QUESTIONS:
1. A 26-year-old woman, gravid 2, para 0, presents at 26 weeks of gestation with a history and
clinical examination consistent with preterm premature rupture of (amniotic) membranes
(preterm PROM). The patient is afbrile, and she has no uterine tenderness or contractions. The
fetus is in the vertex presentation, with estimated fetal weight of 810 g. The fetal heart tones
are reassuring. A group B streprococci (GBS) culture is obtained, with results expected in 36
hours. Your plan in to manage the patient expectantly in the hospital and to administer a course
of antenatal corticosteroids. The best course of action for this patient would be to give
antibiotics
a) Over several days prophylactically
b) Only if the GBS culture is positive
c) Only in labor
d) Only if signs of chorioamnionitis are present
e) Only if the duration of membrane rupture exceeds 7 days
2. A healthy, 28-year-old woman, gravid 1, para 0, presents at 28 weeks of gestation in active
preterm labor. He labor subsides with magnesium sulfate treatment, and she receives a course
of betamethasone (Celestone). She is discharged at 28 weeks and 4 days. The best plan for
additional courses of betamethasone in this patient is
a) Not necessary
b) Repeat for recurrent preterm labor before 32 weeks
c) Repeat for recurrent preterm labor before 34 weeks
d) Repeat for premature rupture of membranes (PROM) before 32 weeks
e) Administer weekly until 32 weeks
3. Which of the following drugs is NOT used to inhibit premature labor?
a) Ethanol
b) Magnesium sulfate
c) Phenobarbital
d) Ritodrine
e) Terbutaline
4. Which of the following is NOT a pre-posing factor for premature labor?
a) Maternal age older than 30 years
b) Smoking more than 10 cigarettes per day
c) Exposure to diethylstilbestrol (DES) in utero with a a documented uterine structurural
abnormality
d) Multiparity with more than four previous deliveries.
e) Twin gestation
5. Which of the following is a sign of late premature labor?
a) Increased vaginal discharge
b) Increased uterine contractions
c) Low back pain
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d) Cervical dilation to 4 cm
e) Worsening pelvic pressure
6. A 39-year-old former Olympic athlete (gravid 5, para 0311) comes for her first prenatal visit at 8
weeks’ gestation. After undergoing a prenatal genetic counseling session, she asks her physician
about current recommendations concerning her risk of having a premature infant. The physician
should explain that
a) She is at no risk for premature delivery
b) She can continue her plans for running a marathon in 1 month
c) Her age has no bearing on this pregnancy
d) He would like to see her more often to perform cervical examinations
e) He would like to see her more often only if any symptoms of premature labor develop
7. Inhibitors of prostaglandin synthesis are not generally used for tocolysis because they
a) Are ineffective
b) Produce marked hypertension
c) May cause premature closure of the fetal ductus anteriosus
d) Are too expensive
e) Are associated with lactic acidosis
8. The most common cause of vaginal bleeding complicating premature labor is
a) A vaginal laceration
b) An endocervical polyp
c) Cervical dilation
d) Placenta dilation
e) Placenta abruption
9. A 16-year old primigravida reports that she is experiencing regular menstrual cramping every 2
minutes. She is 28 weeks pregnant. After taking a history, the first thing that she physician
should do is
a) Send her to the labor floor immediately
b) Confirm the frequency of contractions by abdominal palpation
c) Evaluate fetal well-being with a fetal monitor
d) Evaluate the cervix by speculum examination
10. The percentage of patients with a history of prematurity who will have another premature
infant is
a) 0% to 10%
b) 20% to 30%
c) 40% to 50%
d) 60% to 70%
e) 80% to 90%
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