Puerperium, Rh Isoimmunization and Cesarean Section MCQs

Obstetrics & Gynaecology · 121 free questions with answers & explanations.

1. An Rh-negative unsensitized woman delivers an Rh-positive baby. The Kleihauer-Betke test shows a fetomaternal hemorrhage of 40 mL of fetal blood. Standard dose anti-D immunoglobulin (300 mcg IM) covers up to 30 mL of fetal blood. What is the CORRECT additional management?
2. A woman undergoes a cesarean section for failure to progress. The Pfannenstiel incision and lower uterine segment transverse (LUST) incision are used. Which of the following is the MOST common indication for cesarean section in developed countries?
3. An Rh-negative mother delivers an Rh-positive infant. The Kleihauer-Betke test shows 1.2% fetal cells in the maternal circulation. The dose of anti-D immunoglobulin required is:
4. A Rh-negative woman who had an anti-D injection at 28 weeks presents for delivery at 40 weeks. What is the indication for anti-D after delivery?
5. An Rh-negative primigravida delivers a Rh-positive baby. Her indirect Coombs test at 28 weeks was negative. The Kleihauer-Betke test after delivery shows 0.8% fetal cells in maternal blood. What dose of anti-D immunoglobulin should be administered?
6. A woman develops fever on day 4 postpartum after an emergency cesarean section. She has uterine tenderness, foul-smelling lochia, and WBC of 18,500/µL. Cultures are pending. What is the MOST appropriate first-line empirical antibiotic regimen?
7. A woman had a previous classical (vertical body) cesarean section at 28 weeks for abruptio placentae. She is now pregnant at 38 weeks. What is the recommended timing and mode of delivery?
8. The critical mechanism by which Rh-D immunoprophylaxis (anti-D immunoglobulin) prevents maternal sensitization is:
9. In management of Rh isoimmunization, the middle cerebral artery peak systolic velocity (MCA-PSV) is used to monitor for fetal anemia. An MCA-PSV above which multiple of the median (MoM) indicates the need for cordocentesis and possible intrauterine transfusion?
10. In the Misgav Ladach technique of cesarean section, which specific modification reduces blood loss and operative time compared to the Pfannenstiel-Kerr technique?
11. A Rh-negative woman delivers an Rh-positive infant. The Kleihauer-Betke (acid elution) test shows 2.5% fetal cells in maternal blood. What volume of fetal haemorrhage does this represent and what dose of Rh immunoglobulin (RhIg) is required?
12. A G3P2 with two prior lower segment cesarean sections requests a trial of labour after cesarean (TOLAC). She has no prior uterine rupture and her prior cesarean incision was a low transverse incision. Which is the most significant independent risk factor that would make TOLAC inadvisable in her current pregnancy?
13. In the management of subacute postpartum thyroiditis, which clinical feature distinguishes it from Graves' hyperthyroidism postpartum, and what is the key difference in radioactive iodine uptake (RAIU) test results?
14. The critical antibody titre above which the fetus is at significant risk of severe haemolytic disease of the fetus/newborn (HDFN) requiring invasive surveillance (MCA Doppler/amniocentesis) is:
15. In a patient with a previous lower segment caesarean section (LSCS), which of the following is the MOST reliable sonographic predictor of uterine rupture in a subsequent trial of labour (TOLAC)?
16. According to Clavien-Dindo classification, a postoperative wound dehiscence after caesarean section requiring reoperation under general anaesthesia (but with full recovery and no residual disability) is classified as:
17. A Rh-negative woman is being evaluated for Rh isoimmunization risk. The Kleihauer-Betke (KB) test is performed after delivery. What is the principle of the KB test, and what does a result of 1.8% fetal cells indicate in terms of required anti-D dose?
18. In the management of Rh isoimmunization, the Middle Cerebral Artery (MCA) Peak Systolic Velocity (PSV) is used to predict fetal anemia. What is the pathophysiological basis for increased MCA-PSV in fetal anemia, and at what MCA-PSV threshold is fetal blood sampling/intrauterine transfusion indicated?
19. The Kleihauer-Betke (KB) test quantifies fetal cells in maternal blood by exploiting which principle, and what dose of anti-D RhIg is given per mL of fetal blood detected?
20. A Rh-negative woman at 28 weeks is found to have anti-D titer of 1:32. Fetal Doppler shows MCA-PSV of 1.58 MoM. According to current management guidelines, the next step is:
21. Regarding ERAS (Enhanced Recovery After Surgery) protocols for elective cesarean section, which intervention has the strongest evidence for reducing time to return of bowel function and length of hospital stay?
22. The Kleihauer-Betke (KB) test detects fetal erythrocytes in maternal circulation after a potentially sensitizing event. The calculation to determine the volume of fetomaternal hemorrhage (FMH) and additional anti-D dose needed uses the formula: FMH volume (mL) = % fetal cells × maternal blood volume × correction factor. The standard correction factor used is:
23. In a subsequent pregnancy after a prior uterine rupture (through and through scar involving all layers), the most appropriate counseling regarding mode of delivery is:
24. The ORACLE trial evaluated antibiotics in preterm prelabour rupture of membranes (PPROM). Which antibiotic regimen was found to be harmful (increasing necrotizing enterocolitis risk in the neonate) and should NOT be used in PPROM?
25. The Kleihauer-Betke (KB) test is performed post-delivery in an Rh-negative mother who delivered an Rh-positive infant. The KB result is 1.5%. Assuming maternal blood volume is 5,000 mL and fetal cell volume is twice the maternal, the approximate volume of feto-maternal hemorrhage (FMH) is:
26. In a woman with Rh sensitization (anti-D titer 1:32), weekly middle cerebral artery-peak systolic velocity (MCA-PSV) Doppler monitoring is used to detect fetal anemia. The threshold value of MCA-PSV that indicates need for fetal blood sampling (or intrauterine transfusion in a hydropic fetus) is:
27. Enhanced Recovery After Cesarean (ERAC) protocols recommend which intervention to reduce time to ambulation and reduce postoperative ileus after elective cesarean section?
28. A Rh-negative unsensitized woman at 28 weeks gestation receives antenatal anti-D 300 mcg IM. She then has a vaginal delivery at 38 weeks. A Kleihauer-Betke (KB) test is performed on maternal blood within 1 hour of delivery, showing 1.2% fetal cells. How many additional vials of anti-D (300 mcg each) should she receive?
29. A patient with dichorionic diamniotic (DCDA) twins at 38+2 weeks is in active labor. Twin A is vertex presentation. Twin B is transverse lie. Twin A delivers vaginally. After delivery of Twin A, CTG of Twin B shows a variable deceleration pattern. Estimated weight of Twin B is 2.8 kg. What is the MOST appropriate next management step?
30. A woman requests elective repeat cesarean section (ERCS) at 39 weeks. She is counseled about Trial of Labor After Cesarean (TOLAC). Which factor in her history represents the STRONGEST absolute contraindication to TOLAC?
31. In Rh isoimmunisation, the critical window for anti-D immunoglobulin administration is within 72 hours of a sensitising event. In a Rh-negative woman at 28 weeks of gestation with no anti-D antibodies, antenatal prophylaxis is recommended. What is the mechanism by which anti-D immunoglobulin prevents Rh sensitisation?
32. Middle cerebral artery peak systolic velocity (MCA-PSV) Doppler is used to monitor the fetus of an Rh-sensitised mother. An MCA-PSV >1.5 MoM indicates moderate-to-severe fetal anaemia. Why does fetal anaemia increase the MCA-PSV?
33. The Joel-Cohen incision is used as an alternative to the Pfannenstiel incision for caesarean section. The CAESAR trial and Cochrane reviews compare these techniques. Which of the following describes the anatomical difference between the Joel-Cohen and Pfannenstiel techniques?
34. A Rh-negative woman delivers an Rh-positive baby. Kleihauer-Betke (KB) test reveals 1.5% fetal cells in maternal circulation. How is the total volume of feto-maternal haemorrhage (FMH) and the anti-D dose calculated using this test?
35. The Enhanced Recovery After Caesarean (ERAC) protocol, modelled on ERAS principles, recommends which of the following as a key element differing from traditional post-caesarean care?
36. Post-partum thyroiditis (PPT) affects 5–9% of women in the first year after delivery. Regarding its natural history and clinical management, which statement is accurate?
37. A Rh-negative mother delivers a Rh-positive baby. A Kleihauer-Betke test shows 2.2% fetal cells in maternal circulation. How many doses of anti-D immunoglobulin (300 mcg standard dose) are required to neutralise this fetomaternal hemorrhage?
38. A woman with a previous classical cesarean section presents for planning of her third pregnancy. She is advised against a trial of labour. What is the estimated risk of uterine rupture with a classical (vertical body) uterine incision compared to a low transverse uterine incision, and why does this anatomical difference matter?
39. In RhD isoimmunization, the Kleihauer-Betke (KB) test is performed to quantify fetomaternal haemorrhage. A woman has a KB test with 0.8% fetal cells in maternal blood. The mother's blood volume is estimated at 5000 mL. How many vials of anti-D immunoglobulin (300 µg/vial) would be required, given that each 300 µg anti-D protects against 15 mL of fetal red blood cells (or 30 mL whole fetal blood)?
40. In the assessment of a uterine scar for trial of labour after caesarean (TOLAC), the single most important contraindication to TOLAC according to ACOG 2019 Practice Bulletin is:
41. A Rh-negative woman at 28 weeks gestation receives antenatal anti-D prophylaxis. At delivery, her baby is Rh-positive. The Kleihauer-Betke test shows 0.2% fetal cells in maternal circulation. Maternal blood volume is 4500 mL, haematocrit 33%. Calculate the volume of fetomaternal haemorrhage (FMH) in mL of fetal red cells and the appropriate anti-D dose.
42. A patient with a previous classical (vertical) uterine incision caesarean section at 32 weeks is now 36 weeks pregnant. What is the MOST significant risk differentiating her from a woman with a previous low transverse caesarean section (LSCS)?
43. The GTN (gestational trophoblastic neoplasia) prognostic scoring — NOT to be confused with WHO/FIGO GTN scoring — refers to the Newcastle scoring system for puerperal sepsis risk stratification. However, what is the most validated clinical scoring system currently recommended for screening for postpartum haemorrhage risk used routinely on the labour ward?
44. The Kleihauer-Betke (KB) test quantifies fetal-maternal haemorrhage to determine anti-D immunoglobulin dosing. In a Rh-negative woman post-delivery with 1.2% fetal cells on KB test, maternal blood volume estimated at 5000 mL, and hematocrit 36%, the volume of fetomaternal haemorrhage is approximately (to the nearest mL):
45. In monitoring Rh-alloimmunised pregnancies, the middle cerebral artery peak systolic velocity (MCA-PSV) >1.5 MoM predicts fetal anaemia with what sensitivity and has replaced which older invasive procedure?
46. The Misgav Ladach method of caesarean section uses the Joel-Cohen incision. Compared to the Pfannenstiel-Kerr technique, its advantages include:
47. Rh-negative woman delivers an Rh-positive baby. A Kleihauer-Betke test reveals 1.5% fetal cells in the maternal circulation. What is the minimum volume of fetal-maternal hemorrhage and how many standard doses of anti-D immunoglobulin are required?
48. Enhanced recovery after cesarean (ERAC) protocols have improved postoperative outcomes. Which component of ERAC has the strongest evidence for reducing time to first ambulation and hospital stay?
49. Peripartum cardiomyopathy (PPCM) is a diagnosis of exclusion. According to the ESC 2019 position statement, which drug used for heart failure is ABSOLUTELY CONTRAINDICATED in PPCM during active breastfeeding?
50. An Rh-negative (D-negative) woman at 28 weeks gestation with Rh-negative partner and indirect Coombs test (ICT) negative receives routine antenatal anti-D prophylaxis. The dose of Rh immunoglobulin given at 28 weeks in India/UK guidelines and the half-life of anti-D immunoglobulin respectively are:
51. A Rh-D negative woman delivers an Rh-D positive baby after an emergency cesarean for placental abruption with significant abruption estimated at 250 mL fetal blood exposure. Kleihauer-Betke (acid elution) test shows 2.8% fetal cells in maternal blood. The volume of fetomaternal hemorrhage (FMH) calculated using the Kleihauer-Betke result, assuming maternal blood volume of 5000 mL, is:
52. Regarding uterine rupture scar assessment in trial of labor after cesarean (TOLAC), the MOST important sonographic predictor of scar dehiscence risk is:
53. A Rh-negative woman at 28 weeks gestation with no prior sensitisation (indirect Coombs test negative) receives antenatal anti-D prophylaxis. The rationale for this prophylaxis is:
54. A Rh-negative woman with anti-D titre of 1:64 at 24 weeks is being monitored. Which investigation best predicts fetal anaemia requiring intervention at this gestation?
55. A woman with two previous lower segment cesarean sections is scheduled for her third cesarean. Intraoperatively, the bladder is found densely adherent to the lower uterine segment. Which step should precede uterine incision?
56. A Rh-negative woman who is unsensitised delivers a Rh-positive baby. She did not receive antenatal anti-D prophylaxis. Anti-D immunoglobulin should be administered within what time frame post-delivery to be effective?
57. A woman undergoes elective caesarean section at 39 weeks. She develops a wound haematoma on Day 3 with induration and fluctuation. Temperature is 38.2°C. The haematoma is 8 cm in diameter with purulent discharge. The MOST appropriate management is:
58. The CORONIS collaborative randomised trial assessed 5 caesarean section technical elements. Regarding uterine closure, the trial found that single-layer versus double-layer closure of the uterine incision resulted in:
59. A Rh-negative, antibody-negative primigravida is at 28 weeks. She has not received anti-D immunoglobulin. According to RCOG/ACOG guidelines, antenatal anti-D prophylaxis should be administered as:
60. In Rh isoimmunized pregnancy, which parameter measured by Doppler ultrasound is used as the PRIMARY non-invasive surveillance tool to assess fetal anaemia?
61. The CAESAR trial and CORONIS trial evaluated techniques for cesarean section. Regarding uterine closure, which approach was found to be equivalent or preferable regarding re-entry difficulty and uterine scar thickness?
62. A Rh-negative woman delivers a Rh-positive baby at term. A Kleihauer-Betke (KB) test is performed and reveals 1.2% fetal cells. Using the KB test to calculate the volume of fetomaternal hemorrhage (FMH) and the anti-D dose required (using the formula: FMH mL = KB% × maternal blood volume / 100, maternal blood volume = 5000 mL; 1 vial anti-D = 300 µg neutralises 15 mL fetal RBCs), the required anti-D dose is:
63. Middle cerebral artery (MCA) peak systolic velocity (PSV) Doppler is used to screen for fetal anaemia in Rh-isoimmunized pregnancies. Which MCA-PSV threshold (in multiples of median, MoM) is used to diagnose moderate-to-severe fetal anaemia and guide the decision for intrauterine transfusion?
64. A woman undergoes elective lower segment cesarean section (LSCS) at 39 weeks. The uterine incision is the standard transverse lower uterine segment incision. Compared to the Misgav Ladach (Modified Joel-Cohen) technique, the traditional Pfannenstiel-Kerr technique is associated with:
65. A Rh-negative woman delivers a Rh-positive baby. The Kleihauer-Betke (acid-elution) test on maternal blood shows 0.6% fetal cells. The maternal blood volume is 5,000 mL. Calculate the volume of fetomaternal haemorrhage and the total dose of anti-D required (each 300 mcg vial protects against 30 mL fetal whole blood).
66. In the management of a woman with a previous classical (vertical) caesarean section scar who presents in spontaneous labour at 36 weeks, the correct management is:
67. Puerperal pyrexia is defined as temperature ≥38°C occurring after the first 24 hours of delivery. Which is the MOST common cause of puerperal pyrexia in the first 24–48 hours?
68. A Rh-negative primigravida at 28 weeks gestation has a Kleihauer-Betke test showing 0.8% fetal cells in maternal blood after an antepartum haemorrhage. The estimated fetomaternal haemorrhage (FMH) volume is:
69. In the management of severe Rh alloimmunisation with fetal hydrops at 26 weeks, the treatment of choice is:
70. The peak concentration of Middle Cerebral Artery (MCA) Doppler PSV corresponding to moderate-to-severe fetal anaemia is defined as exceeding what multiples of the median (MoM)?
71. Enhanced recovery after caesarean section (ERAC) protocols include which intervention shown to reduce post-operative ileus and time to first bowel movement?
72. A Rh-negative woman delivers a Rh-positive baby. Kleihauer-Betke test identifies 4 mL of fetal red cells in the maternal circulation. Given that 500 IU of anti-D covers 4 mL of fetal red cells, the required dose of anti-D immunoglobulin is:
73. The Joel-Cohen incision for cesarean section, compared to the Pfannenstiel incision, is associated with which advantage in Cochrane meta-analyses?
74. A 25-year-old woman develops fever (38.9°C), foul-smelling lochia, and uterine tenderness on day 4 postpartum after prolonged labour with ruptured membranes for 18 hours. The most common causative aetiology of puerperal endometritis in this clinical context is:
75. A woman with a single previous low-transverse cesarean section (LTCS) desires VBAC. Which factor is associated with the HIGHEST predicted success for trial of labour after cesarean (TOLAC)?
76. A Rh-negative unsensitised woman at 28 weeks receives antenatal anti-D prophylaxis (500 IU). At 30 weeks, she is involved in a minor road traffic accident with suspected fetal-maternal haemorrhage (FMH). A Kleihauer-Betke test on maternal blood shows 0.8% fetal cells. Her blood volume is estimated at 5000 mL. Calculate the volume of FMH and determine if additional anti-D is required.
77. A 30-year-old woman develops puerperal pyrexia on day 3 post-normal vaginal delivery. Temperature is 38.6°C. Examination reveals a tender, bulky uterus with foul-smelling lochia. WBC is 18,000/µL. The most likely causative organism and appropriate antibiotic regimen is:
78. Enhanced recovery after caesarean section (ERAC) protocols have improved patient outcomes. Which single intervention has the most consistent evidence for reducing opioid consumption after cesarean section without compromising analgesia quality?
79. An Rh-negative primigravida delivers an Rh-positive baby. The Kleihauer-Betke test shows 1.5% fetal cells in maternal blood. What is the minimum dose of anti-D immunoglobulin required to cover this fetomaternal haemorrhage (FMH)?
80. A 30-year-old woman presents for repeat caesarean section (third CS). Intraoperatively, dense bladder adhesions are encountered. The lower uterine segment appears vascular and thinned. Which initial step minimises the risk of bladder injury?
81. The ORACLE I trial evaluated the use of antibiotics in women with preterm prelabour rupture of membranes (PPROM). Its principal finding regarding erythromycin was:
82. A Rh-negative woman delivers a Rh-positive baby after an uncomplicated vaginal delivery. The Kleihauer-Betke (KB) test is performed and shows 0.8% fetal cells. The calculated feto-maternal haemorrhage (FMH) is approximately 40 mL of fetal blood. The dose of anti-D required is:
83. In a woman with previous one lower segment caesarean section (LSCS) undergoing trial of labour, the MOST reliable clinical sign of impending uterine scar rupture during active labour is:
84. The DECISION trial investigated preterm birth in women with a previous caesarean scar thickness ≤2.5 mm. Its primary clinical recommendation was:
85. Puerperal pyrexia is defined in obstetrics as a temperature of ≥38°C on which of the following specific criteria?
86. A Rh-negative woman delivers a Rh-positive baby. Kleihauer-Betke test reveals 0.3% fetal cells in maternal blood. Calculated fetal-maternal hemorrhage is approximately 15 mL of fetal blood. How many doses of standard anti-D immunoglobulin (300 mcg) are required?
87. After cesarean section, the most appropriate thromboprophylaxis for a woman with BMI 35 and prior history of deep vein thrombosis is:
88. A woman has her third consecutive cesarean section. The surgeon notes that the lower uterine segment is thin, adherent to the bladder, and the serosa appears scarred. The most feared intraoperative complication specific to this scenario is:
89. A Rh-negative woman delivers a Rh-positive baby. The Kleihauer-Betke test shows a fetomaternal hemorrhage (FMH) of 35 mL of fetal blood. Each vial of anti-D immunoglobulin (300 mcg/1500 IU) covers a FMH of 30 mL fetal RBCs. How many vials are required?
90. The Joel-Cohen incision for cesarean section differs from a Pfannenstiel incision in which way?
91. Puerperal pyrexia is defined in the UK as a temperature of 38°C or more persisting for how long after delivery?
92. Regarding the anti-D immunoglobulin administration for routine antenatal prophylaxis in Rh-negative women, which schedule is recommended by RCOG?
93. In trial of labor after cesarean (TOLAC), which factor carries the HIGHEST risk for uterine rupture during labor?
94. The Kleihauer-Betke (acid elution) test is performed to quantify fetomaternal hemorrhage. The test exploits the fact that fetal hemoglobin (HbF) is resistant to acid elution while adult hemoglobin (HbA) is eluted. A woman has 1 fetal cell per 3000 maternal cells seen on KB smear. Approximately how many fetal cells in 300,000 maternal cells would be seen per 300,000 RBCs, if this is conceptually extended: and what approximate anti-D dose is required (300 mcg anti-D protects against 30 mL fetal whole blood)?
95. Anti-D immunoglobulin is given routinely at 28 weeks in an Rh-negative woman (antenatal anti-D prophylaxis). What is the primary rationale for this timing?
96. In the WHO classification of indications for cesarean section, what is the WHO's position on the 'optimal' CS rate at a population level (2015 statement)?
97. An Rh-negative primigravida delivers a 3.4 kg Rh-positive baby. A Kleihauer-Betke test is performed on maternal blood. The result shows 0.5% fetal cells in maternal blood. The volume of feto-maternal haemorrhage (FMH) and the additional dose of anti-D immunoglobulin required (above the routine 300 µg) are calculated. The estimated volume of FMH is:
98. In Rh isoimmunisation with hydrops fetalis detected at 24 weeks (peak systolic velocity in middle cerebral artery > 1.5 MoM), the procedure of choice is:
99. Which named trial (CAESAR trial) evaluated the effect of uterine closure technique (single-layer vs double-layer) on subsequent uterine scar thickness?
100. A Rh-negative unsensitised woman delivers a Rh-positive infant. The Kleihauer-Betke test on maternal blood reveals that 0.8% of her red blood cells are fetal. The calculated fetal-maternal haemorrhage volume is approximately 40 mL of fetal whole blood. How many standard 300 μg doses of anti-D immunoglobulin should she receive?
101. Regarding the trial of labour after caesarean (TOLAC), which single factor most significantly increases the risk of uterine rupture compared to a repeat elective caesarean section?
102. A Rh-negative woman delivers an Rh-positive neonate after a normal vaginal delivery. Kleihauer-Betke test shows 0.4% fetal cells in maternal circulation. To calculate the volume of fetal blood in maternal circulation: 0.4% × 50 = 200 mL fetal blood. The number of doses of anti-D immunoglobulin (300 µg per dose) required is:
103. A Rh-negative primigravida at 28 weeks receives antenatal anti-D prophylaxis (300 µg IM). At 36 weeks, indirect Coombs test is weakly positive. The CORRECT interpretation is:
104. A woman has repeat cesarean section. Intraoperatively, an inadvertent cystotomy is made. The PREFERRED repair technique and timing is:
105. A woman presents on day 10 postpartum with high fever (39.5°C), rigors, and a tender, engorged left breast with an area of fluctuance. Ultrasound confirms a 4 cm abscess. The MOST appropriate management is:
106. The lactational amenorrhea method (LAM) of contraception is considered highly effective (>98%) under which SPECIFIC conditions?
107. A Rh-negative woman at 28 weeks has a routine antenatal visit. Her indirect Coombs test (ICT) is negative. She had a term delivery 2 years ago (baby was Rh positive) and received anti-D at that time. What is the correct management now?
108. Middle cerebral artery peak systolic velocity (MCA-PSV) is used in Rh isoimmunised pregnancies. Which MCA-PSV threshold triggers fetal blood sampling and possible intrauterine transfusion?
109. A woman with two previous lower-segment cesarean sections requests a trial of labour (TOLAC). She has a spontaneous onset of labour at 39 weeks. Which finding during labour is the most specific early warning of uterine rupture?
110. A woman 5 days postpartum presents with fever 38.8°C, uterine tenderness, and purulent lochia. Endometritis is diagnosed. She had a cesarean delivery. Which antibiotic regimen is most appropriate?
111. A Rh-negative woman at 28 weeks gestation undergoes amniocentesis for fetal karyotyping. She has not yet received antenatal anti-D prophylaxis. How many international units of anti-D immunoglobulin should be administered?
112. The fetal middle cerebral artery (MCA) peak systolic velocity (PSV) is used to screen for fetal anaemia in Rh-sensitised pregnancies. The threshold PSV value that indicates moderate-to-severe fetal anaemia and warrants cordocentesis or intrauterine transfusion is:
113. The Joel-Cohen incision used for cesarean section differs from the Pfannenstiel incision in which KEY technical way?
114. Puerperal pyrexia is defined as a temperature of 38°C or more on how many occasions after the first 24 hours following delivery, within the first 10 days postpartum?
115. A woman develops fever (38.5°C), uterine tenderness, foul-smelling lochia, and leukocytosis on day 3 postpartum following vaginal delivery. Blood cultures are negative. What is the FIRST-LINE antibiotic regimen for this clinical presentation of postpartum endometritis?
116. The 'OASI' (Obstetric Anal Sphincter Injury) Bundle approach, used in UK and Scandinavia to reduce 3rd and 4th degree perineal tears, includes which key component?
117. In Rh isoimmunization management, the peak systolic velocity (PSV) of the fetal middle cerebral artery (MCA) on Doppler is used to predict fetal anaemia. A MCA-PSV greater than how many multiples of the median (MoM) indicates the need for fetal blood sampling/intrauterine transfusion?
118. A woman develops fever (39°C), uterine tenderness, and foul-smelling lochia on day 3 postpartum. She had a prolonged labour with multiple vaginal examinations. Blood cultures are pending. What is the MOST appropriate empirical antibiotic regimen?
119. Subinvolution of the uterus postpartum is most commonly caused by:
120. In trial of scar (TOLAC), the MOST feared complication is uterine rupture. Which clinical sign MOST SPECIFICALLY indicates impending uterine rupture?
121. A 35-year-old Rh-negative woman delivers her second baby. The baby is Rh-positive. The Kleihauer-Betke test is performed 1 hour after delivery. It shows 0.2% fetal cells in the maternal circulation. Maternal blood volume is 5000 mL. Calculate the FMH volume and determine the dose of anti-D immunoglobulin required.