PRACTICE 1[ OB] Flashcards
A 35-year-old G3 with no prenatal care delivered spontaneously after 12 hours. Examination of the neonate revealed an abnormality. What is the MOST possible cause of this abnormality?
A. Amniotic band
B. Prolonged oligohydramnios
C. Cord torsion
D. Amnion nodosum
A. Amniotic band
High-Yield Rationale:
Amniotic band syndrome results from rupture of the amniotic sac, leading to fibrous bands that can entangle fetal parts, causing constriction or amputation. It is a classic cause of congenital limb deformities in an otherwise normal pregnancy.
Why Not Others:
B. Oligohydramnios: Causes Potter sequence, not isolated limb abnormalities.
C. Cord torsion: Affects blood flow, may cause stillbirth but not limb abnormalities.
D. Amnion nodosum: Associated with oligohydramnios, but not a direct cause of structural deformities.
A 37-year-old G2P1 at 36 weeks AOG presents with her second episode of vaginal bleeding. Ultrasound shows the placental edge is 1.5 cm from the internal cervical os. What is the diagnosis?
A. Low-lying placenta
B. Placenta partialis
C. High-lying placenta
D. Placenta marginalis
A. Low-lying placenta
High-Yield Rationale:
A placenta located within 2 cm of the internal os without covering it is considered low-lying.
Why Not Others:
B. Placenta partialis: Covers the os partially.
C. High-lying: Is far from the os (>2 cm).
D. Marginalis: Placental edge touches the os but doesn’t encroach it—this is not evident in the given 1.5 cm.
A 28-year-old G3P2 presents with 8 weeks of missed period, spotting, and hypogastric pain. Ultrasound shows a 3 x 3 cm complex mass in the left adnexa. Vitals stable. What is the next best step in management?
A. Laparoscopy
B. Repeat ultrasound
C. Observe
D. Laparotomy
A. Laparoscopy
High-Yield Rationale:
A complex adnexal mass in a woman with suspected ectopic pregnancy, stable vitals, and no rupture—laparoscopy is the next step for diagnosis and treatment.
Why Not Others:
B. Repeat U/S: Not helpful with strong ectopic suspicion.
C. Observe: Delays care.
D. Laparotomy: Reserved for ruptured or unstable cases.
A multiparous woman attempting home birth is brought in at the second stage of labor, saying she is tired. IE shows full dilation, ROA, station +2, 2 cm caput. Should assisted vaginal delivery be done?
A. Yes
B. No
B. No
High-Yield Rationale:
Presence of 2 cm caput and exhaustion in the second stage, even at +2 station, suggests cephalopelvic disproportion (CPD) or obstructed labor. Avoid instrumental delivery.
Why Not A:
Instrumental delivery is contraindicated with significant caput/molding without evidence of descent.
Q5:
A woman with abruptio placenta has decreased platelet count and fibrinogen levels. What condition is developing?
A. Dilutional coagulopathy
B. Disseminated intravascular coagulation (DIC)
C. Amniotic fluid embolism
D. Hypovolemic shock
B. Disseminated intravascular coagulation
High-Yield Rationale:
DIC is the most common coagulopathy in placental abruption, due to release of thromboplastin. Characterized by low fibrinogen, platelets, and increased PT/PTT.
Why Not Others:
A. Dilutional: Usually from massive transfusions.
C. Amniotic embolism: Presents with sudden collapse, not coagulopathy alone.
D. Hypovolemic shock: Hypotension, not clotting issue per se.
In performing bimanual uterine compression for uterine atony, which technique is correct?
A. Two hands compress uterus abdominally
B. Two fingers inside the vagina pushing uterine fundus upward
C. Closed fist inside vagina, one hand pressing posterior uterine wall
D. Two fingers inside vagina pushing uterine fundus downward
C. Closed fist inside vagina, one hand pressing posterior wall
High-Yield Rationale:
Bimanual compression involves a fist in the anterior fornix elevating the uterus, while the abdominal hand compresses the fundus to control bleeding.
Why Not Others:
A: Abdominal only = external massage, not bimanual.
B/D: Incorrect manipulation that does not effectively compress the uterus.
A G3P3 had profuse bleeding due to uterine atony. Initial Hct = 36%. Post-hysterectomy Hct = 27%. What is the estimated blood loss?
A. 2500 mL
B. 3500 mL
C. 3000 mL
D. 2000 mL
C. 3000 mL
High-Yield Rationale:
Blood loss is estimated using change in hematocrit. A drop of 9% (36 to 27) suggests ~25% volume loss, which corresponds to about 3000 mL in a postpartum patient.
Why Not Others:
A/D: Underestimates the loss.
B: Overestimates based on drop.
A 20-year-old woman passed meaty material. Cervix is open, minimal bleeding. Curettage done. Histopath: decidua only, no trophoblast. What is the MOST probable diagnosis?
A. Incomplete abortion
B. Complete abortion
C. Normal intrauterine tissue
D. Ectopic pregnancy
D. Ectopic pregnancy
High-Yield Rationale:
No trophoblast in uterine contents suggests no intrauterine pregnancy. With open cervix and history of bleeding, suspect ectopic.
Why Not Others:
A: Would show trophoblastic tissue.
B: Tissue would be intrauterine with trophoblast.
C: Misleading; pregnancy-related tissue missing.
A 16-year-old G1P0 at 15 weeks AOG has uterus enlarged to 20 weeks, BhCG = 700,000 mIU/ml. Preferred evacuation method?
A. TAH + BSO with mole in situ
B. TAH with mole in situ
C. Dilatation and curettage
D. Suction curettage
D. Suction curettage
High-Yield Rationale:
In complete hydatidiform mole, uterine size > AOG and very high BhCG warrant suction curettage, the safest and most effective method.
Why Not Others:
A/B: TAH is for women >40, or with recurrent GTD.
C: D&C less effective than suction.
A 35-year-old G2P1 had molar pregnancy evacuation 6 months ago. Persistent bleeding, 5x5 cm hemorrhagic vaginal mass, CXR shows 2 lung nodules, BhCG = 100,000. What is the stage?
A. Stage III
B. Stage IV
C. Stage II
D. Stage I
A. Stage III
High-Yield Rationale:
Stage III gestational trophoblastic neoplasia = lung metastases, regardless of uterine involvement.
Why Not Others:
B. Stage IV: Distant mets beyond lungs (e.g., liver/brain).
C. Stage II: Limited to pelvis/vagina.
D. Stage I: Limited to uterus.
What is the recommended route of delivery for cases of abruptio placenta in a hemodynamically stable patient with a dead fetus in utero?
A. Emergency cesarean section
B. Vacuum delivery
C. Forceps delivery
D. Vaginal delivery
D. Vaginal delivery
High-Yield Rationale:
In a stable patient with fetal demise, vaginal delivery is preferred to avoid unnecessary surgical risk. Cesarean is reserved for live fetus or unstable mother.
Why Not Others:
A. C-section: Only for fetal/maternal indications.
B/C: Vacuum or forceps only if vaginal delivery is imminent and criteria met.
What is the most common cause of ectopic pregnancy?
A. Anomaly of the fallopian tube
B. All of the above
C. Previous sexually transmitted disease
D. Tubal surgery
B. All of the above
High-Yield Rationale:
Tubal damage from STIs, surgeries, or congenital anomalies increases ectopic risk by impeding ovum transport.
Why Not Others:
Each individual option contributes, but combined damage from all listed factors is the most accurate answer.
A G1P0 at 28 weeks complains of painful fetal movements. On palpation, fetal extremities are superficial. What is the next best step?
A. Serial beta-hCG
B. All of the choices are correct
C. Abdominal ultrasound
D. Intravaginal ultrasound
C. Abdominal ultrasound
High-Yield Rationale:
Superficial fetal parts and pain raise suspicion for oligohydramnios or uterine rupture. Abdominal ultrasound is the most practical and immediate noninvasive diagnostic tool.
Why Not Others:
A. BhCG: Not useful at this stage.
B. “All choices” includes irrelevant tests.
D. Intravaginal U/S not indicated first in this scenario.
A 32-year-old at term underwent emergency CS for profuse, painful vaginal bleeding. The uterus had bluish discoloration. What complication should be anticipated?
A. Uterine atony
B. Hypertonus
C. Uterine inversion
D. Uterine rupture
D. Uterine rupture
High-Yield Rationale:
Bluish, ecchymotic uterus suggests concealed hemorrhage and likely uterine rupture, especially in emergency CS with abruption or prior scar.
Why Not Others:
A. Atony: Uterus is soft, not bluish.
B. Hypertonus: Associated with hyperstimulation, not rupture.
C. Inversion: Uterus prolapses through cervix.
Which adverse maternal outcome is increased in women with threatened abortion?
A. Low birth weight
B. Preterm premature rupture of membranes
C. Preterm birth
D. Placental abruption
D. Placental abruption
High-Yield Rationale:
Threatened abortion reflects underlying decidual/placental dysfunction, increasing later risk of abruption.
Why Not Others:
A/B/C: Also possible but less strongly associated than abruption.
A diabetic G3P2 at 35 weeks presents with watery discharge. FHT: bradycardia. On IE: cervix open, pulsating structure in vaginal vault. What is the most likely diagnosis?
A. Abruptio placenta
B. Cord prolapse
C. Preterm labor
D. Uterine rupture
B. Cord prolapse
High-Yield Rationale:
A pulsating cord felt on IE + bradycardia = cord prolapse, a true emergency requiring immediate delivery.
Why Not Others:
A/D: Do not explain pulsating structure in vagina.
C: Does not involve cord or FHR compromise.
What is the most likely explanation for tubal rupture in ectopic pregnancy?
A. Thinner epithelium
B. All the choices are correct
C. Lack of submucosal layer
D. Thicker muscularis layer
B. All the choices are correct
High-Yield Rationale:
The fallopian tube lacks submucosa, has a thin wall, and insufficient expansion ability → predisposes to rupture.
Why Not Others:
Each factor contributes; the combination leads to rupture.
Which of the following is diagnostic of a complete hydatidiform mole?
A. Serum BhCG of 300,000 mIU/mL
B. Uterus is 5 months size with appreciated fetal parts
C. Elevated FT3 and FT4
D. G3P2, 10 weeks AOG with uterine size of 8 weeks
A. Serum BhCG of 300,000 mIU/mL
High-Yield Rationale:
Extremely high BhCG levels (>100,000) are diagnostic. Moles also often have no fetal parts (unlike partial moles).
Why Not Others:
B: Suggests partial mole or twin pregnancy.
C: Hyperthyroidism is a finding, not diagnostic.
D: Smaller uterine size contradicts diagnosis.
A G1P1 underwent forceps delivery. Post-placental stage shows profuse bleeding with a firm uterus. What is the next best step?
A. Cervical and vaginal inspection
B. Completion curettage
C. Bimanual uterine compression
D. Exploratory laparotomy
A. Cervical and vaginal inspection
High-Yield Rationale:
A firm uterus with bleeding indicates trauma (cervical/vaginal tear), not uterine atony.
Why Not Others:
B: No evidence of retained placenta.
C: For atony, but uterus is firm.
D: Only if internal bleeding suspected.
A G2P1 is in 2nd stage of labor for 2 hours. Fetal head is direct occiput posterior, station +4. Patient is exhausted. What reduces maternal morbidity?
A. Keep forceps in place until head delivers
B. Rotate to occiput anterior
C. Perform mediolateral episiotomy
D. Await spontaneous delivery
C. Perform mediolateral episiotomy
High-Yield Rationale:
OP position + exhaustion + station +4 = assisted delivery likely. Mediolateral episiotomy reduces perineal trauma and facilitates delivery.
Why Not Others:
A: Unsafe and not recommended.
B: Manual rotation not ideal at +4 station.
D: May lead to prolonged labor and complications.
