Obstetric and Gynecologic Emergencies

Review Test


1. For which of the following is outpatient monitoring of -hCG levels an
appropriate treatment?

(A) Inevitable abortion
(B) Threatened abortion
(C) Missed abortion
(D) Incomplete abortion
(E) Septic abortion

Directions: The response option for Items 2-4 are the same. Each item will state
the number of options to choose. Choose exactly this number.

Questions 2-4

(A) Previous occurrence
(B) Diabetes mellitus
(C) Presence of intrauterine device (IUD)
(D) Nulliparity
(E) Previous tubal surgery
(F) Multiple gestation
(G) Multiple partners
(H) History or sexual transmitted disease (STD)
(I) Hydatidiform mole

2. Ectopic pregnancy (select 4 risk factors)

3. Preeclampsia (select 5 risk factors)

4. Pelvic inflammatory disease (select 4 risk factors)

Directions: The response options for Items 5-9 are the same. You will be required
to select one answer for each item in the set

Questions 5-9

Match each cause of maternal bleeding to the appropriate statement.

(A) Abruptio placenta
(B) Placenta previa
(C) Vasa previa
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(D) Uterine rupture
(E) Uterine atony

5. This factor is the cause of early postpartum hemorrhage.
6. In this condition, bleeding may be internal or external.

7. This cause of maternal bleeding carries the risk of fetal exsanguination as
well.

8. Previous cesarean section with the classic vertical incision is a risk factor for
this type of maternal bleeding.

9. Bleeding is painless and is secondary to abnormal implantation when this is
the cause of maternal bleeding.




Answers and Explanations


1-B. A threatened abortion is characterized by painless vaginal bleeding in a pregnant
woman in the first and, sometimes, second trimesters. It is the only one of the
conditions listed that has a chance of resulting in a live birth, so it is the only one for
which monitoring of -hCG levels would be necessary. Except for the bleeding,
physical examination generally is normal. Inevitable and incomplete abortions require
emergent dilatation dilatation and curettage (D&C). Missed and septic abortions are
treated with a scheduled (vs. emergent) D & C.

2-A, C, E, H. Risk factors for ectopic pregnancy include previous ectopic pregnancy,
presence of an intrauterine device (IUD), previous tubal surgery, and a history of
sexually transmitted disease (STD).

3-A, B, D, F, I. Risk factors for preeclampsia include preeclampsia in a previous
pregnancy, diabetes mellitus, nulliparity, multiple gestation, and hydatidiform mole.

4-A, C, G, H. Risk factors for pelvic inflammatory disease (PID) include previous
PID, presence of an intrauterine device (IUD), multiple sexual partners, and a history
of sexually transmitted disease.

5-E. Causes of early (<48 hours after delivery) postpartum hemorrhage are uterine
atony and intrapartum trauma. Causes of late (>48 hours after delivery) postpartum
hemorrhage are endometritis and retained products of conception.

6-A. In abruption placenta, the bleeding can be external (via vagina) or internal,
where it is concealed in the uterus. Unlike the bleeding of placenta previa, this
bleeding is associated with severe pain.
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7-C. Vasa previa results from fetal vessels taking their origin in placental vessels, so
that when the mothers membranes rupture and she bleeds, the fetus bleeds as well.
This is why emergency cesarean section is required.
8-D. Uterine rupture is a full-thickness tear of the uterine muscle (myometrium) and
occurs more frequently in women who have had a previous cesarean section
performed with a classic (vertical) incision versus a Pfannenstiel (low horizontal)
incision. Uterine rupture carries a high fetal mortality, so emergent cesarean section is
required.

9-B. Placenta previa results form premature separation of an abnormally implanted
placenta and results in bright red external bleeding that is painless, which
distinguishes it clinically from abruptio placenta.

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