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AOBOG OB-GYN practice questions

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Question 1Obstetrics

At what gestational age does the fetal heart first become visible on transvaginal ultrasound in a normal pregnancy?

  1. 8 to 9 weeks
  2. 12 to 13 weeks
  3. 10 to 11 weeks
  4. 5 to 6 weeks Correct answer.

Explanation

Cardiac activity can typically be detected by transvaginal ultrasound around 5 to 6 weeks of gestation, corresponding to a crown-rump length of a few millimeters. Waiting until later weeks would delay diagnosis of early pregnancy failure.

Question 2Obstetrics

Which finding on a 20-week anatomy scan is most characteristic of an open neural tube defect?

  1. Echogenic intracardiac focus
  2. Lemon sign with ventriculomegaly Correct answer.
  3. Single umbilical artery
  4. Choroid plexus cyst

Explanation

The lemon sign (scalloping of the frontal bones) together with ventriculomegaly and the banana sign of the cerebellum are the classic cranial signs of open spina bifida. The other listed findings are soft markers for aneuploidy rather than neural tube defects.

Question 3Obstetrics

A woman at 34 weeks' gestation has a blood pressure of 158/112 mmHg on two occasions 4 hours apart with 3+ proteinuria and no symptoms. What is the most appropriate immediate management?

  1. Start antihypertensive therapy and magnesium sulfate prophylaxis Correct answer.
  2. Arrange elective delivery at 37 weeks without treatment
  3. Reassure and recheck blood pressure in one week
  4. Prescribe bed rest at home with weekly urine testing

Explanation

Severe-range hypertension (≥160/110) with proteinuria defines severe preeclampsia, which warrants immediate antihypertensive treatment and magnesium sulfate for seizure prophylaxis regardless of symptoms. Expectant management without treatment risks maternal stroke and eclampsia.

Question 4Obstetrics

Which organism is the leading cause of early-onset neonatal sepsis in term infants?

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

Explanation

Group B Streptococcus (Streptococcus agalactiae) remains the most common cause of early-onset neonatal sepsis, which is why intrapartum antibiotic prophylaxis is offered to colonized women. E. coli is more prominent in preterm infants.

Question 5Obstetrics

A woman at 39 weeks has spontaneous rupture of membranes with a reassuring fetal heart tracing and no contractions. After 18 hours without labor, what is the most appropriate next step?

  1. Give tocolytics to delay labor
  2. Induce labor with oxytocin Correct answer.
  3. Perform immediate cesarean delivery
  4. Continue expectant management for another 24 hours

Explanation

Prolonged rupture of membranes beyond 18 hours at term increases the risk of maternal and neonatal infection, so induction of labor is recommended when the tracing is reassuring. Expectant waiting further raises infection risk, and cesarean is not indicated without an obstetric contraindication to labor.

Question 6Obstetrics

Which parameter is used to define the active phase of the first stage of labor on a partograph?

  1. Cervical dilatation of 6 cm or more with regular contractions Correct answer.
  2. Full cervical dilatation with urge to push
  3. Station at the ischial spines
  4. Cervical effacement of 50%

Explanation

The active phase of the first stage begins at about 6 cm dilatation with regular, effective contractions in modern definitions. Full dilatation marks the second stage, and effacement or station alone do not define the active phase.

Question 7Obstetrics

A woman at 32 weeks presents with painless bright red vaginal bleeding and a soft, non-tender uterus. What is the most likely diagnosis?

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

Explanation

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

Question 8Obstetrics

What is the recommended first-line treatment for gestational diabetes mellitus after diet and exercise fail to control glucose?

  1. Glyburide
  2. Acarbose
  3. Metformin
  4. Insulin Correct answer.

Explanation

Insulin is the preferred pharmacologic agent in pregnancy because it does not cross the placenta and has the most established safety data. Oral agents are used in some settings but are not first-line.

Question 9Obstetrics

A 28-week gestation woman has a fundal height of 24 cm. Which condition should be considered first?

  1. Fetal growth restriction Correct answer.
  2. Multiple gestation
  3. Gestational diabetes
  4. Polyhydramnios

Explanation

Fundal height lagging more than 3 cm behind gestational age suggests fetal growth restriction and warrants ultrasound evaluation. Polyhydramnios and multiple gestations typically produce fundal heights larger than expected.

Question 10Obstetrics

Which fetal heart rate pattern is most concerning for fetal acidemia?

  1. Early decelerations with contractions
  2. Baseline 150 bpm with moderate variability
  3. Recurrent late decelerations Correct answer.
  4. Accelerations with fetal movement

Explanation

Recurrent late decelerations indicate uteroplacental insufficiency and are associated with fetal hypoxemia and acidemia. Early decelerations and accelerations are reassuring patterns.

Question 11Obstetrics

Which medication is used for acute tocolysis during an episode of preterm labor?

  1. Nifedipine Correct answer.
  2. Oxytocin
  3. Misoprostol
  4. Methylergonovine

Explanation

Nifedipine, a calcium channel blocker, is commonly used for acute tocolysis to delay delivery for steroid administration. Oxytocin and misoprostol stimulate uterine contractions, and methylergonovine is used postpartum for uterine atony.

Question 12Obstetrics

A woman at 36 weeks with a prior classical cesarean delivery presents in labor with severe abdominal pain and fetal bradycardia. What is the most likely diagnosis?

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

Explanation

A prior classical cesarean scar substantially increases rupture risk; sudden severe pain with fetal bradycardia in labor is the classic presentation. Prompt laparotomy is required.

Question 13Obstetrics

What is the most effective method to prevent RhD alloimmunization in an unsensitized RhD-negative pregnant woman?

  1. Maternal RhD typing only
  2. Anti-D immune globulin at 28 weeks and postpartum if the infant is RhD positive Correct answer.
  3. Fetal RhD genotyping without prophylaxis
  4. Routine cesarean delivery

Explanation

Anti-D immune globulin given at around 28 weeks and within 72 hours postpartum for an RhD-positive infant prevents sensitization. Typing or genotyping alone does not prevent alloimmunization.

Question 14Obstetrics

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

  1. Cervical dilatation of 4 cm
  2. Contractions every 3 minutes
  3. Fetal fibronectin above 50 ng/mL
  4. Pooling of amniotic fluid in the posterior vaginal fornix Correct answer.

Explanation

Visualization of amniotic fluid pooling in the vagina confirms membrane rupture. Fetal fibronectin, cervical dilatation, and contractions suggest preterm labor but do not confirm rupture.

Question 15Obstetrics

Which is the most common cause of postpartum hemorrhage?

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

Explanation

Uterine atony accounts for the majority of postpartum hemorrhage cases. The other causes are less common and are considered after atony is excluded.

Question 16Obstetrics

A woman at 30 weeks has a blood pressure of 150/95 mmHg and new-onset proteinuria. Which of the following is the most appropriate initial step?

  1. Admit for monitoring and initiate antihypertensive therapy Correct answer.
  2. Prescribe diuretics
  3. Start expectant management at home
  4. Schedule delivery within 24 hours

Explanation

New hypertension with proteinuria at 30 weeks indicates preeclampsia without severe features, which requires admission, monitoring, and treatment of hypertension with continued fetal surveillance. Immediate delivery is reserved for severe features or fetal compromise.

Question 17Obstetrics

Which test is used as a screening test for gestational diabetes at 24 to 28 weeks?

  1. Hemoglobin A1c
  2. 50 g glucose challenge test Correct answer.
  3. Fasting plasma glucose
  4. 75 g oral glucose tolerance test

Explanation

The 50 g glucose challenge test is a non-fasting screening test; abnormal results are followed by a diagnostic 75 g or 100 g test. Fasting glucose and A1c are not the standard screening approach in pregnancy.

Question 18Obstetrics

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

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

Explanation

Placenta previa in a woman with prior cesarean delivery is the strongest risk factor for accreta spectrum because of abnormal decidualization over the scar. Nulliparity and hypertension are not established risk factors.

Question 19Obstetrics

At what gestational age is the nuchal translucency measurement performed for aneuploidy screening?

  1. 8 to 10 weeks
  2. 11 to 13 weeks 6 days Correct answer.
  3. 20 to 22 weeks
  4. 16 to 18 weeks

Explanation

Nuchal translucency is measured between 11 and 13 weeks 6 days when the crown-rump length is 45 to 84 mm. Earlier or later measurements are not valid for screening.

Question 20Obstetrics

A woman at 41 weeks has an unfavorable cervix. What is the most appropriate management?

  1. Elective cesarean delivery
  2. Serial membrane sweeps only
  3. Induction of labor Correct answer.
  4. Expectant management until 42 weeks

Explanation

Induction at 41 to 42 weeks reduces perinatal mortality and meconium aspiration compared with expectant management. Cesarean without indication adds morbidity.

Question 21Obstetrics

Which medication is used for seizure prophylaxis in eclampsia?

  1. Diazepam
  2. Magnesium sulfate Correct answer.
  3. Labetalol
  4. Phenytoin

Explanation

Magnesium sulfate is superior to phenytoin and diazepam for preventing and treating eclamptic seizures. Labetalol is used for blood pressure control, not seizure prophylaxis.

Question 22Obstetrics

Which of the following is the most appropriate initial management of a shoulder dystocia after the head delivers?

  1. Administer oxytocin
  2. Apply fundal pressure
  3. Call for help and perform the McRoberts maneuver Correct answer.
  4. Perform a symphysiotomy

Explanation

Shoulder dystocia is managed first by calling for assistance and performing the McRoberts maneuver with suprapubic pressure. Fundal pressure is contraindicated because it worsens impaction and increases injury.

Question 23Obstetrics

Which of the following is a sign of placental separation during the third stage of labor?

  1. Uterine relaxation
  2. Fresh vaginal bleeding with a contracted uterus
  3. Increase in fundal height
  4. Lengthening of the umbilical cord Correct answer.

Explanation

After placental separation, the uterus becomes globular, the cord lengthens, and a gush of blood occurs. A rising fundal height suggests a concealed hemorrhage or retained placenta rather than separation.

Question 24Obstetrics

A woman with a previous cesarean delivery requests a trial of labor. Which factor most strongly increases the likelihood of successful vaginal birth after cesarean?

  1. Fetal macrosomia
  2. Maternal obesity
  3. Induction of labor
  4. A prior vaginal delivery Correct answer.

Explanation

A prior vaginal delivery is the strongest predictor of successful VBAC. Obesity, induction, and macrosomia all reduce success rates.

Question 25Obstetrics

Which of the following is the recommended treatment for a woman with a first-trimester missed miscarriage and no signs of infection?

  1. Immediate curettage is mandatory
  2. Offer expectant, medical, or surgical management based on patient preference Correct answer.
  3. Progesterone supplementation
  4. Bed rest for two weeks

Explanation

For an uncomplicated missed miscarriage, expectant, medical (misoprostol), and surgical management are all acceptable options based on patient preference and clinical circumstances. Progesterone and bed rest are not effective treatments.

Question 26Obstetrics

A woman at 38 weeks has a reactive non-stress test with a baseline fetal heart rate of 145 bpm. Which feature defines a reactive NST?

  1. Two accelerations of at least 15 bpm lasting 15 seconds within 20 minutes Correct answer.
  2. One acceleration of 10 bpm lasting 10 seconds within 60 minutes
  3. A baseline variability of less than 5 bpm sustained for 40 minutes
  4. Three decelerations coinciding with fetal movement

Explanation

Reactivity in a term fetus requires at least two accelerations reaching 15 bpm above baseline and lasting at least 15 seconds within a 20-minute window. Before 32 weeks the criteria are lower (10 bpm for 10 seconds). Decelerations and reduced variability are not features of reactivity.

Question 27Obstetrics

A woman at 34 weeks is admitted with a blood pressure of 165/110 mmHg and no seizures. Which antihypertensive agent is preferred for rapid control of severe hypertension in pregnancy?

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

Explanation

Intravenous labetalol is a first-line agent for acute severe hypertension in pregnancy, along with intravenous hydralazine and oral immediate-release nifedipine. ACE inhibitors such as enalapril are contraindicated in pregnancy because of fetal renal toxicity. The route matters: sublingual nifedipine is not the recommended formulation.

Question 28Obstetrics

Which organism is the most frequent cause of early-onset neonatal sepsis with group B Streptococcus prophylaxis in place?

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

Explanation

With widespread intrapartum antibiotic prophylaxis against group B Streptococcus, Escherichia coli has become the leading cause of early-onset neonatal sepsis, particularly in preterm infants. Listeria is uncommon and typically associated with maternal febrile illness and foodborne exposure.

Question 29Obstetrics

A woman at 28 weeks reports decreased fetal movements. Which initial assessment is most appropriate?

  1. Cardiotocography with fetal movement counting Correct answer.
  2. Immediate cesarean delivery
  3. Amniocentesis for fetal lung maturity
  4. Maternal serum alpha-fetoprotein measurement

Explanation

Reduced fetal movements warrant prompt evaluation of fetal well-being, usually with cardiotocography and further testing such as biophysical profile if the trace is non-reassuring. Delivery is not indicated solely for decreased movements at 28 weeks. Lung maturity testing and alpha-fetoprotein have no role here.

Question 30Obstetrics

Which finding on vaginal examination is most consistent with a fetal occiput posterior position in the second stage of labor?

  1. A caput succedaneum over the vertex
  2. A posterior fontanelle palpable anteriorly with the sagittal suture in the transverse diameter
  3. A triangular anterior fontanelle palpable anteriorly Correct answer.
  4. The sagittal suture in the anteroposterior diameter with the occiput anterior

Explanation

In occiput posterior position the anterior (bregmatic) fontanelle, which is triangular, is felt anteriorly and the posterior fontanelle lies toward the maternal sacrum. Palpating the posterior fontanelle anteriorly indicates an occiput anterior position. Caput succedaneum is nonspecific.

Question 31Obstetrics

Which is the most common cause of early postpartum hemorrhage occurring within 24 hours of delivery?

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

Explanation

Uterine atony accounts for the majority of primary postpartum hemorrhage. Retained tissue, lacerations, and coagulopathy are less frequent causes but must be considered when atony is not the explanation.

Question 32Obstetrics

A woman at 39 weeks has spontaneous rupture of membranes with clear fluid and no contractions. What is the recommended management?

  1. Antibiotic therapy alone
  2. Immediate cesarean delivery
  3. Expectant management with weekly review
  4. Induction of labor Correct answer.

Explanation

At term, rupture of membranes without labor is managed with induction of labor to reduce the risk of maternal and neonatal infection. Expectant management increases the risk of chorioamnionitis and is generally not recommended at term. Cesarean delivery is reserved for obstetric indications.

Question 33Obstetrics

Which vaccine is routinely recommended during pregnancy to prevent neonatal infection?

  1. Tetanus, diphtheria, and acellular pertussis vaccine Correct answer.
  2. Measles, mumps, and rubella vaccine
  3. Varicella vaccine
  4. Human papillomavirus vaccine

Explanation

The Tdap vaccine is recommended in each pregnancy, ideally between 27 and 36 weeks, to protect the newborn from pertussis. Live vaccines such as MMR and varicella are contraindicated in pregnancy. HPV vaccination is not given during pregnancy as a routine measure.

Question 34Obstetrics

Which condition is most strongly associated with polyhydramnios?

  1. Placental insufficiency
  2. Fetal renal agenesis
  3. Fetal esophageal atresia Correct answer.
  4. Maternal diabetes insipidus

Explanation

Polyhydramnios results from impaired fetal swallowing or increased fetal urine output; esophageal atresia and tracheoesophageal fistula prevent normal swallowing. Renal agenesis causes oligohydramnios because urine production is absent. Placental insufficiency also reduces amniotic fluid.

Question 35Obstetrics

A woman at 20 weeks has a fundal height of 24 cm. Which factor most commonly explains a fundal height larger than expected dates?

  1. Fetal growth restriction
  2. Oligohydramnios
  3. Inaccurate dating Correct answer.
  4. Cervical insufficiency

Explanation

Inaccurate dating is the most common reason for a fundal height that does not match gestational age. After confirming dating, polyhydramnios, multiple gestation, and macrosomia are considered. Growth restriction and oligohydramnios produce a smaller-than-expected fundal height.

Question 36Obstetrics

Which finding is characteristic of the latent phase of the first stage of labor?

  1. Cervical dilatation that progresses slowly to about 4 to 6 cm Correct answer.
  2. Rapid cervical dilatation from 6 to 10 cm
  3. Expulsion of the placenta
  4. Full dilatation with descent of the presenting part

Explanation

The latent phase extends from the onset of labor to about 4 to 6 cm of dilatation and progresses slowly. The active phase follows with more rapid dilatation. Full dilatation marks the second stage, and placental expulsion is the third stage.

Question 37Obstetrics

A woman at 37 weeks has a non-reassuring fetal heart rate tracing with recurrent late decelerations. What is the first step in management?

  1. Reposition the mother and administer intravenous fluids Correct answer.
  2. Perform amnioinfusion
  3. Perform an immediate cesarean delivery
  4. Administer a tocolytic agent

Explanation

Recurrent late decelerations suggest uteroplacental insufficiency, and initial management includes maternal repositioning, intravenous fluid bolus, and correction of hypotension. These intrauterine resuscitation measures are tried before operative delivery. Tocolysis and amnioinfusion address specific causes such as tachysystole or variable decelerations.

Question 38Obstetrics

Which maternal condition is an absolute contraindication to vaginal delivery?

  1. Previous low transverse cesarean delivery
  2. Twin gestation with the first twin cephalic
  3. Gestational hypertension at term
  4. Placenta previa Correct answer.

Explanation

Placenta previa covering or near the cervical os contraindicates vaginal delivery because of the risk of catastrophic hemorrhage. A prior low transverse incision, cephalic first twin, and gestational hypertension are not absolute contraindications.

Question 39Obstetrics

A woman at 33 weeks is diagnosed with preterm labor and receives betamethasone. What is the primary benefit of antenatal corticosteroids?

  1. Reduction in neonatal respiratory distress syndrome Correct answer.
  2. Elimination of the risk of intraventricular hemorrhage
  3. Immediate cessation of uterine contractions
  4. Prevention of maternal infection

Explanation

Antenatal corticosteroids accelerate fetal lung maturation and reduce the incidence and severity of respiratory distress syndrome, along with other neonatal morbidities. They do not abolish the risk of intraventricular hemorrhage, stop contractions, or prevent maternal infection.

Question 40Obstetrics

Which parameter is used to assess fetal acid-base status directly during labor?

  1. Fetal scalp blood sampling for pH Correct answer.
  2. Amniotic fluid optical density
  3. Maternal capillary glucose
  4. Umbilical artery Doppler velocimetry

Explanation

Fetal scalp blood sampling measures fetal pH or lactate and provides a direct assessment of fetal acid-base status when the heart rate tracing is non-reassuring. Doppler velocimetry assesses placental vascular resistance, and amniotic fluid optical density assesses hemolysis.

Question 41Obstetrics

A woman has a prolonged second stage of labor with arrest of descent. Which factor is most predictive of a difficult operative vaginal delivery?

  1. Fetal station at or above the ischial spines Correct answer.
  2. Maternal body mass index over 30
  3. Estimated fetal weight over 3500 g
  4. Duration of the first stage over 12 hours

Explanation

A high station, particularly a presenting part at or above the ischial spines, is a major determinant of failed operative vaginal delivery and should prompt caution. Estimated fetal weight and maternal obesity contribute to difficulty but are less predictive than station.

Question 42Obstetrics

Which finding on ultrasound is most consistent with an ectopic pregnancy in a woman with a positive pregnancy test and pelvic pain?

  1. A thickened endometrium without adnexal findings
  2. A gestational sac with a yolk sac within the uterus
  3. A simple ovarian cyst
  4. An empty uterine cavity with an adnexal mass and free fluid Correct answer.

Explanation

An empty uterus with an adnexal mass and free pelvic fluid in a symptomatic woman with a positive hCG suggests ectopic pregnancy. An intrauterine gestational sac with a yolk sac confirms an intrauterine pregnancy, though heterotopic pregnancy is possible. A simple cyst and thickened endometrium are nonspecific.

Question 43Obstetrics

Which is the most appropriate initial management of a woman at 10 weeks with a confirmed complete hydatidiform mole?

  1. Expectant management until spontaneous expulsion
  2. Hysterectomy with no further follow-up
  3. Methotrexate chemotherapy
  4. Suction curettage with subsequent hCG surveillance Correct answer.

Explanation

Suction curettage is the standard treatment for molar pregnancy, followed by serial hCG monitoring to detect persistent trophoblastic disease. Hysterectomy may be considered in selected older patients but follow-up is still required. Chemotherapy is reserved for persistent disease, and expectant management is not appropriate.

Question 44Obstetrics

A woman at 26 weeks has a cervix measuring 20 mm on transvaginal ultrasound and a history of prior preterm birth. Which intervention reduces the risk of recurrent preterm birth?

  1. Vaginal progesterone Correct answer.
  2. Routine antibiotics
  3. Cervical cerclage in all cases
  4. Bed rest

Explanation

Vaginal progesterone is recommended for women with a short cervix on transvaginal ultrasound, particularly with a history of prior preterm birth. Cerclage is considered in selected cases with a history of preterm birth and short cervix but is not universal. Bed rest and routine antibiotics have not been shown to prevent preterm birth.

Question 45Obstetrics

Which mechanism best explains the fetal heart rate changes seen with umbilical cord compression?

  1. Sinusoidal pattern
  2. Late decelerations
  3. Variable decelerations Correct answer.
  4. Early decelerations

Explanation

Cord compression produces variable decelerations because of intermittent interruption of umbilical blood flow. Late decelerations reflect uteroplacental insufficiency, and early decelerations reflect fetal head compression. A sinusoidal pattern suggests severe fetal anemia.

Question 46Obstetrics

Which is the most common cause of spontaneous abortion in the first trimester?

  1. Thyroid disease
  2. Chromosomal abnormalities Correct answer.
  3. Uterine anomalies
  4. Infections

Explanation

Chromosomal abnormalities account for the majority of first-trimester spontaneous abortions. Uterine anomalies, infections, and endocrine disorders are less frequent causes and are more relevant to recurrent pregnancy loss.

Question 47Obstetrics

A woman at 24 weeks has a blood pressure of 150/95 mmHg with new proteinuria. Which finding would classify the disease as severe?

  1. Mild ankle edema
  2. Platelet count of 200,000 per microliter
  3. Proteinuria of 300 mg per 24 hours
  4. Blood pressure of 160/110 mmHg on two occasions Correct answer.

Explanation

Preeclampsia is classified as severe when blood pressure reaches 160/110 mmHg or higher, or when there is evidence of organ dysfunction such as thrombocytopenia, elevated liver enzymes, or renal impairment. A platelet count of 200,000 is normal.

Question 48Obstetrics

Which factor is most important in determining the success of an external cephalic version for breech presentation?

  1. Maternal height
  2. Fetal sex
  3. Placental location
  4. Amniotic fluid volume and fetal size Correct answer.

Explanation

Adequate amniotic fluid volume and appropriate fetal size increase the likelihood of successful external cephalic version. Maternal height, fetal sex, and placental location are not primary determinants.

Question 49Obstetrics

Which complication is most strongly associated with placenta previa?

  1. Fetal macrosomia
  2. Postpartum hemorrhage from an implanted lower uterine segment Correct answer.
  3. Shoulder dystocia
  4. Umbilical cord prolapse

Explanation

The lower uterine segment contracts poorly after delivery, so placenta previa predisposes to postpartum hemorrhage. It is also associated with accreta spectrum. Shoulder dystocia and macrosomia are not typical associations.

Question 50Obstetrics

A woman at 36 weeks has a biophysical profile score of 4 out of 10. What is the most appropriate next step?

  1. Reassurance and routine follow-up in one week
  2. Maternal hydration and discharge
  3. Repeat the biophysical profile in 24 hours
  4. Further evaluation and consideration of delivery Correct answer.

Explanation

A biophysical profile of 4 or less is abnormal and warrants further evaluation, often with delivery depending on gestational age and clinical context. Reassurance, delayed repeat testing, and hydration alone are not appropriate for an abnormal score.