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Iraqi Board OB/GYN study materials
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Iraqi Board OB/GYN practice questions

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Question 1General Obstetrics (Antenatal, Intrapartum, Postpartum Care)

A 26-year-old woman with no previous pregnancy asks about supplementation before conception. Which daily supplement is recommended for all women planning pregnancy to lower the risk of fetal neural tube defects?

  1. Ferrous sulfate 200 mg
  2. Calcium carbonate 1,000 mg
  3. Vitamin A 10,000 IU
  4. Folic acid 400 micrograms Correct answer.

Explanation

Periconceptional folic acid 400 micrograms daily is recommended for average-risk women, begun at least one month before conception and continued through the first trimester. It reduces the risk of neural tube defects by supporting neural tube closure; higher doses are reserved for women with a previously affected pregnancy or other specific risk factors.

Question 2General Obstetrics (Antenatal, Intrapartum, Postpartum Care)

A woman has a spontaneous vaginal delivery and 30 minutes later has heavy vaginal bleeding. The uterus is soft and poorly contracted, and the placenta is confirmed complete. What is the most likely cause of the hemorrhage?

  1. Lower genital tract laceration
  2. Uterine atony Correct answer.
  3. Retained placental tissue
  4. Inherited coagulopathy

Explanation

Uterine atony is the most common cause of primary postpartum hemorrhage, and a soft, poorly contracted uterus after complete placental delivery is its classic sign. Initial management includes uterine massage and uterotonic drugs while other causes are assessed.

Question 3General Obstetrics (Antenatal, Intrapartum, Postpartum Care)

According to the NICHD three-tier fetal heart rate classification, which tracing is Category III?

  1. Absent variability with recurrent late decelerations Correct answer.
  2. Baseline 150 beats/min with early decelerations and moderate variability
  3. Baseline 145 beats/min with uncomplicated variable decelerations and moderate variability
  4. Baseline 140 beats/min with moderate variability and accelerations

Explanation

The NICHD Category III designation includes absent baseline variability with recurrent late decelerations, recurrent variable decelerations, bradycardia, or a sinusoidal pattern. These tracings indicate abnormal fetal oxygenation and require immediate evaluation and intrauterine resuscitation.

Question 4General Obstetrics (Antenatal, Intrapartum, Postpartum Care)

A 28-year-old woman at 24 weeks' gestation with no risk factors for diabetes is undergoing routine antenatal care. When should she be offered the 75-g oral glucose tolerance test for gestational diabetes?

  1. At 20-22 weeks
  2. At 24-28 weeks Correct answer.
  3. At 32-34 weeks
  4. At 16-18 weeks

Explanation

Routine screening for gestational diabetes with a 75-g oral glucose tolerance test is recommended at 24 to 28 weeks' gestation because insulin resistance increases markedly during this period. Earlier testing is reserved for women with risk factors such as prior gestational diabetes, obesity, or polycystic ovary syndrome.

Question 5General Obstetrics (Antenatal, Intrapartum, Postpartum Care)

A woman at 34 weeks' gestation with severe preeclampsia has a blood pressure of 168/112 mmHg confirmed on repeat measurement. Which medication is appropriate for acute treatment of this severe hypertension?

  1. Oral methyldopa
  2. Oral ramipril
  3. Intravenous furosemide
  4. Intravenous labetalol Correct answer.

Explanation

Acute severe hypertension in pregnancy should be treated promptly with a rapid-acting agent such as intravenous labetalol, intravenous hydralazine, or immediate-release oral nifedipine. ACE inhibitors are contraindicated in pregnancy, and methyldopa has a slow onset that is unsuitable for acute control.

Question 6General Obstetrics (Antenatal, Intrapartum, Postpartum Care)

During a vaginal delivery, shoulder dystocia persists after McRoberts maneuver and suprapubic pressure. Which maneuver involves applying pressure to the anterior aspect of the posterior fetal shoulder to rotate the shoulders into an oblique diameter?

  1. Symphysiotomy
  2. Zavanelli maneuver
  3. Continuous fundal pressure by an assistant
  4. Woods screw maneuver Correct answer.

Explanation

The Woods screw maneuver applies pressure to the anterior aspect of the posterior shoulder to rotate the fetal trunk and disimpact the anterior shoulder. It is used after McRoberts maneuver and suprapubic pressure when shoulder dystocia persists.

Question 7General Obstetrics (Antenatal, Intrapartum, Postpartum Care)

A woman develops a temperature of 38.6°C, lower abdominal pain, and foul-smelling lochia 48 hours after an emergency cesarean delivery. Which empiric antibiotic regimen is most appropriate?

  1. Intravenous clindamycin plus gentamicin Correct answer.
  2. Vaginal povidone-iodine irrigation
  3. Oral amoxicillin-clavulanate for seven days
  4. Intravenous oxytocin infusion alone

Explanation

Postpartum endometritis after cesarean delivery is usually polymicrobial, so empiric therapy must cover anaerobes and gram-negative organisms. Intravenous clindamycin plus gentamicin is a standard regimen, with ampicillin added when enterococcal coverage is desired.

Question 8General Obstetrics (Antenatal, Intrapartum, Postpartum Care)

A 32-year-old woman with one prior cesarean delivery requests a trial of labor. Which prior uterine factor makes trial of labor contraindicated?

  1. Low transverse incision
  2. Classical upper-segment incision Correct answer.
  3. Low vertical incision confined to the lower segment
  4. Prior vaginal delivery after cesarean

Explanation

A classical upper-segment uterine incision carries a high risk of rupture during labor and is an absolute contraindication to trial of labor. Low transverse incisions are compatible with trial of labor, and prior vaginal delivery is a favorable prognostic factor.

Question 9General Obstetrics (Antenatal, Intrapartum, Postpartum Care)

A 30-year-old woman at 31 weeks' gestation presents in preterm labor with intact membranes and is expected to deliver within 24 hours. Which intervention most clearly reduces neonatal respiratory distress syndrome, intraventricular hemorrhage, and neonatal death?

  1. Prophylactic magnesium sulfate
  2. Immediate cesarean delivery
  3. Continuous high-flow maternal oxygen
  4. Antenatal betamethasone Correct answer.

Explanation

Antenatal corticosteroids given between 24 and 34 weeks' gestation accelerate fetal lung maturity and reduce respiratory distress syndrome, intraventricular hemorrhage, and neonatal mortality. Magnesium sulfate is used for fetal neuroprotection but does not produce these respiratory and mortality benefits.

Question 10General Obstetrics (Antenatal, Intrapartum, Postpartum Care)

A woman undergoing trial of labor after cesarean has sudden severe abdominal pain, loss of station, and fetal bradycardia. What is the most likely diagnosis?

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

Explanation

Uterine rupture during trial of labor classically presents with sudden severe abdominal pain, fetal bradycardia, loss of station, and cessation of contractions; fetal bradycardia is the most common sign. It is an obstetric emergency requiring immediate laparotomy and delivery.

Question 11General Obstetrics (Antenatal, Intrapartum, Postpartum Care)

A 30-year-old woman with an uncomplicated singleton pregnancy at 19 weeks' gestation attends for routine antenatal care. She has not yet had a fetal anatomy survey. What is the most appropriate timing for this ultrasound?

  1. Between 11 and 14 weeks' gestation
  2. Between 18 and 22 weeks' gestation Correct answer.
  3. Between 32 and 34 weeks' gestation
  4. Between 8 and 10 weeks' gestation

Explanation

A detailed fetal anatomy survey is best performed between 18 and 22 weeks, when fetal organs are sufficiently developed and amniotic fluid allows clear views. Earlier scanning is used mainly for dating or nuchal translucency, while later scans assess growth and placental location.

Question 12General Obstetrics (Antenatal, Intrapartum, Postpartum Care)

A 24-year-old woman who is exclusively breastfeeding presents 10 days after vaginal delivery with a 39°C fever, flu-like aching, and a tender, erythematous wedge-shaped area on the right breast. What is the most likely diagnosis?

  1. Plugged duct without infection
  2. Lactational mastitis Correct answer.
  3. Breast engorgement
  4. Fibroadenoma

Explanation

Fever, systemic flu-like symptoms, and a focal tender erythematous area in a breastfeeding woman are typical of lactational mastitis, usually due to Staphylococcus aureus. Engorgement is bilateral and afebrile, and a simple plugged duct lacks systemic fever.

Question 13General Obstetrics (Antenatal, Intrapartum, Postpartum Care)

During continuous fetal monitoring in active labor, a tracing shows repetitive abrupt decreases in fetal heart rate from the baseline, each lasting about 30 seconds and returning quickly. What is the most likely cause?

  1. Maternal fever
  2. Fetal sleep cycle
  3. Umbilical cord compression Correct answer.
  4. Uteroplacental insufficiency

Explanation

Variable decelerations are abrupt, brief drops in fetal heart rate that commonly reflect umbilical cord compression. They are managed initially with maternal repositioning and other intrauterine resuscitation measures, not by assuming uteroplacental insufficiency.

Question 14General Obstetrics (Antenatal, Intrapartum, Postpartum Care)

A 27-year-old woman with blood group O negative is at 28 weeks' gestation in her first pregnancy. Her antibody screen is negative, and she has no history of bleeding or sensitizing events. What is the most appropriate management now?

  1. Administer anti-D immunoglobulin prophylaxis Correct answer.
  2. Give oral iron and recheck hemoglobin
  3. Repeat the antibody screen at 36 weeks only
  4. Plan cesarean delivery to avoid fetomaternal hemorrhage

Explanation

Routine antenatal anti-D prophylaxis is offered to unsensitized RhD-negative women, commonly at 28 weeks, to prevent alloimmunization. A negative antibody screen confirms she is not already sensitized, so prophylaxis is appropriate.

Question 15General Obstetrics (Antenatal, Intrapartum, Postpartum Care)

A 24-year-old woman at 16 weeks' gestation has a urine culture growing more than 100,000 colony-forming units per mL of Escherichia coli. She has no urinary symptoms. What is the main reason to treat this finding in pregnancy?

  1. To lower the risk of placenta previa
  2. To eliminate the need for a glucose tolerance test
  3. To prevent gestational diabetes mellitus
  4. To reduce the risk of progression to pyelonephritis Correct answer.

Explanation

Asymptomatic bacteriuria in pregnancy is treated because it substantially increases the risk of pyelonephritis and associated preterm birth. Treatment is with an appropriate antibiotic guided by culture and sensitivity.

Question 16General Obstetrics (Antenatal, Intrapartum, Postpartum Care)

A woman in active labor is receiving oxytocin augmentation. Over a 30-minute period the monitor records an average of six contractions every 10 minutes, with a Category I fetal heart rate tracing. What is the correct term for this contraction pattern?

  1. Hypertonic uterine dysfunction
  2. Precipitate labor
  3. Tachysystole Correct answer.
  4. Normal labor pattern

Explanation

Tachysystole is defined as more than five contractions in 10 minutes averaged over 30 minutes. It is important to recognize even with a normal fetal heart rate tracing because it may precede fetal compromise and usually prompts reduction or stopping of oxytocin.

Question 17General Obstetrics (Antenatal, Intrapartum, Postpartum Care)

A 29-year-old woman presents 12 days after spontaneous vaginal delivery with heavy vaginal bleeding and a uterus that is larger and softer than expected. Ultrasound shows echogenic material within the uterine cavity. What is the most appropriate next step in management?

  1. Perform immediate hysterectomy
  2. Perform uterine evacuation Correct answer.
  3. Start combined oral contraceptives
  4. Reassure and review in 6 weeks

Explanation

Secondary postpartum hemorrhage with ultrasound evidence of retained placental tissue is managed by uterine evacuation, typically with gentle curettage or vacuum aspiration, together with antibiotics and uterotonics as needed. Immediate hysterectomy is reserved for life-threatening hemorrhage uncontrolled by other measures.

Question 18General Obstetrics (Antenatal, Intrapartum, Postpartum Care)

A 31-year-old woman at 33 weeks' gestation reports intense itching, worse at night, affecting the palms and soles. There is no rash. Serum bile acids are 48 micromol/L and alanine aminotransferase is mildly elevated. What is the most likely diagnosis?

  1. Intrahepatic cholestasis of pregnancy Correct answer.
  2. Pruritic urticarial papules and plaques of pregnancy
  3. Atopic eruption of pregnancy
  4. Gestational pemphigoid

Explanation

Intrahepatic cholestasis of pregnancy presents with pruritus, often of the palms and soles and worse at night, without a primary rash, together with elevated bile acids. It is associated with stillbirth and preterm birth, so fetal surveillance and planned delivery are important.

Question 19General Obstetrics (Antenatal, Intrapartum, Postpartum Care)

A 39-year-old woman at 39 weeks' gestation has spontaneous rupture of membranes. On vaginal examination, a pulsating umbilical cord is felt in the vagina, and the fetal heart rate shows recurrent variable decelerations. What is the most appropriate immediate action?

  1. Await full cervical dilatation before intervening
  2. Elevate the presenting part and prepare for immediate delivery Correct answer.
  3. Start oxytocin augmentation to expedite vaginal delivery
  4. Attempt to replace the cord into the uterus and continue labor

Explanation

Cord prolapse is an obstetric emergency. The priority is to relieve cord compression by elevating the presenting part, often with a filled bladder or manual pressure, and to proceed to the fastest safe delivery, usually cesarean.

Question 20General Obstetrics (Antenatal, Intrapartum, Postpartum Care)

A 34-year-old woman at 20 weeks' gestation with a singleton pregnancy has a history of two prior second-trimester pregnancy losses. Transvaginal ultrasound shows a cervical length of 15 mm with no visible membranes. What is the most appropriate intervention to reduce the risk of preterm birth?

  1. Vaginal progesterone alone
  2. Cervical cerclage Correct answer.
  3. Elective delivery at 28 weeks
  4. Bed rest until delivery

Explanation

A history of recurrent second-trimester losses with a short cervix in the current pregnancy suggests cervical insufficiency, and cerclage is the intervention shown to reduce preterm birth in this setting. Vaginal progesterone is used for short cervix without such history but is not the primary treatment here.

Question 21General Obstetrics (Antenatal, Intrapartum, Postpartum Care)

A 28-year-old woman with a regular 28-day menstrual cycle tells you that the first day of her last menstrual period was 10 March 2024. Using Naegele's rule, what is her estimated date of delivery?

  1. 3 December 2024
  2. 24 December 2024
  3. 10 December 2024
  4. 17 December 2024 Correct answer.

Explanation

Naegele's rule adds 7 days to the first day of the last menstrual period and then subtracts 3 months, which is equivalent to adding 9 months and 7 days. For 10 March 2024, adding 7 days gives 17 March and adding 9 months gives 17 December 2024. The calculation assumes a regular 28-day cycle; cycle length variation can shift the estimate and is usually corrected with early ultrasound.

Question 22General Obstetrics (Antenatal, Intrapartum, Postpartum Care)

A nulliparous woman at term is in spontaneous labor and has just reached full cervical dilatation. Which interval defines the second stage of labor?

  1. From full cervical dilatation until delivery of the placenta
  2. From the onset of regular contractions until full cervical dilatation
  3. From full cervical dilatation until delivery of the fetus Correct answer.
  4. From delivery of the fetus until delivery of the placenta

Explanation

The second stage of labor begins when the cervix is fully dilated and ends with delivery of the fetus. The first stage covers the onset of regular contractions to full dilatation, and the third stage covers delivery of the fetus to delivery of the placenta. These boundaries are used to assess progress and diagnose prolonged labor.

Question 23General Obstetrics (Antenatal, Intrapartum, Postpartum Care)

A 30-year-old woman at 38 weeks' gestation with a singleton pregnancy has continuous fetal heart rate monitoring in early labor. Which baseline fetal heart rate range is considered normal?

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

Explanation

A normal baseline fetal heart rate is 110 to 160 beats per minute. A baseline below 110 beats per minute is bradycardia, and a baseline above 160 beats per minute is tachycardia. Baseline rate is assessed over a 10-minute period and guides further fetal surveillance.

Question 24General Obstetrics (Antenatal, Intrapartum, Postpartum Care)

A 33-year-old woman at 30 weeks' gestation presents with painless bright red vaginal bleeding. She is hemodynamically stable, and ultrasound shows a placenta covering the internal cervical os. Which initial management step is most appropriate?

  1. Perform a digital vaginal examination to assess cervical dilatation
  2. Admit, secure IV access, and cross-match blood Correct answer.
  3. Perform an immediate cesarean delivery regardless of fetal status
  4. Give intramuscular methotrexate and arrange outpatient follow-up

Explanation

In suspected placenta previa with stable bleeding, initial management includes admission, intravenous access, blood cross-matching, and close maternal and fetal monitoring. Digital vaginal examination is avoided because it can provoke catastrophic hemorrhage. Immediate cesarean delivery is reserved for heavy bleeding, fetal compromise, or other urgent indications.

Question 25General Obstetrics (Antenatal, Intrapartum, Postpartum Care)

A 35-year-old woman at 36 weeks' gestation has a singleton breech presentation and is being considered for external cephalic version. Which finding is an absolute contraindication to the procedure?

  1. A single previous uncomplicated cesarean delivery
  2. Oligohydramnios with an amniotic fluid index of 6 cm
  3. Maternal body mass index of 32 kg/m²
  4. Placenta previa Correct answer.

Explanation

External cephalic version is contraindicated when placenta previa is present because manipulation may provoke severe bleeding or placental abruption. A prior low transverse cesarean is a relative consideration rather than an absolute contraindication. Oligohydramnios and obesity may reduce success but are not absolute contraindications.

Question 26General Obstetrics (Antenatal, Intrapartum, Postpartum Care)

A 27-year-old woman at 14 weeks' gestation has a confirmed proximal deep vein thrombosis. She has no contraindication to anticoagulation. Which anticoagulant is preferred for treatment during pregnancy?

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

Explanation

Low-molecular-weight heparin is preferred for treating venous thromboembolism in pregnancy because it does not cross the placenta and is not teratogenic. Warfarin can cause embryopathy, and direct oral anticoagulants such as rivaroxaban are generally avoided in pregnancy. Aspirin is not adequate treatment for an established deep vein thrombosis.

Question 27General Obstetrics (Antenatal, Intrapartum, Postpartum Care)

A 32-year-old woman at 24 weeks' gestation with a singleton pregnancy has a cervical length of 15 mm on transvaginal ultrasound. She has no history of preterm birth. Which intervention reduces the risk of preterm birth in this setting?

  1. Bed rest until 37 weeks
  2. Routine antibiotics until 28 weeks
  3. Vaginal progesterone Correct answer.
  4. Cervical cerclage

Explanation

In a singleton pregnancy with a short cervix and no prior preterm birth, vaginal progesterone is recommended to reduce the risk of preterm birth. Cerclage is generally reserved for selected women with a history of prior spontaneous preterm birth or other specific indications. Bed rest and routine antibiotics have not been shown to prevent preterm birth in this population.

Question 28General Obstetrics (Antenatal, Intrapartum, Postpartum Care)

A 28-year-old woman at 30 weeks' gestation has preterm premature rupture of membranes and is not in labor. She has no allergies. Which antibiotic regimen is recommended to prolong latency and reduce neonatal morbidity?

  1. Metronidazole alone for 5 days
  2. Clindamycin plus gentamicin for 14 days
  3. Ampicillin plus erythromycin for 7 days Correct answer.
  4. Ceftriaxone as a single intramuscular dose

Explanation

For preterm premature rupture of membranes, a 7-day course of ampicillin plus erythromycin is recommended to prolong latency and reduce neonatal infectious morbidity. Azithromycin is often used as an alternative to erythromycin. Group B streptococcal prophylaxis is added when labor begins or another indication is present.

Question 29General Obstetrics (Antenatal, Intrapartum, Postpartum Care)

A 30-year-old woman at 35 weeks' gestation with severe preeclampsia has a generalized tonic-clonic seizure in the emergency department. Which is the first-line medication for control and prevention of further eclamptic seizures?

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

Explanation

Magnesium sulfate is the first-line drug for treating eclampsia and preventing recurrent seizures. A typical regimen is a 4 to 6 g intravenous loading dose over 15 to 20 minutes followed by a maintenance infusion. Phenytoin and diazepam are alternatives but are less effective, and labetalol is used for blood pressure control rather than seizure prevention.

Question 30General Obstetrics (Antenatal, Intrapartum, Postpartum Care)

A 36-year-old woman at 35 weeks' gestation has a previous two cesarean deliveries and a complete placenta previa. Ultrasound shows loss of the normal uterovesical interface and placental lacunae, suggesting placenta accreta spectrum. Which management plan is most appropriate?

  1. Methotrexate after delivery to promote placental resorption
  2. Planned cesarean hysterectomy at a specialist center Correct answer.
  3. Induction of labor with oxytocin infusion
  4. Attempt vaginal delivery with manual placental removal

Explanation

Suspected placenta accreta spectrum with placenta previa and prior cesarean deliveries is managed by planned cesarean delivery at a specialist center with a multidisciplinary team prepared for cesarean hysterectomy. Manual placental removal should be avoided because it can cause severe hemorrhage. The usual timing is around 34 to 36 weeks after corticosteroids and careful planning.

Question 31General Obstetrics (Antenatal, Intrapartum, Postpartum Care)

A 26-year-old woman attends a preconception clinic. She has no history of a pregnancy affected by a neural tube defect and takes no regular medication. Which daily folic acid dose should be advised before conception and during the first trimester?

  1. 1 mg daily
  2. 10 mg daily
  3. 5 mg daily
  4. 0.4 mg daily Correct answer.

Explanation

Routine folic acid supplementation of 0.4 mg daily before conception and through the first trimester reduces the risk of neural tube defects in women at average risk. A 5 mg daily dose is reserved for women with a previous affected pregnancy, diabetes, obesity, or anticonvulsant use. Doses of 1 mg or 10 mg are not standard for primary prevention.

Question 32General Obstetrics (Antenatal, Intrapartum, Postpartum Care)

A 31-year-old woman at 39 weeks' gestation is in active labor. A rectovaginal swab taken at 36 weeks was positive for group B streptococcus, and she has no antibiotic allergy. Which intrapartum antibiotic is the first-line choice?

  1. Clindamycin
  2. Penicillin G Correct answer.
  3. Cefazolin
  4. Vancomycin

Explanation

Penicillin G is the first-line intrapartum antibiotic for a group B streptococcus-colonized woman who has no penicillin allergy. Cefazolin is used when there is a non-severe penicillin allergy, whereas clindamycin and vancomycin are reserved for severe allergy or resistant organisms. Prophylaxis should ideally begin at least four hours before delivery.

Question 33General Obstetrics (Antenatal, Intrapartum, Postpartum Care)

A 29-year-old woman has a primary postpartum haemorrhage after a spontaneous vaginal delivery. Intravenous access has been obtained and uterine atony is suspected. Which uterotonic should be given first?

  1. Oxytocin Correct answer.
  2. Misoprostol
  3. Carboprost tromethamine
  4. Methylergonovine

Explanation

Oxytocin is the first-line uterotonic for uterine atony because it acts rapidly and can be titrated intravenously. Misoprostol, carboprost and methylergonovine are second-line options with specific contraindications such as asthma for carboprost and hypertension for methylergonovine. Prompt uterine massage and blood product replacement are also part of postpartum haemorrhage management.

Question 34General Obstetrics (Antenatal, Intrapartum, Postpartum Care)

A 34-year-old woman at 13 weeks' gestation has a history of preeclampsia in her previous pregnancy that required delivery at 34 weeks. Her blood pressure is normal and she has no other medical problems. Which prophylactic measure reduces her risk of recurrent preeclampsia?

  1. Strict bed rest from 20 weeks until delivery
  2. Prophylactic low-molecular-weight heparin throughout pregnancy
  3. Calcium supplementation started in the third trimester
  4. Low-dose aspirin before 16 weeks Correct answer.

Explanation

Low-dose aspirin started before 16 weeks reduces the risk of recurrent preterm preeclampsia in women with a previous affected pregnancy. Calcium is mainly recommended in populations with low dietary calcium intake, and low-molecular-weight heparin is not routine prophylaxis for preeclampsia. Bed rest has no proven benefit and increases thromboembolic risk.

Question 35General Obstetrics (Antenatal, Intrapartum, Postpartum Care)

A 27-year-old woman at 30 weeks' gestation presents with regular painful contractions and cervical dilatation of 3 cm. She has no signs of infection and both mother and fetus are stable. Which intervention most improves neonatal outcome?

  1. Prophylactic antibiotics for group B streptococcus
  2. Antenatal corticosteroids Correct answer.
  3. Tocolysis with nifedipine until 37 weeks
  4. Immediate cesarean delivery

Explanation

Antenatal corticosteroids given between 24 and 34 weeks' gestation are the intervention that most consistently improves neonatal outcomes in preterm labor. They reduce respiratory distress syndrome, intraventricular haemorrhage and neonatal mortality. Tocolysis may provide time for steroids but should not be continued until 37 weeks, and immediate delivery is not indicated in a stable mother and fetus.

Question 36General Obstetrics (Antenatal, Intrapartum, Postpartum Care)

A 32-year-old woman in the second stage of labor has a fetal head impacted against the symphysis pubis after delivery of the head, and the anterior shoulder does not deliver with routine traction. Which maneuver should be performed first?

  1. Fundal pressure
  2. Zavanelli maneuver
  3. Delivery of the posterior arm
  4. McRoberts with suprapubic pressure Correct answer.

Explanation

McRoberts maneuver with suprapubic pressure is the first-line technique for shoulder dystocia because it increases the anterior-posterior pelvic diameter and helps rotate the shoulder. Fundal pressure is contraindicated as it worsens impaction and can cause uterine rupture or brachial plexus injury. Posterior arm delivery and the Zavanelli maneuver are later steps when first-line maneuvers fail.

Question 37General Obstetrics (Antenatal, Intrapartum, Postpartum Care)

A 30-year-old woman develops a temperature of 38.5°C, uterine tenderness and foul-smelling lochia 36 hours after an emergency caesarean delivery. She is haemodynamically stable and has no abscess on imaging. Which antibiotic regimen is most appropriate?

  1. Intravenous fluconazole as monotherapy
  2. Oral amoxicillin alone for 7 days
  3. Clindamycin plus gentamicin IV Correct answer.
  4. Oral metronidazole alone for 7 days

Explanation

Postpartum endometritis after caesarean delivery is polymicrobial, and intravenous clindamycin plus gentamicin provides broad aerobic and anaerobic cover. Treatment is continued until the woman has been afebrile for 24–48 hours. Oral single agents such as amoxicillin or metronidazole do not provide adequate coverage, and fluconazole is not indicated without fungal infection.

Question 38General Obstetrics (Antenatal, Intrapartum, Postpartum Care)

A 35-year-old woman at 20 weeks' gestation has had one previous caesarean delivery with a low transverse uterine incision. She asks about mode of delivery for this pregnancy. Which factor would make a trial of labor after caesarean delivery contraindicated?

  1. Singleton pregnancy with cephalic presentation
  2. Previous low transverse caesarean section
  3. Previous classical uterine incision Correct answer.
  4. Spontaneous onset of labor at term

Explanation

A previous classical or inverted-T uterine incision is a contraindication to trial of labor because it carries a markedly increased risk of uterine rupture. A single low transverse caesarean, a singleton cephalic pregnancy and spontaneous term labor are favorable features for trial of labor. Women should be counselled about the risks and benefits and deliver in a facility with immediate access to caesarean delivery.

Question 39General Obstetrics (Antenatal, Intrapartum, Postpartum Care)

A 33-year-old woman at 36 weeks' gestation has severe preeclampsia. Her blood pressure is 160/110 mmHg, and laboratory tests show a platelet count of 80,000/µL, AST of 120 U/L and LDH of 900 U/L. She has right upper quadrant pain. Which diagnosis best explains these findings?

  1. Cholestasis of pregnancy
  2. Acute fatty liver of pregnancy
  3. HELLP syndrome Correct answer.
  4. Gestational thrombocytopenia

Explanation

HELLP syndrome is characterized by haemolysis, elevated liver enzymes and low platelets, and it commonly presents with right upper quadrant pain in a woman with preeclampsia. Acute fatty liver of pregnancy can mimic HELLP but is more often associated with hypoglycaemia, coagulopathy and liver failure. Gestational thrombocytopenia is mild and isolated, while cholestasis causes pruritus and raised bile acids without this laboratory pattern.

Question 40General Obstetrics (Antenatal, Intrapartum, Postpartum Care)

A 36-year-old woman at 40 weeks' gestation suddenly develops hypotension, hypoxia and a seizure during active labor, followed by vaginal bleeding and disseminated intravascular coagulation. The fetal heart rate shows a prolonged deceleration. Which condition is most likely?

  1. Amniotic fluid embolism Correct answer.
  2. Massive pulmonary thromboembolism
  3. Abruptio placentae with disseminated intravascular coagulation
  4. Severe preeclampsia with eclampsia

Explanation

Amniotic fluid embolism should be suspected when sudden cardiovascular collapse, hypoxia, seizures and disseminated intravascular coagulation occur during labor or immediately postpartum. The diagnosis is clinical and management is supportive with airway support, circulatory resuscitation, blood products and prompt delivery if the fetus is undelivered. Pulmonary embolism, eclampsia and abruption can cause collapse but do not typically produce this combined fulminant picture.

Question 41General Obstetrics (Antenatal, Intrapartum, Postpartum Care)

A 29-year-old woman attends preconception counselling. Her previous pregnancy ended with a fetus affected by myelomeningocele. She takes no regular medication and has no other medical problems. Which folic acid supplementation should she receive before conception and during the first trimester?

  1. Folic acid 10 mg once daily
  2. Folic acid 5 mg once daily Correct answer.
  3. Folic acid 0.4 mg once daily
  4. Folic acid 1 mg once weekly

Explanation

A previous neural tube defect-affected pregnancy is an indication for high-dose folic acid: 5 mg daily, started at least one month before conception and continued through the first trimester. This is ten times the routine 0.4 mg dose used for average-risk women. Higher doses are not standard and weekly dosing is inadequate.

Question 42General Obstetrics (Antenatal, Intrapartum, Postpartum Care)

A 26-year-old woman at 28 weeks' gestation has blood group O, Rh-negative, with a negative indirect Coombs test. She is not sensitised and has had no antenatal bleeding. Which management is most appropriate at this visit?

  1. Give anti-D immunoglobulin 300 micrograms intramuscularly Correct answer.
  2. Repeat the antibody screen at 34 weeks without anti-D
  3. Give anti-D immunoglobulin 50 micrograms intramuscularly
  4. Give anti-D immunoglobulin only after delivery

Explanation

Routine antenatal anti-D prophylaxis is offered to unsensitised Rh-negative women, commonly as 300 micrograms at 28 weeks, with or without a second dose at 34 weeks. It prevents alloimmunisation from silent fetomaternal haemorrhage. Delivery prophylaxis is still given if the baby is Rh-positive, but antenatal dosing is not deferred to delivery.

Question 43General Obstetrics (Antenatal, Intrapartum, Postpartum Care)

A 24-year-old woman at 10 weeks' gestation is admitted with hyperemesis gravidarum. She has persistent vomiting, ketonuria, and has been unable to eat for four days. Intravenous fluids containing dextrose are started. Which vitamin should be given to prevent Wernicke encephalopathy?

  1. Vitamin K
  2. Vitamin B12
  3. Folic acid
  4. Thiamine Correct answer.

Explanation

Prolonged vomiting and dextrose-containing fluids can precipitate Wernicke encephalopathy in thiamine-deficient pregnant women. Thiamine should be given before or alongside glucose-containing fluids in hyperemesis with poor oral intake. Folate, B12, and vitamin K do not prevent this acute neurological complication.

Question 44General Obstetrics (Antenatal, Intrapartum, Postpartum Care)

A 30-year-old woman at 39 weeks' gestation is 6 cm dilated when her membranes rupture spontaneously. The fetal heart rate falls to 70 beats/min and does not recover. On vaginal examination a pulsating umbilical cord is felt in the vagina. What is the most appropriate immediate management?

  1. Start an amnioinfusion and reassess in 30 minutes
  2. Give a tocolytic and wait for spontaneous resolution
  3. Elevate the presenting part and arrange emergency caesarean delivery Correct answer.
  4. Apply fundal pressure to deliver the fetus quickly

Explanation

A palpable pulsating cord after membrane rupture is cord prolapse, an obstetric emergency. The presenting part should be elevated, for example by manual pressure or bladder filling, while immediate caesarean delivery is arranged. Fundal pressure and amnioinfusion do not relieve cord compression and waste time.

Question 45General Obstetrics (Antenatal, Intrapartum, Postpartum Care)

A 31-year-old woman has just delivered the placenta when she becomes pale and hypotensive with heavy vaginal bleeding. The uterus is inverted and the placenta remains attached to the fundus. What is the correct initial management?

  1. Remove the placenta first, then replace the uterus
  2. Proceed directly to hysterectomy
  3. Call for help, replace the uterus manually, and leave the placenta until the uterus is replaced Correct answer.
  4. Give an oxytocin bolus and observe for spontaneous replacement

Explanation

In uterine inversion, the priority is prompt replacement of the uterus, usually manually, with resuscitation and a call for senior help. The placenta should be left in place until the uterus is replaced because removing it first can cause severe haemorrhage. Oxytocin is avoided until replacement because it may worsen inversion by contracting the uterus.

Question 46General Obstetrics (Antenatal, Intrapartum, Postpartum Care)

A 30-year-old woman at 11 weeks' gestation has a twin pregnancy. Ultrasound shows one placental mass and a thin dividing membrane, with the membrane meeting the placenta at a right angle. Which chorionicity does this indicate?

  1. Monochorionic monoamniotic
  2. Dichorionic monoamniotic
  3. Dichorionic diamniotic
  4. Monochorionic diamniotic Correct answer.

Explanation

The T sign, where the dividing membrane meets the placenta at a right angle, is characteristic of monochorionic diamniotic twins. A lambda or twin-peak sign suggests dichorionic placentation. Monochorionic monoamniotic twins have no dividing membrane.

Question 47General Obstetrics (Antenatal, Intrapartum, Postpartum Care)

A 30-year-old woman presents 10 days after a spontaneous vaginal delivery with heavy vaginal bleeding and a uterus enlarged to 14 weeks' size. She is afebrile and haemodynamically stable. Ultrasound shows retained placental tissue. What is the most appropriate management?

  1. Reassure and review in two weeks
  2. Give uterotonics and antibiotics, then perform surgical evacuation Correct answer.
  3. Give oral antibiotics alone
  4. Perform immediate hysterectomy

Explanation

This is secondary postpartum haemorrhage due to retained products of conception. Treatment includes uterotonics and broad-spectrum antibiotics followed by surgical evacuation, with resuscitation as needed. Antibiotics alone do not remove retained tissue, and hysterectomy is reserved for uncontrollable bleeding.

Question 48General Obstetrics (Antenatal, Intrapartum, Postpartum Care)

A 27-year-old woman at 28 weeks' gestation has no contraindications to vaccination. Which vaccine is recommended during every pregnancy, preferably between 27 and 36 weeks, to protect the newborn from pertussis?

  1. Measles-mumps-rubella vaccine
  2. Varicella vaccine
  3. Tetanus-diphtheria-acellular pertussis vaccine Correct answer.
  4. Oral polio vaccine

Explanation

Tdap is recommended in every pregnancy, ideally at 27 to 36 weeks, so that maternal antibodies transfer to the fetus and protect the infant from pertussis. MMR and varicella are live vaccines and are contraindicated in pregnancy. Oral polio vaccine is not routine in pregnancy.

Question 49General Obstetrics (Antenatal, Intrapartum, Postpartum Care)

A 30-year-old woman at 40 weeks' gestation is in active labour with thick meconium-stained amniotic fluid. The fetal heart rate shows recurrent late decelerations. She is 8 cm dilated. What is the most appropriate next step?

  1. Continue routine monitoring and reassess in one hour
  2. Perform amnioinfusion as the definitive treatment
  3. Stop oxytocin if running, give oxygen and intravenous fluids, reposition the mother, and expedite delivery Correct answer.
  4. Perform an immediate forceps delivery

Explanation

Thick meconium with recurrent late decelerations suggests fetal hypoxia and requires intrauterine resuscitation: stop oxytocin, reposition, give oxygen and fluids, and arrange urgent delivery. Amnioinfusion may be considered for variable decelerations but is not definitive here. Forceps at 8 cm is inappropriate because full dilatation has not been reached.

Question 50General Obstetrics (Antenatal, Intrapartum, Postpartum Care)

A 31-year-old woman with monochorionic diamniotic twins is 19 weeks' gestation. Ultrasound shows polyhydramnios in one sac, oligohydramnios in the other, and an absent bladder in the smaller twin. What is the definitive fetal treatment for this condition?

  1. Fetoscopic laser photocoagulation of placental anastomoses Correct answer.
  2. Immediate caesarean delivery
  3. Maternal digoxin therapy
  4. Serial amnioreduction alone

Explanation

The findings describe twin-twin transfusion syndrome, caused by unbalanced placental vascular anastomoses in monochorionic twins. Fetoscopic laser photocoagulation is the definitive treatment and improves survival and neurological outcomes. Amnioreduction is symptomatic, delivery at 19 weeks is not viable, and maternal digoxin is not definitive.