100+ Free CMSA FCOG(SA) Part II Practice Questions

Explanation: The standard South African ESMOE loading regimen for Magnesium Sulfate in severe preeclampsia/eclampsia is 4 g IV (as a 20% solution) slowly over 10-15 minutes, combined with 10 g IM (5 g of 50% solution deep IM into each buttock with 1 mL of 2% lignocaine). Maintenance therapy is 5 g IM into alternating buttocks every 4 hours, provided deep tendon reflexes are present, respiratory rate is > 16/min, and urine output is > 25 mL/hour.

Explanation: Ergometrine causes peripheral vasoconstriction and direct smooth muscle contraction, making it strictly contraindicated in women with hypertension, preeclampsia, or cardiac disease. Repeated doses or IV administration can trigger hypertensive crisis, stroke, or myocardial infarction. Misoprostol, oxytocin infusion, and carboprost (unless asthmatic) are safe alternative uterotonics.

Explanation: Absent end-diastolic flow (AEDF) in the umbilical artery signifies significant placental insufficiency and microvascular obliteration. At 32 weeks gestation, management requires admission, administration of antenatal corticosteroids (Dexamethasone/Betamethasone) for lung maturation, daily cCTG/BPP, and longitudinal Doppler monitoring of the ductus venosus and middle cerebral artery. Delivery is typically indicated around 34 weeks, or earlier if ductus venosus A-wave becomes absent/reversed.

Explanation: Placental abruption (abruptio placentae) presents classic clinical features of painful vaginal bleeding, uterine hypertonus/tenderness, and fetal compromise. Chronic hypertension and preeclampsia are the single strongest risk factors for placental abruption, responsible for nearly 40-50% of severe cases due to maternal decidual vasculopathy.

Explanation: Quintero Stage I TTTS is defined by severe oligohydramnios (DVP < 2 cm) in the donor twin and severe polyhydramnios (DVP > 8 cm) in the recipient twin, but with the donor bladder still visible and normal Doppler studies. Stage II occurs when the donor twin's bladder is no longer visualized. Stage III requires critically abnormal Dopplers (AEDF/REDF in umbilical artery, reversed A-wave in ductus venosus). Stage IV is hydrops fetalis in one or both twins.

Explanation: The clinical picture of sudden loss of uterine contractions, loss of station, severe persistent fetal bradycardia, and acute abdominal pain in a patient with scar rupture indicates complete uterine rupture. Immediate emergency laparotomy is mandatory to rescue the fetus, control maternal hemorrhage, and perform uterine repair or subtotal/total hysterectomy.

Explanation: Oral Erythromycin (250 mg 6-hourly or 500 mg 8-hourly for 10 days) is the established latency antibiotic of choice in PPROM. It prolongs latency, reduces neonatal infectious morbidity, RDS, and necrotizing enterocolitis. Amoxicillin-clavulanic acid (co-amoxiclav) is strictly contraindicated in PPROM because it is strongly associated with an increased incidence of necrotizing enterocolitis (NEC) in neonates.

Explanation: In mitral stenosis during pregnancy, tachycardia shortens diastolic filling time, causing rapid elevation of left atrial pressure and pulmonary edema. Immediate therapy involves IV loop diuretics (Furosemide) to reduce preload, combined with rate-controlling agents such as beta-blockers (Metoprolol) or Digoxin to slow sinus/afib rate and prolong diastole. Direct cardioversion may be needed if hemodynamically unstable.

Explanation: Optimizing glycemic control with a target HbA1c < 6.5% (48 mmol/mol) prior to conception and during early embryogenesis reduces the risk of congenital malformations (including caudal regression syndrome / sacral agenesis, cardiac defects, and neural tube defects) to background population rates (~2%). Higher HbA1c levels (> 8-10%) increase malformation rates exponentially.

Explanation: Vacuum extraction (ventouse) or low/outlet forceps delivery is the standard choice for low station (+3) occipito-anterior position when second stage is prolonged. Vacuum extraction has a high success rate and low maternal perineal trauma profile when fetal head is well engaged at +3 station.