1.

In cases of post-term pregnancy (42-43 weeks), the non-stress test and biophysical profile should be
performed twice weekly and if there is oligohydramnios or if spontaneous decelerations are noted,
delivery has to be accomplished.
2. All patients with pseudocyesis need psychiatric evaluation.
3. Eclampsia is diagnosed when unexplained convuslions occur in the setting of preeclampsia.
4. In complete abortion, the whole conceptus passed through the cervix. The cervix then closes, and
pain and uterine contractions subside.
5. Fetal hydantoin syndrome presents with a small body size with microcephaly, hypoplasia of the distal
phalanx of the fingers and toes, nail hypoplasia, low nasal bridge, hirsutism, cleft palate and rib
anomalies.
6. If maternal serum Alpha-Feto-Protein levels are found to be abnormal in a pregnant patient, the next
step is ultrasonography.
7. A search should be undertaken to determine the cause after the first episode of intrauterine fetal
demise.
8. Metronidazole is the treatment of choice for Trichomonas vaginitis and should be prescribed to both
the patient and the partner.
9. Abdominal pain in a young female in the middle of her cycle with a benign history and clinical
examination is most likely Mittelschmerz.
10. Advanced stage of premature labor should be managed more aggressively and tocolysis has to be
instituted at once. Magnesium sulfate is the drug of choice for tocolysis.
11. Labor should be allowed to proceed in patients with severe congenital anomaly incompatible with
life.
12. Atrophic vaginitis is treated with estrogen; this latter should be balanced with medroxyprogesterone
if the uterus is still present. If the patient is not willing to use oral hormones, Premarin(estrogen) cream
twice daily may be used.
13. In cases of intrauterine growth retardation, presence of oligohydraminos is an indication for
delivery.
14. Physicians have to maintain their obligation to a patient's right to confidentiality, even in the event
of a pregnant minor wanting to withhold the diagnosis from her parents.
15. Fetal alcohol syndrome presents with IUGR, microcephaly and facial dysmorphology which involves
midfacial hypoplasia, micrognathia, flattened philtrum, microphtalmia, short palpebral fissure, and thin
vermillion border of the upper lip.
16. Lupus anticoagulant, seen in SLE patients, leads to recurrent abortions and thromboembolic disease.
17. Penicillin desensitization is considered to be the treatment of choice for the pregnant patients with
syphilis and having penicillin allergy.

18. DUB is the most common cause of abnormal uterine bleeding, but owing to its benign nature, it is a
diagnosis of exclusion. About 70% of cases are caused by anovulatory cycles. After menarche and before
menopause it is considered physiologic. IV estrogen is the drug of choice for uncontroled bleeding.

18. After the events that are associated with excessive feto-maternal hemorrhage (e.g., placental
abruption), the failure to correct the dose of anti-D immune globulin may result in maternal
alloimmunization.
19. The most appropriate test to confirm the diagnosis of Intra Uterine Fetal Demise (IUFD is real time
ultrasonography.
20. Vulvar papillomatosis, or condylomata acuminata, are genital lesions caused by human papilloma
virus (HPV) serotypes 6 and 11. Condylomas present as exophytic lesions with a raised papillomatous or
spiked surface and may grow into large and cauliflower-like formations.
21. Patients with chorioamnionitis exhibit fever greater than 38C(98.7F), uterine tenderness and
irritability, elevated WBC count and fetal tachycardia. It is frequently associated with preterm or
prolonged rupture of membranes.
22. Labor should be induced immediately in patients with intrauterine fetal demise who develop
coagulations abnormalities.
23. Female offsprings of women who ingested diethylstilbestrol during their pregnancy are at increased
risk of developing clear cell adenocarcinoma of the vagina and cervix, as well as cervical anomalies and
uterine malformations.
24. Retinal hemorrhage is considered to be an extremely ominous sign of preeclampsia.
25. Treatment of luteal phase defect is first attempted with progesterone supplements; clomiphene
citrate or hMG can be tried if progesterone gives no results.
26. Uterine rupture presents with an intense abdominal pain associated with vaginal bleeding with can
range from spotting to massive hemorrhage.
27. Early decelerations are due to fetal head compression.
28. Fetal sleep presents with decreased long-term variability.
29. Fetal cord compression presents with variable decelerations.
30. Uteroplacental insufficiency presents with late decelerations.
31. Intrauterine infection presents with tachycardia, which may be associated with other signs of fetal
distress.
32. The increased incidence of UTI seen in females is due to the shorter length of the urethra. Other
predisposing factors are the use of spermicidal contraceptives, a wet periurethral environment, urethral
termination beneath the labia and the close proximity of the urethra to the anus.
33. Primary dysmenorrhea usually appears 6 to 12-months after menarche. NSAIDs are highly effective
for treatment; oral cntraceptive pills inhibit ovulation and are also effective.
34. BUN, serum creatinine, and hematocrit are often decreased in pregnant patients, and it is due to a
dilutional affect.
35. Preeclampsia is a hypertensive disorder that is defined by the association of hypertension, nondependant edema (in the hands and face), and proteinuria > 300mg/24hr and it occurs almost
exclusively in the young primigravida woman in her third trimester. Severe preeclampsia is defined by
BP greater than 160/110 and the presence of one or more of certain signs which include head-ache,
elevated serum creatinine and many others.
36. Missed abortion involves a dead fetus that is still retained in the uterus. The diagnosis is suspected
when there is disappearance of the nausea and vomiting of early pregnancy, and an arrest of uterine
growth.

37. PCOD is characterized by an unbalanced estrogen secretion that may result in endometrial
hyperplasia. Patients are treated with combined oral contraceptive pills or cyclic progestins.
38. Infertility in premature ovarian failure is treated with egg donation.
39. The most appropriate next step in managing variable deceleration is mask oxygen and change in
maternal position.
40. Triad of renal failure, microangiopathic hemolytic anemia and thrombocytopenia occurs in hemolytic
uremic syndrome.
41. Before 37-weeks of gestation, fetuses in breech presentation need no intervention as they may
convert to vertex automatically.
42. For gross lesions, biopsy is needed and Pap smear is no longer appropriate. Know and understand
the utility and indications of each procedure aiming at screening or diagnosing cervical pre malignancies.
43. OCPs have been shown to decrease the risk of ovarian and endometrial carcinoma. As for breast
cancer, the risk does not seem to change with their use. Beside hypertension, OCPs expose to other
complications such as thromboembolism, cerebrovascular disease, MI, gallblader disease and benign
hepatic tumors.
44. Metformin is indicated in polycystic ovarian syndrome patients with impaired glucose tolerance. It
helps in preventing type 2 diabetes mellitus and correcting obesity, hirsutism, menstrual irregularity,
and infertility.
45. Neuroblastomas have been shown to be associated with exposure to phenytoin and other
hydantoins in utero.
46. Physical exercise can be beneficial during pregnancy and is helpful in maintaining a feeling of well
being. It is usually recommended to keep it at the same level as before pregnancy.
47. Total abdominal hysterectomy is the treatment of choice for uterine rupture. However, debridement
and closure of the site of rupture can be considered in women with low parity or who desire more
children.
48. Management of placenta previa depends on the severity of bleeding and the age of pregnancy.
Know how each factor intervenes in management decision.
49. Combination of thrombocytopenia, microangiopathic hemolytic anemia and increased liver enzymes
in a patient with preeclampsia is defined as HELLP syndrome.
50. The increase in blood pressure that appears before 20-weeks gestation is either chronic
hypertension or hydatiform mole.
51. Oral contraceptive pills are first line agents in the treatment of endometriosis in young women
desiring future fertility.
52. In a pregnant female in her first trimester, who presents with severe and persistent vomiting, one
has to think of hyperemesis gravidarum.
53. Active phase arrest occurs when dilation fails to progress in the active phase of labor over a period
of at least two hours. In the primigravida, cervical dilatation in the active phase progresses at a speed of
1.2 cm/hr. So after 2 hours this patient must be at 7.5 cm. Active phase arrest may be due to abnormal
fetal lie, fetopelvic disproportion, inadequate uterine contractions or cervical anomalies. This patient
has adequate contractions; therefore, IV oxytocin should not be used.
Forceps can not be used unless the cervix is fully dilated.

Therapeutic rest is advised for prolonged latent phase; not in the active phase.
54. Semen analysis is a simple test that helps to identify male factor as the cause of infertility. Semen
analysis should be performed early in the evaluation of the infertile couple, usually as the initial
screening test.
55. Clomiphene citrate acts by binding to hypothalamic estrogen receptors and suppressing the
inhibitory effect estrogen has on GnRH production.
56. Adenomyosis occurs most frequently in women above 40 and typically presents with severe
dysmenorrhea and menorrhagia. The physical exam reveals an enlarged and generally symmetrical
uterus.
57. The most common cause of abnormal serum Alpha-Feto-protein is gestational age error.
58. A decrease in MSAFP and Estriol, and an increase in beta-hCG level is typical of Downs
syndrome.
59. Beta-2 agonists may worsen the edema by decresaed water clearance, tachycardia and increased
myocardial workload.
60. Postcoital or emergency contraception has become necessary because it is estimated that around
60% of pregnancies in the US are unplanned. It can be given upto 72 hours.
61. Diabetes screening is performed between 24 and 28-weeks of gestation. The screening test is the 1hour 50 g oral glucose tolerance test. Confirmation is done by the 3-hour 150 g OGTT.
62. Reassurance and outpatient follow up is the standard of care for threatened abortion.
63. Patients with testicular feminization syndrome present with amenorrhea, developed breasts, absent
pubic and axillary hair, absent internal reproductive organs, and a 46 XY karyotype.
64. Patients with placental abruption in labor have to be managed aggressively to insure a rapid vaginal
delivery. C.section is used only when there are obstetrical indications, or when there is a rapid
deterioration of the state of either the mother or the fetus, and labor is in an early stage.
65. Grave's disease is the most common cause of maternal hyperthyroidism. New onset, significant
arrhythmias (not premature beats) in a pregnant patient could be from hyperthyroidism. TSH should be
ordered as the next step.
66. Candida vaginitis is not considered a sexually transmitted disease and occurs in presence of risk
factors such as diabetes mellitus, oral contraceptive pills, pregnancy and immunosuppressive therapy.
67. Diagnosis of luteal phase defect is confirmed by endometrial biopsy.
68. In false labor, progressive cervical changes are absent and all such patients need reassurance.
69. In cases of mild preeclamsia, if the pregnancy is remote from term and/or fetal lungs are not mature
yet, the patient is managed with bed rest, salt-reduced diet, and close observation.
70. Estrogen replacement therapy increases the requirement for L-thyroxine in patients receiving
estrogen replacement therapy. The potential causes may include induction of liver enzymes, increased
level of TBG, and an increased volume of the distribution of thyroid hormones. In pregnancy, also,
thyroid hormone requirements will be increased, and the patient should be monitored every 4-6 weeks
for dose adjustments.
71. Preeclampsia is defined as hypertension occurring in the second trimester of pregnancy and
associated with proteinuria. Risk factors include first conception, diabetes, renal failure, and extremes of
age. The hypertension regresses after delivery.

72. Arrest disorder resulting from midpelvic contraction is treated with C. section.
73. Total biophysical profile score of 8-10 is considered normal, and should only be repeated once or
twice weekly until term for high risk pregnancies.
74. The most common cause of mucopurulent cervicitis is Chlamydia trachomatis.
75. Edema of the lower extremities in pregnancy is most commonly a benign problem. Pre-eclampsia
should be suspected if the edema is associated with hypertension or proteinuria, or if it is located on the
hands and/or face. Know when to order Duplex.
76. The chancre characterizes the primary stage of syphilis: it is a painless, indurated ulceration with a
punched-out base and rolled edges. Serologic testing is not reliable at this stage and includes a high rate
of false-negatives, so diagnosis in the first stage is made via spirochete identification on dark field
microscopy.
77. Patients with endometriosis present with dysmenorrhea, dyspareunia and dyschezia and the
physical exam reveals tender adnexal mass and firm nodularity located in the broad ligaments, the
uterosacral ligament or in the cul-de-sac.
78. In the ovulatory phase, cervical mucus is profuse, clear and thin in opposition to the mucus of the
post and pre-ovulatory phases, which is scant, opaque and thick. Evaluation of the cervical mucus is part
of infertility workup. Normally, cervical mucus extends to at least 6 cm when lifted vertically, and its pH
is 6.5 or more.
79. Ovarian solid tumors discovered accidentally in a multiparous African-American woman: Think of
pregnancy leuteoma.
80. In all patients of childbearing age presenting with amenorrhoea, it is of utmost importance to first
rule out pregnancy, by measuring serum beta-hCG levels, before any other step, and this regardless of
the presence or not of any symptoms or signs. If beta-hCG result is negative, the problem is most likely
due to oral contraceptives and can be treated accordingly.
81. Hypertrophic dystrophy of vulva is most commonly seen in postmenopausal women and is treated
with local application of 1% corticosteroid ointment three times a day for 6 weeks. Hyperplastic
dystrophy cannot be distinguished clinically from cancer of the vulva and biopsy is therefore required
every time the diagnosis is suspected.
82. Presence of dysmenorrhea, heavy menses, and enlarge uterus is almost diagnostic of either
adenomyosis or fibroid uterus.
83. Amniotic fluid embolism may occur after amniocentesis or during labor. It is characterized by
bronchospasm, cardiovascular collapse and disseminated intravascular coagulation. Respiratory support
is the fist step of management. Know when to intubate a patient.
84. Grave's disease and migraine headaches improve in pregnancy.
85. Steroids are used to enhance fetal lung maturity when premature rupture of membrabes occur less
than 34-weeks of gestation.
86. Septic abortion is managed with cervical and blood sampling, IV antibiotics and gentle suction
curettage.
87. Chorionic villus sampling is the best test for detection of fetal chromosomal abnormalities in the first
trimester of pregnancy.
88. The major source of estrogen in menopausal women is from the peripheral conversion of adrenal
androgens by fat tissue.

89. High risk populations for tuberculosis are immigrants, women of low socioeconomic status, and HIVpositive women. PPD is positive when it exceeds 10 mm in high-risk populations, and 5 mm in HIV
patients.
If PPD is positive, order a chest X ray; the patient is not necessarily infected.
90. MRKH is the result of a mullerian agenesis. Patients have normal secondary sexual characteristics,
amenorrhea, absent or rudimentary uterus, and a 46, XX karyotype.
91. Idiopathic precocious puberty is managed with GnRH agonist therapy in order to prevent premature
fusion of the epiphyseal plates.
92. Abdominal circumference is the most effective parameter for estimation of fetal weight in cases of
suspected IUGR.
93. Screening cultures for group B streptococcus should be performed at 36-37 weeks gestation, and
positive cases should be treated with penicillin G during labor, even in the absence of frank
chorioamnionitis, thus reducing the risk of neonatal infections.
94. In pregnant lady with Toxoplasmosis (recognize contact with cats), Spiramycin is drug of choice in
first trimester, however combination of pyrimethamine and sulfadiazine is preferred in second and third
trimester. Elective termination of pregnancy is an option in first trimester of pregnancy.
95. Once the diagnosis of missed abortion is confirmed, surgical evacuation (dilation and curettage) of
the uterus has to be performed to avoid the patient serious complications, such as DIC and sepsis and to
minimize the extent of the hemorrhage.
96. Lymphogranuloma venereum is a sexually transmitted disease caused by Chlamydia trachomatis
serotypes L1, L2 and L3 and manifests with generalized malaise, headaches and fever followed by a
papule, which subsequently transforms into a painless ulcer and reactive inguinal adenitis. Classic
'groove' sign is usually seen in men and in the second stage of disease.
97. In incomplete abortion, the cervix is dilated; there is an incomplete evacuation of the conceptus with
fragments retained in the uterine cavity.
98. Reactive non-stress test is reassuring and it should be repeated weekly.
99. Voiding after intercourse has been shown to decrease the risk of UTI in sexually-active females.
100. The risk factors for osteoporoses include: Thin body habitus, smoking, alcohol intake, steroid use,
menopause, malnutrition, family history of osteoporosis, and Asian or Caucasian race.
101. Low back pain is a very common complaint in the third trimester of pregnancy. It is believed to be
caused by the increase in lumbar lordosis and the relaxation of the ligaments supporting the joints of
the pelvic girdle.
102. Hypertension in a pregnant female in the setting of massive proteinuria, malar rash, and the
positive ANA titer is most likely due to systemic lupus erythematosus which frequently causes
glomerulonephritis.
103. In primary stage of syphilis, serologic testing is not reliable and includes a high rate of falsenegatives, so diagnosis is made via spirochete identification on dark field microscopy.
104. C.section is used in the management of placental abruption when there are obstetrical indications,
or when there is a rapid deterioration of the state of either the mother or the fetus, and labor is in an
early stage.
105. Pap smear should be performed annually in all women once they become sexually active. After 3
normal results 1 year apart, perform the screening every 2 to 5 years.

106. GnRH stimulation test serves to differentiate between true isosexual and pseudoisosexual
precocious puberty.
107. In the presence of vaginal hemorrhage, abdominal pain and/or amenorrhea in a woman of
childbearing age, suspect ectopic pregnancy. In all secondary amenorrheas, pregnancy should be the
first diagnosis to suspect.
108. Anesthesia may reduce uterine activity if administered in the latent phase.
109. Pregnancy has a protective effect against peptic ulcer disease and multiple sclerosis.
110. Patients with polycystic ovarian disease are at risk of developing type II diabetes.
111. In a postmenopausal female who has vulvar itch and dryness, lichen sclerosis must be suspected.
However, vulvar carcinoma in situ must also be in the differential and a biopsy obtained if suspicion is
high.
112. Lichen sclerosis is usually seen in postmenopausal women but may develop at any age. It present
with pruritus, burning and dyspareunia and is treated with 'superpotent topical corticosteroids' such as
clobetasol or halobetasol.
*Itchy spot in a postmenopausal women needs biopsy.
113. The treatment of choice for Bacterial Vaginosis in a pregnant lady is clindamycin cream or
metronidazole cream.
114. Cervical dysplasia in a high risk patient should be investigated with colposcopy.
115. Delivery is the definitive treatment of HELLP syndrome in women beyond 34-weeks gestation.
116. Transvaginal ultrasonogram is more accurate than transabdominal ultrasonogram in diagnosing
ectopic pregnancy, and should be performed when beta-hCG levels are below 1500 to 2000 mIU/mL.
117. An antepartum hemorrhage with fetal heart changes, progressing from tachycardia, to bradycardia,
to a sinusoidal pattern occurring suddenly after rupture of membranes suggest the diagnosis of vasa
previa.
118. Radiation levels used for diagnostic exams are not assocaited with teratogenicity.
119. Turner syndrome is characterized by primary ovarian failure, amenorrhea, multiple congenital
anomalies, short stature and bilateral streaked ovaries. FSH elevation, greater than LH elevation, is
classic for primary ovarian failure in Turner syndrome.
120. Excessive use of oxytocin may cause water retention, hyponatremia and seizures (water
intoxication).
121. Asymptomatic bacteriuria increases the risk of cystitis and pyelonephritis in pregnancy more than
in the non-pregnant state. Escherichia coli accounts for more than 70% of cases. Treatment in pregnancy
consists of a 7 to 10-day course of nitrofurantoin, ampicillin or first generation cephalosporin.
122. Clotrimazole cream is an effective treatment for Candidal vaginitis, and partners need not be
treated.
123. Local heat, bed rest and NSAIDs are the mainstay of treatment of superficial thrombophlebitis.
Anticoagulants are indicated only when clot extends into the deep vein system.
124. In severe preeclampsia, the patient has to be evaluated and stabilized before management decision
is taken. Bed rest and salt reduced diet are mandatory; patients with blood pressure greater than
160/110 mmHg necessitate antihypertensive therapy. If the response to treatment is prompt and the
patient is stabilized, the decision will then depend on the term: If the patient is at term or fetal lungs are
mature, delivery has to be done. In the opposite case, delivery can be delayed until 34 weeks gestation

or until fetal lungs become mature.

125. Neonates of patients with Grave's disease treated with surgery are at risk for thyrotoxicosis
because of the passage of thyroid stimulating immunoglobulin across the placenta.
126. Primary ovarian failure results in decreased estrogen and increased FSH and LH as a result of loss of
feedback inhibition of estrogen and inhibin on these hormones. FSH elevation, more than LH elevation,
is diagnostic of primary ovarian failure.
127. Depressed deep tendon reflexes is the earliest sign of magnesium sulfate toxicity which requires
stopping of the magnesium sulfate infusion and administeration of calcium gluconate.
128. Asymmetrical IUGR is a result of a late exposition to the insult past 28-weeks and is characterized
by a normal or almost normal head size and a reduced abdominal circumference. It is usually caused by
maternal factors such as hypertension, preeclampsia and chronic renal disease.
129. Granuloma inguinale is a sexually transmitted disease caused by the bacterium Donovania
granulomatis and characterized by an initial papule, which rapidly evolves into a painless ulcer with
irregular borders and a beefy-red granular base.
130. RhoGAM is indicated in previously unsensitized Rh-negative women at 28 weeks gestation, and
within 72 hours after any procedure or incident (e.g. abortion, ectopic pregnancy), and delivery.
131. The most effective agent used for the treatment or prevention of seizures in eclampsia is
magnesium sulfate.
132. Raloxifene is a mixed agonist/antagonist of estrogen receptors. In breast tissue and vaginal tissue, it
is an antagonist, whereas in bone tissue, it is an agonist and may be used to treat osteoporosis. It
increases the risk of thrombo-embolism.
133. In inevitable abortion, cervix is dilated without passage of the conceptus. It manifests with vaginal
bleeding, lower abdominal cramps that may radiate to the back and perineum.
134. n a patient with primary amenorrhoea and no breasts, estrogen is low and FSH measurement
should be ordered: if it is decreased, GnRH stimulation test is the next step; if it is increased, karyotype
is the next step.
135. Transvaginal ultrasonogram is more accurate than transabdominal ultrasonogram in diagnosing
ectopic pregnancy, and should be performed when beta-hCG levels are below 1500 to 2000 mIU/mL.
136. The incidence of vertical transmission of HIV can be reduced from 25% to 8% by administrating ZDV
to pregnant women and their offspring. ZDV is administered orally during pregnancy after the first
trimester, intravenously during labor and delivery, and orally to the neonate for the first 6 weeks of life.
137. In the presence antepartum hemorrhage, pelvic examination must not be done before ruling out
placenta previa. Placenta previa presents with painless third trimester vaginal bleeding.
138. Human chorionic gonadotropin is a hormone secreted by the syncytiotrophoblast and is
responsible for maintenance of progesterone secretion by preservation of the corpus luteum until the
placenta starts producing progesterone on its own.
139. Fetal distress (repetitive late decelerations) is an indication for emergent C.section.
140. Tamoxifen decreases the overall mortality in patients with breast cancer by preventing recurrences,
and cancer development in the opposite breast.
141. An antepartum hemorrhage with fetal heart changes, progressing from tachycardia, to bradycardia,
to a sinusoidal pattern occurring suddenly after rupture of membranes suggest the diagnosis of vasa
previa.

142. In the ovulatory phase of the menstrual cycle, cervical mucus is profuse, clear and thin.
143. A child's blood group frequently differs from the mothers blood group, but this fact does not
create a potential for alloimmunization-related fetal damage. Antibodies to ABO antigens belong to the
IgM class and do not cross the placenta.
144. C.section is used in the management of placental abruption when there are obstetrical indications,
or when there is a rapid deterioration of the state of either the mother or the fetus, and labor is in an
early stage.
145. Painful third trimester vaginal bleeding with normal ultrasound is most likely due to placental
abruption.
146. Uterine rupture presents with an intense abdominal pain associated with vaginal bleeding with can
range from spotting to massive hemorrhage.
147. Reassurance and outpatient follow up is the standard of care for threatened abortion.
148. The peritoneal factor is the most common cause of female infertility.
149. Midplevis contraction which is indicated by prominent ischial spines is an important cause of arrest
disorder of dilation.
150. The major cause of death in eclampsia is hemorrhagic stroke.
151. Suction curettage is the treatment of choice for inevitable abortion.
152. Labetalol is a perfect substitute of enalapril in pregnant women with diabetic nephropathy.
153. Most of the breech presentations assume cephalic presentation by 34-weeks gestation.
154. Threatened abortion is characterized by any hemorrhage occurring before the 20th week gestation,
with live fetus and closed cervix.
155. The initial tests to assess the ovulatory function are BBT and midluteal progesterone level.
156. Once the diagnosis of missed abortion is confirmed, surgical evacuation (dilation and curettage) of
the uterus has to be performed to avoid the patient serious complications, such as DIC and sepsis and to
minimize the extent of the hemorrhage.
157. Laparoscopy is the gold standard for the diagnosis of endometriosis.
158. Treatment for overflow incontinence include cholinergic agents and intermittent selfcatheterization.
159. Bed rest and hydration are the first step in stopping uterine contractions in early stages of preterm
labor and if these measures fail, tocolytics are indicated.
160. Patients with severe placental abruption in labor have to be managed aggressively to insure a rapid
vaginal delivery.
161. Pregnancy is associated with an increase in total T4 (normal free T4), an increase in TBG, and a
normal TSH.
162. Cervical dysplasia in a high risk patient should be investigated with colposcopy.
163. In cases of mild preeclamsia, if the pregnancy is remote from term and/or fetal lungs are not
mature yet, the patient is managed with bed rest, salt-reduced diet, and close observation.
164. Tubo-ovarian abcesses are usually managed with triple antibiotic therapy. Drainage is indicated if
there is no response to antibiotic therapy after 24 to 48-hours.
165. Biophysical profile score of less than 2 is alarming and baby should be delivered immediately.
166. Maintenance of airway, breathing and circulation is always the first priority. Hemodynamic

resuscitation has to be promptly initiated before starting any measure to diagnose the source of blood
loss in patients with antepartum hemorrhage who are unstable hemodynamically.
167. When to perform endometrial biopsy to rule out endometrial carcinoma in patients with DUB? If
the patient is older than 35 years, obese, diabetic or with chronic hypertension.
168. Vasa previa or fetal vessel rupture necessitates immediate C. section.
169. In the presence of decreased fetal movements, fetal compromise should be suspected, and the
best next step in management in such case is the performance of a non-stress test (NST).
170. Hypotension is a common side effect of epidural anesthesia. The cause of hypotension is blood
redistribution to the lower extremities and venous pooling.
171. Oral hypoglycemic agents and ACE inhibitors are contraindicated in pregnancy. Insulin is used for
diabetes mellius in pregnancy and hydralazine, methyldopa and labetalol are used for hypertension in
pregnancy.
172. Endometritis is the most common cause of puerperal fever on the 2nd and 3rd day postpartum.
Predisposing risk factors include prolonged labor, prolonged and premature rupture of membranes,
manual removal of the placenta and repeated pelvic examinations. It is also more frequent after
cesarean delivery or operative vaginal delivery. Clinically it presents with fever, uterine tenderness and
foul smelling lochia. Endometritis is a polymicrobial infection; it is due in 70% of cases to anaerobic
organisms such as Peptostreptococcus, Peptococcus and streptococcus, often mixed with Bacteroides
fragilis. Of aerobic pathogens, E. coli is the most common, followed by enterococci. When endometritis
is diagnosed, cultures for aerobic and anaerobic organisms should be obtained. Antibiotic therapy
should be instituted as early as possible and should provide coverage of both aerobic and anaerobic
organisms; the most appropriate antibiotic combination is clindamycin with either aminoglycoside or
ampicillin.