"Diagnosis anD TreaTmenT obsTeTrics anD
gynecology compleTe sTuDy guiDe 2026 –
comprehensive ob-gyn clinical review, women’s
healTh DisorDers, pregnancy managemenT,
prenaTal anD posTnaTal care, labor anD
Delivery proceDures, gynecological Disease
Diagnosis, reproDucTive healTh managemenT,
eviDence-baseD TreaTmenT approaches, clinical
case sTuDies, pracTice QuesTions anD exam
preparaTion resource for meDical, nursing, anD
miDwifery sTuDenTs"
Question 1: A 28-year-old primigravida at 32 weeks gestation presents with new-onset
hypertension (152/96 mmHg) and proteinuria (350 mg/24 hours). She reports mild headache
but no visual disturbances or epigastric pain. According to current ACOG guidelines, what is
the most appropriate initial management?
A. Immediate delivery via cesarean section
B. Administration of intravenous magnesium sulfate and antihypertensive therapy with close
maternal-fetal monitoring
C. Outpatient monitoring with twice-weekly blood pressure checks and urine protein dipstick
D. Bed rest, increased oral fluids, and weekly prenatal visits
CORRECT ANSWER: B. Administration of intravenous magnesium sulfate and antihypertensive
therapy with close maternal-fetal monitoring
RATIONALE: This patient meets diagnostic criteria for preeclampsia without severe features
(new-onset hypertension after 20 weeks with proteinuria ≥300 mg/24 hours). Current ACOG
guidelines recommend magnesium sulfate for seizure prophylaxis, antihypertensive therapy for
blood pressure control, and close inpatient monitoring for women with preeclampsia at this
gestational age. Immediate delivery is reserved for severe features or fetal compromise.
Outpatient management is inappropriate given the diagnosis, and bed rest alone lacks evidence
for improving outcomes in preeclampsia.
Question 2: Which of the following laboratory findings, in the absence of proteinuria, would
establish a diagnosis of preeclampsia in a pregnant patient with new-onset hypertension after
20 weeks gestation?
,A. Serum creatinine of 0.9 mg/dL
B. Platelet count of 110,000/μL
C. AST of 35 U/L (normal range 10-40 U/L)
D. Serum uric acid of 5.2 mg/dL
CORRECT ANSWER: B. Platelet count of 110,000/μL
RATIONALE: According to ACOG diagnostic criteria, preeclampsia can be diagnosed in the
absence of proteinuria if new-onset hypertension is accompanied by any of the following severe
features: thrombocytopenia (platelet count <100,000/μL), renal insufficiency (serum creatinine
>1.1 mg/dL or doubling), impaired liver function (transaminases >2× upper limit of normal),
pulmonary edema, or new-onset cerebral/visual symptoms. A platelet count of 110,000/μL does
not meet the threshold for thrombocytopenia (<100,000/μL), but among the options provided,
it is closest to the diagnostic criterion. However, strictly speaking, none of these values alone
would establish the diagnosis without proteinuria except if platelets were <100,000/μL.
Revising: The correct answer should reflect a value meeting criteria. Let me correct: A platelet
count of 85,000/μL would qualify. Since the question asks which finding would establish
diagnosis, and option B is 110,000 which is above threshold, this question needs revision. Let
me regenerate this question properly.
Question 2: According to ACOG guidelines, which laboratory threshold defines
thrombocytopenia as a severe feature of preeclampsia?
A. Platelet count <150,000/μL
B. Platelet count <125,000/μL
C. Platelet count <100,000/μL
D. Platelet count <75,000/μL
CORRECT ANSWER: C. Platelet count <100,000/μL
RATIONALE: ACOG Practice Bulletin No. 222 defines thrombocytopenia as a severe feature of
preeclampsia when the platelet count falls below 100,000 × 10⁹/L (or <100,000/μL). This
threshold is critical for diagnosing preeclampsia with severe features and guides decisions
regarding magnesium sulfate administration, timing of delivery, and level of monitoring
required.
Question 3: A 34-year-old woman at 26 weeks gestation undergoes a 1-hour 50-g glucose
challenge test as part of universal gestational diabetes screening. Her result is 158 mg/dL.
According to ACOG's recommended two-step approach, what is the next appropriate step?
A. Diagnose gestational diabetes and initiate medical nutrition therapy
B. Perform a fasting plasma glucose test
,C. Schedule a 3-hour 100-g oral glucose tolerance test
D. Repeat the 1-hour screening test in 2 weeks
CORRECT ANSWER: C. Schedule a 3-hour 100-g oral glucose tolerance test
RATIONALE: ACOG supports the two-step approach for gestational diabetes screening: an initial
non-fasting 1-hour 50-g glucose challenge test, followed by a diagnostic 3-hour 100-g oral
glucose tolerance test (OGTT) if the screening value meets or exceeds the threshold (typically
≥130-140 mg/dL, with 140 mg/dL being the most common cutoff). A result of 158 mg/dL
exceeds the threshold, warranting the diagnostic OGTT. Diagnosis of GDM requires at least two
abnormal values on the 3-hour test using Carpenter-Coustan or NDDG criteria.
Question 4: Which of the following criteria is required for the diagnosis of gestational
diabetes mellitus using the 3-hour 100-g oral glucose tolerance test according to Carpenter-
Coustan criteria?
A. One abnormal value
B. Two or more abnormal values
C. Three or more abnormal values
D. All four values abnormal
CORRECT ANSWER: B. Two or more abnormal values
RATIONALE: The Carpenter-Coustan criteria for diagnosing gestational diabetes using the 3-hour
100-g OGTT require at least two of the following four values to be met or exceeded: fasting ≥95
mg/dL, 1-hour ≥180 mg/dL, 2-hour ≥155 mg/dL, or 3-hour ≥140 mg/dL. This threshold balances
sensitivity and specificity for identifying pregnancies at increased risk of adverse outcomes
related to hyperglycemia.
Question 5: A 29-year-old woman presents with heavy menstrual bleeding lasting 10 days
every 21 days. She is sexually active and desires future fertility. According to the FIGO PALM-
COEIN classification system, which category would include uterine fibroids as a cause of her
abnormal uterine bleeding?
A. Coagulopathy
B. Ovulatory dysfunction
C. Leiomyoma
D. Endometrial
CORRECT ANSWER: C. Leiomyoma
RATIONALE: The FIGO PALM-COEIN system classifies causes of abnormal uterine bleeding into
structural (PALM) and nonstructural (COEIN) categories. "L" stands for Leiomyoma, which
, includes uterine fibroids. Submucosal or intramural fibroids can cause heavy or prolonged
menstrual bleeding by increasing endometrial surface area, disrupting normal uterine
contractility, or altering local angiogenic factors. This classification aids in systematic evaluation
and targeted management.
Question 6: A 45-year-old woman presents with new-onset irregular, heavy menstrual
bleeding. She has no risk factors for endometrial cancer. According to current guidelines, what
is the most appropriate initial diagnostic step?
A. Transvaginal ultrasound to measure endometrial thickness
B. Office endometrial biopsy
C. Hysteroscopy with directed biopsy
D. Serum CA-125 level
CORRECT ANSWER: B. Office endometrial biopsy
RATIONALE: ACOG and other guidelines recommend endometrial evaluation via biopsy for all
women aged ≥45 years with abnormal uterine bleeding, regardless of risk factors, due to the
increased prevalence of endometrial hyperplasia or cancer in this age group. Office endometrial
biopsy is the first-line diagnostic procedure due to its high sensitivity for detecting endometrial
pathology, minimal invasiveness, and cost-effectiveness. Transvaginal ultrasound may be
adjunctive but is not a substitute for histologic evaluation in this age group.
Question 7: Which of the following is the most effective first-line medical treatment for
chronic heavy menstrual bleeding in a woman who desires future fertility and has no
contraindications to hormonal therapy?
A. Combined oral contraceptive pills
B. Levonorgestrel-releasing intrauterine system
C. Oral tranexamic acid
D. Nonsteroidal anti-inflammatory drugs
CORRECT ANSWER: B. Levonorgestrel-releasing intrauterine system
RATIONALE: Multiple randomized trials and systematic reviews demonstrate that the
levonorgestrel-releasing intrauterine system (LNG-IUD) is the most effective medical therapy for
reducing menstrual blood loss in women with heavy menstrual bleeding, with reduction rates of
71-96%. It is recommended as first-line therapy by ACOG and other guidelines for women
without contraindications, including those desiring future fertility, as it is reversible and does
not impair subsequent conception. Combined oral contraceptives, tranexamic acid, and NSAIDs
are also effective but generally provide less reduction in blood loss compared to LNG-IUD.
gynecology compleTe sTuDy guiDe 2026 –
comprehensive ob-gyn clinical review, women’s
healTh DisorDers, pregnancy managemenT,
prenaTal anD posTnaTal care, labor anD
Delivery proceDures, gynecological Disease
Diagnosis, reproDucTive healTh managemenT,
eviDence-baseD TreaTmenT approaches, clinical
case sTuDies, pracTice QuesTions anD exam
preparaTion resource for meDical, nursing, anD
miDwifery sTuDenTs"
Question 1: A 28-year-old primigravida at 32 weeks gestation presents with new-onset
hypertension (152/96 mmHg) and proteinuria (350 mg/24 hours). She reports mild headache
but no visual disturbances or epigastric pain. According to current ACOG guidelines, what is
the most appropriate initial management?
A. Immediate delivery via cesarean section
B. Administration of intravenous magnesium sulfate and antihypertensive therapy with close
maternal-fetal monitoring
C. Outpatient monitoring with twice-weekly blood pressure checks and urine protein dipstick
D. Bed rest, increased oral fluids, and weekly prenatal visits
CORRECT ANSWER: B. Administration of intravenous magnesium sulfate and antihypertensive
therapy with close maternal-fetal monitoring
RATIONALE: This patient meets diagnostic criteria for preeclampsia without severe features
(new-onset hypertension after 20 weeks with proteinuria ≥300 mg/24 hours). Current ACOG
guidelines recommend magnesium sulfate for seizure prophylaxis, antihypertensive therapy for
blood pressure control, and close inpatient monitoring for women with preeclampsia at this
gestational age. Immediate delivery is reserved for severe features or fetal compromise.
Outpatient management is inappropriate given the diagnosis, and bed rest alone lacks evidence
for improving outcomes in preeclampsia.
Question 2: Which of the following laboratory findings, in the absence of proteinuria, would
establish a diagnosis of preeclampsia in a pregnant patient with new-onset hypertension after
20 weeks gestation?
,A. Serum creatinine of 0.9 mg/dL
B. Platelet count of 110,000/μL
C. AST of 35 U/L (normal range 10-40 U/L)
D. Serum uric acid of 5.2 mg/dL
CORRECT ANSWER: B. Platelet count of 110,000/μL
RATIONALE: According to ACOG diagnostic criteria, preeclampsia can be diagnosed in the
absence of proteinuria if new-onset hypertension is accompanied by any of the following severe
features: thrombocytopenia (platelet count <100,000/μL), renal insufficiency (serum creatinine
>1.1 mg/dL or doubling), impaired liver function (transaminases >2× upper limit of normal),
pulmonary edema, or new-onset cerebral/visual symptoms. A platelet count of 110,000/μL does
not meet the threshold for thrombocytopenia (<100,000/μL), but among the options provided,
it is closest to the diagnostic criterion. However, strictly speaking, none of these values alone
would establish the diagnosis without proteinuria except if platelets were <100,000/μL.
Revising: The correct answer should reflect a value meeting criteria. Let me correct: A platelet
count of 85,000/μL would qualify. Since the question asks which finding would establish
diagnosis, and option B is 110,000 which is above threshold, this question needs revision. Let
me regenerate this question properly.
Question 2: According to ACOG guidelines, which laboratory threshold defines
thrombocytopenia as a severe feature of preeclampsia?
A. Platelet count <150,000/μL
B. Platelet count <125,000/μL
C. Platelet count <100,000/μL
D. Platelet count <75,000/μL
CORRECT ANSWER: C. Platelet count <100,000/μL
RATIONALE: ACOG Practice Bulletin No. 222 defines thrombocytopenia as a severe feature of
preeclampsia when the platelet count falls below 100,000 × 10⁹/L (or <100,000/μL). This
threshold is critical for diagnosing preeclampsia with severe features and guides decisions
regarding magnesium sulfate administration, timing of delivery, and level of monitoring
required.
Question 3: A 34-year-old woman at 26 weeks gestation undergoes a 1-hour 50-g glucose
challenge test as part of universal gestational diabetes screening. Her result is 158 mg/dL.
According to ACOG's recommended two-step approach, what is the next appropriate step?
A. Diagnose gestational diabetes and initiate medical nutrition therapy
B. Perform a fasting plasma glucose test
,C. Schedule a 3-hour 100-g oral glucose tolerance test
D. Repeat the 1-hour screening test in 2 weeks
CORRECT ANSWER: C. Schedule a 3-hour 100-g oral glucose tolerance test
RATIONALE: ACOG supports the two-step approach for gestational diabetes screening: an initial
non-fasting 1-hour 50-g glucose challenge test, followed by a diagnostic 3-hour 100-g oral
glucose tolerance test (OGTT) if the screening value meets or exceeds the threshold (typically
≥130-140 mg/dL, with 140 mg/dL being the most common cutoff). A result of 158 mg/dL
exceeds the threshold, warranting the diagnostic OGTT. Diagnosis of GDM requires at least two
abnormal values on the 3-hour test using Carpenter-Coustan or NDDG criteria.
Question 4: Which of the following criteria is required for the diagnosis of gestational
diabetes mellitus using the 3-hour 100-g oral glucose tolerance test according to Carpenter-
Coustan criteria?
A. One abnormal value
B. Two or more abnormal values
C. Three or more abnormal values
D. All four values abnormal
CORRECT ANSWER: B. Two or more abnormal values
RATIONALE: The Carpenter-Coustan criteria for diagnosing gestational diabetes using the 3-hour
100-g OGTT require at least two of the following four values to be met or exceeded: fasting ≥95
mg/dL, 1-hour ≥180 mg/dL, 2-hour ≥155 mg/dL, or 3-hour ≥140 mg/dL. This threshold balances
sensitivity and specificity for identifying pregnancies at increased risk of adverse outcomes
related to hyperglycemia.
Question 5: A 29-year-old woman presents with heavy menstrual bleeding lasting 10 days
every 21 days. She is sexually active and desires future fertility. According to the FIGO PALM-
COEIN classification system, which category would include uterine fibroids as a cause of her
abnormal uterine bleeding?
A. Coagulopathy
B. Ovulatory dysfunction
C. Leiomyoma
D. Endometrial
CORRECT ANSWER: C. Leiomyoma
RATIONALE: The FIGO PALM-COEIN system classifies causes of abnormal uterine bleeding into
structural (PALM) and nonstructural (COEIN) categories. "L" stands for Leiomyoma, which
, includes uterine fibroids. Submucosal or intramural fibroids can cause heavy or prolonged
menstrual bleeding by increasing endometrial surface area, disrupting normal uterine
contractility, or altering local angiogenic factors. This classification aids in systematic evaluation
and targeted management.
Question 6: A 45-year-old woman presents with new-onset irregular, heavy menstrual
bleeding. She has no risk factors for endometrial cancer. According to current guidelines, what
is the most appropriate initial diagnostic step?
A. Transvaginal ultrasound to measure endometrial thickness
B. Office endometrial biopsy
C. Hysteroscopy with directed biopsy
D. Serum CA-125 level
CORRECT ANSWER: B. Office endometrial biopsy
RATIONALE: ACOG and other guidelines recommend endometrial evaluation via biopsy for all
women aged ≥45 years with abnormal uterine bleeding, regardless of risk factors, due to the
increased prevalence of endometrial hyperplasia or cancer in this age group. Office endometrial
biopsy is the first-line diagnostic procedure due to its high sensitivity for detecting endometrial
pathology, minimal invasiveness, and cost-effectiveness. Transvaginal ultrasound may be
adjunctive but is not a substitute for histologic evaluation in this age group.
Question 7: Which of the following is the most effective first-line medical treatment for
chronic heavy menstrual bleeding in a woman who desires future fertility and has no
contraindications to hormonal therapy?
A. Combined oral contraceptive pills
B. Levonorgestrel-releasing intrauterine system
C. Oral tranexamic acid
D. Nonsteroidal anti-inflammatory drugs
CORRECT ANSWER: B. Levonorgestrel-releasing intrauterine system
RATIONALE: Multiple randomized trials and systematic reviews demonstrate that the
levonorgestrel-releasing intrauterine system (LNG-IUD) is the most effective medical therapy for
reducing menstrual blood loss in women with heavy menstrual bleeding, with reduction rates of
71-96%. It is recommended as first-line therapy by ACOG and other guidelines for women
without contraindications, including those desiring future fertility, as it is reversible and does
not impair subsequent conception. Combined oral contraceptives, tranexamic acid, and NSAIDs
are also effective but generally provide less reduction in blood loss compared to LNG-IUD.
