CF: 6-10

Question 1

29 yo G5P4 woman at 39 wk gestation w/ preeclampsia delivers vaginally. Denies FHx bleeding diathesis. After placenta is delivered, there is appreciable vaginal bleeding, estimated at 1000 cc.
Most likely Dx?
Next step in therapy?

Answer 1

Uterine atony

Dilute IV oxytocin. If this is ineffective, then IM PGF2alpha or PR misoprostol

Question 2

20 yo G1P0 woman at 16 wk gestation by a fairly certain LMP has a serum MAFP test that returned as 2.8 MOM.
Next diagnostic step?

Answer 2

Basic OB US to assess for dates and multiple gestations

Question 3

31 yo G4P3 woman at 36 wk gestation w/ twin pregnancy presents in labor. Upon ROM, there’s moderate vaginal bleeding. Twin A has fetal tachycardia and now a sinusoidal HR pattern.
Most likely Dx?
Cause of this condition?
Next step?

Answer 3

• Vasa previa
• Exact pathophys unknown. Assoc w/ velamentous cord insertion, accessory placental lobes and 2nd trimester placenta previa.
• STAT C/S and alert peds for likely anemia in twin A

Question 4

31 yo G3P2 woman at 39 wk gestation is in labor and had ROM 2 hr ago. Has Hx HSV and is taking PO ACV suppressive therapy. 1 day hx of tingling in perineal area.
Nest step?
Most likely dx?

Answer 4

Counsel patient about risks of neonatal HSV and offer a C/S

HSV recurrence w/ prodromal Sx

Question 5

30 y0 G5P4 woman at 32 wk gestation c/o painless vaginal bleeding. 4 wk ago, she had some postcoital vaginal spotting. Abd is soft and uterus non-tender. FHR 140-150.
Next step?
Most likely Dx?
Long-term management?

Answer 5

US
Placenta previa
Expectant management as long as bleeding isn’t excessive. C/S at 34 wk.