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CAQ-OBGYN study materials
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CAQ-OBGYN practice questions

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Question 1Obstetrics

A 28-year-old G2P1 at 39 weeks presents with spontaneous rupture of membranes and contractions every 3 minutes. On sterile speculum exam, a pulsating umbilical cord is visualized protruding through the cervix. What is the most appropriate immediate management?

  1. Administer tocolytics and observe for 30 minutes
  2. Call for immediate cesarean delivery while elevating the presenting part off the cord Correct answer.
  3. Perform a full pelvic exam to assess cervical dilation before acting
  4. Attempt to replace the cord into the uterus and continue labor

Explanation

Umbilical cord prolapse is an obstetric emergency requiring immediate delivery, usually by cesarean, while the presenting part is elevated to relieve cord compression. Cord replacement and delay for further examination increase the risk of fetal hypoxia and death.

Question 2Obstetrics

Which maternal condition is the most common predisposing factor for preterm premature rupture of membranes (PPROM)?

  1. Gestational diabetes
  2. Placenta previa
  3. Chronic hypertension
  4. Intra-amniotic infection Correct answer.

Explanation

Intra-amniotic infection and genital tract infection are among the strongest and most common risk factors for PPROM because inflammation weakens the membranes. Chronic hypertension, gestational diabetes, and placenta previa are not the leading predisposing factors.

Question 3Obstetrics

A patient at 34 weeks has preeclampsia with severe features. Which finding alone meets the criteria for severe features?

  1. Mild ankle edema
  2. Blood pressure of 165/115 mmHg on two occasions 4 hours apart Correct answer.
  3. 1+ proteinuria on dipstick
  4. Blood pressure of 145/95 mmHg

Explanation

Severe-range blood pressure (systolic at least 160 mmHg or diastolic at least 110 mmHg) confirmed on two occasions qualifies as a severe feature. Lower blood pressures, mild proteinuria, and dependent edema do not meet severe criteria.

Question 4Obstetrics

What is the recommended timing of delivery for a patient with preeclampsia without severe features who is stable at 37 weeks?

  1. Deliver immediately regardless of gestational age
  2. Deliver at 37 weeks or thereafter Correct answer.
  3. Await spontaneous labor without induction offer
  4. Expectant management until 42 weeks

Explanation

For preeclampsia without severe features, delivery at 37 weeks or later is recommended to reduce maternal complications while accepting minimal neonatal risk. Expecting until 42 weeks or deferring induction increases maternal risk.

Question 5Obstetrics

A woman at 32 weeks presents with painless bright red vaginal bleeding. Ultrasound shows the placenta covering the internal cervical os. Which management step is contraindicated?

  1. Ultrasound confirmation of placental location
  2. Digital cervical examination Correct answer.
  3. Continuous fetal monitoring
  4. Intravenous access and type and screen

Explanation

In placenta previa, digital cervical examination can provoke catastrophic hemorrhage and is contraindicated. Monitoring, IV access, and ultrasound are appropriate and safe.

Question 6Obstetrics

Which finding is most characteristic of placental abruption on clinical presentation?

  1. Pruritic rash over the abdomen
  2. Painless vaginal bleeding with a soft uterus
  3. Painful vaginal bleeding with a tender, rigid uterus Correct answer.
  4. Fever and purulent discharge

Explanation

Abruption classically presents with painful bleeding, uterine tenderness, and a hypertonic uterus, though bleeding may be concealed. Painless bleeding with a soft uterus suggests placenta previa instead.

Question 7Obstetrics

A patient at 30 weeks has a fundal height of 24 cm. Which condition should be highest on the differential for this discrepancy?

  1. Gestational diabetes with macrosomia
  2. Multiple gestation
  3. Fetal growth restriction Correct answer.
  4. Polyhydramnios

Explanation

A fundal height smaller than expected dates suggests fetal growth restriction or oligohydramnios. Polyhydramnios, multiple gestation, and macrosomia typically produce larger-than-expected measurements.

Question 8Obstetrics

What is the first-line medication for acute seizure prophylaxis in eclampsia?

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

Explanation

Magnesium sulfate is superior to phenytoin and diazepam for preventing and treating eclamptic seizures. Labetalol is used for blood pressure control, not seizure prophylaxis.

Question 9Obstetrics

A patient with severe preeclampsia is receiving magnesium sulfate. Which finding indicates magnesium toxicity requiring immediate intervention?

  1. Blood pressure of 150/95 mmHg
  2. Loss of deep tendon reflexes Correct answer.
  3. Fetal heart rate of 140 bpm
  4. Urine output of 60 mL/hour

Explanation

Loss of deep tendon reflexes is an early sign of magnesium toxicity, followed by respiratory depression and cardiac arrest. Adequate urine output, a fetal heart rate of 140, and moderate hypertension do not indicate toxicity.

Question 10Obstetrics

Which fetal heart rate pattern is classified as category III and requires immediate evaluation?

  1. Accelerations with a baseline of 150 bpm
  2. Early decelerations with moderate variability
  3. Baseline of 140 bpm with moderate variability and no decelerations
  4. Absent variability with recurrent late decelerations Correct answer.

Explanation

Category III includes absent variability with recurrent late decelerations or bradycardia, indicating possible fetal acidemia and requiring immediate intervention. The other patterns are category I or II and generally reassuring.

Question 11Obstetrics

A patient at 41 weeks with a favorable cervix and reassuring fetal testing is discussing induction. What is the recommended management?

  1. Schedule elective cesarean
  2. Offer induction of labor Correct answer.
  3. Perform amniotomy without induction
  4. Await spontaneous labor until 44 weeks

Explanation

Induction is recommended between 41 and 42 weeks to reduce perinatal mortality and meconium aspiration risk. Waiting beyond 42 weeks increases stillbirth risk, and cesarean or isolated amniotomy is not the standard approach.

Question 12Obstetrics

Which organism is the most common cause of early-onset neonatal sepsis when intrapartum antibiotic prophylaxis is not given?

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

Explanation

Group B Streptococcus is the leading cause of early-onset neonatal sepsis, which is why universal screening and intrapartum prophylaxis are recommended. The other organisms can cause neonatal infection but are less common in this setting.

Question 13Obstetrics

A pregnant patient at 36 weeks has active genital herpes lesions. What is the recommended mode of delivery?

  1. Spontaneous vaginal delivery
  2. Cesarean delivery Correct answer.
  3. Vacuum-assisted vaginal delivery
  4. Induction of labor with oxytocin

Explanation

Active genital herpes lesions at the time of labor are an indication for cesarean delivery to reduce neonatal herpes transmission. Vaginal delivery, operative vaginal delivery, and induction with oxytocin increase the risk of neonatal infection.

Question 14Obstetrics

Which test is used to screen for gestational diabetes at 24 to 28 weeks?

  1. Random plasma glucose
  2. Hemoglobin A1c
  3. 50-g oral glucose challenge test Correct answer.
  4. Fasting urine glucose

Explanation

The 50-g one-hour glucose challenge test is the standard initial screening test for gestational diabetes, followed by a diagnostic 100-g or 75-g test if abnormal. Hemoglobin A1c, random glucose, and urine glucose are not appropriate screening tools.

Question 15Obstetrics

A patient with type 1 diabetes becomes pregnant. Which fetal complication is increased due to poor glycemic control?

  1. Oligohydramnios
  2. Preterm premature rupture of membranes
  3. Placental abruption
  4. Congenital heart defects Correct answer.

Explanation

Poor periconceptional glycemic control increases the risk of congenital anomalies, particularly cardiac and neural tube defects. Oligohydramnios and abruption are not the classic anomalies associated with maternal diabetes.

Question 16Obstetrics

Which condition is associated with anti-D alloimmunization causing fetal anemia?

  1. Rh incompatibility Correct answer.
  2. Glucose-6-phosphate dehydrogenase deficiency
  3. ABO incompatibility
  4. Alpha-thalassemia

Explanation

Rh incompatibility can cause maternal anti-D antibodies to cross the placenta and hemolyze fetal red cells, leading to anemia and hydrops. ABO incompatibility typically causes mild disease, and the other conditions are unrelated.

Question 17Obstetrics

A patient at 20 weeks reports decreased fetal movement and is found to have an elevated maternal serum alpha-fetoprotein. Which condition should be considered?

  1. Down syndrome
  2. Gestational trophoblastic disease
  3. Turner syndrome
  4. Neural tube defect Correct answer.

Explanation

Elevated maternal serum alpha-fetoprotein is associated with open neural tube defects because AFP leaks into amniotic fluid. Down syndrome and Turner syndrome typically show low or normal AFP, and molar pregnancy does not fit this presentation.

Question 18Obstetrics

What is the recommended initial management for a patient at 34 weeks with preterm labor and no contraindications?

  1. Bed rest until term
  2. Prophylactic antibiotics alone
  3. Immediate delivery
  4. Tocolysis for 48 hours with antenatal corticosteroids Correct answer.

Explanation

At 34 weeks, short-term tocolysis may allow administration of antenatal corticosteroids to improve fetal lung maturity. Immediate delivery, antibiotics alone, or prolonged bed rest are not the standard approach.

Question 19Obstetrics

Which medication is used for fetal neuroprotection in preterm labor before 32 weeks?

  1. Magnesium sulfate Correct answer.
  2. Indomethacin
  3. Betamethasone
  4. Nifedipine

Explanation

Magnesium sulfate given before 32 weeks reduces the risk of cerebral palsy. Betamethasone is used for lung maturity, while nifedipine and indomethacin are tocolytics.

Question 20Obstetrics

A patient at 26 weeks presents with a short cervix of 10 mm on transvaginal ultrasound. What is the recommended intervention?

  1. Prophylactic antibiotics
  2. Cerclage for all patients
  3. Vaginal progesterone Correct answer.
  4. Immediate delivery

Explanation

Vaginal progesterone is recommended for women with a short cervix to reduce the risk of preterm birth. Cerclage is reserved for specific indications, and delivery or antibiotics are not appropriate.

Question 21Obstetrics

Which finding suggests chorioamnionitis in a laboring patient?

  1. Painless vaginal bleeding
  2. Elevated liver enzymes
  3. Decreased fetal movement only
  4. Maternal fever with uterine tenderness and fetal tachycardia Correct answer.

Explanation

Chorioamnionitis typically presents with maternal fever, uterine tenderness, and fetal tachycardia, often with foul-smelling amniotic fluid. Painless bleeding or isolated decreased movement is not characteristic.

Question 22Obstetrics

What is the recommended treatment for a patient with HELLP syndrome at 36 weeks?

  1. Immediate delivery Correct answer.
  2. Expectant management until 39 weeks
  3. Antihypertensive therapy alone
  4. Corticosteroids to delay delivery for 2 weeks

Explanation

HELLP syndrome is a severe complication requiring immediate delivery, often by cesarean depending on obstetric factors. Delaying delivery increases the risk of maternal morbidity.

Question 23Obstetrics

A patient at 32 weeks has a positive fetal fibronectin test. What does this indicate?

  1. Presence of intra-amniotic infection
  2. Imminent delivery within 24 hours
  3. Fetal growth restriction
  4. Increased risk of preterm delivery Correct answer.

Explanation

A positive fetal fibronectin test indicates an increased risk of preterm birth but has poor specificity. It does not predict delivery within 24 hours or diagnose infection or growth restriction.

Question 24Obstetrics

Which is a risk factor for shoulder dystocia?

  1. Fetal macrosomia Correct answer.
  2. Maternal short stature
  3. Preterm delivery
  4. Oligohydramnios

Explanation

Fetal macrosomia is a major risk factor for shoulder dystocia because of the large shoulder diameter. Short stature, oligohydramnios, and preterm delivery are not classic risk factors.

Question 25Obstetrics

A patient at 10 weeks presents with a positive pregnancy test but no intrauterine gestational sac on ultrasound and an hCG level of 1500 mIU/mL. Which diagnosis is most likely?

  1. Normal early pregnancy
  2. Complete miscarriage
  3. Ectopic pregnancy Correct answer.
  4. Molar pregnancy

Explanation

An empty uterus with an hCG above the discriminatory zone suggests an ectopic pregnancy or nonviable intrauterine pregnancy. A normal early pregnancy would typically show a gestational sac at this hCG level.

Question 26Obstetrics

A 28-year-old G2P1 at 39 weeks presents in active labor with spontaneous rupture of membranes 2 hours ago. She has a history of one prior low transverse cesarean delivery. Which finding most strongly suggests uterine rupture?

  1. Gradual increase in contraction frequency with cervical dilation
  2. Sudden loss of fetal station with nonreassuring fetal heart tracing Correct answer.
  3. Mild lower abdominal discomfort between contractions
  4. Clear amniotic fluid with a stable fetal heart rate baseline

Explanation

Uterine rupture classically presents with sudden loss of fetal station (the fetus extruding into the abdomen), abnormal fetal heart rate patterns, and abdominal pain. The combination of loss of station with a nonreassuring tracing in a patient with a prior uterine scar is the most concerning pattern.

Question 27Obstetrics

A 24-year-old G1 at 12 weeks presents with vaginal bleeding and passage of grape-like tissue. Ultrasound shows a snowstorm appearance with no fetus. Which complication should be monitored due to this condition?

  1. Gestational trophoblastic neoplasia with persistent hCG elevation Correct answer.
  2. Preterm premature rupture of membranes
  3. Placenta accreta in a subsequent pregnancy
  4. Rh isoimmunization requiring anti-D

Explanation

A complete hydatidiform mole carries a risk of persistent gestational trophoblastic neoplasia, which is monitored with serial quantitative hCG levels until undetectable. Rising or plateauing hCG suggests malignant transformation requiring further treatment.

Question 28Obstetrics

A 32-year-old G3P2 at 34 weeks presents with painless bright red vaginal bleeding. Ultrasound shows the placenta covering the internal cervical os. Which is the most appropriate initial management step?

  1. Amniotomy to relieve pressure
  2. Immediate digital cervical examination to assess dilation
  3. Outpatient follow-up in 1 week with activity restriction
  4. Admission, IV access, and preparation for cesarean delivery Correct answer.

Explanation

Placenta previa with active bleeding requires admission, IV access, blood product availability, and preparation for cesarean delivery, usually via a low transverse or vertical incision depending on placental location. Digital examination is contraindicated because it can provoke catastrophic hemorrhage.

Question 29Obstetrics

A patient at 38 weeks presents with a fetal heart tracing showing a baseline of 145 bpm, moderate variability, and recurrent late decelerations that persist despite maternal repositioning and IV fluid bolus. What is the next appropriate step?

  1. Perform a fetal scalp stimulation
  2. Continue observation and reassess in 1 hour
  3. Administer oxygen and perform amnioinfusion
  4. Prepare for expedited delivery Correct answer.

Explanation

Recurrent late decelerations that do not resolve with intrauterine resuscitation (repositioning, IV fluids, oxygen) indicate possible uteroplacental insufficiency and warrant expedited delivery. Continued observation risks fetal acidemia.

Question 30Obstetrics

A 30-year-old G1 at 40 weeks has a Bishop score of 4 and requires induction for post-term pregnancy. Which cervical ripening agent is appropriate in the presence of a favorable fetal status and intact membranes?

  1. Misoprostol 25 mcg vaginally
  2. Dinoprostone vaginal insert Correct answer.
  3. High-dose oxytocin with amniotomy
  4. Intravenous oxytocin alone

Explanation

A dinoprostone vaginal insert is a standard cervical ripening agent for an unfavorable Bishop score with intact membranes. It provides controlled release and can be removed if tachysystole occurs.

Question 31Obstetrics

A 27-year-old G1 at 8 weeks presents with severe unilateral pelvic pain and a positive pregnancy test. Ultrasound shows an empty uterus and a mass in the adnexa. She is hemodynamically stable. Which management is most appropriate?

  1. Progesterone supplementation
  2. Methotrexate therapy or surgical management based on hCG and mass size Correct answer.
  3. Cerclage placement
  4. Expectant management with repeat ultrasound in 4 weeks

Explanation

Ectopic pregnancy in a stable patient is managed with methotrexate if criteria are met (small mass, low hCG, no fetal cardiac activity) or with surgical management if criteria are not met or the patient prefers surgery. Expectant management is not appropriate for a confirmed ectopic with an adnexal mass.

Question 32Obstetrics

A 35-year-old G1 at 37 weeks has a fetus with an estimated fetal weight of 4,600 g. Which intrapartum complication is most increased in this setting?

  1. Placental abruption
  2. Postpartum hemorrhage from uterine atony
  3. Umbilical cord prolapse
  4. Shoulder dystocia Correct answer.

Explanation

Macrosomia increases the risk of shoulder dystocia due to impaction of the anterior shoulder behind the symphysis pubis. This is the most characteristic intrapartum complication of a large fetus.

Question 33Obstetrics

A patient at 33 weeks presents with regular contractions and cervical dilation of 4 cm. She has no history of prior preterm birth. Which intervention has been shown to reduce neonatal respiratory morbidity?

  1. Magnesium sulfate infusion
  2. Antenatal corticosteroids Correct answer.
  3. Prophylactic antibiotics
  4. Tocolytic therapy alone

Explanation

Antenatal corticosteroids given between 24 and 34 weeks accelerate fetal lung maturation and reduce respiratory distress syndrome, intraventricular hemorrhage, and neonatal mortality. They are the cornerstone of preterm labor management.

Question 34Obstetrics

A 29-year-old G2P1 at 36 weeks presents with a blood pressure of 158/108 mmHg and 3+ proteinuria. She has a platelet count of 90,000 and elevated liver enzymes. Which diagnosis best fits?

  1. Gestational hypertension
  2. Preeclampsia with severe features Correct answer.
  3. Chronic hypertension
  4. HELLP syndrome

Explanation

Blood pressure ≥160/110, proteinuria, thrombocytopenia, and elevated liver enzymes meet criteria for preeclampsia with severe features. HELLP is a related variant but requires hemolysis, elevated liver enzymes, and low platelets as the defining triad, and this patient's presentation is best classified as severe preeclampsia.

Question 35Obstetrics

A patient at 39 weeks delivers vaginally and has a postpartum hemorrhage. Which medication is contraindicated in a patient with severe asthma?

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

Explanation

Methylergonovine is an ergot alkaloid that causes vasoconstriction and bronchoconstriction, so it is contraindicated in patients with severe asthma. Oxytocin, carboprost, and misoprostol do not carry this specific contraindication.

Question 36Obstetrics

A 31-year-old G1 at 20 weeks has a cervical length of 18 mm on transvaginal ultrasound with no prior preterm birth. Which management is most appropriate?

  1. Serial cervical length measurement only
  2. Vaginal progesterone Correct answer.
  3. Bed rest
  4. Cerclage placement

Explanation

A short cervix (≤25 mm) in a singleton pregnancy without prior preterm birth is an indication for vaginal progesterone, which reduces preterm birth risk. Cerclage is generally reserved for patients with prior preterm birth or specific history.

Question 37Obstetrics

A patient at 28 weeks presents with a fundal height of 22 cm. Which condition should be considered in the differential for this discrepancy?

  1. Polyhydramnios
  2. Multiple gestation
  3. Oligohydramnios Correct answer.
  4. Macrosomia

Explanation

A fundal height significantly smaller than expected gestational age suggests fetal growth restriction or oligohydramnios. Both reduce uterine size and should prompt ultrasound evaluation.

Question 38Obstetrics

A 34-year-old G2P1 at 30 weeks has a fetus with an estimated weight below the 10th percentile and an elevated umbilical artery Doppler resistance index. Which condition is most likely?

  1. Chorioamnionitis
  2. Gestational diabetes with macrosomia
  3. Rh alloimmunization
  4. Placental insufficiency with fetal growth restriction Correct answer.

Explanation

Fetal growth restriction with elevated umbilical artery Doppler resistance suggests placental insufficiency and increased fetal risk. Doppler surveillance helps guide timing of delivery.

Question 39Obstetrics

A patient at 16 weeks has a history of a prior preterm birth at 24 weeks. Which intervention is most appropriate?

  1. History-indicated cerclage placement Correct answer.
  2. Antenatal corticosteroids now
  3. Vaginal progesterone
  4. Serial cervical length only

Explanation

A history of a prior preterm birth before 34 weeks is an indication for history-indicated cerclage, typically placed between 12 and 14 weeks. This reduces recurrent preterm birth in high-risk patients.

Question 40Obstetrics

A 25-year-old G1 at 40 weeks is in active labor. Which finding is most consistent with normal labor progress?

  1. No cervical change over 4 hours despite adequate contractions
  2. Cervical dilation of 1 cm per hour in active phase Correct answer.
  3. Maternal temperature of 38.5°C
  4. Fetal heart rate baseline of 180 bpm

Explanation

Active-phase labor is expected to progress at roughly 1 cm per hour or faster in many patients. Arrest of dilation despite adequate contractions, fetal tachycardia, or maternal fever are abnormal findings.

Question 41Obstetrics

A patient at 37 weeks presents with a fetus in transverse lie. Which delivery route is recommended?

  1. Vaginal delivery with forceps
  2. External cephalic version at term followed by vaginal delivery if successful
  3. Trial of labor with fetal monitoring
  4. Cesarean delivery Correct answer.

Explanation

A persistent transverse lie at term is an indication for cesarean delivery because vaginal delivery is not feasible and carries a high risk of cord prolapse and obstructed labor. External version may be attempted earlier but does not change the delivery route if the lie persists.

Question 42Obstetrics

A 28-year-old G1 at 41 weeks has a reassuring fetal heart tracing and a Bishop score of 3. She requests induction. Which statement best reflects appropriate counseling?

  1. Induction should be delayed until 42 weeks regardless of cervical status
  2. Induction can proceed with cervical ripening, and the patient should be counseled about the increased risk of cesarean with an unfavorable cervix Correct answer.
  3. Amniotomy alone is sufficient for induction
  4. Misoprostol is contraindicated at 41 weeks

Explanation

At 41 weeks, induction is reasonable, but an unfavorable Bishop score increases the chance of failed induction and cesarean delivery. Cervical ripening should be offered and the risks discussed.

Question 43Obstetrics

A patient at 26 weeks presents with a positive fetal fibronectin test and cervical length of 28 mm. What does the positive fetal fibronectin indicate?

  1. Presence of chorioamnionitis
  2. Guaranteed preterm birth
  3. Increased risk of preterm birth within the next 7 to 14 days Correct answer.
  4. Imminent delivery within 24 hours

Explanation

Fetal fibronectin is a negative predictive marker; a positive result modestly increases the risk of preterm birth within 7 to 14 days but does not confirm it. A cervical length of 28 mm is reassuring and lowers the overall risk.

Question 44Obstetrics

A 22-year-old G1 at 10 weeks presents with hyperemesis gravidarum and persistent vomiting. Which electrolyte abnormality is most likely?

  1. Hypercalcemia with respiratory alkalosis
  2. Hyperkalemia with metabolic acidosis
  3. Hypernatremia with metabolic acidosis
  4. Hypokalemia with hypochloremic metabolic alkalosis Correct answer.

Explanation

Prolonged vomiting leads to loss of gastric acid (HCl) and potassium, producing hypochloremic metabolic alkalosis with hypokalemia. Fluid and electrolyte replacement is the mainstay of management.

Question 45Obstetrics

A patient at 34 weeks has a fetus with a heart rate baseline of 110 bpm, minimal variability, and recurrent variable decelerations. Which intervention is most appropriate initially?

  1. Immediate cesarean delivery
  2. Fetal scalp blood sampling
  3. Oxytocin augmentation
  4. Maternal repositioning and IV fluid bolus Correct answer.

Explanation

Variable decelerations suggest umbilical cord compression, and initial management includes maternal repositioning, IV fluids, and possibly amnioinfusion. Immediate delivery is reserved for persistent nonreassuring patterns despite resuscitation.

Question 46Obstetrics

A 30-year-old G2P1 at 38 weeks presents with a seizure. She has a blood pressure of 170/110 mmHg and proteinuria. Which medication is first-line for seizure prophylaxis and treatment?

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

Explanation

Magnesium sulfate is the first-line agent for prevention and treatment of eclamptic seizures. It is more effective than phenytoin or diazepam and is continued during and after delivery.

Question 47Obstetrics

A patient at 32 weeks presents with a suspected placental abruption and fetal bradycardia. Which management is most appropriate?

  1. Expedited cesarean delivery Correct answer.
  2. Amnioinfusion
  3. Tocolytic therapy
  4. Expectant management with serial ultrasounds

Explanation

Placental abruption with fetal compromise or bradycardia requires expedited delivery, usually by cesarean. Maternal stabilization with IV fluids and blood products occurs simultaneously.

Question 48Obstetrics

A 36-year-old G1 at 12 weeks asks about first-trimester aneuploidy screening. Which combination is part of the first-trimester combined screen?

  1. Maternal serum alpha-fetoprotein and hCG only
  2. Chorionic villus sampling
  3. Nuchal translucency, free beta-hCG, and PAPP-A Correct answer.
  4. Cell-free DNA alone

Explanation

First-trimester combined screening uses nuchal translucency, free beta-hCG, and pregnancy-associated plasma protein A (PAPP-A), often with maternal age. It is performed between 11 and 14 weeks.

Question 49Obstetrics

A patient at 28 weeks has a fetus with an estimated weight at the 50th percentile and normal amniotic fluid. Which statement about routine third-trimester ultrasound is most accurate?

  1. All pregnancies require a 32-week growth scan
  2. Universal third-trimester ultrasound is not recommended for low-risk pregnancies Correct answer.
  3. Growth scans are only performed if the patient requests them
  4. Third-trimester ultrasound replaces fundal height measurement

Explanation

Routine third-trimester ultrasound is not recommended for low-risk pregnancies because it has not been shown to improve outcomes. Ultrasound is reserved for specific indications such as growth concerns or discrepancy in fundal height.

Question 50Obstetrics

A 33-year-old G3P2 at 39 weeks delivers a 4,200 g infant and has a postpartum hemorrhage. Which is the most common cause of postpartum hemorrhage?

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

Explanation

Uterine atony is the most common cause of postpartum hemorrhage, accounting for the majority of cases. Risk factors include overdistension, prolonged labor, and multiparity.