Bleeding During Pregnancy

10 Questions | By Obgynume | Updated: Nov 30, 2022 | Attempts: 3054

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1.

A 22 year old female presents to the ED with complaints of severe stabbing pain in her right inguinal region and right shoulder pain for the past 2 hours. Physical exam is positive for abdominal tenderness to palpation and minimal vaginal bleeding. Abdominal US shows intraabdominal fluid, bHCG of 1600 with an unknown LMP. VS= BP 90/42 P=105 T=98.3. What is the next best step in management.
- A.
  
  Pelvic MRI
- B.
  
  Bedside paracentesis
- C.
  
  IV fluids and monitor
- D.
  
  Exploratory laparotomy
- E.
  
  Administer methotrexate
2.

31 year old Asian female, G4P0030, presents to OB triage complaining of lightheadedness and moderate vaginal bleeding. She notes it has been 6 weeks since her 2^nd round of IVF. Emergency US reveals a viable intrauterine pregnancy with consistent gestational age, additionally free fluid is noted in the peritoneum. bHCG was positive with a pending quantification. Transvaginal US reveals left adnexal mass with low resistance flow. What is a risk factor for this patients diagnosis?
- A.
  
  Age
- B.
  
  Race
- C.
  
  IVF
- D.
  
  Placenta previa
- E.
  
  PID
3.

32 year old homeless lady, G2P0100 who claims to be 32 weeks pregnant based on her last LMP presents to the ED with complaint of heavy vaginal bleeding. She has not received any prenatal care. She reports minimal cramping pain in her lower abdomen. Her uterus is soft and non-tender. Vital signs are stable. What is the next step in management?
- A.
  
  Begin PCN G
- B.
  
  Sterile speculum exam
- C.
  
  IV fluids with observation
- D.
  
  Digital pelvic exam
- E.
  
  Transabdominal ultrasound.
4.

Which of the following is not a risk factor associated with the diagnosis is patient 3?
- A.
  
  Alcohol consumption
- B.
  
  Twins
- C.
  
  Age of 15
- D.
  
  Age of 25
- E.
  
  Age of 35
5.

34 year old G3P2 at 37 weeks presents to OB triage with painful bright red vaginal bleeding. She reports tripping and landing on her buttocks nearly 1 hour ago. Physical exam reveals a tender and firm uterus. Emergency US reveals FHT in the 100’s with a posterior placenta. VS= BP 100/60 HR= 112 R=18= T=98.2. What is the most likely diagnosis?
- A.
  
  Vasa previa
- B.
  
  Placental abruption
- C.
  
  Normal labor
- D.
  
  Uterine rupture
- E.
  
  Placenta accrete
6.

What is the next best step in management.
- A.
  
  Kleihauer Betke test
- B.
  
  IV fluid and observe
- C.
  
  Type and Screen
- D.
  
  Administer pitocin
- E.
  
  Pelvic MRI
7.

On a mission trip to Mexico a 35 year old G6P4105 has been in active labor for 12 hours. To facilitate her delivery she is given Pitocin. Three hours later the FHT drop to 90 from a previous baseline of 120, tocometry reveals no contractions. Moderate vaginal bleeding is also noted, and a vertical abdominal scar. What has likely occurred?
- A.
  
  Uterine rupture
- B.
  
  Intraamniotic infection
- C.
  
  Placental abruption
- D.
  
  Placenta previa
8.

What is a risk factor for this condition?
- A.
  
  AMA
- B.
  
  Previous C-section
- C.
  
  Gestational diabetes
- D.
  
  Smoking
- E.
  
  Nulliparity
9.

22 year old female G1 at 17 weeks presents to Triage reporting spotting after sex with her husband. She is worried she may be having a miscarage. Doppler confirms FHT, and speculum exam reveals a closed cervix with bright red margins noted on the transformation zone. What is the likely cause of bleeding?
- A.
  
  Complete AB
- B.
  
  Placental abruption
- C.
  
  Ectropion
- D.
  
  Inevitable AB
10.

Whats the next best step in management?
- A.
  
  IV Fluid
- B.
  
  Reassure
- C.
  
  Administer methotrexate
- D.
  
  D&C