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Common Obstetrical Complications Flashcards

7 cards from real MCCQE practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.

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  1. A 34-year-old G1P0 at 39 weeks is in the second stage of labour for 3 hours. Fetal head is at +2 station, occiput posterior. CTG shows Category II tracing with variable decelerations. What is the most appropriate next step?

    Answer: Proceed to operative vaginal delivery or caesarean

    Arrest of second-stage labour (>3 hours in nulliparas with epidural) with Category II tracing warrants operative delivery — either assisted vaginal delivery if feasible or caesarean.

  2. A 27-year-old G3P2 delivers a 4.2 kg infant vaginally. The anterior shoulder is delivered but the body does not follow despite gentle downward traction. The turtle sign is noted. What manoeuvre should be performed first?

    Answer: McRoberts manoeuvre with suprapubic pressure

    McRoberts manoeuvre (hyperflexion of maternal thighs) combined with suprapubic pressure is the first-line management for shoulder dystocia.

  3. A woman at 36 weeks presents with pruritus affecting palms and soles, worse at night, without rash. Liver enzymes are mildly elevated and bile acids are 48 µmol/L. What is the most serious fetal risk?

    Answer: Intrauterine fetal death

    Intrahepatic cholestasis of pregnancy (ICP) is associated with sudden unexplained stillbirth, particularly when bile acids exceed 40 µmol/L.

  4. A 23-year-old primigravida at 22 weeks presents with painless cervical dilation of 3 cm and bulging membranes. There are no contractions and no signs of infection. What is the most appropriate intervention?

    Answer: Emergency cervical cerclage

    Physical (emergency) cerclage placed for cervical incompetence with dilated cervix and bulging membranes at pre-viable gestational age can prolong pregnancy significantly.

  5. A 40-year-old G1P0 at 41+3 weeks undergoes IOL with cervical ripening. After 12 hours, the CTG shows a baseline of 165 bpm with reduced variability and repetitive late decelerations. The cervix is 4 cm dilated and 80% effaced. What is the most appropriate management?

    Answer: Proceed to emergency caesarean section for non-reassuring fetal status

    Persistent late decelerations with reduced variability constitute a Category III (non-reassuring) CTG pattern requiring expedient delivery, typically by caesarean at this stage of labour.

  6. A 31-year-old woman with Type 1 diabetes at 36 weeks has her glucose poorly controlled (HbA1c 9.2%). Which neonatal complication is most directly related to maternal hyperglycemia during the third trimester?

    Answer: Neonatal hypoglycemia from fetal hyperinsulinism

    Maternal hyperglycemia causes fetal hyperglycemia, which stimulates fetal pancreatic beta cells to produce excess insulin; after birth, this hyperinsulinism causes neonatal hypoglycemia.

  7. A 29-year-old at 34 weeks develops fever (38.8°C), uterine tenderness, maternal tachycardia, and fetal tachycardia (baseline 175 bpm) after PPROM 36 hours ago. What is the correct management?

    Answer: Immediate delivery regardless of gestational age plus broad-spectrum antibiotics

    Clinical chorioamnionitis is an indication for immediate delivery at any gestational age, combined with broad-spectrum intrapartum antibiotics, as expectant management risks maternal sepsis and fetal death.