, CJE WOMEN'S HEALTH EXAM NEWEST 2026/2027
| VERSION 2.0 - ADVANCED CLINICAL SCENARIOS
& COMPREHENSIVE RATIONALES
TABLE OF CONTENTS
Section Topic Questions
1 High-Risk Antepartum Complications 1-15
2 Critical Intrapartum Management 16-30
3 Complex Postpartum Emergencies 31-45
4 Neonatal Critical Care & Congenital Anomalies 46-55
5 Advanced Gynecologic Oncology 56-70
6 Reproductive Endocrinology & Infertility 71-85
7 Infectious Diseases & Immunocompromised States 86-100
8 Menopause & Bone Health Complexities 101-110
9 Surgical Gynecology & Urogynecology 111-120
10 Pharmacotherapeutics & Drug Interactions 121-135
,Section Topic Questions
11 Mental Health & Psychosocial Issues 136-145
12 Ethics, Legal Issues & Patient Safety 146-155
13 Emerging Technologies & Future Trends 156-160
SECTION 1: HIGH-RISK ANTEPARTUM COMPLICATIONS (Questions 1-
15)
Q1. A 37-year-old G4P2012 at 33 weeks' gestation with chronic hypertension (baseline BP
150/95 mmHg) presents to triage with a BP of 178/112 mmHg, headache, visual scotomata, and
epigastric pain. Laboratory results reveal platelet count 82,000/mm³, AST 92 U/L, ALT 78 U/L,
and LDH 540 U/L. Urine protein is 5.2 g/24 hours. The patient is diagnosed with HELLP
syndrome. Which of the following management strategies is most appropriate for this patient at
33 weeks?
A. Immediate cesarean delivery regardless of fetal status
B. Corticosteroid administration for 48 hours followed by delivery
C. Expectant management with close monitoring until 34 weeks
D. Immediate magnesium sulfate and antihypertensives with vaginal delivery planned
CorreCt Answer: B. Corticosteroid administration for 48 hours
followed by delivery
Rationale: For HELLP syndrome at 33 weeks with maternal stabilization, administration of
corticosteroids (betamethasone or dexamethasone) for 48 hours is recommended to promote
fetal lung maturity while preparing for delivery. Delivery at 33 weeks is indicated due to
maternal organ dysfunction. Immediate cesarean is not always required if vaginal delivery can
be safely attempted. Expectant management is not appropriate given the severity of maternal
findings. Magnesium sulfate for seizure prophylaxis and antihypertensives should be
administered while preparing for delivery. The presence of severe thrombocytopenia (82,000)
and elevated liver enzymes confirms HELLP syndrome requiring prompt intervention.
, Q2. A 28-year-old primigravida at 26 weeks' gestation presents with painless vaginal
bleeding and a low-lying placenta noted on ultrasound. She is diagnosed with placenta previa.
She reports a previous episode of vaginal bleeding at 20 weeks that resolved spontaneously.
Which of the following represents the greatest risk factor for placenta accreta in this patient?
A. Maternal age over 35
B. Prior cesarean section
C. Prior vaginal delivery
D. Multiparity
CorreCt Answer: B. Prior cesarean section
Rationale: Prior cesarean section in the presence of placenta previa is the strongest risk
factor for placenta accreta spectrum disorders. The risk increases with the number of prior
cesarean sections. A woman with placenta previa and one prior cesarean has a 10-20% risk of
accreta, increasing to >60% with four or more cesarean sections. Maternal age and parity are
less significant risk factors. Vaginal delivery does not increase accreta risk.
Q3. A 34-year-old G3P1011 at 28 weeks' gestation with type 2 diabetes mellitus presents
with polyhydramnios and a fetus measuring 4 weeks ahead on ultrasound. Estimated fetal
weight is 2,400 g (95th percentile). The patient's hemoglobin A1c is 8.2%. Which of the
following complications is this pregnancy at highest risk for?
A. Intrauterine growth restriction
B. Fetal hydrops
C. Shoulder dystocia
D. Oligohydramnios
CorreCt Answer: C. Shoulder dystocia
Rationale: Poorly controlled diabetes with an A1c of 8.2% significantly increases the risk of
fetal macrosomia (large for gestational age), which is a primary risk factor for shoulder dystocia
during vaginal delivery. Other associated risks include polyhydramnios (not oligohydramnios),
congenital anomalies, stillbirth, and neonatal hypoglycemia. Macrosomia results from fetal
hyperinsulinemia in response to maternal hyperglycemia, promoting excessive fetal growth,
particularly of the truncal and shoulder circumference.
| VERSION 2.0 - ADVANCED CLINICAL SCENARIOS
& COMPREHENSIVE RATIONALES
TABLE OF CONTENTS
Section Topic Questions
1 High-Risk Antepartum Complications 1-15
2 Critical Intrapartum Management 16-30
3 Complex Postpartum Emergencies 31-45
4 Neonatal Critical Care & Congenital Anomalies 46-55
5 Advanced Gynecologic Oncology 56-70
6 Reproductive Endocrinology & Infertility 71-85
7 Infectious Diseases & Immunocompromised States 86-100
8 Menopause & Bone Health Complexities 101-110
9 Surgical Gynecology & Urogynecology 111-120
10 Pharmacotherapeutics & Drug Interactions 121-135
,Section Topic Questions
11 Mental Health & Psychosocial Issues 136-145
12 Ethics, Legal Issues & Patient Safety 146-155
13 Emerging Technologies & Future Trends 156-160
SECTION 1: HIGH-RISK ANTEPARTUM COMPLICATIONS (Questions 1-
15)
Q1. A 37-year-old G4P2012 at 33 weeks' gestation with chronic hypertension (baseline BP
150/95 mmHg) presents to triage with a BP of 178/112 mmHg, headache, visual scotomata, and
epigastric pain. Laboratory results reveal platelet count 82,000/mm³, AST 92 U/L, ALT 78 U/L,
and LDH 540 U/L. Urine protein is 5.2 g/24 hours. The patient is diagnosed with HELLP
syndrome. Which of the following management strategies is most appropriate for this patient at
33 weeks?
A. Immediate cesarean delivery regardless of fetal status
B. Corticosteroid administration for 48 hours followed by delivery
C. Expectant management with close monitoring until 34 weeks
D. Immediate magnesium sulfate and antihypertensives with vaginal delivery planned
CorreCt Answer: B. Corticosteroid administration for 48 hours
followed by delivery
Rationale: For HELLP syndrome at 33 weeks with maternal stabilization, administration of
corticosteroids (betamethasone or dexamethasone) for 48 hours is recommended to promote
fetal lung maturity while preparing for delivery. Delivery at 33 weeks is indicated due to
maternal organ dysfunction. Immediate cesarean is not always required if vaginal delivery can
be safely attempted. Expectant management is not appropriate given the severity of maternal
findings. Magnesium sulfate for seizure prophylaxis and antihypertensives should be
administered while preparing for delivery. The presence of severe thrombocytopenia (82,000)
and elevated liver enzymes confirms HELLP syndrome requiring prompt intervention.
, Q2. A 28-year-old primigravida at 26 weeks' gestation presents with painless vaginal
bleeding and a low-lying placenta noted on ultrasound. She is diagnosed with placenta previa.
She reports a previous episode of vaginal bleeding at 20 weeks that resolved spontaneously.
Which of the following represents the greatest risk factor for placenta accreta in this patient?
A. Maternal age over 35
B. Prior cesarean section
C. Prior vaginal delivery
D. Multiparity
CorreCt Answer: B. Prior cesarean section
Rationale: Prior cesarean section in the presence of placenta previa is the strongest risk
factor for placenta accreta spectrum disorders. The risk increases with the number of prior
cesarean sections. A woman with placenta previa and one prior cesarean has a 10-20% risk of
accreta, increasing to >60% with four or more cesarean sections. Maternal age and parity are
less significant risk factors. Vaginal delivery does not increase accreta risk.
Q3. A 34-year-old G3P1011 at 28 weeks' gestation with type 2 diabetes mellitus presents
with polyhydramnios and a fetus measuring 4 weeks ahead on ultrasound. Estimated fetal
weight is 2,400 g (95th percentile). The patient's hemoglobin A1c is 8.2%. Which of the
following complications is this pregnancy at highest risk for?
A. Intrauterine growth restriction
B. Fetal hydrops
C. Shoulder dystocia
D. Oligohydramnios
CorreCt Answer: C. Shoulder dystocia
Rationale: Poorly controlled diabetes with an A1c of 8.2% significantly increases the risk of
fetal macrosomia (large for gestational age), which is a primary risk factor for shoulder dystocia
during vaginal delivery. Other associated risks include polyhydramnios (not oligohydramnios),
congenital anomalies, stillbirth, and neonatal hypoglycemia. Macrosomia results from fetal
hyperinsulinemia in response to maternal hyperglycemia, promoting excessive fetal growth,
particularly of the truncal and shoulder circumference.
