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ABPS Obstetrics & Gynecology study materials
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ABPS Obstetrics & Gynecology practice questions

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Question 1General Obstetrics (antepartum, intrapartum, postpartum care)

A woman at 39 weeks' gestation has a Bishop score of 4. Which cervical finding is most consistent with this score?

  1. Cervix dilated 5 cm, fully effaced, anterior
  2. Cervix dilated 3 cm, 50% effaced, soft, midposition
  3. Cervix dilated 1 cm, 20% effaced, firm, posterior Correct answer.
  4. Cervix closed, firm, posterior, 0% effaced

Explanation

The Bishop score sums dilation, effacement, consistency, position, and station; a total of 4 reflects an unfavorable cervix with minimal change. A cervix that is 1 cm dilated, minimally effaced, firm, and posterior contributes low points in each category. Scores of 6 or more generally indicate a cervix favorable for induction.

Question 2General Obstetrics (antepartum, intrapartum, postpartum care)

Which laboratory finding is most characteristic of preeclampsia without severe features?

  1. Platelet count below 100,000/µL
  2. Serum creatinine above 1.1 mg/dL
  3. Transaminases elevated to twice the upper limit of normal
  4. Proteinuria of 300 mg or more per 24 hours with new hypertension after 20 weeks Correct answer.

Explanation

Preeclampsia is defined by new hypertension after 20 weeks plus proteinuria or other end-organ dysfunction. Proteinuria of at least 300 mg/24 h is the classic threshold. Thrombocytopenia, renal insufficiency, and elevated liver enzymes are markers of severe disease.

Question 3General Obstetrics (antepartum, intrapartum, postpartum care)

A woman at 32 weeks' gestation reports regular painful contractions. Her cervix is 1 cm dilated and 30% effaced. Which management step is most appropriate?

  1. Amniotomy to assess fluid color
  2. Immediate cesarean delivery
  3. Discharge home with routine follow-up in 4 weeks
  4. Tocolysis and antenatal corticosteroid administration with transfer planning Correct answer.

Explanation

Preterm labor before 34 weeks is managed with tocolysis to allow time for antenatal corticosteroids and, when indicated, magnesium sulfate for neuroprotection. Delivery is generally not expedited solely for preterm labor when the mother and fetus are stable.

Question 4General Obstetrics (antepartum, intrapartum, postpartum care)

Which finding best distinguishes hyperemesis gravidarum from ordinary nausea and vomiting of pregnancy?

  1. Morning predominance of symptoms
  2. Mild nausea relieved by small meals
  3. Nausea limited to the first trimester
  4. Vomiting accompanied by ketonuria and weight loss Correct answer.

Explanation

Hyperemesis gravidarum is characterized by persistent vomiting leading to dehydration, ketonuria, electrolyte disturbance, and weight loss, often with a need for hospitalization. Ordinary nausea and vomiting of pregnancy is typically milder without metabolic derangement.

Question 5General Obstetrics (antepartum, intrapartum, postpartum care)

A 28-year-old at 36 weeks' gestation has a blood pressure of 158/112 mmHg on two occasions. She has no headache, visual change, or right upper quadrant pain, and platelets and liver enzymes are normal. What is the most appropriate next step?

  1. Immediate delivery by cesarean
  2. Start antihypertensive therapy and continue monitoring Correct answer.
  3. Reassure and recheck in one week
  4. Order a 24-hour urine protein and await results

Explanation

Persistent severe-range blood pressure (≥160/110 mmHg) requires treatment with antihypertensive medication to reduce the risk of maternal stroke and other complications. Delivery timing depends on gestational age and maternal-fetal status but acute blood pressure control is the immediate priority.

Question 6General Obstetrics (antepartum, intrapartum, postpartum care)

Which statement about the physiology of the second stage of labor is correct?

  1. Maternal pushing adds to uterine contractions to effect delivery Correct answer.
  2. Descent of the fetal head is driven primarily by uterine contractions alone
  3. The second stage ends with full cervical dilation
  4. Passive fetal descent occurs only after rupture of membranes

Explanation

The second stage begins at full dilation and ends with delivery. Uterine contractions provide the primary force, and maternal expulsive effort augments descent and rotation. Fetal descent also occurs passively before active pushing.

Question 7General Obstetrics (antepartum, intrapartum, postpartum care)

A woman at 41 weeks' gestation has a reactive nonstress test. Which statement best reflects the role of a contraction stress test in this setting?

  1. It replaces the need for any further antenatal testing
  2. It is the preferred primary test for post-term surveillance
  3. It is contraindicated after 40 weeks
  4. It assesses fetal tolerance of the stress of uterine contractions Correct answer.

Explanation

The contraction stress test evaluates whether the fetus can tolerate the transient hypoperfusion associated with uterine contractions. A negative test is reassuring, but the nonstress test or biophysical profile is more commonly the primary surveillance tool.

Question 8General Obstetrics (antepartum, intrapartum, postpartum care)

A patient at 34 weeks' gestation presents with painless bright red vaginal bleeding. Which initial management step is most appropriate?

  1. Ultrasound to localize the placenta and fetal monitoring Correct answer.
  2. Immediate induction of labor
  3. Digital cervical examination to determine dilation
  4. Discharge with instructions to return if bleeding increases

Explanation

Painless third-trimester bleeding suggests placenta previa, and digital examination risks provoking catastrophic hemorrhage. Ultrasound localizes the placenta, and continuous fetal monitoring assesses maternal and fetal status.

Question 9General Obstetrics (antepartum, intrapartum, postpartum care)

Which ultrasound finding is the most reliable sign of a complete hydatidiform mole?

  1. Oligohydramnios with a normal placenta
  2. A snowstorm appearance with multiple cystic spaces and no fetus Correct answer.
  3. A single fetus with growth restriction
  4. A thickened placenta with a live fetus at 12 weeks

Explanation

A complete mole shows a characteristic vesicular, cystic placental mass without fetal tissue. Partial moles may have a fetus, but complete moles lack fetal development.

Question 10General Obstetrics (antepartum, intrapartum, postpartum care)

A 30-year-old at 38 weeks' gestation has a fever of 39.2°C, uterine tenderness, and foul-smelling amniotic fluid. Which diagnosis is most likely?

  1. Chorioamnionitis Correct answer.
  2. Placental abruption
  3. Preeclampsia
  4. Round ligament pain

Explanation

Maternal fever with uterine tenderness and malodorous amniotic fluid is the classic presentation of intraamniotic infection (chorioamnionitis). Management includes broad-spectrum antibiotics and delivery.

Question 11General Obstetrics (antepartum, intrapartum, postpartum care)

Which intervention has been shown to reduce the risk of postpartum hemorrhage from uterine atony?

  1. Delayed cord clamping alone
  2. Routine episiotomy
  3. Routine uterine massage after 24 hours
  4. Active management of the third stage including prophylactic oxytocin Correct answer.

Explanation

Active management of the third stage, including prophylactic uterotonics such as oxytocin, controlled cord traction, and uterine massage, reduces the incidence of postpartum hemorrhage from atony.

Question 12General Obstetrics (antepartum, intrapartum, postpartum care)

A woman at 12 weeks' gestation reports cramping and vaginal bleeding. The cervix is closed and ultrasound shows a live intrauterine pregnancy. What is the most likely diagnosis?

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

Explanation

A threatened abortion is defined by vaginal bleeding with a closed cervix and a viable intrauterine pregnancy. It is distinguished from inevitable abortion by the closed cervix and from missed abortion by the presence of fetal cardiac activity.

Question 13General Obstetrics (antepartum, intrapartum, postpartum care)

A patient at 28 weeks' gestation has a fundal height of 22 cm. Which next step is most appropriate?

  1. Schedule routine follow-up in 6 weeks
  2. Ultrasound evaluation for fetal growth and amniotic fluid Correct answer.
  3. Reassure that fundal height is unreliable
  4. Immediate induction of labor

Explanation

A fundal height lagging more than 2-3 cm behind gestational age warrants ultrasound assessment for fetal growth restriction, oligohydramnios, or inaccurate dating.

Question 14General Obstetrics (antepartum, intrapartum, postpartum care)

Which regimen is recommended for routine prevention of early-onset group B streptococcal disease in a laboring woman who is colonized?

  1. No treatment if the infant will be monitored
  2. Oral amoxicillin at the onset of labor
  3. Intravenous penicillin G at the onset of labor or rupture of membranes Correct answer.
  4. Single dose of intramuscular ceftriaxone postpartum

Explanation

Intrapartum intravenous penicillin G (or ampicillin) given at least 4 hours before delivery reduces vertical transmission of group B streptococcus. Oral agents do not achieve adequate intrapartum levels.

Question 15General Obstetrics (antepartum, intrapartum, postpartum care)

A woman at 20 weeks' gestation has a blood pressure of 130/85 mmHg and 1+ proteinuria on dipstick. She has no other symptoms. What is the most appropriate interpretation?

  1. This is chronic hypertension with superimposed preeclampsia
  2. This does not establish preeclampsia because hypertension is not present Correct answer.
  3. This meets criteria for preeclampsia with severe features
  4. This requires immediate delivery

Explanation

Preeclampsia requires new hypertension (≥140/90) after 20 weeks plus proteinuria or end-organ dysfunction. A blood pressure of 130/85 mmHg does not meet the hypertension threshold.

Question 16General Obstetrics (antepartum, intrapartum, postpartum care)

Which statement about magnesium sulfate for eclampsia prophylaxis is correct?

  1. It should be continued indefinitely postpartum
  2. It is preferred over antihypertensives for acute blood pressure control
  3. It is indicated for all patients with any hypertension in pregnancy
  4. It reduces the risk of recurrent seizures in eclampsia Correct answer.

Explanation

Magnesium sulfate is the drug of choice for preventing and treating eclamptic seizures and reduces recurrence. It is not a primary antihypertensive and is generally continued for 24 hours postpartum in patients with eclampsia or severe features.

Question 17General Obstetrics (antepartum, intrapartum, postpartum care)

A patient in active labor has a category III fetal heart rate tracing with recurrent late decelerations and minimal variability. Which action is most appropriate?

  1. Amnioinfusion as the sole intervention
  2. Continue observation and reassess in 30 minutes
  3. Intrauterine resuscitation measures and preparation for expedited delivery Correct answer.
  4. Administer a tocolytic and await spontaneous improvement

Explanation

A category III tracing indicates abnormal fetal status and requires immediate intrauterine resuscitation (maternal repositioning, oxygen, fluid bolus, stopping oxytocin) and preparation for expedited delivery if the pattern does not resolve.

Question 18General Obstetrics (antepartum, intrapartum, postpartum care)

Which of the following is a recognized risk factor for placenta accreta spectrum?

  1. Prior cesarean delivery with placenta previa Correct answer.
  2. Gestational diabetes
  3. Nulliparity
  4. Twin gestation

Explanation

Prior cesarean delivery, especially with placenta previa, is the strongest risk factor for placenta accreta spectrum because of defective decidualization over the scar. Risk rises with the number of prior cesareans.

Question 19General Obstetrics (antepartum, intrapartum, postpartum care)

A woman at 16 weeks' gestation has a singleton pregnancy and a history of a prior preterm birth at 34 weeks. Which intervention is most likely to reduce the risk of recurrent preterm birth?

  1. Bed rest for the remainder of pregnancy
  2. Vaginal progesterone supplementation Correct answer.
  3. Routine cerclage at 12 weeks
  4. Weekly corticosteroids from 24 weeks

Explanation

Vaginal progesterone is recommended for women with a singleton pregnancy and a prior spontaneous preterm birth. Cerclage is reserved for specific cervical shortening or history indications, and repeated corticosteroids are not given prophylactically.

Question 20General Obstetrics (antepartum, intrapartum, postpartum care)

Which finding on physical examination is most consistent with a normal first-trimester uterus?

  1. Uterus palpable just above the symphysis pubis at 12 weeks Correct answer.
  2. Fundal height at the umbilicus
  3. Cervix dilated 2 cm
  4. Uterine size consistent with 20 weeks

Explanation

At approximately 12 weeks the uterus becomes palpable just above the symphysis pubis. The fundus reaches the umbilicus around 20 weeks.

Question 21General Obstetrics (antepartum, intrapartum, postpartum care)

A patient at 37 weeks' gestation has ruptured membranes and no contractions. She is group B streptococcus positive. Which management is most appropriate?

  1. Discharge home with instructions to return when contractions begin
  2. Induction of labor with intrapartum antibiotic prophylaxis Correct answer.
  3. Expectant management for up to 24 hours without antibiotics
  4. Immediate cesarean delivery

Explanation

At term, rupture of membranes without labor is managed with induction to reduce the risk of chorioamnionitis and neonatal infection. Group B streptococcus positivity warrants intrapartum antibiotic prophylaxis.

Question 22General Obstetrics (antepartum, intrapartum, postpartum care)

Which statement about the physiology of lactation is correct?

  1. Progesterone stimulates alveolar development after delivery
  2. Prolactin is responsible for milk ejection
  3. Oxytocin mediates milk let-down Correct answer.
  4. Colostrum is produced only after the first week

Explanation

Oxytocin released from the posterior pituitary causes contraction of myoepithelial cells and milk ejection, while prolactin drives milk synthesis. Colostrum is present from late pregnancy.

Question 23General Obstetrics (antepartum, intrapartum, postpartum care)

A woman at 10 weeks' gestation has a quantitative β-hCG of 1,200 mIU/mL and an empty uterus on transvaginal ultrasound. Which diagnosis is most likely?

  1. Normal intrauterine pregnancy
  2. Threatened abortion with viable pregnancy
  3. Ectopic pregnancy or early pregnancy of unknown location Correct answer.
  4. Complete hydatidiform mole

Explanation

With a β-hCG above the discriminatory zone and no intrauterine gestational sac, the differential includes ectopic pregnancy and early pregnancy of unknown location. Serial hCG measurements and repeat ultrasound are used to distinguish them.

Question 24General Obstetrics (antepartum, intrapartum, postpartum care)

Which of the following is the most appropriate initial management of a postpartum patient with suspected endometritis after cesarean delivery?

  1. Intravenous broad-spectrum antibiotics and uterine evaluation Correct answer.
  2. Observation without antibiotics
  3. Outpatient oral antibiotics with follow-up in 48 hours
  4. Immediate hysterectomy

Explanation

Postpartum endometritis is treated with intravenous broad-spectrum antibiotics, typically clindamycin plus gentamicin. Clinical improvement usually occurs within 48-72 hours.

Question 25General Obstetrics (antepartum, intrapartum, postpartum care)

A patient at 24 weeks' gestation is diagnosed with gestational diabetes on a 3-hour oral glucose tolerance test. Which initial management is most appropriate?

  1. Metformin as first-line therapy
  2. No intervention until 32 weeks
  3. Immediate insulin therapy
  4. Medical nutrition therapy and glucose monitoring Correct answer.

Explanation

Gestational diabetes is initially managed with medical nutrition therapy, exercise, and self-monitoring of glucose. Pharmacologic therapy is added if glucose targets are not met.

Question 26General Obstetrics (antepartum, intrapartum, postpartum care)

A patient at 39 weeks' gestation is in active labor and the fetal heart rate tracing shows repetitive variable decelerations. Which initial maneuver is most appropriate?

  1. Perform an immediate cesarean delivery
  2. Administer a maternal dose of betamethasone
  3. Reposition the patient to a lateral decubitus position Correct answer.
  4. Increase the oxytocin infusion rate

Explanation

Variable decelerations typically reflect umbilical cord compression, and maternal repositioning (often left lateral or knee-chest) is the first-line maneuver to relieve it. Intrauterine resuscitation also includes oxygen and fluid boluses as needed. Immediate operative delivery is reserved for tracings that do not improve with resuscitative measures.

Question 27General Obstetrics (antepartum, intrapartum, postpartum care)

A 26-year-old at 8 weeks' gestation by sure dates has a uterus that is nontender and appropriate in size on bimanual examination. Which finding is most consistent with a normal early pregnancy?

  1. Bright red painless vaginal bleeding
  2. Uterus enlarged to the umbilicus
  3. Cervix softened with a closed os Correct answer.
  4. Fundal height of 20 cm

Explanation

In early pregnancy the cervix becomes softened (Goodell sign) and the external os remains closed in the absence of labor or miscarriage. Uterine size at 8 weeks is roughly the size of a small orange, well below the umbilicus. Painless bright red bleeding suggests placenta previa or other pathology rather than a normal finding.

Question 28General Obstetrics (antepartum, intrapartum, postpartum care)

A woman at 39 weeks' gestation delivers a term infant and has a postpartum hemorrhage from uterine atony despite uterine massage and oxytocin. Which medication is contraindicated in a patient with severe asthma?

  1. Misoprostol
  2. Oxytocin
  3. Methylergonovine
  4. Carboprost tromethamine Correct answer.

Explanation

Carboprost is a prostaglandin F2-alpha analog that can cause bronchospasm and is contraindicated in severe asthma. Methylergonovine is avoided in hypertension, and misoprostol is generally acceptable in asthma. Oxytocin is the first-line uterotonic and is not contraindicated in asthma.

Question 29General Obstetrics (antepartum, intrapartum, postpartum care)

A patient at 36 weeks' gestation with a singleton pregnancy presents with regular painful contractions and a cervix dilated to 6 cm. Which diagnosis applies?

  1. Prodromal labor
  2. Threatened abortion
  3. Preterm labor Correct answer.
  4. Term labor

Explanation

Preterm labor occurs before 37 completed weeks of gestation. Regular painful contractions with substantial cervical dilation at 36 weeks therefore indicate established preterm labor.

Question 30General Obstetrics (antepartum, intrapartum, postpartum care)

A 32-year-old at 30 weeks' gestation reports a sudden gush of clear fluid from the vagina. Speculum examination shows pooling of fluid in the posterior fornix. Which test best confirms rupture of membranes?

  1. Fetal fibronectin testing
  2. Maternal serum white blood cell count
  3. Nitrazine paper turning blue Correct answer.
  4. Cervical cultures for gonorrhea

Explanation

Amniotic fluid is alkaline and turns nitrazine paper from yellow to blue, supporting membrane rupture. Fetal fibronectin is a marker of preterm labor risk rather than a confirmatory test for rupture. Cultures and white counts assess infection but do not confirm membrane status.

Question 31General Obstetrics (antepartum, intrapartum, postpartum care)

A patient at 28 weeks' gestation has a blood pressure of 158/110 mmHg confirmed on repeat measurement. Which antihypertensive is preferred for acute severe hypertension in pregnancy?

  1. Spironolactone given orally
  2. Atenolol given orally
  3. Lisinopril given orally
  4. Labetalol given intravenously Correct answer.

Explanation

Intravenous labetalol is a first-line agent for acute severe hypertension in pregnancy because it lowers blood pressure rapidly with an acceptable safety profile. ACE inhibitors such as lisinopril are contraindicated in pregnancy due to fetal renal toxicity. Atenolol is associated with growth restriction, and spironolactone is not used for acute control.

Question 32General Obstetrics (antepartum, intrapartum, postpartum care)

A woman at 34 weeks' gestation presents with painless bright red vaginal bleeding and a soft uterus. Which diagnosis is most likely?

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

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 tense, tender uterus. Uterine rupture and vasa previa have different clinical features, including fetal compromise.

Question 33General Obstetrics (antepartum, intrapartum, postpartum care)

A patient at 41 weeks' gestation has a Bishop score of 3. Which cervical ripening agent is appropriate in the absence of contraindications?

  1. Intravenous oxytocin alone
  2. Dinoprostone vaginal insert Correct answer.
  3. Oral terbutaline
  4. Intramuscular methylergonovine

Explanation

A low Bishop score indicates an unfavorable cervix, and prostaglandin agents such as dinoprostone are used for cervical ripening before induction. Oxytocin alone is less effective when the cervix is unfavorable and is typically used after ripening. Methylergonovine and terbutaline are not cervical ripening agents.

Question 34General Obstetrics (antepartum, intrapartum, postpartum care)

A patient at 24 weeks' gestation is diagnosed with gestational diabetes after a 3-hour oral glucose tolerance test. Which initial management step is most appropriate?

  1. Delivery at 34 weeks
  2. Discontinuation of all prenatal vitamins
  3. Lifestyle modification with medical nutrition therapy Correct answer.
  4. Immediate initiation of insulin

Explanation

Gestational diabetes is initially managed with medical nutrition therapy and physical activity, with glucose monitoring to assess response. Insulin is added if glucose targets are not met with lifestyle measures. Early delivery is not indicated for well-controlled gestational diabetes.

Question 35General Obstetrics (antepartum, intrapartum, postpartum care)

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

  1. Begin antenatal corticosteroids
  2. Reassure the patient and recheck in 4 weeks
  3. Obtain an ultrasound to assess fetal growth Correct answer.
  4. Schedule an immediate cesarean delivery

Explanation

A fundal height more than 3 cm below gestational age warrants further evaluation, typically with ultrasound to assess fetal growth and amniotic fluid. Simple reassurance without evaluation risks missing growth restriction. Cesarean delivery and corticosteroids are not indicated based on this finding alone.

Question 36General Obstetrics (antepartum, intrapartum, postpartum care)

A patient at 38 weeks' gestation has a fever of 39.0°C, uterine tenderness, and foul-smelling amniotic fluid. Which diagnosis is most likely?

  1. Preeclampsia
  2. Placental abruption
  3. Hyperemesis gravidarum
  4. Chorioamnionitis Correct answer.

Explanation

Maternal fever with uterine tenderness and foul-smelling amniotic fluid suggests intraamniotic infection, also called chorioamnionitis. This condition warrants antibiotics and consideration of delivery. Preeclampsia, abruption, and hyperemesis do not produce this combination of findings.

Question 37General Obstetrics (antepartum, intrapartum, postpartum care)

A woman at 16 weeks' gestation has a prior spontaneous preterm birth at 34 weeks. Which intervention is most appropriate to reduce the risk of recurrent preterm birth?

  1. Scheduled delivery at 36 weeks
  2. Routine antenatal corticosteroids
  3. Cerclage placement in all cases
  4. Vaginal progesterone supplementation Correct answer.

Explanation

A history of spontaneous preterm birth is a risk factor for recurrence, and vaginal progesterone is recommended for prevention in many such patients. Cerclage is reserved for specific indications such as cervical insufficiency. Corticosteroids and scheduled early delivery are not preventive measures at 16 weeks.

Question 38General Obstetrics (antepartum, intrapartum, postpartum care)

A patient at 12 weeks' gestation has cramping and vaginal bleeding, and the cervix is open on examination. Which diagnosis is most likely?

  1. Ectopic pregnancy
  2. Inevitable abortion Correct answer.
  3. Complete abortion
  4. Missed abortion

Explanation

An open cervix with cramping and bleeding in early pregnancy indicates an inevitable abortion, meaning pregnancy loss is underway. A missed abortion typically has a closed cervix with a nonviable fetus. Ectopic pregnancy usually presents with pain and a closed cervix.

Question 39General Obstetrics (antepartum, intrapartum, postpartum care)

A patient at 36 weeks' gestation with a singleton pregnancy and a prior low transverse cesarean is in labor. Which statement about trial of labor after cesarean is correct?

  1. It should be avoided if the patient has had a prior vaginal delivery
  2. It is contraindicated in all patients with a prior cesarean
  3. It eliminates the risk of uterine rupture
  4. It requires continuous fetal monitoring and ready access to emergency cesarean Correct answer.

Explanation

Trial of labor after cesarean is an option for many patients with a prior low transverse incision and requires continuous fetal monitoring and immediate availability of emergency cesarean delivery. A prior vaginal delivery actually improves success rates. Uterine rupture risk is reduced but not eliminated.

Question 40General Obstetrics (antepartum, intrapartum, postpartum care)

A patient at 30 weeks' gestation has a blood pressure of 150/95 mmHg and 3+ proteinuria. Which laboratory abnormality is most consistent with severe preeclampsia?

  1. Hemoglobin of 12 g/dL
  2. Platelet count of 90,000/µL Correct answer.
  3. Aspartate aminotransferase of 20 U/L
  4. Serum creatinine of 0.6 mg/dL

Explanation

Thrombocytopenia (platelet count below 100,000/µL) is a criterion for severe features of preeclampsia. Normal hemoglobin, creatinine, and transaminase values do not indicate severe disease. Severe preeclampsia also includes elevated liver enzymes and renal insufficiency.

Question 41Maternal-Fetal Medicine / High-Risk Obstetrics

A 28-year-old G3P2 at 34 weeks has a blood pressure of 165/115 mmHg on two occasions 4 hours apart with 3+ proteinuria. Which antihypertensive is most appropriate for acute blood pressure control in this setting?

  1. Intravenous labetalol Correct answer.
  2. Oral enalapril
  3. Oral losartan
  4. Sublingual nifedipine

Explanation

Acute severe hypertension in pregnancy is managed with agents that are safe for the fetus and rapidly effective, with IV labetalol, IV hydralazine, and oral immediate-release nifedipine as first-line options. ACE inhibitors and ARBs are contraindicated in pregnancy because of fetal renal toxicity and are reserved for postpartum use.

Question 42Maternal-Fetal Medicine / High-Risk Obstetrics

Which finding defines severe features of preeclampsia independent of blood pressure level?

  1. Serum creatinine of 1.3 mg/dL
  2. Aspartate aminotransferase of 80 U/L Correct answer.
  3. Platelet count of 130,000/µL
  4. Blood pressure of 150/95 mmHg

Explanation

Severe features include thrombocytopenia under 100,000/µL, renal insufficiency with creatinine above 1.1 mg/dL, impaired liver function with transaminases twice the upper limit of normal, pulmonary edema, and new cerebral or visual symptoms. A transaminase level of 80 U/L exceeds twice the typical upper limit and qualifies.

Question 43Maternal-Fetal Medicine / High-Risk Obstetrics

A 32-year-old G1 at 37 weeks has new-onset hypertension and generalized tonic-clonic seizure in the triage area. After airway and breathing are secured, what is the most appropriate first medication?

  1. Intravenous phenytoin
  2. Intravenous diazepam
  3. Intravenous magnesium sulfate Correct answer.
  4. Oral labetalol

Explanation

Magnesium sulfate is the drug of choice for treating and preventing eclamptic seizures and is superior to phenytoin and diazepam. It is given as a loading dose followed by continuous infusion with monitoring of reflexes, respiration, and urine output.

Question 44Maternal-Fetal Medicine / High-Risk Obstetrics

A patient receiving magnesium sulfate infusion develops loss of deep tendon reflexes and a respiratory rate of 10 breaths/min. What is the immediate next step?

  1. Increase the infusion rate
  2. Administer intravenous calcium gluconate Correct answer.
  3. Give a bolus of magnesium sulfate
  4. Obtain a serum magnesium level and continue infusion

Explanation

Loss of reflexes and respiratory depression are signs of magnesium toxicity, and the infusion must be stopped immediately while calcium gluconate is given as the antidote. Serum levels guide subsequent management but treatment should not be delayed for laboratory results.

Question 45Maternal-Fetal Medicine / High-Risk Obstetrics

Which regimen is recommended for prevention of early-onset group B streptococcal disease in a woman in preterm labor at 35 weeks with unknown colonization status?

  1. Oral amoxicillin at the time of admission
  2. Intrapartum clindamycin regardless of susceptibility
  3. Intravenous penicillin G during labor Correct answer.
  4. No prophylaxis unless cultures are positive

Explanation

Women in preterm labor before 37 weeks with unknown GBS status should receive intrapartum antibiotic prophylaxis, and intravenous penicillin G is the preferred agent. Oral therapy is inadequate because intrapartum prophylaxis requires sustained high tissue levels during labor.

Question 46Maternal-Fetal Medicine / High-Risk Obstetrics

A 30-year-old G2P1 at 33 weeks presents with painless bright red vaginal bleeding and a soft, non-tender uterus. Which diagnosis is most likely?

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

Explanation

Painless vaginal bleeding with a soft, non-tender uterus in the third trimester is the classic presentation of placenta previa. Abruption typically presents with painful bleeding and a firm, tender uterus.

Question 47Maternal-Fetal Medicine / High-Risk Obstetrics

A woman at 36 weeks with a known complete placenta previa has a stable, non-bleeding examination. Which delivery plan is most appropriate?

  1. Amniotomy to assess bleeding
  2. Planned cesarean delivery at 36 to 37 weeks Correct answer.
  3. Trial of labor with continuous monitoring
  4. Expectant management until 40 weeks

Explanation

Planned cesarean delivery at 36 to 37 weeks is recommended for placenta previa because it balances the risk of emergent hemorrhage against prematurity. Vaginal delivery and amniotomy are contraindicated with a complete previa.

Question 48Maternal-Fetal Medicine / High-Risk Obstetrics

A 26-year-old G1 at 31 weeks has a cervix dilated 4 cm with regular contractions and ruptured membranes. Which intervention most clearly improves neonatal outcome?

  1. Immediate cesarean delivery
  2. Prophylactic antibiotics for 7 days
  3. Tocolytic therapy with indomethacin
  4. Antenatal corticosteroids Correct answer.

Explanation

Antenatal corticosteroids given between 24 and 34 weeks reduce neonatal respiratory distress syndrome, intraventricular hemorrhage, and mortality. Tocolysis may delay delivery briefly but does not itself improve neonatal outcomes.

Question 49Maternal-Fetal Medicine / High-Risk Obstetrics

A 24-year-old G1 at 27 weeks presents with regular contractions and a cervical length of 18 mm on transvaginal ultrasound. Which intervention reduces the risk of delivery within 48 hours?

  1. Cerclage placement
  2. Bed rest in the hospital
  3. Indomethacin tocolysis Correct answer.
  4. Vaginal progesterone

Explanation

Tocolytics such as indomethacin can delay delivery for 48 hours, allowing time for corticosteroid administration and transfer to a facility with neonatal intensive care. Vaginal progesterone is used for prevention of preterm birth in women with a short cervix identified earlier in pregnancy, not for acute tocolysis.

Question 50Maternal-Fetal Medicine / High-Risk Obstetrics

A 35-year-old G2P1 at 20 weeks has a history of a prior second-trimester loss at 16 weeks with painless cervical dilation. Which intervention is most appropriate?

  1. Vaginal progesterone supplementation
  2. Prophylactic antibiotics
  3. Cerclage placement Correct answer.
  4. Weekly cervical length surveillance only

Explanation

A history of painless second-trimester loss with cervical dilation is consistent with cervical insufficiency, for which cerclage is indicated. Progesterone and surveillance are appropriate for short cervix without such a history.