I85PREP
⌘ K
Arab Board OB/GYN Final Clinical & Oral study materials
Arab Board OB/GYN Final Clinical & Oral study resources

Arab Board OB/GYN Final Clinical & Oral practice questions

One question at a time. Build your Arab Board OB/GYN Final Clinical & Oral 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 1Obstetrics: Antenatal Care and Maternal-Fetal Medicine

A 28-year-old primigravida at 10 weeks' gestation has a body mass index of 32 kg/m². Which antenatal recommendation is most appropriate?

  1. Arrange a routine growth scan every 2 weeks from 20 weeks
  2. Screen for gestational diabetes at the first visit Correct answer.
  3. Start low-dose aspirin from 12 weeks for pre-eclampsia prophylaxis
  4. Restrict total gestational weight gain to under 5 kg

Explanation

Obesity is a recognised risk factor for early gestational diabetes, and the Arab Board/FIGO approach is to screen at booking rather than wait until 24–28 weeks. Weight-gain restriction targets are not this strict, serial fortnightly scans are not routine, and aspirin prophylaxis is indicated for specific pre-eclampsia risk combinations rather than obesity alone.

Question 2Obstetrics: Antenatal Care and Maternal-Fetal Medicine

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

  1. 8 to 10 weeks
  2. 15 to 18 weeks
  3. 18 to 22 weeks
  4. 11 to 13+6 weeks Correct answer.

Explanation

Nuchal translucency is measured when the crown-rump length corresponds to 45–84 mm, which is 11 to 13+6 weeks. Outside this window the measurement is not valid for combined screening.

Question 3Obstetrics: Antenatal Care and Maternal-Fetal Medicine

A 30-year-old woman at 32 weeks has a singleton pregnancy, previous caesarean, and a placenta previa. She reports a sudden painless vaginal bleed. What is the initial management step?

  1. Outpatient review with repeat scan in one week
  2. Hospital admission with maternal and fetal monitoring and steroid administration Correct answer.
  3. Digital vaginal examination to assess dilatation
  4. Immediate caesarean delivery regardless of fetal status

Explanation

Painless bleeding with placenta previa requires admission, resuscitation as needed, continuous maternal and fetal monitoring, and antenatal corticosteroids if preterm. Digital vaginal examination is contraindicated because it can provoke catastrophic haemorrhage; delivery is dictated by maternal and fetal condition rather than the bleed alone.

Question 4Obstetrics: Antenatal Care and Maternal-Fetal Medicine

Which finding on a mid-trimester scan is most specific for open neural tube defect?

  1. Lemon-shaped skull with a small posterior fossa Correct answer.
  2. Echogenic bowel
  3. Mild pyelectasis
  4. Choroid plexus cyst

Explanation

The lemon sign (frontal bone scalloping) together with the banana sign of the cerebellum is strongly associated with open spina bifida and reflects altered intracranial pressure dynamics. Choroid plexus cysts, echogenic bowel and pyelectasis are soft markers with low specificity.

Question 5Obstetrics: Antenatal Care and Maternal-Fetal Medicine

A 26-year-old woman at 36 weeks has a fetus in the frank breech presentation. External cephalic version is being considered. Which factor most strongly predicts success?

  1. A posterior placenta
  2. Ample amniotic fluid volume with a non-engaged presenting part Correct answer.
  3. Maternal body mass index above 35
  4. Nulliparity

Explanation

Version success is favoured by adequate liquor volume, a non-engaged presenting part, multiparity, and a posterior or fundal placenta with a normal uterus. High maternal BMI, nulliparity and an engaged presenting part all reduce success.

Question 6Obstetrics: Antenatal Care and Maternal-Fetal Medicine

Which test best confirms the diagnosis of gestational diabetes in a woman with an abnormal 50 g glucose challenge test?

  1. Random plasma glucose
  2. Haemoglobin A1c
  3. 75 g oral glucose tolerance test Correct answer.
  4. Fasting plasma glucose alone

Explanation

A 75 g two-hour oral glucose tolerance test is the diagnostic standard after an abnormal screening challenge. Fasting glucose alone, HbA1c and random glucose are not sufficiently sensitive to diagnose gestational diabetes.

Question 7Obstetrics: Antenatal Care and Maternal-Fetal Medicine

A woman at 24 weeks has a blood pressure of 150/95 mmHg on two occasions with 2+ proteinuria. Which statement best describes the most important immediate risk to the fetus?

  1. Polyhydramnios
  2. Fetal hyperinsulinaemia
  3. Fetal macrosomia
  4. Placental insufficiency with growth restriction Correct answer.

Explanation

Pre-eclampsia causes uteroplacental vascular dysfunction, leading to impaired perfusion, growth restriction and fetal compromise. Hyperinsulinaemia and macrosomia relate to maternal diabetes, and polyhydramnios is not typical of pre-eclampsia.

Question 8Obstetrics: Antenatal Care and Maternal-Fetal Medicine

A 34-year-old woman at 28 weeks has a previous infant with a neural tube defect. What is the most appropriate preventive measure in this pregnancy?

  1. A single dose of vitamin B12 in the first trimester
  2. Dietary folate alone without supplementation
  3. High-dose folic acid started at least one month before conception Correct answer.
  4. Low-dose folic acid started at 12 weeks

Explanation

A previous affected pregnancy warrants 4–5 mg of folic acid daily starting at least one month before conception and continuing through the first trimester. Standard 0.4 mg supplementation is inadequate for recurrence prevention.

Question 9Obstetrics: Antenatal Care and Maternal-Fetal Medicine

A 22-year-old at 9 weeks has a haemoglobin of 9.8 g/dL with a mean corpuscular volume of 68 fL. What is the most likely diagnosis?

  1. Iron deficiency anaemia Correct answer.
  2. Anaemia of chronic disease
  3. Folate deficiency
  4. Thalassaemia trait

Explanation

Microcytic anaemia in early pregnancy is most often due to iron deficiency. Thalassaemia trait also causes microcytosis but usually with a normal or raised red cell count and a normal ferritin; folate deficiency is macrocytic.

Question 10Obstetrics: Antenatal Care and Maternal-Fetal Medicine

Which parameter is the most reliable marker of fetal anaemia in a pregnancy complicated by red cell alloimmunisation?

  1. Amniotic fluid optical density at 450 nm
  2. Umbilical artery pulsatility index
  3. Middle cerebral artery peak systolic velocity Correct answer.
  4. Maternal antibody titre alone

Explanation

Doppler measurement of middle cerebral artery peak systolic velocity is the non-invasive standard for detecting fetal anaemia; values above 1.5 multiples of the median are suspicious. Amniotic fluid optical density has largely been superseded, and antibody titres only guide the need for surveillance.

Question 11Obstetrics: Antenatal Care and Maternal-Fetal Medicine

A 29-year-old at 20 weeks has a cervical length of 18 mm on transvaginal scan. She has had one previous preterm birth. What is the most appropriate intervention?

  1. Cervical cerclage plus vaginal progesterone Correct answer.
  2. Bed rest until term
  3. Vaginal progesterone only
  4. Cervical cerclage only

Explanation

A short cervix with a prior preterm birth is the highest-risk combination, and evidence supports cerclage combined with vaginal progesterone. Either intervention alone is less effective in this subgroup, and bed rest is not beneficial.

Question 12Obstetrics: Antenatal Care and Maternal-Fetal Medicine

Which of the following is the most appropriate first-line antihypertensive for severe hypertension in pregnancy?

  1. Enalapril given orally
  2. Ramipril given orally
  3. Labetalol given intravenously Correct answer.
  4. Atenolol given orally

Explanation

Intravenous labetalol is a first-line agent for severe hypertension in pregnancy, alongside hydralazine and nifedipine. ACE inhibitors such as enalapril and ramipril are contraindicated because of fetal renal toxicity, and atenolol is associated with growth restriction.

Question 13Obstetrics: Antenatal Care and Maternal-Fetal Medicine

A 31-year-old at 26 weeks has an oral glucose tolerance test showing a fasting glucose of 5.4 mmol/L and a two-hour value of 7.6 mmol/L. What is the most appropriate initial management?

  1. Dietary modification and glucose monitoring Correct answer.
  2. Repeat the test in four weeks
  3. Start insulin immediately
  4. Start metformin and stop monitoring

Explanation

Gestational diabetes is initially managed with medical nutrition therapy, exercise and home glucose monitoring, with pharmacotherapy added if targets are not met. Insulin is not started before a trial of lifestyle measures unless glucose values are markedly elevated.

Question 14Obstetrics: Antenatal Care and Maternal-Fetal Medicine

Which of the following is the strongest indication for antenatal fetal surveillance with twice-weekly cardiotocography in the third trimester?

  1. Maternal age of 36 years
  2. A single previous uncomplicated term delivery
  3. Pre-eclampsia with fetal growth restriction Correct answer.
  4. Gestational diabetes controlled on diet alone

Explanation

Pre-eclampsia complicated by growth restriction reflects significant placental insufficiency and warrants intensified surveillance. Maternal age, an uncomplicated obstetric history and diet-controlled diabetes are low-risk features.

Question 15Obstetrics: Antenatal Care and Maternal-Fetal Medicine

A 25-year-old at 13 weeks has a crown-rump length of 60 mm and a nuchal translucency of 3.4 mm. What is the most appropriate next step?

  1. Offer non-invasive prenatal testing or invasive diagnostic testing Correct answer.
  2. Perform a maternal serum quadruple test
  3. Repeat the scan at 16 weeks
  4. Reassure and arrange routine anomaly scan only

Explanation

A nuchal translucency above the 95th centile is associated with aneuploidy, structural cardiac defects and genetic syndromes. Further assessment with cell-free DNA testing or diagnostic testing (chorionic villus sampling or amniocentesis) should be offered, along with a detailed anatomy and fetal echocardiography.

Question 16Obstetrics: Antenatal Care and Maternal-Fetal Medicine

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

  1. Measles-mumps-rubella vaccine
  2. Tetanus, diphtheria and pertussis vaccine Correct answer.
  3. Live attenuated varicella vaccine
  4. Live attenuated influenza vaccine

Explanation

Inactivated tetanus, diphtheria and pertussis vaccine is recommended in each pregnancy to protect the neonate through transplacental antibody transfer. Live vaccines such as varicella, MMR and live influenza are contraindicated in pregnancy.

Question 17Obstetrics: Antenatal Care and Maternal-Fetal Medicine

A 38-year-old at 34 weeks reports reduced fetal movements. Cardiotocography shows a sinusoidal pattern. What is the most appropriate interpretation?

  1. A reassuring pattern requiring discharge
  2. A pre-terminal pattern indicating severe fetal anaemia or hypoxia Correct answer.
  3. An artefact requiring no action
  4. A normal sleep cycle pattern

Explanation

A true sinusoidal pattern is rare and ominous, indicating severe fetal anaemia or hypoxia, and requires urgent evaluation and delivery. It must be distinguished from a pseudosinusoidal pattern, which is not sustained or uniform.

Question 18Obstetrics: Antenatal Care and Maternal-Fetal Medicine

Which of the following best describes the recommended timing for the routine mid-trimester fetal anomaly scan?

  1. 16 to 17 weeks
  2. 24 to 26 weeks
  3. 18 to 22 weeks Correct answer.
  4. 28 to 32 weeks

Explanation

The detailed anatomy scan is performed between 18 and 22 weeks, when organs are large enough to assess and termination remains an option. Earlier scans have limited resolution, and later scans miss the window for legal options in many settings.

Question 19Obstetrics: Antenatal Care and Maternal-Fetal Medicine

A 27-year-old at 30 weeks has a singleton pregnancy with estimated fetal weight below the 3rd centile and an umbilical artery pulsatility index above the 95th centile. What is the most appropriate management?

  1. Immediate caesarean delivery
  2. Expectant management with weekly growth scans only
  3. Close surveillance with Doppler studies and delivery if deterioration occurs Correct answer.
  4. Discharge with instructions to return if movements reduce

Explanation

Early-onset growth restriction with abnormal umbilical artery Doppler requires intensive surveillance, corticosteroids if preterm, and timed delivery based on Doppler progression and fetal status. Immediate delivery is not automatically indicated if the fetus is stable.

Question 20Obstetrics: Antenatal Care and Maternal-Fetal Medicine

Which of the following is the most appropriate screening test for syphilis at the first antenatal visit?

  1. Cervical swab culture
  2. Non-treponemal serology confirmed by a treponemal test Correct answer.
  3. Urine polymerase chain reaction
  4. Dark-ground microscopy of vaginal discharge

Explanation

Syphilis screening uses a non-treponemal test (such as rapid plasma reagin or Venereal Disease Research Laboratory) with confirmation by a treponemal test. Direct methods are used for lesion diagnosis, not population screening.

Question 21Obstetrics: Antenatal Care and Maternal-Fetal Medicine

A 32-year-old at 16 weeks has a history of a previous unexplained stillbirth at 36 weeks. Which intervention has the strongest evidence for reducing recurrence?

  1. Serial growth scans and fetal surveillance in the third trimester Correct answer.
  2. Daily low-dose aspirin from 12 weeks
  3. Routine cervical cerclage
  4. Prophylactic heparin throughout pregnancy

Explanation

A previous unexplained stillbirth warrants increased third-trimester surveillance, including serial growth assessment and fetal monitoring from around 32 weeks. Aspirin, cerclage and heparin are not indicated without a specific thrombophilia, cervical or placental indication.

Question 22Obstetrics: Antenatal Care and Maternal-Fetal Medicine

A 24-year-old at 11 weeks has a temperature of 38.5°C with a maculopapular rash and arthralgia. Which infection is most likely to cause fetal harm in this scenario?

  1. Rubella Correct answer.
  2. Cytomegalovirus
  3. Bacterial vaginosis
  4. Herpes simplex virus type 2

Explanation

Rubella in the first trimester carries the highest risk of congenital rubella syndrome, including deafness, cataract and cardiac defects. CMV is usually asymptomatic, HSV is transmitted perinatally, and bacterial vaginosis is not associated with this presentation.

Question 23Obstetrics: Antenatal Care and Maternal-Fetal Medicine

Which of the following is the recommended first-trimester screening strategy for Down syndrome?

  1. Combined nuchal translucency and maternal serum biochemistry with a dating scan Correct answer.
  2. Second-trimester anomaly scan alone
  3. Maternal serum alpha-fetoprotein alone
  4. Maternal age alone

Explanation

Combined first-trimester screening uses nuchal translucency, free beta-hCG and pregnancy-associated plasma protein A, with accurate dating, achieving the highest detection rate. Age alone and alpha-fetoprotein alone are inferior strategies.

Question 24Obstetrics: Antenatal Care and Maternal-Fetal Medicine

A 35-year-old at 33 weeks has a blood pressure of 160/110 mmHg with headache and visual disturbance. What is the most appropriate immediate management?

  1. Oral methyldopa and outpatient review
  2. Immediate caesarean section without stabilisation
  3. Fluid restriction and observation
  4. Intravenous magnesium sulfate and antihypertensive therapy Correct answer.

Explanation

Severe hypertension with neurological symptoms indicates severe pre-eclampsia with imminent eclampsia risk. Magnesium sulfate prevents seizures and antihypertensives reduce blood pressure, with delivery planned after maternal stabilisation.

Question 25Obstetrics: Antenatal Care and Maternal-Fetal Medicine

Which of the following statements about the dating of pregnancy is most accurate?

  1. Fundal height in the second trimester is the preferred dating method
  2. The last menstrual period is more accurate than any ultrasound measurement
  3. A third-trimester scan is the most reliable dating method
  4. A first-trimester crown-rump length measurement is the most accurate method for estimating gestational age Correct answer.

Explanation

Crown-rump length measurement in the first trimester is the most accurate method for establishing gestational age, with an error of about 5–7 days. Later ultrasound measurements and the last menstrual period are less reliable.

Question 26Obstetrics: Antenatal Care and Maternal-Fetal Medicine

A 30-year-old woman at 10 weeks of gestation has a body mass index of 32 kg/m². Which antenatal intervention has the strongest evidence for reducing the risk of gestational diabetes in this woman?

  1. Prophylactic low-dose aspirin from 12 weeks
  2. Routine metformin from the first trimester
  3. A structured lifestyle intervention with dietary advice and physical activity Correct answer.
  4. Routine early oral glucose tolerance testing at 16 weeks

Explanation

In women with obesity, randomised trials show that structured lifestyle interventions combining dietary counselling and physical activity reduce the incidence of gestational diabetes. Metformin is not recommended for prevention outside research settings, and early testing detects but does not prevent the condition. Low-dose aspirin is used for pre-eclampsia prophylaxis, not for preventing gestational diabetes.

Question 27Obstetrics: Antenatal Care and Maternal-Fetal Medicine

A 28-year-old woman at 18 weeks of gestation has a singleton pregnancy and a history of two previous preterm births at 28 and 30 weeks. Which prophylactic measure has the strongest evidence for reducing the risk of another preterm birth?

  1. Intramuscular 17-alpha-hydroxyprogesterone caproate weekly from 16 weeks
  2. Cervical cerclage at 14 weeks
  3. Vaginal progesterone pessary from 16 weeks Correct answer.
  4. Bed rest and avoidance of intercourse

Explanation

Vaginal progesterone is recommended for women with a history of spontaneous preterm birth and a short cervix, and evidence supports its use in women with a prior preterm birth even without a short cervix. Cerclage is generally reserved for women with a short cervix and prior preterm birth, and 17-alpha-hydroxyprogesterone caproate is not recommended due to lack of proven benefit in recent trials. Bed rest has no proven benefit and may cause harm.

Question 28Obstetrics: Antenatal Care and Maternal-Fetal Medicine

A 35-year-old woman at 26 weeks of gestation has a fasting plasma glucose of 5.6 mmol/L on a 75 g oral glucose tolerance test. Which statement best describes the most appropriate management?

  1. Start dietary modification and home glucose monitoring, with insulin if targets are not met Correct answer.
  2. Admit for immediate insulin therapy
  3. No action is needed as this value is within normal limits
  4. Repeat the oral glucose tolerance test in 2 weeks

Explanation

A fasting plasma glucose of 5.6 mmol/L meets the diagnostic threshold for gestational diabetes (≥5.1 mmol/L). Initial management is lifestyle modification with glucose monitoring, and insulin is added if glucose targets are not achieved. Immediate insulin is not required without a trial of diet, and repeating the test is unnecessary once diagnostic criteria are met.

Question 29Obstetrics: Antenatal Care and Maternal-Fetal Medicine

A 24-year-old woman at 12 weeks of gestation has a blood pressure of 142/92 mmHg on two occasions. She has no history of hypertension and is not on medication. Which statement best describes the most appropriate next step?

  1. Admit for investigation of secondary hypertension
  2. Confirm with ambulatory blood pressure monitoring and assess for target organ damage Correct answer.
  3. Reassure and repeat blood pressure in 4 weeks
  4. Start antihypertensive therapy immediately

Explanation

Mild hypertension in early pregnancy should be confirmed with ambulatory or home blood pressure monitoring and evaluated for target organ damage to distinguish chronic hypertension from white-coat hypertension. Antihypertensive therapy is not started for mild hypertension without confirmation, and admission for secondary causes is not routine.

Question 30Obstetrics: Antenatal Care and Maternal-Fetal Medicine

A 29-year-old woman at 20 weeks of gestation has a history of a previous fetus with anencephaly. She is not taking folic acid. Which counselling statement is most accurate?

  1. Folic acid 400 micrograms daily is sufficient to reduce the risk of recurrence
  2. High-dose folic acid (5 mg daily) should have been started pre-conception and continued until 12 weeks Correct answer.
  3. Folic acid supplementation should be started now and continued until delivery
  4. Folic acid has no role in preventing neural tube defects after 12 weeks

Explanation

Women with a previous neural tube defect-affected pregnancy should take high-dose folic acid (5 mg daily) starting at least 1 month before conception and continuing until 12 weeks of gestation to reduce the recurrence risk. Standard-dose folic acid is insufficient for recurrence prevention, and starting after 12 weeks is too late for neural tube closure.

Question 31Obstetrics: Antenatal Care and Maternal-Fetal Medicine

A 32-year-old woman at 28 weeks of gestation has a singleton pregnancy. She has no risk factors for pre-eclampsia. Which statement best describes the recommended approach to pre-eclampsia screening?

  1. Routine uterine artery Doppler at 20 weeks
  2. Routine blood pressure and urine protein assessment at each antenatal visit Correct answer.
  3. Routine serum placental growth factor measurement at 28 weeks
  4. Routine 24-hour ambulatory blood pressure monitoring

Explanation

For women at low risk, pre-eclampsia screening relies on regular measurement of blood pressure and urine protein at each antenatal visit. Uterine artery Doppler, placental growth factor, and ambulatory monitoring are not recommended as routine screening in low-risk women.

Question 32Obstetrics: Antenatal Care and Maternal-Fetal Medicine

A 27-year-old woman at 16 weeks of gestation has a history of a previous spontaneous preterm birth at 34 weeks. She is currently asymptomatic. Which statement best describes the recommended screening for cervical shortening?

  1. Transvaginal cervical length measurement at 18–24 weeks Correct answer.
  2. Routine cervical cerclage at 14 weeks
  3. Transabdominal cervical length measurement at 28 weeks
  4. Digital cervical examination at each visit

Explanation

Women with a history of spontaneous preterm birth should be offered transvaginal cervical length screening between 18 and 24 weeks to identify those who may benefit from progesterone or cerclage. Digital examination is unreliable, transabdominal measurement is less accurate, and cerclage is not placed routinely without evidence of cervical shortening.

Question 33Obstetrics: Antenatal Care and Maternal-Fetal Medicine

A 31-year-old woman at 32 weeks of gestation presents with a 2-day history of fever, dysuria, and flank pain. Urinalysis shows pyuria and nitrites. Which statement best describes the most appropriate management?

  1. Outpatient oral ciprofloxacin for 7 days
  2. No treatment as urinary tract infections are common in pregnancy
  3. Admission for intravenous antibiotics and observation Correct answer.
  4. Oral nitrofurantoin for 5 days

Explanation

Acute pyelonephritis in pregnancy requires admission for intravenous antibiotics and monitoring because of the risk of sepsis and preterm labour. Nitrofurantoin is not appropriate for pyelonephritis as it does not achieve adequate renal tissue levels, and fluoroquinolones are generally avoided in pregnancy.

Question 34Obstetrics: Antenatal Care and Maternal-Fetal Medicine

A 33-year-old woman at 36 weeks of gestation has a singleton pregnancy. She has no medical complications and a normal cardiotocograph. Which statement best describes the recommended fetal presentation assessment?

  1. Routine magnetic resonance imaging at 38 weeks
  2. Clinical abdominal palpation at each visit from 36 weeks Correct answer.
  3. No assessment needed until labour
  4. Ultrasound at 36 weeks to confirm presentation

Explanation

Clinical abdominal palpation is recommended at each antenatal visit from 36 weeks to assess fetal presentation. Ultrasound is reserved for uncertain clinical findings or specific indications, and routine imaging is not recommended.

Question 35Obstetrics: Antenatal Care and Maternal-Fetal Medicine

A 26-year-old woman at 14 weeks of gestation has a body mass index of 35 kg/m². She asks about the risk of complications. Which statement is most accurate?

  1. Maternal obesity is associated with a reduced risk of caesarean section
  2. Maternal obesity reduces the risk of fetal macrosomia
  3. Maternal obesity increases the risk of gestational diabetes and pre-eclampsia Correct answer.
  4. Maternal obesity has no effect on the risk of thromboembolism

Explanation

Maternal obesity is associated with an increased risk of gestational diabetes, pre-eclampsia, caesarean delivery, thromboembolism, and fetal macrosomia. It does not reduce the risk of caesarean section or macrosomia, and it increases thromboembolic risk.

Question 36Obstetrics: Antenatal Care and Maternal-Fetal Medicine

A 30-year-old woman at 24 weeks of gestation has a history of a previous preterm birth at 26 weeks. She is diagnosed with a short cervix of 15 mm on transvaginal ultrasound. Which intervention has the strongest evidence for reducing the risk of preterm birth?

  1. Bed rest
  2. Cervical cerclage
  3. Antibiotic prophylaxis
  4. Vaginal progesterone Correct answer.

Explanation

In women with a history of preterm birth and a short cervix, vaginal progesterone is the recommended intervention with the strongest evidence for reducing preterm birth. Cerclage is an alternative in selected cases but is generally considered when progesterone is not used or in women with prior cerclage, and bed rest and antibiotics are not effective.

Question 37Obstetrics: Antenatal Care and Maternal-Fetal Medicine

A 34-year-old woman at 28 weeks of gestation has a singleton pregnancy and a history of a previous stillbirth at 38 weeks. Which antenatal surveillance strategy is most appropriate?

  1. Daily home Doppler auscultation
  2. Weekly cardiotocography from 32 weeks Correct answer.
  3. Ultrasound every 4 weeks only
  4. No additional surveillance beyond routine care

Explanation

Women with a previous stillbirth are at increased risk of recurrent stillbirth and should be offered increased fetal surveillance, typically weekly cardiotocography starting from 32 weeks, in addition to growth scans. Routine care alone is insufficient, and home Doppler is not a validated surveillance tool.

Question 38Obstetrics: Antenatal Care and Maternal-Fetal Medicine

A 29-year-old woman at 30 weeks of gestation has a singleton pregnancy and a history of a previous preterm birth at 34 weeks. She is diagnosed with a short cervix of 20 mm. Which statement best describes the most appropriate management?

  1. Intramuscular progesterone 250 mg weekly
  2. Cervical cerclage
  3. No treatment
  4. Vaginal progesterone 200 mg nightly Correct answer.

Explanation

Vaginal progesterone is recommended for women with a history of spontaneous preterm birth and a short cervix (≤25 mm) to reduce the risk of preterm birth. Cerclage is an alternative but is generally reserved for women with a prior cerclage or those who cannot use progesterone, and intramuscular progesterone is not recommended.

Question 39Obstetrics: Antenatal Care and Maternal-Fetal Medicine

A 36-year-old woman at 12 weeks of gestation has a history of a previous pregnancy complicated by pre-eclampsia at 34 weeks. Which intervention is most appropriate for reducing the risk of recurrence?

  1. Low-dose aspirin 75–150 mg daily from 28 weeks
  2. Calcium supplementation 1 g daily
  3. Low-dose aspirin 75–150 mg daily from 12 weeks Correct answer.
  4. No intervention as the risk is low

Explanation

Women with a history of pre-eclampsia are at high risk of recurrence and should receive low-dose aspirin (75–150 mg daily) starting from 12 weeks of gestation. Starting at 28 weeks is too late, and calcium supplementation is not routinely recommended for prevention in women with adequate dietary intake.

Question 40Obstetrics: Antenatal Care and Maternal-Fetal Medicine

A 28-year-old woman at 20 weeks of gestation has a singleton pregnancy and a history of a previous preterm birth at 32 weeks. She is diagnosed with a short cervix of 10 mm on transvaginal ultrasound. Which statement best describes the most appropriate management?

  1. Serial cervical length measurements only
  2. Cervical cerclage in addition to vaginal progesterone Correct answer.
  3. Bed rest
  4. Vaginal progesterone alone

Explanation

In women with a history of preterm birth and a very short cervix (≤10 mm), cerclage in addition to vaginal progesterone is recommended to reduce the risk of preterm birth. Progesterone alone may be insufficient, and bed rest is not effective.

Question 41Obstetrics: Labour, Delivery, and Intrapartum Care

A nulliparous woman at 38 weeks has a fetal heart tracing showing recurrent variable decelerations to 80 bpm lasting 45 seconds. What is the most appropriate initial management?

  1. Perform a fetal scalp blood sample immediately
  2. Change maternal position and reassess the tracing Correct answer.
  3. Administer intravenous oxytocin
  4. Immediate caesarean delivery

Explanation

Variable decelerations usually reflect umbilical cord compression, and the first-line response is maternal repositioning (e.g., left lateral or knee-chest) with reassessment of the tracing. Operative delivery or scalp sampling is reserved for decelerations that persist despite simple measures or show features of hypoxia.

Question 42Obstetrics: Labour, Delivery, and Intrapartum Care

Which finding on a cardiotocograph is the most reliable single indicator of fetal acidaemia?

  1. Maternal pyrexia
  2. Baseline tachycardia
  3. Reduced baseline variability Correct answer.
  4. Early decelerations

Explanation

Reduced or absent baseline variability is strongly associated with fetal metabolic acidaemia and is a key pathological feature. Baseline rate changes and deceleration type are supportive, but variability is the most discriminatory single feature.

Question 43Obstetrics: Labour, Delivery, and Intrapartum Care

A woman in active labour has a cervical dilatation of 5 cm with regular contractions. According to the WHO partograph, what cervical dilatation rate should prompt consideration of slow progress?

  1. Less than 1 cm per hour
  2. Less than 2 cm per hour
  3. Less than 0.5 cm per hour Correct answer.
  4. Less than 0.2 cm per hour

Explanation

The WHO partograph uses an alert line corresponding to a cervical dilatation rate of 1 cm per hour, and slower progress than this (particularly below 0.5 cm/hour over 4 hours) suggests poor progress requiring reassessment. This helps identify obstructed or prolonged labour early.

Question 44Obstetrics: Labour, Delivery, and Intrapartum Care

Which of the following is the most common cause of primary postpartum haemorrhage?

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

Explanation

Uterine atony accounts for the majority of primary postpartum haemorrhage cases because the uterus fails to contract and compress the placental bed vessels. Trauma, retained tissue, and coagulopathy are less common causes.

Question 45Obstetrics: Labour, Delivery, and Intrapartum Care

A woman with a previous caesarean section is in labour and the fetal heart shows prolonged deceleration with a rising baseline. What is the most appropriate next step?

  1. Perform an amniotomy
  2. Administer tocolytics and observe
  3. Expedite delivery by caesarean section Correct answer.
  4. Continue labour with close monitoring

Explanation

A prolonged deceleration with a rising baseline in a woman with a previous caesarean scar raises concern for scar dehiscence or fetal compromise and warrants urgent delivery. Delay increases the risk of fetal hypoxia and uterine rupture complications.

Question 46Obstetrics: Labour, Delivery, and Intrapartum Care

What is the recommended first-line uterotonic for active management of the third stage of labour?

  1. Intramuscular oxytocin Correct answer.
  2. Intramuscular carboprost
  3. Oral misoprostol
  4. Intravenous ergometrine

Explanation

Intramuscular oxytocin (typically 10 IU) is the recommended first-line uterotonic for active management of the third stage because it is effective and has fewer side effects than ergometrine. Misoprostol and carboprost are used when oxytocin is unavailable or ineffective.

Question 47Obstetrics: Labour, Delivery, and Intrapartum Care

Which of the following best describes the mechanism of shoulder dystocia?

  1. The anterior shoulder becomes impacted behind the symphysis pubis Correct answer.
  2. The umbilical cord prolapses before the head
  3. The fetal head fails to engage in the pelvis
  4. The fetal occiput rotates to the occipitoposterior position

Explanation

Shoulder dystocia occurs when the anterior fetal shoulder impacts against the symphysis pubis after delivery of the head, preventing delivery of the body. It is a mechanical obstruction requiring specific manoeuvres.

Question 48Obstetrics: Labour, Delivery, and Intrapartum Care

Which manoeuvre is recommended first to relieve shoulder dystocia after calling for help?

  1. Symphysiotomy
  2. Fundal pressure
  3. Delivery of the posterior arm
  4. McRoberts' manoeuvre with suprapubic pressure Correct answer.

Explanation

McRoberts' manoeuvre (hyperflexion of the maternal hips) combined with suprapubic pressure is the recommended first-line approach because it is effective and minimally invasive. More invasive manoeuvres follow if this fails.

Question 49Obstetrics: Labour, Delivery, and Intrapartum Care

A woman at 41 weeks with a bishop score of 3 requests induction. Which cervical ripening agent is most appropriate?

  1. Vaginal dinoprostone or misoprostol Correct answer.
  2. Intravenous oxytocin alone
  3. Intramuscular ergometrine
  4. Amniotomy alone

Explanation

An unfavourable cervix (low Bishop score) benefits from prostaglandin ripening with vaginal dinoprostone or misoprostol before oxytocin or amniotomy. Prostaglandins improve the likelihood of successful vaginal delivery.

Question 50Obstetrics: Labour, Delivery, and Intrapartum Care

Which of the following is a recognised risk factor for umbilical cord prolapse?

  1. Maternal hypertension
  2. Polyhydramnios with a fixed cephalic presentation
  3. Previous uncomplicated vaginal delivery
  4. Artificial rupture of membranes with a high presenting part Correct answer.

Explanation

Cord prolapse is more likely when the presenting part is not well applied to the cervix, such as after artificial rupture of membranes with a high head. Polyhydramnios and malpresentation also increase risk.