Obstetric Care

A patient at 36 weeks with preeclampsia without severe features is being counseled about expectant management. Which finding would most strongly prompt delivery rather than continued observation?

  1. Blood pressure of 142/92 mmHg
  2. 1+ proteinuria on dipstick
  3. Mild ankle edema
  4. Fetal growth restriction with abnormal umbilical artery Doppler Correct answer.

Explanation

Fetal growth restriction with abnormal umbilical artery Doppler indicates placental insufficiency and fetal compromise, which favors delivery over expectant management at 36 weeks. Mild hypertension, low-grade proteinuria, and dependent edema are expected findings that do not by themselves mandate delivery.

Question 5Maternal-Fetal Medicine and High-Risk Obstetric Care

Which is the most common cause of postpartum hemorrhage?

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

Explanation

Uterine atony accounts for roughly 70-80% of postpartum hemorrhage and is the leading cause. Lacerations, retained placenta, and coagulopathy are less common causes and are considered after atony is addressed.

Question 6Maternal-Fetal Medicine and High-Risk Obstetric Care

A woman at 39 weeks delivers and has estimated blood loss of 1200 mL with ongoing heavy bleeding. After uterine massage and oxytocin, bleeding continues. Which medication is contraindicated in a patient with severe asthma?

  1. Tranexamic acid
  2. Carboprost tromethamine Correct answer.
  3. Methylergonovine
  4. Misoprostol

Explanation

Carboprost is a prostaglandin F2-alpha analog that causes bronchoconstriction and is contraindicated in asthma. Methylergonovine is contraindicated in hypertension, not asthma. Misoprostol and tranexamic acid are not contraindicated in asthma.

Question 7Maternal-Fetal Medicine and High-Risk Obstetric Care

A patient at 33 weeks presents with painless bright red vaginal bleeding and a soft, nontender uterus. Which is the most likely diagnosis?

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

Explanation

Painless bright red vaginal bleeding with a soft, nontender uterus is characteristic of placenta previa. Abruption typically presents with painful bleeding and a tender, rigid uterus. Uterine rupture is associated with prior uterine surgery and fetal distress. Vasa previa causes fetal bleeding with rupture of membranes.

Question 8Maternal-Fetal Medicine and High-Risk Obstetric Care

A patient at 28 weeks with a known low-lying placenta has an episode of painless vaginal bleeding. Which is the most appropriate initial step in evaluation?

  1. Digital cervical examination
  2. Amniotomy
  3. Immediate cesarean delivery
  4. Transvaginal ultrasound Correct answer.

Explanation

Transvaginal ultrasound is safe and is the preferred imaging modality to evaluate placental location and confirm placenta previa. Digital cervical examination is contraindicated when placenta previa is suspected because it can provoke catastrophic hemorrhage. Delivery is not indicated at 28 weeks for a stable patient without severe bleeding.

Question 9Maternal-Fetal Medicine and High-Risk Obstetric Care

Which finding is most consistent with placental abruption?

  1. Painless bleeding with a soft uterus
  2. Fetal bradycardia with a normal uterus
  3. Painful bleeding with a firm, tender uterus Correct answer.
  4. Bleeding after membrane rupture with fetal anemia

Explanation

Placental abruption classically presents with painful vaginal bleeding and a firm, tender uterus due to retroplacental hematoma and uterine hypertonicity. Painless bleeding with a soft uterus suggests placenta previa. Bleeding after membrane rupture with fetal anemia suggests vasa previa.

Question 10Maternal-Fetal Medicine and High-Risk Obstetric Care

A woman with a prior classical cesarean delivery at 36 weeks reports sudden severe abdominal pain and loss of fetal station with fetal bradycardia. Which is the most likely diagnosis?

  1. Chorioamnionitis
  2. Uterine rupture Correct answer.
  3. Preterm labor
  4. Placental abruption

Explanation

Sudden severe abdominal pain, loss of fetal station, and fetal bradycardia in a patient with prior classical cesarean are classic for uterine rupture. Abruption causes pain and bleeding but not loss of station. Preterm labor and chorioamnionitis do not cause acute loss of station with fetal bradycardia.

Question 11Maternal-Fetal Medicine and High-Risk Obstetric Care

A patient with a history of preterm birth at 30 weeks is now at 16 weeks with a singleton pregnancy. Which intervention has the strongest evidence for reducing recurrent preterm birth?

  1. Weekly progesterone injections
  2. Cerclage in all patients
  3. Vaginal progesterone Correct answer.
  4. Activity restriction

Explanation

Vaginal progesterone is recommended for patients with a singleton pregnancy and a prior spontaneous preterm birth, with evidence supporting reduction in recurrent preterm birth. Cerclage is reserved for specific indications such as cervical insufficiency. Activity restriction has not been shown to reduce preterm birth.

Question 12Maternal-Fetal Medicine and High-Risk Obstetric Care

A patient at 24 weeks has a cervical length of 18 mm on transvaginal ultrasound with no prior preterm birth. Which management is most appropriate?

  1. Bed rest
  2. Vaginal progesterone Correct answer.
  3. Cerclage
  4. No intervention

Explanation

A short cervix (≤25 mm) on transvaginal ultrasound in a singleton pregnancy is an indication for vaginal progesterone, which reduces preterm birth risk. Cerclage is generally reserved for patients with prior preterm birth and short cervix or cervical insufficiency. Bed rest is not effective.

Question 13Maternal-Fetal Medicine and High-Risk Obstetric Care

Which is the most accurate statement about the use of antenatal corticosteroids for fetal lung maturity?

  1. They are given only after 36 weeks
  2. They are contraindicated in multiple gestations
  3. They are given routinely at 20 weeks
  4. They are given between 24 and 34 weeks when preterm delivery is anticipated within 7 days Correct answer.

Explanation

Antenatal corticosteroids are recommended for patients at 24 to 34 weeks gestation at risk of delivery within 7 days to accelerate fetal lung maturity and reduce neonatal morbidity. They are not routinely given at 20 weeks or only after 36 weeks. Multiple gestations are not a contraindication.

Question 14Maternal-Fetal Medicine and High-Risk Obstetric Care

A patient at 31 weeks presents with regular contractions and cervical dilation of 3 cm. Which tocolytic is contraindicated in the setting of chorioamnionitis?

  1. Terbutaline
  2. Indomethacin Correct answer.
  3. Magnesium sulfate
  4. Nifedipine

Explanation

Indomethacin is a prostaglandin synthesis inhibitor that can mask signs of infection and is contraindicated in chorioamnionitis. Nifedipine, terbutaline, and magnesium sulfate are not absolutely contraindicated in chorioamnionitis, though delivery is often indicated.

Question 15Maternal-Fetal Medicine and High-Risk Obstetric Care

Which finding is most consistent with preterm premature rupture of membranes?

  1. Uterine tenderness with fever
  2. Fetal heart rate decelerations
  3. Cervical dilation of 4 cm with intact membranes
  4. Positive fern test with pooling of fluid Correct answer.

Explanation

Pooling of amniotic fluid in the vagina with a positive fern test is diagnostic of ruptured membranes. Cervical dilation with intact membranes indicates labor, not rupture. Fetal heart rate decelerations and uterine tenderness with fever suggest other conditions such as cord compression or chorioamnionitis.

Question 16Maternal-Fetal Medicine and High-Risk Obstetric Care

A patient at 34 weeks with PPROM and no signs of infection or labor is being managed. Which is the most appropriate management?

  1. Amnioinfusion
  2. Cerclage placement
  3. Immediate induction of labor
  4. Expectant management with antibiotics and corticosteroids Correct answer.

Explanation

For PPROM at 34 to 36 weeks without infection or labor, expectant management with antibiotics and antenatal corticosteroids is appropriate, with delivery typically by 37 weeks. Immediate induction is not required at 34 weeks in the absence of complications. Cerclage and amnioinfusion are not indicated.

Question 17Maternal-Fetal Medicine and High-Risk Obstetric Care

Which is the recommended treatment for a pregnant patient with a positive syphilis screen and confirmed infection?

  1. Intramuscular penicillin G benzathine Correct answer.
  2. Oral azithromycin
  3. Topical clotrimazole
  4. Oral doxycycline

Explanation

Intramuscular penicillin G benzathine is the only recommended treatment for syphilis in pregnancy and prevents congenital syphilis. Azithromycin is not reliable, doxycycline is contraindicated in pregnancy, and clotrimazole is an antifungal.

Question 18Maternal-Fetal Medicine and High-Risk Obstetric Care

A pregnant patient at 20 weeks has a positive group B streptococcus culture. What is the appropriate management?

  1. Intrapartum intravenous penicillin at the time of labor Correct answer.
  2. Immediate cesarean delivery
  3. Oral penicillin now and again at 36 weeks
  4. No treatment at any time

Explanation

Group B streptococcus colonization is managed with intrapartum intravenous antibiotic prophylaxis (penicillin or ampicillin) during labor to prevent neonatal early-onset disease. Treatment before labor is not effective in eradicating colonization and is not recommended. Cesarean delivery is not indicated for colonization.

Question 19Maternal-Fetal Medicine and High-Risk Obstetric Care

A patient with type 1 diabetes is planning pregnancy. Which pre-conception hemoglobin A1c target is recommended to reduce congenital malformations?

  1. Below 8%
  2. Below 6.5% Correct answer.
  3. Below 12%
  4. Below 10%

Explanation

A preconception HbA1c below 6.5% is recommended to reduce the risk of congenital malformations and miscarriage. Higher targets are associated with increased risk of anomalies, particularly cardiac and neural tube defects.

Question 20Maternal-Fetal Medicine and High-Risk Obstetric Care

A patient with gestational diabetes at 39 weeks has an estimated fetal weight of 4,600 g. Which is the most appropriate delivery plan?

  1. Outpatient monitoring until spontaneous labor
  2. Trial of labor with expectant management
  3. Cesarean delivery Correct answer.
  4. Induction at 41 weeks

Explanation

An estimated fetal weight of 4,500 g or greater in a patient with diabetes is an indication for cesarean delivery to reduce the risk of shoulder dystocia. A trial of labor and expectant management increase that risk.

Question 21Maternal-Fetal Medicine and High-Risk Obstetric Care

Which is the recommended screening approach for gestational diabetes at 24 to 28 weeks?

  1. Fasting glucose only
  2. Random glucose
  3. Hemoglobin A1c
  4. One-step 75-g 2-hour OGTT Correct answer.

Explanation

The one-step 75-g 2-hour oral glucose tolerance test is a recommended screening approach for gestational diabetes at 24 to 28 weeks. Fasting glucose alone, HbA1c, and random glucose are not adequate screening tests for gestational diabetes.

Question 22Maternal-Fetal Medicine and High-Risk Obstetric Care

A pregnant patient at 32 weeks has a blood pressure of 150/95 mmHg and new proteinuria. Which medication is contraindicated for chronic blood pressure management in pregnancy?

  1. Methyldopa
  2. Enalapril Correct answer.
  3. Nifedipine
  4. Labetalol

Explanation

ACE inhibitors such as enalapril are contraindicated in pregnancy due to fetal renal toxicity and teratogenicity. Labetalol, nifedipine, and methyldopa are acceptable antihypertensives in pregnancy.

Question 23Maternal-Fetal Medicine and High-Risk Obstetric Care

A patient at 26 weeks presents with a blood pressure of 168/112 mmHg and a headache. Which is the most appropriate immediate action?

  1. Reassurance and outpatient follow-up
  2. Immediate treatment of severe hypertension and magnesium sulfate Correct answer.
  3. Induction of labor
  4. Oral labetalol with reassessment in 1 week

Explanation

Severe-range hypertension with neurologic symptoms at 26 weeks requires immediate treatment of severe hypertension and magnesium sulfate for seizure prophylaxis, with delivery planning based on maternal and fetal status. Outpatient follow-up or delayed reassessment is unsafe. Induction at 26 weeks is not the immediate priority.

Question 24Maternal-Fetal Medicine and High-Risk Obstetric Care

Which is the most appropriate management for a patient at 37 weeks with preeclampsia without severe features?

  1. Delivery Correct answer.
  2. Outpatient monitoring
  3. Expectant management until 40 weeks
  4. Weekly labs until 42 weeks

Explanation

For preeclampsia without severe features at 37 weeks or later, delivery is recommended. Expectant management beyond 37 weeks increases maternal and fetal risk without benefit.

Question 25Maternal-Fetal Medicine and High-Risk Obstetric Care

A patient with a history of preeclampsia in a prior pregnancy is now at 14 weeks. Which intervention reduces the risk of recurrent preeclampsia?

  1. Low-dose aspirin Correct answer.
  2. Bed rest
  3. Calcium supplementation
  4. Heparin

Explanation

Low-dose aspirin started before 16 weeks reduces the risk of recurrent preeclampsia in patients with prior preeclampsia. Calcium supplementation is beneficial mainly in low-calcium-intake populations, heparin is not indicated, and bed rest is not effective.

Question 26Maternal-Fetal Medicine and High-Risk Obstetric Care

A 30-year-old G2P1 at 36 weeks presents with a blood pressure of 170/110 mmHg and a platelet count of 85,000/µL. She has no headache, visual changes, or right upper quadrant pain. Which diagnosis is most appropriate?

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

Explanation

Preeclampsia with severe features is diagnosed when there is new-onset hypertension (≥140/90) with proteinuria or other end-organ dysfunction, and severe features include severe blood pressure elevation (≥160/110) or thrombocytopenia (<100,000/µL). This patient meets criteria for severe features based on both blood pressure and platelet count.

Question 27Maternal-Fetal Medicine and High-Risk Obstetric Care

A 28-year-old G1 at 26 weeks presents with a blood pressure of 165/115 mmHg and a severe headache. She has no seizures. Which is the most appropriate initial medication for seizure prophylaxis?

  1. Hydralazine
  2. Nifedipine
  3. Magnesium sulfate Correct answer.
  4. Labetalol

Explanation

Magnesium sulfate is the drug of choice for prevention and treatment of eclamptic seizures in patients with preeclampsia with severe features. Antihypertensives such as labetalol, hydralazine, and nifedipine are used to lower blood pressure but do not prevent seizures.

Question 28Maternal-Fetal Medicine and High-Risk Obstetric Care

A 34-year-old G3P2 at 18 weeks has a history of preeclampsia requiring delivery at 32 weeks in her last pregnancy. She is normotensive now. Which intervention is most likely to reduce her risk of recurrent preeclampsia?

  1. Low-dose aspirin 81 mg daily Correct answer.
  2. Labetalol 100 mg twice daily
  3. Bed rest for the remainder of pregnancy
  4. Calcium supplementation 1 g daily

Explanation

Low-dose aspirin (81 mg daily) started before 16 weeks is recommended for patients at high risk of preeclampsia, including those with a history of preterm preeclampsia. It has been shown to reduce the risk of recurrent preeclampsia.

Question 29Maternal-Fetal Medicine and High-Risk Obstetric Care

A 32-year-old G2P1 at 30 weeks presents with a blood pressure of 155/100 mmHg and 3+ proteinuria. She has no severe features. Which is the most appropriate management?

  1. Expectant management with close maternal and fetal monitoring Correct answer.
  2. Delivery by cesarean immediately
  3. Administration of betamethasone and induction of labor in 48 hours
  4. Initiation of labetalol and discharge home

Explanation

For preeclampsia without severe features before 37 weeks, expectant management with close monitoring is recommended to allow fetal maturation, provided maternal and fetal status remain stable. Delivery is indicated for severe features or at 37 weeks.

Question 30Maternal-Fetal Medicine and High-Risk Obstetric Care

A 25-year-old G1 at 22 weeks has a blood pressure of 145/95 mmHg. She has no proteinuria and normal lab results. Which is the most likely diagnosis?

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

Explanation

Hypertension before 20 weeks of gestation is classified as chronic hypertension. Gestational hypertension and preeclampsia typically develop after 20 weeks.

Question 31Antepartum Care and Prenatal Diagnosis

A 26-year-old G1P0 at 10 weeks' gestation has a hemoglobin of 10.8 g/dL and MCV of 72 fL. Which laboratory test is the most appropriate next step to confirm the suspected diagnosis?

  1. Vitamin B12 level
  2. Serum ferritin Correct answer.
  3. Hemoglobin electrophoresis
  4. Reticulocyte count

Explanation

Microcytic anemia in pregnancy is most often iron deficiency, and serum ferritin is the most specific confirmatory test (a low ferritin reflects depleted iron stores). Hemoglobin electrophoresis is reserved for suspected thalassemia when iron studies are normal or the picture is atypical.

Question 32Antepartum Care and Prenatal Diagnosis

Which fetal structure is best visualized to confirm gestational age by crown-rump length in the first trimester?

  1. Nuchal translucency
  2. Femur length
  3. Fetal crown to rump in a neutral position Correct answer.
  4. Biparietal diameter

Explanation

Crown-rump length measured in a neutral fetal position is the most accurate first-trimester dating parameter between roughly 7 and 13 weeks. Biparietal diameter and femur length are second- and third-trimester parameters with wider error margins.

Question 33Antepartum Care and Prenatal Diagnosis

A woman at 28 weeks' gestation has a 1-hour 50-g glucose challenge result of 152 mg/dL. What is the next appropriate step?

  1. Repeat the 50-g challenge in 4 weeks
  2. Reassure the patient that this is normal
  3. Proceed to a 3-hour 100-g oral glucose tolerance test Correct answer.
  4. Begin insulin therapy immediately

Explanation

A 1-hour challenge value at or above the screening threshold (commonly 130–140 mg/dL) requires a diagnostic 3-hour 100-g oral glucose tolerance test. Treatment is not started on the screening test alone.

Question 34Antepartum Care and Prenatal Diagnosis

Routine prenatal care recommends a screening test for RhD status and antibody formation at which point in pregnancy?

  1. Initial visit with repeat antibody screen at 28 weeks Correct answer.
  2. Only in the third trimester
  3. Only at delivery
  4. Only if the patient has had a prior transfusion

Explanation

Blood type, Rh status, and an antibody screen are obtained at the initial prenatal visit and the antibody screen is repeated at approximately 28 weeks, when Rh immune globulin is also given to Rh-negative unsensitized women.

Question 35Antepartum Care and Prenatal Diagnosis

Which finding on a 20-week anatomy ultrasound most strongly suggests an open neural tube defect?

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

Explanation

The lemon sign (scalloped frontal bones) combined with the banana sign (caudally displaced cerebellum) is associated with open neural tube defects such as spina bifida. The other findings are soft markers more typically linked to aneuploidy risk.

Question 36Antepartum Care and Prenatal Diagnosis

A 32-year-old G2P1 at 12 weeks has a history of a prior child with a neural tube defect. Which preventive measure should be recommended for this pregnancy?

  1. Vitamin A 10,000 IU daily
  2. Folic acid 4 mg daily started before conception Correct answer.
  3. Folic acid 0.4 mg daily
  4. No supplementation is needed

Explanation

Women with a prior affected pregnancy are at increased recurrence risk and should take high-dose folic acid (4 mg daily) beginning at least one month before conception through the first trimester. Standard 0.4 mg dosing is for average-risk women.

Question 37Antepartum Care and Prenatal Diagnosis

A patient at 35 weeks reports decreased fetal movement. Which initial assessment is most appropriate?

  1. Nonstress test with or without a biophysical profile Correct answer.
  2. Maternal blood glucose measurement only
  3. Repeat ultrasound in 2 weeks
  4. Immediate cesarean delivery

Explanation

Decreased fetal movement warrants prompt fetal surveillance, typically a nonstress test and, if indicated, a biophysical profile or contraction stress test. Delivery is reserved for abnormal testing or other obstetric indications.

Question 38Antepartum Care and Prenatal Diagnosis

Which condition is a contraindication to vaginal delivery and typically requires cesarean delivery?

  1. Gestational thrombocytopenia
  2. Complete placenta previa Correct answer.
  3. Low-lying placenta at 20 weeks
  4. Marginal sinus bleeding

Explanation

Complete placenta previa covering the cervical os precludes vaginal delivery because of the risk of catastrophic hemorrhage. A low-lying placenta at 20 weeks often resolves with uterine growth and is re-evaluated later.

Question 39Antepartum Care and Prenatal Diagnosis

A 30-year-old at 16 weeks has a blood pressure of 150/95 mmHg on two occasions before pregnancy. Which diagnosis is most consistent?

  1. Chronic hypertension Correct answer.
  2. Preeclampsia
  3. White coat hypertension
  4. Gestational hypertension

Explanation

Elevated blood pressure documented before 20 weeks' gestation (or before pregnancy) defines chronic hypertension. Gestational hypertension and preeclampsia are diagnosed at or after 20 weeks.

Question 40Antepartum Care and Prenatal Diagnosis

Which test is the most sensitive single screening test for fetal aneuploidy in the first trimester?

  1. Nuchal translucency alone
  2. Cell-free fetal DNA Correct answer.
  3. Triple screen
  4. Maternal serum alpha-fetoprotein

Explanation

Cell-free fetal DNA screening has the highest detection rate for trisomy 21 (greater than 99%) among screening options. It is a screening test, not diagnostic, and abnormal results require confirmatory testing.

Question 41Antepartum Care and Prenatal Diagnosis

A pregnant patient at 18 weeks reports a rash and is found to have a temperature of 38.5°C with a parotid swelling. Which infection is most consistent?

  1. Toxoplasmosis
  2. Parvovirus B19
  3. Mumps Correct answer.
  4. Cytomegalovirus

Explanation

Parotid swelling with fever is characteristic of mumps, which can occur in pregnancy. The other infections do not typically produce parotitis.

Question 42Antepartum Care and Prenatal Diagnosis

Which is the recommended approach to screening for group B Streptococcus colonization?

  1. No screening is recommended
  2. Vaginal-rectal culture at 36–37 weeks Correct answer.
  3. Serum antibody testing at 28 weeks
  4. Urine culture at 12 weeks

Explanation

Universal culture-based screening for group B Streptococcus is performed by vaginal-rectal swab at 36–37 weeks' gestation to guide intrapartum chemoprophylaxis.

Question 43Antepartum Care and Prenatal Diagnosis

A 28-year-old at 32 weeks has a fundal height of 26 cm. Which is the most appropriate next step?

  1. Ultrasound for fetal growth assessment Correct answer.
  2. Immediate induction of labor
  3. Reassurance and return in 4 weeks
  4. Repeat fundal height in 1 week

Explanation

A fundal height measurement that is 3 cm or more below gestational age suggests fetal growth restriction or oligohydramnios and warrants ultrasound evaluation.

Question 44Antepartum Care and Prenatal Diagnosis

Which of the following is the most common cause of first-trimester vaginal bleeding?

  1. Vasa previa
  2. Placenta previa
  3. Spontaneous abortion Correct answer.
  4. Ectopic pregnancy

Explanation

Spontaneous abortion (miscarriage) is the most frequent cause of first-trimester bleeding. Ectopic pregnancy is less common but must be excluded because of its severity.

Question 45Antepartum Care and Prenatal Diagnosis

A patient at 24 weeks has a cervical length of 18 mm on transvaginal ultrasound. Which intervention reduces the risk of preterm birth?

  1. Bed rest
  2. Vaginal progesterone Correct answer.
  3. Cerclage for all patients
  4. Routine antibiotics

Explanation

A short cervix (less than 25 mm) in a singleton pregnancy is an indication for vaginal progesterone, which reduces preterm birth risk. Cerclage is reserved for specific histories or examination findings.

Question 46Antepartum Care and Prenatal Diagnosis

Which finding on urinalysis in a pregnant patient suggests preeclampsia rather than a urinary tract infection?

  1. Hematuria with bacteriuria
  2. Positive leukocyte esterase
  3. Positive nitrites
  4. Proteinuria with a bland sediment Correct answer.

Explanation

Proteinuria without signs of infection (bland sediment) supports preeclampsia. Nitrites, leukocyte esterase, and bacteriuria suggest infection.

Question 47Antepartum Care and Prenatal Diagnosis

At what gestational age is the quad screen typically performed?

  1. 15–22 weeks Correct answer.
  2. 24–28 weeks
  3. 32–36 weeks
  4. 6–8 weeks

Explanation

The maternal serum quad screen (AFP, hCG, estriol, inhibin A) is drawn between approximately 15 and 22 weeks' gestation.

Question 48Antepartum Care and Prenatal Diagnosis

A patient at 34 weeks presents with painless vaginal bleeding and a soft uterus. Which diagnosis should be suspected first?

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

Explanation

Painless third-trimester bleeding with a soft, nontender uterus is classic for placenta previa. Abruption typically presents with painful bleeding and a tense uterus.

Question 49Antepartum Care and Prenatal Diagnosis

Which is an appropriate screening interval for cervical cancer in a 25-year-old pregnant patient with prior normal results?

  1. Every 10 years with cytology alone
  2. No screening during pregnancy
  3. Every 3 years with cytology alone Correct answer.
  4. Every year with cytology alone

Explanation

Current guidelines allow cytology alone every 3 years for average-risk women aged 21–29. Pregnancy does not alter the screening schedule.

Question 50Antepartum Care and Prenatal Diagnosis

A patient at 10 weeks has a positive urine culture for Escherichia coli with 100,000 CFU/mL. What is the recommended management?

  1. Repeat culture in 4 weeks
  2. Treat with an appropriate antibiotic Correct answer.
  3. No treatment unless symptomatic
  4. Admit for intravenous antibiotics

Explanation

Asymptomatic bacteriuria in pregnancy should be treated to reduce the risk of pyelonephritis and preterm birth. Culture-directed oral antibiotics are appropriate.