OBGYN uwise Exam Part 1 Questions AND Correct Answers
19-year-old G1 woman at 36 weeks gestation presents for her
first prenatal visit, stating she was recently diagnosed with
HIV after her former partner tested positive. The HIV Western
Blot is positive. The CD4 count is 612 cells/µl. The viral load is
9,873 viral particles per ml of patient serum. Which of the
management options would best decrease the risk for
perinatal transmission of HIV?
A. Treatment with intravenous zidovudine at the time of
delivery
B. Treatment of the newborn with oral zidovudine only if HIV-
positive
C. One week maternal treatment with zidovudine now
D. Cesarean section in second stage of labor
E. Single drug therapy to minimize drug resistance - ✔✔A.
Antiretroviral therapy should be offered to all HIV-infected
pregnant women to begin maternal treatment as well as to
reduce the risk of perinatal transmission regardless of CD4+ T-
cell count or HIV RNA level. The baseline transmission rate of
HIV to newborns can be reduced from about 25% to 2% with
the HAART (highly active antiretroviral therapy) protocol
antepartum and continuing through delivery with intravenous
zidovudine in labor and zidovudine treatment for the neonate.
,Cesarean section prior to labor can reduce this rate to 2%
(although the benefit is less clear in women with viral loads).
19-year-old G1 woman presents at 28 weeks gestation for
prenatal care. Her past medical history is unremarkable
except for a splenectomy following a motor vehicle accident
four years ago. Prenatal labs today show a hemoglobin of 12
g/dL; blood type O positive; Rh negative with antibody screen
positive for Lewis (titer 1:16). What is the next best step in the
management of this pregnancy?
A. Check father of the baby's antibody status
B. Biophysical profile
C. Serial amniocentesis
D. Percutaneous umbilical blood sampling
E. Reassurance - ✔✔E. The patient should be reassured that
the fetus is not at risk even though the antibody titer is 1:16.
Lewis antibodies are IgM antibodies and do not cross the
placenta, therefore are not associated with isosensitization or
hemolytic disease of the fetus. The father of the baby does
not need to be tested nor does this unaffected fetus need a
biophysical profile. The other tests listed above are invasive
and used to monitor fetuses at risk for anemia, hydrops and
fetal death.
,29-year-old G1P0 woman at 42 weeks gestation presents in
labor. She denies ruptured membranes. Her prenatal course
was complicated by chronic hypertension. Her vital signs are:
blood pressure 130/80; pulse 72; afebrile; fundal height 36
cm; and estimated fetal weight of 2100 gm. Cervix is dilated to
4 cm, 100% effaced, +1 station. The fetal heart rate tracing is
shown below. What is the most likely diagnosis?
(fetal heart rate min after peak of CTX)
A. Normal fetal heart rate pattern
B. Sinusoidal rhythm
C. Late deceleration
D. Variable decelerations
E. Early decelerations - ✔✔C. Late decelerations are a
symmetric fall in the fetal heart rate, beginning at or after the
peak of the uterine contraction and returning to baseline only
after the contraction has ended. Late decelerations are
associated with uteroplacental insufficiency. Variable
decelerations show an acute fall in the FHR with a rapid down
slope and a variable recovery phase. They are
characteristically variable in duration, intensity, and timing,
and may not bear a constant relationship to uterine
, contractions. Early decelerations are physiologic caused by
fetal head compression during uterine contraction, resulting
in vagal stimulation and slowing of the heart rate. This type of
deceleration has a uniform shape, with a slow onset that
coincides with the start of the contraction and a slow return
to the baseline that coincides with the end of the contraction.
Thus, it has the characteristic mirror image of the contraction.
The true sinusoidal pattern is a regular, smooth, undulating
form typical of a sine wave that occurs with a frequency of
two to five cycles/minute and an amplitude range of five to 15
beats per minute. It is also characterized by a stable baseline
heart rate of 120 to 160 beats per minute and absent beat-to-
beat variability.
32-year-old G1P1 is status post uncomplicated normal
spontaneous vaginal delivery. She is taking sertraline (Zoloft),
a selective serotonin uptake inhibitor (SSRI) as an
antidepressant and wants to breastfeed. What is the next best
step in management of this patient?
A. Decrease her SSRI dose by 50%, since these drugs are
concentrated in the breast milk
B. Consult psychiatry about changing medications and discard
the expressed milk in the meantime
C. Discontinue the medications so she can breastfeed
19-year-old G1 woman at 36 weeks gestation presents for her
first prenatal visit, stating she was recently diagnosed with
HIV after her former partner tested positive. The HIV Western
Blot is positive. The CD4 count is 612 cells/µl. The viral load is
9,873 viral particles per ml of patient serum. Which of the
management options would best decrease the risk for
perinatal transmission of HIV?
A. Treatment with intravenous zidovudine at the time of
delivery
B. Treatment of the newborn with oral zidovudine only if HIV-
positive
C. One week maternal treatment with zidovudine now
D. Cesarean section in second stage of labor
E. Single drug therapy to minimize drug resistance - ✔✔A.
Antiretroviral therapy should be offered to all HIV-infected
pregnant women to begin maternal treatment as well as to
reduce the risk of perinatal transmission regardless of CD4+ T-
cell count or HIV RNA level. The baseline transmission rate of
HIV to newborns can be reduced from about 25% to 2% with
the HAART (highly active antiretroviral therapy) protocol
antepartum and continuing through delivery with intravenous
zidovudine in labor and zidovudine treatment for the neonate.
,Cesarean section prior to labor can reduce this rate to 2%
(although the benefit is less clear in women with viral loads).
19-year-old G1 woman presents at 28 weeks gestation for
prenatal care. Her past medical history is unremarkable
except for a splenectomy following a motor vehicle accident
four years ago. Prenatal labs today show a hemoglobin of 12
g/dL; blood type O positive; Rh negative with antibody screen
positive for Lewis (titer 1:16). What is the next best step in the
management of this pregnancy?
A. Check father of the baby's antibody status
B. Biophysical profile
C. Serial amniocentesis
D. Percutaneous umbilical blood sampling
E. Reassurance - ✔✔E. The patient should be reassured that
the fetus is not at risk even though the antibody titer is 1:16.
Lewis antibodies are IgM antibodies and do not cross the
placenta, therefore are not associated with isosensitization or
hemolytic disease of the fetus. The father of the baby does
not need to be tested nor does this unaffected fetus need a
biophysical profile. The other tests listed above are invasive
and used to monitor fetuses at risk for anemia, hydrops and
fetal death.
,29-year-old G1P0 woman at 42 weeks gestation presents in
labor. She denies ruptured membranes. Her prenatal course
was complicated by chronic hypertension. Her vital signs are:
blood pressure 130/80; pulse 72; afebrile; fundal height 36
cm; and estimated fetal weight of 2100 gm. Cervix is dilated to
4 cm, 100% effaced, +1 station. The fetal heart rate tracing is
shown below. What is the most likely diagnosis?
(fetal heart rate min after peak of CTX)
A. Normal fetal heart rate pattern
B. Sinusoidal rhythm
C. Late deceleration
D. Variable decelerations
E. Early decelerations - ✔✔C. Late decelerations are a
symmetric fall in the fetal heart rate, beginning at or after the
peak of the uterine contraction and returning to baseline only
after the contraction has ended. Late decelerations are
associated with uteroplacental insufficiency. Variable
decelerations show an acute fall in the FHR with a rapid down
slope and a variable recovery phase. They are
characteristically variable in duration, intensity, and timing,
and may not bear a constant relationship to uterine
, contractions. Early decelerations are physiologic caused by
fetal head compression during uterine contraction, resulting
in vagal stimulation and slowing of the heart rate. This type of
deceleration has a uniform shape, with a slow onset that
coincides with the start of the contraction and a slow return
to the baseline that coincides with the end of the contraction.
Thus, it has the characteristic mirror image of the contraction.
The true sinusoidal pattern is a regular, smooth, undulating
form typical of a sine wave that occurs with a frequency of
two to five cycles/minute and an amplitude range of five to 15
beats per minute. It is also characterized by a stable baseline
heart rate of 120 to 160 beats per minute and absent beat-to-
beat variability.
32-year-old G1P1 is status post uncomplicated normal
spontaneous vaginal delivery. She is taking sertraline (Zoloft),
a selective serotonin uptake inhibitor (SSRI) as an
antidepressant and wants to breastfeed. What is the next best
step in management of this patient?
A. Decrease her SSRI dose by 50%, since these drugs are
concentrated in the breast milk
B. Consult psychiatry about changing medications and discard
the expressed milk in the meantime
C. Discontinue the medications so she can breastfeed
