ABOG Obstetric Complications & Emergency Management 1 — Questions and Answers
Question 1: A patient delivers vaginally and has 1,200 mL blood loss within 1 hour of birth with hemodynamic instability. What is the FIRST-LINE uterotonic agent for postpartum hemorrhage?
- Oxytocin IV infusion (Correct answer)
- Methylergonovine IM
- Carboprost IM
- Misoprostol rectal
Correct answer: Oxytocin IV infusion
Oxytocin is the first-line uterotonic for postpartum hemorrhage due to its rapid onset, efficacy, and safety profile compared to other agents.
Question 2: During vaginal delivery, shoulder dystocia is encountered. Which maneuver should be attempted FIRST after calling for help and applying suprapubic pressure?
- McRoberts maneuver (Correct answer)
- Rubin II maneuver
- Woods screw maneuver
- Delivery of posterior arm
Correct answer: McRoberts maneuver
McRoberts maneuver (hyperflexion of maternal thighs) combined with suprapubic pressure is the recommended first step for shoulder dystocia, resolving up to 50% of cases.
Question 3: A G2P1 at 38 weeks presents with a generalized tonic-clonic seizure, BP 160/110, and proteinuria. After securing the airway, what is the immediate pharmacologic priority?
- Magnesium sulfate IV loading dose (Correct answer)
- Diazepam IV bolus
- Labetalol IV push
- Phenytoin IV infusion
Correct answer: Magnesium sulfate IV loading dose
Magnesium sulfate is the drug of choice for eclamptic seizure prophylaxis and treatment, given as a 4–6 g IV loading dose followed by 1–2 g/hr maintenance.
Question 4: A patient with complete placenta previa is admitted at 29 weeks with painless vaginal bleeding that has now stopped. What is the most appropriate management?
- Expectant management with hospitalization and antenatal corticosteroids (Correct answer)
- Immediate cesarean delivery
- Cervical cerclage placement
- Prostaglandin cervical ripening
Correct answer: Expectant management with hospitalization and antenatal corticosteroids
Expectant management with hospitalization, corticosteroids for fetal lung maturity, and close monitoring is appropriate for stable previa remote from term, aiming to prolong gestation.
Question 5: A patient with prior classical cesarean scar presents at 32 weeks with sudden severe abdominal pain, fetal bradycardia, and loss of fetal station on exam. What is the most likely diagnosis?
- Uterine rupture (Correct answer)
- Placental abruption
- Vasa previa rupture
- Cord prolapse
Correct answer: Uterine rupture
Uterine rupture classically presents with sudden abdominal pain, fetal heart rate abnormalities, loss of fetal station, and hemodynamic instability, especially in patients with a prior uterine scar.
Question 6: An umbilical cord is palpated in the vagina at 3 cm dilation. While preparing for emergency cesarean, what is the most important immediate action?
- Manually elevate the presenting part off the cord (Correct answer)
- Place patient in lithotomy position
- Administer tocolytics to stop contractions
- Insert intrauterine pressure catheter
Correct answer: Manually elevate the presenting part off the cord
Manual elevation of the presenting part relieves cord compression and maintains fetal oxygenation while emergency cesarean is prepared for cord prolapse.
Question 7: A patient suddenly develops cardiovascular collapse, hypoxia, and DIC immediately after delivery with no other identifiable cause. Which diagnosis should be immediately suspected?
- Amniotic fluid embolism (Correct answer)
- Massive pulmonary embolism
- Septic shock
- Uterine inversion
Correct answer: Amniotic fluid embolism
Amniotic fluid embolism (anaphylactoid syndrome of pregnancy) presents with sudden cardiorespiratory collapse and DIC peripartum and carries a high mortality rate.
ABOG Obstetric Complications & Emergency Management 1
A patient delivers vaginally and has 1,200 mL blood loss within 1 hour of birth with hemodynamic instability.
What is the FIRST-LINE uterotonic agent for postpartum hemorrhage?