SMLE Obstetrics and Gynaecology 4

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?

Accepted Answer

Genital tract trauma (laceration)

Answer

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?

Accepted Answer

Perimenopause

Answer

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?

Accepted Answer

Colposcopy and biopsy

Answer

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?

Accepted Answer

Uterine atony

Answer

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?

Accepted Answer

Expectant management with antibiotics and corticosteroids

Answer

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.

SMLE Practice Test

SMLE Practice Test

SMLE Obstetrics and Gynaecology 4