DHA Maternal, Newborn & Women's Health — Questions and Answers
Question 1: A primigravida at 38 weeks gestation presents with blood pressure 158/104 mmHg, proteinuria 2+, and headache. Which condition does this most likely represent?
- Gestational hypertension
- Preeclampsia with severe features (Correct answer)
- Chronic hypertension
- HELLP syndrome
Correct answer: Preeclampsia with severe features
BP ≥160/110 mmHg with proteinuria and a severe symptom (headache) meets criteria for preeclampsia with severe features. Gestational hypertension has no proteinuria; chronic hypertension predates 20 weeks; HELLP requires hemolysis, elevated liver enzymes, and low platelets.
Question 2: A newborn's APGAR score is assessed at 1 minute. The baby has a heart rate of 90 bpm, weak cry, some flexion of limbs, grimaces to stimulation, and is blue peripherally but pink centrally. What is the APGAR score?
- 5
- 6 (Correct answer)
- 7
- 4
Correct answer: 6
HR 90 bpm = 1 (below 100), weak cry = 1, some flexion = 1, grimace = 1, blue peripherally/pink centrally (acrocyanosis) = 1. Total = 6. Each of 5 criteria scores 0–2.
Question 3: Which of the following is the FIRST-LINE management for postpartum hemorrhage caused by uterine atony?
- Surgical uterine artery ligation
- Uterine massage and oxytocin administration (Correct answer)
- Bimanual uterine compression and misoprostol
- Emergency hysterectomy
Correct answer: Uterine massage and oxytocin administration
Oxytocin is the first-line uterotonic agent for atonic PPH; uterine fundal massage is initiated simultaneously. Surgical options and misoprostol are escalation steps if oxytocin fails.
Question 4: At which cervical dilation does the active phase of the first stage of labor begin, according to contemporary obstetric guidelines?
- 4 cm
- 6 cm (Correct answer)
- 8 cm
- 3 cm
Correct answer: 6 cm
Current ACOG/WHO guidelines (revised from older 4 cm threshold) define the onset of active labor at 6 cm dilation, with regular contractions and progressive cervical change.
Question 5: A breastfeeding mother asks how to recognize correct infant latch. Which finding indicates a PROPER latch?
- Only the nipple is in the infant's mouth
- The infant's lips are turned inward (inverted)
- Most of the areola is inside the infant's mouth with lips flanged outward (Correct answer)
- The infant makes a clicking sound during feeding
Correct answer: Most of the areola is inside the infant's mouth with lips flanged outward
A correct latch involves the infant taking most of the areola (not just the nipple) into the mouth, with lips flanged outward. Nipple-only latch causes pain and poor milk transfer; clicking indicates a suction break.
Question 6: A neonate born at 34 weeks gestation is assessed for respiratory distress syndrome (RDS). Which finding is MOST consistent with this diagnosis?
- Bilateral rhonchi and productive cough
- Expiratory grunting, nasal flaring, and subcostal retractions (Correct answer)
- Inspiratory stridor and barking cough
- Absent breath sounds on one side with tracheal deviation
Correct answer: Expiratory grunting, nasal flaring, and subcostal retractions
RDS in preterm neonates is caused by surfactant deficiency and presents with expiratory grunting (auto-PEEP), nasal flaring, and subcostal/intercostal retractions shortly after birth. Stridor suggests upper airway obstruction; absent breath sounds with deviation suggest pneumothorax.
DHA Maternal, Newborn & Women's Health
A primigravida at 38 weeks gestation presents with blood pressure 158/104 mmHg, proteinuria 2+, and headache.
Which condition does this most likely represent?