SMLE Obstetrics and Gynaecology 4 — Questions and Answers
Question 1: A 28-year-old woman in the third stage of labour has persistent vaginal bleeding despite placental delivery. The uterus is well contracted. What is the most likely cause of the bleeding?
- Uterine atony
- Genital tract trauma (laceration) (Correct answer)
- Retained placental fragments
- Coagulopathy
Correct answer: Genital tract trauma (laceration)
When the uterus is well contracted and the placenta has been delivered completely, persistent bleeding is most likely from genital tract trauma (cervical, vaginal, or perineal lacerations). Systematic examination of the birth canal is required.
Question 2: A 45-year-old woman presents with irregular heavy periods, hot flushes, and night sweats. FSH is elevated and oestradiol is low. What stage of reproductive life is she in?
- Premature ovarian insufficiency
- Perimenopause (Correct answer)
- Menopause
- Hypothalamic amenorrhoea
Correct answer: Perimenopause
Perimenopause (menopausal transition) is characterised by irregular menstrual cycles, vasomotor symptoms (hot flushes, night sweats), and hormonal changes (rising FSH, declining oestradiol). Menopause is diagnosed retrospectively after 12 months of amenorrhoea.
Question 3: A 30-year-old woman undergoes a Pap smear that shows high-grade squamous intraepithelial lesion (HSIL). What is the recommended next step?
- Repeat Pap smear in 6 months
- Colposcopy and biopsy (Correct answer)
- Immediate hysterectomy
- HPV testing alone
Correct answer: Colposcopy and biopsy
HSIL on Pap smear requires colposcopy with directed biopsy for histological confirmation. This allows visualisation of the transformation zone, identification of abnormal areas, and tissue sampling to determine the grade of cervical intraepithelial neoplasia (CIN).
Question 4: What is the most common cause of postpartum haemorrhage?
- Genital tract trauma
- Retained placenta
- Uterine atony (Correct answer)
- Coagulation disorders
Correct answer: Uterine atony
Uterine atony (failure of the uterus to contract adequately after delivery) accounts for approximately 70-80% of all cases of postpartum haemorrhage. Risk factors include overdistended uterus, prolonged labour, grand multiparity, and uterine relaxants.
Question 5: A pregnant woman at 32 weeks gestation is diagnosed with preterm premature rupture of membranes (PPROM). There are no signs of infection or fetal distress. What is the management?
- Immediate delivery by caesarean section
- Expectant management with antibiotics and corticosteroids (Correct answer)
- Induction of labour
- Tocolytics indefinitely
Correct answer: Expectant management with antibiotics and corticosteroids
PPROM at 32 weeks without signs of infection, fetal distress, or placental abruption is managed expectantly. Antibiotics (to prolong latency and reduce infection) and corticosteroids (for fetal lung maturity) are administered while monitoring for complications.
Question 6: A 55-year-old woman presents with a pelvic mass, ascites, and elevated CA-125. CT shows an ovarian mass with peritoneal deposits. What is the most likely diagnosis?
- Ovarian fibroma with Meigs syndrome
- Epithelial ovarian carcinoma (Correct answer)
- Endometriosis
- Benign ovarian cyst
Correct answer: Epithelial ovarian carcinoma
Epithelial ovarian carcinoma is the most lethal gynaecological malignancy. It typically presents late with a pelvic mass, ascites, and elevated CA-125. Peritoneal carcinomatosis indicates advanced stage (FIGO III-IV). Surgical debulking and chemotherapy are the mainstay of treatment.
SMLE Obstetrics and Gynaecology 4
A 28-year-old woman in the third stage of labour has persistent vaginal bleeding despite placental delivery.
The uterus is well contracted.
What is the most likely cause of the bleeding?