CMS CMS Obstetric Complications & Emergency Management 2 — Questions and Answers
Question 1: HELLP syndrome is characterized by which laboratory findings?
- Hemolysis, elevated liver enzymes, low platelets (Correct answer)
- Hypoglycemia, elevated lipids, low potassium
- Hypernatremia, elevated lactate, low protein
- Hemoglobinuria, elevated BUN, low calcium
Correct answer: Hemolysis, elevated liver enzymes, low platelets
HELLP syndrome stands for Hemolysis, Elevated Liver enzymes, and Low Platelets, a severe variant of preeclampsia with significant maternal morbidity.
Question 2: Which intervention is first-line for primary postpartum hemorrhage (PPH) from uterine atony?
- Uterine massage and IV oxytocin (Correct answer)
- Emergency hysterectomy
- B-Lynch suture
- Uterine artery embolization
Correct answer: Uterine massage and IV oxytocin
Uterine massage combined with IV oxytocin is the first-line treatment for atonic PPH, promoting uterine contraction and vasoconstriction.
Question 3: A laboring patient at 39 weeks suddenly becomes hypotensive, cyanotic, and develops coagulopathy minutes after AROM. What is the most likely diagnosis?
- Amniotic fluid embolism (AFE) (Correct answer)
- Pulmonary embolism
- Anaphylactic shock
- Severe sepsis
Correct answer: Amniotic fluid embolism (AFE)
AFE presents with sudden cardiovascular collapse, respiratory failure, and DIC following rupture of membranes or delivery, and carries high maternal mortality.
Question 4: Which antihypertensive is the first-line agent for acute severe hypertension in pregnancy in the US?
- Labetalol IV or hydralazine IV (Correct answer)
- Nifedipine oral only
- Methyldopa IV
- Enalapril IV
Correct answer: Labetalol IV or hydralazine IV
IV labetalol and IV hydralazine are both first-line agents for acute severe hypertension in pregnancy; ACE inhibitors like enalapril are contraindicated.
Question 5: The recommended management for a patient with shoulder dystocia that does not resolve with McRoberts maneuver and suprapubic pressure is:
- Rubin II or Woods screw maneuver to rotate the fetal shoulder (Correct answer)
- Fundal pressure
- Forceps delivery
- Immediate cesarean section
Correct answer: Rubin II or Woods screw maneuver to rotate the fetal shoulder
If McRoberts and suprapubic pressure fail, rotational maneuvers (Rubin II, Woods screw, Zavanelli) are performed; fundal pressure worsens impaction.
Question 6: Which fetal heart rate pattern requires immediate delivery or intrauterine resuscitation measures?
- Sinusoidal pattern with absent variability (Correct answer)
- Early decelerations with good variability
- Accelerations with moderate variability
- Mild variable decelerations returning to baseline
Correct answer: Sinusoidal pattern with absent variability
A sinusoidal FHR pattern with absent variability is a Category III (ominous) pattern indicating severe fetal compromise requiring immediate intervention.
CMS CMS Obstetric Complications & Emergency Management 2
HELLP syndrome is characterized by which laboratory findings?