MCCQE Common Obstetrical Complications 2 — Questions and Answers
Question 1: A 32-year-old G2P1 at 36 weeks presents with sudden onset severe epigastric pain, vomiting, and jaundice. Labs show AST 850 U/L, ALT 920 U/L, bilirubin 6.2 mg/dL, platelets 48,000, and PT prolonged. What is the most likely diagnosis?
- HELLP syndrome
- Acute fatty liver of pregnancy (Correct answer)
- Intrahepatic cholestasis of pregnancy
- Viral hepatitis
Correct answer: Acute fatty liver of pregnancy
Acute fatty liver of pregnancy (AFLP) presents with jaundice, coagulopathy, and markedly elevated transaminases in late pregnancy, distinguishable from HELLP by the degree of liver failure.
Question 2: A 28-year-old primigravida at 39 weeks in active labour has fetal bradycardia to 80 bpm lasting 3 minutes after a strong contraction, with slow return to baseline. On exam, the cervix is 7 cm dilated and you palpate the umbilical cord. What is the immediate management?
- Administer oxygen and reposition to left lateral
- Manually elevate the presenting part and proceed to emergency caesarean section (Correct answer)
- Apply fetal scalp electrode for continuous monitoring
- Perform amnioinfusion
Correct answer: Manually elevate the presenting part and proceed to emergency caesarean section
Cord prolapse requires immediate digital elevation of the presenting part to relieve cord compression while preparing for emergency caesarean delivery.
Question 3: A 26-year-old G1P0 at 34 weeks presents with painless, bright red vaginal bleeding. She denies contractions. Ultrasound shows placenta previa. What is the most appropriate next step?
- Immediate caesarean delivery
- Amniotomy to hasten delivery
- Admit for observation, IV access, crossmatch, and corticosteroids (Correct answer)
- Digital cervical exam to assess dilation
Correct answer: Admit for observation, IV access, crossmatch, and corticosteroids
Stable placenta previa at 34 weeks warrants expectant management with hospitalization, corticosteroids for fetal lung maturity, and avoidance of digital exam to prevent further hemorrhage.
Question 4: Which of the following is the most common cause of postpartum hemorrhage?
- Retained placental tissue
- Uterine atony (Correct answer)
- Genital tract lacerations
- Coagulopathy
Correct answer: Uterine atony
Uterine atony accounts for approximately 70-80% of postpartum hemorrhage cases.
Question 5: A 35-year-old G3P2 at 38 weeks with no prenatal care presents with BP 165/110, headache, and 3+ proteinuria. Labs show platelets 95,000, LDH 650, and creatinine 1.3. She seizes on the ward. What medication should be given first?
- Diazepam 10 mg IV
- Phenytoin 15 mg/kg IV
- Magnesium sulfate 4-6 g IV bolus (Correct answer)
- Lorazepam 2 mg IV
Correct answer: Magnesium sulfate 4-6 g IV bolus
Magnesium sulfate is the drug of choice for both treatment and prevention of eclamptic seizures in obstetric patients.
Question 6: A 30-year-old primigravida undergoes IOL at 41 weeks. After 18 hours of oxytocin augmentation, she is 9 cm dilated. Suddenly, she reports sharp constant abdominal pain, fetal heart rate drops to 60 bpm, and her uterine contraction pattern disappears. What is the most likely diagnosis?
- Placental abruption
- Amniotic fluid embolism
- Uterine rupture (Correct answer)
- Cord prolapse
Correct answer: Uterine rupture
Uterine rupture classically presents with sudden cessation of contractions, fetal distress, constant abdominal pain, and can occur with prolonged oxytocin use.
Question 7: A woman delivers a healthy infant but her placenta fails to deliver after 40 minutes of active management. On manual exploration, the placenta cannot be separated from the uterine wall. What is the most likely diagnosis?
- Placenta previa
- Placenta accreta (Correct answer)
- Retained placental cotyledon
- Uterine inversion
Correct answer: Placenta accreta
Placenta accreta is characterized by abnormal adherence of placental villi to the myometrium, preventing normal separation and delivery.
MCCQE Common Obstetrical Complications 2
A 32-year-old G2P1 at 36 weeks presents with sudden onset severe epigastric pain, vomiting, and jaundice.
Labs show AST 850 U/L, ALT 920 U/L, bilirubin 6.2 mg/dL, platelets 48,000, and PT prolonged.
What is the most likely diagnosis?