ACOG Practice Bulletins Questions With Complete
Solutions
are pre-prandial or post-prandial measurements of glucose better
predictors of GDM management? Correct Answers post
prandial (in diabetes who are not pregnant, pre-prandial is a
better predictor)
- threshold: 140 mg/dL at 1 hour or 120 mg/dL at 2 hours
are there interventions that decrease the incidence of late/post
term pregnancies? Correct Answers - ACCURATE GA
determination, not just by LMP but confirmed by sono
- membrane sweeping
are women at 40+ GA candidates for TOLAC? Correct
Answers decreased rates
are women with >1 previous c/s candidates for TOLAC?
Correct Answers - women with TWO previous c/s with low
transverse incision are candidates for successful VBAC
are women with macrosmic fetuses candidates for TOLAC?
Correct Answers lower likelihood of VBAC, especially with
past indication of dystocia
higher uterine rupture rate
are women with previous low vertical incision candidates for
TOLAC? Correct Answers similar rates to women who had
VBAC with transverse incision; therefore may proceed with
VBAC after vertical
,are women with twin gestation candidates for TOLAC? Correct
Answers yes they are if they had a previous c/s with low
transverse incision and meet other appropriate criteria (i.e.
VTX/VTX)
are women with unknown previous uterine incisions candidates
for TOLAC? Correct Answers TOLAC is not contraindicated
in women with previous c/s with an unknown uterine scar
(unless there is a high suspicion of classical incision)
at what gestational age is gestational diabetes mellitus screened?
Correct Answers 24-28 weeks
At what stage in the pregnancy does warfarin typically have a
pathological effect? Correct Answers first trimester (will see
embryological pathology appear between weeks 6-12)
b-hcg >2000 + TVUS non-diagnostic = ? Correct Answers
likely ectopic pregnancy
can warfarin/LMWH/UFH be given postpartum while the
mother is breast feeding? Correct Answers Because warfarin,
LMWH, and unfractionated hepa- rin do not accumulate in
breast milk and do not induce an anticoagulant effect in the
infant, these anticoagulants are compatible with breastfeeding.
Define Late term pregnancy. Define post term pregnancy
Correct Answers Late term = patients who are 41.0 - 41.6
weeks
Post term = 42+ weeks
,define obesity and its association with still birth Correct
Answers prepregnancy BMI >30 (risk 8/1000)
hazard ratio increase with gestational age (2.1at 38-36 weeks to
4.6 at 40 weeks)
define oligohydramnios. Correct Answers single deepest
vertical pocket of amniotic fluid of 2cm or lessor an AFI that is
less than 5 cm
Definition of Stillbirth Correct Answers >20 weeks of GA or
wt >350 g
fetus showing no signs of life:
1. no breathing
2. no heart beats
3. no pulsation of umbilical cord
or
4. no definite movements of voluntary muscles
describe the relationship of chromosomal abnormalities and still
birth. What percent of stillbirths are associated with abnormal
karyotypes? what are the most common abnormalities Correct
Answers abnormal karyotypes are found in 8-13% of still
births
most common
1. monosomy X (23%)
2. trisomy 21 (23%)
3. trisomy 18 (21%)
4. trisomy 13 (8%)
, during reproductive years, estrogen is elevated allowing for
production of lactobacilli and other heterogeneous bacteria.
What is the pH during this time? Correct Answers pH <4.7
For findings of bacterial vaginosis or trichomonas on a pap
smear cytology report, what is appropriate management?
Correct Answers always do your pH, wet mount and amine test
and cultures because paps are 49% sensitive and 93% specific
For symptomatic patients with vaginitis with a high pH but
normal microscopy, what is appropriate management? Correct
Answers recent intercourse, menses, cervical mucus, or recent
medical treatment may alter the pH of the vagina, therefore in
the presence of normal microscopy, but with symptoms, women
should be treated appropriately (including cultures for yeast and
trichomonas)
For vaginitis in pediatric or adolescent patients, what is
appropriate management, and are there any special
considerations? Correct Answers
frequency of still births Correct Answers 6.2 per 1000 (in US)
20-27 weeks = 3.2/1000
>28 = 3.1/1000
how are C. Trachomatis and N. Gonorrhea diagnosed? Correct
Answers presents as mucopurulent cervicitis with an abnormal
yellow discharge
requires culture or DNA tests
Solutions
are pre-prandial or post-prandial measurements of glucose better
predictors of GDM management? Correct Answers post
prandial (in diabetes who are not pregnant, pre-prandial is a
better predictor)
- threshold: 140 mg/dL at 1 hour or 120 mg/dL at 2 hours
are there interventions that decrease the incidence of late/post
term pregnancies? Correct Answers - ACCURATE GA
determination, not just by LMP but confirmed by sono
- membrane sweeping
are women at 40+ GA candidates for TOLAC? Correct
Answers decreased rates
are women with >1 previous c/s candidates for TOLAC?
Correct Answers - women with TWO previous c/s with low
transverse incision are candidates for successful VBAC
are women with macrosmic fetuses candidates for TOLAC?
Correct Answers lower likelihood of VBAC, especially with
past indication of dystocia
higher uterine rupture rate
are women with previous low vertical incision candidates for
TOLAC? Correct Answers similar rates to women who had
VBAC with transverse incision; therefore may proceed with
VBAC after vertical
,are women with twin gestation candidates for TOLAC? Correct
Answers yes they are if they had a previous c/s with low
transverse incision and meet other appropriate criteria (i.e.
VTX/VTX)
are women with unknown previous uterine incisions candidates
for TOLAC? Correct Answers TOLAC is not contraindicated
in women with previous c/s with an unknown uterine scar
(unless there is a high suspicion of classical incision)
at what gestational age is gestational diabetes mellitus screened?
Correct Answers 24-28 weeks
At what stage in the pregnancy does warfarin typically have a
pathological effect? Correct Answers first trimester (will see
embryological pathology appear between weeks 6-12)
b-hcg >2000 + TVUS non-diagnostic = ? Correct Answers
likely ectopic pregnancy
can warfarin/LMWH/UFH be given postpartum while the
mother is breast feeding? Correct Answers Because warfarin,
LMWH, and unfractionated hepa- rin do not accumulate in
breast milk and do not induce an anticoagulant effect in the
infant, these anticoagulants are compatible with breastfeeding.
Define Late term pregnancy. Define post term pregnancy
Correct Answers Late term = patients who are 41.0 - 41.6
weeks
Post term = 42+ weeks
,define obesity and its association with still birth Correct
Answers prepregnancy BMI >30 (risk 8/1000)
hazard ratio increase with gestational age (2.1at 38-36 weeks to
4.6 at 40 weeks)
define oligohydramnios. Correct Answers single deepest
vertical pocket of amniotic fluid of 2cm or lessor an AFI that is
less than 5 cm
Definition of Stillbirth Correct Answers >20 weeks of GA or
wt >350 g
fetus showing no signs of life:
1. no breathing
2. no heart beats
3. no pulsation of umbilical cord
or
4. no definite movements of voluntary muscles
describe the relationship of chromosomal abnormalities and still
birth. What percent of stillbirths are associated with abnormal
karyotypes? what are the most common abnormalities Correct
Answers abnormal karyotypes are found in 8-13% of still
births
most common
1. monosomy X (23%)
2. trisomy 21 (23%)
3. trisomy 18 (21%)
4. trisomy 13 (8%)
, during reproductive years, estrogen is elevated allowing for
production of lactobacilli and other heterogeneous bacteria.
What is the pH during this time? Correct Answers pH <4.7
For findings of bacterial vaginosis or trichomonas on a pap
smear cytology report, what is appropriate management?
Correct Answers always do your pH, wet mount and amine test
and cultures because paps are 49% sensitive and 93% specific
For symptomatic patients with vaginitis with a high pH but
normal microscopy, what is appropriate management? Correct
Answers recent intercourse, menses, cervical mucus, or recent
medical treatment may alter the pH of the vagina, therefore in
the presence of normal microscopy, but with symptoms, women
should be treated appropriately (including cultures for yeast and
trichomonas)
For vaginitis in pediatric or adolescent patients, what is
appropriate management, and are there any special
considerations? Correct Answers
frequency of still births Correct Answers 6.2 per 1000 (in US)
20-27 weeks = 3.2/1000
>28 = 3.1/1000
how are C. Trachomatis and N. Gonorrhea diagnosed? Correct
Answers presents as mucopurulent cervicitis with an abnormal
yellow discharge
requires culture or DNA tests
