OB quiz 2
During what gestational age is spontaneous placental abruption most likely to occur?
24-28 weeks
When is HELLP syndrome most commonly diagnosed?
28-36 weeks gestation.
What is the human chorionic gonadotropin (hCG) value beyond which an intrauterine pregnancy should be able to be visualized on transvaginal ultrasound?
3500 international units per liter. However, some sources use 2000 international units per liter.
Under what week of gestation is considered preterm premature rupture of membranes (PPROM)?
37 weeks.
What hemoglobin A1c value is diagnostic of gestational diabetes?
6.5% .
How often do placenta previas detected in the first trimester resolve before the second trimester?
90% of the time.
What is the definition of postpartum hemorrhage?
A cumulative blood loss of ≥ 1000 mL regardless of route of delivery.
Which of the following is the initial laboratory study used for gestational diabetes screening? A1 hour glucose challenge test B3 hour glucose tolerance test CFasting blood glucose DHemoglobin A1c
A1 hour glucose challenge test
A 35-year-old G3P2 pregnant woman presents to the emergency department with a headache. She estimates she is 20 weeks gestation by her last menstrual period. She does not have a primary care provider and has not been receiving prenatal care due to lack of health insurance. Her vital signs upon arrival are T 37.5°C, HR 99, BP 165/115, RR 20. Which of the following would support a diagnosis of preeclampsia rather than gestational hypertension? A3+ proteinuria BAbdominal ultrasound that places gestational age at 26 weeks CDiastolic pressure greater than 110 DSystolic pressure greater than 160
A3+ proteinuria
A 38-year-old pregnant woman at 35 weeks gestation with a history of tobacco use presents to the emergency department with sudden onset painful vaginal bleeding and contractions. On bimanual examination, her uterus feels firm and rigid. Which of the following is the most likely diagnosis? AAbruptio placenta BPlacenta previa CPreterm labor DSubchorionic hemorrhage
AAbruptio placenta
An 18-year-old woman in her third trimester presents with acute onset of significant pelvic pain and blood per vagina. Thus far, her pregnancy has been normal. Her past medical history is significant for hypertension, asthma, and recreational cocaine use. Examination reveals a tender, extremely tense uterus. Which of the following is the most likely diagnosis? AAbruptio placentae BPreeclampsia CUterine atony DVasa previa
AAbruptio placentae
A 31-year-old G1P0 woman who is 29 weeks pregnant presents to the hospital with contractions. She is found to be in acute preterm labor. Cervical exam reveals that she is 2 cm dilated. Which of following is the next appropriate step in management? AAdminister tocolytics BBedrest CIntravenous hydration DProgesterone supplementation
AAdminister tocolytics
Which of the following is recommended to use as an anti-hypertensive in a pregnant woman? AAlpha-methyldopa BLisinopril CLosartan DValsartan
AAlpha-methyldopa
A 25-year-old G1P0 woman at 33 weeks gestation presents to her obstetrician with a complaint of wetness and leakage from her vaginal area. On physical exam, fluid can be seen coming from the cervical canal. The cervix is not dilated. Fern test is positive. Which of the following medications should be given at this time to delay delivery? AAmpicillin BBetamethasone CIndomethacin DProgesterone
AAmpicillin
A 32-year-old G4P3 woman with a history significant for polyhydramnios is brought to the emergency department 15 minutes after a home birth. She complains of persistent vaginal bleeding with thick clots. She is anxious and diaphoretic. Her physical exam is notable for a large, boggy uterus. She receives oxytocin intramuscularly as intravenous access is started. Repeat examination reveals a persistently boggy uterus with significant active vaginal bleeding. Which of the following is an absolute contraindication to the use of carboprost in the management of this patient? AAsthma BCoronary artery disease CHypertension DSeizures
AAsthma
A 30-year-old woman at 33-weeks gestation presents to the obstetrics ward for admission with contractions every five minutes. Her cervix is 3 cm dilated. The pregnancy has otherwise been normal, and evaluation of the fetal heart rate indicates no fetal distress. Which of the following treatments has the best potential to reduce morbidity and mortality associated with preterm delivery? ABetamethasone BIndomethacin CMagnesium sulfate DPenicillin
ABetamethasone
A 21-year-old woman with no prenatal care presents for evaluation of lower abdominal pain and fever. She estimates that she is approximately 7.5 months pregnant. On questioning, she acknowledges intermittent pain for two days and a gush of fluid shortly after the pain began. Her temperature is 101.8°F. Physical examination is notable for purulent material in the vaginal vault. Which of the following is the most likely diagnosis? AChorioamnionitis BEndometritis CPelvic inflammatory disease DUrinary tract infection
AChorioamnionitis
A 44-year-old woman with a history of hypertension presents to her primary care provider's office with complaints of nausea and vomiting. Her last menstrual cycle was six weeks ago. Two years ago she had a bilateral tubal ligation performed. On physical exam, her abdomen is nontender and her uterus is not enlarged. Pelvic exam is unremarkable. Her serum human chorionic gonadotropin level is 5,000 mIU/mL. A transvaginal ultrasound does not demonstrate an intrauterine gestational sac. Which of the following is the most likely diagnosis? AEctopic pregnancy BGestational trophoblastic disease CHeterotopic pregnancy DThreatened abortion
AEctopic pregnancy
A 31-year-old G3P2 at 39 weeks gestational age is on a fetal heart monitor in labor and delivery after presenting with ruptured membranes. Fetal heart monitor abruptly changes revealing severe prolonged bradycardia with variable decelerations. In the event of a prolapsed umbilical cord, which of the following can be done to reduce pressure on the cord while preparing for emergency delivery? AElevating the fetal head BPlacing mother in reverse Trendelenburg CPlacing prolapsed portion of cord in ice bath DStraight catheterizing the mother's bladder to remove any urine providing additional pressure to the cord
AElevating the fetal head
A 26-year-old previously healthy woman presents to the emergency department with abdominal pain. She was at home when she developed sudden onset lower abdominal pain followed by a brief syncopal episode. Her vital signs include blood pressure of 88/46 mm Hg, heart rate of 112 beats/minute, respiratory rate of 18 breaths/minute, temperature of 37.6°C, and oxygen saturation of 98%. She had a positive home pregnancy test yesterday. After initiating aggressive resuscitation, what is the most appropriate next step in management? AEmergent OB/Gyn consult BObtain a complete blood count CObtain a serum human chorionic gonadotropin (hCG) level DPelvic ultrasound
AEmergent OB/Gyn consult
Which of the following is the treatment of choice for threatened abortion? AExpectant management BMifepristone CMisoprostol DSurgical evacuation
AExpectant management
A 25-year-old woman presents to your office with amenorrhea, abdominal cramping, and irregular vaginal bleeding. She usually has monthly menstrual cycles, but has been intermittently spotting over the last 2 months. Her exam shows a firm uterus without tenderness and a dilated cervix with blood in the vaginal vault. Her beta hCG is positive and a bedside ultrasound reveals a yolk sac, fetal pole and no evidence of cardiac activity. What is the most likely diagnosis? AInevitable abortion BPhysiologic bleeding CSeptic abortion DThreatened abortion
AInevitable abortion
A G1P0 woman presents to the obstetrics clinic at eight weeks of gestation. Her blood pressure confirmed with repeat measurement is 160/110 mm Hg. Her blood pressure was 162/112 mm Hg at her previous visit. She has no clinical or laboratory findings suggesting end-organ damage. Which of the following is the best treatment for her hypertension? ALabetalol BLisinopril CNo pharmacologic therapy DSpironolactone
ALabetalol
Ectopic pregnancy triad
Amenorrhea Vaginal bleeding Abdominal pain
What is a septic abortion?
Any type of abortion that results in infected retained products of conception in uterine cavity
According to the United States Preventive Services Task Force (USPSTF), which of the following is considered to put a pregnant woman at high risk for developing preeclampsia? A Autoimmune disease B History of cesarean section C Hyperlipidemia D Young maternal age
Autoimmune disease
A 17-year-old G1P0 woman at 25-weeks gestation presents with intermittent blurred vision. On presentation, she is currently asymptomatic. Vital signs are HR 84, BP 165/97, oxygen saturation 97%. Physical examination reveals 2+ pitting edema on both lower extremities and urinalysis has 3+ protein on dip. Which of the following is the next best step in management? AAdministration of phenytoin BAdmit for further obstetric evaluation CArrange follow up with the patient's obstetrician DEmergency cesarean section
BAdmit for further obstetric evaluation
An 18-year-old woman at 37 weeks gestation presents with a spontaneous leakage of fluid from the vagina. She has no other signs of active labor. Vital signs are unremarkable and the patient has no complaints except for the leakage of fluid. What management is indicated? AAdminister corticosteroids BAdmit to obstetrics for delivery CAmoxicillin IV DTocolysis
BAdmit to obstetrics for delivery
Based on the anatomy of the uterus, where would you expect to find the placenta accreta? AAttached to the decidua BAttached to the myometrium CPenetrated into the myometrium DPenetrated into the uterine serosa
BAttached to the myometrium
An 18-year-old woman comes to the emergency department with sudden onset of right lower abdominal pain. She describes the pain as crampy and intermittent. Her last menstrual period was 7 weeks ago. She has noticed vaginal spotting during the past few days. Physical examination shows a tender lower abdomen with guarding. Pelvic examination shows a slightly enlarged uterus, cervical motion tenderness, and a palpable adnexal mass. Which of the following is the most likely diagnosis? AAcute appendicitis BEctopic pregnancy COvarian torsion DUrinary tract infection
BEctopic pregnancy
A 30-year-old Gravida 2, Para 1 woman at 12 weeks of pregnancy presents for routine prenatal care. She has a history of gestational diabetes mellitus managed with diet alone during her previous pregnancy. She denies any episodes of hypoglycemia. Today, her fasting blood glucose is 145 mg/dL and her hemoglobin A1c is 7.5%. Which of the following represents an ideal intrapartum glycemic target for this woman? AFasting glucose less than 110 mg/dL BFasting glucose less than 95 mg/dL COne-hour postprandial glucose level less than 200 mg/dL DTwo-hour postprandial glucose level less than 200 mg/dL
BFasting glucose less than 95 mg/dL
A 33-year-old G3P2 at 26 weeks' gestation presents to the clinic for a regular prenatal visit. She has no complaints at presentation and notes normal fetal movement. Vitals are normal. Body mass index is 35.6 kg/m². A 50 gram oral glucose load is given and one hour later, her glucose level is elevated at 212 mg/dL. The patient has no prior history of elevated glucose readings. Which of the following is the most likely presumptive diagnosis? ADiabetes mellitus type 2 BGestational diabetes CPolycystic ovary syndrome DPregestational diabetes
BGestational diabetes
A 36-year-old G2P1 woman is being seen for routine obstetrical care. She is at 26 weeks gestation and has no complaints. She has no past medical history. Vital signs are only abnormal for a blood pressure of 152/84 mm Hg. Previous blood pressure at her 22 week visit was 148/88 mm Hg. Physical exam is normal. Urine dip in the office is negative. Complete blood count with differential and comprehensive metabolic panel is within normal limits. What is the most likely diagnosis? AEclampsia BGestational hypertension CHELLP syndrome DPreeclampsia
BGestational hypertension
A woman in her third trimester of pregnancy is involved in a motor vehicle collision. She presents to the ED with new-onset vaginal bleeding and pelvic pain. Which of the following laboratory abnormalities is consistent with the most likely diagnosis? ADecreased prothrombin time BHypofibrinogenemia CProteinuria DThrombocytosis
BHypofibrinogenemia
A nulliparous, 41-year-old pregnant woman at 36 weeks gestation presents to the emergency department with concerns about her blood pressure and complaint of severe headache and blurry vision. She says that her home blood pressure readings have been elevated, and her blood pressure taken four hours ago was 175/115 mm Hg. Vital signs in the emergency department include a blood pressure of 180/120 mm Hg. Urine dipstick shows a protein level of 2+. She is diagnosed with preeclampsia. Which of the following is the most appropriate next step in management? AAdminister diuretics BInduce delivery CRestrict sodium DStrict bedrest
BInduce delivery
Which of the following is the best option for pharmacologic therapy in women with gestational diabetes mellitus that is not controlled with dietary changes? AGlyburide BInsulin CMetformin DPharmacologic antihyperglycemics should never be used during pregnancy
BInsulin
Which of the following fetal heart tracings patterns is indicative of uteroplacental insufficiency? AEarly decelerations BLate decelerations CSinusoidal DVariable decelerations
BLate decelerations
A 25-year-old woman presents to the emergency department with abdominal pain in the lower left quadrant. An ultrasound shows an ectopic pregnancy. Which of the following make her a candidate for methotrexate therapy? AFree peritoneal fluid BMass size less than 4 cm CPeptic ulcer disease DRenal insufficiency
BMass size less than 4 cm
A woman is diagnosed with an ectopic pregnancy. She has normal renal and hepatic function and normal platelet levels. She is hemodynamically stable. Her human chorionic gonadotropin level is 4000 international units per liter, and there is no fetal cardiac activity on transvaginal ultrasound. Which of the following is the best treatment plan? AExpectant management BMethotrexate CProgesterone DSurgical intervention
BMethotrexate
In which situation should Rho(D) immune globulin be administered? AMother is Rh-negative and baby is Rh-negative BMother is Rh-negative and baby is Rh-positive CMother is Rh-positive and baby is Rh-negative DMother is Rh-positive and baby is Rh-positive
BMother is Rh-negative and baby is Rh-positive
A 26-year-old G2P1 at 37 weeks of gestation presents to labor and delivery reporting an episode of gushing vaginal fluid while at home. She has not started contractions. After a sterile speculum examination is performed, which of the following should be considered to confirm a diagnosis of premature rupture of the membranes? ADigital cervicovaginal examination BNitrazine test CNonstress test DTransabdominal ultrasound
BNitrazine test
A 39-year-old woman presents to the office with painless vaginal bleeding in the third trimester (32 weeks) of pregnancy. She has a history of tobacco use and has received no prenatal care. Her five other children were all delivered via cesarean section. She denies any lower extremity edema. Her vital signs are normal. Which of the following conditions should you be most concerned about? ALabor BPlacenta previa CPlacental abruption DPreeclampsia
BPlacenta previa
A 32-year-old gravida 2 para 1 at 33 weeks gestation presents to the emergency room for sharp abdominal pain. She has not had any prenatal care during this pregnancy. Physical exam reveals vaginal bleeding, uterine pain between contractions, and fetal distress. Her first pregnancy was uncomplicated, with a vaginal delivery at term. Which one of the following is the most likely diagnosis? APlacenta previa BPlacental abruption CUterine rupture DVasa previa
BPlacental abruption
A 30-year-old woman presents for follow-up after dilation and curettage for a partial hydatidiform mole. Which of the following laboratory studies is the best method for identifying persistent or recurrent gestational trophoblastic disease? AQualitative beta-human chorionic gonadotropin BQuantitative beta-human chorionic gonadotropin CSerum alpha-fetoprotein DSerum follicle stimulating hormone
BQuantitative beta-human chorionic gonadotropin
A 27-year-old G2P1 is brought into labor and delivery complaining of contractions. Her estimated gestational age is 34 weeks. Which of the following physical examination findings would support a diagnosis of preterm labor? ARegular, painful contractions with cervical dilation of 2 cm BRegular, painful contractions with cervical dilation of 3 cm CRegular, painful contractions with cervical length of 24 mm DSix uterine contractions in the past hour with cervical length of 20 mm
BRegular, painful contractions with cervical dilation of 3 cm
Which of the following is the most common cause of early postpartum hemorrhage? ARetained placenta BUterine atony CUterine inversion DVaginal laceration
BUterine atony
A 22-year-old gravida 1, para 0 woman at 40 weeks gestation presents to the emergency department in active labor. Her pregnancy was complicated by gestational diabetes. As labor progresses, the fetal head appears, but then retracts back into the perineum. Gentle downward traction fails to accomplish delivery of the anterior shoulder. Which of the following is the most likely diagnosis? ADysgeusia BDysphoria CDystocia DDystonia
CDystocia
A G2P1 woman who is 31 weeks pregnant with twins presents to the emergency department concerned that she is in labor. She reports a large gush of fluid from her vagina one hour ago. She does not report any contractions. Sterile speculum exam reveals fluid pooling in the vaginal vault, and when the fluid is examined under a microscope, a distinct fern pattern is observed. An ultrasound and fetal heart monitoring are performed and reveal no fetal distress. What is the best management at this time? AAdminister tocolytics BEmergent C-section CExpectant management DInduce labor
CExpectant management
Which of the following diagnoses is most likely in a gravid woman presenting in her 18th week of pregnancy with hypertension, emesis, proteinuria, and a beta-human chorionic gonadotropin level of > 100,000 mIU/mL? AChoriocarcinoma BGestational diabetes CHydatidiform mole DPreeclampsia
CHydatidiform mole
A 21-year-old woman G1P0 at 35 weeks gestation presents with headache, blurry vision, and shortness of breath. Vital signs include a blood pressure of 195/110 mm Hg, heart rate of 90 beats per minute, respiratory rate of 21 breaths per minute, oral temperature of 37.1℃, and oxygen saturation of 90% on room air. Urinalysis reveals 3+ protein. A chest radiograph reveals pulmonary edema. In addition to magnesium, which of the following medications should be administered to reduce blood pressure? AEnoxaparin BFurosemide CHydralazine DLosartan
CHydralazine
A G1P0 25-year-old woman who is 23 weeks gestation presents to the emergency department with severe abdominal pain and vaginal bleeding. On exam, the uterus is rigid and tender. Fetal heart tones reveal a pulse of 90 bpm. Which of the following is a risk factor for this condition? AGestational diabetes BHistory of sexually transmitted infection CHypertension DIncompetent cervix
CHypertension
A 25-year-old G3P2 woman at eight weeks zero days of gestation presents to the emergency department complaining of pelvic pain and vaginal bleeding. Pelvic examination confirms the uterus as the source of bleeding and reveals a dilated cervix. No products of conception are seen. Pelvic ultrasound shows an embryo with a crown-rump length of 9 millimeters without fetal cardiac activity. Which of the following is the most likely diagnosis? AComplete abortion BIncomplete abortion CInevitable abortion DThreatened abortion
CInevitable abortion
A 38-year-old woman known to be at 12 weeks gestation presents with vaginal bleeding and crampy pelvic pain. Pelvic exam reveals that the cervical os is dilated and products of conception are visualized through the cervical os. Which of the following is the most likely diagnosis? AComplete abortion BIncomplete abortion CInevitable abortion DThreatened abortion
CInevitable abortion
A 32-year-old G1P0 woman presents to labor and delivery at 37 weeks gestation for elevated blood pressure and proteinuria noted in her obstetrician's office. The patient endorses a mild temporal headache and nausea. Blood pressure is found to be 168/102 mm Hg. On physical examination, there is edema of bilateral hands and hyperreflexia. On laboratory studies, the patient has 4+ protein on urine dipstick. There is no evidence of hemolytic anemia or thrombocytopenia, but liver enzymes are elevated. In addition to urgently preparing for delivery, which of the following would be the most appropriate next step in the patient's management? ABetamethasone to promote fetal lung maturity BIntravenous nitroprusside to reduce blood pressure CMagnesium sulfate for seizure prophylaxis DVigorous intravenous hydration to prevent renal failure
CMagnesium sulfate for seizure prophylaxis
A 36-year-old G1P0 woman at 9 weeks gestation presents to your office complaining of nausea and vomiting. She also reports mild vaginal bleeding. Pelvic exam shows a closed cervical os and dark blood in the posterior vault. The size of the uterus is felt to be larger than expected. Her beta-hCG level is 500,000 IU/L. A transvaginal ultrasound reveals a central heterogeneous mass with many discrete anechoic spaces. Which of the following is the most likely diagnosis? AHyperemesis gravidarum BMissed abortion CMolar pregnancy DThreatened abortion
CMolar pregnancy
A 24-year-old G1P0 woman presents to the emergency department for atraumatic vaginal bleeding at 12 weeks of gestation. The woman's vital signs are within normal limits. On examination, she is found to have blood in the vaginal vault with an open cervical os. Obstetrics is consulted. Rh(D) immunoglobulin is given to the patient after laboratory results are available. Which of the following test results indicated the patient's need for Rh(D) immunoglobulin? ADecrease in hCG by 40% BLow hemoglobin and hematocrit on complete blood count CNegative Rh(D) on blood typing and antibody screen DPositive Kleihauer-Betke test
CNegative Rh(D) on blood typing and antibody screen
A G2P1 25-year-old woman who is 26 weeks pregnant presents to the office for prenatal care. She reports that she has not been receiving routine prenatal care due to a lapse in insurance. Her last pregnancy was complicated by gestational diabetes and preeclampsia. What diagnostic test should be conducted to evaluate for gestational diabetes? AFasting blood glucose BGlycosylated hemoglobin COral glucose challenge DRandom blood glucose
COral glucose challenge
A 28-year-old G2P1 woman who is 37 weeks pregnant presents in the emergency department with bright red vaginal bleeding with no abdominal pain. Her blood pressure is 120/80 mm Hg and temperature is 98.6° F. The patient has a scar from a previous C-section. Which of the following is the most likely diagnosis? AAbruptio placentae BHydatidiform mole CPlacenta previa DSpontaneous abortion
CPlacenta previa
A 17-year-old girl is examined for a routine visit. She eats a healthy diet. She also stays active by playing volleyball three times a week. Her grades are mostly Bs. She reports she started to be sexually active for the past six months and has delayed periods for two months now. She had her menarche at 12 years old and has regular periods. She also smokes a quarter of a pack of cigarettes per day. Which of the following is an adverse pregnancy outcome due to maternal smoking? AHyperbilirubinemia BLarge for gestational age CPlacental abruption DRespiratory distress syndrome
CPlacental abruption
A 35-year-old G2P1 woman at 28 weeks gestation presents to the Emergency Department with abdominal pain, continuous uterine contractions, and decreased fetal movement. She has a history of hypertension and endorses a 1.5 pack per day smoking history. She denies any vaginal bleeding or rush of water. Her vital signs upon arrival are T 37.2°C, HR 130, BP 80/50, RR 22. Fibrinogen is 200 mg/dL. A fetal heart rate by bedside Doppler is 100. Physical exam reveals a rigid, tender uterus. An ultrasound shows a normally implanted posterior placenta with diffuse thickening. Which of the following is the most likely diagnosis? AChorioamnionitis BPlacenta accreta CPlacental abruption DUterine rupture
CPlacental abruption
Which of the following statements is true regarding gestational diabetes? AGestational diabetes eventually evolves into type 2 diabetes BGlitazones are the first-line treatment CPreliminary screening is a blood glucose > 130 mg/dL 1 hour after a 50-gram glucose load DScreening is performed between 32 and 36 weeks gestation
CPreliminary screening is a blood glucose > 130 mg/dL 1 hour after a 50-gram glucose load
Which of the following is the greatest risk factor for an ectopic pregnancy? AMultiple sexual partners BPrevious abdominal surgery CPrevious ectopic pregnancy DPrevious pelvic inflammatory disease
CPrevious ectopic pregnancy
A 33-year-old gravid female who is at 18 weeks gestation presents to clinic complaining of headaches, worsened peripheral and facial edema, and oliguria. The presence of which of the following helps differentiate preeclampsia from gestational hypertension? ADeep vein thrombosis BHemolytic anemia CProteinuria DSeizures
CProteinuria
Which of the following combination of laboratory findings is most suggestive of hemolysis, elevated liver enzymes, and low platelet count syndrome of pregnancy? ADecreased total bilirubin, elevated aspartate aminotransferase and alanine aminotransferase greater than twice normal, decreased hemoglobin BIncreased total bilirubin, aspartate aminotransferase and alanine aminotransferase levels < 50 U/L CSchistocytes, thrombocytopenia, and elevated aspartate aminotransferase and alanine aminotransferase greater than twice normal DSchistocytes, thrombocytosis, decreased aspartate aminotransferase and alanine aminotransferase levels
CSchistocytes, thrombocytopenia, and elevated aspartate aminotransferase and alanine aminotransferase greater than twice normal
What is the most common cause of postpartum hemorrhage? ACoagulopathy BRetained placental tissue CUterine atony DUterine inversion
CUterine atony
What is the most common cause of traumatic postpartum hemorrhage?
Cervical tears.
What infectious condition should all prelabor rupture of membranes patients be evaluated for?
Chorioamnionitis, an inflammation of the fetal membranes (amnion and chorion) due to a bacterial infection.
What serious maternal infection can occur as a complication of prelabor rupture of membranes?
Chorioamnionitis.
#1 reason for first trimester abortions
Chromosomal abnormalities (autosomal trisomony)
Which bacterium was associated with sepsis related to first-trimester medication abortion?
Clostridium sordellii.
What medication is administered to a mother to promote fetal lung maturity if delivery is expected prior to 37 weeks gestation?
Corticosteroids.
A 26-year-old woman presents with abdominal cramping after a positive home pregnancy test. She states that the pregnancy is wanted. Her vitals are T 98.7°F, HR 94 bpm, BP 110/66 mm Hg, RR 18/min, and oxygen saturation 97%. Her exam is unremarkable. Labs reveal a serum beta-hCG of 1,000 mIU, and she is Rh-positive. An ultrasound is performed as seen above. Which of the following is the appropriate management for this patient? AAdminister methotrexate BAdminister Rhogam and discharge home with repeat beta-hCG in 48 hours CAdminister Rhogam and methotrexate DDischarge home with repeat beta-hCG in 48 hours
DDischarge home with repeat beta-hCG in 48 hours
A 19-year-old G1P0 woman at 26 weeks presents with abdominal pain after being involved in a motor vehicle collision. External pelvic examination reveals vaginal bleeding. Which of the following is true regarding this presentation? AA normal ultrasound rules out placental abruption BDisseminated intravascular coagulation is uncommon in placental abruption CEarly pelvic digital examination should be performed DEmergent fetal monitoring and obstetric consultation are required
DEmergent fetal monitoring and obstetric consultation are required
What is the most common anatomical site of an ectopic pregnancy? AAbdominal cavity BCervix CCornua of the uterus
DFallopian tube
A 36-year-old G1P0 woman presents at 32 weeks gestation with right upper quadrant abdominal pain. She has no past medical history and her pregnancy has thus far been uncomplicated. Her vital signs on arrival are T 37.3°C, HR 110 bpm, BP 125/75 mm Hg, RR 24/min. Her physical exam is significant for moderate right upper quadrant tenderness to palpation. Her laboratory studies are remarkable for WBC 14 x 109/L, hemoglobin 9 g/dL, hematocrit 27%, platelets 70 X 109/L, AST 120 U/L, ALT 100 U/L, total bilirubin 1.5 mg/dL and LDH 1,000 U/L. Which of the following is the most likely diagnosis? ACholecystitis BCholedocholithiasis CFitz-Hugh Curtis syndrome DHELLP syndrome
DHELLP syndrome
Which of the following medications is a preferred outpatient treatment of hypertension in pregnancy? AHydrochlorothiazide BLisinopril CLosartan DMethyldopa
DMethyldopa
A 22-year-old woman at 36 weeks gestation presents with complaints of feeling a sudden gush of water coming from her vagina. She has had regular obstetrical follow-up and a normally progressing pregnancy. Which of the following is the most appropriate next step in management? AAdministration of corticosteroids BImmediate digital examination of the cervix CInitiation of magnesium sulfate infusion DMicroscopic evaluation of vaginal fluid
DMicroscopic evaluation of vaginal fluid
An 18-year-old G1P0 woman at 16 weeks gestation presents with vaginal bleeding. She has had no prenatal care. Vital signs are unremarkable and physical examination only reveals a small amount of blood in the vaginal vault. A transvaginal ultrasound is performed as seen above. What is the next best step in management of this patient? AAdminister methotrexate BCT scan of the abdomen and pelvis CIntravenous antibiotics DObstetrics consultation
DObstetrics consultation
A 35-year-old obese woman who just delivered a 10 lb baby after 48 hours of labor starts hemorrhaging from the vaginal area and has a sudden drop in blood pressure. She was in her 41st week of gestation when she was admitted to have labor induced. Which of the following is the best initial step in diagnosing the underlying cause of bleeding? ADo manual exploration of the uterine cavity BOrder a complete blood count COrder a pelvic and abdominal ultrasound to identify the source of bleeding DPalpate to determine the size and firmness of the uterus
DPalpate to determine the size and firmness of the uterus
A 39-year-old woman in her third trimester presents with 2 days of bloody "spotting" on her underwear. This is her third pregnancy, which thus far has been uncomplicated. Her initial delivery was vaginal, and her second delivery was via cesarean section. She is currently sexually active and has a history of trichomoniasis. She denies pelvic pain. Laboratory examination reveals hematocrit of 32%, white blood cell count of 10,000/µL, platelet count of 260,000/µL, international normalized ratio of 1.1, and activated partial thromboplastin time of 32 seconds. Pelvic examination shows a nonerythematous cervix with clear mucus. Which of the following is the most likely diagnosis? ACervicitis BHemolysis, elevated liver enzymes, and low platelet count syndrome CMaternal coagulopathy DPlacenta previa
DPlacenta previa
A G1P0 woman who is 38 weeks pregnant presents to the clinic reporting a sudden gush of clear fluid from her vagina. The leakage was so significant that it soaked her clothes and bed sheets. She denies contractions. Which of the following would be expected finding in this patient? AAbsence of arborization on microscopic exam of vaginal fluid BpH of 4.0 on Nitrazine blue paper testing CPolyhydramnios on ultrasonography DPooling of amniotic fluid in the vaginal fornix on physical exam
DPooling of amniotic fluid in the vaginal fornix on physical exam
A 23-year-old G1P0 woman with no significant past medical history presents to the outpatient obstetrics office for a follow-up on an isolated elevated blood pressure reading last week. She is at 31 weeks gestation and has had no complications during this pregnancy except that last week her blood pressure was 150/88 mm Hg. Her urine dip at that time that showed 3+ protein. She has no complaints today. Vital signs today are blood pressure 148/92 mm Hg, pulse 78 bpm, respirations 16 bpm, temperature 98.8℉. Outpatient 24-hour urine for protein showed 400 mg in 24 hours. The physical exam is within normal limits. What is the most likely diagnosis? AChronic hypertension BEclampsia CGestational hypertension DPreeclampsia
DPreeclampsia
A 24-year-old G1P0 24 weeks' gestation presents to her gynecologist for follow-up visit. She states that she has been having headaches with blurred vision and some epigastric pain. Her blood pressure is 162/92 although prior to her pregnancy she was normotensive. Protein is noted in her urine. What condition should be considered at this time? AEclampsia BGestational hypertension CHELLP syndrome DPreeclampsia
DPreeclampsia
A 25-year-old G1P0 woman at 34 weeks gestation presents to the clinic for a regular prenatal visit. She has noticed swelling in her feet but denies any associated pain as well as any other new symptoms. Temperature is 98.0°F, blood pressure is 155/92 mm Hg, and body mass index is 38.0 kg/m². Serum creatinine is 1.8 mg/dL. Which of the following is the most likely diagnosis? ADeep vein thrombosis BEclampsia CLymphedema DPreeclampsia
DPreeclampsia
A 40-year-old woman who is at 22 weeks gestation returns to the office for a routine obstetric appointment. She has a history of benign essential hypertension that is normally controlled with diet and exercise. She has a blood pressure of 154/89 mm Hg with mild proteinuria on dipstick. She has an unremarkable complete blood count. She does not complain of any symptoms, and a physical exam and fetal ultrasound are unremarkable. Which of the following is the most likely diagnosis? AEclampsia BHemolysis, elevated liver enzymes, and low platelet count syndrome CMalignant hypertension DPreeclampsia
DPreeclampsia
A 34-year-old G5P4 woman at 24 weeks gestation presents to the emergency department with vaginal bleeding. A transabdominal ultrasound done in the emergency department shows the placenta overlying the cervical os. Which of the following is a risk factor for this condition? AMaternal hypertension BMaternal trauma CPremature rupture of membranes DPrior dilation and curettage
DPrior dilation and curettage
A 25-year-old woman is admitted to the labor and delivery unit. Fetal heart rate monitor has been placed. Which of the following findings would necessitate the planning for emergent intervention and possible cesarean section or instrumented vaginal delivery? AAbsence of variable decelerations BBaseline fetal heart rate of 110 to 160 bpm CModerate fetal heart rate variability (6 to 25 bpm) DRecurrent late decelerations
DRecurrent late decelerations
A 31-year-old G3P2 at 35 weeks estimated gestational age is rushed to labor and delivery from outpatient clinic due to hypertension of 172/100 mm Hg, proteinuria, right upper quadrant pain, and nausea. A complete blood count and peripheral smear are obtained. What other tests should be ordered to confirm the diagnosis of HELLP syndrome? AADAMTS13 and lactate dehydrogenase BHepatitis panel and serum aspartate aminotransferase CLactate dehydrogenase and bilirubin DSerum aspartate aminotransferase and bilirubin
DSerum aspartate aminotransferase and bilirubin
A 22-year-old woman presents with vaginal bleeding with clots that started one hour prior to arrival. She is 10 weeks pregnant based on a previous ultrasound confirming her intrauterine pregnancy. Bedside ultrasound today does not show an intrauterine pregnancy. Her blood type is A negative and the father of the baby's blood type is not currently known. Which of the following is true regarding the administration of Rh immunoglobulin? AA test dose is administered first because of the risk of an anaphylactoid reaction BRh immunoglobulin 300 µg is indicated immediately CRh immunoglobulin is not indicated DShe should receive 50 µg Rh immunoglobulin within 72 hours
DShe should receive 50 µg Rh immunoglobulin within 72 hours
Which of the following is most important to rule out when considering a diagnosis of endometritis in a postpartum female who recently underwent cesarean section delivery? ABacterial vaginosis BChorioamnionitis CNeisseria gonorrhoeae cervicitis DSurgical site infection
DSurgical site infection
Which of the following is true regarding the treatment plan of placental abruption? AAll patients with placental abruption should be delivered at a gestational age of 36 weeks BAll patients with placental abruption should undergo cesarean delivery CAll patients with placental abruption should undergo immediate delivery DThe treatment plan depends on fetal status, maternal hemodynamic stability, and gestational age of the fetus
DThe treatment plan depends on fetal status, maternal hemodynamic stability, and gestational age of the fetus
A 25-year-old G2P1 woman presents to your office at 32 weeks gestation with a complaint of severe itching, particularly on the palms of her hands and the soles of her feet. Lab results reveal elevated bile acids. Regarding this disease, which of the following statements is most correct? AAminotransferases are low BDisease recurrence is rare in subsequent pregnancies CThe treatment of choice is cholestyramine DThere is an increased risk for fetal demise
DThere is an increased risk for fetal demise
A 31-year-old woman at 35-weeks gestation presents with brief painless, bright red vaginal bleeding. In addition to fetal monitoring, which of the following is the most important initial management? AAdministration of betamethasone to hasten fetal lung maturity BSterile digital cervical exam CSterile speculum examination DTransvaginal ultrasound
DTransvaginal ultrasound
A 23-year-old G1P0 woman at 30 weeks gestation presents to the emergency department for vaginal bleeding. She has had no prior prenatal care. She reports that she is soaking through one pad every 8 hours, denies abdominal cramping or a gush of water and endorses good fetal movement. Her vital signs are T 37.2°C, HR 100, BP 105/70, RR 18. Her abdomen is soft, non-tender, and consistent with a 30 week pregnancy. A transabdominal ultrasound shows a viable intrauterine pregnancy and a placenta that completely overlies the cervical os. Which of the following investigations is indicated in this patient? ANitrazine test BPelvic exam CTransvaginal ultrasound DType and screen
DType and screen
Which of the following best describes an inevitable abortion? AParts of the product of conception have been passed and may be visible in the cervical os or vaginal canal BRetention of a nonviable intrauterine pregnancy within the uterus, no cardiac activity, and a closed cervical os CVaginal bleeding before 20 weeks gestation with a closed internal cervical os DVaginal bleeding before 20 weeks gestation with an open internal cervical os
DVaginal bleeding before 20 weeks gestation with an open internal cervical os
A 28-year-old woman at 31 weeks gestation comes to the emergency department after noticing a gush of clear fluid from her vagina. Which of the following features is most suggestive of preterm rupture of membranes? AMicroscopic evaluation of vaginal fluid revealing pseudohyphae BPresence of bloody vaginal secretions CVaginal epithelial cells with a stippled appearance on microscopic evaluation DVaginal fluid pH > 6.5
DVaginal fluid pH > 6.5
What is the first line management for gestational diabetes during pregnancy?
Diabetic diet, exercise, and glucose monitoring.
Which hematologic condition leading to consumption of clotting factors and platelets and severe bleeding commonly occurs in conjunction with severe abruptio placentae?
Disseminated intravascular coagulation (DIC).
What imaging technique is used for noninvasive, external, fetal heart rate monitoring?
Doppler ultrasound applied to the maternal abdomen.
What obstetrical complication occurs most often during the 6th and 8th week of pregnancy?
Ectopic pregnancies.
What is the treatment of choice in postpartum hemorrhage due to a morbidly adherent placenta?
Emergency hysterectomy.
What are the serum glucose measurement cutoffs for the fasting, one-hour, two-hour, and three-hour measurements during the second step of the two-step approach used to diagnose gestational diabetes mellitus?
Fasting ≥ 95 mg/dL, one hour ≥ 180 mg/dL, two hour ≥ 155 mg/dL, and three hour ≥ 140 mg/dL. The diagnosis of gestational diabetes is confirmed in patients who meet at least two of these four criteria.
What additional studies are recommended in patients with nonreassuring patterns on fetal heart tracings?
Fetal scalp stimulation or fetal scalp pH measurement.
Which gestational disorder may lead to preeclampsia presenting prior to the 20th week of gestation?
Gestational trophoblastic disease
What antihypertensive drugs are used to treat severe hypertension in pregnancy?
Hydralazine, nifedipine, labetalol, and sodium nitroprusside in severe cases
What are the diagnostic criteria for preeclampsia?
Hypertension after 20 weeks of pregnancy plus proteinuria or other signs of end-organ dysfunction
What is the definition of gestational hypertension?
Hypertension without proteinuria or other signs or symptoms of preeclampsia that develops after 20 weeks gestation.
What is the most concerning complication of a newborn born to a diabetic mother?
Hypoglycemia.
How do you treat unstable ruptured ectopic pregnancy
IV fluids blood products vasopressor medication (if needed) surgery (exploratory laparotomy)
A 22-year-old woman presents complaining of vaginal bleeding and cramping for the last 4 hours. She is known to be 14-weeks pregnant. Her cervical os is dilated to 4 cm and she is actively bleeding. Pelvic ultrasound shows the gestational sac in the lower uterine segment near the cervix. Which of the following is the most likely diagnosis? Complete abortion Inevitable abortion Missed abortion Septic abortion
Inevitable abortion
Open cervix in
Inevitable abortion Incomplete abortion Septic abortion
What is the difference between a threatened miscarriage and inevitable miscarriage?
Inevitable miscarriage is vaginal bleeding during the first trimester of pregnancy with a dilated cervical os. Threatened miscarriage is vaginal bleeding during the first trimester of pregnancy with a closed cervical os.
What are the three treatment options for inevitable abortion?
It can be managed surgically (dilation and curettage), with medication (misoprostol), or expectantly.
What is missed abortion?
It is the in utero death of a fetus before 20 weeks gestation but the conceptus has not been expelled and the cervical os is closed on exam.
What medication can be used prophylactically to reduce the risk of preeclampsia in a woman who is at high risk at her initial pregnancy consultation?
Low dose aspirin therapy can reduce the risk of preeclampsia.
What is the only medication proven to decrease risk of developing preeclampsia in high risk women when administered during the second and third trimester?
Low dose aspirin.
Where is the most common site of metastasis of gestational trophoblastic disease?
Lungs.
<4cm, B-hcg <5,000, no fetal heartbeat uncomplicated ectopic pregnancy treat with
Methotrexate
In a hemodynamically stable pregnant patient with an ectopic pregnancy, what medication is recommended for medical management?
Methotrexate.
High levels of B-hcg, larger than normal uterine size, and "snowstorm" appearance?
Molar pregnancy
What underlying process should be suspected if preeclampsia develops in the first trimester of pregnancy?
Molar pregnancy.
What test determines the presence of premature rupture of membranes?
Nitrazine paper test or Fern test.
Can a woman with complete placenta previa undergo a vaginal delivery?
No, cesarean delivery is indicated for all patients with sonographic evidence of complete placenta previa.
How long after a molar pregnancy should a women wait before trying to have more children?
One year
What is the preferred method of delivery in a woman with placental abruption?
Oxytocin-induced vaginal delivery. Cesarean delivery is reserved for significant maternal and fetal instability.
What is the classic clinical presentation of placental abruption?
Painful third-trimester vaginal bleeding.
Which molar pregnancy have lower potential of becoming malignant?
Partial moles
How is a molar pregnancy diagnosed?
Pathologic examination
What is the clinical condition when the placenta attaches to the myometrium?
Placenta accreta.
What are the most common complications of a molar pregnancy?
Preeclampsia/eclampsia, pulmonary embolism of trophoblastic cells, and hyperemesis gravidarum.
What is the classic ultrasound finding in patients with placental abruption?
Retroplacental hematoma.
Which women presenting with bleeding during pregnancy should be given anti-D immunoglobulin?
Rh-negative women
What medication do mothers who are Rh negative need to be administered when abruptio placentae occurs?
Rhogam.
What are the three options for managing an ectopic pregnancy?
Surgical treatment, with either salpingectomy or salpingostomy, methotrexate therapy, and expectant management.
What sonographic findings suggest a spontaneous abortion?
The sonographic criteria for spontaneous abortion are gestational sac ≥ 25 millimeters in diameter that does not contain a yolk sac or embryo, or an embryo with a crown-rump length (CRL) ≥ 7 millimeters that does not have cardiac activity.
Cervix closed in
Threatened abortion Complete abortion
What is the most common cause of bleeding in the primigravid woman?
Threatened abortion.
Endocrine problems that can cause abortion
Thyroid problems
A 26-year-old woman just vaginally delivered twin, macrosomic boys. This was her fourth pregnancy, which has been the longest of them all at 43 weeks gestation. Her delivery was difficult and required forceps to complete. Estimated blood loss was 1,100 mL. Currently, she is hypotensive, tachycardic, and anemic. Which of the following is the most likely diagnosis? Amniotic fluid embolism Incision dehiscence Rh sensitization Uterine atony
Uterine atony
What umbilical cord abnormalities are correlated with placenta previa?
Vasa previa and velamentous cord insertion.
Dietary deficiency of which vitamin is associated with an increased risk for complete mole?
Vitamin A.
If a woman received Rh immunoglobulin in a previous pregnancy, is it required with subsequent pregnancies?
YES
A 26-year-old woman who is nine weeks pregnant presents to the clinic with vaginal bleeding. She reports crampy pelvic pain. Vaginal exam reveals a dilated cervix. Products of conception can be visualized through the cervical os. Which of the following best describes this patient's condition? AComplete abortion BInevitable abortion CMissed abortion DThreatened abortion
b
Is the risk of gestational trophoblastic neoplasia higher after a complete mole or a partial mole?
complete mole
How do you treat stable ruptured ectopic pregnancy
exploratory laparoscopy (evacuate the hemoperitoneum, coagulate bleedings, and resect the ectopic pregnancy
What is the HELLP syndrome?
hemolysis, elevated liver enzymes, low platelets
Placental abruption
premature separation of the placenta
Strongest risk for ectopic pregnancy
prior ectopic pregnancy
True/False: Anti-D immunoglobulin can cause a positive Rh antibody screen in a pregnant woman.
true
