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EFOG-EBCOG Part 1 study materials
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EFOG-EBCOG Part 1 practice questions

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Question 1Obstetrics

A woman at 34 weeks' gestation has a blood pressure of 158/112 mmHg on two occasions four hours apart with 3+ proteinuria. Which diagnosis best fits this presentation?

  1. Gestational hypertension
  2. Chronic hypertension with superimposed pre-eclampsia
  3. Severe pre-eclampsia Correct answer.
  4. Eclampsia

Explanation

Pre-eclampsia is defined as new hypertension after 20 weeks plus proteinuria or maternal organ dysfunction. Blood pressure of 160/110 mmHg or above, or heavy proteinuria, places a woman in the severe category. There are no seizures, so eclampsia is excluded.

Question 2Obstetrics

Which finding is most characteristic of a complete hydatidiform mole rather than a partial mole?

  1. Triploid karyotype
  2. Presence of a fetus or fetal parts
  3. Focal trophoblastic proliferation
  4. Diffuse hydropic swelling of all villi with absent fetal tissue Correct answer.

Explanation

A complete mole is diploid, usually 46XX of paternal origin, with generalised hydropic change of all villi and no fetal tissue. Partial moles are triploid with focal swelling and often a malformed fetus.

Question 3Obstetrics

A woman at 32 weeks presents with painless vaginal bleeding; ultrasound shows the placenta covering the internal cervical os. Which initial management step is most appropriate once she is haemodynamically stable?

  1. Oxytocin infusion to expedite delivery
  2. Digital vaginal examination to assess dilatation
  3. Corticosteroids for fetal lung maturity and admission for observation Correct answer.
  4. Immediate amniotomy

Explanation

In placenta praevia, digital vaginal examination is contraindicated because it may provoke catastrophic haemorrhage. A stable preterm woman is admitted, given antenatal corticosteroids, and delivery is planned according to bleeding and fetal status.

Question 4Obstetrics

Which organism is the most common cause of early-onset neonatal sepsis following prolonged rupture of membranes?

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

Explanation

Group B Streptococcus (Streptococcus agalactiae) is the leading cause of early-onset neonatal sepsis, particularly after prolonged rupture of membranes. Intrapartum antibiotic prophylaxis is offered to colonised women.

Question 5Obstetrics

A woman at 28 weeks reports reduced fetal movements. Cardiotocography shows a sinusoidal pattern. What is the most appropriate next step?

  1. Repeat CTG in one week
  2. Reassurance and discharge home
  3. Urgent further assessment and consideration of delivery Correct answer.
  4. Oral glucose tolerance test

Explanation

A true sinusoidal pattern is a non-reassuring sign associated with severe fetal anaemia or hypoxia. It warrants urgent evaluation, including ultrasound and consideration of delivery.

Question 6Obstetrics

Which of the following is the most reliable method for confirming rupture of membranes when the diagnosis is uncertain?

  1. Sterile speculum examination with pooling of fluid Correct answer.
  2. Maternal history of a gush of fluid
  3. Maternal temperature measurement
  4. Abdominal palpation

Explanation

Sterile speculum examination demonstrating pooling of amniotic fluid in the posterior fornix is a reliable sign of membrane rupture. History alone is unreliable, and digital examination increases infection risk.

Question 7Obstetrics

A woman at 36 weeks has an ultrasound showing a fetus with an estimated weight below the 10th centile and abnormal umbilical artery Doppler. Which statement best describes the appropriate management?

  1. Immediate caesarean section regardless of gestational age
  2. Reassurance that this is constitutional smallness
  3. Maternal bed rest as the only intervention
  4. Closer surveillance with consideration of delivery if Doppler worsens Correct answer.

Explanation

Fetal growth restriction with abnormal umbilical artery Doppler indicates increased risk of hypoxia and stillbirth. Management involves intensified surveillance and timed delivery when deterioration is detected.

Question 8Obstetrics

Which of the following best describes the mechanism of action of magnesium sulphate in the prevention of eclampsia?

  1. It increases platelet aggregation
  2. It stimulates uterine contractions
  3. It lowers blood pressure by blocking calcium channels
  4. It acts as a cerebral vasodilator and NMDA receptor antagonist Correct answer.

Explanation

Magnesium sulphate reduces seizure risk through cerebral vasodilatation and antagonism at NMDA receptors. It is not primarily used as an antihypertensive agent.

Question 9Obstetrics

A woman at 38 weeks has a prolonged second stage. Which finding on fetal blood sampling would most strongly indicate the need for expedited delivery?

  1. Lactate 4.0 mmol/L
  2. pH 7.22
  3. pH 7.15 Correct answer.
  4. pH 7.28

Explanation

A fetal scalp pH below 7.20 is regarded as abnormal, and below 7.15 indicates significant acidosis warranting expedited delivery. Values of 7.20–7.25 are borderline and require repeat sampling.

Question 10Obstetrics

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

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

Explanation

Uterine atony accounts for the majority of primary postpartum haemorrhage. Trauma, retained products and coagulopathy are less frequent causes but must be considered.

Question 11Obstetrics

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

  1. Spontaneous onset of labour
  2. Induction of labour with prostaglandins Correct answer.
  3. Maternal age under 30
  4. Single previous lower-segment caesarean

Explanation

Induction with prostaglandins, particularly in a woman with a prior caesarean, increases the risk of uterine rupture compared with spontaneous labour. A single lower-segment scar carries the lowest risk.

Question 12Obstetrics

Which of the following is the most appropriate first-line treatment for a woman with hyperemesis gravidarum who is dehydrated and unable to tolerate oral intake?

  1. Oral rehydration salts only
  2. Immediate termination of pregnancy
  3. Intravenous fluids with antiemetics and thiamine supplementation Correct answer.
  4. High-dose corticosteroids

Explanation

Hyperemesis gravidarum with dehydration requires intravenous fluid replacement, antiemetics and thiamine to prevent Wernicke's encephalopathy. Corticosteroids are reserved for refractory cases.

Question 13Obstetrics

Which of the following best describes the pathophysiology of gestational diabetes mellitus?

  1. Insulin resistance driven by placental hormones such as human placental lactogen Correct answer.
  2. Excess glucagon secretion from a pancreatic tumour
  3. Absolute deficiency of insulin due to beta-cell destruction
  4. Increased insulin sensitivity in pregnancy

Explanation

Pregnancy induces insulin resistance through placental hormones including human placental lactogen, cortisol and progesterone. Gestational diabetes arises when pancreatic reserve cannot meet this increased demand.

Question 14Obstetrics

A woman at 26 weeks presents with a cervix dilated to 3 cm and membranes bulging. Which intervention has the strongest evidence for reducing the risk of preterm delivery in this situation?

  1. Progesterone supplementation
  2. Cervical cerclage Correct answer.
  3. Antibiotics alone
  4. Vaginal pessary

Explanation

In women with painless cervical dilatation in the second trimester, cervical cerclage reduces preterm birth. Vaginal pessaries and progesterone have roles in other clinical scenarios.

Question 15Obstetrics

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

  1. Nulliparity
  2. Multiple gestation
  3. Previous caesarean deliveries with placenta praevia Correct answer.
  4. Maternal smoking

Explanation

Placenta accreta spectrum is strongly associated with prior caesarean delivery combined with placenta praevia. The risk rises with the number of previous caesareans.

Question 16Obstetrics

A woman at 30 weeks has a deep vein thrombosis confirmed on ultrasound. Which anticoagulant is preferred for ongoing treatment during pregnancy?

  1. Direct oral anticoagulants
  2. Warfarin
  3. Low molecular weight heparin Correct answer.
  4. Aspirin

Explanation

Low molecular weight heparin is the anticoagulant of choice in pregnancy because it does not cross the placenta and is safe for the fetus. Warfarin is teratogenic, and DOACs are contraindicated.

Question 17Obstetrics

Which of the following is the most appropriate management for a woman with pre-eclampsia at 37 weeks who has developed HELLP syndrome?

  1. Repeat blood tests in two weeks
  2. Expectant management until 40 weeks
  3. Antihypertensives alone with discharge
  4. Stabilisation and delivery Correct answer.

Explanation

HELLP syndrome is a severe manifestation of pre-eclampsia and an indication for delivery once the mother is stabilised. Expectant management risks maternal and fetal deterioration.

Question 18Obstetrics

Which of the following best describes the mechanism of action of oxytocin in inducing labour?

  1. It binds myometrial oxytocin receptors causing contraction Correct answer.
  2. It blocks calcium entry into myocytes
  3. It inhibits prostaglandin synthesis
  4. It relaxes uterine smooth muscle

Explanation

Oxytocin binds to myometrial oxytocin receptors, increasing intracellular calcium and causing contraction. It also stimulates prostaglandin release.

Question 19Obstetrics

A woman with a previous third-degree perineal tear is planning a subsequent vaginal delivery. Which statement is most accurate?

  1. Recurrence risk is increased and counselling should include this Correct answer.
  2. Episiotomy prevents recurrence
  3. There is no increased risk of recurrence
  4. Elective caesarean section is mandatory

Explanation

A previous obstetric anal sphincter injury increases the risk of recurrence. Women should be counselled about this and about the option of caesarean section.

Question 20Obstetrics

Which of the following is the most appropriate initial investigation for a suspected ectopic pregnancy in a haemodynamically stable woman?

  1. Diagnostic laparoscopy
  2. Transvaginal ultrasound with serial beta-hCG Correct answer.
  3. MRI pelvis
  4. Plain abdominal radiograph

Explanation

Transvaginal ultrasound combined with serial beta-hCG measurements is the standard initial assessment for suspected ectopic pregnancy in a stable woman. Laparoscopy is reserved for unstable or unclear cases.

Question 21Obstetrics

A woman at 41 weeks has a Bishop score of 3. Which of the following is the most appropriate method for cervical ripening?

  1. Amniotomy alone
  2. Prostaglandin E2 or a mechanical balloon catheter Correct answer.
  3. Intravenous oxytocin alone
  4. Await spontaneous labour

Explanation

An unfavourable cervix (Bishop score of 6 or less) is best ripened with prostaglandins or a mechanical balloon catheter before induction. Amniotomy and oxytocin alone are less effective in an unripe cervix.

Question 22Obstetrics

Which of the following congenital infections is most classically associated with hydrocephalus, intracranial calcifications and chorioretinitis?

  1. Herpes simplex virus
  2. Rubella
  3. Cytomegalovirus
  4. Toxoplasmosis Correct answer.

Explanation

The classic triad of congenital toxoplasmosis is hydrocephalus, diffuse intracranial calcifications and chorioretinitis. CMV more typically produces periventricular calcifications and sensorineural deafness.

Question 23Obstetrics

A woman with a known twin pregnancy presents at 36 weeks with the first twin in cephalic presentation and the second in breech. Which statement is most appropriate regarding mode of delivery?

  1. Elective caesarean is the only safe option
  2. Vaginal delivery is contraindicated
  3. External cephalic version of the second twin is routine
  4. Vaginal delivery may be considered with experienced staff and facilities for emergency caesarean Correct answer.

Explanation

Vaginal delivery of a twin pregnancy with the first twin cephalic is often possible with experienced staff and theatre access. The second twin may be delivered by internal podalic version or caesarean if needed.

Question 24Obstetrics

Which of the following is the most common cause of maternal death in the UK?

  1. Thromboembolism
  2. Sepsis
  3. Cardiac disease Correct answer.
  4. Pre-eclampsia

Explanation

Cardiac disease is the leading cause of maternal death in the UK according to MBRRACE-UK reports. Thromboembolism and sepsis are also important causes but are less frequent.

Question 25Obstetrics

A woman at 20 weeks has a serum alpha-fetoprotein level markedly elevated. Which of the following is the most likely explanation?

  1. Trisomy 18
  2. Molar pregnancy
  3. Neural tube defect Correct answer.
  4. Down syndrome

Explanation

Elevated maternal serum alpha-fetoprotein is associated with open neural tube defects because AFP leaks into amniotic fluid. It is also raised in abdominal wall defects and multiple pregnancy.

Question 26Obstetrics

A woman at 34 weeks' gestation has a blood pressure of 158/112 mmHg on two readings four hours apart, with 3+ proteinuria and a platelet count of 88 × 10⁹/L. Which finding upgrades her condition to severe pre-eclampsia with a need for urgent delivery planning?

  1. Platelet count below 100 × 10⁹/L Correct answer.
  2. Blood pressure above 150/100 mmHg
  3. Gestational age beyond 32 weeks
  4. Proteinuria of 3+ on dipstick

Explanation

Severe pre-eclampsia is defined by features of end-organ dysfunction, and a platelet count under 100 × 10⁹/L is one of the recognised severe features alongside transaminitis, renal impairment, pulmonary oedema and neurological symptoms. Blood pressure thresholds for severity are 160/110 mmHg, and proteinuria grade alone does not determine severity.

Question 27Obstetrics

Which single measurement on a cardiotocograph most strongly predicts fetal acidaemia when the trace is otherwise uninterpretable?

  1. Presence of a single deceleration
  2. Contraction frequency of 5 in 10 minutes
  3. Baseline variability of 2 beats per minute Correct answer.
  4. Baseline rate of 150 beats per minute

Explanation

Reduced baseline variability, particularly less than 5 beats per minute for over 50 minutes, reflects fetal metabolic compromise and correlates most strongly with acidaemia. Decelerations must be assessed by type and depth, and baseline rate within 110–160 beats per minute is normal.

Question 28Obstetrics

A woman at 39 weeks has an uncomplicated pregnancy and requests information about membrane sweeping at her routine appointment. What is the most accurate counselling point?

  1. It carries a measurable risk of amniotic sac infection
  2. It reliably shortens the total duration of the first stage of labour
  3. It should be avoided until the cervix is at least 3 cm dilated
  4. It reduces the proportion of women reaching 41 weeks and may increase discomfort or bleeding Correct answer.

Explanation

Membrane sweeping at term reduces the need for formal induction and the proportion of pregnancies continuing past 41 weeks, at the cost of minor bleeding and discomfort. It does not reliably shorten established labour and is not restricted to a particular cervical dilatation.

Question 29Obstetrics

A woman at 28 weeks reports reduced fetal movements. Cardiotocography is normal and ultrasound shows normal growth and liquor volume. What is the most appropriate next step?

  1. Reassure and advise repeat assessment if movements reduce again Correct answer.
  2. Prescribe a course of antenatal corticosteroids
  3. Repeat the ultrasound in 48 hours
  4. Arrange immediate induction of labour

Explanation

When movements have returned to normal, the cardiotocograph is normal and ultrasound shows normal growth and liquor volume, no further intervention is required beyond safety-netting advice. Induction and steroids are not indicated in an otherwise normal pregnancy at 28 weeks.

Question 30Obstetrics

A woman at 12 weeks has a haemoglobin of 105 g/L with a mean corpuscular volume of 72 fL. Which finding best supports iron deficiency over thalassaemia trait as the cause?

  1. A raised red cell distribution width Correct answer.
  2. Presence of target cells on the film
  3. A normal serum ferritin
  4. A haemoglobin A2 fraction of 3.5%

Explanation

Iron deficiency produces a raised red cell distribution width because the population of red cells becomes heterogeneous as microcytosis develops. Thalassaemia trait typically shows a normal red cell distribution width, a normal or high ferritin and a raised haemoglobin A2.

Question 31Obstetrics

A woman at 33 weeks presents with a painful, red, swollen left leg. Compression ultrasound confirms a popliteal vein thrombosis. Which statement about management is correct?

  1. Therapeutic anticoagulation should be withheld until after delivery
  2. Low molecular weight heparin should be continued through labour and delivery Correct answer.
  3. Thrombolysis is first-line therapy for proximal limb thrombosis
  4. Warfarin is the agent of choice during the third trimester

Explanation

Low molecular weight heparin is continued throughout pregnancy and peripartum because it does not cross the placenta and can be reversed or timed around delivery. Warfarin is teratogenic in early pregnancy and is avoided antenatally.

Question 32Obstetrics

Which organism is the most frequent cause of early-onset neonatal sepsis acquired from the maternal genital tract?

  1. Neisseria gonorrhoeae
  2. Listeria monocytogenes
  3. Group B streptococcus Correct answer.
  4. Candida albicans

Explanation

Group B streptococcus colonises the maternal genital tract in a substantial minority of women and is the leading cause of early-onset neonatal sepsis in many settings. Listeria and gonorrhoea cause neonatal infection but are far less common.

Question 33Obstetrics

A woman at 18 weeks is diagnosed with a complete hydatidiform mole. Which feature most reliably distinguishes a complete from a partial mole?

  1. Vaginal bleeding in the second trimester
  2. Presence of a fetus with triploid karyotype
  3. Absence of fetal tissue with diffuse trophoblastic proliferation Correct answer.
  4. Uterine size smaller than dates

Explanation

A complete mole shows diffuse trophoblastic hyperplasia without fetal tissue and is usually diploid, arising from an empty ovum. A partial mole typically contains fetal tissue, is triploid and shows focal hydropic change.

Question 34Obstetrics

A woman at 31 weeks is admitted with a blood pressure of 165/115 mmHg and headache. Which antihypertensive is most appropriate for rapid blood pressure control in this setting?

  1. Sublingual nifedipine as a single large dose
  2. Oral enalapril
  3. Intravenous hydralazine given as a slow bolus without monitoring
  4. Intravenous labetalol Correct answer.

Explanation

Intravenous labetalol is a first-line agent for acute severe hypertension in pregnancy, titrated to a target blood pressure while avoiding abrupt falls that could impair uteroplacental perfusion. Hydralazine is also used but requires careful bolus administration with monitoring.

Question 35Obstetrics

A woman at 16 weeks has a singleton pregnancy and a history of a previous preterm birth at 28 weeks. Which intervention has the best evidence for reducing recurrent preterm birth in this setting?

  1. Routine cervical cerclage at 12 weeks
  2. Vaginal progesterone supplementation Correct answer.
  3. Bed rest for the remainder of pregnancy
  4. Prophylactic antibiotics from 16 weeks

Explanation

Vaginal progesterone reduces the risk of recurrent preterm birth in women with a previous spontaneous preterm birth, particularly where the cervix is short. Cerclage is reserved for specific indications such as cervical insufficiency with progressive shortening.

Question 36Obstetrics

A woman at 24 weeks has a cervix measuring 18 mm on transvaginal ultrasound with no history of preterm birth. Which management is most appropriate?

  1. Elective delivery at 34 weeks
  2. Immediate cervical cerclage
  3. Serial ultrasound alone without treatment
  4. Vaginal progesterone Correct answer.

Explanation

A short cervix detected on transvaginal ultrasound in a singleton pregnancy without prior preterm birth is an indication for vaginal progesterone, which reduces the risk of preterm delivery. Cerclage is generally reserved for women with a history of preterm birth or other specific indications.

Question 37Obstetrics

A woman at 35 weeks has a fetus in the transverse lie. Which factor most increases the likelihood of this malpresentation?

  1. Maternal age over 30 years
  2. Gestational diabetes controlled on diet
  3. Uterine fibroids distorting the cavity Correct answer.
  4. Previous uncomplicated vaginal delivery

Explanation

Uterine anomalies and fibroids that distort the cavity predispose to transverse lie by preventing the fetus from assuming a longitudinal axis. Other recognised associations include multiparity, placenta praevia and polyhydramnios.

Question 38Obstetrics

A woman at 30 weeks has a fetus with an estimated weight below the 3rd centile, absent end-diastolic flow in the umbilical artery and normal amniotic fluid. What is the most appropriate management?

  1. Immediate caesarean section without steroids
  2. Admission for monitoring and antenatal corticosteroids with planned preterm delivery Correct answer.
  3. Discharge with routine growth scan in four weeks
  4. Expectant management until 39 weeks

Explanation

Absent end-diastolic flow in the umbilical artery indicates severe placental insufficiency, so admission, close surveillance, corticosteroids for fetal lung maturity and planned delivery are appropriate. Delivery timing balances the risk of stillbirth against prematurity.

Question 39Obstetrics

A woman at 14 weeks has a blood pressure of 135/85 mmHg and a history of pre-eclampsia requiring delivery at 30 weeks in her first pregnancy. Which intervention reduces her risk of recurrent pre-eclampsia?

  1. Prophylactic low molecular weight heparin
  2. Low-dose aspirin started at 28 weeks
  3. Calcium supplementation in a woman with adequate intake
  4. Low-dose aspirin from 12 to 16 weeks Correct answer.

Explanation

Low-dose aspirin started before 16 weeks reduces the incidence of pre-eclampsia in women at high risk, including those with previous early-onset disease. Starting later in pregnancy has less benefit.

Question 40Obstetrics

A woman at 37 weeks reports a sudden gush of clear fluid and is uncertain whether her membranes have ruptured. Which bedside finding most reliably supports rupture of membranes?

  1. A fundal height smaller than expected
  2. Pooling of amniotic fluid in the posterior fornix on speculum examination Correct answer.
  3. A sensation of leakage reported by the woman
  4. A positive nitrazine test on a vaginal swab

Explanation

Direct visualisation of amniotic fluid pooling in the posterior fornix on sterile speculum examination is the most reliable bedside sign of membrane rupture. Nitrazine testing is affected by blood, semen and infection, giving false positives.

Question 41Obstetrics

A woman in the second stage of labour has a prolonged deceleration lasting four minutes with a baseline falling to 90 beats per minute. Which action should be taken first?

  1. Administer a tocolytic and continue pushing
  2. Call for help, stop oxytocin and reposition the woman Correct answer.
  3. Prepare for an immediate forceps delivery
  4. Perform fetal blood sampling

Explanation

A prolonged deceleration is an obstetric emergency, and initial management involves calling for help, stopping any oxytocin, repositioning the woman and correcting hypotension. Fetal blood sampling is not performed during a prolonged deceleration.

Question 42Obstetrics

Which statement about the mechanism of the fetal ejection reflex in the second stage of labour is correct?

  1. Ferguson reflex describes increased oxytocin release in response to vaginal and cervical stretch Correct answer.
  2. It is initiated by fetal head compression against the perineum
  3. The reflex is mediated primarily by progesterone withdrawal
  4. It is abolished by epidural analgesia in all cases

Explanation

The Ferguson reflex is a positive feedback loop in which stretch of the cervix and vagina triggers oxytocin release, augmenting contractions in the second stage. It is not initiated by head compression or progesterone withdrawal.

Question 43Obstetrics

A woman at 32 weeks has a singleton pregnancy with polyhydramnios and an estimated fetal weight above the 95th centile. She has a history of a macrosomic infant requiring shoulder dystocia manoeuvres. Which factor most strongly predicts recurrence of shoulder dystocia?

  1. Gestational age of 32 weeks
  2. Polyhydramnios alone
  3. Maternal body mass index of 28
  4. Previous shoulder dystocia with birth weight above 4 kg Correct answer.

Explanation

A previous shoulder dystocia with a macrosomic infant is the strongest predictor of recurrence, with reported rates of around 10–15%. Other factors such as maternal obesity and polyhydramnios contribute but carry less weight.

Question 44Obstetrics

A woman at 36 weeks presents with a painful, tense uterus and a single episode of dark vaginal bleeding after a minor fall. Which initial management step is most appropriate?

  1. Immediate caesarean section without ultrasound if fetal heart is abnormal
  2. Discharge with analgesia and review in 24 hours
  3. Vaginal examination to assess cervical dilatation
  4. Ultrasound to localise the placenta and assess fetal wellbeing Correct answer.

Explanation

Painful bleeding with a tense uterus suggests placental abruption, and ultrasound helps localise the placenta and assess fetal wellbeing while continuous monitoring is started. Vaginal examination is avoided until placenta praevia is excluded.

Question 45Obstetrics

A woman at 39 weeks is in established labour. Which finding on vaginal examination is most consistent with a persistent occipitoposterior position?

  1. Sagittal suture in the transverse diameter with the posterior fontanelle felt anteriorly
  2. A caput succedaneum obscuring the sutures
  3. Sagittal suture in the oblique diameter with the posterior fontanelle felt anteriorly Correct answer.
  4. Sagittal suture in the oblique diameter with the anterior fontanelle felt anteriorly

Explanation

In an occipitoposterior position the posterior fontanelle lies anteriorly and the sagittal suture is in an oblique diameter. This position is associated with a longer labour and back pain.

Question 46Obstetrics

A woman at 34 weeks has a blood pressure of 150/95 mmHg and 1+ proteinuria. Which investigation is most useful for detecting early end-organ involvement?

  1. Serum beta-hCG
  2. Full blood count and liver function tests Correct answer.
  3. Oral glucose tolerance test
  4. Cervical swab for group B streptococcus

Explanation

Full blood count and liver function tests detect thrombocytopenia, haemolysis and transaminitis that signal end-organ involvement in pre-eclampsia. These guide decisions about admission and timing of delivery.

Question 47Obstetrics

A woman at 10 weeks has a confirmed missed miscarriage. She is keen to avoid surgery and has no signs of infection. Which management option is most appropriate to discuss?

  1. Prophylactic antibiotics before expectant management
  2. Immediate surgical evacuation as the only option
  3. Expectant management with safety-netting advice Correct answer.
  4. Methotrexate therapy

Explanation

Expectant management is a reasonable option for a missed miscarriage in a haemodynamically stable woman without infection, with advice to return if bleeding or pain develops. Medical management with misoprostol is an alternative.

Question 48Obstetrics

A woman at 26 weeks has regular painful contractions and a cervix dilated to 4 cm. Which intervention has the strongest evidence for reducing neonatal respiratory morbidity?

  1. Tocolysis with nifedipine
  2. Antenatal betamethasone Correct answer.
  3. Magnesium sulphate infusion
  4. Prophylactic antibiotics

Explanation

Antenatal corticosteroids such as betamethasone reduce neonatal respiratory distress syndrome, intraventricular haemorrhage and neonatal mortality when birth is anticipated before 34 weeks. Magnesium sulphate is used for neuroprotection, not lung maturation.

Question 49Obstetrics

A woman at 28 weeks has a deep vein thrombosis confirmed on ultrasound. Which anticoagulant is preferred for ongoing treatment?

  1. Aspirin
  2. Rivaroxaban
  3. Warfarin
  4. Low molecular weight heparin Correct answer.

Explanation

Low molecular weight heparin is the anticoagulant of choice in pregnancy because it does not cross the placenta and has a predictable dose response. Direct oral anticoagulants and warfarin are avoided in pregnancy.

Question 50Obstetrics

Which statement about the mechanism of magnesium sulphate in eclampsia is correct?

  1. It acts by inhibiting platelet aggregation
  2. It acts as a central nervous system depressant by blocking calcium channels and NMDA receptors Correct answer.
  3. It lowers blood pressure primarily by peripheral vasodilatation
  4. It works by reducing circulating antiangiogenic factors

Explanation

Magnesium sulphate prevents and treats eclamptic seizures through central nervous system depression, including calcium channel blockade and NMDA receptor antagonism. It is not primarily an antihypertensive agent.