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?
AInfection
BHypercoagulable state
CDiabetes
DChronic hypertension
EAge
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?
AIntramuscular carboprost
BManual exploration of the uterus
CDiscontinuing oxytocin
DIntravenous methylergonovine
EUterine fundal massage
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?
AAbruptio placentae
BPolyhydramnios
CUterine rupture
DSpontaneous abortion
EPlacenta previa
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