Obstetrics

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Management of Positive HCG in Non-Pregnant Patients

Regarding elevated human chorionic gonadotropin (hCG) in non-pregnant patients without gynecologic malignancy, which one of the following statements is false?

  • Patients who have frequent contact with goats, rabbits, and mice may have elevated hCG due to heterophile antibodies.
  • Stable low hCG levels in postmenopausal patients is an ominous finding and requires workup.
  • Familial hCG syndrome is a rare genetic defect which can lead to elevated hCG levels in male or female patients.
  • hCG has been used by athletes exogenously to stimulate weight loss.
Volume 41.4 - Question 2

Episiotomy and Tears Following Delivery

Prophylactic antibiotics significantly reduce the risk of clinically relevant wound complications in women with episiotomies and second-degree tears.

  • True
  • False
Volume 41.3 - Question 15

Doula Care

Which one of the following statements about doula care is false?

  • It is associated with more vaginal births after cesarean delivery.
  • It is associated with improved attendance at postpartum visits.
  • It is associated with fewer preterm births.
  • The effect of doula care is not consistent across race.
Volume 41.3 - Question 12

Lubricant Use for Sexual Activity

You are seeing a 27-year-old woman. She has a new sexual partner, and they have been dating for the past two months. When questioning her STI risk, she tells you that she does not use condoms, because of the friction and discomfort they cause during sexual intercourse due to vaginal dryness.
Volume 41.2 - Question 38

Adverse Pregnancy Outcome and Risk of Stroke

Women who have an adverse pregnancy outcome (preterm delivery, small for gestational age, preeclampsia, other hypertensive disorders, and gestational diabetes) need early prevention and long-term clinical care to reduce their lifelong risk of stroke.

  • True
  • False
Volume 41.2 - Question 12

Perinatal HIV Transmission

Starting antiretroviral therapy before pregnancy and sustaining a maternal HIV viral load of <50 copies per mL through birth was associated with zero observed risk of perinatal transmission of HIV.

  • True
  • False
Volume 41.2 - Question 11

Iron Deficiency in Pregnancy

Which one of the following statements regarding iron deficiency anemia in pregnancy is false?

  • Anemia in pregnancy is associated with postpartum hemorrhage.
  • Prenatal vitamins inhibit absorption of iron supplementation in pregnancy.
  • Oral iron supplementation is likely to meaningfully increase ferritin levels during pregnancy.
  • IV iron is a safe treatment in the second and third trimesters of pregnancy.
Volume 41.1 - Question 11

Ferric Derisomaltose vs Iron Sucrose in Pregnancy

When ferric derisomaltose is used for treatment of iron deficiency anemia in pregnancy, as opposed to iron sucrose, which one of the following statements is false?

  • IV infusion times per visit are shorter.
  • Patients treated receive a higher total dose of IV iron.
  • Mean treatment cost per patient per pregnancy is higher.
  • There is a higher incidence of adverse reactions.
Volume 41.1 - Question 10

Antibiotic Use for UTI and Risk of Congenital Malformations

When treating patients with a UTI in the first trimester of pregnancy, trimethoprim-sulfamethoxazole is associated with an increased risk of congenital malformation compared with treatment with a β-Lactam antibiotic.

  • True
  • False
Volume 41.1 - Question 3

Immediate Skin to Skin Contact in Very Preterm Neonates

Which one of the following statements regarding very preterm neonates (born at 28 weeks 0 days to 31 weeks 6 days gestation) who receive two hours of mother-neonate skin to skin contact in the delivery room compared to standard care in the incubator is false?

  • Risk of developmental delay at 2 to 3 years of age is enhanced in the skin to skin contact group.
  • More infants in the skin to skin contact group are breastfed at discharge.
  • The duration of exclusive breastfeeding is longer in the skin to skin contact group.
  • Neurodevelopmental outcomes between the two groups at 3 and 12 months are similar.
Volume 40.6 - Question 4

Methylphenidate and Atomoxetine in Pregnancy

Pregnant women affected by ADHD who were receiving treatment with methylphenidate showed a significantly higher frequency of congenital anomalies or miscarriages compared to the general population.

  • True
  • False
Volume 40.5 - Question 5

Prediction of Preeclampsia

Among pregnant people who develop preterm preeclampsia, compared to those who do not, soluble fms-like tyrosine kinase 1 (sFlt-1) levels are significantly lower when measured before 13 weeks gestation.

  • True
  • False
Volume 40.4 - Question 15

Oral Glucose-Lowering Agents vs. Insulin in Gestational Diabetes

Treatment of gestational diabetes with metformin and additional glyburide, if needed, is noninferior when compared with insulin with respect to the proportion of infants born large for gestational age.

  • True
  • False
Volume 40.4 - Question 14

Hyperemesis Gravidarum

Which one of the following statements about hyperemesis gravidarum is false?

  • Ondansetron is considered safe for use in pregnancy.
  • Daily intravenous treatment in an outpatient setting has been shown to be as effective as hospital admission to resolve dehydration.
  • If intravenous fluid therapy is given, it should include 100 mg of thiamine supplementation daily.
  • Beginning doxylamine succinate and pyridoxine hydrochloride preemptively once pregnancy is confirmed may reduce the overall severity and duration of nausea and vomiting in pregnancy.
Volume 40.4 - Question 13

Respiratory Syncytial Virus Vaccination in Pregnancy

Which one of the following statements about respiratory syncytial virus (RSV) vaccination in pregnancy is false?

  • RSVpreF vaccination in pregnancy protects infants up to 6 months of age.
  • Maternal vaccination decreases infant RSV infections and hospital admissions.
  • Health Canada has authorized RSVpreF vaccination at 32-36 weeks’ gestation.
  • Vaccination in pregnancy is not an alternative to infant RSV immunization.
Volume 40.4 - Question 6

Respiratory Syncytial Virus

You have been providing prenatal care to a 30 year old woman (G1P0). She attends your office for a routine prenatal visit at 22 weeks. Her estimated date of delivery is in November. At the end of her visit she asks about the new vaccine for protecting her infant from respiratory syncytial virus (RSV).
Volume 40.3 - Question 39

Gestational Diabetes and Radon Exposure

There is a significant association between radon exposure and the risk of developing Gestational Diabetes in nulliparous pregnant individuals.

  • True
  • False
Volume 40.3 - Question 23

Methylphenidate and Atomoxetine in Pregnancy

Methylphenidate or atomoxetine intake during pregnancy are not associated with higher frequency of congenital anomalies.

  • True
  • False
Volume 40.3 - Question 18

Prenatal cfDNA Sequencing and Maternal Cancer

Which one of the following is the most common cause of a non-reportable or unusual cell-free DNA-sequencing result in a pregnant patient?

  • Cancer
  • Fibroids
  • Placental mosaicism
  • Clonal hematopoiesis
Volume 40.3 - Question 17

Pruritus in Pregnancy

A 28-year-old pregnant G1P0 patient at 31-weeks of gestation attends your office and describes two weeks of palm and sole pruritus. The patient notes that the pruritus is worse at night. Further history-taking does not reveal any other significant symptoms. The patient’s past medical history and antepartum course have been uncomplicated. Physical examination does not reveal any dermatologic findings save excoriations. You suspect a disease unique to pregnancy.
Volume 40.21 - Question 15

Pruritus in Pregnancy

A 28-year-old pregnant G1P0 patient at 31-weeks of gestation attends your office and describes two weeks of palm and sole pruritus. The patient notes that the pruritus is worse at night. Further history-taking does not reveal any other significant symptoms. The patient’s past medical history and antepartum course have been uncomplicated. Physical examination does not reveal any dermatologic findings save excoriations. You suspect a disease unique to pregnancy.
Volume 40.2 - Question 39

Metformin Use in First Trimester

For type 2 diabetic women on metformin prior to pregnancy, continuing metformin and adding insulin does not increase risk of congenital malformations.

  • True
  • False
Volume 40.2 - Question 8

Prenatal Cannabis Use and Maternal Pregnancy Outcomes

Prenatal cannabis use is associated with a greater risk of all the following except:

  • Excessive gestational weight gain
  • Gestational diabetes
  • Preeclampsia
  • Placental abruption
Volume 40.2 - Question 7

Hypertensive Disorders of Pregnancy

The rate of severe maternal morbidity associated with hypertensive disorders of pregnancy has decreased in Canada between 2012 and 2021.

  • True
  • False
Volume 40.1 - Question 14

Listeriosis in Pregnancy

Which one of the following statements about Listeriosis in pregnancy is false?

  • Invasive listeriosis (bacteremia or meningitis) in pregnancy leads to major fetal consequences, including fetal loss.
  • Most exposures in pregnancy to listeriosis result in symptoms.
  • Investigations or treatment are not indicated in asymptomatic patients who have ingested possibly contaminated foods.
  • In febrile patients with possible exposure to L. monocytogenes, blood cultures should be immediately drawn and high-dose ampicillin initiated.
Volume 40.1 - Question 13

Inflammatory Bowel Disease in Patients of Childbearing Age

Which one of the following statements regarding inflammatory bowel disease (IBD) is false?

  • Female patients with IBD are recommended to be in remission for at least 6 months before attempting to conceive.
  • Biologic therapies are not recommended during lactation.
  • Folic acid doses of 2-5 mg/day are recommended throughout pregnancy for patients taking sulfasalazine.
  • Planned cesarean delivery is usually recommended and associated with high risk of perianal injury.
Volume 39.6 - Question 16

Syphilis-Related Stillbirth

Syphilis-related stillbirths account for more than 10% of all stillbirths at the largest tertiary referral centre in Manitoba.

  • True
  • False
Volume 39.6 - Question 15

Esketamine and Post Partum Depression

For mothers with prenatal depression, a single low dose of esketamine after childbirth decreases major depressive episodes at 42 days post partum. 

  • True
  • False
Volume 39.5 - Question 9

Diagnosis and Treatment of Hyperemesis Gravidarum

Which one of the following statements about hyperemesis gravidarum is false?

  • Multiple pregnancy is associated with an increased risk of hyperemesis gravidarum.
  • Dimenhydrinate is effective in controlling vomiting.
  • The use of corticosteroids is reserved for patients for whom symptoms are not adequately controlled with other antiemetics.
  • Antihistamines can be effective for hypersalivation.
Volume 39.5 - Question 8

Peripartum Cardiomyopathy

Which one of the following statements about peripartum cardiomyopathy is false? 

  • Cardiovascular function typically recovers in more than half of affected patients.   
  • Levels of plasma brain natriuretic peptide are usually elevated.   
  • Vaginal delivery is contraindicated even in hemodynamically stable patients.   
  • Presentation more than one week after delivery is an indicator of an adverse outcome. 
Volume 39.4 - Question 12

Peri-Partum Depression

Your next patient is a 26-year-old female patient. She gave birth to a healthy baby 4 months ago. She has an older 4-year-old son. The patient says that, for the past two months, she has been feeling sad, cries daily, has no energy and feels inadequate as a mother. She feels guilty that she is not as present for her older child and not as invested as her friends with their newborn children.
Volume 39.3 - Question 42

Umbilical Cord Clamping After Preterm Birth

Which one of the following umbilical cord clamping strategies for preterm births has the greatest effect in reducing infant death?

  • Immediate clamping and milking of the cord.
  • Short delayed clamping (≥15 s to <45 s).
  • Medium delayed clamping (≥45 s to <120 s).
  • Long delayed clamping greater than (≥120 s).
Volume 39.3 - Question 13

Induced Abortion and Rh Sensitization

Rh testing and provision of Rh immune globulin should be provided for induced abortion care at less than 12 weeks’ gestation.

  • True
  • False
Volume 39.3 - Question 3

Hormonal Contraception

Which one of the following statements about initiating hormonal contraception is false? 

  • Most patients can safely begin using hormonal contraception at any point in their menstrual cycle.   
  • Women do not require a pelvic examination before they are prescribed oral contraceptive medications.   
  • Those who use ulipristal for emergency contraception should wait five days before starting hormonal contraception.   
  • There are more menstrual pattern disruptions for those who start between menses than for those who wait until starting with next menses. 
Volume 36.6 - Question 6

Macrolides in Pregnancy

Macrolide use in early pregnancy is associated with an increased risk of major birth defects. 

  • True
  • False
Volume 36.6 - Question 5

COVID-19 infection in pregnancy 

COVID-19 infection in pregnancy is associated with an increased risk of stillbirth.  

  • True
  • False
Volume 36.6 - Question 4

Screening for Gestational Diabetes

One-step screening, as compared with two-step screening, doubles the incidence of the diagnosis of gestational diabetes without affecting perinatal risks.  

  • True
  • False
Volume 36.6 - Question 3

SAMP Male infertility

A 32-year-old man comes to see you concerning infertility. He has been trying to conceive for 1 year. His partner is also being evaluated for infertility by her family physician. He has type 2 diabetes and hypertension.  
Volume 36.5 - Question 41

Analgesia in Labour

Which one of the following statements about pain relief in labour is false? 

  • Immersion in water during the first stage of labor can reduce the use of regional anesthesia.   
  • Women in the upright position in the first stage of labour are less likely to use an epidural.   
  • Patients who use hypnosis during labor are more likely to use analgesic medications.   
  • Aromatherapy has not been shown to be beneficial. 
Volume 36.5 - Question 6

Labor Dystocia in Nulliparous Women

Which one of the following statements about labor dystocia in nulliparous women is false?  

  • Labor induction at 39 weeks gestation in low-risk women increases the cesarean delivery rate.   
  • Walking and upright positioning reduces the cesarean delivery rate.   
  • Epidural anesthesia increases the likelihood of operative vaginal delivery.   
  • The transition point of the active phase of labor begins at 6 cm. 
Volume 36.5 - Question 5

Comparison of Fetal Surveillance Methods

 Which one of the following statements about intermittent auscultation (IA) compared to other methods of intrapartum fetal surveillance is false? 

  • It reduces the risk of emergency cesarean delivery.   
  • It reduces the risk of instrumental deliveries for suspected fetal distress.   
  • It does not increase the risk of neonatal intensive care unit admission.   
  • It increases the risk of neonatal acidemia. 
Volume 36.5 - Question 4

Postpartum Depression

Which one of the following alternative therapies has the best evidence to support its use in treatment of postpartum depression? 

  • Physical activity   
  • Cognitive behavioural therapy    
  • Telecommunications therapies    
  • Hormonal treatments  
Volume 36.4 - Question 7

Ectopic Pregnancy

The majority of tubal pregnancies with an initial β-hCG <175 IU/L will resolve spontaneously.  

  • True
  • False
Volume 36.4 - Question 5

NSAIDs Use in Pregnancy

Use of nonsteroidal anti-inflammatory drugs is not advised during pregnancy beginning at 20 weeks’ gestation. 

  • True
  • False
Volume 36.4 - Question 1

Umbilical Cord Management for Preterm Newborns

Which one of the following is a recommended practice regarding umbilical cord management for infants born at 35 weeks’ gestational age?

  • Perform delayed cord clamping on the maternal abdomen.
  • Perform delayed cord clamping while warming the infant with warm towels.
  • Perform umbilical cord milking.
  • Administer intravenous oxytocin to the mother during delayed cord clamping.
Volume 37.6 - Question 15

Preeclampsia

Which one of these statements about preeclampsia is false?

  • Fetal manifestations include macrosomia.
  • Severe anemia is a risk factor.
  • The preventative impact of ASA is not dose dependent.
  • Risk of maternal death is highest postpartum.
Volume 37.6 - Question 13

Obstetric Lacerations

Which one of the following statements about obstetric lacerations is false?

  • Late pregnancy perineal self-massage reduces the rate of perineal lacerations in primiparous women.
  • Perineal support during delivery reduces obstetric anal sphincter injuries.
  • Surgical glue should not be used for repair of vaginal lacerations.
  • Conservative management of well approximated first- and second-degree lacerations reduces dyspareunia at three months postpartum.
Volume 37.1 - Question 15

Cytomegalovirus Infection in Pregnancy

Which one of the following statements about Cytomegalovirus (CMV) infection in pregnancy is false?

  • Pregnant patients with a mononucleosis-like illness should be investigated for CMV infection.
  • The most common neurological sequelae of Congenital CMV (cCMV) is sensorineural hearing loss.
  • Risk of long-term sequelae for the infant is directly proportional to the gestational age at which cCMV is acquired.
  • Risk of CMV transmission to the fetus increases proportionally with the gestational age at which the mother is infected.
Volume 37.2 - Question 7

Specific Dermatoses of Pregnancy

You are seeing a 29-year-old primiparous woman who is currently 34 weeks gestation in the office today. She has presented with complaints of a new itchy rash on her skin. While pre-existing skin conditions and non–pregnancy specific conditions such as psoriasis, urticaria, drug eruptions, contact dermatitis and scabies are important to consider, there is a specific group of conditions that the clinician should consider when assessing a pregnant woman presenting with pruritus alone or a pruritic rash.   
Volume 37.4 - Question 44

Postpartum Thyroiditis

Which one of the following statements about postpartum thyroiditis is false?

  • It is a painless condition.
  • Recurrence with subsequent pregnancies is rare.
  • Radioactive iodine uptake and scan imaging is contraindicated in patients who are breastfeeding.
  • Tapering of levothyroxine dose around 12 months is recommended.
Volume 37.4 - Question 31

Prescribed Mifepristone in Canada

Which one of the following statements about normally prescribed mifepristone as compared to when it was unavailable in Canada is false?

  • The abortion rate has continued to increase.
  • The proportion of abortions provided by medication increased rapidly.
  • There was a small increase in ongoing intrauterine pregnancy continuing to delivery.
  • Adverse results remain stable.
Volume 37.4 - Question 26

COVID-19 and Fertility

Compared with unvaccinated females, women who received at least one dose of COVID-19 vaccine before a given menstrual cycle had a lower probability of conceiving during that cycle.

  • True
  • False
Volume 37.4 - Question 8

Monkeypox Infection in Pregnancy

Which one of the following about monkeypox infection and pregnancy is false? 

  • It is not known whether pregnant people are more susceptible to the infection.
  • It can be confused with pruritic urticarial papules and plaques of pregnancy. 
  • Adverse pregnancy outcomes have been reported after infection. 
  • Post-exposure prophylaxis with attenuated vaccine is contraindicated in pregnancy.
Volume 38.1 - Question 14

Obesity in Pregnancy

A 23-year-old patient with obesity presents to your office for preconceptual counselling. Specifically, she is concerned about her weight affecting her fertility and its effects on pregnancy. You measure her height and weight, and she has a BMI of 45.
Volume 38.2 - Question 36

Hypertension in Pregnancy

In pregnant women with mild chronic hypertension, active treatment with a blood-pressure target of less than 140/90 mm Hg was associated with better pregnancy outcomes than a strategy of no antihypertensive treatment unless the systolic blood pressure was 160 mm Hg or higher or the diastolic pressure was 105 mm Hg or higher.

  • True
  • False
Volume 38.2 - Question 3

Membrane Sweeping at Term

Performing a membrane sweep in pregnant patients who are positive for group B streptococci has been shown to result in an increased risk of negative outcomes.

  • True
  • False
Volume 38.2 - Question 2

Preterm Birth

Vaginal progesterone is the most effective treatment to prevent spontaneous preterm birth in women with singleton pregnancy who are at high risk.

  • True
  • False
Volume 37.5 - Question 30

Polycystic Ovary Syndrome

Which one of the following statements regarding Polycystic Ovary Syndrome (PCOS) is false?

  • Menstrual cycle irregularity in the first 3 years post-menarche is uncommon outside of PCOS.
  • Unopposed estrogen increases the risk of endometrial cancer.
  • Pregnant patients with PCOS have an increased risk of gestational diabetes.
  • Screening for cardiovascular disease in this population should follow general population recommendations.
Volume 37.5 - Question 13

Treatment for Mild Chronic Hypertension during Pregnancy

In pregnant women with mild chronic hypertension, a strategy of targeting a blood pressure of <140/90 is associated with better pregnancy outcomes than reserving treatment only for severe hypertension.

  • True
  • False
Volume 37.5 - Question 7

Elective Induction vs Expectant Management of Labour

Among nulliparous persons, which one of the following statements regarding elective induction of labour at 39+ weeks, versus expectant management, is false?

  • Median length of stay is longer in those who undergo elective induction of labour. 
  • A significantly greater proportion of patients who are expectantly managed require secondary caesarean delivery.  
  • Patients in the expectant management group have a greater risk of composite adverse perinatal outcome. 
  • Patients in the expectant management group have a greater risk of composite adverse maternal outcome.
Volume 38.1 - Question 12

Covid-19 Vaccination in Pregnancy

Maternal vaccination with two doses of mRNA vaccine against Covid-19 is associated with a reduced risk of hospitalization among infants younger than 6 months of age. 

  • True
  • False
Volume 38.1 - Question 6

Postpartum Hemorrhage and Hemorrhagic Shock

You are caring for a 30-year-old G2P1 who is currently at 28 weeks gestation. Her last delivery was complicated by a post-partum hemorrhage (PPH). She is concerned about a recurrence. Her hemoglobin Hgb at 28 weeks was 120 mg/dL.
Volume 38.4 - Question 35

Postpartum Hemorrhage

During the active management of the third stage of labour following a vaginal delivery, there is sudden brisk vaginal bleeding, a mass in the vagina, and vasovagal syncope.
Volume 38.3 - Question 41

Endometriosis

A 26-year-old woman presents with recurrent pelvic pain during menstruation. She suspects endometriosis, as her mother also had this condition. She would like to discus the diagnosis and treatment options.
Volume 38.3 - Question 38

Antenatal Depression and Preterm Birth

An improved antenatal depression symptom trajectory, compared with worsened symptoms is associated with decreased odds of preterm birth for pregnant people referred for mental health care. 

  • True
  • False
Volume 39.1 - Question 17

Fetal Growth Restriction

Which one of the following statements regarding fetal growth restriction is false? 

  • “Small for gestational age” is a strong risk factor for perinatal morbidity. 
  • Symphysis-fundal height measurement has high specificity in detecting fetal growth restriction in low-risk patients with normal body mass index. 
  • Umbilical artery Doppler waveforms are typically abnormal in placenta-mediated early-onset fetal growth restriction. 
  • Ultrasonography should be used to detect fetal growth restriction in patients with a body mass index >35 kg/m2. 
Volume 39.1 - Question 16

Primary Immune Thrombocytopenia (ITP) in Pregnancy

Which one of the following statements about thrombocytopenia in pregnancy is false? 

  • Gestational thrombocytopenia is the most common cause of low platelet counts in pregnancy. 
  • Gestational thrombocytopenia has not been found to be a cause of maternal bleeding. 
  • For treatment of Immune Thrombocytopenia (ITP), prednisone is more likely to affect the fetus than dexamethasone. 
  • Approximately 10 % of neonates born to mothers with ITP have marked thrombocytopenia at birth. 
Volume 39.1 - Question 15

Vol 39.1 Q14 - Prenatal Care #2

Which one of the following statements about prenatal care is false? 

  • Patients taking folic acid antagonists should take 4 mg of folic acid daily. 
  • Patients should be screened for bacteriuria at the first prenatal visit.  
  • Untreated depression and anxiety-related disorders increase the risk of preterm delivery. 
  • Patients should be screened for intimate partner violence. 
Volume 39.1 - Question 14

Venous Thromboembolism Prophylaxis in Pregnancy

In women with a history of venous thromboembolism, weight-adjusted intermediate-dose low molecular-weight heparin during the combined antepartum and post-partum periods is associated with a lower risk of recurrence than fixed low-dose low-molecular-weight heparin.

  • True
  • False
Volume 38.4 - Question 9

Breastfeeding #3

Which one of the following statements about medications during breastfeeding is false?

  • Fluoxetine is preferred over Paroxetine to treat depression.
  • Lorazepam is preferred over clonazepam to treat anxiety.
  • Angiotensin-converting enzyme inhibitors do not pass significantly into breast milk.
  • Metformin is preferred over newer oral medications for diabetes.
Volume 38.3 - Question 9

Induction of Labour

Misoprostol may be used for induction of labour in term pre-labour rupture of membranes.

  • True
  • False
Volume 38.4 - Question 8

Breastfeeding #2

Trimethoprim / Sulfamethoxazole should not be taken by the mother while breastfeeding during the first month postpartum.

  • True
  • False
Volume 38.3 - Question 8

Breastfeeding #1

Which one of the following statements about medications during breastfeeding is false?

  • Topical medications are generally safer than oral medications.
  • Administer single daily-dose medication after breastfeeding and just before the longest sleep interval for the infant to minimize infant exposure to maternal medication.
  • The LactMed database is a peer-reviewed online resource that can be helpful.
  • Long-term use of naproxen is preferred over ibuprofen for analgesia during lactation.
Volume 38.3 - Question 7

Opioid Use Disorder in Pregnancy

In the treatment of opioid use disorder in pregnancy, comparing exposure to methadone or buprenorphine, buprenorphine treatment is associated with each of the following except:

  • A lower risk of fetal abstinence syndrome in infants exposed in the 30 days before delivery.
  • Fewer preterm births among infants exposed in early pregnancy.
  • A lower risk of low birth weight in infants exposed during early pregnancy.
  • Fewer severe maternal complications in mothers exposed in early pregnancy.
Volume 38.3 - Question 6

Balloon Catheters Versus Vaginal Prostaglandins for Labour Induction

Which one of the following statements regarding the use of balloon catheters versus prostaglandins for induction of labour is false?

  • There is a similar rate of caesarian delivery for failure to progress.
  • There is a similar rate of caesarian delivery for fetal distress.
  • Adverse perinatal outcomes are lower.
  • Adverse maternal outcomes are lower.
Volume 38.3 - Question 5

Antenatal Corticosteroids

Infants exposed to one course of antenatal corticosteroids have an increased risk of serious infection during the first 12 months of life.

  • True
  • False
Volume 39.2 - Question 6

Prenatal Care #1

Which one of the following statements about prenatal care is false?

  • Initiating low dose-aspirin (81 mg daily) starting at 12 weeks should be considered in patients diagnosed with COVID-19 in pregnancy. 
  • Chronic hypertension (hypertension before 20 weeks) should be treated to less than 140/90 mm Hg. 
  • Screening for thyroid disorders has been shown to improve pregnancy outcomes.  
  • Patients at risk of preeclampsia should be started on prophylactic low-dose aspirin (81 mg) between 12 and 16 weeks. 
Volume 39.1 - Question 13

Skin Conditions in Pregnancy

You are working in a busy prenatal clinic and several women present with concerns about skin conditions.
Volume 38.6 - Question 42

Short-Term Adverse Outcomes After Mifepristone-Misoprostol

Which one of the following statements regarding oral mifepristone combined with misoprostol for first-trimester pharmaceutical induced abortion is false?

  • The combination has an efficacy of about 97%.
  • There is an ongoing pregnancy rate of less than 1% when used before 10 weeks gestation.
  • There is an ongoing pregnancy rate of about 10% when used after 10 weeks gestation.
  • Short-term adverse events are more likely after mifepristone–misoprostol induced abortion than procedural induced abortion.
Volume 38.6 - Question 29

Menstrual Cups

Which one of the following statements regarding menstrual cups is false?

  • They can be inserted for up to 12 hours at a time.
  • There is no risk of toxic shock syndrome.
  • Bacterial vaginosis may be less common than with a sanitary pad or tampon.
  • Dislodgement of intrauterine devices has been reported with their use.
Volume 38.6 - Question 15

Early Pregnancy Loss

Which one of the following statements about early pregnancy loss (in the first trimester) is false?

  • Expectant management is safe for patients without signs of infection or hemorrhage who have ready access to emergency care.
  • Anticoagulation use is a contraindication to managing early pregnancy loss with medications.
  • Hemoglobin less than 9 g/dL is not a contraindication to medication management.
  • Human chorionic gonadotropin may take several weeks to reach undetectable levels following pregnancy.
Volume 38.6 - Question 14

Gestational Weight Gain for Women with Obesity

In pregnant women with pre-pregnancy class I obesity (BMI 30-34), the optimal gestational weight change for reduced risk of major neonatal morbidity is -1 to 4 kg.

  • True
  • False
Volume 38.6 - Question 13

Metformin for Gestational Diabetes Mellitus

In patients with gestational diabetes Mellitus treated with metformin, neonatal birth weight is significantly lower compared to those treated with insulin.

  • True
  • False
Volume 38.6 - Question 12

Gestational Diabetes Mellitus

Among pregnant women, immediate treatment of gestational diabetes mellitus before 20 weeks’ gestation leads to a lower incidence of a composite of adverse neonatal outcomes (birth at <37 weeks’ gestation, birth trauma, birth weight of ≥4500 g, respiratory distress, phototherapy, stillbirth or neonatal death, or shoulder dystocia) than no immediate treatment.

  • True
  • False
Volume 38.6 - Question 11

Postpartum IUD Placement

There is no difference in complete expulsion rates of IUDs between early (2-4 weeks) and standard (6-8 weeks) postpartum timing of placement.

  • True
  • False
Volume 38.5 - Question 21

Adverse Pregnancy Outcomes

 Which one of the following statements regarding adverse pregnancy outcomes and long term risk of ischemic heart disease is false?

  • Preterm delivery is not associated with increased risk after delivery.
  • Small for gestational age is associated with increased risk after delivery.
  • Gestational diabetes is associated with increased risk after delivery.
  • The association between hypertensive disorders of pregnancy and increased risk is driven by new onset hypertension during pregnancy.
Volume 38.5 - Question 18

Delivery Planning

Which one of the following statements regarding the Society of Obstetricians and Gynaecologists of Canada recommendations for delivery planning is false?

  • Oral administration of castor oil at term may reduce the need for induction of labour in low risk multiparous individuals.
  • Vaginal intercourse at term increases the rate of spontaneous onset of labour.
  • Delivery can be considered at 39-40 weeks gestation for women with a body mass index of 40 kg/m2 or greater.
  • Cervical length (in cm) has replaced effacement (as a percentage) in the modified Bishop score.
Volume 38.5 - Question 17

Cervical Ripening

Which one of the following statements regarding the Society of Obstetricians and Gynaecologists of Canada recommendations for cervical ripening is false?

  • For outpatient settings, the use of a cervical balloon is the preferred method.  
  • Adding tension to a balloon catheter increases its effectiveness.
  • Misoprostol may be used in the first or second trimester, but not in the third trimester with previous cesarean delivery.
  • Misoprostol-induced fever is rarely seen in the doses used for cervical ripening or induction of labour.
Volume 38.5 - Question 16

Antenatal Care in Refugee Patients

Among resettled refugees in Canada, those in the government-assisted pathway were more likely to receive adequate prenatal care than privately sponsored refugees.

  • True
  • False
Volume 38.5 - Question 14

RSV Vaccination in Pregnancy

Which one of the following statements about vaccination in pregnancy to prevent respiratory syncytial virus (RSV) illness in infants is false?

  • There is an increased risk of spontaneous abortion in subsequent pregnancies in vaccinated women.
  • Serious adverse events are rare in the newborns of vaccinated women.
  • It reduces the incidence of severe RSV-associated lower respiratory tract illness in infants within 90 days after birth.
  • It is a single dose vaccine.
Volume 38.5 - Question 9

Aerobic Exercise During Pregnancy

Aerobic exercise intervention reduces the incidence of gestational hypertension among pregnant women.

  • True
  • False
Volume 38.5 - Question 8

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