Advanced maternal age US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Advanced maternal age. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Advanced maternal age US Medical PG Question 1: A 39-year-old G3P0 woman presents for preconception counseling and evaluation. The patient’s past medical history reveals hypertension and type 1 diabetes. She is currently on an insulin pump and medications for hypertension including labetalol. Her blood pressure is 130/85 mm Hg; pulse, 76/min; and BMI, 26 kg/m2. Her most recent HbA1c is 6.5%. Her previous pregnancies ended in spontaneous abortion during the 1st trimester despite adequate prenatal care. The patient intends to have a healthy pregnancy and desires to learn more about the risk factors that potentially trigger miscarriage. Which of the following maternal risk factors is most likely associated with early pregnancy loss?
- A. Infection
- B. Hypercoagulable state
- C. Diabetes
- D. Chronic hypertension
- E. Age (Correct Answer)
Advanced maternal age Explanation: ***Age***
- **Maternal age** is a significant risk factor for aneuploidy, which is the leading cause of early pregnancy loss.
- As women age, the quality of their oocytes declines, increasing the risk of chromosomal abnormalities.
*Infection*
- While certain **infections** (e.g., toxoplasmosis, rubella, cytomegalovirus, herpes simplex) can cause miscarriage, they are less common causes of recurrent early pregnancy loss than chromosomal abnormalities.
- Infections would typically present with other systemic symptoms or specific laboratory findings, which are not mentioned here.
*Hypercoagulable state*
- **Hypercoagulable states** (e.g., antiphospholipid syndrome) are known causes of recurrent pregnancy loss, particularly in the second and third trimesters, but also in early pregnancy.
- However, for general early pregnancy loss, advanced maternal age leading to aneuploidy is a more common and direct risk factor.
*Diabetes*
- Poorly controlled **diabetes** (especially with HbA1c >8%) is a significant risk factor for miscarriage and congenital anomalies.
- This patient's HbA1c of 6.5% indicates reasonably good control, reducing the likelihood of diabetes being the primary sole cause for her recurrent losses.
*Chronic hypertension*
- **Chronic hypertension** is associated with an increased risk of preeclampsia, fetal growth restriction, and stillbirth, especially in later trimesters.
- While it can contribute to adverse pregnancy outcomes, it is not the most common direct cause of **early pregnancy loss,** particularly in the first trimester.
Advanced maternal age US Medical PG Question 2: Immediately following prolonged delivery of the placenta at 40 weeks gestation, a 32-year-old multiparous woman develops vaginal bleeding. Other than mild asthma, the patient’s pregnancy has been uncomplicated. She has attended many prenatal appointments and followed the physician's advice about screening for diseases, laboratory testing, diet, and exercise. Previous pregnancies were uncomplicated. She has no history of a serious illness. She is currently on intravenous infusion of oxytocin. Her temperature is 37.2°C (99.0°F), blood pressure is 108/60 mm Hg, pulse is 88/min, and respirations are 17/min. Uterine palpation reveals a soft enlarged fundus that extends above the umbilicus. Based on the assessment of the birth canal and placenta, which of the following options is the most appropriate initial step in patient management?
- A. Intramuscular carboprost
- B. Manual exploration of the uterus
- C. Discontinuing oxytocin
- D. Intravenous methylergonovine
- E. Uterine fundal massage (Correct Answer)
Advanced maternal age Explanation: ***Uterine fundal massage***
- The patient presents with **postpartum hemorrhage** indicated by vaginal bleeding and a **soft, enlarged fundus** after placental delivery, suggesting **uterine atony**.
- **Uterine fundal massage** is the **first-line intervention** to encourage uterine contraction and reduce bleeding by expelling clots and compressing vessels.
*Intramuscular carboprost*
- **Carboprost** is a **prostaglandin F2 alpha analog** used to treat **uterine atony** when initial measures like uterine massage and oxytocin are insufficient.
- It is contraindicated in patients with **asthma** due to its bronchoconstrictive effects, which this patient has.
*Manual exploration of the uterus*
- **Manual exploration of the uterus** is indicated when there is suspicion of **retained placental fragments** or **uterine rupture**.
- While these can cause postpartum hemorrhage, the primary finding of a soft, boggy uterus points more strongly to atony, making massage the immediate priority.
*Discontinuing oxytocin*
- The patient is already on an **intravenous oxytocin infusion**, which is a uterotonic agent used to prevent and treat uterine atony.
- Discontinuing it would worsen **uterine atony** and increase blood loss, directly contradicting the goal of management.
*Intravenous methylergonovine*
- **Methylergonovine** is an **ergot alkaloid** used to treat **uterine atony**, but it is contraindicated in patients with **hypertension**, which is not explicitly present here, but it is a potent vasoconstrictor and second-line.
- It is often used as a **second-line agent** if oxytocin and massage are ineffective and there are no contraindications.
Advanced maternal age US Medical PG Question 3: A 28-year-old woman, gravida 2, para 1, at 30 weeks' gestation comes to the physician because of headache for the past 5 days. Her pregnancy has been uncomplicated to date. Pregnancy and vaginal delivery of her first child were uncomplicated. The patient does not smoke or drink alcohol. She does not use illicit drugs. Medications include folic acid and a multivitamin. Her temperature is 37°C (98.6°F), pulse is 82/min, and blood pressure is 150/92 mm Hg. Physical examination reveals 2+ pitting edema in the lower extremities. Laboratory studies show:
Hemoglobin 11.8 g/dL
Platelet count 290,000/mm3
Urine
pH 6.3
Protein 2+
WBC negative
Bacteria occasional
Nitrites negative
The patient is at increased risk of developing which of the following complications?
- A. Abruptio placentae (Correct Answer)
- B. Polyhydramnios
- C. Uterine rupture
- D. Spontaneous abortion
- E. Placenta previa
Advanced maternal age Explanation: ***Abruptio placentae***
- The patient presents with **preeclampsia** (new-onset hypertension after 20 weeks gestation, proteinuria, and edema), which is a significant risk factor for **placental abruption**.
- Preeclampsia can lead to **vasoconstriction** and **decidual hemorrhage**, causing premature separation of the placenta from the uterine wall.
*Polyhydramnios*
- **Polyhydramnios** is an excess of amniotic fluid, typically associated with **fetal anomalies** (e.g., esophageal atresia, anencephaly) or **maternal diabetes**, none of which are indicated here.
- While it can complicate pregnancy, it is not directly linked to preeclampsia as a primary complication.
*Uterine rupture*
- **Uterine rupture** is a rare but catastrophic event, most commonly associated with a **prior Cesarean section**, extensive uterine surgery, or **traumatic injury**.
- This patient had an uncomplicated vaginal delivery previously, and there are no signs suggesting a heightened risk for uterine rupture.
*Spontaneous abortion*
- **Spontaneous abortion** occurs before 20 weeks of gestation. This patient is at **30 weeks' gestation**, making spontaneous abortion highly unlikely.
- The term for pregnancy loss after 20 weeks is stillbirth, which is also not the most immediate or direct complication linked to preeclampsia for the mother.
*Placenta previa*
- **Placenta previa** occurs when the placenta covers the cervical os, a condition diagnosed by **ultrasound** and presenting with **painless vaginal bleeding**.
- Preeclampsia does not directly cause placenta previa; these are distinct obstetric complications with different etiologies.
Advanced maternal age US Medical PG Question 4: A 35-year-old woman gravida 2, para 1, comes to the physician for her first prenatal visit. Pregnancy and delivery of her first child were uncomplicated. She is not sure about the date of her last menstrual period. Pelvic examination shows a uterus consistent in size with a 10-week gestation. An ultrasound examination confirms the gestational age and shows one fetus with no indication of multiple gestations. During counseling on pregnancy risks and possible screening and diagnostic tests, the patient states she would like to undergo screening for Down syndrome. She would prefer immediate and secure screening with a low risk to herself and the fetus. Which of the following is the most appropriate next step in management at this time?
- A. Nuchal translucency, pregnancy-associated plasma protein-A, human chorionic gonadotropin
- B. Maternal serum α-fetoprotein, human chorionic gonadotropin, unconjugated estriol, and inhibin A
- C. Chorionic villus sampling
- D. Amniocentesis
- E. Cell-free fetal DNA testing (Correct Answer)
Advanced maternal age Explanation: ***Cell-free fetal DNA testing***
- This is the most appropriate choice given the patient's desire for **immediate and secure screening with low risk** because it is a **non-invasive prenatal screening (NIPS)** method offering high sensitivity and specificity for Down syndrome, particularly in higher-risk pregnancies.
- It involves a simple maternal blood draw and can be performed as early as **10 weeks of gestation**, perfectly aligning with the patient's current gestational age and desire for early screening.
*Nuchal translucency, pregnancy-associated plasma protein-A, human chorionic gonadotropin*
- This combination represents the **first-trimester combined screen**, which is typically performed between 11 and 14 weeks of gestation. While suitable for early screening, **cell-free DNA testing offers higher detection rates and lower false-positive rates** for Down syndrome.
- The patient specifically asked for the most **secure and least risky** screening, and NIPS outperforms the combined screen in terms of diagnostic accuracy for aneuploidies.
*Maternal serum α-fetoprotein, human chorionic gonadotropin, unconjugated estriol, and inhibin A*
- This refers to the **quad screen**, which is typically performed in the **second trimester (15-20 weeks)**, making it too late for the patient's desire for immediate screening at 10 weeks gestational age.
- While a widely used screening tool, the quad screen has a **lower detection rate** for Down syndrome compared to cell-free DNA testing.
*Chorionic villus sampling*
- **Chorionic villus sampling (CVS)** is a **diagnostic, invasive procedure** that carries a small risk of miscarriage (approximately 1 in 455 or 0.22%) and is not a screening test.
- Although it can be performed earlier (typically between 10 and 13 weeks), the patient specifically requested a **low-risk screening** option, which CVS is not.
*Amniocentesis*
- **Amniocentesis** is also an **invasive diagnostic procedure** with a risk of miscarriage (approximately 1 in 900 or 0.11%) and is typically performed in the **second trimester (15-20 weeks)**.
- This option is unsuitable because the patient is at 10 weeks gestation and desires **immediate and low-risk screening**, not a diagnostic procedure with procedural risks a few weeks later.
Advanced maternal age US Medical PG Question 5: A 37-year-old primigravid woman comes to the physician at 13 weeks' gestation for a prenatal visit. She feels well. Her only medication is folic acid. Vital signs are within normal limits. Pelvic examination shows a uterus consistent in size with a 13-week gestation. Ultrasonography shows a nuchal translucency above the 99th percentile. Maternal serum pregnancy-associated plasma protein A is decreased and human chorionic gonadotropin concentrations are elevated to 2 times the median level. Which of the following is most likely to confirm the diagnosis?
- A. Chorionic villus sampling (Correct Answer)
- B. Cell-free DNA testing
- C. Triple screening test
- D. Amniocentesis
- E. Quadruple marker test
Advanced maternal age Explanation: ***Chorionic villus sampling***
- This procedure can be performed between **10 to 13 weeks of gestation** to obtain fetal cells for genetic analysis, which is within the patient's gestational age.
- It provides a definitive diagnosis of **chromosomal abnormalities** by directly sampling placental tissue, which shares the same genetic material as the fetus.
*Cell-free DNA testing*
- While it has high sensitivity and specificity for various **aneuploidies**, it is a **screening test**, not a diagnostic one.
- An abnormal result from cell-free DNA testing still requires **confirmatory diagnostic testing** such as CVS or amniocentesis.
*Triple screening test*
- This test is typically performed between **15 and 20 weeks of gestation**, which is too late to confirm the findings presented at 13 weeks gestation.
- It measures **AFP, hCG, and unconjugated estriol**, and an abnormal result would indicate a need for further diagnostic testing.
*Amniocentesis*
- This procedure is generally performed later in pregnancy, typically between **15 and 20 weeks gestation**, so it would require waiting several more weeks.
- While it provides definitive genetic results, **chorionic villus sampling is preferred at 13 weeks** due to earlier diagnostic potential.
*Quadruple marker test*
- This test is also performed between **15 and 20 weeks of gestation** and measures **AFP, hCG, unconjugated estriol, and inhibin A**.
- It is a **screening test**, similar to the triple screen, and does not provide a definitive diagnosis, requiring further confirmatory testing if abnormal.
Advanced maternal age US Medical PG Question 6: A 33-year-old woman, gravida 2, para 1, at 26 weeks' gestation comes to the emergency department because of frequent contractions. The contractions are 40 seconds each, occurring every 2 minutes, and increasing in intensity. Her first child was delivered by lower segment transverse cesarean section because of a nonreassuring fetal heart rate. Her current medications include folic acid and a multivitamin. Her temperature is 36.9°C (98.4°F), heart rate is 88/min, and blood pressure is 126/76 mm Hg. Contractions are felt on the abdomen. There is clear fluid in the vulva and the introitus. The cervix is dilated to 5 cm, 70% effaced, and station of the head is -2. A fetal ultrasound shows polyhydramnios, a median cleft lip, and fused thalami. The corpus callosum, 3rd ventricle, and lateral ventricles are absent. The spine shows no abnormalities and there is a four chamber heart. Which of the following is the most appropriate next step in management?
- A. Initiate misoprostol therapy
- B. Allow vaginal delivery (Correct Answer)
- C. Perform dilation and evacuation
- D. Initiate nifedipine therapy
- E. Perform cesarean delivery
Advanced maternal age Explanation: ***Allow vaginal delivery***
- The presence of severe fetal anomalies, including **holoprosencephaly** (median cleft lip, fused thalami, absent corpus callosum, 3rd and lateral ventricles), indicates that the fetus is **incompatible with life**.
- Given the prognosis, the most appropriate and safest approach for the mother is to **allow vaginal delivery**, as there is no benefit to delaying delivery or attempting a surgical intervention that might pose more risks to the mother.
*Initiate misoprostol therapy*
- **Misoprostol** is a prostaglandin analog used to induce labor or abortion, particularly in cases of uterine atony or to ripen the cervix.
- While it aids in cervical ripening and uterine contractions, the cervix is already 5 cm dilated and 70% effaced, indicating a **rapidly progressing labor** not requiring additional induction.
*Perform dilation and evacuation*
- **Dilation and evacuation (D&E)** is typically performed in the second trimester for fetal demise or termination of pregnancy, usually before 24 weeks' gestation.
- At 26 weeks' gestation with advanced labor and significant cervical dilation, D&E is a **high-risk procedure** for the mother and less appropriate than vaginal delivery.
*Initiate nifedipine therapy*
- **Nifedipine is a tocolytic** used to suppress preterm labor by relaxing the uterine muscles.
- Given the **lethal fetal anomalies** and the advanced stage of labor (5 cm dilated, 70% effaced, intense contractions), stopping labor would only prolong a non-viable pregnancy and increase maternal risk.
*Perform cesarean delivery*
- **Cesarean delivery** would expose the mother to surgical risks (e.g., infection, hemorrhage, future pregnancy complications) without any benefit to the fetus, who has anomalies **incompatible with survival**.
- A previous cesarean section does not preclude a vaginal delivery in this context, especially when **fetal viability is not a concern**.
Advanced maternal age US Medical PG Question 7: A 26-year-old woman, gravida 2, para 1, at 28 weeks' gestation comes to the physician for a prenatal visit. She feels well. Pregnancy and delivery of her first child were uncomplicated. Her temperature is 37.2°C (99°F) and blood pressure is 163/105 mm Hg. Her blood pressure 10 weeks ago was 128/84 mm Hg. At her last visit two weeks ago, her blood pressure was 142/92 mm Hg. Pelvic examination shows a uterus consistent in size with a 28-week gestation. A complete blood count and serum concentrations of electrolytes, creatinine, and hepatic transaminases are within the reference range. A urinalysis is within normal limits. Which of the following is the most appropriate next step in management?
- A. Oral labetalol therapy (Correct Answer)
- B. Lisinopril therapy
- C. Magnesium sulfate therapy
- D. Complete bed rest
- E. Dietary salt restriction
Advanced maternal age Explanation: **Oral labetalol therapy**
- The patient has developed **gestational hypertension** (blood pressure ≥140/90 mmHg on two occasions at least 4 hours apart after 20 weeks gestation, without proteinuria or other signs of preeclampsia), with her current BP of 163/105 mmHg confirming **severe range hypertension** (systolic ≥160 mmHg or diastolic ≥110 mmHg).
- **Labetalol** is a first-line agent for managing hypertension in pregnancy due to its established safety profile and efficacy in lowering blood pressure.
*Lisinopril therapy*
- **Angiotensin-converting enzyme (ACE) inhibitors** like lisinopril are **contraindicated in pregnancy** as they can cause fetal renal dysfunction, oligohydramnios, and neonatal hypotension.
- This medication choice would be harmful to the fetus.
*Magnesium sulfate therapy*
- **Magnesium sulfate** is indicated for the **prevention and treatment of seizures in preeclampsia/eclampsia**, not for blood pressure control itself.
- While the patient has hypertension, there are no signs of preeclampsia (e.g., proteinuria, signs of end-organ damage), making magnesium sulfate inappropriate at this stage.
*Complete bed rest*
- **Complete bed rest** is no longer recommended for the management of gestational hypertension or preeclampsia, as studies have shown it does not improve maternal or fetal outcomes and can increase the risk of **thromboembolism**.
- It can also negatively impact a patient's quality of life without providing therapeutic benefit.
*Dietary salt restriction*
- While generally recommended for hypertension outside of pregnancy, **severe salt restriction** in pregnancy is **not typically recommended** for gestational hypertension or preeclampsia, as it has not been shown to improve outcomes and could potentially worsen maternal fluid balance.
- The primary management for severe range gestational hypertension involves antihypertensive medications.
Advanced maternal age US Medical PG Question 8: A 23-year-old primigravid woman comes to the physician at 36 weeks' gestation for her first prenatal visit. She confirmed the pregnancy with a home urine pregnancy kit a few months ago but has not yet followed up with a physician. She takes no medications. Vital signs are within normal limits. Pelvic examination shows a uterus consistent in size with a 36-week gestation. Laboratory studies show:
Hemoglobin 10.6 g/dL
Serum
Glucose 88 mg/dL
Hepatitis B surface antigen negative
Hepatitis C antibody negative
HIV antibody positive
HIV load 11,000 copies/mL (N < 1000 copies/mL)
Ultrasonography shows an intrauterine fetus consistent in size with a 36-week gestation. Which of the following is the most appropriate next step in management of this patient?
- A. Intrapartum zidovudine and vaginal delivery when labor occurs
- B. Intrapartum zidovudine and cesarean delivery at 38 weeks' gestation
- C. Start cART and prepare for vaginal delivery at 38 weeks' gestation
- D. Conduct cesarean delivery immediately
- E. Start cART and schedule cesarean delivery at 38 weeks' gestation (Correct Answer)
Advanced maternal age Explanation: ***Start cART and schedule cesarean delivery at 38 weeks' gestation***
- This patient presents at 36 weeks with a **newly diagnosed HIV infection** and a **viral load of 11,000 copies/mL**, which is considered high. Starting **combination antiretroviral therapy (cART)** immediately is crucial to reduce the viral load and the risk of **mother-to-child transmission (MTCT)**.
- For patients with **HIV viral loads > 1,000 copies/mL** near term, a **scheduled cesarean delivery at 38 weeks** is recommended to minimize fetal exposure to maternal blood and secretions during labor, further reducing the risk of MTCT.
*Intrapartum zidovudine and vaginal delivery when labor occurs*
- This approach is appropriate for HIV-positive mothers with a **low viral load (< 1,000 copies/mL)** at or near delivery, as a scheduled cesarean section would not significantly further reduce the risk of transmission.
- Given the patient's **high viral load (11,000 copies/mL)**, **only intrapartum zidovudine** would be insufficient to adequately reduce the risk of MTCT during a vaginal delivery.
*Intrapartum zidovudine and cesarean delivery at 38 weeks' gestation*
- While a **scheduled cesarean delivery at 38 weeks** is indicated for a high viral load, simply administering **intrapartum zidovudine without prior cART** misses the opportunity to significantly reduce viral load before delivery.
- Starting **cART immediately** offers the best chance to lower viral load and optimize outcomes for both mother and child, which is superior to only intrapartum prophylaxis.
*Start cART and prepare for vaginal delivery at 38 weeks' gestation*
- Starting **cART is essential**, but preparing for a vaginal delivery with a **viral load of 11,000 copies/mL** at 36 weeks is inappropriate.
- A **high viral load** necessitates a ** scheduled cesarean delivery** to minimize the risk of MTCT, regardless of cART initiation at this late stage.
*Conduct cesarean delivery immediately*
- While immediate action is needed, an **emergency cesarean delivery** is not indicated at 36 weeks unless there are other obstetric complications or rapid deterioration.
- The primary goal is to **reduce viral load through cART** and then perform a **scheduled cesarean at 38 weeks**, balancing safety for both mother and fetus with the greatest reduction in HIV transmission risk.
Advanced maternal age US Medical PG Question 9: A 36-year-old G3P2002 presents to her obstetrician’s office for her first prenatal visit at ten weeks and two days gestation. She notes that she has felt nauseous the last several mornings and has been especially tired for a few weeks. Otherwise, she feels well. The patient has had two uncomplicated spontaneous vaginal deliveries at full term with her last child born six years ago. She is concerned about the risk of Down syndrome in this fetus, as her sister gave birth to an affected child at age 43. The patient has a history of generalized anxiety disorder, atopic dermatitis, and she is currently on escitalopram. At this visit, this patient’s temperature is 98.6°F (37.0°C), pulse is 70/min, blood pressure is 121/67 mmHg, and respirations are 13/min. The patient appears anxious, but overall comfortable, and cardiopulmonary and abdominal exams are unremarkable. Pelvic exam reveals normal female external genitalia, a closed and slightly soft cervix, a ten-week-sized uterus, and no adnexal masses. Which of the following is the best next step for definitively determining whether this patient’s fetus has Down syndrome?
- A. Anatomy ultrasound
- B. Genetic testing of patient’s sister
- C. Chorionic villus sampling (Correct Answer)
- D. Nuchal translucency test
- E. Amniocentesis
Advanced maternal age Explanation: ***Chorionic villus sampling***
- **Chorionic villus sampling (CVS)** is a diagnostic procedure performed between 10 and 13 weeks of gestation that involves taking a sample of placental tissue for genetic analysis. It provides a definitive diagnosis for chromosomal abnormalities like **Down syndrome** earlier in pregnancy than amniocentesis.
- Given the patient's anxiety and desire for definitive diagnosis due to family history, CVS is the most appropriate next step for an early and conclusive result.
*Anatomy ultrasound*
- An **anatomy ultrasound** (typically performed at 18-20 weeks) is a screening, not diagnostic, tool for fetal anomalies. While it can detect **structural abnormalities** associated with Down syndrome, it cannot definitively diagnose the condition.
- It would be too late to provide the early definitive diagnosis the patient is seeking regarding **Down syndrome**.
*Genetic testing of patient’s sister*
- The sister's genetic testing would confirm her child's diagnosis or carrier status for **chromosomal translocations**, but it does not provide information about the current patient's fetus.
- A definitive diagnosis for the current pregnancy must come from **fetal genetic material**.
*Nuchal translucency test*
- The **nuchal translucency test** is a **screening test** performed between 11 and 14 weeks that measures the fluid at the back of the fetal neck and is used in conjunction with biochemical markers (first-trimester screening) to assess the risk of Down syndrome. It is not diagnostic.
- An abnormal result would indicate an increased risk but would still require a **diagnostic test** like CVS or amniocentesis for confirmation.
*Amniocentesis*
- **Amniocentesis** is a diagnostic procedure that samples amniotic fluid for genetic analysis, typically performed between 15 and 20 weeks of gestation.
- While it provides a definitive diagnosis for **chromosomal abnormalities**, it is usually performed later in pregnancy than CVS. The patient is at 10 weeks and two days, making CVS a timelier option for early diagnosis.
Advanced maternal age US Medical PG Question 10: Six hours after giving birth to a healthy 3100 g (6 lb 13oz) girl, a 40-year-old woman, gravida 1, para 1 suddenly has a tonic-clonic seizure for 2-minutes while on the ward. She had been complaining of headache, blurry vision, and abdominal pain for an hour before the incident. Her pregnancy was complicated by gestational hypertension and iron deficiency anemia. Her medications until birth included labetalol, iron supplements, and a multivitamin. Her temperature is 37°C (98.7°F), pulse is 95/min, respirations are 18/min, and blood pressure is 152/100 mm Hg. The cranial nerves are intact. Muscle strength is normal. Deep tendon reflexes are 3+ with a shortened relaxation phase. Which of the following is the most appropriate next step in management?
- A. Calcium gluconate
- B. Phenytoin
- C. Magnesium sulfate (Correct Answer)
- D. Hydralazine
- E. Valproic acid
Advanced maternal age Explanation: ***Magnesium sulfate***
- The patient's presentation with a **tonic-clonic seizure**, headache, blurry vision, abdominal pain, hypertension, and hyperreflexia in the postpartum period is highly suggestive of **eclampsia**.
- **Magnesium sulfate** is the first-line and most appropriate agent for both the prevention and treatment of seizures in patients with eclampsia due to its neuroprotective and anticonvulsant effects.
*Calcium gluconate*
- **Calcium gluconate** is the antidote for **magnesium sulfate toxicity**, not a primary treatment for eclamptic seizures.
- Administering calcium gluconate before magnesium sulfate would be incorrect as it would counteract a beneficial medication that isn't yet administered.
*Phenytoin*
- **Phenytoin** is an **antiepileptic drug** that can be used for seizure control, but it is considered a second-line agent for eclampsia, after magnesium sulfate has been tried or is contraindicated.
- Magnesium sulfate has superior efficacy and a better side-effect profile for eclamptic seizures compared to phenytoin.
*Hydralazine*
- **Hydralazine** is an **antihypertensive medication** used to manage severe hypertension, particularly in pregnancy.
- While the patient's blood pressure is elevated, the priority in eclampsia is seizure control, which is not directly addressed by hydralazine.
*Valproic acid*
- **Valproic acid** is a broad-spectrum **antiepileptic drug** used for various seizure types.
- It is not the first-line agent for eclamptic seizures and its use in this context is less established and less effective than magnesium sulfate.
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