[OB2] LE 1 Flashcards
Q: The ONLY antenatal test that equates to doing a physical examination of the fetus?
A. Non-stress Test (NST)
B. Doppler Velocimetry
C. Biophysical Profile (BPP)
D. Contraction Stress Test (CST)
C. Biophysical Profile (BPP)
Rationale: The BPP evaluates fetal well-being by assessing both acute (e.g., tone, movement, breathing) and chronic (e.g., amniotic fluid) indicators, making it the closest to a physical exam for the fetus.
Q: What is the ONLY chronic marker included in a Biophysical Profile (BPP)?
A. Fetal Tone
B. Fetal Movement
C. Fetal Breathing
D. Amniotic Fluid
D. Amniotic Fluid
Rationale: Amniotic fluid volume reflects long-term (chronic) placental function. The rest are acute markers of fetal well-being. Hence, AFI is the only chronic marker.
Q: A non-reactive Non-Stress Test (NST) is indicated when the fetal tracing shows:
A. At least 2 accelerations in 20 minutes without fetal movement
B. Less than 2 accelerations in 20 minutes despite fetal movement
C. No contractions for 20 minutes
D. Absence of decelerations during fetal movements
B. Less than 2 accelerations in 20 minutes despite fetal movement
Rationale: A reactive NST requires ≥2 accelerations in 20 minutes; absence indicates non-reactivity and may need further testing such as BPP or CST.
Q: Which of the following statements is TRUE regarding thick meconium staining during labor?
A. It is always an indication for emergency delivery
B. It is a benign finding in late-term pregnancies
C. It should only be considered worrisome when there is an abnormal CTG tracing
D. Meconium aspiration is inevitable once meconium is present
C. It should only be considered worrisome when there is an abnormal CTG tracing
Rationale: Thick meconium alone is not always a cause for concern unless it is associated with signs of fetal distress such as abnormal CTG patterns (e.g., late decelerations or bradycardia).
Q: Recurrent mid-trimester pregnancy loss associated with painless cervical dilatation is most likely due to:
A. Placenta Previa
B. Preterm Labor
C. Cervical Incompetence
D. Uterine Rupture
C. Cervical Incompetence
Rationale: Cervical insufficiency typically presents as painless dilation leading to mid-trimester losses. Management often includes cerclage to support the cervix in future pregnancies.
Q: Which lifestyle factor is LEAST likely associated with spontaneous preterm labor?
A. Smoking
B. Illicit drug use
C. Inadequate maternal weight gain
D. Regular physical activity
D. Regular physical activity
Rationale: While smoking, substance use, and poor maternal nutrition are all risk factors for preterm labor, regular physical activity is generally protective when done appropriately during pregnancy.
Q: A congenital anomaly scan is BEST performed at what gestational age?
A. 12–14 weeks
B. 16–18 weeks
C. 18–22 weeks
D. 24–28 weeks
D. 24–28 weeks
Q: In Biophysical Profile (BPP), which of the following observations receives a score of 2?
A. One limb movement noted
B. 3 gross movements of the fetal trunk
C. Intermittent fetal tone changes
D. Absent breathing movement
B. 3 gross movements of the fetal trunk
Rationale: For fetal body movements, a score of 2 is awarded if at least 3 discrete body or limb movements are observed in 30 minutes.
Q: Which antepartum test evaluates the basal oxygenation of the placental bed?
A. Non-Stress Test (NST)
B. Doppler Ultrasound
C. Biophysical Profile (BPP)
D. Contraction Stress Test (CST)
D. Contraction Stress Test (CST)
Rationale: The CST assesses uteroplacental reserve by inducing contractions and evaluating how well the placenta oxygenates the fetus under stress, thus testing basal oxygenation.
Q: Which statement is TRUE regarding fetal movement (FM) counting?
A. FM is reduced during maternal activity
B. FM is highest during maternal sleep
C. FM is expectedly at its peak 1 hour after meals
D. FM becomes less relevant after 28 weeks
C. FM is expectedly at its peak 1 hour after meals
Rationale: Fetal movements typically increase after meals due to maternal glucose rise, making 1 hour post-meal the best time for kick counts.
Q: Brain sparing effect in fetal circulation is best demonstrated in which vessel?
A. Umbilical artery
B. Ductus venosus
C. Middle cerebral artery
D. Aortic isthmus
C. Middle cerebral artery
Rationale: Brain sparing refers to fetal adaptation during hypoxia, where blood flow is redirected to vital organs. Doppler showing decreased resistance in the MCA indicates this compensatory mechanism.
Q: In a Biophysical Profile (BPP), which variable is the last to disappear in cases of fetal hypoxia?
A. Fetal breathing movements
B. Amniotic fluid volume
C. Fetal tone
D. Gross body movement
C. Fetal tone
Rationale: In fetal hypoxia, tone is the last variable to be affected, as it reflects chronic and severe compromise. It is considered the most resilient among BPP components.
Q: A G2P1 woman at 26 weeks gestation presents with regular uterine contractions and cervical changes. She has a history of preterm birth. Despite therapy and corticosteroids, she delivers at 28 weeks. Which of the following is LEAST likely to influence neonatal outcome?
A. History of preterm birth
B. Birthweight
C. Gestational age at delivery
D. Administration of corticosteroids
A. History of preterm birth
Rationale: While history of preterm birth increases risk of recurrence, it has no direct impact on neonatal outcome. Gestational age, birthweight, and antenatal corticosteroids are stronger predictors of neonatal prognosis.
Q: A patient diagnosed with Preterm Premature Rupture of Membranes (PPROM) is at increased risk of developing which complication?
A. Abruptio placenta
B. Chorioamnionitis
C. Uterine rupture
D. Post-term pregnancy
B. Chorioamnionitis
Rationale: PPROM leads to prolonged exposure of the amniotic sac to ascending infections, greatly increasing the risk of chorioamnionitis, which can compromise both maternal and fetal health.
Q: A patient with Preterm Premature Rupture of Membranes (PPROM) is at increased risk of which complication?
A. Preeclampsia
B. Placenta Previa
C. Chorioamnionitis
D. Uterine atony
C. Chorioamnionitis
Rationale: PPROM exposes the amniotic cavity to ascending infection, making chorioamnionitis the most common and serious complication. Vigilant monitoring for maternal fever and leukocytosis is essential.
Q: A G3P2 woman with a history of gestational diabetes mellitus (GDM) in a previous pregnancy is currently 28 weeks pregnant. What is her most important risk factor for developing preeclampsia?
A. Advanced maternal age
B. Obesity
C. History of GDM
D. Family history of hypertension
C. History of GDM
Rationale: A prior history of GDM increases the risk for preeclampsia in subsequent pregnancies due to endothelial dysfunction and metabolic disturbances associated with insulin resistance.
Q: A G4P3 patient presents at 32 weeks of gestation with painless vaginal bleeding. What is the most likely diagnosis?
A. Placental abruption
B. Vasa previa
C. Cervicitis
D. Placenta previa
D. Placenta previa
Rationale: Painless third-trimester bleeding is classically associated with placenta previa, where the placenta lies close to or covers the cervical os. It is a common cause of antepartum hemorrhage.
Q: A pregnant patient with symptomatic systemic lupus erythematosus (SLE) is at increased risk for which obstetric complication?
A. Fetal macrosomia
B. Preterm birth
C. Placenta accreta
D. Post-term pregnancy
B. Preterm birth
Rationale: Active SLE during pregnancy is linked to higher risks of preterm birth, fetal growth restriction, preeclampsia, and fetal loss due to placental insufficiency and inflammation.
Q: Compared to singleton pregnancies, twin pregnancies have an increased risk of which complication?
A. Post-term pregnancy
B. Shoulder dystocia
C. Preeclampsia
D. Gestational diabetes only
C. Preeclampsia
Rationale: Twin pregnancies carry a higher risk of preeclampsia, largely due to increased placental mass and higher levels of angiogenic imbalance and inflammation.
Q: A patient with PPROM presents with fever. Which factor will most influence the decision to induce labor within the next week?
A. Fetal lung maturity
B. Amniotic fluid index
C. Maternal fever
D. Gestational age alone
C. Maternal fever
Rationale: Maternal fever is a sign of intra-amniotic infection such as chorioamnionitis, which is an indication for immediate delivery regardless of gestational age due to the risk to both mother and fetus.
Q: A patient with gestational hypertension presents with sudden severe abdominal pain, vaginal bleeding, and fetal distress at 34 weeks AOG. What is the most likely diagnosis?
A. Uterine rupture
B. Placenta previa
C. Preterm labor
D. Abruptio placenta
D. Abruptio placenta
Rationale: Abruptio placenta presents with painful bleeding, uterine tenderness, and fetal distress, especially in hypertensive patients. It’s a major obstetric emergency requiring immediate intervention.
Q: A primigravid woman with a normal-term delivery develops severe postpartum hemorrhage (PPH) despite no uterine atony. What is the most likely cause?
A. Retained placenta
B. Uterine rupture
C. Coagulopathy
D. Cervical laceration
C. Coagulopathy
Rationale: When PPH occurs with a well-contracted uterus, coagulopathy (e.g., DIC) should be considered, especially in patients with risk factors like abruption or prolonged labor.
Q: A G2P1 patient with BMI of 38 is at increased risk of developing which pregnancy complication?
A. Intrauterine growth restriction
B. Macrosomia
C. Preterm labor
D. Oligohydramnios
B. Macrosomia
Rationale: Obesity (BMI ≥30) is a known risk factor for fetal macrosomia due to increased insulin resistance and glucose levels, leading to excess fetal growth.
Q: A G1P0 patient delivered a macrosomic baby via cesarean section and develops postpartum hemorrhage (PPH). What is the most likely cause?
A. Cervical laceration
B. Uterine rupture
C. Uterine atony
D. Retained products of conception
C. Uterine atony
Rationale: Macrosomia and prolonged labor predispose to uterine atony, the most common cause of PPH, due to overdistension and poor uterine contractility postpartum.
Q: A pregnant patient at 38 weeks gestation desires vaginal delivery. Which factor increases the likelihood of a successful vaginal delivery?
A. Previous preterm labor
B. Short interpregnancy interval
C. Adequate pelvic dimensions
D. Fetal macrosomia
C. Adequate pelvic dimensions
Rationale: Adequate pelvic dimensions improve the likelihood of a successful vaginal delivery by ensuring sufficient space for the fetus to descend and pass through the birth canal.
Q: A 35-year-old G3P2 at 35 weeks gestation with two previous cesarean sections desires a vaginal birth after cesarean (VBAC). She is in active labor, and her membranes rupture spontaneously. Shortly after, she complains of constant abdominal pain and decreased fetal movement. What is the most likely diagnosis?
A. Placenta previa
B. Preterm labor
C. Abruptio placenta
D. Uterine rupture
D. Uterine rupture
Rationale: Uterine rupture is a life-threatening complication, especially in VBAC candidates. Sudden abdominal pain, fetal distress, and loss of station are hallmark signs, particularly after membrane rupture during labor.
Q: A 28-year-old G1P0 at 28 weeks gestation is diagnosed with severe oligohydramnios, and the fetus is small for gestational age. What is the most likely cause of the oligohydramnios?
A. Fetal urinary tract obstruction
B. Placenta previa
C. Maternal dehydration
D. Fetal anemia
A. Fetal urinary tract obstruction
Rationale: In early to mid-pregnancy, amniotic fluid is primarily produced by fetal kidneys. A urinary tract obstruction, such as posterior urethral valves, can severely reduce fluid production, leading to oligohydramnios and growth restriction.
Q: Pregnant patients with a BMI of 38 are most likely to end up with what type of fetus?
A. Macrosomic
B. Premature
C. Small for gestational age
D. Anemic
A. Macrosomic
Rationale: Obesity (BMI ≥30) is associated with fetal macrosomia due to increased insulin resistance and maternal glucose levels, leading to enhanced fetal growth. While prematurity is possible, macrosomia is more consistently linked.
Q: For patients with a poor obstetric history, including a prior neonatal death, when should antepartum surveillance begin?
A. At 20 weeks
B. At 28 weeks
C. 2 weeks before the gestational age of prior neonatal death
D. At the time of fetal viability
C. 2 weeks before the gestational age of prior neonatal death
Rationale: High-risk patients, especially those with previous neonatal demise, should start antepartum surveillance 2 weeks earlier than the gestational age at which the complication occurred to improve fetal outcomes.
Q: During Doppler interrogation, the presence of notching in the uterine arteries at 35 weeks in a primigravid patient suggests:
A. Imminent delivery
B. Preeclampsia may ensue sooner or later
C. Intrauterine infection
D. Placental abruption
B. Preeclampsia may ensue sooner or later
Rationale: Persistent notching in the uterine artery waveform, especially in the third trimester, suggests impaired placental perfusion, which is a strong predictor for preeclampsia or IUGR.
Q: Which of the following is the most pertinent question to ask a 40-year-old primigravid with triplets at 10 weeks of gestation?
A. Do you have a history of hypertension?
B. Did you have a prior miscarriage?
C. Did you undergo infertility workup with an OB-GYN?
D. Are you taking multivitamins?
C. Did you undergo infertility workup with an OB-GYN?
Rationale: Multifetal pregnancies in older women, especially primigravidas over 35, often result from assisted reproductive technologies (ART), so this history is highly relevant.
Q: C.J., 37 years old, G2P11001, presents for her first prenatal checkup but cannot recall her LMP. What is the most reliable method to establish gestational age in the second trimester?
A. Fundal height measurement
B. Quickening
C. Biparietal diameter
D. Fetal heart tones
C. Biparietal diameter
Rationale: In the second trimester, Biparietal Diameter (BPD) on ultrasound is the most accurate tool for dating pregnancy, especially when the last menstrual period is unknown.
Q: A multiparous woman reports feeling quickening on June 15, 2024. What is the earliest estimated date of her **last menstrual period (LMP)?
A. February 28, 2024
B. March 2, 2024
C. March 15, 2024
D. April 1, 2024
B. March 2, 2024
Rationale: Quickening in multiparas typically occurs around 16 weeks, so counting back 16 weeks from June 15 gives an LMP around March 2, 2024. This is a helpful method for dating pregnancy when LMP is uncertain.
Q: A patient with 4 weeks of amenorrhea and a history of gestational diabetes presents to the ER. Ultrasound confirms an intrauterine pregnancy but no fetal heartbeat is seen. What is the most likely explanation?
A. Missed abortion
B. Incorrect gestational age assessment
C. Threatened abortion
D. Blighted ovum
B. Incorrect gestational age assessment
Rationale: At 4–5 weeks of amenorrhea, it’s often too early to detect a fetal heartbeat. The most likely cause of a non-visualized heartbeat this early is incorrect dating, not necessarily fetal demise.
Q: A patient under 40 weeks gestation presents to the ER with no fetal movement for 1 day. A BPS done 2 days ago was 8/8. Repeat ultrasound shows no fetal movement or heartbeat. What is the most likely explanation for the stillbirth?
A. Poor maternal diet
B. Sudden cord accident or undiagnosed anomaly
C. Incorrect gestational age
D. Fetal chromosomal abnormality
B. Sudden cord accident or undiagnosed anomaly
Rationale: A previously reassuring BPS (8/8) followed by sudden fetal demise suggests an acute catastrophic event, such as cord accident, placental abruption, or undetected congenital anomaly. These can occur even in low-risk pregnancies.
Q: A 33-year-old woman with a history of cesarean section for arrest in descent with a 4kg baby presents for her first prenatal checkup after 2 months of missed menses. What is the most important initial lab test to request?
A. Hemoglobin and hematocrit
B. OGTT
C. Urinalysis
D. Blood typing
B. OGTT
Rationale: The patient has multiple risk factors for gestational diabetes (prior GDM/macrosomia, age >30, obesity likely). OGTT is the most appropriate early screening test for glucose intolerance in high-risk pregnancies.
Q: A 25-year-old G2P1 is diagnosed with placenta previa at 20 weeks gestation. What is the most appropriate management?
A. Immediate cesarean delivery
B. Hospital admission and bed rest
C. Close antenatal surveillance with ultrasound
D. Tocolytic therapy
C. Close antenatal surveillance with ultrasound
Rationale: Placenta previa diagnosed at 20 weeks often resolves as the uterus grows. Management is expectant, involving serial ultrasounds to monitor placental position unless bleeding occurs or persists into the third trimester.
Q: A 25-year-old G2P1000 at 28 weeks gestation presents with regular uterine contractions and cervical dilation. What is the most appropriate initial management?
A. Immediate delivery
B. Magnesium sulfate only
C. Tocolytic therapy and corticosteroids
D. Amniotomy
C. Tocolytic therapy and corticosteroids
Rationale: This patient is in preterm labor. Management includes tocolytics to delay labor and corticosteroids to promote fetal lung maturity, especially between 24–34 weeks gestation.
Q: A 32-year-old G1P1 with chronic hypertension presents at 34 weeks with headache, blurred vision, RUQ pain, and labs showing thrombocytopenia, elevated liver enzymes, and proteinuria. What is the appropriate management?
A. Antihypertensives and observation
B. Magnesium sulfate and tocolytics
C. Immediate cesarean delivery
D. Repeat labs in 12 hours
C. Immediate cesarean delivery
Rationale: This is HELLP syndrome, a severe form of preeclampsia. The definitive treatment is delivery, especially after viability is reached. Delay increases maternal and fetal risk.
Q: A 42-year-old primigravida with hypertension and hypothyroidism presents for her first prenatal checkup. What test should be prioritized for fetal well-being?
A. Doppler velocimetry
B. Fetal non-stress test
C. Detailed fetal ultrasound
D. Quad screen
C. Detailed fetal ultrasound
Rationale: In high-risk pregnancies with advanced maternal age and comorbidities, an early detailed fetal anatomic scan is essential to assess for anomalies and growth issues.
Q: A 45-year-old G1P0 with gestational diabetes at 28 weeks has persistently elevated blood sugar despite insulin therapy. What is the next best step in management?
A. Repeat OGTT
B. Cesarean section at 32 weeks
C. Hospitalization and strict dietary control
D. Fetal surveillance and biophysical profile
D. Fetal surveillance and biophysical profile
Rationale: Poorly controlled gestational diabetes increases risk of macrosomia, stillbirth, and placental insufficiency. Fetal BPP helps monitor well-being and guide timing of delivery.
Q: A 43-year-old G1P0 at 36 weeks gestation with placenta previa presents to the ER with vaginal bleeding. Given her age and maternal condition, what is the most appropriate management?
A. Expectant management
B. Immediate cesarean delivery
C. Induction of labor
D. Bed rest and observation
B. Immediate cesarean delivery
Rationale: At 36 weeks with active bleeding and placenta previa, cesarean delivery is indicated to prevent maternal hemorrhage and fetal compromise. Advanced maternal age increases risks, warranting timely intervention.
Q: A 32-year-old G2P1 with a BMI of 35 at 12 weeks gestation. What intervention is most beneficial for weight management and complication reduction?
A. Strict low-calorie diet
B. Bed rest
C. Moderate-intensity exercise
D. Weight loss medication
C. Moderate-intensity exercise
Rationale: In obese pregnant patients, moderate-intensity exercise (e.g., brisk walking) is safe and helps reduce risk of GDM, hypertension, and macrosomia. Dieting or weight loss meds are not advised during pregnancy.
Q: A 38-year-old primigravida with BMI 32 is concerned about breastfeeding. What is the most helpful intervention?
A. Delay breastfeeding until milk comes in
B. Start formula supplementation immediately
C. Early lactation support and education
D. Postpartum weight loss programs
C. Early lactation support and education
Rationale: Obese mothers are at higher risk of delayed lactogenesis and early cessation of breastfeeding. Early support and education greatly improve breastfeeding initiation and continuation.
Q: A 28-year-old G2P1 with a history of mitral valve prolapse (MVP) presents at 12 weeks and is asymptomatic. What is the most appropriate management plan?
A. Start beta-blockers immediately
B. Antibiotic prophylaxis for delivery
C. Close cardiac monitoring throughout pregnancy
D. Immediate echocardiogram and cardiology referral
C. Close cardiac monitoring throughout pregnancy
Rationale: Most asymptomatic MVP cases are benign in pregnancy, but due to potential for arrhythmias or regurgitation, regular monitoring is recommended. No routine antibiotic prophylaxis is needed unless complicated.
Q: A 28-year-old G2P1 with a previous cesarean delivery is scheduled for a repeat cesarean section. What is the most important preoperative counseling point?
A. Pain control options
B. Neonatal respiratory distress
C. Risk for uterine rupture during labor
D. Need for blood transfusion
C. Risk for uterine rupture during labor
Rationale: The most crucial counseling point when discussing a repeat cesarean (especially if the patient considered TOLAC) is the risk of uterine rupture. This risk shapes decisions on trial of labor vs. planned C-section.
Q: A 32-year-old G2P1 at 34 weeks has oligohydramnios on ultrasound with an amniotic fluid index (AFI) of 5 cm. What is the most appropriate initial management?
A. Immediate delivery
B. Amnioinfusion
C. Close fetal monitoring with biophysical profile
D. Repeat ultrasound in 4 weeks
C. Close fetal monitoring with biophysical profile
Rationale: An AFI ≤5 cm is considered oligohydramnios. If the patient is stable and preterm, management includes close surveillance with serial BPPs to monitor fetal well-being and delay delivery when possible.
Q: A 41-week pregnant patient complains of subjectively reduced fetal movement during a prenatal visit. What is the best next step in management?
A. Induce labor immediately
B. Perform a Doppler study
C. Subject patient to contraction stress test (CST)
D. Perform Leopold’s maneuver
C. Subject patient to contraction stress test
Rationale: In post-term pregnancies with decreased fetal movement, a contraction stress test is appropriate to assess placental function and fetal tolerance to stress, helping guide whether immediate delivery is necessary.
Q: A 28-year-old woman has early menstruation and a positive pregnancy test. Her last menstrual period (LMP) was June 20, 2024. What is her gestational age as of August 15, 2024?
A. 6 weeks and 5 days
B. 7 weeks and 6 days
C. 8 weeks and 2 days
D. 9 weeks and 0 days
B. 7 weeks and 6 days
Rationale: From June 20 to August 15 is 7 weeks and 6 days. Gestational age is calculated from the first day of the LMP, not from the date of conception.
Q: A 28-year-old G1P0 at 32 weeks with chronic hypertension presents with decreased fetal movement. Biophysical profile (BPP) score is 4/10 with absent fetal movement and decreased amniotic fluid. What is the most appropriate next step?
A. Induce labor immediately
B. Administer magnesium sulfate
C. Repeat BPP in 24 hours
D. Perform emergency cesarean section
C. Repeat BPP in 24 hours
Rationale: A BPP of 4/10 is equivocal. In preterm patients, if non-reassuring but not critical, the preferred management is to repeat the test in 24 hours to monitor trends before deciding on early delivery.
Q: A 35-year-old G3P2 at 34 weeks has a BPP score of 8/10, with 0 for movement but reactive fetal heart tracing. What is the most appropriate management?
A. Emergency cesarean section
B. Repeat BPP in 1 hour
C. Induce labor
D. Continue close antenatal surveillance
D. Continue close antenatal surveillance
Rationale: A BPP score of 8/10 is considered reassuring, especially if fetal heart tracing is reactive. The loss of 1 parameter does not immediately necessitate delivery. Close follow-up is sufficient.
Q: A 35-year-old G1P0 with chronic hypertension at 37 weeks presents with labor pains. NST is non-reactive. Internal exam: 1 cm dilated. What is the next best step in management?
A. Immediate cesarean section
B. Repeat NST in 24 hours
C. Induce labor
D. Perform contraction stress test (CST)
D. Perform contraction stress test (CST)
Rationale: A non-reactive NST is inconclusive. At term, next step is to perform CST to assess placental reserve and how the fetus tolerates contractions. This helps determine need for delivery or expectant management.
Q: A 35-year-old G3P2 at 41 weeks with gestational diabetes has a non-reactive NST and a negative CST. What is the most appropriate next step in management?
A. Schedule cesarean delivery
B. Induce labor
C. Repeat NST in 48 hours
D. Perform biophysical profile
B. Induce labor
Rationale: At 41 weeks with GDM, pregnancy is post-term and high risk. A non-reactive NST suggests possible compromise, but negative CST indicates fetal tolerance. Induction is appropriate to avoid complications of prolonged pregnancy.
Q: A 38-year-old G1P0 with chronic hypertension at 20 weeks has a reactive NST showing 2 accelerations in 20 minutes. What is the most appropriate next management?
A. Repeat NST in 24 hours
B. Perform contraction stress test
C. Repeat NST in one week
D. Deliver immediately
C. Repeat NST in one week
Rationale: In chronic hypertensive pregnancies, antepartum fetal surveillance typically starts in the third trimester. If an NST is reactive, there’s no immediate concern. Weekly testing is appropriate at this stage.
Q: A 35-year-old G3P2 at 34 weeks with preeclampsia has a non-reactive NST and variable decelerations. What is the most appropriate next step in management?
A. Repeat NST in 24 hours
B. Administer corticosteroids and monitor
C. Schedule cesarean delivery
D. Perform Doppler velocimetry
C. Schedule cesarean delivery
Rationale: In a patient with preeclampsia, non-reactive NST plus variable decelerations indicates fetal compromise. At 34 weeks, the risk of intrauterine demise outweighs prematurity. Immediate delivery is indicated.
Q: A 24-year-old primigravida with a history of long menstrual cycles and PCOS presents for a prenatal visit. What is the most appropriate next step?
A. Immediate ultrasound
B. Induce ovulation
C. Further assessment based on history and symptoms
D. Repeat pregnancy test
C. Further assessment based on history and symptoms
Rationale: In patients with PCOS and irregular cycles, gestational dating and risk factors must be evaluated carefully. Individualized assessment is key before proceeding to further interventions.
Q: A 39–40 week pregnant woman presents for prenatal checkup and complains of reduced fetal movement. What is the best course of action?
A. Advise hydration and observe
B. Induce labor immediately
C. Request for Biophysical Profile (BPP)
D. Perform Leopold’s maneuver
C. Request for Biophysical Profile (BPP)
Rationale: Decreased fetal movement at term can indicate fetal compromise. A BPP is a comprehensive test to evaluate fetal well-being and determine the need for immediate intervention or delivery.
Q: A 30-year-old G4P2 (0302) has no history of smoking or alcohol use, with a pre-pregnancy weight of 120 lbs and current weight of 125 lbs. What factor places her at increased risk for preterm birth?
A. Maternal weight
B. Nutritional status
C. Obstetric history
D. Lifestyle habits
C. Obstetric history
Rationale: A prior obstetric history of pregnancy loss or preterm birth is the strongest risk factor for future preterm labor, even in the absence of lifestyle or medical risk factors.
Q: A 26-year-old primigravida presents to the ER with regular labor pains. Her EDC is July 31. Internal exam: 3 cm dilated, 50% effaced. What is the best management?
A. Discharge with instructions
B. Emergency cesarean delivery
C. Admit and augment labor
D. Perform NST
C. Admit and augment labor
Rationale: A patient in early active labor (≥3 cm) with regular contractions should be admitted. If labor is slow to progress, augmentation with oxytocin may be initiated depending on clinical assessment.
Q: A 34-year-old G4P3 (3003) at 36 weeks gestation with all prior deliveries via low transverse cesarean section (LTCS) and no history of vaginal delivery presents with good fetal movement. What is the most important test to perform?
A. Non-stress test
B. Contraction stress test
C. Ultrasound for placental status
D. Internal examination
C. Ultrasound for placental status
Rationale: In patients with multiple prior cesareans, there’s an increased risk of placenta previa or accreta. An ultrasound to evaluate placental location is critical before considering trial of labor or planning delivery.
Q: A 29-week pregnant woman is in the deceleration phase of labor. Fetal heart rate baseline is 140 bpm with moderate variability, and there are occasional early decelerations. What is the most appropriate management?
A. Perform emergency cesarean
B. Initiate tocolysis
C. Continue to monitor fetal heart rate
D. Administer corticosteroids
C. Continue to monitor fetal heart rate
Rationale: Early decelerations with moderate variability and normal baseline are benign and usually due to head compression. No intervention is required; continued monitoring is appropriate.
Q: A 26-year-old G1P0 at 32 weeks gestation with oligohydramnios of uncertain etiology (OED) has a reactive NST with one variable deceleration. What is the most appropriate next step?
A. Emergency delivery
B. Consider a biophysical profile (BPP)
C. Repeat NST in 1 week
D. Doppler velocimetry
B. Consider a biophysical profile
Rationale: A reactive NST with isolated variable deceleration warrants further assessment of fetal well-being, especially with OED. A BPP offers a more comprehensive evaluation.
Q: A 30-year-old G1P0 at 36 weeks gestation with OED has a non-reactive NST. What is the most appropriate next step?
A. Induce labor
B. Emergency cesarean section
C. Request a biophysical profile
D. Repeat NST in 48 hours
C. Request a biophysical profile
Rationale: A non-reactive NST requires confirmation of fetal status. A BPP provides a broader picture, assessing both acute and chronic markers of fetal well-being before deciding on delivery.
Q: A 32-year-old G2P1 at 36 weeks with gestational diabetes has a reassuring biophysical profile and a reactive NST. What is the most appropriate next step in management?
A. Schedule delivery immediately
B. Repeat BPP in 3 days
C. Repeat NST in one week
D. Perform contraction stress test
C. Repeat NST in one week
Rationale: In well-controlled gestational diabetes with reassuring fetal testing, management includes weekly NSTs starting around 32–36 weeks. There is no indication for early delivery or more frequent testing if stable.
Q: A 33-year-old primigravida at 38 weeks gestation has a Biophysical Profile (BPP) score of 8/10, with a score of 0 for amniotic fluid index (AFI). What is the most appropriate next step in management?
A. Repeat BPP in 48 hours
B. Immediate delivery
C. Perform backup tests like contraction stress test (CST)
D. Observe and repeat NST
C. Perform backup tests like contraction stress test (CST)
Rationale: A BPP score of 8/10 with low AFI (oligohydramnios) suggests chronic uteroplacental insufficiency. A CST or further fetal surveillance helps determine if the fetus can tolerate labor or if immediate delivery is needed.
Q: A 26-year-old G1P0 at 32 weeks gestation is diagnosed with mild oligohydramnios. What is the appropriate management?
A. Immediate delivery
B. Emergency cesarean section
C. Expectant management
D. Contraction stress test
C. Expectant management
Rationale: In cases of mild oligohydramnios and a stable pregnancy, especially at preterm gestation, the best approach is close monitoring with serial ultrasounds and fetal testing.
Q: A 26-year-old G1P0 at 32 weeks with oligohydramnios of uncertain etiology (OED) is being managed expectantly. She now presents with regular uterine contractions. What is the most appropriate next step?
A. Induce labor
B. Emergency C-section
C. Give corticosteroids to accelerate fetal lung maturity
D. Observe without intervention
C. Give corticosteroids to accelerate fetal lung maturity
Rationale: At 32 weeks with signs of preterm labor, antenatal corticosteroids should be given to enhance fetal lung development, reducing neonatal morbidity if preterm birth occurs.
Q: Which of the following is NOT true regarding preterm labor?
A. It occurs before 37 weeks
B. It may present with cervical change and contractions
C. It always occurs after 37 weeks
D. Risk factors include infection, low BMI, and multiple gestation
C. It always occurs after 37 weeks
Rationale: Preterm labor is defined as labor that occurs before 37 weeks gestation. Any reference to it occurring after 37 weeks is incorrect and refers to term or post-term labor.
Q: Which of the following lifestyle factors is least associated with spontaneous preterm labor?
A. Smoking
B. Low maternal weight
C. Illicit drug use
D. Obesity
D. Obesity
Rationale: While smoking, low BMI, and substance abuse increase risk for spontaneous preterm labor, obesity is more commonly associated with post-term pregnancy, macrosomia, and preeclampsia, not spontaneous preterm labor.
Q: A 26-year-old G1P0 at 29 weeks gestation presents with yellowish vaginal discharge and labor pains. Which of the following routes of infection is least likely to cause spontaneous preterm labor?
A. Transplacental
B. Retrograde flow
C. Ascending infection
D. Respiratory droplets
D. Respiratory droplets
Rationale: The main infectious routes that lead to spontaneous preterm labor are ascending infections (from the vagina), transplacental, and retrograde from the peritoneum. Respiratory droplets do not cause intrauterine infection directly and are not implicated in spontaneous preterm labor.
Q: What is the most reliable clinical indicator of chorioamnionitis?
A. Uterine tenderness
B. Foul-smelling discharge
C. Maternal tachycardia
D. Fever
D. Fever
Rationale: Maternal fever is the most reliable and consistent clinical sign of chorioamnionitis, particularly when associated with maternal or fetal tachycardia, uterine tenderness, or foul-smelling amniotic fluid.
Q: Corticosteroids are administered to a woman at risk of preterm birth to prevent neonatal respiratory distress syndrome (RDS). To be effective, the birth should be delayed by at least how many hours after steroid administration?
A. 6 hours
B. 12 hours
C. 24 hours
D. 48 hours
C. 24 hours
Rationale: For antenatal corticosteroids (e.g., betamethasone) to significantly reduce the risk of RDS, delivery should ideally be delayed by at least 24 hours to allow time for fetal lung maturation.
Q: What is the most appropriate management for preterm premature rupture of membranes (PPROM) beyond 34 weeks?
A. Administer tocolytics
B. Prolong pregnancy until 37 weeks
C. Expedite delivery
D. Strict bed rest
C. Expedite delivery
Rationale: Once the fetus reaches 34 weeks, the risks of infection (e.g., chorioamnionitis) outweigh the risks of prematurity. The recommendation is to expedite delivery, particularly if there are no contraindications.
Q: RO is admitted due to preterm labor, and a fetal fibronectin (fFN) assay is requested. Which of the following statements is NOT true about fetal fibronectin?
A. It is useful in predicting preterm birth
B. It is not found in cervical secretions after 20 weeks if no risk
C. Negative test has high negative predictive value
D. You will not identify Kerning pattern
D. You will not identify Kerning pattern
Rationale: The statement “You will not identify Kerning pattern” is irrelevant to fetal fibronectin. The fFN assay is used to predict preterm birth risk and has high negative predictive value. Kerning’s sign is associated with meningitis, not OB.
Q: Which of the following is NOT included in preterm labor prevention advice?
A. Cerclage
B. Progestins
C. Addressing healthcare issues (e.g., infections)
D. Cesarean section
D. Cesarean section
Rationale: C-section is not a preventive measure for preterm labor. Prevention strategies include cerclage (in cervical insufficiency), progestins (in high-risk patients), and addressing modifiable health issues like infections.
Q: What is the recommended antepartum surveillance test for patients at term?
A. Biophysical Profile
B. Ultrasound only
C. Non-Stress Test
D. Contraction Stress Test
D. Contraction Stress Test
Rationale: At term, a Contraction Stress Test (CST) is a reliable way to assess placental reserve and fetal tolerance to labor. It’s especially useful when the non-stress test is non-reactive, and the fetus is mature enough for delivery if needed.
Q: A pregnant patient is diagnosed with polyhydramnios. She is most likely at risk for developing which of the following complications?
A. Cord prolapse
B. Abruptio placenta
C. Chorioamnionitis
D. Uterine rupture
B. Abruptio placenta
Rationale: Polyhydramnios causes uterine overdistension, which increases the risk for placental abruption, preterm labor, and malpresentation. Sudden uterine decompression may trigger placental separation.
Q: A 41-week pregnant patient presents for a prenatal check-up complaining of reduced fetal movement. What is the best course of action?
A. Perform biophysical profile
B. Subject the patient to contraction stress test
C. Induce labor immediately
D. Repeat NST in 24 hours
B. Subject the patient to contraction stress test
Rationale: At 41 weeks, placental aging increases the risk of fetal compromise. With decreased fetal movement, a CST is appropriate to evaluate fetal tolerance to stress and decide if delivery is needed.
Q: Pregnant patients with a BMI of 38 are most likely to develop which complication?
A. Fetal growth restriction
B. Cardio-renal disease
C. Oligohydramnios
D. Preterm labor
B. Cardio-renal disease
Rationale: Obesity in pregnancy (BMI ≥30) is associated with cardiovascular and renal complications, as well as gestational diabetes, preeclampsia, and macrosomia. The risk increases with higher BMI levels.
Q: Placenta previa is most commonly seen in which group of pregnant patients?
A. Nulliparous
B. Adolescents
C. Multiparous
D. First-trimester pregnancies
C. Multiparous
Rationale: Placenta previa is more common in multiparous women, especially those with prior uterine surgeries or cesarean deliveries. The risk increases with parity and endometrial damage.
Q: What is the most common consequence of incompetent cervix?
A. Preterm labor
B. Preeclampsia
C. Immature delivery
D. IUGR
C. Immature delivery
Rationale: Cervical insufficiency often leads to painless cervical dilation in the second trimester, resulting in immature or mid-trimester delivery — a hallmark presentation of this condition.
Q: In cases of fetal hypoxia, which biophysical profile (BPP) variable is the last to disappear?
A. Fetal breathing
B. Amniotic fluid index
C. Fetal movement
D. Fetal tone
D. Fetal tone
Rationale: Among BPP parameters, fetal tone is the most resistant to hypoxia and is the last to be affected. It reflects chronic hypoxia only after other signs have already deteriorated.
Q: During labor, thick meconium staining is noted. What is the best next step in management?
A. Deliver immediately
B. Start maternal antibiotics
C. Monitor closely for abnormal fetal heart tracing
D. Proceed with amnioinfusion
C. Monitor closely for abnormal fetal heart tracing
Rationale: Thick meconium may indicate fetal stress, but intervention depends on fetal heart tracing. If reassuring, observe. If non-reassuring, expedited delivery may be warranted.
Q: Which of the following best describes a reactive non-stress test (NST)?
A. <2 accelerations in 20 minutes with fetal movement
B. 2 or more accelerations in 20 minutes, each lasting ≥15 sec and rising ≥15 bpm
C. Decelerations without contractions
D. Flat baseline variability
B. 2 or more accelerations in 20 minutes, each lasting ≥15 sec and rising ≥15 bpm
Rationale: A reactive NST indicates reassuring fetal well-being, with 2 or more accelerations in 20 minutes. Less than 2 is considered non-reactive.
Q: A 33-year-old primigravid patient at 38 weeks AOG presents with a Biophysical Profile Score (BPS) of 8/10, with oligohydramnios as the abnormal parameter. As the attending physician, what should you do next?
A. Proceed to immediate delivery
B. Administer corticosteroids
C. Perform a contraction stress test
D. Repeat BPP in 24 hours
C. Perform a contraction stress test
Rationale: A BPP of 8/10 with low AFI (oligohydramnios) suggests potential placental insufficiency. A contraction stress test (CST) is used as a backup test to evaluate fetal tolerance to stress and determine if delivery is needed.
Q: Which vessel is most commonly assessed via Doppler velocimetry to evaluate the uteroplacental circulation?
A. Middle cerebral artery
B. Uterine artery
C. Umbilical artery
D. Aortic arch
C. Umbilical artery
Rationale: The umbilical artery Doppler is the standard for evaluating placental resistance and blood flow. Abnormal flow patterns (e.g., absent or reversed end-diastolic flow) indicate uteroplacental insufficiency.
Q: In which clinical scenario is variable descent of the fetal head most commonly expected?
A. True labor
B. Preterm labor
C. Premature rupture of membranes (PROM)
D. Fetal macrosomia
C. Premature rupture of membranes (PROM)
Rationale: PROM leads to loss of amniotic fluid cushioning, increasing the likelihood of variable descent of the fetal head and umbilical cord compression, which may cause variable decelerations.
Q: Which Biophysical Profile (BPP) observation would result in a score of 0?
A. 3 fetal tone movements
B. 2 gross body movements
C. 2 breathing movements in 30 minutes
D. Absence of limb extension
B. 2 gross body movements
Rationale: A score of 2 for gross body movement requires at least 3 distinct movements within 30 minutes. Only 2 movements does not meet the criteria and scores 0.
Q: In fetal monitoring, which type of deceleration is the most concerning and requires immediate evaluation and possible intervention?
A. Early deceleration
B. Variable deceleration
C. Late deceleration
D. Prolonged acceleration
C. Late deceleration
Rationale: Late decelerations are a sign of uteroplacental insufficiency and fetal hypoxia, especially when recurrent. They warrant immediate evaluation, often requiring delivery if persistent.
Q: The “Count to 10” fetal movement method entails which of the following?
A. Count the number of movements in 10 minutes
B. Count the number of minutes it takes for 10 fetal movements to occur
C. Count fetal movements for 1 hour
D. Count fetal hiccups as well as movements
B. Count the number of minutes it takes for 10 fetal movements to occur
Rationale: The “Count to 10” method involves recording how long it takes for a pregnant patient to perceive 10 fetal movements. Typically, 10 movements within 2 hours is considered reassuring.
Q: Which of the following is true about fetal scalp stimulation?
A. It causes sustained decelerations
B. Very limited use in case of fetal tachycardia
C. It worsens late decelerations
D. It confirms the presence of uterine rupture
B. Very limited use in case of fetal tachycardia
Rationale: Fetal scalp stimulation is used to assess fetal well-being during labor. However, its use is limited when fetal tachycardia is present, as it may further increase heart rate and is not reliable in that setting.
Q: Uterine contractions occurring every 5 to 10 minutes are considered:
A. Normal labor pattern
B. Hypotonic contractions
C. Braxton Hicks
D. Tachysystole
D. Tachysystole
Rationale: Tachysystole refers to more than 5 uterine contractions in 10 minutes, averaged over 30 minutes. If contractions are too frequent, even at 5-minute intervals or less, they may compromise fetal oxygenation.
Q: Which antenatal test is most similar to doing a physical examination of the fetus?
A. Contraction stress test
B. Doppler velocimetry
C. Non-stress test
D. Biophysical profile (BPP)
D. Biophysical profile (BPP)
Rationale: The BPP evaluates fetal tone, movement, breathing, and amniotic fluid, providing a comprehensive functional assessment of the fetus — essentially mimicking a fetal physical exam.
Q: A 25-year-old at 32 weeks gestation with intrauterine growth restriction (IUGR) presents with an abnormal Doppler waveform. What is the most appropriate management?
A. Immediate delivery
B. Hospitalization and corticosteroids
C. Expectant management and complete bed rest
D. Emergency cesarean section
C. Expectant management and complete bed rest
Rationale: For IUGR at 32 weeks with abnormal Doppler findings but no signs of fetal distress, expectant management with close monitoring, bed rest, and possibly corticosteroids is appropriate to prolong pregnancy safely.
Q: Determining fetal heart rate by auscultation using a stethoscope or Doppler is comparable to electronic monitoring, provided that:
A. The fetal heart rate is within normal range
B. Fetal heart rate is auscultated for a whole minute
C. The patient is not in active labor
D. The baby is moving during auscultation
B. Fetal heart rate is auscultated for a whole minute
Rationale: For auscultation to be reliable and comparable to continuous monitoring, the fetal heart rate must be counted for a full minute, especially after a contraction, to detect baseline and variability changes.
Q: Which antepartum test evaluates fetal breathing based on reactivity?
A. Contraction Stress Test
B. Biophysical Profile
C. Doppler Ultrasound
D. Non-Stress Test (NST)
D. Non-Stress Test (NST)
Rationale: A reactive NST reflects normal autonomic regulation, indirectly suggesting adequate oxygenation and neurologic activity — including fetal breathing movements. It’s a key tool for assessing fetal well-being.
Q: A 39-year-old woman at 41 weeks AOG comes in for a labor check-up. What is a valid concern in this scenario?
A. Placenta previa
B. Meconium aspiration
C. Preterm labor
D. Gestational trophoblastic disease
B. Meconium aspiration
Rationale: Post-term pregnancies are at higher risk for meconium-stained amniotic fluid, which may lead to meconium aspiration syndrome (MAS) — a potentially serious neonatal respiratory condition.
Q: A doppler velocimetry result revealing notching in the uterine artery waveform during pregnancy suggests what next step?
A. Continue routine prenatal care
B. Admit patient for steroid administration
C. Immediate delivery
D. Perform cesarean section
B. Admit patient for steroid administration
Rationale: Early diastolic notching in the uterine artery Doppler, especially in the second or early third trimester, suggests impaired uteroplacental perfusion. Steroids are indicated to promote fetal lung maturity in anticipation of preterm delivery.
Q: The region evaluated by Doppler velocimetry to assess for brain-sparing effect in fetal hypoxia is:
A. Umbilical vein
B. Aortic arch
C. Middle cerebral artery
D. Uterine artery
C. Middle cerebral artery
Rationale: In fetal hypoxia, the fetus compensates by redistributing blood flow to vital organs like the brain. This “brain-sparing” effect is best observed by a decrease in pulsatility index in the middle cerebral artery (MCA) on Doppler.
What are the characteristics of a Category I fetal heart rate (FHR) tracing?
A. Bradycardia, absent variability, no accelerations
B. Baseline 110–160 bpm, moderate variability, no late/variable decels
C. Tachycardia, minimal variability, variable decelerations
D. Absent accelerations, early decelerations, minimal variability
B. Baseline 110–160 bpm, moderate variability, no late/variable decels
Q: Which BPP variable is the most predictive of a positive infection (early fetal compromise)?
A. Fetal tone
B. Amniotic fluid volume
C. Fetal breathing
D. Gross fetal movement
C. Fetal breathing
Rationale: Fetal breathing is one of the first BPP parameters to be affected by hypoxia or infection, making it highly sensitive for early fetal compromise.
Q: What is the only chronic marker among the Biophysical Profile (BPP) variables?
A. Fetal tone
B. Fetal breathing
C. Gross body movement
D. Amniotic fluid volume
D. Amniotic fluid volume
Rationale: Amniotic fluid volume reflects chronic placental function, whereas other BPP parameters (tone, movement, breathing, NST) are acute markers of fetal well-being.
Q: Which antepartum test correlates best with how the fetus will tolerate labor?
A. Biophysical Profile (BPP)
B. Doppler velocimetry
C. Contraction Stress Test (CST)
D. Non-Stress Test (NST)
C. Contraction Stress Test (CST)
Rationale: The CST assesses fetal response to uterine contractions, simulating the stress of labor. It evaluates uteroplacental sufficiency, making it highly relevant to predicting intrapartum tolerance.
Q39: When is the congenital anomaly scan best performed during pregnancy?
A. 12–16 weeks
B. 17–20 weeks
C. 24–38 weeks
D. After 40 weeks
C. 24–38 weeks
Rationale: The congenital anomaly scan is best performed in the mid to late second trimester, commonly between 18–24 weeks, but can still be useful up to 38 weeks in some high-risk pregnancies or late referrals.
Q41: Which of the following antepartum tests does not require a dilated cervix or ruptured membranes?
A. Amniotomy
B. Fetal scalp pH
C. Internal fetal monitoring
D. Indirect electronic fetal monitoring (CTG)
D. Indirect electronic fetal monitoring (CTG)
Rationale: CTG (Cardiotocography) uses external sensors and does not require cervical dilation or ruptured membranes, unlike internal methods such as fetal scalp electrodes or pH sampling.
Q42: Which of the following is true regarding fetal scalp pH?
A. A pH above 7.3 requires immediate cesarean
B. Fetal scalp pH is only done at term
C. When pH is <7.2, immediate abdominal delivery is warranted
D. It should be done in all laboring patients
C. When pH is <7.2, immediate abdominal delivery is warranted
Rationale: A fetal scalp pH <7.2 suggests fetal acidemia, which is an indication for urgent delivery, often via cesarean section, to prevent hypoxic injury.
Q43: How many infusions of uterotonic agent (e.g., oxytocin) are proven effective in managing missed abortion?
A. One
B. Two
C. Three
D. Four
C. Three
Rationale: In missed abortion, three infusions of oxytocin have been shown to be effective in stimulating uterine contractions to complete the evacuation process.
Q44: A 35-year-old parturient is noted to be 70% effaced with cervical dilation and a tracing that shows contractions. What is the most appropriate interpretation?
A. Uterine rupture
B. Inadequate uterine contractions
C. Adequate uterine contraction
D. Precipitous labor
C. Adequate uterine contraction
Rationale: Based on progressive cervical dilation with 70% effacement and a supportive tracing, the patient is showing signs of effective labor contractions leading to cervical changes.
Q45: What is the normal baseline fetal heart rate based on the tracing?
A. 100–110 bpm
B. 110–120 bpm
C. 140–150 bpm
D. 160–170 bpm
C. 140–150 bpm
Rationale: A normal baseline FHR ranges from 110–160 bpm. A rate of 140–150 bpm is considered normal and reassuring, indicating a well-oxygenated fetus.
Q46: In fetal heart rate tracing, what is considered the most important feature in assessing fetal well-being?
A. Baseline heart rate
B. Presence of accelerations
C. Presence of early decelerations
D. Absence of variability
B. Presence of accelerations
Rationale: Accelerations are a strong indicator of fetal well-being and intact autonomic function. Their presence implies adequate oxygenation and no significant acidosis, making them the most reassuring feature.
Q47: Which of the following is part of fetal resuscitation methods during labor?
A. Administer uterotonics
B. Discontinue uterine stimulants
C. Perform amniotomy
D. Increase oxytocin infusion
B. Discontinue uterine stimulants
Rationale: In fetal distress, reducing uterine activity is a key resuscitative step. Stopping oxytocin and giving maternal oxygen, IV fluids, or changing position helps improve fetal oxygenation.
Q48: What is the purpose of adjusting maternal positioning or using gel during an ultrasound in pregnancy?
A. Diagnose oligohydramnios
B. Induce labor
C. Provide better view of ultrasound resolution
D. Confirm gestational diabetes
C. Provide better view of ultrasound resolution
Rationale: Optimizing maternal position or using ultrasound gel can enhance resolution and improve visualization of fetal anatomy, especially when views are suboptimal due to maternal habitus or fetal position.
Q49: What is a common potential problem associated with tall pregnant patients?
A. Oligohydramnios
B. Breech presentation
C. Macrosomic deliveries
D. Preterm labor
C. Macrosomic deliveries
Rationale: Taller women often have larger pelvic capacity, which correlates with larger fetal growth potential. This makes macrosomia a more common concern, increasing the risk of labor complications.
Q51: Which of the following is true regarding post-term pregnancy?
A. Twin gestation increases the risk of post-term pregnancy
B. History of preterm labor is a risk factor
C. Previous post-term pregnancy is a risk factor
D. Post-term pregnancies are rare in primigravidas
C. Previous post-term pregnancy is a risk factor
Rationale: A prior history of post-term pregnancy significantly increases the risk of recurrence due to possible genetic or hormonal predisposition.
Q52: At what gestational age does amniotic fluid volume peak?
A. 28 weeks
B. 32 weeks
C. 36 weeks
D. 38 weeks
C. 36 weeks
Rationale:
Amniotic fluid volume increases throughout pregnancy and reaches its peak at around 36 weeks of gestation, averaging about 800 to 1000 mL. After this peak, the volume gradually decreases as term approaches due to decreased fetal urine production and increased fetal swallowing.
• At 28 weeks, fluid volume is still increasing.
• By 32 weeks, it’s nearing its peak but not yet at the maximum.
• 36 weeks is when the peak typically occurs.
• By 38 weeks, the volume usually begins to decline.
Q60: A modified Biophysical Profile (BPP) with a perfect score of 8 is considered acceptable provided that:
A. AFI is 1–5 cm
B. AFI is 2–7.9 cm
C. There are at least 2 fetal movements
D. Fetal tone is normal
B. Amniotic fluid volume is 2–7.9 cm
Rationale: In modified BPP, a score of 8/8 is acceptable only if the amniotic fluid index (AFI) falls within 2–7.9 cm, as this reflects chronic placental sufficiency.
Q: Which of the following is NOT a component of the Bishop Score?
A. Position
B. Contraction
C. Dilation
D. Effacement
B. Contraction
Rationale: The Bishop Score includes dilation, effacement, station, consistency, and position of the cervix. Contractions are not part of the scoring but may influence labor decisions.
Q: A patient at 42 weeks AOG has a vaginal exam showing: closed cervix, firm consistency, normal external genitalia. What is the Bishop score, and what is the best next step?
A. Give cervical ripening agent
B. Start oxytocin infusion
C. Proceed to cesarean section
D. Repeat vaginal exam in 12 hours
A. Give cervical ripening agent
Rationale: A closed, firm cervix in a post-term pregnancy results in a low Bishop score (<6). The cervix is unfavorable, so the appropriate management is to begin cervical ripening before initiating labor induction.
Q56: Which complication is most commonly anticipated in a post-term pregnancy?
A. Oligohydramnios
B. Polyhydramnios
C. Respiratory distress syndrome (RDS)
D. Chorioamnionitis
A. Oligohydramnios
Rationale: Post-term pregnancy is commonly associated with oligohydramnios due to declining placental function, leading to decreased fetal urine output and lower amniotic fluid levels.
Q57: Which of the following does NOT describe a postmature baby?
A. Wrinkled skin
B. Open eyes; alert appearance
C. Long nails
D. Long, wide soft tissue mass
D. Long, wide soft tissue mass
Rationale: Postmature infants are thin with decreased subcutaneous fat, wrinkled dry skin, and long nails. They appear alert, but do not have large or wide soft tissue mass, which is not characteristic of postmaturity.
Q58: Skin changes seen in postmaturity are due to:
A. Increased blood flow
B. Loss of protective vernix
C. Excessive lanugo
D. Accumulation of meconium
B. Loss of protective vernix
Rationale: In post-term infants, the vernix caseosa (protective coating) is absent, leading to dry, cracked, peeling skin — a hallmark of postmaturity.
Q59: Which of the following patients is most likely to have a post-term pregnancy?
A. A patient with prolonged latent phase
B. A patient with a history of preterm birth
C. A patient who previously had a growth-restricted infant
D. A patient with a previous post-term pregnancy
D. A patient with a previous post-term pregnancy
Rationale: A history of post-term pregnancy is the strongest risk factor for recurrence due to genetic and hormonal influences.
Q60: A fetus with normal amniotic fluid and preserved placental function in a post-term pregnancy is expected to be:
A. Growth-restricted
B. Hydropic
C. Healthy and large
D. Dysmature
C. Healthy and large
Rationale: In post-term pregnancies with intact placental function and normal AFI, the fetus continues to grow and is often macrosomic (large for gestational age), representing a healthy and well-nourished baby.
Q61: Which of the following is true regarding dysmaturity syndrome (postmaturity syndrome)?
A. Polyhydramnios
B. Macrosomia
C. Oligohydramnios
D. Premature delivery
C. Oligohydramnios
Rationale: Dysmaturity syndrome is associated with placental insufficiency, leading to oligohydramnios, fetal wasting, and features such as peeling skin, long nails, and meconium staining.
Q62: A patient presents at term by size but is unsure of her last menstrual period (LMP). Which of the following is most beneficial in determining age of gestation (AOG)?
A. Fundic height
B. Force her to remember
C. Quickening
D. Estimated fetal weight via ultrasound
A. Fundic height
Rationale: In late pregnancy, if LMP is unknown, the fundic height provides a quick and reasonable estimate of gestational age, especially when ultrasound dating is unavailable or uncertain.
Q63: What is the most reliable indicator of gestational age in the second trimester?
A. Quickening
B. Biophysical profile (BPP)
C. Fundic height
D. Biparietal diameter (BPD) via ultrasound
D. Biparietal diameter (BPD) via ultrasound
Rationale: In the second trimester, ultrasound measurement of biparietal diameter (BPD) is the most accurate and reliable way to determine gestational age when dating by LMP is not possible.
Q68: Cervical ripening in preparation for labor can be achieved through which of the following methods?
A. Oxytocin and rest
B. Prostaglandin and membrane stripping
C. Amniotomy and fundal massage
D. Epidural anesthesia and hydration
B. Prostaglandin and membrane stripping
Rationale: Cervical ripening is commonly achieved using prostaglandins (e.g., misoprostol or dinoprostone) and mechanical methods like membrane stripping, which promote cervical effacement and dilation.
Q69: A post-term baby is at increased risk for which of the following complications?
A. Respiratory distress syndrome (RDS)
B. Hypoglycemia
C. Meconium aspiration
D. Down syndrome
C. Meconium aspiration
Rationale: Post-term infants are at high risk of meconium-stained amniotic fluid, which may lead to meconium aspiration syndrome (MAS) — a serious respiratory complication in newborns.
Q70: At what gestational age does the uterine fundus typically reach the level of the umbilicus?
A. 12 weeks
B. 16 weeks
C. 20 weeks
D. 28 weeks
C. 20 weeks
Rationale: The fundus reaches the level of the umbilicus at approximately 20 weeks gestation, which is a common clinical method for estimating gestational age during prenatal checkups.
Q71: Babies born with neural tube defects are more commonly:
A. Post-term
B. Full-term
C. Preterm
D. Growth-restricted
C. Preterm
Rationale: Neural tube defects are associated with preterm delivery, either spontaneous or medically indicated due to fetal anomalies. They are not linked to post-term pregnancies.
Q73: Which of the following is a maternal complication to anticipate in a post-term pregnancy?
A. Stillbirth
B. Meconium aspiration
C. Preeclampsia
D. Shoulder dystocia
C. Preeclampsia
Rationale: Post-term pregnancy increases maternal risk for preeclampsia, postpartum hemorrhage, and cesarean delivery. Stillbirth and meconium aspiration are fetal complications.
Q74: Which of the following is true regarding placental dysfunction?
A. Associated with decreased kisspeptin levels
B. Associated with low progesterone production
C. Causes polyhydramnios in most cases
D. Associated with multiple gestation
A. Associated with decreased kisspeptin levels
Rationale: Kisspeptin, a placental hormone, plays a role in trophoblast invasion and placental development. Low kisspeptin levels are linked with placental insufficiency, especially in IUGR and post-term pregnancies.
Q75: Which of the following is a complication caused by oligohydramnios?
A. Pulmonary hypoplasia
B. Macrosomia
C. Neural tube defects
D. Shoulder dystocia
A. Pulmonary hypoplasia
Rationale: Oligohydramnios restricts fetal movement and lung development, especially when prolonged, and is associated with pulmonary hypoplasia, limb contractures, and cord compression.
Q76: Which of the following statements about preterm labor is true?
A. It occurs after 37 weeks
B. It is not associated with cervical changes
C. It is associated with cervical change
D. It is only diagnosed in twin gestations
C. It is associated with cervical change
Rationale: Preterm labor is defined as regular uterine contractions with progressive cervical changes (dilation or effacement) before 37 weeks gestation.
Q77: Which of the following statements about preterm infants is NOT true?
A. Those delivered after 37 weeks
B. Higher risk for RDS
C. More likely to have NEC
D. May require NICU care
A. Those delivered after 37 weeks
Rationale: Preterm infants are born before 37 weeks. Infants born after 37 weeks are considered term. The rest of the options correctly describe preterm neonatal risks.
Q82: Which of the following statements is NOT true regarding uterine distension as a cause of spontaneous preterm labor?
A. Uterine overdistension occurs in multiple gestation
B. Polyhydramnios can lead to uterine overdistension
C. Uterine distension may trigger contractions
D. Absence of regular uterine contraction
D. Absence of regular uterine contraction
Rationale: Uterine distension (from multiples or polyhydramnios) is a known cause of spontaneous preterm labor due to increased myometrial stretch, leading to regular contractions — not their absence.
Q83: What is the most common route of infection that may cause spontaneous preterm labor?
A. Transplacental transfer of systemic infection
B. Retrograde flow of infection
C. Ascending infection
D. Respiratory droplets
C. Ascending infection
Rationale: The most common route of infection leading to preterm labor is ascending infection from the vagina/cervix, often involving bacteria like GBS or anaerobes ascending into the amniotic cavity.
Q84: Loss associated with painless cervical dilatation is most commonly due to:
A. Cervical deficiency
B. Cervical ineffectiveness
C. Cervical inability
D. Cervical incompetence
D. Cervical incompetence
Rationale: Cervical incompetence is defined as painless cervical dilatation typically occurring in the second trimester, leading to recurrent pregnancy loss or preterm birth without contractions.
Q85: Which of the following is a possible clinical indicator of chorioamnionitis in a woman with preterm premature rupture of membranes (PPROM)?
A. Fetal tachycardia
B. Positive vaginal culture
C. Leukocytosis
D. Fever
D. Fever
Rationale: The most reliable clinical sign of chorioamnionitis is maternal fever. While fetal tachycardia and leukocytosis may be present, fever is the most indicative and diagnostic sign.
Q86: Which of the following is a possible indication for cerclage?
A. Recurrent mid-trimester losses
B. Short cervix identified during sonography
C. Threatened preterm labor with cervical dilation
D. All of the above
D. All of the above
Rationale: Cerclage is indicated in patients with:
Recurrent second-trimester losses
Ultrasound-diagnosed short cervix
Cervical changes with threatened preterm labor
All three scenarios justify cerclage to prevent pregnancy loss or preterm delivery.
Why should nifedipine not be given concurrently with magnesium sulfate (MgSO₄) in obstetric management?
A. Risk of fetal bradycardia due to uterine hypoperfusion
B. Risk of uterine hyperstimulation
C. Risk of additive neuromuscular blockade, which may depress cardiac and respiratory function
D. Risk of rebound hypertension after discontinuation
C. Risk of additive neuromuscular blockade, which may depress cardiac and respiratory function
High-Yield Rationale:
Nifedipine (a calcium channel blocker) and magnesium sulfate (a neuromuscular blocker) both reduce calcium influx in muscle tissue. Co-administration can result in exaggerated neuromuscular blockade, leading to hypotension, respiratory depression, and cardiac compromise — especially dangerous in preterm labor and preeclampsia cases.
Which of the following statements about Magnesium Sulfate (MgSO₄) is NOT correct?
A. It acts as a calcium antagonist and reduces myometrial contractility
B. It is used for neuroprotection in term infants with normal birth weight
C. It requires monitoring of respiratory rate, urine output, and deep tendon reflexes
D. Its antidote in toxicity is 1 g calcium gluconate IV over 3 minutes
B. It is used for neuroprotection in term infants with normal birth weight
High-Yield Rationale:
MgSO₄ provides neuroprotection primarily for very low birth weight preterm infants (<32 weeks), reducing the risk of cerebral palsy. It is not indicated for neuroprotection in term or normal birth weight infants. All other statements regarding mechanism, monitoring, and toxicity management are correct.
