CEN Obstetric and Gynecologic Emergencies 2 — Questions and Answers
Question 1: A pregnant woman at 32 weeks presents with sudden severe abdominal pain, a rigid abdomen, and fetal bradycardia. Vaginal bleeding is minimal. What is the most likely diagnosis?
- Placenta previa
- Placental abruption (Correct answer)
- Uterine rupture
- Preterm labor
Correct answer: Placental abruption
Placental abruption classically presents with sudden severe abdominal pain, uterine rigidity, and fetal distress; the bleeding may be concealed (minimal external bleeding).
Question 2: When should cardiopulmonary resuscitation in a pregnant patient include lateral uterine displacement?
- Only after 30 weeks gestation
- After 20 weeks gestation or when the uterus is palpable at the umbilicus (Correct answer)
- Only during the third trimester
- Not indicated during CPR
Correct answer: After 20 weeks gestation or when the uterus is palpable at the umbilicus
After 20 weeks gestation, the gravid uterus can compress the aorta and inferior vena cava; manual left lateral uterine displacement during CPR improves venous return.
Question 3: A patient presents with sudden severe lower abdominal pain, fever, cervical motion tenderness, and mucopurulent cervical discharge. What is the most likely diagnosis?
- Appendicitis
- Pelvic inflammatory disease (PID) (Correct answer)
- Ovarian torsion
- Ruptured ovarian cyst
Correct answer: Pelvic inflammatory disease (PID)
The classic triad of PID is lower abdominal pain, cervical motion tenderness, and adnexal tenderness, often accompanied by fever and cervical discharge.
Question 4: What is the emergency treatment for ovarian torsion?
- IV antibiotics and observation
- Emergent surgical detorsion (Correct answer)
- Anticoagulation therapy
- Hormonal suppression therapy
Correct answer: Emergent surgical detorsion
Ovarian torsion requires emergent surgical detorsion to restore blood flow and preserve ovarian viability; delay leads to ischemia and ovarian loss.
Question 5: Magnesium toxicity in a preeclamptic patient on magnesium sulfate infusion is first evidenced by loss of which reflex?
- Corneal reflex
- Patellar (knee-jerk) reflex (Correct answer)
- Gag reflex
- Pupillary reflex
Correct answer: Patellar (knee-jerk) reflex
Loss of the patellar reflex (deep tendon reflex) is the earliest clinical sign of magnesium toxicity, occurring at serum levels of 7–10 mEq/L before respiratory depression.
Question 6: What is the antidote for magnesium sulfate toxicity causing respiratory depression in a preeclamptic patient?
- Furosemide 40 mg IV
- Calcium gluconate 1 g IV (Correct answer)
- Naloxone 0.4 mg IV
- Protamine sulfate IV
Correct answer: Calcium gluconate 1 g IV
Calcium gluconate 1 g IV (10 mL of 10% solution) directly antagonizes the neuromuscular effects of magnesium and is the antidote for respiratory depression.
CEN Obstetric and Gynecologic Emergencies 2
A pregnant woman at 32 weeks presents with sudden severe abdominal pain, a rigid abdomen, and fetal bradycardia.
Vaginal bleeding is minimal.
What is the most likely diagnosis?