CEN Obstetric and Gynecologic Emergencies 1 — Questions and Answers
Question 1: A 26-year-old woman presents with acute pelvic pain, vaginal bleeding, and a positive pregnancy test. She has a BP of 80/50 mmHg and signs of peritoneal irritation. What is the most likely diagnosis?
- Threatened abortion
- Ruptured ectopic pregnancy (Correct answer)
- Ovarian cyst rupture
- Placental abruption
Correct answer: Ruptured ectopic pregnancy
Hemodynamic instability with pelvic pain, vaginal bleeding, and positive pregnancy test is ruptured ectopic pregnancy until proven otherwise, requiring emergent surgical intervention.
Question 2: A 36-week pregnant patient presents with severe headache, visual disturbances, BP of 160/110 mmHg, and 3+ proteinuria. What is the diagnosis?
- Gestational hypertension
- Severe preeclampsia (Correct answer)
- Eclampsia
- HELLP syndrome
Correct answer: Severe preeclampsia
BP ≥160/110 mmHg with headache, visual changes, and proteinuria after 20 weeks meets criteria for severe preeclampsia with severe features.
Question 3: What is the drug of choice to prevent and treat seizures in eclampsia?
- Diazepam 10 mg IV
- Lorazepam 2 mg IV
- Magnesium sulfate 4–6 g loading dose IV (Correct answer)
- Phenytoin 20 mg/kg IV
Correct answer: Magnesium sulfate 4–6 g loading dose IV
Magnesium sulfate is the drug of choice for eclampsia prophylaxis and treatment, given as a 4–6 g IV loading dose over 20–30 minutes followed by a maintenance infusion.
Question 4: A patient at 34 weeks gestation presents with painless, bright red vaginal bleeding. What is the most likely cause?
- Placental abruption
- Placenta previa (Correct answer)
- Cervical polyp
- Bloody show of labor
Correct answer: Placenta previa
Painless bright red vaginal bleeding in the third trimester is the classic presentation of placenta previa, where the placenta covers the cervical os.
Question 5: Which assessment is CONTRAINDICATED in a patient with suspected placenta previa?
- Abdominal ultrasound
- External fetal monitoring
- Digital cervical examination (Correct answer)
- IV access and blood type/crossmatch
Correct answer: Digital cervical examination
Digital cervical examination is absolutely contraindicated in placenta previa as it can disrupt the placenta, causing life-threatening hemorrhage.
Question 6: A postpartum patient (1 hour after delivery) develops heavy vaginal bleeding with a boggy, enlarged uterus. What is the priority intervention?
- Immediate hysterectomy
- Uterine massage and oxytocin administration (Correct answer)
- Packing the uterine cavity
- Oral ergotamine
Correct answer: Uterine massage and oxytocin administration
Uterine atony is the most common cause of postpartum hemorrhage; bimanual uterine massage combined with IV oxytocin is the first-line treatment to stimulate uterine contraction.
CEN Obstetric and Gynecologic Emergencies 1
A 26-year-old woman presents with acute pelvic pain, vaginal bleeding, and a positive pregnancy test.
She has a BP of 80/50 mmHg and signs of peritoneal irritation.
What is the most likely diagnosis?