CREOG 2022

A 35-year-old woman, gravida 3, para 2, presents for her first prenatal visit at 14 weeks of gestation. She has a history of rhesus alloimmunization, which was diagnosed during her last pregnancy. She gave birth to a term neonate who required phototherapy for hyperbilirubinemia as well as a blood transfusion. Her current pregnancy resulted from a different father than her two previous pregnancies, and she has no contact with him. The most reasonable next step in management is to assess

• fetal hemoglobin level
• fetal rhesus type by noninvasive prenatal testing
• maternal anti-D titer
• middle cerebral artery (MCA) peak systolic velocity
• paternal rhesus D antigen status

A 26-year-old, gravida 3, para 1, presents to your office at 18 weeks of gestation for a routine anatomical survey. She reports increased discharge and mild pelvic pressure over the past 2 weeks but reports no vaginal bleeding, contractions, or fever. Her previous pregnancy was delivered at 24 weeks of gestation after presenting with advanced cervical dilation and preterm prelabor rupture of membranes. She is receiving 17α-hydroxyprogesterone caproate injections weekly. Transvaginal ultrasonography shows a cervical length of 1.5 cm with cervical funneling. On your evaluation, speculum examination reveals a thin, white/grey discharge with rare clue cells, no yeast visualized on wet prep, and a negative fern test result. Digital examination reveals the cervix 1 cm dilated and 50% effaced. The condition that best explains these findings is

• bacterial vaginosis
• cervical insufficiency
• chorioamnionitis
• preterm labor
• preterm prelabor rupture of membranes

A 37-year-old patient, gravida 2, para 1, at 34 weeks of gestation calls your office for advice. She has no medical concerns and has had routine prenatal care. Her son was sent home from school yesterday with a fever and has tested positive for influenza A. The patient continues to care for her sick son. She denies fever, cough, shortness of breath, chest pain, and nausea. She denies contractions and reports fetal movement. The most appropriate management for her exposure is

• monitor for symptoms of influenza
• administer influenza vaccine
• test her for influenza A
• begin oseltamivir

A 21-year-old white woman comes to your office for contraceptive counseling. She elects to start combination oral contraceptives (OCs). She has no significant medical history and is taking no medications. On questioning about her family history, she tells you that her sister was recently diagnosed with a pulmonary embolism 3 days after a cesarean delivery and is now taking warfarin. Her mother has no history of thromboembolic disorders, but her father died suddenly from a stroke at age 50 years. The most likely thrombophilia to be found in this patient is

• prothrombin gene mutation (G20210A)
• antithrombin III deficiency
• factor V Leiden
• protein C deficiency
• protein S deficiency

A 28-year-old woman, gravida 2, para 1, was noted to have a fetus in breech presentation at 36 weeks of gestation. The woman is now at 38 weeks of gestation and presents for a planned external cephalic version (ECV). The fetal heart tracing is reactive, and the patient is having irregular contractions. Bedside ultrasonography confirms breech presentation with anterior placenta and an amniotic fluid index of 14 cm. In order to improve the chance for a successful ECV in this case, you administer

• indomethacin
• nifedipine
• nitric oxide
• terbutaline

A 32-year-old patient, gravida 3, para 2, at 41 weeks of gestation, was admitted to the labor and delivery unit for active labor. Her medical and surgical histories are noncontributory. Her labor course was complicated by a category III fetal heart rate tracing during the second stage. The patient underwent a spontaneous vaginal delivery, and umbilical cord arterial blood acid–base and gas measurements were obtained. Upon evaluation of the newborn, the neonatologist suspected a diagnosis of neonatal encephalopathy. The component of the umbilical cord blood that is most consistent with a neurologic injury that is a result of an acute intrapartum event is

• base deficit
• partial pressure of carbon dioxide (Pco2)
• partial pressure of oxygen (PO2)
• pH

A 25-year-old woman, gravida 3, para 1, comes to your office at 5 weeks of gestation. She has a history of spontaneous preterm delivery at 35 weeks of gestation followed by a first-trimester miscarriage. She is healthy and has no medical comorbidities. The patient smokes a half pack of cigarettes daily. In addition to advising smoking cessation and checking for asymptomatic bacteriuria, the most effective management recommendation to diminish her risk of preterm delivery is

• 17α-hydroxyprogesterone caproate
• abstinence from sexual intercourse
• prophylactic cervical cerclage
• limited physical activity
• oral progesterone

A 23-year-old woman, gravida 1, presents for prenatal care at 11 weeks of gestation. Her initial prenatal laboratory results show her rapid plasma reagen is positive with a titer of 1:16. Treponema pallidum passive particle agglutination is positive. She has no known history of syphilis and denies any symptoms. Her current partner has no history of syphilis. She has no drug allergies. The best treatment option is

• azithromycin for a week
• ceftriaxone for 3 days
• penicillin G benzathine intravenous IV for one dose
• penicillin G benzathine intramuscular IM or one dose
• penicillin G benzathine intramuscular for three weekly doses

A 36-year-old woman, gravida 2, para 2, with a history of homozygous factor V Leiden has been taking low-molecular-weight heparin during her pregnancy for thromboprophylaxis. She received a dose of low-molecular-weight heparin yesterday and had an uncomplicated vaginal delivery without epidural anesthesia today. After delivery, her low-molecular-weight heparin should be restarted in

• 1–2 hours
• 4–6 hours
• 10–12 hours
• 18–24 hours
• 36–48 hours

A 22-year-old woman, gravida 2, para 1, presents at 16 weeks of gestation for cervical length examination. She is currently receiving 17α-hydroxyprogesterone caproate for her history of spontaneous preterm delivery at 33 weeks of gestation. Her cervical length today is 24 mm.

• Bed Rest
• Cerclage
• expectant management
• vaginal progesterone