ABOG Obstetric Complications & Emergency Management 2 — Questions and Answers
Question 1: According to ACOG criteria, which finding is required to diagnose preeclampsia in a patient WITHOUT proteinuria at 34 weeks gestation?
- New-onset thrombocytopenia (platelets <100,000/μL) (Correct answer)
- Bilateral lower extremity edema
- Weight gain >2 lbs/week
- Mild headache with BP 140/90
Correct answer: New-onset thrombocytopenia (platelets <100,000/μL)
Per ACOG 2013 guidelines, preeclampsia can be diagnosed without proteinuria if severe features are present, including thrombocytopenia (<100,000/μL), renal insufficiency, impaired liver function, pulmonary edema, or new-onset headache.
Question 2: A patient at 32 weeks is found to have hemolysis on peripheral smear, AST 320 U/L, and platelets of 78,000/μL. Which condition does this represent?
- HELLP syndrome (Correct answer)
- Acute fatty liver of pregnancy
- Immune thrombocytopenic purpura
- Thrombotic thrombocytopenic purpura
Correct answer: HELLP syndrome
HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets) is a severe variant of preeclampsia with this characteristic triad and requires prompt delivery planning.
Question 3: A patient at 36 weeks presents with painful, constant uterine contractions, vaginal bleeding, and a rigid board-like abdomen. Fetal heart tones show late decelerations. What is the most likely diagnosis?
- Placental abruption (Correct answer)
- Placenta previa
- Uterine rupture
- Vasa previa
Correct answer: Placental abruption
Placental abruption classically presents with painful vaginal bleeding, uterine rigidity/hypertonicity, and fetal distress due to retroplacental hemorrhage separating the placenta from the uterine wall.
Question 4: A patient on magnesium sulfate infusion develops loss of deep tendon reflexes and respiratory rate of 10 breaths/min. What is the correct immediate management?
- Stop magnesium infusion and administer calcium gluconate IV (Correct answer)
- Reduce magnesium infusion rate by 50%
- Administer naloxone IV
- Intubate and continue magnesium at current rate
Correct answer: Stop magnesium infusion and administer calcium gluconate IV
Magnesium toxicity manifests as loss of deep tendon reflexes followed by respiratory depression; treatment is immediate cessation of magnesium and IV calcium gluconate (1 g) as an antidote.
Question 5: Vasa previa is most definitively diagnosed by which modality, and what is the recommended delivery route?
- Transvaginal ultrasound with color Doppler; planned cesarean at 34–36 weeks (Correct answer)
- MRI pelvis; vaginal delivery with continuous fetal monitoring
- Transabdominal ultrasound; induction of labor at 37 weeks
- Amniocentesis with Apt test; cesarean only if fetal distress occurs
Correct answer: Transvaginal ultrasound with color Doppler; planned cesarean at 34–36 weeks
Transvaginal ultrasound with color Doppler identifies fetal vessels traversing the membranes over the cervical os, and planned cesarean at 34–36 weeks avoids catastrophic hemorrhage at membrane rupture.
Question 6: Immediately after delivery, a patient develops sudden uterine inversion with the fundus protruding through the cervix. What is the FIRST step in management?
- Manual replacement of the uterus before placental removal (Correct answer)
- Remove the placenta then manually replace the uterus
- Administer oxytocin to contract the uterus before replacement
- Proceed directly to laparotomy for surgical replacement
Correct answer: Manual replacement of the uterus before placental removal
The uterus should be manually replaced as quickly as possible before the cervical ring contracts; removing the placenta first increases blood loss and cervical constriction, making replacement more difficult.
Question 7: A patient with severe preeclampsia develops DIC with fibrinogen of 80 mg/dL and active bleeding. Which blood product most directly corrects the fibrinogen deficiency?
- Cryoprecipitate (Correct answer)
- Fresh frozen plasma
- Platelets
- Packed red blood cells
Correct answer: Cryoprecipitate
Cryoprecipitate contains concentrated fibrinogen, factor VIII, von Willebrand factor, and factor XIII, making it the most efficient product for correcting hypofibrinogenemia in obstetric DIC.
ABOG Obstetric Complications & Emergency Management 2
According to ACOG criteria, which finding is required to diagnose preeclampsia in a patient WITHOUT proteinuria at 34 weeks gestation?