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Arab Board Ob/Gyn Final Written study materials
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Arab Board Ob/Gyn Final Written practice questions

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Question 1General Obstetrics and Intrapartum Care

A 28-year-old woman with no history of an affected pregnancy is planning conception and asks about folic acid supplementation. What daily dose is recommended for routine preconception use?

  1. 4.0 mg daily
  2. 5.0 mg daily
  3. 0.4 mg daily Correct answer.
  4. 1.0 mg daily

Explanation

For women at average risk, 400 micrograms (0.4 mg) of folic acid daily, started at least one month before conception and continued through the first trimester, reduces the incidence of neural tube defects. Higher doses of 4–5 mg are reserved for women with a previously affected pregnancy, pre-existing diabetes, obesity or anticonvulsant use.

Question 2General Obstetrics and Intrapartum Care

A woman with a regular 28-day cycle reports that her last menstrual period began on 10 March. Using Naegele's rule, what is her estimated date of delivery?

  1. 3 December
  2. 10 December
  3. 24 December
  4. 17 December Correct answer.

Explanation

Naegele's rule adds 7 days to the first day of the last menstrual period and then subtracts 3 months, giving 17 December in this case. The calculation assumes a regular 28-day cycle with ovulation on day 14; an early dating ultrasound is more accurate when the cycle is irregular.

Question 3General Obstetrics and Intrapartum Care

The second stage of labour is defined as the interval from:

  1. Full dilatation to delivery of the baby Correct answer.
  2. Onset of regular contractions to full cervical dilatation
  3. Full dilatation to delivery of the placenta
  4. Rupture of membranes to delivery of the baby

Explanation

The first stage ends at full dilatation, the second stage runs from full dilatation to birth of the baby, and the third stage ends with expulsion of the placenta. These boundaries matter because prolonged second stage has its own management thresholds and operative delivery criteria.

Question 4General Obstetrics and Intrapartum Care

Primary postpartum haemorrhage after a vaginal birth is conventionally defined as blood loss of at least:

  1. 200 mL within 24 hours
  2. 500 mL within 24 hours Correct answer.
  3. 300 mL within 24 hours
  4. 1000 mL within 24 hours

Explanation

Primary postpartum haemorrhage is blood loss of 500 mL or more within 24 hours of vaginal birth, or 1000 mL or more after caesarean birth, or any loss accompanied by haemodynamic compromise. Visual estimation systematically underestimates loss, so measured collection is preferred.

Question 5General Obstetrics and Intrapartum Care

Which manoeuvre is the recommended first step in the management of shoulder dystocia once the diagnosis has been made?

  1. McRoberts manoeuvre Correct answer.
  2. Fundal pressure by an assistant
  3. Symphysiotomy under anaesthesia
  4. Delivery of the posterior arm

Explanation

McRoberts manoeuvre, hyperflexion of the maternal hips with suprapubic pressure, is the recommended first-line measure and resolves most cases. Fundal pressure is contraindicated because it worsens impaction and increases the risk of uterine rupture and brachial plexus injury.

Question 6General Obstetrics and Intrapartum Care

A pregnancy delivered at 35 weeks and 4 days' gestation is classified as:

  1. Full term
  2. Early term
  3. Moderate preterm
  4. Late preterm Correct answer.

Explanation

Late preterm birth is defined as delivery between 34+0 and 36+6 weeks, early term as 37+0 to 38+6 weeks, and full term as 39+0 to 40+6 weeks. Late preterm infants have higher rates of respiratory morbidity, jaundice and feeding difficulty than term infants.

Question 7General Obstetrics and Intrapartum Care

In an unsensitised Rh-negative woman with an Rh-positive partner, routine antenatal anti-D immunoglobulin is normally given at:

  1. 16 weeks' gestation
  2. 20 weeks' gestation
  3. 28 weeks' gestation Correct answer.
  4. 36 weeks' gestation

Explanation

Routine antenatal anti-D prophylaxis is given at around 28 weeks, with some programmes using a two-dose schedule at 28 and 34 weeks, in addition to cover for any sensitising event. Fetal RHD genotyping is increasingly used so that anti-D is only given when the fetus is Rh-positive.

Question 8General Obstetrics and Intrapartum Care

Universal screening for gestational diabetes with an oral glucose tolerance test is best performed at:

  1. 18–22 weeks
  2. 12–16 weeks
  3. 8–12 weeks
  4. 24–28 weeks Correct answer.

Explanation

Screening is offered at 24–28 weeks because insulin resistance rises markedly in the second trimester, which maximises test sensitivity. Women with major risk factors may be tested earlier, but a normal early test should be repeated at 24–28 weeks.

Question 9General Obstetrics and Intrapartum Care

A 30-year-old woman had preeclampsia requiring delivery at 30 weeks in her previous pregnancy and is now at 12 weeks in a new pregnancy. Which intervention reduces her risk of recurrent preeclampsia?

  1. Prophylactic low-molecular-weight heparin
  2. Strict bed rest from 24 weeks
  3. Calcium 2 g daily from 20 weeks
  4. Low-dose aspirin before 16 weeks Correct answer.

Explanation

Low-dose aspirin, usually 81–162 mg at night, started before 16 weeks reduces the incidence of preterm preeclampsia in women with a history of early-onset disease. Heparin, bed rest and calcium alone are not established strategies for preventing recurrence in this group.

Question 10General Obstetrics and Intrapartum Care

A woman at 29 weeks' gestation is in established preterm labour with no contraindication to continuing the pregnancy. Which intervention specifically reduces the risk of cerebral palsy in her baby?

  1. Amoxicillin-clavulanate
  2. Nifedipine tocolysis for 48 hours
  3. Intravenous magnesium sulphate Correct answer.
  4. Prolonged maternal oxygen therapy

Explanation

Magnesium sulphate given to women at risk of delivery before 32 weeks reduces the incidence and severity of cerebral palsy. Tocolysis buys time for corticosteroids but has no direct neuroprotective effect, and antibiotics are given for latency or group B streptococcal prophylaxis.

Question 11General Obstetrics and Intrapartum Care

A woman presents at 33 weeks and 2 days with confirmed rupture of membranes, no contractions and no signs of infection. Which management plan is most appropriate?

  1. Induction of labour after 12 hours
  2. Latency antibiotics and steroids Correct answer.
  3. Home care with weekly review visits
  4. Immediate caesarean delivery for all cases

Explanation

Before 34 weeks, preterm prelabour rupture of membranes is managed expectantly with latency antibiotics, antenatal corticosteroids and close surveillance for infection, abruption and cord prolapse. Delivery is indicated for chorioamnionitis, non-reassuring fetal status or once 34 weeks is reached.

Question 12General Obstetrics and Intrapartum Care

A cardiotocograph shows a regular sine-wave-like undulation of the baseline at 3–5 cycles per minute with absent variability and no accelerations. Which pattern is described?

  1. Sinusoidal pattern Correct answer.
  2. Saltatory pattern
  3. Prolonged deceleration
  4. Pseudosinusoidal pattern

Explanation

The sinusoidal pattern is a smooth sine-wave undulation of the baseline at 3–5 cycles per minute with absent variability and no accelerations, and it is associated with severe fetal anaemia or hypoxia. It warrants immediate evaluation, correction of any cause and preparation for urgent delivery.

Question 13General Obstetrics and Intrapartum Care

A woman in spontaneous labour with ruptured membranes is 6 cm dilated; after 4 hours of adequate contractions there is no cervical change. What is the best description of this finding?

  1. Second stage protraction
  2. Latent phase prolongation
  3. Normal active phase progress
  4. Active phase arrest Correct answer.

Explanation

Active phase arrest is defined as no cervical change for at least 4 hours with adequate contractions, or 6 hours with inadequate contractions, at 6 cm or more with ruptured membranes. Management options include oxytocin augmentation or caesarean delivery when progress fails to resume.

Question 14General Obstetrics and Intrapartum Care

Umbilical cord prolapse is diagnosed at 7 cm dilatation immediately after spontaneous rupture of membranes, with a reassuring fetal heart rate. What is the most appropriate immediate action?

  1. Call for help and elevate the head Correct answer.
  2. Await full dilatation for a vacuum delivery
  3. Start an oxytocin infusion
  4. Replace the cord into the uterus

Explanation

Cord prolapse is an obstetric emergency: summon help, elevate the presenting part digitally or with a balloon, position the woman in knee-chest or Trendelenburg position, and deliver by the fastest safe route, usually caesarean. Tocolysis or bladder filling may be used temporarily to reduce cord compression while theatre is prepared.

Question 15General Obstetrics and Intrapartum Care

Which pharmacological adjunct has been shown to reduce mortality from postpartum haemorrhage when given within 3 hours of birth?

  1. Naloxone
  2. Recombinant factor VIIa
  3. Tranexamic acid Correct answer.
  4. Ergometrine

Explanation

The WOMAN trial demonstrated that intravenous tranexamic acid 1 g given within 3 hours of birth reduces death due to bleeding without increasing thrombosis. It is given alongside uterotonics and mechanical measures, not as a substitute for them.

Question 16General Obstetrics and Intrapartum Care

Which prior uterine incision is an absolute contraindication to a trial of labour after caesarean?

  1. Unknown scar from a prior myomectomy
  2. Classical upper-segment incision Correct answer.
  3. Single low transverse caesarean
  4. Two prior low transverse caesareans

Explanation

A classical or high vertical incision carries a rupture rate of roughly 4–9% in labour and trial of labour is contraindicated. A single low transverse incision carries a rupture risk of about 0.5–0.7%, which is low enough to permit a planned trial of labour.

Question 17General Obstetrics and Intrapartum Care

An uncomplicated singleton breech pregnancy is confirmed at 37 weeks with adequate amniotic fluid and a normally grown fetus. What is the most appropriate initial management option?

  1. Await spontaneous version until 40 weeks
  2. Plan an immediate caesarean at 37 weeks
  3. Perform magnetic resonance pelvimetry
  4. Offer external cephalic version Correct answer.

Explanation

External cephalic version at 36–37 weeks converts a substantial proportion of breech presentations to cephalic and lowers caesarean rates, and it should be offered after counselling with CTG monitoring and tocolysis available. Planned caesarean remains an option if version fails or is declined.

Question 18General Obstetrics and Intrapartum Care

A woman with one previous low transverse caesarean requires induction of labour with an unfavourable cervix. Which cervical ripening method is preferred?

  1. Misoprostol 25 µg vaginally
  2. Oxytocin infusion without ripening
  3. Dinoprostone vaginal insert
  4. Transcervical Foley balloon Correct answer.

Explanation

Mechanical ripening with a transcervical Foley balloon avoids the increased risk of uterine rupture associated with prostaglandins in women with a prior caesarean. Prostaglandins are best avoided in this group, and oxytocin alone with an unfavourable cervix has a low likelihood of success.

Question 19General Obstetrics and Intrapartum Care

In a growth-restricted fetus, which umbilical artery Doppler finding carries the highest risk of stillbirth and warrants urgent delivery?

  1. Absent or reversed flow Correct answer.
  2. Increased pulsatility index
  3. Normal end-diastolic flow
  4. Reduced amniotic fluid index

Explanation

Absent or reversed end-diastolic flow in the umbilical artery reflects severe placental insufficiency and is associated with a high risk of stillbirth, prompting delivery after corticosteroids if the fetus is preterm. Increased pulsatility with preserved forward flow indicates milder compromise and is usually managed with closer surveillance.

Question 20General Obstetrics and Intrapartum Care

A labouring woman at 39 weeks develops a temperature of 39°C, uterine tenderness and foul-smelling amniotic fluid. What is the most appropriate management?

  1. Await delivery; antibiotics after birth
  2. Paracetamol and continued observation
  3. Antibiotics now and expedite delivery Correct answer.
  4. Immediate caesarean delivery

Explanation

Clinical chorioamnionitis is treated with prompt broad-spectrum intravenous antibiotics and expeditious delivery regardless of cervical dilatation, with caesarean reserved for standard obstetric indications. Delaying antibiotics increases the risk of maternal sepsis, uterine atony and neonatal infection.

Question 21General Obstetrics and Intrapartum Care

A woman with ongoing postpartum haemorrhage has received oxytocin, ergometrine, carboprost, tranexamic acid and an intrauterine balloon. Her fibrinogen is 1.0 g/L. Which blood component is most appropriate next?

  1. Fresh frozen plasma alone
  2. Cryoprecipitate Correct answer.
  3. Platelet concentrate
  4. Packed red cells alone

Explanation

Fibrinogen falls early in massive obstetric haemorrhage, and a level below 2 g/L predicts progression to severe haemorrhage. Cryoprecipitate or fibrinogen concentrate replaces fibrinogen rapidly, whereas fresh frozen plasma is a slower and much less concentrated source.

Question 22General Obstetrics and Intrapartum Care

Ten minutes after an uncomplicated vaginal delivery, a woman becomes acutely breathless, hypotensive and unresponsive, and heavy vaginal bleeding with a non-clotting blood sample follows. What is the most appropriate immediate management?

  1. Urgent uterine artery embolisation
  2. Intravenous antibiotics and observation
  3. Immediate hysterectomy
  4. Supportive resuscitation and blood products Correct answer.

Explanation

This is the classic presentation of amniotic fluid embolism: sudden cardiovascular collapse, hypoxia and coagulopathy around labour or delivery, diagnosed clinically. Management is supportive, with airway and circulatory resuscitation, correction of coagulopathy with blood products and treatment of uterine atony; no specific antidote exists.

Question 23General Obstetrics and Intrapartum Care

A woman attempting vaginal birth after caesarean is 8 cm dilated when she suddenly reports severe constant abdominal pain; the fetal heart rate falls to 70 bpm and the station regresses. What is the most appropriate next step?

  1. Give opioids and continue labour
  2. Perform an urgent ultrasound to confirm the diagnosis
  3. Start an oxytocin infusion
  4. Proceed to immediate laparotomy Correct answer.

Explanation

Sudden fetal bradycardia with loss of station, constant pain and cessation of contractions is the classic picture of uterine rupture, which is a clinical diagnosis. Immediate laparotomy with delivery of the fetus and repair of the uterus is required; imaging or further labour would cause dangerous delay.

Question 24General Obstetrics and Intrapartum Care

A woman at 33 weeks with HELLP syndrome has a platelet count of 18 × 10⁹/L and requires caesarean delivery for fetal compromise. Which is the most appropriate immediate action?

  1. Transfuse packed red cells only
  2. Perform surgery without haematological support
  3. Give intravenous immunoglobulin and delay surgery
  4. Transfuse platelets before surgery Correct answer.

Explanation

Platelets are transfused before caesarean when the count is below about 50 × 10⁹/L, and below about 20 × 10⁹/L before vaginal birth, to reduce the risk of major haemorrhage. Delivery remains the definitive treatment and should only be delayed for the time needed to give the transfusion.

Question 25General Obstetrics and Intrapartum Care

An Rh-negative woman has an anti-D titre of 1:32 at 28 weeks and a middle cerebral artery peak systolic velocity above 1.5 multiples of the median. What does this finding most likely indicate?

  1. Fetal anaemia Correct answer.
  2. Fetal growth restriction
  3. Fetal cardiac arrhythmia
  4. Normal fetal haemodynamics

Explanation

A middle cerebral artery peak systolic velocity above 1.5 multiples of the median is the best non-invasive predictor of moderate to severe fetal anaemia and, in red cell alloimmunisation, prompts cordocentesis for fetal haematocrit with intrauterine transfusion if confirmed. The test is most reliable after 20 weeks and before hydrops develops.

Question 26General Obstetrics and Intrapartum Care

A woman with a prolonged second stage delivers the fetal head, but the anterior shoulder does not emerge with routine axial traction. What is the most appropriate initial manoeuvre?

  1. Delivery of the posterior fetal arm
  2. Symphysiotomy by the obstetrician
  3. Fundal pressure to dislodge the impacted shoulder
  4. McRoberts' manoeuvre with maternal hip hyperflexion Correct answer.

Explanation

McRoberts' manoeuvre is the first-line intervention: hyperflexing the hips rotates the symphysis pubis cephalad and frees the impacted shoulder in about half of cases. Suprapubic pressure is added if it fails, followed by internal rotational manoeuvres. Fundal pressure is contraindicated because it worsens impaction and risks uterine rupture.

Question 27General Obstetrics and Intrapartum Care

A woman at 38 weeks has a generalised tonic-clonic seizure. Her blood pressure is 170/110 mmHg and her reflexes are brisk. Which drug is first-line for controlling the seizure and preventing recurrence?

  1. Intravenous magnesium sulphate with a loading dose Correct answer.
  2. Oral levetiracetam commenced at seizure onset
  3. Intravenous phenytoin with cardiac monitoring
  4. Intravenous diazepam given as a slow bolus

Explanation

Intravenous magnesium sulphate is the drug of choice for eclampsia because it more effectively prevents recurrent seizures than phenytoin or diazepam. A typical regimen is a 4 g loading dose over 20 minutes followed by 1 g/hour for 24 hours, with monitoring of reflexes, respiratory rate and urine output.

Question 28General Obstetrics and Intrapartum Care

In a low-risk woman having a spontaneous vaginal birth, which uterotonic is recommended for routine prophylaxis of postpartum haemorrhage?

  1. Ergometrine 500 micrograms by intravenous injection
  2. Carboprost 250 micrograms by intramuscular injection
  3. Oxytocin 10 IU by intramuscular injection Correct answer.
  4. Misoprostol 800 micrograms by sublingual route

Explanation

Oxytocin 10 IU intramuscularly is the recommended uterotonic for routine third-stage prophylaxis in low-risk births, and it may be given as soon as the anterior shoulder delivers. It is effective, heat-stable and has few contraindications compared with ergometrine and carboprost.

Question 29General Obstetrics and Intrapartum Care

A 28-year-old at 35 weeks has a blood pressure of 158/104 mmHg and 2+ proteinuria. Which additional finding confirms pre-eclampsia with severe features?

  1. Proteinuria of 1+ on dipstick testing
  2. Platelet count of 85 × 10⁹/L Correct answer.
  3. Bilateral ankle oedema
  4. Blood pressure of 152/96 mmHg

Explanation

Pre-eclampsia with severe features is defined by a platelet count below 100 × 10⁹/L in addition to hypertension and proteinuria or other organ dysfunction. Other severe features include blood pressure ≥160/110 mmHg, transaminases over twice normal, creatinine above 97 µmol/L, pulmonary oedema and neurological or visual symptoms.

Question 30General Obstetrics and Intrapartum Care

A nulliparous woman at 40 weeks is 5 cm dilated with thick meconium-stained amniotic fluid. The cardiotocograph is normal. What is the most appropriate management?

  1. Continue labour with continuous fetal monitoring Correct answer.
  2. Immediate caesarean delivery for thick meconium
  3. Intrapartum intravenous antibiotics until cultures are available
  4. Transcervical amnioinfusion to dilute the meconium

Explanation

Thick meconium in term labour with a normal cardiotocograph does not itself mandate caesarean delivery; labour can continue with continuous fetal monitoring and a paediatric team present for airway assessment. Amnioinfusion has not been shown to improve outcomes in this setting, and antibiotics are not indicated without evidence of infection.

Question 31General Obstetrics and Intrapartum Care

A woman at 38 weeks is in labour and is known to be colonised with group B streptococcus. She has no penicillin allergy. What is the recommended intrapartum prophylaxis?

  1. No antibiotic unless membranes have been ruptured over 18 hours
  2. Oral amoxicillin 500 mg four times daily until delivery
  3. Intravenous penicillin G 3 g then 1.5 g every 4 hours Correct answer.
  4. Intravenous gentamicin 5 mg/kg once daily

Explanation

Intrapartum intravenous penicillin G is the first-line prophylaxis for a woman colonised with group B streptococcus and reduces early-onset neonatal disease. A 3 g loading dose followed by 1.5 g every 4 hours until delivery is standard, with ampicillin as an acceptable alternative.

Question 32General Obstetrics and Intrapartum Care

A woman sustains a perineal tear after a forceps delivery. On examination, the anal sphincter complex is torn, with less than 50% of the external anal sphincter thickness involved and an intact internal sphincter. How is this tear classified?

  1. Fourth-degree tear
  2. Third-degree tear, 3b
  3. Second-degree tear
  4. Third-degree tear, 3a Correct answer.

Explanation

A third-degree tear involves the anal sphincter complex: 3a is less than 50% of the external anal sphincter thickness, 3b is more than 50%, and 3c also involves the internal anal sphincter. A fourth-degree tear extends into the anal epithelium.

Question 33General Obstetrics and Intrapartum Care

A woman at 33 weeks with a known major placenta praevia presents with a painless vaginal bleed. She is haemodynamically stable, the fetus is alive and the cardiotocograph is normal. What is the most appropriate initial management?

  1. Immediate caesarean delivery under general anaesthesia after rapid sequence induction
  2. Admission, steroids and caesarean at 36–37 weeks Correct answer.
  3. Artificial rupture of membranes to assess the liquor colour
  4. Gentle digital vaginal examination to assess cervical dilatation

Explanation

A haemodynamically stable woman with a major placenta praevia and a painless bleed is managed expectantly to allow fetal maturation, with corticosteroids and anti-D immunoglobulin if she is Rh-negative. Delivery is usually by caesarean at 36–37 weeks, or sooner for heavy bleeding or fetal compromise. Digital vaginal examination is avoided because it can provoke catastrophic haemorrhage.

Question 34General Obstetrics and Intrapartum Care

A nulliparous woman with epidural analgesia has been at full dilatation for three hours. The fetal head is at station 0 in the occipito-anterior position with moderate caput, and there has been no descent despite adequate contractions. What is the most appropriate management?

  1. Continued pushing for a further hour
  2. Vacuum-assisted vaginal delivery
  3. Caesarean delivery Correct answer.
  4. Oxytocin augmentation of contractions

Explanation

In a nulliparous woman, the second stage is considered prolonged after three hours with epidural analgesia, and arrest with no descent at station 0 indicates caesarean delivery. Continued pushing or oxytocin is unlikely to overcome the mechanical arrest and increases maternal and fetal trauma. Operative vaginal delivery is unsuitable when the head is at station 0 with significant caput and no descent.

Question 35Maternal-Fetal Medicine and High-Risk Obstetrics

Which finding establishes the diagnosis of preeclampsia in a previously normotensive woman at 34 weeks' gestation?

  1. Blood pressure of 130/85 mmHg with ankle oedema at 30 weeks
  2. Blood pressure above 140/90 mmHg on two readings taken before 20 weeks
  3. New hypertension with proteinuria or maternal organ dysfunction Correct answer.
  4. Proteinuria above 300 mg per day with persistently normal blood pressure

Explanation

Preeclampsia is defined as new-onset hypertension after 20 weeks together with proteinuria or evidence of maternal end-organ dysfunction such as thrombocytopenia, renal impairment, liver involvement, pulmonary oedema or visual symptoms. Neither isolated proteinuria nor oedema alone is sufficient, and hypertension documented before 20 weeks suggests chronic hypertension.

Question 36Maternal-Fetal Medicine and High-Risk Obstetrics

At what gestation is routine screening for gestational diabetes recommended for an average-risk pregnant woman?

  1. At the first antenatal visit
  2. Between 24 and 28 weeks Correct answer.
  3. Between 32 and 34 weeks
  4. At 36 weeks, before delivery planning

Explanation

Universal screening for gestational diabetes is performed at 24 to 28 weeks, when the physiological rise in insulin resistance is established and there is still time to treat. Women with risk factors may also be tested earlier in pregnancy.

Question 37Maternal-Fetal Medicine and High-Risk Obstetrics

An unsensitised RhD-negative woman gives birth to an RhD-positive infant. Up to how long after delivery can anti-D immunoglobulin still be given to prevent sensitisation?

  1. 48 hours
  2. 72 hours Correct answer.
  3. 7 days
  4. 24 hours

Explanation

Anti-D immunoglobulin should be given as soon as possible after delivery and is considered effective when administered within 72 hours. A dose sufficient to cover a large fetomaternal haemorrhage is required, and the size of the bleed should be quantified when the fetal Rh status is positive.

Question 38Maternal-Fetal Medicine and High-Risk Obstetrics

What is the accepted normal baseline fetal heart rate on cardiotocography?

  1. 120 to 180 beats per minute
  2. 90 to 110 beats per minute
  3. 110 to 160 beats per minute Correct answer.
  4. 100 to 140 beats per minute

Explanation

A baseline of 110 to 160 beats per minute is normal; below 110 is bradycardia and above 160 is tachycardia. The baseline is the mean rate over a 10-minute window in the absence of accelerations or decelerations.

Question 39Maternal-Fetal Medicine and High-Risk Obstetrics

Which medication reduces the risk of progression to eclampsia in a woman with preeclampsia with severe features?

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

Explanation

Magnesium sulfate is the anticonvulsant of choice for preventing and treating eclamptic seizures and roughly halves the risk of progression to eclampsia. Antihypertensives lower blood pressure but do not prevent seizures, and corticosteroids are given for fetal lung maturity.

Question 40Maternal-Fetal Medicine and High-Risk Obstetrics

A woman whose previous pregnancy was affected by a neural tube defect is planning another pregnancy. Which folic acid dose should she take before conception?

  1. 5 mg weekly
  2. 0.4 mg daily
  3. 4 mg daily Correct answer.
  4. 1 mg daily

Explanation

Women with a previously affected pregnancy should take high-dose folic acid, 4 mg (or 5 mg in some protocols) daily, starting at least one month before conception and continuing through the first trimester. This reduces the recurrence risk of neural tube defects substantially.

Question 41Maternal-Fetal Medicine and High-Risk Obstetrics

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

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

Explanation

Painless antepartum bleeding with a relaxed, non-tender uterus is the classic presentation of placenta praevia, which is confirmed by transvaginal ultrasound. Abruption typically causes pain and a tender, tense uterus, while vasa praevia usually bleeds after membrane rupture with rapid fetal compromise.

Question 42Maternal-Fetal Medicine and High-Risk Obstetrics

Which amniotic fluid index value is diagnostic of oligohydramnios?

  1. Less than 12 cm
  2. Less than 15 cm
  3. Less than 8 cm
  4. Less than 5 cm Correct answer.

Explanation

An amniotic fluid index of 5 cm or less, or a single deepest pocket of 2 cm or less, defines oligohydramnios. Values of 5 to 8 cm are sometimes described as borderline but are not diagnostic.

Question 43Maternal-Fetal Medicine and High-Risk Obstetrics

A woman at 34 weeks and 3 days has blood pressure 168/112 mmHg, platelets 88 × 10⁹/L and right upper quadrant pain. The fetal heart tracing is normal. What is the most appropriate management?

  1. Deliver only if growth restriction develops
  2. Treat with antihypertensives and reassess in one week as an outpatient
  3. Delivery with magnesium sulfate for seizure prophylaxis Correct answer.
  4. Continue expectant management until 37 weeks

Explanation

Preeclampsia with severe features at 34 weeks or beyond is an indication for delivery, because continuing the pregnancy exposes mother and fetus to worsening end-organ injury. Magnesium sulfate is given for seizure prophylaxis and antihypertensives are used for acute severe hypertension.

Question 44Maternal-Fetal Medicine and High-Risk Obstetrics

Which triad characterises HELLP syndrome?

  1. Haematuria, elevated creatinine and low urine output
  2. Haemolysis, elevated liver enzymes and low platelets Correct answer.
  3. Hyperbilirubinaemia, elevated amylase and low fibrinogen
  4. Hypoglycaemia, elevated transaminases and prolonged prothrombin time

Explanation

HELLP is a severe variant of preeclampsia comprising haemolysis (raised lactate dehydrogenase, schistocytes), elevated liver enzymes and thrombocytopenia. It can occur with only mildly raised or even normal blood pressure and mandates urgent assessment and usually delivery.

Question 45Maternal-Fetal Medicine and High-Risk Obstetrics

A woman with gestational diabetes has fasting glucose persistently above 5.5 mmol/L despite dietary advice at 30 weeks. Which is the preferred first-line pharmacological treatment?

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

Explanation

Insulin is the preferred first-line pharmacological agent for gestational diabetes because it does not cross the placenta and reliably achieves glycaemic targets. Oral agents such as metformin are used in some settings but are not considered equivalent first-line therapy.

Question 46Maternal-Fetal Medicine and High-Risk Obstetrics

Between 24 and 32 weeks' gestation, which intervention given to a woman in preterm labour reduces the risk of cerebral palsy in the offspring?

  1. Progesterone supplementation
  2. Magnesium sulfate infusion Correct answer.
  3. Antenatal betamethasone
  4. Nifedipine tocolysis

Explanation

Antenatal magnesium sulfate given when preterm birth before about 32 weeks is anticipated reduces the risk of cerebral palsy and severe motor dysfunction. It is given as an infusion over several hours alongside corticosteroids, which reduce respiratory and other neonatal morbidities but not cerebral palsy.

Question 47Maternal-Fetal Medicine and High-Risk Obstetrics

A woman with antiphospholipid syndrome and three previous second-trimester losses is pregnant. Which treatment reduces further pregnancy loss?

  1. Aspirin plus low-molecular-weight heparin Correct answer.
  2. Intravenous immunoglobulin repeated each trimester
  3. Low-dose aspirin used on its own from conception
  4. Prednisolone 40 mg daily until delivery

Explanation

In antiphospholipid syndrome with recurrent pregnancy loss, low-dose aspirin combined with prophylactic heparin or low-molecular-weight heparin significantly improves live-birth rates. Aspirin alone is insufficient, and routine corticosteroids add maternal morbidity without proven benefit.

Question 48Maternal-Fetal Medicine and High-Risk Obstetrics

In a monochorionic diamniotic twin pregnancy at 20 weeks, which combination of ultrasound findings suggests twin-twin transfusion syndrome?

  1. Polyhydramnios in both sacs with a single placental mass
  2. Oligohydramnios in one sac and polyhydramnios in the other Correct answer.
  3. Both twins with oligohydramnios
  4. Discordant growth with normal amniotic fluid in both sacs

Explanation

Twin-twin transfusion syndrome is diagnosed in monochorionic diamniotic twins when one sac has a deepest vertical pocket of 8 cm or more and the other has 2 cm or less. The underlying cause is an unbalanced placental vascular anastomosis.

Question 49Maternal-Fetal Medicine and High-Risk Obstetrics

A 30-week fetus has an estimated weight below the 3rd centile with absent end-diastolic flow in the umbilical artery. The cardiotocograph is normal and the mother is well. What is the most appropriate next step?

  1. Discharge with twice-weekly outpatient ultrasound surveillance
  2. Induce labour with oxytocin
  3. Immediate caesarean section
  4. Admit for steroids and close monitoring Correct answer.

Explanation

Absent end-diastolic flow in the umbilical artery identifies a growth-restricted fetus at high risk of deterioration, so inpatient surveillance, antenatal corticosteroids and serial Doppler and cardiotocographic assessment are indicated. Delivery is then timed according to Doppler progression, usually around 32 to 34 weeks if flow reverses or other abnormalities appear.

Question 50Maternal-Fetal Medicine and High-Risk Obstetrics

Which manoeuvre is performed first in the management of shoulder dystocia?

  1. Zavanelli manoeuvre
  2. Delivery of the posterior arm
  3. McRoberts' manoeuvre Correct answer.
  4. Symphysiotomy

Explanation

McRoberts' manoeuvre, hyperflexing the mother's thighs onto her abdomen, is the first-line manoeuvre and relieves about half of cases by rotating the symphysis pubis. Suprapubic pressure is then added, followed by internal rotational manoeuvres and finally the more invasive procedures.