Medical Disorders in Pregnancy

Topics in this chapter

• Diabetes in Pregnancy
• Hypertensive Disorders in Pregnancy
• Cardiac Disease in Pregnancy
• Thyroid Disorders in Pregnancy
• Gastrointestinal Disorders in Pregnancy
• Autoimmune Disease and Fetal Effects
• Infections and Antimicrobial Management

Practice questions

1. Question 1Q-4733FE

   A 28-year-old primigravida at 34 weeks of gestation presents with a 2-day history of severe right upper quadrant pain, nausea, and vomiting. Laboratory investigations reveal: Hemoglobin 9.2 g/dL, Platelet count $75,000/\mu L$, AST 145 IU/L, ALT 160 IU/L, Total Bilirubin 2.8 mg/dL, and LDH 650 IU/L. Peripheral blood smear shows schistocytes. Blood pressure is 142/94 mmHg, and trace proteinuria is present. What is the most appropriate next step in management?

   1. A.Immediate stabilization and delivery regardless of gestational age
   2. B.Conservative management with corticosteroids and magnesium sulfate until 37 weeks
   3. C.Therapeutic plasma exchange for suspected TTP
   4. D.Administration of broad-spectrum antibiotics and ursodeoxycholic acid
   See the answer and solution
2. Question 2Q-6E90A1

   A 30-year-old G2P1 at 28 weeks of gestation with known pre-existing type 1 diabetes mellitus presents for a routine antenatal check-up. Her HbA1c at booking was 8.2%. She is currently on a basal-bolus insulin regimen. Fetal growth ultrasound shows estimated fetal weight at the 95th percentile, and amniotic fluid index is 26 cm. Which of the following fetal complications is she at highest risk of developing due to her glycemic status?

   1. A.Neural tube defects
   2. B.Caudal regression syndrome
   3. C.Intrauterine growth restriction (IUGR)
   4. D.Polycythemia and neonatal hypoglycemia
   See the answer and solution
3. Question 3Q-2F1A82

   A 26-year-old primigravida at 16 weeks of gestation is diagnosed with overt hypothyroidism. Her thyroid-stimulating hormone (TSH) is 8.5 mIU/L and free T4 is low. She is started on levothyroxine replacement. Which of the following is the primary goal of maintaining optimal maternal thyroid hormone levels during pregnancy?

   1. A.Prevention of maternal postpartum hemorrhage
   2. B.Prevention of fetal neurodevelopmental impairment and cretinism
   3. C.Prevention of gestational trophoblastic disease
   4. D.Prevention of maternal gestational diabetes mellitus
   See the answer and solution
4. Question 4Q-05846C

   A 32-year-old pregnant woman with known rheumatic mitral stenosis (NYHA Class II) at 30 weeks of gestation presents with acute onset shortness of breath, orthopnea, and pink frothy sputum following a bout of strenuous physical activity. On examination, she is tachycardic, tachypneic, and bilateral basal crackles are audible. What is the immediate first-line medical management for acute pulmonary edema in this patient?

   1. A.Intravenous beta-blockers and oral digoxin
   2. B.Supplemental oxygen, upright posture, and intravenous loop diuretics (furosemide)
   3. C.Emergency percutaneous balloon mitral valvotomy
   4. D.Intravenous fluid bolus and oxytocin infusion
   See the answer and solution
5. Question 5Q-79C695

   A 25-year-old primigravida at 12 weeks of gestation is screened for viral hepatitis as part of routine antenatal care. Her laboratory results show: HBsAg positive, HBeAg positive, and Anti-HBc IgM negative. What is the recommended prophylaxis for the newborn immediately after birth to prevent vertical transmission of Hepatitis B?

   1. A.Hepatitis B vaccine only within 7 days of birth
   2. B.Hepatitis B immunoglobulin (HBIG) and Hepatitis B vaccine within 12 hours of birth
   3. C.Antiviral therapy to the mother and no intervention for the neonate
   4. D.Hepatitis B immunoglobulin (HBIG) alone at 4 weeks of age
   See the answer and solution