A 26 year-old gravida 2 para 1 female at 9 weeks' estimated gestational age (by last normal menstrual period) presents to the Emergency Department complaining of heavy vaginal bleeding which began two hours earlier. She denies having any sexual intercourse in the past seven days. Her vital signs...
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A 26 year-old gravida 2 para 1 female at 9 weeks' estimated gestational age (by last normal menstrual period) presents to the Emergency Department complaining of heavy vaginal bleeding which began two hours earlier. She denies having any sexual intercourse in the past seven days. Her vital signs are stable. A
quantitative serum hCG returns at a value of 3200 mIU/mL and a transvaginal ultrasound reveals a mean gestational sac diameter of 30mm and no embryo. She reports passing no tissue and a speculum examination reveals the cervix is visually closed. In counseling the patient about her options, which of the following statements is true? correct answers Medical management with misoprostol is more effective than expectant management Correct
Which of the following is a contraindication for medical management of an ectopic pregnancy with methotrexate? correct answersPresence of embryonic cardiac activity Correct
A 19-yo primigravida at approximately 40 weeks' estimated gestational age comes to the hospital with painful contractions. She has received no prenatal care. Examination: Cervix is 4 cm dilated and 80% effaced at station -1. Blood pressure is 164/111 mm Hg, and a urine dipstick shows 3+ protein. She reports having had severe headaches for three days and has noticed swelling in her hands and feet. Moments after her blood is drawn and IV access is obtained, she has a generalized tonic-clonic seizure. Which of the following is the most appropriate immediate course of action? correct answersAdminister magnesium sulfate six grams IV over 15-20 minutes Correct
A 29 year-old gravida 3 para 2 female at 28 weeks' estimated gestational age is found to have a pulmonary embolus. She is hemodynamically stable and you are discussing therapeutic anticoagulation with her. According to the 2012 American College of Chest Physicians Guidelines, the treatment of choice
for venous thromboembolism in pregnancy is which one of the following? correct answersLow-molecular
weight heparin Correct
According to the NICHD Fetal Heart Rate Classification System, which category tracing requires prompt evaluation and expedient interventions to address the pattern (as the tracing in this category is considered abnormal and predictive of abnormal fetal acid-base status at the time of observation)? correct answersCategory III electronic fetal monitoring tracing Correct
A cesarean delivery may be considered due to failed induction after arrest of labor in which of the following primiparous labor scenarios? correct answersAfter maximum oxytocin dosing for six hours with
ruptured membranes, there is failure to generate adequate contractions or progress at 7 cm Correct Which of the following defines an occiput posterior position? correct answersFetal occiput toward the maternal spine Correct
All of the following are true statements regarding multiple gestation pregnancies EXCEPT: correct answersThere is a decreased incidence of congenital anomalies Correct
A 32-year-old gravida 2 para 1 female at 40 6/7 weeks' estimated gestational age has been fully dilated for four hours, and has now been pushing for two hours. She is physically and emotionally exhausted, so you have a discussion with her regarding assisted vaginal delivery. Which of the following are prerequisites to an instrumented delivery? correct answersLack of suspicion of severe cephalopelvic disproportion Correct
Which of the following is an antenatal risk factor for shoulder dystocia? correct answersMaternal obesity
Correct
Documentation in the medical record after a delivery with a shoulder dystocia is an essential risk management tool. Which of the following should be documented in the medical record pertaining to the
circumstances that took place during the shoulder dystocia? correct answersThe elapsed amount of time
from delivery of the fetal head until complete delivery of the baby Correct
Postpartum hemorrhage is a common maternal morbidity in high resource countries and is on the rise. Which one of the following is the most common cause of postpartum hemorrhage? correct answersAtonic uterus Correct
You are attending the delivery of a 36-year-old gravida 6 para 5 female at term. Her pregnancy has been uncomplicated, with the exception of chronic hypertension treated with Labetalol 100 mg po BID. After a
normal spontaneous vaginal delivery, you note a large gush of blood, prompt delivery of the placenta, and brisk vaginal bleeding. In addition to uterine massage, which of the following uterotonic agents should not be used to treat postpartum hemorrhage in this patient? correct answersMethylergonovine 0.2 mg IM Correct
In managing an early postpartum hemorrhage, what threshold volume of blood loss requires immediate maternal resuscitation measures using an interdisciplinary team approach including anesthesia, laboratory, nursing, surgery, and blood bank staff? correct answers1500 mL Correct
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