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FRANZCOG Written MCQ study materials
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FRANZCOG Written MCQ practice questions

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Question 1Obstetrics

A woman at 39 weeks gestation has a confirmed intrauterine fetal death. Which management option is most appropriate for induction of labour?

  1. Prostaglandin E1 analogue with concurrent oxytocin infusion
  2. Immediate caesarean section under general anaesthesia
  3. Expectant management for up to two weeks before induction
  4. Low-dose vaginal misoprostol combined with a cervical ripening balloon as needed Correct answer.

Explanation

Induction of labour after intrauterine fetal death is typically achieved with vaginal misoprostol, and mechanical methods such as a transcervical balloon can be added if the cervix is unfavourable. Concurrent oxytocin may be used later, but PGE1 analogues are not standard for this indication because of tachysystole and uterine rupture concerns.

Question 2Obstetrics

Which finding on a cardiotocograph is classified as a normal baseline feature?

  1. Baseline variability of 3 beats per minute
  2. Baseline variability of 8 beats per minute Correct answer.
  3. Baseline rate of 115 beats per minute
  4. Baseline rate of 165 beats per minute

Explanation

A normal baseline fetal heart rate is between 110 and 160 beats per minute, and normal variability is between 5 and 25 beats per minute. A variability of 8 beats per minute therefore falls within the normal range and is a reassuring feature.

Question 3Obstetrics

A nulliparous woman at 34 weeks has a singleton pregnancy with a fundal placenta and painless vaginal bleeding. Which initial step is most appropriate?

  1. Routine discharge home with outpatient follow-up
  2. Digital vaginal examination to assess cervical dilatation
  3. Corticosteroid administration and maternal stabilisation with monitoring Correct answer.
  4. Immediate caesarean delivery regardless of fetal status

Explanation

Painless vaginal bleeding in the second half of pregnancy suggests placenta praevia until proven otherwise. Initial management involves maternal stabilisation, blood group and crossmatch, fetal monitoring, and antenatal corticosteroids if preterm delivery is likely, while avoiding digital examination.

Question 4Obstetrics

Which parameter is the most reliable single indicator of fetal acid-base status at birth?

  1. One-minute Apgar score
  2. Umbilical artery base deficit Correct answer.
  3. Umbilical vein pH
  4. Birth weight percentile

Explanation

Umbilical artery base deficit reflects the cumulative metabolic acid load in the fetus and correlates better with hypoxic injury than pH alone. Apgar scores are influenced by many factors including prematurity and sedation, and venous blood reflects placental rather than fetal status.

Question 5Obstetrics

A woman at 36 weeks has a blood pressure of 150/95 mmHg on two occasions with 2+ proteinuria and a normal platelet count. Which diagnosis is most consistent with these findings?

  1. Eclampsia
  2. Pre-eclampsia without severe features Correct answer.
  3. Gestational hypertension without proteinuria
  4. Chronic hypertension with superimposed pre-eclampsia

Explanation

New hypertension after 20 weeks with proteinuria but no severe features meets the criteria for pre-eclampsia without severe features. Eclampsia requires seizures, and chronic hypertension would have been present before 20 weeks.

Question 6Obstetrics

Which medication is the first-line treatment for prevention of eclamptic seizures in a woman with severe pre-eclampsia?

  1. Oral labetalol
  2. Oral nifedipine
  3. Intravenous magnesium sulfate Correct answer.
  4. Intravenous hydralazine

Explanation

Magnesium sulfate is the anticonvulsant of choice for prevention and treatment of eclamptic seizures. Antihypertensives such as nifedipine, hydralazine, and labetalol lower blood pressure but do not prevent seizures.

Question 7Obstetrics

A woman at 32 weeks presents with a confirmed deep vein thrombosis. Which anticoagulant regimen is most appropriate?

  1. Warfarin adjusted to INR
  2. Unfractionated heparin at prophylactic dose
  3. Aspirin 150 mg daily
  4. Low molecular weight heparin at therapeutic dose Correct answer.

Explanation

Therapeutic low molecular weight heparin is the standard treatment for venous thromboembolism in pregnancy because it does not cross the placenta and has a predictable dose response. Warfarin is teratogenic, aspirin is inadequate for treatment, and prophylactic dosing is insufficient for established thrombosis.

Question 8Obstetrics

Which factor is most strongly associated with an increased risk of preterm birth?

  1. Previous preterm birth Correct answer.
  2. Male fetal sex
  3. Maternal age of 30 years
  4. Gestational diabetes controlled by diet

Explanation

A history of spontaneous preterm birth is one of the strongest predictors of recurrence, with recurrence rates rising with the number of prior preterm deliveries. Other listed factors are either weak or not established risk factors.

Question 9Obstetrics

A woman at 28 weeks has a cervical length of 20 mm on transvaginal ultrasound and a previous spontaneous preterm birth. Which intervention reduces the risk of recurrent preterm birth?

  1. Bed rest until delivery
  2. Routine antibiotics for the remainder of pregnancy
  3. Cervical cerclage in all cases
  4. Vaginal progesterone Correct answer.

Explanation

Vaginal progesterone is recommended for women with a short cervix, and the benefit is greatest in those with a prior preterm birth. Cerclage is considered in selected cases, but not universally, and bed rest has not been shown to be effective.

Question 10Obstetrics

A woman at 41 weeks with an uncomplicated singleton pregnancy is counselled about induction of labour. Which statement best reflects current evidence?

  1. Expectant management beyond 42 weeks has no associated risks
  2. Induction at 41 weeks reduces perinatal mortality compared with expectant management Correct answer.
  3. Induction at 41 weeks increases the caesarean section rate compared with expectant management
  4. Induction should be delayed until 43 weeks in all women

Explanation

Induction of labour at or after 41 weeks reduces perinatal mortality and meconium aspiration compared with expectant management, and does not increase caesarean delivery. Expectant management beyond 42 weeks carries increasing risks of stillbirth and fetal compromise.

Question 11Obstetrics

Which finding is characteristic of a uterine rupture during trial of labour after caesarean section?

  1. Gradual onset of maternal hypertension
  2. Increased fetal heart rate variability
  3. Copious clear vaginal discharge
  4. Sudden prolonged fetal bradycardia with loss of station Correct answer.

Explanation

Uterine rupture typically presents with sudden fetal bradycardia or prolonged deceleration, loss of station, and abdominal pain, often accompanied by maternal tachycardia and hypotension. Hypertension and increased variability are not features.

Question 12Obstetrics

Which organism is the most common cause of early-onset neonatal sepsis?

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

Explanation

Group B Streptococcus remains the leading cause of early-onset neonatal sepsis in settings with intrapartum antibiotic prophylaxis. Escherichia coli is the second most common and is more often associated with preterm infants.

Question 13Obstetrics

A woman at 30 weeks has a singleton pregnancy with a cervical length of 25 mm and no prior preterm birth. Which management is most appropriate?

  1. Immediate cervical cerclage
  2. Routine tocolysis at this gestation
  3. Elective caesarean section at 34 weeks
  4. Vaginal progesterone therapy Correct answer.

Explanation

Vaginal progesterone is recommended for women with a short cervix (less than 25 mm) on transvaginal ultrasound, even without a prior preterm birth. Cerclage is not indicated in the absence of a prior preterm birth or cervical insufficiency.

Question 14Obstetrics

Which condition is associated with the highest risk of developing gestational diabetes mellitus?

  1. Multiparous woman with no prior complications
  2. Maternal age of 25 years
  3. Previous macrosomic infant Correct answer.
  4. Normal pre-pregnancy body mass index

Explanation

A history of a previous macrosomic infant is a recognised strong risk factor for gestational diabetes, along with obesity, previous gestational diabetes, and family history. Young maternal age and normal body mass index reduce risk.

Question 15Obstetrics

A woman at 37 weeks with a singleton pregnancy has a fetus in the persistent occipitotransverse position during the second stage of labour. Which manoeuvre is most appropriate to correct the malposition?

  1. Increase oxytocin to augment contractions
  2. Apply fundal pressure during contractions
  3. Perform manual rotation of the fetal head Correct answer.
  4. Encourage the woman to lie supine

Explanation

Manual rotation of the fetal head is a recognised manoeuvre to correct persistent occipitotransverse or occipitoposterior positions in the second stage. Fundal pressure is unsafe, and supine positioning does not correct malposition.

Question 16Obstetrics

Which finding on a cardiotocograph is classified as a category III (abnormal) tracing?

  1. Baseline 150 beats per minute with early decelerations
  2. Moderate variability with a single variable deceleration
  3. Baseline 140 beats per minute with variability of 10 beats per minute
  4. Absent variability with recurrent late decelerations Correct answer.

Explanation

Absent baseline variability combined with recurrent late decelerations meets category III criteria, indicating a high probability of fetal acidaemia and requiring urgent intervention. Early decelerations and moderate variability are reassuring features.

Question 17Obstetrics

A woman with a previous caesarean section is considering a trial of labour. Which factor most strongly increases the risk of uterine rupture?

  1. Induction of labour with prostaglandins Correct answer.
  2. Spontaneous onset of labour
  3. Single previous low transverse caesarean
  4. Prior vaginal delivery after caesarean

Explanation

Induction with prostaglandins, particularly misoprostol, significantly increases the risk of uterine rupture in women with a prior caesarean. A single low transverse scar with prior vaginal delivery and spontaneous labour carries a lower risk.

Question 18Obstetrics

Which screening test is recommended for gestational diabetes at 24 to 28 weeks in a woman with a body mass index of 32?

  1. Urine glucose dipstick
  2. 75 g oral glucose tolerance test Correct answer.
  3. Random plasma glucose only
  4. Glycated haemoglobin measurement

Explanation

A 75 g oral glucose tolerance test is the recommended screening test for gestational diabetes in women with risk factors such as obesity. Glycated haemoglobin is not sufficiently sensitive, and random glucose or urine dipstick are unreliable for diagnosis.

Question 19Obstetrics

A woman at 20 weeks has a singleton pregnancy with a low-lying placenta. Which management is most appropriate?

  1. Digital vaginal examination at every visit
  2. Intercourse restriction for the remainder of pregnancy
  3. Repeat ultrasound in the third trimester Correct answer.
  4. Immediate caesarean delivery

Explanation

Most low-lying placentas identified at the mid-trimester ultrasound resolve as the uterus grows. A repeat ultrasound in the third trimester is appropriate to confirm placental position before delivery planning.

Question 20Obstetrics

Which finding is most suggestive of a molar pregnancy on ultrasound?

  1. A snowstorm appearance with multiple cystic spaces Correct answer.
  2. An empty gestational sac with a thin decidual reaction
  3. A single viable fetus with normal anatomy
  4. A thickened placenta with normal fetal growth

Explanation

A complete hydatidiform mole typically appears as a heterogeneous mass with multiple cystic spaces described as a snowstorm pattern. A normal viable fetus with normal anatomy is not consistent with a molar pregnancy.

Question 21Obstetrics

A woman at 26 weeks has a blood pressure of 160/110 mmHg and a platelet count of 90 x 10^9/L with elevated liver enzymes. Which feature defines this as pre-eclampsia with severe features?

  1. Gestational age of 26 weeks
  2. Blood pressure of 160/110 mmHg Correct answer.
  3. Normal fetal growth
  4. Absence of proteinuria

Explanation

Severe hypertension (systolic at least 160 mmHg or diastolic at least 110 mmHg) is a severe feature of pre-eclampsia, as are thrombocytopenia and elevated liver enzymes. Gestational age and fetal growth are not defining features.

Question 22Obstetrics

Which intervention is recommended for prevention of early-onset group B streptococcal disease in a woman with a previous infant affected by invasive GBS disease?

  1. Intrapartum intravenous penicillin Correct answer.
  2. Routine caesarean section
  3. No prophylaxis is required
  4. Oral amoxicillin in the third trimester

Explanation

Intrapartum intravenous penicillin is recommended for women with a previous infant affected by invasive GBS disease, regardless of current colonisation status. Oral antibiotics do not reliably eradicate colonisation or prevent neonatal disease.

Question 23Obstetrics

Which statement about the physiology of the third stage of labour is correct?

  1. Uterine contraction and retraction compress spiral arteries to achieve haemostasis Correct answer.
  2. Placental separation is primarily driven by maternal Valsalva effort
  3. Uterine blood flow increases after placental separation
  4. Cervical dilatation continues to increase after placental delivery

Explanation

After placental separation, uterine contraction and retraction compress the spiral arteries and limit bleeding from the placental bed. Uterine blood flow decreases after delivery, and placental separation is driven by myometrial contraction rather than maternal effort.

Question 24Obstetrics

A woman at 34 weeks has a singleton pregnancy with ruptured membranes and no contractions. Which management is most appropriate?

  1. Tocolysis for 48 hours followed by discharge
  2. Immediate caesarean section
  3. Induction of labour with oxytocin immediately
  4. Antenatal corticosteroids and antibiotics with expectant management Correct answer.

Explanation

For preterm prelabour rupture of membranes at 34 weeks, antenatal corticosteroids and antibiotics with expectant management until 37 weeks are recommended. Immediate delivery is not required in the absence of infection or fetal compromise.

Question 25Obstetrics

Which condition is most likely to cause a prolonged second stage of labour in a nulliparous woman?

  1. Previous caesarean section
  2. Mild anaemia
  3. Occipitoposterior position Correct answer.
  4. Gestational diabetes

Explanation

Occipitoposterior position is a common cause of prolonged second stage because the fetal head must rotate further to negotiate the pelvis. Gestational diabetes, mild anaemia, and a previous caesarean scar are not direct causes of prolonged second stage.

Question 26Obstetrics

A 24-year-old primigravida at 39 weeks has a spontaneous onset of labour. She progresses normally to full dilatation. After 45 minutes of active pushing, the fetal head is at the level of the ischial spines, with a small caput succedaneum. The fetal heart rate is 140 bpm with normal variability. What is the most appropriate next step in management?

  1. Perform a symphysiotomy
  2. Perform an immediate caesarean section
  3. Apply vacuum extraction
  4. Continue pushing and reassess in 30 minutes Correct answer.

Explanation

For a nulliparous woman in the second stage, active pushing of less than one hour with a reassuring fetal status and descent is normal; continued pushing with reassessment is appropriate. Operative delivery is reserved for prolonged second stage or fetal compromise. Symphysiotomy is not performed in modern obstetrics.

Question 27Obstetrics

A 30-year-old woman at 28 weeks gestation presents with a blood pressure of 150/100 mmHg and 3+ proteinuria on dipstick. She has no symptoms. Which diagnosis is most likely?

  1. Acute fatty liver of pregnancy
  2. Gestational hypertension
  3. Chronic hypertension
  4. Pre-eclampsia Correct answer.

Explanation

Pre-eclampsia is defined as new-onset hypertension after 20 weeks gestation accompanied by proteinuria or other end-organ dysfunction. This woman has both hypertension and significant proteinuria. Gestational hypertension lacks proteinuria, and chronic hypertension would have been present before 20 weeks.

Question 28Obstetrics

A 32-year-old woman at 34 weeks gestation with a singleton pregnancy presents with a history of a low-lying placenta on her 20-week scan. A repeat ultrasound at 34 weeks shows the placental edge 1 cm from the internal os. She is asymptomatic. What is the most appropriate management?

  1. Repeat ultrasound at 36 weeks
  2. Plan caesarean section at 37 weeks Correct answer.
  3. Allow vaginal delivery
  4. Perform amniocentesis

Explanation

A placental edge less than 2 cm from the internal os at 34 weeks is considered a low-lying placenta that may require caesarean delivery. Guidelines recommend caesarean section for a placenta within 2 cm of the os at term. Repeat ultrasound is not necessary as the diagnosis is established.

Question 29Obstetrics

A 28-year-old woman at 39 weeks gestation is in the active phase of labour. She has a fever of 38.5°C, uterine tenderness, and foul-smelling amniotic fluid. The fetal heart rate is 170 bpm with minimal variability. What is the most likely diagnosis?

  1. Puerperal sepsis
  2. Endometritis
  3. Chorioamnionitis Correct answer.
  4. Urinary tract infection

Explanation

Chorioamnionitis (intra-amniotic infection) presents with maternal fever, uterine tenderness, foul-smelling amniotic fluid, and fetal tachycardia. Endometritis occurs postpartum, and puerperal sepsis is a broader term for postpartum infection. Urinary tract infection would not cause foul-smelling amniotic fluid or uterine tenderness.

Question 30Obstetrics

A 35-year-old woman at 36 weeks gestation has a singleton pregnancy and a body mass index of 35. She has no other risk factors. Which intrapartum complication is she at increased risk of?

  1. Uterine rupture
  2. Shoulder dystocia Correct answer.
  3. Placental abruption
  4. Cord prolapse

Explanation

Maternal obesity is a risk factor for fetal macrosomia, which increases the risk of shoulder dystocia. Uterine rupture, cord prolapse, and placental abruption are not primarily associated with obesity alone. Therefore, shoulder dystocia is the most likely complication among the options.

Question 31Obstetrics

A 30-year-old woman at 28 weeks gestation presents with a blood pressure of 160/110 mmHg and 3+ proteinuria. She is diagnosed with severe pre-eclampsia. Which medication is most appropriate for seizure prophylaxis?

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

Explanation

Magnesium sulfate is the drug of choice for prevention and treatment of eclamptic seizures in severe pre-eclampsia. It is more effective than diazepam or phenytoin. Labetalol is used for blood pressure control, not seizure prophylaxis.

Question 32Obstetrics

A 32-year-old woman at 34 weeks gestation with a singleton pregnancy presents with spontaneous rupture of membranes. She has no contractions and a normal fetal heart rate pattern. What is the most appropriate management?

  1. Caesarean section
  2. Amnioinfusion
  3. Expectant management with antibiotics and corticosteroids Correct answer.
  4. Immediate induction of labour

Explanation

For preterm prelabour rupture of membranes (PPROM) at 34 weeks, expectant management with antibiotics and corticosteroids is recommended to reduce neonatal morbidity. Immediate delivery is considered if there is evidence of infection or fetal compromise. Caesarean section is not indicated solely for PPROM.

Question 33Obstetrics

A 28-year-old woman at 20 weeks gestation has a routine ultrasound that shows a “snowstorm” appearance and no fetal parts. Her beta-hCG level is markedly elevated. What is the most likely diagnosis?

  1. Missed miscarriage
  2. Complete hydatidiform mole Correct answer.
  3. Partial hydatidiform mole
  4. Twin pregnancy

Explanation

A complete hydatidiform mole typically presents with a “snowstorm” ultrasound appearance, absence of fetal parts, and markedly elevated beta-hCG. Partial moles may show some fetal parts. Missed miscarriage would not show a snowstorm pattern or such high beta-hCG.

Question 34Obstetrics

A 30-year-old woman at 38 weeks gestation is in the second stage of labour. The fetal head is visible at the introitus, and the perineum is stretching. Which manoeuvre is most appropriate to prevent perineal trauma?

  1. Manual perineal protection Correct answer.
  2. Kristeller manoeuvre
  3. Fundal pressure
  4. Episiotomy

Explanation

Manual perineal protection (such as the Finnish manoeuvre) during the second stage has been shown to reduce the incidence of obstetric anal sphincter injuries. Fundal pressure and Kristeller manoeuvre are not recommended. Episiotomy is not routinely performed for prevention of trauma.

Question 35Obstetrics

A 26-year-old woman at 12 weeks gestation has a history of recurrent pregnancy loss. She is found to have a bicornuate uterus on ultrasound. Which complication is she at increased risk of?

  1. Preterm birth Correct answer.
  2. Preeclampsia
  3. Gestational diabetes
  4. Placenta praevia

Explanation

Müllerian anomalies such as a bicornuate uterus are associated with an increased risk of preterm birth, miscarriage, and malpresentation. Gestational diabetes, placenta praevia, and preeclampsia are not specifically linked to uterine anomalies. Therefore, preterm birth is the most likely complication.

Question 36Obstetrics

A 34-year-old woman at 28 weeks gestation presents with a blood pressure of 160/110 mmHg and a platelet count of 90 x 10^9/L. She has elevated liver enzymes and right upper quadrant pain. Which diagnosis is most likely?

  1. Thrombotic thrombocytopenic purpura
  2. HELLP syndrome Correct answer.
  3. Gallstone disease
  4. Acute fatty liver of pregnancy

Explanation

HELLP syndrome is characterised by haemolysis, elevated liver enzymes, and low platelets, often with right upper quadrant pain. Acute fatty liver typically presents with hypoglycaemia and coagulopathy. Thrombotic thrombocytopenic purpura and gallstone disease do not typically present with this triad.

Question 37Obstetrics

A 30-year-old woman at 39 weeks gestation is in labour. She has a history of a previous caesarean section for breech presentation. She is now in the active phase of labour with a reassuring fetal heart rate. Which factor most strongly increases her risk of uterine rupture?

  1. Previous vaginal delivery
  2. Epidural analgesia
  3. Induction of labour with prostaglandins Correct answer.
  4. Oxytocin augmentation

Explanation

Induction of labour with prostaglandins in a woman with a previous caesarean section significantly increases the risk of uterine rupture. Oxytocin augmentation also increases risk but less so than prostaglandins. Epidural analgesia and previous vaginal delivery do not increase the risk.

Question 38Obstetrics

A 28-year-old woman at 30 weeks gestation has a singleton pregnancy and a cervical length of 25 mm on transvaginal ultrasound. She has no history of preterm birth. Which management is most appropriate?

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

Explanation

A short cervical length (<25 mm) in a singleton pregnancy without prior preterm birth is an indication for vaginal progesterone to reduce the risk of preterm birth. Cervical cerclage is not indicated without a history of preterm birth. Bed rest is not recommended.

Question 39Obstetrics

A 32-year-old woman at 41 weeks gestation with a singleton pregnancy is undergoing induction of labour. Which method is most appropriate for cervical ripening if the Bishop score is 4?

  1. Dinoprostone vaginal insert Correct answer.
  2. Oxytocin infusion
  3. Membrane sweep
  4. Amniotomy

Explanation

For an unfavourable cervix (Bishop score ≤6), prostaglandin analogues such as dinoprostone are recommended for cervical ripening. Oxytocin and amniotomy are used when the cervix is favourable. Membrane sweep is a adjunct but not sufficient for ripening.

Question 40Obstetrics

A 34-year-old woman at 36 weeks gestation presents with a blood pressure of 150/100 mmHg and 2+ proteinuria. She has a history of chronic hypertension. Which diagnosis is most likely?

  1. Gestational hypertension
  2. Superimposed pre-eclampsia Correct answer.
  3. Chronic hypertension
  4. White coat hypertension

Explanation

Superimposed pre-eclampsia is diagnosed when a woman with chronic hypertension develops new proteinuria or worsening hypertension after 20 weeks. Gestational hypertension lacks proteinuria. Chronic hypertension alone would not explain the new proteinuria.

Question 41Obstetrics

A 28-year-old woman at 38 weeks gestation is in the second stage of labour. The fetal head is at +2 station and the fetal heart rate shows recurrent late decelerations. Which intervention is most appropriate?

  1. Operative vaginal delivery Correct answer.
  2. Tocolytic administration
  3. Fundal pressure
  4. Continue pushing

Explanation

Recurrent late decelerations indicate fetal hypoxia and require expedited delivery. At +2 station, operative vaginal delivery with vacuum or forceps is appropriate if criteria are met. Continuing pushing or fundal pressure would worsen hypoxia. Tocolytics are not indicated in this scenario.

Question 42Obstetrics

A 30-year-old woman at 24 weeks gestation has a routine ultrasound that shows a shortened cervix of 20 mm. She has a history of a previous preterm birth at 28 weeks. Which management is most appropriate?

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

Explanation

A history of preterm birth and a short cervical length (<25 mm) at 24 weeks is an indication for cervical cerclage. Vaginal progesterone is an alternative but cerclage is preferred in this high-risk group. Bed rest and pessary are not first-line.

Question 43Obstetrics

A 32-year-old woman at 40 weeks gestation is in the first stage of labour. She has a fever of 38.0°C and the fetal heart rate is 160 bpm. Which investigation is most appropriate to confirm the diagnosis of chorioamnionitis?

  1. Clinical diagnosis is sufficient Correct answer.
  2. Placental histology
  3. Maternal blood cultures
  4. Amniocentesis for culture

Explanation

Chorioamnionitis is a clinical diagnosis based on maternal fever and at least two of: uterine tenderness, foul-smelling amniotic fluid, fetal tachycardia, or maternal tachycardia. Amniocentesis, blood cultures, and placental histology are not routinely needed for diagnosis. Therefore, clinical diagnosis is sufficient.

Question 44Obstetrics

A 28-year-old woman at 34 weeks gestation presents with a blood pressure of 170/110 mmHg and a platelet count of 80 x 10^9/L. She has a headache and visual disturbances. Which medication is most appropriate for blood pressure control?

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

Explanation

Labetalol is a first-line antihypertensive for severe hypertension in pregnancy. Methyldopa is used for chronic hypertension but is less effective for acute severe hypertension. Nifedipine and hydralazine are also used but labetalol is often preferred.

Question 45Obstetrics

A 30-year-old woman at 38 weeks gestation is in the second stage of labour. The fetal head is at +3 station and the fetal heart rate shows a prolonged deceleration to 80 bpm. Which intervention is most appropriate?

  1. Perform fetal scalp stimulation
  2. Administer oxygen
  3. Change maternal position
  4. Expedite delivery Correct answer.

Explanation

A prolonged deceleration to 80 bpm indicates acute fetal compromise and requires expedited delivery. Changing position and oxygen are initial measures but do not address the need for urgent delivery. Fetal scalp stimulation is not appropriate during a prolonged deceleration.

Question 46Obstetrics

A 28-year-old woman at 28 weeks gestation has a singleton pregnancy and a cervical length of 10 mm. She has no history of preterm birth. Which management is most appropriate?

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

Explanation

Vaginal progesterone is recommended for women with a short cervix (<25 mm) without a history of preterm birth. Cerclage is not indicated without prior preterm birth. Bed rest is not effective.

Question 47Obstetrics

A 32-year-old woman at 39 weeks gestation is in labour. She has a history of a previous caesarean section for failure to progress. She is now in the active phase with a reassuring fetal heart rate. Which factor most strongly increases her risk of uterine rupture?

  1. Oxytocin augmentation
  2. Previous vaginal delivery
  3. Epidural analgesia
  4. Induction with prostaglandins Correct answer.

Explanation

Prostaglandin induction in women with a previous caesarean section is associated with the highest risk of uterine rupture. Oxytocin also increases risk but less so. Epidural and previous vaginal delivery do not increase risk.

Question 48Obstetrics

A 30-year-old woman at 36 weeks gestation presents with a blood pressure of 160/110 mmHg and 3+ proteinuria. She has a headache and visual changes. Which medication is most appropriate for seizure prophylaxis?

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

Explanation

Magnesium sulfate is the drug of choice for prevention and treatment of eclamptic seizures in severe pre-eclampsia. It is more effective than diazepam or phenytoin. Labetalol is for blood pressure control.

Question 49Obstetrics

A 28-year-old woman at 34 weeks gestation presents with a blood pressure of 150/100 mmHg and 2+ proteinuria. She has no symptoms. Which diagnosis is most likely?

  1. Acute fatty liver of pregnancy
  2. Chronic hypertension
  3. Pre-eclampsia Correct answer.
  4. Gestational hypertension

Explanation

Pre-eclampsia is new-onset hypertension after 20 weeks with proteinuria. This woman has both. Gestational hypertension lacks proteinuria. Chronic hypertension would be pre-existing.

Question 50Obstetrics

A 32-year-old woman at 38 weeks gestation is in the second stage of labour. The fetal head is at +2 station and the fetal heart rate shows recurrent late decelerations. Which intervention is most appropriate?

  1. Fundal pressure
  2. Operative vaginal delivery Correct answer.
  3. Tocolytic administration
  4. Continue pushing

Explanation

Recurrent late decelerations indicate fetal hypoxia and require expedited delivery. At +2 station, operative vaginal delivery is appropriate. Continuing pushing or fundal pressure would worsen hypoxia.