A 29-year-old woman, gravida 1, para 0, at 36 weeks' gestation is brought to the emergency department after an episode of dizziness and vomiting followed by loss of consciousness lasting 1 minute. She reports that her symptoms started after lying down on her back to rest, as she felt tired during yoga class. Her pregnancy has been uncomplicated. On arrival, she is diaphoretic and pale. Her pulse is 115/min and blood pressure is 90/58 mm Hg. On examination, the patient is lying in the supine position with a fundal height of 36 cm. There is a prolonged fetal heart rate deceleration to 80/min. Which of the following is the most appropriate action to reverse this patient's symptoms in the future?

Lying in the left lateral decubitus position

Gentle compression with an abdominal binder

Lying in the supine position and elevating legs

Performing the Valsava maneuver

A 40-year-old pregnant woman, G4 P3, visits your office at week 30 of gestation. She is very excited about her pregnancy and wants to be the healthiest she can be in preparation for labor and for her baby. What vaccination should she receive at this visit?

Tetanus, diphtheria, and acellular pertussis (Tdap)

Measles, mumps, and rubella (MMR)

Live attenuated influenza vaccine

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?

Manual exploration of the uterus

A 27-year-old Hispanic G2P1 presents for a routine antepartum visit at 26 weeks gestation. She has no complaints. The vital signs are normal, the physical examination is within normal limits, and the gynecologic examination corresponds to 25 weeks gestation. The oral glucose tolerance test (OGTT) with a 75-g glucose load is significant for a glucose level of 177 mg/dL at 1 hour and 167 mg/dL at 2 hour. The fasting blood glucose level is 138 mg/dL (7.7 mmol/L), and the HbA1c is 7%. Which of the following represents the proper initial management?

Dietary and lifestyle modification

A 44-year-old woman with high blood pressure and diabetes presents to the outpatient clinic and informs you that she is trying to get pregnant. Her current medications include lisinopril, metformin, and sitagliptin. Her blood pressure is 136/92 mm Hg and heart rate is 79/min. Her physical examination is unremarkable. What should you do regarding her medication for high blood pressure?

Discontinue lisinopril and initiate labetalol

Discontinue lisinopril and initiate aliskiren

Continue her current regimen and add a beta-blocker for increased control

Discontinue lisinopril and initiate candesartan

A 23-year-old nulligravida presents for evaluation 5 weeks after her last menstrual period. Her previous menstruation cycle was regular, and her medical history is benign. She is sexually active with one partner and does not use contraception. A urine dipstick pregnancy test is negative. The vital signs are as follows: blood pressure 120/80 mm Hg, heart rate 71/min, respiratory rate 13/min, and temperature 36.8°C (98.2°F). The physical examination is notable for breast engorgement, increased pigmentation of the nipples, and linea nigra. The gynecologic examination demonstrates cervical and vaginal cyanosis. Measurement of which of the following substances is most appropriate in this case?

Blood human chorionic gonadotropin

Urinary human chorionic gonadotropin

A 29-year-old woman presents to a medical office complaining of fatigue, nausea, and vomiting for 1 week. Recently, the smell of certain foods makes her nauseous. Her symptoms are more pronounced in the mornings. The emesis is clear-to-yellow without blood. She has had no recent travel out of the country. The medical history is significant for peptic ulcer, for which she takes pantoprazole. The blood pressure is 100/60 mm Hg, the pulse is 70/min, and the respiratory rate is 12/min. The physical examination reveals pale mucosa and conjunctiva, and bilateral breast tenderness. The LMP was 9 weeks ago. What is the most appropriate next step in the management of this patient?

Beta-HCG levels and a transvaginal ultrasound

Beta-HCG levels and a transabdominal ultrasound

Beta-HCG levels and a pelvic CT

Three days after delivery of a male newborn, a 36-year-old gravida 1, para 1 woman has fever and pain in her left leg. Pregnancy was complicated by premature rupture of membranes; the child was delivered at 35 weeks' gestation by lower segment transverse cesarean section because of a nonreassuring fetal heart rate. The patient has smoked half a pack of cigarettes daily for 5 years and continued to smoke during her pregnancy. Her temperature is 38.9°C (102°F), pulse is 110/min, and blood pressure is 110/80 mm Hg. Examination shows an edematous, erythematous, and warm left leg. Passive dorsiflexion of the left foot elicits pain in the calf. The peripheral pulses are palpated bilaterally. The uterus is nontender and palpated at the umbilicus. Ultrasonography of the left leg shows an incompressible left popliteal vein. Which of the following is the most appropriate initial step in management?

Graduated compression stockings

Exercise in pregnancy for USMLE Step 1: High-Yield OB/GYN Lessons

Benefits & Recommendations - Fit for Two

ACOG Guideline: All pregnant patients without contraindications should be encouraged to engage in regular physical activity.
- Dose: 150 minutes/week of moderate-intensity aerobic exercise (e.g., brisk walking, swimming, stationary cycling).
- Can be divided into 30-minute sessions, 5 days a week.
Maternal & Fetal Benefits:
- ↓ Risk of preeclampsia, gestational hypertension.
- ↓ Risk of gestational diabetes (GDM).
- ↓ Cesarean delivery & operative vaginal delivery rates.
- ↓ Postpartum recovery time.
- Improved weight management.

⭐ High-Yield: Regular exercise is associated with a lower incidence of fetal macrosomia, without increasing the risk for small-for-gestational-age (SGA) infants.

Pregnant women exercising with light weights

Contraindications - Red Light, Green Light

Safe exercise in pregnancy hinges on identifying high-risk conditions. The American College of Obstetricians and Gynecologists (ACOG) provides clear guidance, categorizing contraindications into two main groups: absolute and relative. This framework helps clinicians decide whether to advise against exercise entirely or to proceed with caution and close monitoring.

⭐ ACOG guidelines specify placenta previa after 26 weeks gestation as an absolute contraindication. Before this, the placenta may still migrate away from the cervix, but persistence poses a significant risk of hemorrhage with physical activity.

Safe vs. Unsafe Activities - The Do & Don't List

Pregnant women exercising in a pool

Safe Activities (Low-impact):
- Walking, swimming, stationary cycling
- Modified yoga & Pilates (avoiding supine positions)
Unsafe Activities (Avoid):
- Contact Sports: Basketball, ice hockey, soccer
- High Fall Risk: Skiing, gymnastics, horseback riding
- Scuba Diving: Risk of fetal gas embolism
- Hot Yoga/Bikram: Risk of hyperthermia

⭐ After the 1st trimester, avoid exercises in the supine position. The gravid uterus can compress the inferior vena cava, reducing venous return and causing supine hypotension.

Warning Signs - Stop and See the Doc

Discontinue exercise and seek immediate medical evaluation if any of the following occur:

Vaginal bleeding
Amniotic fluid leakage ("gush of fluid")
Dyspnea before exertion
Severe headache or dizziness
Chest pain
Muscle weakness affecting balance
Calf pain or swelling

Deep Vein Thrombosis (DVT) vs. Normal Leg Anatomy

⭐ Calf pain/swelling is a major red flag for Deep Vein Thrombosis (DVT), a life-threatening condition requiring urgent ultrasound for diagnosis.

High‑Yield Points - ⚡ Biggest Takeaways

Regular, moderate-intensity exercise is recommended for most pregnant women, aiming for ≥150 minutes/week.

Key benefits include reduced risk of gestational diabetes, preeclampsia, and cesarean delivery.

Absolute contraindications include significant heart/lung disease, incompetent cervix, and placenta previa after 26 weeks.

Avoid contact sports, activities with a high risk of falling, and the supine position after the first trimester.

Advise patients to stop exercising for vaginal bleeding, dizziness, chest pain, or calf pain/swelling.

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