Antepartum Hemorrhage

 Antepartum Hemorrhage:

1. Antepartum haemorrhage may be caused by the following, EXCEPT:

A. Placenta previa

B. Cervical cancer

C. Abruptio placenta

D. Ectopic pregnancy

E. Vasa praevia

2. Each of the following typical feature of placenta previa, EXCEPT:

A. Painless bleeding

B. First episode of bleeding is usually self limited

C. May be associated with post coital bleeding

D. Commonly associated with coagulopathy

E. The uterus tends to be soft and non-tender

3. A 33 year old woman at 37 weeks gestation confirmed by early sonogram presents

with moderate to sever vaginal bleeding, and is note by sonogram to have

placenta previa, which of the following is the best management for her.

A. Induction of labor

B. Give tocolytic drugs

C. Caesarean section

D. Expectant management

E. Artificial rupture of the membrane

4. Regarding Abruptio placenta:

A. Postpartum hemorrhage occurs only when there in hypofibrinogenemia

B. Maternal anemia is a major cause for abruptio placenta

C. Fetus is not usually affected

D. Associated with antecedent hypertension

E. On Examination the abdomen is usually soft and lax

5. Regarding Placenta previa:

A. Is diagnosed when the placenta occupies the funds and start to bleed

B. Recognized to be complicated by postpartum hemorrhage

C. The fetal heart rate is usually abnormal.

D. Less common in patients with repeat caesarian section

E. Diagnosis is confirmed when bleeding starts at 13 weeks of gestation

6. In placenta previa: Which is true?

A. It is common primigravida

B. May cause abnormal lie

C. Causes recurrent painful bleeding

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D. All patients should be induced with prostaglandin pessaries

E. Digital examination is mandatory to exclude local causes

7. Antepartum hemorrhage: Which is true?

A. Is any bleeding from the genital tract during any stage of pregnancy

B. Requires assessment by vaginal examination

C. May be caused by cervical carcinoma

D. Is always painless

E. All patients should be delivered by Caesarian Section

8. A pregnant woman presents with a placenta praevia of a major defect and fetus is

malformed. Which of the following will be the best management?

A. Caesarian section

B. Oxytocin drip

C. Rupture of membranes

D. Induce with PG E2

E. Forceps delivery in the second stage to accelerate delivery.

9. Abruptio placenta:

A. Is defined as premature separation of low lying placenta.

B. There is no increase risk of recurrence.

C. The etiology of placental abruption is usually known.

D. The diagnosis of placental abruption is frequently confirmed by

ultrasound.

E. The most predisposing condition is chronic maternal Hypertension.

10. Management of Placental Abruption includes all of the following EXCEPT:

A. Coagulation studies.

B. Expectant management in cases of IUFD.

C. Augmentation of labor.

D. Artificial rupture of Amniotic membrane.

E. Intensive I.V. fluid replacement.

11. The most common risk factors for placental abruption:

A. Diabetes.

B. Increased maternal age, Multiparity, hypertension & cigarette smoking.

C. Intrauterine growth retardation.

D. Rh isoimmunization.

E. Multiple pregnancy.

12. The following is a contraindication for the use of amnio-hook:

A. Plcenta previa

B. Abruptio placenta

C. Breech presentation

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D. IUGR

E. Face presentation

13. Regarding Abruptio placenta:

A. Is defined as premature separation of low lying placenta

B. There is no increase risk of recurrence

C. The etiology of placental abruption is usually known

D. The diagnosis of recent placental abruption is frequently confirmed by

ultrasound

E. Chronic maternal hypertension is a known cause.

14. Management of placental abruption includes all of the following EXCEPT:

A. Coagulation studies

B. Tocolytic drugs if the baby is premature

C. Augmentation of labor

D. Artificial rupture of amniotic membrane

E. Intensive intravenous fluid replacement

15. The followings are causes of Antepartum hemorrhage EXCEPT:

A. Abruptio placenta.

B. Placenta brevia.

C. Cervical polyp.

D. Vasa previa.

E. Rh isoimmunization.

16. Extensive bleeding into the myometrium & beneath the uterine serosa in severe

cases of abruption placenta may result in :

A. A couvelaire uterus.

B. Active uterus

C. Placental perfusion

D. Normal fetal heart rate

E. Reactive CTG tracing

17. Which of the following is NOT a complication of abruption placenta ?

A. Postpartum hemorrhage

B. Consumptive hemorrhage

C. Fetal demise

D. Acute renal failure

E. Subsequent ectopic

18. One of the following contraindications for the use of amnio-hook :

A. Placental previa

B. Abruptio placenta

C. Breech presentation

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D. IUGR

E. Face presentation

19. Which of the following signs is most useful in predicting the absence of placental

abruption following trauma :

A. Absence of uterine contraction

B. Absence of vaginal bleeding

C. Presence of normal fetal heart tones

D. Absence of tense , painful uterus

E. Absence of nausea and vomiting

20. 24 -year- old patient ( G2 P1 + 0 ). At 34 weeks of gestation presented to

emergency with vaginal bleeding. Which one of the following is NOT TRUE ?

A. Admit the patient

B. Resuscitate the patient

C. Do digital examination immediately

D. Cross-match blood

E. Do ultrasound

21. In the management of placenta previa centralis :

A. Once diagnosis is made, the treatment should urgent caesarean section

B. Patient may stay at home if she is living near the hospital

C. Vaginal examination should be done carefully to confirm diagnosis

D. If the pregnancy has advanced to 37 weeks, it is usually best to perform

C/S

E. If the baby is premature liberal blood transfusion is the treatment of

choice for severe hemorrhage

22. The likely causes of ante -partum hemorrhage in 32 weeks pregnant women has

recurrent attack of vaginal bleeding with proven fundal placenta are :

A. Subserous uterine fibroid

B. Diabetes

C. Circumvallate placenta

D. Anemia

E. Multiple pregnancy

23. The condition of placental abruption is associated with :

A. External cephalic version

B. Nulliparus women, among whom it is more common

C. Direct trauma which may be the main cause

D. A clinical diagnosis

E. Always presents with vaginal bleeding

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24. An 18 year old woman is noted to have a marginal placenta previa on an US at 24

weeks gestation. Which of the following is the most appropriate management?

A. Schedule cesarean delivery at 38 weeks.

B. Schedule an amniocentesis at 36 weeks & delivery by C-section if the

fetal lung is mature.

C. Reassess placental position at 33-34 weeks.

D. Recommend termination of pregnancy.

E. Reassess placental position digitally by vaginal examination 32-34 weeks.

25. The following may be signs of abruptio placenta, EXCEPT :

A. Vaginal bleeding.

B. Absence of uterine contractions.

C. Blood stained amniotic fluid.

D. Abnormal fetal heart rate.

E. Tense painful uterus.

26. In Placenta previa, all help in the diagnosis, EXCEPT:

A. Constant lower abdominal pain

B. Mal presentation

C. Painless vaginal bleeding

D. US

E. History of repeated C-section.

27. 33 year female at 37 weeks gestation confirmed by early sonography presents with

moderate severe vaginal bleeding, she is noted to have placenta previa, which of

the following is the best management for her :

A. Induction of labor

B. C-Section.

C. Expectant management

D. Artificial rupture of membrane

E. Give tocolytic drugs

28. Which of the following patients would be most likely to have a placenta previa:

A. 19-year-old G1, P0, Vertex presentation.

B. 24-year-old G2, P1, cephalic presentation, 2/5 palpable.

C. 34-year-old G5, P3+ 1(abortion), vertex presentation.

D. 36-year-old G7, Previous 5 LSCS, P6, transverse lie.

E. 28-year-old G3, P1+1(abortion), head at 0 station.

29. Routine pelvic examination is contraindicated in which of the following situations

during pregnancy:

A. Carcinoma of the cervix.

B. Gonorrhea.

C. Prolapsed cord.

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D. Placenta previa.

E. Active labor.

30. Which of the following is NOT a complication of abruptio placenta:

A. Postpartum hemorrhage.

B. Consumptive hemorrhage.

C. Fetal demise.

D. Acute renal failure.

E. Subsequent ectopic.

31. Placenta previa is more likely to be found in a pregnancy associated with:

A. Multiple pregnancy.

B. Previous manual removal of placenta.

C. Pyometra.

D. IVF pregnancy.

E. Previous C-section.

32. In placenta previa:

A. Common in primigravida.

B. Presents with vaginal bleeding with abdominal pain.

C. Hx. Of repeated C-section is a risk factor.

D. Characterized by bleeding at 10weeks gestation.

E. Associated with fetal anomalies.

33. Vasa previa diagnosis in early labor is best treated with:

A. Spontaneous delivery.

B. Tocolytic agents to prevent uterine contraction.

C. Forceps delivery as soon as the cervix is dilated.

D. C-section.

E. Ventouse delivery at 8 cm dilation.

34. The most common cause of vaginal bleeding complicating premature labor is:

A. Vaginal laceration.

B. An endocervical polyp.

C. Cervical dilation.

D. Placenta previa.

E. Placental abruption.

35. All are complication of abruptio placenta EXCEPT:

A. Macrosomia

B. IUFD

C. DIC

D. PPH

E. Uterine atony

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36. Velamentous insertion of the cord is associated with an increased risk for:

A. Premature rupture of the membranes.

B. Fetal bleeding before labor.

C. Torsion of the umbilical cord.

D. Fetal malformation.

E. Uterine malformations.