Obstetrics - 2M Flashcards
Which of the following describes Pinards
maneuver?
Two fingers of the provider are placed beneath
and then parallel to the femur and knees must be
flexed to bring the foot within reach.
Which of the following studies stated that there is
no excessive morbidity in term breech singletons
delivered vaginally provided strict fetal biometric
and maternal pelvimetry parameters are applied?
Lille Breech Study Group
Regarding breech delivery, which of the following
has Level II-1, Grade A recommendation?
The absence of adequate progress in labor during
the first stage of labor in a patient who is
undergoing a planned vaginal delivery is an
indication for CS.
What is the best indicator of pelvic adequacy for
vaginal breech delivery?
Phase of maximum slope reaching second stage
of labor after 2 hours accompanied by regular
contractions in a multigravida
A 28 yo G5P4 at 38wks AOG came in due to labor
pains. On pelvic examination, you noted that the
foot is already visible at the introitus. The cervix
was seemingly fully dilated and fully effaced.
What is the next most appropriate in the
management?
Immediate CS
A 27 yo G2P1 (1001) at 32 wks AOG has been at
the labor room for 2 wks for the management of
preterm premature rupture of membranes
(PPROM). Her most recent ultrasound showed
an appropriately grown fetus in a footling breech
presentation showing oligohydramnios. The OB
resident refers back the patient because there are
recurrent fetal heart rate decelerations as low as
70bpm on her NST. If you’re the attending
consultant, what is the initial verbal order you give
to the resident when you go to see the patient?
Immediately do internal examination
(A 27 yo G2P1 (1001) at 32 wks AOG has been at
the labor room for 2 wks for the management of
preterm premature rupture of membranes
(PPROM). Her most recent ultrasound showed
an appropriately grown fetus in a footling breech
presentation showing oligohydramnios. The OB
resident refers back the patient because there are
recurrent fetal heart rate decelerations as low as
70bpm on her NST.)
Same patient as #6. On examination, the 2 feet
and loop of umbilical cord was noted at the
vaginal introitus. Patient was brought to the OR.
At the OR, FHR was noted to be recovered after
resuscitation. A repeat examination revealed that
the scapula of the fetus are passed to what
seems to be completely dilated cervix and the
fetal buttocks are at the introitus. Which of the
following is true regarding vaginal breech in this
setting?
There is an increased risk of head entrapment
(A 27 yo G2P1 (1001) at 32 wks AOG has been at
the labor room for 2 wks for the management of
preterm premature rupture of membranes
(PPROM). Her most recent ultrasound showed
an appropriately grown fetus in a footling breech
presentation showing oligohydramnios. The OB
resident refers back the patient because there are
recurrent fetal heart rate decelerations as low as
70bpm on her NST.)
Same patient. How will you best manage the
most common complication?
Do incision at the 2 o’clock and 10 o’clock
position, possibly 6 o’clock position of the cervix
(Duhrssen incision)
(A 27 yo G2P1 (1001) at 32 wks AOG has been at
the labor room for 2 wks for the management of
preterm premature rupture of membranes
(PPROM). Her most recent ultrasound showed
an appropriately grown fetus in a footling breech
presentation showing oligohydramnios. The OB
resident refers back the patient because there are
recurrent fetal heart rate decelerations as low as
70bpm on her NST.)
Same patient. If the procedure that you
performed is not successful, which of the
following may aid in the fetal delivery?
Assisted vaginal delivery using Piper’s forceps
A primigravida patient who underwent CS
because of primi breech at 39 wks AOG followed
up at the clinic for postpartum care. You
explained to her that during the surgery, the
uterus was normal and no anomalies were
identified. She asked you what are the chances
that she will have a breech presentation in her
future pregnancies. How will you answer this
patient?
With one previous breech presentation at term,
the chances that she will have another breech
presentation is 10%.
Application of forceps is appropriate in which of
the following situations?
Mentum anterior, station +3, cervix completely
dilated and membranes ruptures
Anticipating success, an obstetrician has made a
concerted attempt to deliver a patient using
forceps. The attempt fails. How is the procedure
termed?
Failed forceps
A 35 yo G7P6 38 wks pregnant, presents in
advance labor with a frank breech presenting at
the perineum. The vaginal breech delivers
without difficulty until the head becomes
entrapped in the incompletely dilated cervix. To 2
release the head, which of the following should
be done?
Duhrssen incision
- A 28 yo G4P3 at 39 wks came in due to labor
pains. IE was done revealing 5 cm dilated, fully
effaced, +BOW, station -1, cephalic. Labor
progressed up to full cervical dilation. However,
during the 2nd stage of labor, there was
prolongation and you noted that the sagittal
sutures are being palpated. Further descent of
the fetal head at station +2, you palpated the
ears. How is the situation resolved after
placement of forceps?
Pulling and pushing each branch along the long
axis
- What is the most favorable clinical scenario for a
successful vaginal delivery after a CS birth?
Previous vaginal delivery
28 yo G1P0 at 38wks AOG came in due to labor
pains. IE upon admission was 4cm. Labor
progressed until she was at 2nd stage of labor.
After 2 hrs without epidural anesthesia, you noted
that the occiput is at the sacrum, station -3. Which
of the following actions is necessary to rotate a
fetus from this position to appropriate position?
Flexion of the fetal head
(28 yo G1P0 at 38wks AOG came in due to labor
pains. IE upon admission was 4cm. Labor
progressed until she was at 2nd stage of labor.
After 2 hrs without epidural anesthesia, you noted
that the occiput is at the sacrum, station -3.)
Same patient. In this setting, when the occiput is
at the sacrum, correctly placed blades are
equidistant at what landmarks?
Midline of the face and the brow
(28 yo G1P0 at 38wks AOG came in due to labor
pains. IE upon admission was 4cm. Labor
progressed until she was at 2nd stage of labor.
After 2 hrs without epidural anesthesia, you noted
that the occiput is at the sacrum, station -3.)
Same patient. Which of the following pelvic types
is generally associated if the position of the fetal
head persists?
Anthropoid
(28 yo G1P0 at 38wks AOG came in due to labor
pains. IE upon admission was 4cm. Labor
progressed until she was at 2nd stage of labor.
After 2 hrs without epidural anesthesia, you noted
that the occiput is at the sacrum, station -3.)
Same patient. Estimated fetal weight is 3400g.
Considering the presentation of this patient,
which of the following would be associated with
failure of operative delivery?
The occiput posterior position
A 31 yo primigravid undergoing induction of labor
reaches 2nd stage of labor after 36 hrs. Before
beginning to push, she says that she’s too tired
and desires an operative vaginal delivery. You
decided to do a vacuum extraction. Which of the
following is a prerequisite for vacuum extraction
but not for forceps assisted vaginal delivery?
Minimum of 34 wks
A patient presents approximately 10 yrs
postmenopause with complaints of a vulvar mass
which on examination turned out to be a
prolapsed uterus. She is a G10P10 and all her
children were home delivered. Which of the
following pelvic muscles were most likely
compromised during the vaginal delivery?
Levator ani muscles
A 36 yo G3P2 3 mos pregnant develops bleeding,
abdominal cramps, and passes tissues per
vagina. After 2 hrs, she bled profusely hence was
brought to the ER. On admission, the cervix
admits one finger, and tissues were felt within the
os. What is the indicated procedure?
Curettage
A 20 yo primigravid whose LMP was 10 wks ago
presented with scanty vaginal bleeding. TVS
showed the uterus to be 15 wks size with various
sized cystic structures inside the endometrial
cavity. No fetus seen. The cervix was long and
closed. The hCG titer is 10,000IU. What is the
initial step in the indicated procedure?
Slow dilatation of the cervix
A postpartum woman who underwent a
prolonged labor and uneventful vaginal delivery
under epidural anesthesia complained of severe
hypogastric pain 5 hrs postpartum. On
examination, the hypogastrium was distended.
Which of the following is the most probable
diagnosis?
Urinary retention
A 24 yo G3P2 diagnosed to have missed
abortion was undergoing curettage. And just as
the operator was finishing with the procedure,
there was sudden profuse bleeding from the
uterus. Which of the following might be the cause
of the bleeding?
Laceration of the uterine artery
A 31 yo G1P1 consulted due to vaginal bleeding
3 wks postpartum. She claimed that her delivery
was uncomplicated. Which of the following is
considered the first line treatment in a vaginal
bleeding 3 wks postpartum?
Antibiotics
(A 31 yo G1P1 consulted due to vaginal bleeding
3 wks postpartum. She claimed that her delivery
was uncomplicated.)
Same patient. You started your first line
treatment, but still the patient had vaginal 3
bleeding. What will be the next efficacious
treatment for this patient?
Curettage
A 32 yo G3P3 3003 who came in because of
breast tenderness. She delivered via CS 2 wks
ago. She is breastfeeding. She presented with 2
days fever, chills, and breast pain. She cannot
breastfeed on the affected side. On examination,
the breast is warm, red, and tender. Your
considerations were mastitis vs abscess. What is
the best management of this patient after seeing
the ultrasound result? (Doc says the ultrasound
shows abscess)
Give antibiotics, drain abscess, do culture,
pumping or breastfeeding continued for both
breasts
A patient had CS for obstructed labor. Postop,
she had spiking temperature despite antibiotics.
The diagnosis of postpartum pelvic
thrombophlebitis was made and suddenly, she
complained of chestpain and dyspnea. Which of
the following will be the most likely diagnosis?
Pulmonary embolism
18 yo primigravida delivered a 4000g infant
vaginally. Her prenatal course was complicated
by anemia, poor weight gain and maternal
obesity. Her labor was protracted including a 3 hr
second stage. A low forceps delivery was done
with episiotomy that extended to a 3rd degree
perineal tear. Which of the following is the
greatest predisposing cause of puerperal
infection in this patient?
Poor nutrition
Images were not shown, doc only described the
pictures.
Picture A - Normal waveform.
Picture B - Decrease in diastole.
What can you say about the umbilical artery?
SD ratio is greater in B than A
28 yo primigravid diagnosed with GDM at 24 wks.
She was managed with diet and is controlled.
However, at 32 wks, the fundal height was
smaller than AOG. Impression was IUGR.
Doppler velocimetry was requested revealing
these findings (images not shown). Low diastole.
What can you say about the doppler waveform?
There is increased impedance to flow with
abnormally elevated SD ratio
28 yo primigravid diagnosed with GDM at 24 wks.
She was managed with diet and is controlled.
However, at 32 wks, the fundal height was
smaller than AOG. Impression was IUGR.
Doppler velocimetry was requested revealing
these findings (images not shown).
Same patient. What is the implication of the result
of the doppler velocimetry to the fetus?
30% placental occlusion and MR of 5.6%
28 yo primigravid diagnosed with GDM at 24 wks.
She was managed with diet and is controlled.
However, at 32 wks, the fundal height was
smaller than AOG. Impression was IUGR.
Doppler velocimetry was requested revealing
these findings (images not shown).
Same patient as in 33. Doppler velocimetry
showed same results. On checking the MCA, it
has low pulsatility index and resistance index.
What does this imply?
Brain sparing indicative of acute hypoxia.
28 yo primigravid diagnosed with GDM at 24 wks.
She was managed with diet and is controlled.
However, at 32 wks, the fundal height was
smaller than AOG. Impression was IUGR.
Doppler velocimetry was requested revealing
these findings (images not shown).
Same patient. Your decision regarding time of
delivery would be guided by which of the
following?
Ctg and amniotic fluid volume
Which of the following Doppler results warrants
an urgent C section for it may lead to fetal
distress?
Normal umbilical artery pulsatility index+
decreased MCA pulsatility index.
A 38 year old G4P3 (3003) came in due to labor
pain. Fundic height is 35cm. Patient is diagnosed
with GDM. IE was 6cm. Labor progress was until
the second stage of labor. Upon delivery, there
was a recoil of the fetal head at the perinium.
Shoulder dystocia was diagnosed. Which
maneuver will you use for anterior disimpaction of
the shoulder?
Shoulder is pushed to the chest.
(A 38 year old G4P3 (3003) came in due to labor
pain. Fundic height is 35cm. Patient is diagnosed
with GDM. IE was 6cm. Labor progress was until
the second stage of labor. Upon delivery, there
was a recoil of the fetal head at the perinium.
Shoulder dystocia was diagnosed.)
Same patient (37) which is the vaginal approach for anterior shoulder disimpaction?
Rubin’s
What fetal heart abnormality shows cerebral
palsy and indicates prompt intervention?
No specific fetal heart rate pattern
A 47 year old G1P1, had spontaneous vaginal
delivery at 28 weeks, but developed intracranial
hemorrhage. What is the most common etiology?
Hypoxia ischemia
21 year old regularly menstruating female
experiences amenorrhea for 5.5 weeks. He B
HcG test was positive, had tender breasts, and
nausea. Picture presented of a transvaginal
ultrasound ( one gestational sac, one yolk sac). 4
Pregnancy uterine, 5 weeks AOG by mean sac
diameter. After 2 weeks, another scan was done.
( 1 gestational sac, 1 yolk sac, 2 embryos). What
type of twinning is this?
Mono mono
(21 year old regularly menstruating female
experiences amenorrhea for 5.5 weeks. He B
HcG test was positive, had tender breasts, and
nausea. Picture presented of a transvaginal
ultrasound ( one gestational sac, one yolk sac). 4
Pregnancy uterine, 5 weeks AOG by mean sac
diameter. After 2 weeks, another scan was done.
( 1 gestational sac, 1 yolk sac, 2 embryos)
Same patient, this twinning results from division
at?
8-12 days after fertilization
21 year old regularly menstruating female
experiences amenorrhea for 5.5 weeks. He B
HcG test was positive, had tender breasts, and
nausea. Picture presented of a transvaginal
ultrasound ( one gestational sac, one yolk sac). 4
Pregnancy uterine, 5 weeks AOG by mean sac
diameter. After 2 weeks, another scan was done.
( 1 gestational sac, 1 yolk sac, 2 embryos).
Same patient, how will you consult this patient?
Early delivery
27 year old G2P1 (1001) with abdominal
enlargement sought consult. LMP was last
November 2020. First pregnancy was term, with
no complications. Fundal height is 28cm, two fetal
heart tones. This was her first prenatal checkup.
You requested an US, which revealed IU
pregnancy 24 weeks AOG.. Twin A, cephalic
presentation, male, seen on maternal right,
inferiorly located, amt placenta grade 2 estimated
weight 2.5 kg. Twin B, breech, male, left side,
superiorly located, placenta grade 2 weight:
2.1kg. There is an intervening membrane
measuring 2 cm. What is the type of twinning?
Di, di
27 year old G2P1 (1001) with abdominal
enlargement sought consult. LMP was last
November 2020. First pregnancy was term, with
no complications. Fundal height is 28cm, two fetal
heart tones. This was her first prenatal checkup.
You requested an US, which revealed IU
pregnancy 24 weeks AOG.. Twin A, cephalic
presentation, male, seen on maternal right,
inferiorly located, amt placenta grade 2 estimated
weight 2.5 kg. Twin B, breech, male, left side,
superiorly located, placenta grade 2 weight:
2.1kg. There is an intervening membrane
measuring 2 cm.
Same patient, what will be the best plan of
delivery for the patient?
Vaginal delivery for first twin, a complete breech
extraction for second.
27 year old G2P1 (1001) with abdominal
enlargement sought consult. LMP was last
November 2020. First pregnancy was term, with
no complications. Fundal height is 28cm, two fetal
heart tones. This was her first prenatal checkup.
You requested an US, which revealed IU
pregnancy 24 weeks AOG.. Twin A, cephalic
presentation, male, seen on maternal right,
inferiorly located, amt placenta grade 2 estimated
weight 2.5 kg. Twin B, breech, male, left side,
superiorly located, placenta grade 2 weight:
2.1kg. There is an intervening membrane
measuring 2 cm.
Same patient, is there growth discordance?
None
A 35 year old, has a missed period for 6 weeks.
B HcG positive, has symptoms like nausea,
breast tenderness. Her US findings showed 1
gestational sac, 2 embryos, 2 yolk sac. What
type of twinning it is?
Monochorionic, diamnionic
A 35 year old, has a missed period for 6 weeks.
B HcG positive, has symptoms like nausea,
breast tenderness. Her US findings showed 1
gestational sac, 2 embryos, 2 yolk sac
Same patient, repeated US at 28 weeks, showed
the following findings, intrauterine twin
pregnancy. Twin A: 26 weeks, 4 days by fetal
biometry, cephalic, maternal right side, more
superiorly located, approx weight is 1200g, single
vertical pocket of amniotic fluid is 1.8 cm. Twin B,
29 weeks 5 days live, breech, maternal left, more
inferiorly located estimated fetal weight is 1900g,
single vertical pocket is 8.3 cm. Thin intervening
membrane seen. What is the condition?
Twin to twin transfusion syndrome
A 35 year old, has a missed period for 6 weeks.
B HcG positive, has symptoms like nausea,
breast tenderness. Her US findings showed 1
gestational sac, 2 embryos, 2 yolk sac
Same patient, repeated US at 28 weeks, showed
the following findings, intrauterine twin
pregnancy. Twin A: 26 weeks, 4 days by fetal
biometry, cephalic, maternal right side, more
superiorly located, approx weight is 1200g, single
vertical pocket of amniotic fluid is 1.8 cm. Twin B,
29 weeks 5 days live, breech, maternal left, more
inferiorly located estimated fetal weight is 1900g,
single vertical pocket is 8.3 cm. Thin intervening
membrane seen.
Same patient, after 2 weeks, repeat US, twin A:
27 weeks 2 days, live, cephalic, wt: 1320g, single
vertical pocket is 1.7cm . Twin B 31 weeks,
breech, wt: 2300g, single vertical pocket is 9cm
with ascites and hydrothorax. What is the
diagnosis of in the photo presented, you can see
reversal of end diastolic flow?
TTS stage 4
A 35 year old, has a missed period for 6 weeks.
B HcG positive, has symptoms like nausea,
breast tenderness. Her US findings showed 1
gestational sac, 2 embryos, 2 yolk sac
Same patient, repeated US at 28 weeks, showed
the following findings, intrauterine twin
pregnancy. Twin A: 26 weeks, 4 days by fetal
biometry, cephalic, maternal right side, more
superiorly located, approx weight is 1200g, single
vertical pocket of amniotic fluid is 1.8 cm. Twin B,
29 weeks 5 days live, breech, maternal left, more
inferiorly located estimated fetal weight is 1900g,
single vertical pocket is 8.3 cm. Thin intervening
membrane seen.
Same patient, How will you manage?
Admit, close fetal surveillance and give
corticosteroids and MgSO4
This medical complication can cause preterm
birth
Preeclampsia
Which of the following is true
*preterm/postterm topic
Short stature maybe a factor in preterm birth
This is the most imp factor for women who maybe
at risk of preterm birth
Prior preterm birth
Which is true regarding US evaluation of cervical
length
Cervical length is measured at 16-24 weeks
Which of the following is false in the management
of bacterial vaginosis
Bac vaginosis is an infection caused by
Gardnerella
27 year old, 33 weeks AOG, complains of watery
discharge from the vagina 3 days ago. Vital signs
are normal. FHT 140 bpm, FH of 31cm. Cephalic,
uterine contraction every 4-5 minutes, speculum
exam: amniotic fluid pooling, IE: 2cm dilated, 50%
effaced, st-2. What is the management?
Tocolytic, betamethasone, antibiotics, mgso4
32 year old, 31-32 AOG, complains of watery
discharge from vagina 3 days ago, normal vital
signs. FHT is 170bpm, LMP breech. IE: 2 cm,
50% effaced. - membranes
Management?
Antibiotics and do C section
Which of the following recommendations are
appropriate for women with ruptured membranes
at 34 weeks and below
If maternal and fetal status are reassuring,
transfer them to ante partum unit
Which of the following are not feared
constituents of nearing post partum or post
partum women?
Fetal hypoglycaemia
Which is the most appropriate management at
41 weeks of gestation with IE: 2cm dilated, 50%
effaced, st -3, medium consistency and
posterior?
Insert laminaria tent
32 year old female comes at the Opd for consult.
Amenorrheic for 8 weeks, positive B HcG, second
pregnancy. First pregnancy was delivered at 35
weeks in oct 2019, by emergent C section due to
blood pressure of 180/100, severe headache,
blurring of vision. Her BP is still intermittently high
even after delivery, failed to follow up. At the
clinic, bp is 100/70, rr: 21, temp: 36. What is the
impression?
Chronic hypertension
32 year old female comes at the Opd for consult.
Amenorrheic for 8 weeks, positive B HcG, second
pregnancy. First pregnancy was delivered at 35
weeks in oct 2019, by emergent C section due to
blood pressure of 180/100, severe headache,
blurring of vision. Her BP is still intermittently high
even after delivery, failed to follow up. At the
clinic, bp is 100/70, rr: 21, temp: 36.
Same patient, at 31 weeks now, complains of
headache. No other complains. For vitals, her bp
is 200/110, pulse rate is 90bpm, FHT is 30cm, no
uterine contractions. Cervix closed, uterus
enlarged to AOG. Albumin+2, -ve sugar in the
urine. What is the diagnosis?
Preeclampsia superimposed on chronic
hypertension.
32 year old female comes at the Opd for consult.
Amenorrheic for 8 weeks, positive B HcG, second
pregnancy. First pregnancy was delivered at 35
weeks in oct 2019, by emergent C section due to
blood pressure of 180/100, severe headache,
blurring of vision. Her BP is still intermittently high
even after delivery, failed to follow up. At the
clinic, bp is 100/70, rr: 21, temp: 36.
Same patient, how will you manage the case?
Control bp, give corticosteroid, seizure
prophylaxis
32 year old female comes at the Opd for consult.
Amenorrheic for 8 weeks, positive B HcG, second
pregnancy. First pregnancy was delivered at 35
weeks in oct 2019, by emergent C section due to
blood pressure of 180/100, severe headache,
blurring of vision. Her BP is still intermittently high
even after delivery, failed to follow up. At the
clinic, bp is 100/70, rr: 21, temp: 36.
Same patient, bp comes down to 150-160/ 100-
110. Eventually the patient develops difficulty in
breathing with mid facial bipedal edema. Bp
becomes 170/100, pulse rate of 120 bpm.
Auscultation of chest reveals *****(not clear)What
is the possible complication?
Pulmonary congestion. But always consider
COVID
A 31 year old G3P2, (2002) pregnant for 33
weeks, has vaginal spotting and headache.
Diagnosed with hypertension starting 20 weeks,
maintained at methyldopa 250mg BID. Bp is
160/100, FH 30cm. FHT 130bpm. Cervix is
smooth, no bleeding, IE not done. Hb is 120, wbc
is 8.2, platelet of 80,000 proteinuria +1, no sugar,
pus cells 0-2, LDH 960/L, SGPT 200unit/L,
creatinine 1mg/dl. TransAbdominal US revealed
a live intrauterine pregnancy at 33 weeks,
placenta anterograde, high lying, adequate
amniotic fluid. What is your adequate
impression?
HELLP syndrome
A 31 year old G3P2, (2002) pregnant for 33
weeks, has vaginal spotting and headache.
Diagnosed with hypertension starting 20 weeks,
maintained at methyldopa 250mg BID. Bp is
160/100, FH 30cm. FHT 130bpm. Cervix is
smooth, no bleeding, IE not done. Hb is 120, wbc
is 8.2, platelet of 80,000 proteinuria +1, no sugar,
pus cells 0-2, LDH 960/L, SGPT 200unit/L,
creatinine 1mg/dl. TransAbdominal US revealed
a live intrauterine pregnancy at 33 weeks,
placenta anterograde, high lying, adequate
amniotic fluid.
Same patient, what is the best plan of
management?
Seizure prophylactic, give steroids, deliver after
completion of steroids
A 31 year old G3P2, (2002) pregnant for 33
weeks, has vaginal spotting and headache.
Diagnosed with hypertension starting 20 weeks,
maintained at methyldopa 250mg BID. Bp is
160/100, FH 30cm. FHT 130bpm. Cervix is
smooth, no bleeding, IE not done. Hb is 120, wbc
is 8.2, platelet of 80,000 proteinuria +1, no sugar,
pus cells 0-2, LDH 960/L, SGPT 200unit/L,
creatinine 1mg/dl. TransAbdominal US revealed
a live intrauterine pregnancy at 33 weeks,
placenta anterograde, high lying, adequate
amniotic fluid.
Same patient, given seizure prophylactic via IV,
1g/hr, for 6-8 hours. Urine output was 10 ml/ hour.
Rr Increases to 26, until she has labor breathing.
Given the patient’s condition, what is the level of
MgSO4 now?
10meqs/L
A 25 year old G1P0, pregnant at 6 weeks comes
to the clinic for prenatal care. She is non-diabetic
and non-hypertensive and given folic acid. You
requested for laboratory work ups, after 2 weeks
the patient came back with normal lab results.
TVS revealed an intrauterine pregnancy 7 weeks
of gestation, patient was advised to continue the
folic acid. However at 21 weeks the BP was
150/90, you start her on Methyldopa 200mg/tab
BID, her BP is maintained on normal levels until
on her 29th week, she started having bipedal
edema with elevations 160-170/100-110 with
proteinuria of +3. What is your diagnosis?
D. Preeclampsia with severe features
A 25 year old G1P0, pregnant at 6 weeks comes
to the clinic for prenatal care. She is non-diabetic
and non-hypertensive and given folic acid. You
requested for laboratory work ups, after 2 weeks
the patient came back with normal lab results.
TVS revealed an intrauterine pregnancy 7 weeks
of gestation, patient was advised to continue the
folic acid. However at 21 weeks the BP was
150/90, you start her on Methyldopa 200mg/tab
BID, her BP is maintained on normal levels until
on her 29th week, she started having bipedal
edema with elevations 160-170/100-110 with
proteinuria of +3.
Same patient, what will be your plan of
management?
A. Admit the patient for BP control, seizure
prophylaxis, corticosteroids for fetal lung
maturity
A primigravid at 34 weeks was admitted because
of persistently elevated 160/110 BP despite
medications, she was diagnosed with IUGR.
Doppler ultrasound revealed decreased end
diastolic flow, 24 hour album revealed 5000mg.
What is the indication for delivery?
A. BP of 160/110mmHg
Which of the following legal theories describe the
failure of a physician to disclose a risk of
procedure
C. Informed consent
Which legal document sets out the patient’s
wishes regarding her future health status
including end of life issues
Advance directive
When we give importance to the role women
should play in decision making in respect to their
health care, we are invoking their right to?
C. Autonomy
Because of the intimate personal nature of
obstetrics and gynecologic care, there is a special
need to protect the patients?
Confidentiality
Which of the following ethical principles identifies
familial, social, institutional, financial and legal
settings within which a particular case takes place
insofar as they influence medical decisions.
C. Principle of Justice and Fairness
A 23 year old primigravid at 38 weeks wants to
undergo elective cesarean delivery per request
because of fear of labor pains and complications
of pelvic organ prolapse. What is the number 1
ethical principle applied in this case?
B. Principle of Beneficence
A G3P2 2002, 30 year old, with 2 previous CS
wants a tubal ligation to be done along with her
3rd CS. She said that her husband does not want
to give his consent because he wants to have 4
children.
A. The physician should support the patient’s
right to decide about future reproduction.
A G1P0 35 year old, desires to deliver a fatally
malformed fetus by CS because she believes this
procedure will increase newborn’s chance of
surviving. However in the physician’s best
judgment, the theoretical benefit to a non viable
infant may not justify the risk of the surgical
delivery to the woman. Which of the following
ethical principles may run in conflict with the OB’s
obligation to respect the patient’s autonomy
B. Beneficence
In giving COVID 19 vaccination, what is the
number 1 ethical principle that must be implied?
C. Autonomy
What ethical principle is being applied in a female
patient diagnosed with ectopic pregnancy, live
fetus who presented with hemodynamically
status and will undergo methotrexate
management that will kill the live fetus
immediately?
C. Double effect
As an adaptation to pregnancy, preload rises at
what age of gestation?
B. 10-20 weeks
. Which of the following statements does not
describe the adaptation of the cardiovascular
system in pregnancy?
A. Increase heart rate = decrease CO
Cardiac output may increase as early as what
age of gestation?
A. 5 weeks
Which is responsible for the limited physical
activities for patients in 28-32 weeks AOG
B. Increase intravascular volume
Which of the following cardiovascular conditions
of pregnancy is each therapeutic measure trying
to address the likelihood of complication of
gravidocardiac?
D. Postpartum intravascular fluid immobilization
Which of the following cardiovascular conditions
of pregnancy is each therapeutic measure trying
to decrease the likelihood of complication of
gravidocardiac?
C. Hypercoagulability
Which of the following cardiovascular conditions
of pregnancy is each therapeutic measure trying
to address in order to decrease likelihood of
complications of gravidocardiac, the epidural
anesthesia during labor?
E. Marked increase of peripartal cardiac output.
Which of the statements may predict cardiac
complications in pregnancy?
A. Left-sided obstruction
- Which of the following is true regarding
intrapartum heart failure?
A. Fluid overload is treated with diuresis
- Aortic stenosis is caused by
B. Congenital bicuspid valve
In making incision, when it is imperative to incise
higher on the uterus to avoid laceration of the
uterine vessels or unintended entry into the
vagina
A. Completed dilated cervix
In making a higher incision to avoid laceration of
the uterine vessels which of the following is being
used as a guide in the procedure
B. The vesico-uterine serosal reflection
A primi patient on her 28 weeks gestation goes
into labor with passage of watery vaginal
discharge, and suddenly develops signs of
chorioamnionitis. Upon internal examination, the
cervix has poor bishop score, you plan to do CS
section so what is the best uterine incision for the
patient?
C. Vertical incision on the upper segment of the
uterus or Classical CS
- 24 year old G2P1(1001) at 37 weeks LMP,
supported by a 9-week ultrasound, states that her
mother is in town in the next 4 days and will be
available to assist in taking care of her baby. She
requested for CS, although controversial, CS
delivery on maternal request should only be
considered as option when which of the following
criteria have been met?
A. Pregnancy reached at least 39 weeks
- 24 year old G2P1(1001) at 37 weeks LMP,
supported by a 9-week ultrasound, states that her
mother is in town in the next 4 days and will be
available to assist in taking care of her baby. She
requested for CS, although controversial, CS
delivery on maternal request. Which of the
following is the best response to the patient’s
request of doing CS at 37 weeks?
C. CS at 37 weeks increases neonatal
complications compared to 39 weeks
- Which of the following abdominal incision
involves the separation of rectus muscles to the
symphysis pubis and separated from the
pyramidalis
C. Cherney incision
A single layer closure of uterus with 2 layer
closure of abdomen is done in what type of
abdominal incision?
B. Misgav Ladach procedure
Which vessel should be anticipated halfway
between the skin and fascia several centimeters
from the midline during the pfannenstiel incision?
B. Superficial epigastric arteries
The separation of the bladder from the lower
uterine segment should not exceed in what
distance?
C. 5cm
Which of the abdominal incisions has increased
risk of interrupting the perforating capillaries
causing superficial hematoma?
C. Transverse incision
