1. Which of the following is TRUE regarding physiologic 5.

A 29 y/o G1P0 PU 8wks with RHD, mitral and tricuspid

cardiovascular changes during pregnancy? regurgitation with history of atrial fibrillation. Which
a. No change in cardiac rate anticoagulant should be given?
b. Leg edema commencing at 1st trimester a. Aspirin
c. Cardiac output increased as much as 50% b. Heparin
d. Increased peripheral vascular resistance c. Warfarin

Physiologic changes in the cardiovascular system: Cardac output is increased by as

much as 50%, occurs by 8wks, and maximized by midpregnancy. (28wks). Unfractionated heparin is given at 6-12wks. Then resumed at 36wks, then
discontinued before delivery.

2. A primigravid on her 34th week of pregnancy consulted because

of easy fatigability. She claims she is experiencing shortness of 6. Maternal pulmonary adaptations to pregnancy is influenced by:
breath on climbing 2 flights of stairs. Which of the following will a. Increased body mass index
prompt cardiovascular workup? b. Wider rib cage
a. Progressive chest tightness c. Elevation of diaphragm
b. Undisturbed sleep d. Displacement of the heart
c. Pulse rate of 85bpm, regular
d. Grade 1 bipedal edema in late afternoon
The diaphragm rises about 4cm during pregnancy. The subcostal angle widens
appreciably as the transverse diameter of the thoracic cage lengthens approximately
SYMPTOMS CLINICAL FINDINGS 2cm. the thoracic circumference increases about 6cm, but not sufficiently to prevent
Progressive dyspnea or Cyanosis residual lung volumes created by the elevated diaphragm. Even so, diaphragmatic
orthopnea Clubbing of fingers excursion is greater in pregnant than in nonpregnant women.
Nocturnal cough Persistent neck vein distention
Hemoptysis Systolic murmur Grade 3/6 or greater
Syncope Diastolic murmur
Chest pain Cardiomegaly 7. A 27 y/o G1P0 PU 36 wks consulted because of 3 days high grade
Persistent arrhythmia fever, productive cough and dyspnea. PE: t 38.7C, RR 26, PR
Persistent split 2nd sound 104, BP 100/60; (+) crackles on both lung fields; FHT: 150.
Criteria for pulmonary hypertension Which of the following is the initial management?
a. CXR
b. ABG
3. A 25 y/o gymnastics coach consulted for first prenatal care at c. MRI
10wks AOG. She gives a history of mitral valve prolapse. On d. CT Scan
history, she denies any symptom of easy fatigability or chest
tightness. What is the NYHA Classification of this patient?
a. I Any pregnant woman suspected of having pneumonia should undergo Chest
b. II Radiography.
c. III
d. IV

CLASS 1 CLASS 2 8. 38 y/o G1P1 (1001) developed postpartum hemorrhage

Uncompromised (no limitation of Slight limitation of physical activity: immediately after placental delivery. She is a known asthmatic.
physical activity) These women are comfortable at What is the management?
These women do not have symptoms of rest, but if ordinary physical activity is a. Oxytocin infusion
cardiac insufficiency or experience undertaken, discomfort results in the b. Methylergometrine
anginal pain. form of excessive fatigue, palpitation, c. TAH
dyspnea or angina pain. d. A&B
CLASS 3 CLASS 4
Marked limitation of physical activity: Severely compromised, inability to
The women are comfortable at rest, but perform any physical activity without For the laboring asthmatic, postpartum hemorrhage is treated with oxytocin or
less than ordinary activity causes discomfort: prostaglandin E2. Prostaglandin F2 α or ergotamine derivatives are
excessive fatigue, palpitation, dyspnea, Symptoms of cardiac insufficiency or contraindicated because they may cause significant bronchospasm.
or anginal pain. angina even at rest, and if any activity
is undertaken, discomfort is
increased.
9. 21 y/o G1P0 PU 7wks came for first prenatal care. On history,
her mother has been recently diagnosed with PTB and is on her
4. A 29 y/o G1P0 39 wks s/p Valvuloplasty with no residual defect 1st wk of treatment. The patient is asymptomatic. What is the
was admitted in active labor at 5cm cervical dilatation. She is BEST advise?
classified as NYHA Class 1. Which of the following is TRUE a. Observe and reassure patient
regarding labor and delivery management? b. Request for a PPD
a. Flat on bed while in labor c. Start patient on INH
b. Intrapartum IV sedation should be given d. Request for a CXR
c. Endocarditis prophylaxis should be given
d. Assisted vaginal delivery A pregnant woman who has a history of exposure to TB should be tested for TB
because if found to be positive with TB, pregnancy likely has adverse effects on the
course of active tuberculosis, if without anti-TB therapy.
Vaginal delivery, preferably Assisted delivery, is preferred unless there is obstetrical
indication for CS.

10. Which of the situation doesn’t warrant the diagnosis of

preeclampsia?
a. BP: 170/100mmHg; with pulmonary edema
b. BP: 160/100mmHg; 24hr urine protein 50mg
 c. BP: 130/90mmHg; platelet count 90,000  Non-reassuring fetal status
d. BP: 140/80mmHg; with persistent headache  Labor or rupture of membranes ≥ 34 wks gestation
Preeclampsia:

 BP ≥ 140/90 13. The following indicate significant proteinuria EXCEPT?

 Proteinuria (300mg/24hr urine sample or (+)1 dipstick a. 300mg protein in a 24 hr urine sample
 In the absence of proteinuria, HPN with any of the ff: (TReLiCeP) b. trace protein on urinalysis
o Thrombocytopenia (Plt count <100,000/ml) c. 0.4mg/dl urine protein: creatinine ratio
o Renal insufficiency (Creatinine >1.1 mg/dl or doubling of the d. ++ on dipstick analysis
creatinine)
o Liver impairment (liver enzymes 2x normal value)
o Cerebral or visual symptoms Proteinuria: 300mg/24hr urine sample OR (+) 1 dipstick
o Pulmonary edema

11. This is not part of the HELLP syndrome. 14. Which of these are mainly responsible for the pathogenesis of
a. Hemoconcentration hypertension during pregnancy?
b. Hemolysis a. Increased blood volume
c. Elevated SGPT b. Sodium retention
d. Thrombocytopenia c. Increased heart rate and cardiac output
H – hemolysis (inc LDH) d. Vasospasm of vessels and endothelial damage

EL – elevated liver enzymes (inc AST or ALT)

Pathogenesis of hypertension during pregnancy:
LP – low platelet count (<100,000)
 Vasospasm
 Endothelial damage

12. For pregnancies with severe preeclampsia less than 34wks, in 15. In which situation is Preeclampsia considered mild?
which situation is immediate delivery indicated? a. BP: 140/90mmHg; liver enzyme elevated
a. Reversed diastolic flow in the umbilical artery b. BP: 150/100mmHg; all labs normal
b. Intrauterine growth restriction c. BP: 140/80mmHg; with IUGR
c. Eclampsia d. BP: 130/90mmHg; HELLP syndrome
d. Severe oligohydramnios
Pregnancies ≥ 34wks of gestation complicated by severe preeclampsia is best
managed by delivery after maternal stabilization Classification of Preeclampsia:

 Eclampsia  Mild – non-severe of less severe

 Pulmonary edema  Severe – preeclampsia + ≥ 1 of a series of complication (TReLiCeP)
 DIC
 Suspected abruption placenta

16. A 20-year old sought consult for her first prenatal care. AOG: 18 weeks. FHT 140s. BP 150/100. 24hour urine protein is 500mg. Classify the
hypertensive disorder.
A. Gestational hypertension
B. Preeclampsia
C. Chronic Hypertension
D. Chronic Hypertension with superimposed preeclampsia

Gestational hypertension Chronic Hypertension Preeclampsia Chronic Hypertension with

superimposed preeclampsia
BP ≥140mmHg BP ≥140mmHg BP ≥140mmHg Women with HPN ONLY IN EARLY
AFTER 20wks AOG BEFORE 20wks AOG or GESTATION who develop
AFTER 20wks AOG and PROTEINURIA AFTER 20wks AOG
persistent AFTER 12wks
postpartum
NO proteinuria WITH PROTEINURIA
BP returns to normal Persistent AFTER 12wks In the ABSENCE OF Women with HPN and PROTEINURIA
BEFORE 12wks postpartum PROTEINURIA, check for any of before 20wks AOG who:
postpartum the ff: (TRELICEP)  Sudden exacerbation of HPN
(see below)  Substantial increase in proteinuria
HPN diagnosed for the 1st HPN diagnosed before TRELICEP:  Thrombocytopenia (platelet
time during pregnancy pregnancy or BEFORE 20wks  Thrombocytopenia (platelet <100,000)
AOG count <100,000)  Renal Insufficiency (Creatinine level
 Renal Insufficiency (Creatinine >1.1mg/dL)
level >1.1mg/dL or doubling of  Liver Impairment (elevation of liver
the creatinine) enzymes, RUQ pain)
 Liver Impairment (liver  Cerebral symptoms (Severe
enzymes 2x normal) headaches)
 Cerebral symptoms or visual  Pulmonary Edema
symptoms
 Pulmonary Edema
17. A primigravid on her 35th week of pregnancy was brought to the ER due to convulsions. BP: 220/110mmHg. FHT: 100bpm. What is the best
management?
A. administer MgSO4, stabilize the patient then proceed with delivery
B. give antihypertensive until the BP is at least 120/80 then observe
C. give MgSO4 antihypertensive and steroids
D. proceed immediately with caesarean section

Convulsions  Eclampsia (seizures that cannot be attributed to other causes in a woman with pre-eclampsia)
Magnesium sulphate – given for 24h to control convulsions
TREATMENT FOR ECLAMPSIA
1. Control of convulsions using an intravenously administered loading dose of magnesium sulfate, followed either by a continuous infusion of magnesium sulfate or by an
intramuscular loading dose and periodic intramuscular injections.
2. Intermittent intravenous or oral administration of an antihypertensive medication to lower blood pressure whenever the diastolic pressure is considered dangerously high.
3. Avoidance of diuretics and limitation of intravenous fluid administration.
4. Delivery (definitive cure for pre-eclampsia)

18. A 28 y/o G2 was admitted due to elevated BP. AOG: 32 weeks. Initial labs revealed LDH and SGPT with decreased platelet count. Give the
most appropriate management.
A. give platelet transfusion until the count becomes normal.
B. give antihypertensives and repeat the lab every 3 days.
C. give MgSO4 then proceed with delivery
D. give MgSO4, antihypertensives then deliver after steroid therapy

Remember severe features of Pre-eclampsia

CRITERIA FOR THE DIAGNOSIS OF SEVERE
PREECLAMPSIA

Any of these findings:

1. BP of 160/110 mmHg
2. Thrombocytopenia (platelets <100,000/ml)
3. Renal insufficiency (creatinine >1.1mg/dl)
4. Liver function impairment/ RUQ pain
5. Cerebral or visual disturbances
6. Pulmonary edema

Management for Severe Pre-eclampsia remote from Term <34weeks

19. Who among the following should be given MgSO4?
A. G4P3 (3003) PU 12 weeks BP 160/110 mmHg
B. G1P0 PU 38 weeks BP 160/110mmHg with severe headache
C. G2P1 PU 32 weeks BP 140/90mmHg dipstick protein ++
D. Nulligravid BP 220/110mmHg with blurring of vision

A) G4P3 (3003) PU 12 weeks BP 160/110 mmHg  Chronic Hypertension

B) G1P0 PU 38 weeks BP 160/110mmHg with severe headache  severe pre-eclampsia
C) G2P1 PU 32 weeks BP 140/90mmHg dipstick protein ++  Non-severe pre-eclampsia
D) Nulligravid BP 220/110mmHg with blurring of vision  Chronic hypertension

20. A pre-eclamptic woman whose BP remained elevated beyond 3 months postpartum should be classified as having
A. preeclampsia with severe features
B. preeclampsia mild
C. chronic hypertension
D. chronic hypertension with superimposed preeclampsia

Gestational hypertension Chronic Hypertension Preeclampsia Chronic Hypertension with

superimposed preeclampsia
BP ≥140mmHg BP ≥140mmHg BP ≥140mmHg Women with HPN ONLY IN
AFTER 20wks AOG BEFORE 20wks AOG or EARLY GESTATION who develop
AFTER 20wks AOG and PROTEINURIA AFTER 20wks
persistent AFTER 12wks AOG
postpartum
NO proteinuria WITH PROTEINURIA
BP returns to normal Persistent AFTER 12wks In the ABSENCE OF Women with HPN and
BEFORE 12wks postpartum PROTEINURIA, check for any of PROTEINURIA before 20wks
postpartum the ff: (TRELICEP) AOG who:
(see below)  Sudden exacerbation of HPN
HPN diagnosed for the 1st HPN diagnosed before TRELICEP:  Substantial increase in
time during pregnancy pregnancy or BEFORE 20wks  Thrombocytopenia (platelet proteinuria
AOG count <100,000)  Thrombocytopenia (platelet
 Renal Insufficiency (Creatinine <100,000)
level >1.1mg/dL or doubling of  Renal Insufficiency (Creatinine
the creatinine) level >1.1mg/dL)
 Liver Impairment (liver  Liver Impairment (elevation of
enzymes 2x normal) liver enzymes, RUQ pain)
 Cerebral symptoms or visual  Cerebral symptoms (Severe
symptoms headaches)
 Pulmonary Edema  Pulmonary Edema

21. G1P0 PU 14 weeks AOG developed fever, headache and body 22. What is the AOG in weeks with the highest risk of fetal
malaise. She developed multiple vesicular lesions all over her body transmission of varicella infection?
the following day. The MOST common cause of mortality of this A. <13
disese is secondary to: B. 13-20
A. renal failure C. 20-26
B. pneumonia D. 26-30
C. infected lesions
D. anemia EXPOSURE RISK BASED ON AGE OF GESTATION
< 13 weeks 0.4%
Diagnosis: Varicella/Chicken pox (basis: fever, headache, body malaise, vesicular 13 – 20 weeks Highest risk
lesions)
Most common cause of mortality: Pneumonia > 20 weeks None

23. G3P2 consulted because of flu-like symptoms and multiple vesicular lesions all over her body with accompanying itchiness. Which of the
following is not a recommended management?
A. Advised bed rest and vitamin C
b. Request for chest Xray
c. Acyclovir
D. vaccination
Diagnosis: Varicella/Chicken pox
VACCINATION
 Non pregnant: 4 to 8 weeks apart
 NOT recommended for pregnant and within a month following each vaccine dose
 Not secreted in breastmilk
Recommended during Contraindicated during Post-partum and Breastfeeding
Pregnancy Pregnancy
Influenza Varicella Non pregnant: give 4-8wks apart; Not secreted in breastmilk
MMR (Measles, Mumps, MMR - Pregnancy is avoided 1 month after vaccination; Measles vaccine - can
Rubella) be given during postpartum breastfeeding
Measles only
HPV Can be given to breastfeeding women

24. A nulligravid had a varicella vaccination and plans to get

pregnant. When is pregnancy advised? Congenital Rubella Syndrome
A. immediately  Cataracts and congenital glaucoma
B. after 1 week  Patent Ductus Arteriosus and peripheral pulmonary artery stenosis
C. after 1 month  SENSORINEURAL DEAFNESS – the MOST COMMON single defect
D. after 1 year  Central nervous system defects (Microcephaly, Mental retardation)
 Pigmentary retinopathy
See #23 Rationale  Purpura
 Hepatosplenomegaly / Jaundice
25. G1P0 PU 12 weeks had fever for 3 days followed by  Radioluscent bone densities
maculopapular rashes and post-auricular lymphadenopathy. The
transmission of this disease is highest at what age of gestation in
weeks?
A. <12 27. A G3P2 (0201) PU 32 weeks consulted because of uterine
B. 13-14 contractions. She mentioned that her previous deliveries were
C. 15-16 preterm and the last baby died due to sepsis. On examination, cervix
D. 18-20 was 1cm open, 50% effaced, intact bag of waters, cephalic. What is
the preferred antibiotic prophylaxis for her?
Diagnosis: Rubella A. penicillin
Clinical S/Sx: B. azithromycin
 Mild, febrile illness with generalized maculopapular rash C. Cefazolin
 Arthralgias D. ceftriaxone
 Arthritis
 Lymphadenopathy Diagnosis: Group B streptococcus
o Suboccipital
o Postauricular Drug of Choice Penicillin
o Cervical Alternative Amoxicillin
 Conjunctivitis Penicilline Allergic Cefazolin
Fetal Effects: Clindamycin
Abortion and severe congenital malformations Vancomycin
1st 12 weeks 80%
13-14 weeks 54% Intrapartum Antimicrobial Prophylaxis
 4 hours or more before delivery
>14 weeks 25%  Erythromycin no longer used for penicillin allergic patients
 Women undergoing CS before labor with intact membranes do not need
GBS prophylaxis regardless of GBS status and Age of Gestation
26. What is the MOST common single congenital defect associated
with rubella infection?
A. sensorineural deafness
B. retinopathy
C. hepatosplenomegaly
D. glaucoma

28. A G3P2 PU 12 weeks consulted because of painless solitary ulcer noted on the labia majora. On examination, the ulcer has smooth base with
red firm border with inguinal lymphadenopathy. What is the diagnosis?
A. herpes genitalis
B. donovanosis
C. syphilis
D. granuloma inguinale

Donovanosis = Granuloma Inguinale

Genital Ulcers (from Gyne)

Syphilis Herpes Donovanosis
Incubation Period 2-4 weeks (1-12weeks) 2-7 days 1-4weeks (up to 6mos)
Primary Lesion Papule Vesicle Papule
Number of Lesions Usually one Multiple, may coalesce Variable
Diameter (mm) 5-15 1-2 Variable
Edges Sharply demarcated Erythematous Elevated, irregular
Elevated, round or oval
 Depth Superficial or Deep Superficial Elevated
Base Smooth Serous Red and rough
Non-purulent Erythematous “BEEFY”
Induration Firm None Firm
Pain Unusual Common Uncommon
Lymphadenopathy Firm Firm Pseudoadenopathy
Non-tender Tender
Bilateral Bilateral

29. A G1P0 PU 38 weeks came in labor. She has fever for 2 days with o Has been recommended to decrease HIV prenatal
multiple painful ulcers at the labia majora. What is the BEST transmission for patients with 1000 copies/mL of HIV RNA
management? load at 38 weeks
A. rupture the bag of waters  IV Zidovudine
B. await spontaneous delivery o As loading dose prior to CS followed by 2 more hours of
C. give Oxytocin to hasten delivery continuous maintenance therapy
D. immediate CS
31. Which of the following is NOT DERIVED from the
Diagnosis: Herpes (Herpes = multiple ulcers vs Syphilis = Solitary) MULLERIAN DUCTS?
See also #28 for basis of diagnosis a. Fallopian Tubes
Highest transmission during peripartum, therefore A, B, and C are not advised. b. Ovary
c. Uterus
NEONATAL TRANSMISSION d. Upper Vagina
Intrauterine 5%
Peripartum 85% Structures/Parts of the Mullerian ducts are:
(During labor and delivery) Fallopian Tube
Postnatal 10% Uterus
Cervix
PERIPARTUM SHEDDING PROPHYLAXIS Upper Vagina
 Acyclovir and Valacyclovir suppression at 36 weeks will decrease the
number HSV outbreak at term 32. A G1P0 PU * weeks AOG was diagnosed to have a Mullerian
 CS is RECOMMENDED for women with ACTIVE GENITAL lesions or Anomaly, Which of the following modalities is done INITIALLY to
prodromal symptoms SCREEN for an associated RENAL ANOMALY?
 CS is NOT recommended for ACTIVE lesions in NON GENITAL area a. Renal Sonography
 No evidence that external lesions causes ascending infection in PPROM b. Intravenous Pyelography
 No absolute duration of membrane rupture beyond which the fetus will c. Magnetic Resonance Imaging
benefit from CS delivery d. Computed Tomography
 Breastfeeding is allowed as long as there is no breast lesions
Di ko mahanap yung RATIO neto, pero nasa samplex sya.

30. Which of the following is recommended for HIV infection during 33. What uterine anomaly ARISES from a COMPLETE LACK OF
pregnancy? FUSION resulting in SEPARATE HEMIUTERI, CERVICES and
A. rupture the bag during the active phase of labor VAGINAS?
B. deliver the baby by forceps extraction a. Bicornuate Uterus
C. vaccinate for pneumonia and tetanus b. Septate Uterus
D. methylergonovine to prevent atony c. Uterine Didelphys
d. Arcuate Uterus – MILD deviation from normally developed
For HIV infection: uterus.
 CS and pneumococcal, HepB, HepA, Tdap and Influenza vaccines are
recommended.
 Avoid Artificial rupture, methergine administration. BICORNUATE/SEPTATE UTERUS UTERINE DIDELPHYS
UTERUS 2 2
MANAGEMENT DURING PREGNANCY
CERVIX 1 2
 Serum creatinine, hemogram, and bacteriuria screening
 Plasma HIV RNA quantification – “viral load”, CD4+ T-lymphocyte count,
and antiretroviral resistance testing 34. In a woman diagnosed to have a BICORNUATE UTERUS,
 Serum hepatic aminotransferase levels which of the following complications is LEAST LIKELY to occur?
 HSV-1 and -2, cytomegalovirus, toxoplasmosis, and hepatitis C serology a. Ectopic Pregnancy
screening b. Miscarriage
 Chest radiograph c. Malpresentation
 Tuberculosis skin testing – Purified protein derivative (PPD) or interferon d. Preterm birth
– gamma release assay
 Pneumococcal, hepatitis B, hepatitis A, Tdap, and Influenza vaccines There is an increased incidence of Pre-term delivery (miscarriage?), Abnormal Fetal
 Sonographic evaluation to establish gestational age. Lie (Malpresentation) and CS delivery.

PRENATAL HIV TRANSMISSION (PREVENTION) 35. A 16 year old consulted because of PRIMARY AMENORRHEA
 Highly active antiretroviral therapy or HAART and cyclic abdominal pain. Which of the following is the MOST
o Reduced perinatal HIV transmission LIKELY diagnosis?
 Avoid artificial rupture of membranes, invasive fetal monitoring a. Longitudinal Vaginal Septum
 Avoid forceps or vacuum extraction b. Imperforate Hymen
 Methergine and other ergot adversely interact with antiretroviral drugs c. Unicornuate Uterus
causing vasoconstriction d. Bicornuate Uterus
o Do NOT administer
 CS
Imperforate Hymen
-is NOT ENCOUNTERED in Pregnancy (assumed that the patient is not 41. A Primigravid came in for consult due to PRURITIC PAPULES.
pregnant cause she is just 16 year, and just came for consult due to the amenorrhea Thee were noted within her STRIAE, face, palm & sole, but
and cyclic abdominal pain). SPARING her PERIUMBILICAL AREA. What is the Diagnosis?
-It’s common presentation is PRIMARY AMENORRHEA and a. Eczema of Pregnancy
HEMATOCOLPOS (accumulation of menstrual blood in the vagina due to intact b. PUPP
hymen) c. Pemphigoid Gestationis
d. Cholestasis of Pregnancy
Longitudinal Vaginal Septum, Unicornuate and Bicornuate Uterus are all UTERINE
MALFORMATION, and is discovered at CS or manual exploration of uterine cavity Pemphigoid Gestationis -starts as PRURITIC PAPULE > Plaque > BULLAE; It has
after delivery. Abdominal lesion involving the Umbilicus.

36. Which of the following is NOT A COMMON associated symptom PUPP looks like Pemphigoid Gestations that has not blistered (so PRURITIC PAPULE).
of a RETROFLEXED INCARCERATED UTERUS? Rash affects the Abdomen, Proximal Thigh, but has UMBILICAL SPARING.
a. Pelvic Pressure
b. Abdominal Pain 42. Elsa, G2P1 on her second trimester of pregnancy developed
c. Vaginal Bleeding Scaly, Dry, Thickened RED PATCHES on her EXTREMITIES and
d. Urinary Retention NECK. On further lab work-ups, the serum IgE were elevated. What
is the diagnosis?
Accoding to the TRANS, Symptom of RETROFLEXED INCARCERATED UTERUS are: a. Prurigo of Pregnancy
Abdominal Discomfort (Abdominal Pain, Pelvic Pressure?) b. Pruritic Folliculitis of Pregnancy
Inability to void normally (Urinary Retention) c. PUPP
d.Eczema of Pregnancy
37. A 5x6 cm BARTHOLIN’S CYST was noted in a Gravida 2 Para
1, Term, in labor. Which of the ff is NOT THE APPROPRIATE
MANAGEMENT? Prurigo of Preg - Pruritic RED PAPULES; Extensor surface and Trunk.
a. Allow Labor to continue Pruritic Folliculitis - small RED PAPULES; Sterile Pustules on Trunk.
b. Cesarean Section PUPP - Erythematous PRURITIC PAPULES/ Plaques on Abdomen and Thigh
c. Vaginal Delivery ECZEMA OF PREG - Dry, RED SCALY PATCHES on Flexor Extremities, Neck and
d. Needle Aspiration of the Cyst Face.

38. Which of the following conditions will NOT ALLOW a An ELEVATED IgE is also seen in ECZEMA of PREG ONLY! It is not seen in the other
spontaneous vaginal delivery? 2 AEP Dermatoses.
a. Extensive Venereal Warts
b. Cystocoele 43. Which of the following MEDICATIONS CAN BE GIVEN to
c. Rectocoele women with ATOPIC ERUPTION of PREGNANCY?
d. Uterine Anteflexion a. Oral Corticosteroids
b. Oral Antihistamine
Extensive Venereal Warts is cause by HPV, which can be transmitted (vertical c. Topical Corticosteroids
transmission) to the child through NSD. Therefore, we deliver a child from a mother d. All of the Above
with venereal warts through CS.
LOW TO MOD
39. Which of the following pregnancy specific dermatoses is Topical Corticosteroids
associated with ABNORMALLY ELEVATED SERUM BILE AND Oral Antihistamine
HEPATIC AMINOTRANSFERASE LEVEL? SEVERE
a. Intrahepatic Cholestasis of Pregnancy Topical Corticosteroid (Ultrapotent and Short Course)
b. Pemphigoid Gestationis Oral Corticosteroid, Cyclosporine, Narrow Band UVB (Occasionally
c. PUPP required)
d.Eczema of Pregnancy

INTRAHEPATIC CHOLESTASIS vs. ECZEMA OF PREGNANCY 44. Pregnancy DOES NOT exert much influence on the course of
Intrahepatic Cholestasis of Pregnancy Breast Cancer
 Both Serum Bile and Hepatic Aminotransferase are ELEVATED. a. True
Eczema of Pregnancy b. False
 Elevated Bile Acid, but up to expected for normal pregnancy
 NORMAL AMINOTRANSFERASE. *Nakalagay mismo sa trans.
Pemphigoid Gestationis
 Elevated IgG against collagen XVII (BP 180) 45. A primigravid on her First Trimester came in for follow-up with
PUPP - Unknown cause a Pap Smear result of CIN I. What is the next best thing to do?
a. Colposcopy
40. What is the GOLD STANDARD procedure in diagnosis b. Conization
PEMPHIGOID GESTATIONIS? c. Curettage
a. KOH Smear d. LEEP
b. Immunofluorescent Skin Tissue Staining
c. Gram Staining Management of women with CIN1/LSIS (low-grade squamous Intraepithelial lesion):
d. Tzank Smear 1. PAP SMEAR
1. COLPOSCOPY
IMMUNOFLUORESCENT SKIN TISSUE STAIN - GOLD STD; Since the pathology of 1. if with POSITIVE HPV TEST
Pemphigoid Gestationis is that maternal IgG works against Collagen XVII (BP180), 2. if with NO HPV TEST
which is found in the Basement Membrane of the Skin, you have to perform 2. REPEAT COTESTING
Immunofluor. Skin test Stain to demonstrate the reaction of IgG and collagen in the 1. If NEGATIVE HPV TEST
skin. *Since Papsmear lang ginawa, and NO HPV TEST… COLPOSCOPY is the best
answer. (SOURCE IS GYNE TRANS on CIN and CERVICAL CA)
KOH - to demonstrate Fungal morphology
Gram Stain - to demonstrate Bacterial Morphology Conization, Curettage and LEEP can be done if the result of COLPOSCOPY is
Tzank Smear - Used to demonstrate Multinucleate Giant Cells of Herpes, Varicella, INADEQUATE.
CMV.
46. A multigravida currently on her 20th week AOG sought consult
due to vaginal bleeding. On examination, the cervix was converted
to a 3x3 fungating mass with smooth and pliable parametria. What
is the next BEST thing to do?
A. Pap Smear
B. Cervical Biopsy
C. Curettage
D. Radical hysterectomy
 Endocervical curettage should NOT be performed during pregnancy to avoid
risk of hemorrhage and membrane rupture
 Colposcopically directed Biopsies are used liberally to assess any
suspicious lesions.
47. A primigravid at 10 weeks AOG came in at the emergency room
because of an on and off abdominal pain. She had an ultrasound done
4 weeks ago with a finding of a left adnexal mass measuring 6x6cm.
On PE, her abdomen was soft but with tenderness on the left lower
quadrant, FHT of 140bpm. What is the MOST likely diagnosis?
A. Ovarian torsion
B. Acute appendicitis
C. Ruptured ectopic pregnancy
D. Fecal stasis
 The two most common complications of any ovarian mass are torsion and
hemorrhage. Torsion usually causes acute constant or episodic lower abdominal pain
that frequently is accompanied by nausea and vomiting. (Williams Obstetrics 24th ed)
48. What is the threshold for significant proteinuria during
pregnancy?
A. 50 mg/day
B. 100 mg/day
C. 200 mg/day
D. 300 mg/day
 Abnormal protein excretion is arbitrarily defined by 24 hour urine
excretion exceeding 300mg; a urine protein;creatinine ration of more than or
equal to 0.3; or persistent 30 mg/dl (1+dipstick) protein in random urine samples
(Williams Obstetrics 24th ed)
49. Which is TRUE of asymptomatic bacteriuria during pregnancy?
A. it has its highest incidence among affluent Caucasian of low parity
B. if not treated, it will develop into an acute symptomatic
infection during pregnancy in 25% of women
C. it has not been associated with adverse pregnancy outcome
D. it is diagnosed by catheterized specimen containing
>100,000 organism per ml in asymptomatic women
 The highest incidence is in African-American multiparas with sickle-cell trait,
and the lowest incidence is in affluent white women of low parity.
 If asymptomatic bacteriuria is not treated, approximately 25 % of infected
women will develop symptomatic infection during pregnancy.
 In some, but not all studies, covert bacteriuria has been associated with preterm
or low-birthweight infants
 A clean-voided specimen containing more than 100,000
organisms/mL is diagnostic
(Williams Obstetrics 24th ed)
50. A 22 year old G1P0 PU 20 weeks ago of gestation sought consult
because of frequency, urgency, pyuria, and dysuria. Urine culture
was negative. The most likely diagnosis is:
A. Eschericia coli cystitis
B. Group B Streptococcus cystitis
C. Chlamydia trachomatis urethritis
D. Neisseria gonorrhea urethritis
Chlamydia trachomatis
- Common pathogen of GUT
- Frequency, urgency, dysuria and pyuria accompanied by urine
culture with no growth
- Mucopurulent cervicitis coexists
- Erythromycin is effective
51. Which of the following is TRUE of hyperemesis gravidarum?
A. It is very common in pregnancy up until the 16th week
of gestation
B. It can cause weight loss, dehydration and hypokalemia
C. It is more likely to trigger hospitalization in obese patients
D. It is more common if carrying a male fetus
 Mild to moderate nausea and vomiting are especially common in
pregnant women until approximately 16 weeks
 Severe unrelenting nausea and vomiting—hyperemesis gravidarum—is defined
variably as being sufficiently severe to produce weight loss, dehydration,
ketosis, alkalosis from loss of hydrochloric acid, and hypokalemia
 obese women are less likely to be hospitalized (Williams Obstetrics 24th ed)
 And for unknown reasons—perhaps estrogen-related—a female fetus
increases the risk by 1.5-fold (Williams Obstetrics 24th ed)
52. Which of the following is the MOST commonly observed finding
of appendicitis in pregnancy?
A. Fever
B. Anorexia
C. Nausea and vomiting
D. Persistent abdominal pain and tenderness
 Anorexia, nausea and vomiting that accompany normal pregnancy are also
common symptoms of appendicitis
 Persistent abdominal pain and tenderness – most reproducible findings
53. G1P0 PU 9 weeks age of gestation was admitted because of
hyperemesis gravidarum. The first line treatment in the
management is?
A. Glucocorticoids
B. Enteral nutrition
C. Antacids
D. IV hydration and antiemetics
 There is little evidence that treatment with glucocorticosteroids is effective.
 Cochrane review reported a salutary effect from several antiemetics given orally
or by rectal suppository as first-line agents (Jewell, 2000). The Food and Drug
Administration (2013) recently approved Diclegis—a combination of
doxylamine-pyridoxine—for morning sickness. When simple measures fail,
intravenous Ringer lactate or normal saline solutions are given to correct
dehydration, ketonemia, electrolyte deficits, and acid-base imbalances. If
vomiting persists after rehydration and failed outpatient management,
hospitalization is recommended. (Williams Obstetrics 24th ed).
 Serotonin antagonists are most effective for controlling chemotherapy-induced
nausea and vomiting (Williams Obstetrics 24th ed).
54. Which of the following is associated with normal pregnancy?
A. Decreased mucus secretion
B. Increased gastric secretion
C. Decreased gastric motility
D. Constriction of lower esophageal sphincter
 Reflux of acidic secretions into lower esophagus
 Lower esophageal sphincter tone is decreased
55. The following are common indications for surgery during
pregnancy EXCEPT:
A. Adnexal mass
B. Cholelithiasis
C. Peptic ulcer
D. Appendicitis
Most common indications for surgery during pregnancy:
 Appendicitis
 Adnexal mass
 Cholecystitis
Mostly performed before 20 weeks
No deleterious effects for either mother or child
Most common non-gynecological procedures performed during pregnancy
 Cholecystectomy
 Appendectomy
56. Which of the following vitamin deficiency is associated with  Patients with well-controlled DM and no complicating factors may await
hyperemesis? spontaneous labor but expectant management beyond the expected date of
A. Vitamin A delivery (40 weeks) is NOT recommended
B. Vitamin B  Elective cesarean section in patients with GDM must be performed at 39 weeks
C. Vitamin C
D. Vitamin K
61. A 28 year old primigravid with GDM delivered a 4kg neonate
At least two serious vitamin deficiencies have been reported with with good outcome. When should a 75g OGTT be performed?
hyperemesis in pregnancy: Wernicke encephalopathy from thiamine deficiency A. Prior to discharge
(Vitamin B1) has been reported with increasing frequency & Vitamin K deficiency has B. 2 – 5 weeks post partum
been reported to cause maternal coagulopathy and fetal intracranial hemorrhage C. 6 – 12 weeks postpartum
D. after 12 weeks postpartum

57. Which labarotory result will give the diagnosis of overt DM  Women diagnosed with GDM or DM ( during pregnancy) should be screened
during pregnancy? for Type 2 DM using 75 gram OGTT at 6-12 weeks postpartum
A. FBS 135 mg/dl with polydipsia
B. HgbA1C 6.0% with polyphagia
C. RBS 190 mg/dl with polyuria 62. To meet the increased need for the thyroid hormones during
D. 50 OGCT 140 mg/dl with polyhydramnios pregnancy, which of the following is TRUE?
A. Increase in both TRH and TSH
B. Increase in uterine clearance of iodide
C. Thyroid gland hyperplasia
D. All of the above

 The renal clearance of iodide increases substantially because of an increased

glomerular filtration rate
 The thyroid gland compensates by enlarging its size and increasing
the plasma uptake of iodine to produce sufficient thyroid hormones
to maintain the euthyroid state.

58. Which of the following maternal effects is LEAST likely to occur

in patients with gestational DM? 63. 24 y/o G1P0 PU 10 weeks consulted because of palpitation. She
A. Preeclampsia denies any orthopnea or dyspnea. Pertinent PE findings: PR –
B. Nephropathy 112/min RR 21; FHT 160’s; with fine tremors of the hands. Which of
C. Ketoacidosis the following should be requested?
D. Infections A. hCG, TSH, T4
B. TRH, T4, T3
Maternal Effects of Overt DM C. TSH, FT4
 Preeclampsia D. TSH, serum iodine
 Diabetic Nephropathy – EXCLUSIVE FOR OVERT DM
 Diabetic Retinopathy – EXCLUSIVE FOR OVERT DM Thyroid Function Tests:
 Diabetic Neuropathy – EXCLUSIVE FOR OVERT DM  TSH
 Ketoacidosis  Free T4
 Infection  Free T3
measuring the bound T3 and T4 during pregnancy may give a falsely elevated results

59. A 35 year old G5 had her 50 gram oral glucose challenge test.
AOG: 18 weeks Result = 140 mg/dl. What is the NEXT step? 64. A 29 y/o primigravid at 8 weeks is diagnosed with
A. Monitor the capillary blood glucose 3x a day hyperthyroidism. Pertinent PE: BP 100/70 PR 89 RR 19cpm; FHT
B. Start her on diabetic diet 160’s. Which of the following is the MOST appropriate treatment at
C. Request for a 100 gram OGTT this time?
D. Repeat the OGCT at 24-28 weeks A. Propylthiouracil
B. Methimazole
 screening for gestational diabetes should be performed between 24 and C. Propanolol
28 weeks age of gestation D. A & C
 a 50-g oral glucose challenge test is followed by a diagnostic 100-g oral
glucose tolerance test if results exceed a predetermined plasma glucose
concentration.
 Plasma glucose level is measured 1 hour after a 50-g glucose load without
regard to the time of day or time of last meal.
 Determine plasma sugar after hour –
o if 130 - 140mg/dl: do 100 grams OGTT after 8- 14
hours fasting

PTU and Methimazole does not have any difference when it comes to efficacy.
60. A 40 year old G3 with overt DM asked you on when is the best PTU – for 1st trimester (patient is at 8 weeks)
date to deliver her baby. Her last 2 pregnancies were delivered via Methimazole – 2nd trimester onwards (Methimazole is teratogenic at 1st trimester)
caesarean section. Current AOG is 36 weeks. The BEST answer is
A. 37 weeks
B. 38 weeks 65. What is a life threatening condition associated with poorly
C. 39 weeks controlled hyperthyroidism that may be precipitated by labor &
D. 40 weeks delivery?
A. Preeclampsia
 Labor is induced at 39 weeks among patients with GDM requiring insulin B. Thyroid storm
C. Hypothyroidism
D. Atrial Fibrillation
 an acute, life-threatening, hyper-metabolic state A. Reticulocyte count
 Patients typically present with a fever as high as 40 0C, marked tachycardia, B. Bone marrow iron
prostration, and severe dehydration C. Serum iron
 precipitating factors are labor, cesarean section, or infection D. Serum Ferritin
 up to 25% mortality rate, despite aggressive, and appropriate, medical
management “When pregnant women with moderate iron deficiency anemia are given adequate
iron therapy, a hematological response is detected by an elevated reticulocyte count.
The rate of increase of hemoglobin concentration or hematocrit is typically slower
66. Which of the following is a fetal/neonatal effect of a maternal than in nonpregnant women due to the increasing and larger blood volumes during
elevated TSH and low T4? pregnancy.” (Williams Obstetrics 24th ed)
A. Goitrous Hyperthyrotoxicosis
B. Neonatal Hypothyroidism
C. Intellectual impairment 72. G2P1 PU 37 weeks previous CS, is for repeat CS at 39 weeks.
D. Motor paralysis However, haemoglobin was 9 gms/dL. What is the BEST treatment
for her?
 Maternal hypothyroidism may impair fetal neuropsychological development. A. Ferrous sulphate
B. Ferrous gluconate
C. Ferrous fumarate
67. What are the MOST common causes of anemia during D. Iron sucrose
pregnancy?
A. Iron deficiency, Acute blood loss If a woman cannot or will not take oral iron preparations, then parenteral therapy is
B. Iron deficiency, Sickle cell disease given. Although both are administered intravenously, ferrous sucrose has been
C. Folate deficiency, Acute blood loss shown to be safer than iron-dextran
D. Folate deficiency, Sickle cell disease

“The two most common causes of anemia during pregnancy and the puerperium are
iron deficiency and acute blood loss.” (Williams Obstetrics 24th ed)
68. What is the total requirement during a normal pregnancy?
A. 100 mg
B. 300 mg
C. 1000 mg
D. 3000 mg
In a typical singleton gestation, the maternal need for iron averages close to 1000
mg.
300 mg - fetus and placenta
500 mg - maternal hemoglobin mass expansion
200 mg - shed normally through the gut, urine, and skin.
(Williams Obstetrics 24th ed)
69. G2P2 diagnosed to havean acute antepartum pyelonephritis and
she developed anemia on work up. What is the cause of anemia?
A. Decreased erythropoietin production
B. Increased red cell destruction due to endotoxemia
C. Dilution secondary to intravenous hydration
D. Decreased iron stores
“ Anemia often accompanies acute pyelonephritis but is due to acute endotoxin-
mediated erythrocyte destruction. With normal erythropoietin production, red
cell mass is restored as pregnancy progresses.” (Williams Obstetrics 24 th ed)
73. Which of the following condition/s is/are associated with
thrombocytopenia during pregnancy?
A. Severe preeclampsia
B. Amniotic fluid embolism
C. Systemic Lupus Erythematosus
D. All of the above
“Thrombocytopenia in obstetrics is seen often with severe preeclampsia syndrome;
massive hemorrhage with transfusions; consumptive coagulopathy from placental
abruption, sepsis syndrome, or amnionic-fluid embolism; hemolytic anemias;
systemic lupus erythematosus and antiphospholipid antibody syndrome; or
hypoplastic or aplastic anemia. Other causes include viral infections, exposure to
various drugs, and allergic reactions.” (Williams Obstetrics 24th ed)
74. What is the MOST appropriate INITIAL treatment for a
pregnant woman with ITP?
A. Systemic corticosteroids
B. Azathioprine
C. Rituximab
D. Laparoscopic splenectomy
 Primary treatment includes IVIG or corticosteroids. Prednisone, 1
mg/kg daily, is given to suppress the phagocytic activity of the splenic
monocyte-macrophage system.
 In pregnant women with no response to corticosteroid or IVIG therapy,
open or laparoscopic splenectomy may be effective.

70. During pregnancy, majority of iron requirement will be 75. In a primigravid, term, cephalic, in labor, diagnosed with ITP,
distributed to the – what is the manner of delivery?
A. Fetus A. Vaginal delivery
B. Placenta B. Caesarean delivery
C. Hemoglobin mass
D. Gastrointestinal tract “Because of the low incidence of severe neonatal thrombocytopenia and morbidity,
fetal platelet
300 mg - fetus and placenta determinations and cesarean delivery are not recommended for women with ITP.”
500 mg - maternal hemoglobin mass expansion (Williams Obstetrics 24th ed)
200 mg - shed normally through the gut, urine, and skin.

71. G3P1 PU 12 weeks diagnosed case of moderate anemia was given

iron supplements. What test should be requested to determine
adequate haematological response?
76. Predisposing factor/s for the development of chorioamnionitis
include:
A. Prolonged rupture of membranes
B. Prolonged labor
C. Frequent internal examinations
D. All of the above
E. A and B only

The route of delivery is the single most significant risk factor for the development of
uterine infection.
Vaginal delivery: membrane rupture, prolonged labor, multiple cervical examination
CS: prolonged labor, membrane rupture, multiple cervical examinations, internal fetal
monitoring

77. Thyrotoxicosis may occur in a H-mole. This is due to the  Incomplete abortion bleeding that follows partial or complete placental
thyrotrophin effect of which hormone? separation and dilatation of the cervical os
A. hCG
B. FSH
C. LH 82. What is the MOST frequent associated condition with abruption
D. hPL placenta?
A. Multifetal pregnancy
The thyrotropin-like effects of hCG frequently cause serum fT4 levels to be elevated B. Smoking
and TSH levels to be decreased. C. Hypertension
D. Hydramnios

78. Prophylactic cerclage is usually done at what age of gestation (in

weeks)?
A. 5 – 7
B. 8 – 10
C. 12 – 16
D. 18 – 22
Elective cerclage is usually done between 12 and 14 weeks’ gestation
Emergent cerclage: there is a debate as to how late this should be performed. This is
usually not performed after 23 weeks.

79. Amor is 28 years old primigravid with a finding of blighted ovum

on ultrasound. On internal exam, the cervix was soft and closed. She
was admitted for dilatation and curettage. You decided to give
medical treatment to dilate the cervix. Which among the following 83. Which of the following is a risk factor for uterine atony?
can be used? A. Oligohydramnios
A. Prostaglandin B. Precipitate delivery
B. Oxytocin C. Primiparity
C. Dinoprostone D. Spontaneous labor and delivery
D. A and B
E. All of the above
84. What is the most common cause of Disseminated Intravascular
Medications used for cervical preparations: Misoprostol, Mifepristone, Prostaglandins Coagulation?
E2 and F2A A. Abruptio Placenta
Midtrimester abortion: Oxytocin, Prostaglandins E2 and E1 B. Intrauterine fetal demise
C. Eclampsia
D. Sepsis
80. Which of the following is LEAST likely to increase the risk of
ectopic pregnancy?
A. Prior to pelvic infection 85. Which is NOT an indication for forceps delivery?
B. Prior ectopic pregnancy A. Umbilical cord prolapse
C. Prior hydatidiform mole B. Placenta previa
D. Current assisted reproductive technology use C. Placental abruption
D. Non-reassuring fetal heart rate

81. Antepartum bleeding from this cause is secondary to rupture of

a spiral artery causing a retroplacental hematoma 86. The latent phase of labor has been completed if the cervix is ____
A. Placenta previa cms or more.
B. Abruptio placenta A. 4
C. Vasa previa B. 6
D. Incomplete abortion C. 8
D. 10
 Placenta previa placenta that is implanted somewhere in the lower uterine
segment
 Abruptio placenta separation of the placenta. The process begins as a decidual 87. What phase of labor will you expect the head to descend
hematoma and expands to cause separation and compression of the adjacent maximally?
placenta. A. Latent
 Vasa previa vessels within the membranes overlie the cervical os. Hence, they B. Acceleration
are vulnerable to compression and also to laceration or avulsion with rapid fetal C. Phase of maximum slope
exsanguination. D. Deceleration
 C. Biochemical test
D. Physical examination
88. Clinical pelvimetry findings showed the following:
ULTRASONOGRAPHY Most accurate way to diagnose multifetal
Sacral promontory not reached at 11.5cms, shallow gestation. Separate gestational sac can be
sacrum, prominent ischial spines, convergent sidewalls, narrow identified early in twin pregnancy
sacrosciatic notch, intertuberous diameter 9 cms. The level of the RADIOGRAPHY Can be used if fetal number in higher order
contraction is at the – multifetal gestation is uncertain. But have limited
A. Inlet utility and may lead to an incorrect diagnosis if
B. Midplane there is hydramnios, obesity, fetal movement
C. Outlet during exposure or inappropriate exposure time
D. All
BIOCHEMICAL TEST There is no biochemical test that reliably identifies
multiple fetuses
89. G5P2 was admitted fully dilated, with “gridiron feel” of the PHYSICAL EXAM Difficult to diagnose by palpation esp. If one twin
presenting part. What is the BEST management? overlies the other, woman is obese, or (+)
A. Wait for spontaneous delivery hydramnios
B. Internal podalic version
C. Manual rotation
D. Caesarean section 96. What is the BEST time to establish the chronicity of twin
gestation by ultrasound?
A. 10-13 weeks
90. This type of breech is diagnosed when one or both feet are flexed: B. 18-20 weeks
A. Complete breech C. 24-28 weeks
B. Incomplete breech D. 28-32 weeks
C. Frank breech
D. Footling breech UTZ can determine chronicity as early as the first trimester (10-13 weeks). If beyond
13 weeks, gestational sac usually fuses making it difficult to determine chronicity.

91. This manuever is done to deliver the aftercoming head

A. Pinard 97. At what AOG is an elective caesarean section performed to
B. Loveset ensure fetal maturity?
C. Mauriceau A. 37 weeks
D. Ritgen B. 38 weeks
C. 39 weeks
PINARD Breech; Delivery of legs (popliteal fossa) D. 40 weeks
LOVESET Breech; Delivery of the arms (landmark: scapula)
MAURICEAU Breech; Delivery of the aftercoming head (malar eminence) Adverse neonatal sequelae from neonatal immaturity with elective delivery before 39
Landmark: nape completed weeks are appreciable. To avoid these, assurance of fetal maturity before
Index and middle finger of one hand are applied over the scheduled electiver srugey is essential.
maxilla, the flex the head. While the fetal body rests on the
palms of the hand and forearm
RITGEN Vaginal delivery; Allows controlled fetal head delivery and 98. Which of the following is an advantage of a midline infraumbilical
favors neck extension so that the head passes through the incision over the pfannenstiel incision?
introitus and over the perineum with its smallest diameters A. Better cosmetic result
B. Less potent operative pain
92. A macrosomic infant weighs how many grams at birth? C. Less incidence of dehiscence
A. 4500 or more D. Shorter incision to delivery time
B. 3000 – 3500
C. 2800 – 3000 MIDLINE INFRAUMBILICAL PFANNENSTIEL INCISION
D. 2500 – 2750 INCISION (VERTICAL) (TRANSVERSE)
Shorter incision to delivery time Better cosmetic result
MACROSOMIA Can be rapidly extended Stronger incision
- Fetuses weighing 4500 grams or more at birth Quickest to make Less likely to cause dehiscence or
- Infants exceeding the 90th percentile hernia
Suboptimal exposure
93. This is considered a MAJOR risk factor for preterm labor. Reentry is more difficult due to scarring
A. Threatened abortion
B. Previous preterm birth 99. What is the single most significant factor for puerperal metritis?
C. Working long hours A. Number of pelvic exams
D. Periodontal disease B. Duration of labor
C. Duration of membrane rupture
A major risk factor for preterm labor is prior preterm delivery. Recurrent D. Route of delivery
preterm delivery risk for women whose first delivery was preterm was increased three-
fold compared with that of women whose first neonate was born at term. ROUTE OF DELIVERY – single most significant risk factor for the development of
postpartum uterine infection
94. During expectant management for PPROM what is an important Other factors:
parameter to monitor?  # of PELVICX EXAMS -  postpartum endometritis
A. Blood pressure  DURATION OF LABOR (prolonged
B. Urine output  RUPTURE OF MEMBRANES
C. Pulse rate o >6 hours  (+) pathogenic bacteria
D. Respiratory rate o 95% develop endometritis

100. Persistent fever after childbirth is most often caused by which

95. What is considered the safest and most accurate way to diagnose of the following?
multifetal gestation? A. Breast engorgement
A. Ultrasound B. Pyelonephritis
B. Radiography C. Atelectasis
 D. Genital tract infections CAUSES OF PPH
EARLY PPH (W/IN 24 HRS) LATE PPH (>24 HRS)
BREAST ENGORGEMENT Atony (most common) Retained placental seccundines or
- 2nd to 3rd day after delivery. Commonly causes brief temp Genital tract lacerations, Uterine accreta
elevationrarely exceeding 39C and no longer than 24 hours Rupture, Dissecting Hematomas Placental polyp
PYELONEPHRITIS Uterine Inversion Infection
- emp elevation with CVA tenderness followed by n/v Coagulation defects Uterine Subinvolution
ATELECTASIS
- within 24 hours in women who delivered via CS
GENITAL TRACT INFECTIONS 104. A woman had her missed period for 2 months. Pregnancy test
- Most persistent fevers after childbirth are caused by genital tract was positive. She had history of vaginal bleeding and passage of
infections (shigh spiking fever within 24 hrs  group A or B strep) meaty material 1 week prior to consult. On PE, she had scanty
brownish discharge, cervix was firm and close, uterus was
unenlarged. What is the diagnosis?
101. Compared to partial H-mole, which of the following statements A. Threatened abortion
is TRUE regarding Complete H-mole? B. Complete abortion – cervix is closed, small uterus
A. Persistent trophoblastic disease is 15-20% C. Incomplete abortion – passage of meaty material
B. Persistent trophoblastic disease is 1-5% D. Missed abortion
C. Medical complications are rare
D. Theca lutein cysts are rare

105. A primigravid with GDM at 40 weeks age of gestation was

admitted in beginning labor. She was started on oxytocin drip to
augment the labor but inspite of good uterine contractions, the
cervix remains at 6cm dilatation at station -1 for 4 hours. What is
the diagnosis?
A. Protracted active phase dilatation
B. Arrest in cervical dilatation
102. Pre-requisites for forceps application EXCEPT: C. Prolonged deceleration phase
A. Head must be engaged D. Failure of descent
B. Cervix must be fully dilated
C. Intact bag of waters Labor Pattern Diagnostic Criteria
D. No suspected CPD
Nulliparas Multiparas
PREREQUISITES FOR FORCEPS APPLICATION Prolongation Disorder
1. head must be engaged
(Prolonged latent phase) > 20 hr > 14 hr
2. fetus must present as a vertex or by the face with the chin anterior
3. position of the fetal head must be precisely known Protraction Disorders
4. cervix must be completely dilated
5. membranes must be ruptured 1. Protracted active-phase dilatation < 1.2 cm/hr < 1.5 cm/hr
6. no suspected cephalic–pelvic disproportion
2. Protracted descent < 1.0 cm/hr < 2 cm/hr
Arrest Disorders
103. What is the most common cause of post-partum hemorrhage?
A. Uterine atony 1. Prolonged deceleration phase > 3 hr > 1 hr
B. Cervical laceration 2. Secondary arrest of > 2 hr > 2 hr
C. Vaginal laceration dilatation
D. Uterine rupture
3. Arrest of descent > 1 hr, > 1 hr
4. Failure of descent with no descent in
deceleration phase or
second stage