Obstetrics & Gynecology Prometric exam questions with answers

1. Question 1General Obstetrics: Preconception, Antenatal Care & Normal Pregnancyeasy

   A 29-year-old woman whose previous pregnancy was affected by a neural tube defect is planning to conceive. Which folic acid regimen is recommended?

   1. AHigh-dose folic acid (4 to 5 mg daily) from at least 1 month before conception to 12 weeks
   2. BNo supplement if her diet is rich in folate
   3. CHigh-dose folic acid starting at 16 weeks of gestation
   4. DFolic acid 400 micrograms daily starting once pregnancy is confirmed
   Show answer and explanation▾

   Answer: A. High-dose folic acid (4 to 5 mg daily) from at least 1 month before conception to 12 weeks

   Women with a previous pregnancy affected by a neural tube defect should take high-dose folic acid (4 mg in ACOG guidance, 5 mg in UK practice) starting before conception and continuing through the first trimester. Neural tube closure is complete by about 28 days after conception, so starting at confirmation of pregnancy or later is too late to prevent recurrence. Dietary folate alone is insufficient.

2. Question 2General Obstetrics: Preconception, Antenatal Care & Normal Pregnancymedium

   A 33-year-old woman with chronic hypertension books for antenatal care at 10 weeks' gestation. Which intervention best reduces her risk of pre-eclampsia?

   1. ALow-dose aspirin started at 24 weeks if blood pressure rises
   2. BVitamin C and vitamin E supplements
   3. CBed rest from 20 weeks of gestation
   4. DLow-dose aspirin from 12 weeks of gestation until birth
   Show answer and explanation▾

   Answer: D. Low-dose aspirin from 12 weeks of gestation until birth

   Chronic hypertension is a high-risk factor for pre-eclampsia, and low-dose aspirin (75 to 150 mg, or 81 mg in the US) started ideally between 12 and 16 weeks and continued until birth reduces the risk of pre-eclampsia, particularly preterm disease. Starting after the second trimester, once placentation is established, is far less effective. Bed rest and antioxidant vitamins have not been shown to prevent pre-eclampsia.

3. Question 3Labour, Delivery & Intrapartum Careeasy

   During a vaginal birth, the fetal head delivers but retracts against the perineum and routine axial traction fails to deliver the shoulders. Help has been called. What is the most appropriate first manoeuvre?

   1. AStrong lateral traction on the fetal head
   2. BFundal pressure
   3. CMcRoberts positioning with suprapubic pressure
   4. DZavanelli manoeuvre
   Show answer and explanation▾

   Answer: C. McRoberts positioning with suprapubic pressure

   McRoberts positioning (hyperflexion of the maternal hips) with suprapubic pressure resolves a large proportion of shoulder dystocias and is the recommended first step, followed by internal manoeuvres or delivery of the posterior arm. Fundal pressure worsens impaction and increases the risk of uterine rupture and brachial plexus injury. Excessive or lateral traction on the head causes brachial plexus injury, and the Zavanelli manoeuvre is a last resort.

4. Question 4Obstetric Emergencies & Maternal Critical Caremedium

   A woman with severe pre-eclampsia is receiving magnesium sulfate 1 g/hour. Two hours later her patellar reflexes are absent, her respiratory rate is 9/min and she is oliguric. What is the most appropriate management?

   1. AStop the infusion and give 10 mL of 10% calcium gluconate intravenously
   2. BReduce the infusion to 0.5 g/hour and recheck reflexes in 1 hour
   3. CContinue the infusion and give intravenous naloxone
   4. DGive intravenous furosemide to increase magnesium excretion
   Show answer and explanation▾

   Answer: A. Stop the infusion and give 10 mL of 10% calcium gluconate intravenously

   Loss of deep tendon reflexes and respiratory depression indicate magnesium toxicity, made more likely by oliguria because magnesium is renally excreted. The infusion must be stopped, calcium gluconate given as the antidote and the airway and breathing supported, with a serum magnesium level checked. Simply reducing the dose delays treatment of a life-threatening problem, and naloxone has no role.

5. Question 5Obstetric Emergencies & Maternal Critical Carehard

   A woman with pre-eclampsia (blood pressure 158/104 mmHg) and asthma has a postpartum haemorrhage from uterine atony after a vaginal birth. Bleeding continues despite bimanual compression, an oxytocin infusion and intravenous tranexamic acid. Which additional uterotonic is most appropriate?

   1. AIntramuscular ergometrine 500 micrograms
   2. BIntramuscular carboprost 250 micrograms
   3. CSublingual misoprostol 800 micrograms
   4. DIntramuscular ergometrine-oxytocin combination
   Show answer and explanation▾

   Answer: C. Sublingual misoprostol 800 micrograms

   Ergometrine-containing drugs cause vasoconstriction and are contraindicated in hypertension and pre-eclampsia, and carboprost (15-methyl prostaglandin F2-alpha) can cause severe bronchospasm and is avoided in asthma. Misoprostol is an appropriate second-line uterotonic in this situation while preparing for surgical measures such as balloon tamponade if bleeding continues. Tranexamic acid should be given within 3 hours of birth, as here.

6. Question 6Maternal-Fetal Medicine & High-Risk Pregnancymedium

   A 30-year-old woman has a 75 g oral glucose tolerance test at 26 weeks. Fasting glucose is 5.3 mmol/L (95 mg/dL), 1-hour glucose 9.2 mmol/L (166 mg/dL) and 2-hour glucose 7.9 mmol/L (142 mg/dL). Using IADPSG/WHO 2013 criteria, what is the correct interpretation?

   1. ANormal result, because the 1-hour and 2-hour values are below threshold
   2. BGestational diabetes, because one abnormal value is sufficient and the fasting value is raised
   3. CGestational diabetes, because at least two values exceed their thresholds
   4. DOvert diabetes in pregnancy that requires immediate insulin
   Show answer and explanation▾

   Answer: B. Gestational diabetes, because one abnormal value is sufficient and the fasting value is raised

   The IADPSG/WHO 2013 thresholds are fasting 5.1 mmol/L (92 mg/dL), 1-hour 10.0 mmol/L (180 mg/dL) and 2-hour 8.5 mmol/L (153 mg/dL), and a single value at or above threshold diagnoses gestational diabetes; here only the fasting value is abnormal. The two-value rule belongs to the older two-step Carpenter-Coustan approach. Overt diabetes requires much higher values, such as fasting glucose of 7.0 mmol/L or more.

7. Question 7Maternal-Fetal Medicine & High-Risk Pregnancyhard

   A RhD-negative woman with anti-D antibodies at a rising titre is 26 weeks pregnant. Doppler shows a fetal middle cerebral artery peak systolic velocity of 1.7 multiples of the median. What is the most appropriate next step?

   1. AImmediate delivery by caesarean section
   2. BRepeat Doppler assessment in 4 weeks
   3. CFetal blood sampling with preparation for intrauterine transfusion
   4. DGive anti-D immunoglobulin 1500 IU
   Show answer and explanation▾

   Answer: C. Fetal blood sampling with preparation for intrauterine transfusion

   A middle cerebral artery peak systolic velocity above 1.5 multiples of the median predicts moderate to severe fetal anaemia, so cordocentesis with intrauterine transfusion ready should be performed in a fetal medicine unit. At 26 weeks, delivery would expose the baby to severe prematurity when in utero transfusion is effective. Anti-D immunoglobulin has no role once the woman is already sensitised.

8. Question 8Early Pregnancy Problems & Postpartum Caremedium

   A 28-year-old woman has a tubal ectopic pregnancy on transvaginal ultrasound. She is haemodynamically stable with minimal pain. Which finding makes her unsuitable for methotrexate treatment?

   1. AHaemoglobin is 118 g/L
   2. BFetal cardiac activity is visible in the adnexal mass
   3. CSerum hCG is 1,200 IU/L
   4. DThe adnexal mass measures 25 mm
   Show answer and explanation▾

   Answer: B. Fetal cardiac activity is visible in the adnexal mass

   Medical management with methotrexate is suitable for a stable woman with an unruptured ectopic, a low hCG (under 1,500 IU/L in NICE guidance, with success falling at higher levels), a small mass under about 35 mm and no fetal heart activity. Visible cardiac activity predicts treatment failure and rupture, so surgery is preferred. The other findings are all compatible with medical management.

9. Question 9Reproductive Endocrinology & Infertilitymedium

   A 27-year-old woman with polycystic ovary syndrome and a BMI of 29 kg/m2 has anovulatory infertility. Her partner's semen analysis and her tubal patency tests are normal. What is the recommended first-line pharmacological ovulation induction?

   1. ALetrozole
   2. BMetformin alone
   3. CClomiphene citrate
   4. DInjectable gonadotrophins
   Show answer and explanation▾

   Answer: A. Letrozole

   The international evidence-based PCOS guideline recommends letrozole as first-line ovulation induction because it achieves higher live birth rates than clomiphene with lower multiple pregnancy rates. Clomiphene, alone or with metformin, is an alternative where letrozole is unavailable. Metformin alone is less effective, and gonadotrophins are second-line because of the risks of multiple pregnancy and ovarian hyperstimulation.

10. Question 10Gynecologic Oncologymedium

    A 61-year-old woman who does not use hormone therapy has a single episode of postmenopausal bleeding. Transvaginal ultrasound shows an endometrial thickness of 9 mm. What is the most appropriate next step?

    1. AReassure and repeat ultrasound in 12 months
    2. BEndometrial sampling by pipelle or hysteroscopy-directed biopsy
    3. CStart cyclical progestogen therapy
    4. DCervical screening test only
    Show answer and explanation▾

    Answer: B. Endometrial sampling by pipelle or hysteroscopy-directed biopsy

    In women with postmenopausal bleeding, an endometrial thickness of 4 mm or less has a very high negative predictive value for endometrial cancer, but a thicker endometrium requires histological sampling. Endometrial cancer must be excluded before any treatment, so reassurance or empirical progestogens are inappropriate. A cervical screening test does not assess the endometrium.

11. Question 11Gynecologic Oncologyhard

    After suction evacuation of a complete hydatidiform mole, a 32-year-old woman's weekly serum hCG values over 3 weeks are 1,850, 1,820, 1,870 and 1,840 IU/L. Imaging shows no metastases. What is the most likely diagnosis and appropriate management?

    1. AChoriocarcinoma; perform hysterectomy as first-line treatment
    2. BNormal post-molar regression; continue weekly hCG monitoring
    3. CRetained molar tissue; repeat suction evacuation
    4. DPost-molar gestational trophoblastic neoplasia; stage, score and start single-agent chemotherapy
    Show answer and explanation▾

    Answer: D. Post-molar gestational trophoblastic neoplasia; stage, score and start single-agent chemotherapy

    FIGO criteria diagnose post-molar gestational trophoblastic neoplasia when hCG plateaus over four measurements across 3 weeks or rises over three measurements across 2 weeks. After staging and calculating the FIGO prognostic score, low-risk disease is treated with single-agent methotrexate or actinomycin D, with excellent cure rates. A plateau is not normal regression, and repeat evacuation or primary hysterectomy are not standard first-line treatment.

12. Question 12Urogynecology & Pelvic Floor Disorderseasy

    A 42-year-old woman has urinary leakage when coughing, sneezing and running. Urinalysis is normal and there are no urgency symptoms. What is the recommended first-line treatment?

    1. AOral oxybutynin
    2. BOpen colposuspension
    3. CMidurethral sling surgery
    4. DSupervised pelvic floor muscle training for at least 3 months
    Show answer and explanation▾

    Answer: D. Supervised pelvic floor muscle training for at least 3 months

    For stress urinary incontinence, supervised pelvic floor muscle training for at least 3 months is first-line, alongside lifestyle measures such as weight loss and reducing caffeine. Surgical options such as colposuspension, autologous slings or midurethral tapes are considered if conservative treatment fails. Antimuscarinic drugs such as oxybutynin treat overactive bladder, not stress incontinence.

13. Question 13Operative Gynecology, Perioperative Management & Surgical Complicationshard

    Ten days after an abdominal hysterectomy, a 47-year-old woman has continuous watery vaginal leakage while also voiding normally. Methylene blue is instilled into the bladder with three swabs placed in the vagina; the swabs become wet but none is stained blue. What is the most likely diagnosis?

    1. AVesicovaginal fistula
    2. BUrethrovaginal fistula
    3. CUreterovaginal fistula
    4. DOverflow incontinence from an underactive detrusor
    Show answer and explanation▾

    Answer: C. Ureterovaginal fistula

    In the three-swab test, blue staining indicates a vesicovaginal fistula, whereas clear urine wetting the swabs while the bladder contains blue dye indicates urine entering the vagina directly from a ureter. Continued normal voiding fits a unilateral ureteric fistula, as the other kidney drains into the bladder. CT urography or retrograde pyelography confirms the site, and management often begins with ureteric stenting.

14. Question 14Contraception, Family Planning & Sexual Healthmedium

    A 24-year-old woman with epilepsy taking carbamazepine requests reliable long-term contraception. Which method is most appropriate?

    1. ACopper intrauterine device or levonorgestrel intrauterine system
    2. BEtonogestrel subdermal implant
    3. CCombined oral contraceptive pill at standard dose
    4. DProgestogen-only pill
    Show answer and explanation▾

    Answer: A. Copper intrauterine device or levonorgestrel intrauterine system

    Carbamazepine induces hepatic enzymes and reduces the efficacy of oral hormonal methods and the progestogen implant, so methods unaffected by enzyme inducers, such as the copper IUD, the levonorgestrel IUS or injectable medroxyprogesterone, are recommended. The implant is highly effective normally but its efficacy is reduced with enzyme inducers. Standard-dose combined or progestogen-only pills are unreliable in this setting.

15. Question 15Contraception, Family Planning & Sexual Healtheasy

    A woman 8 weeks postpartum is fully breastfeeding day and night and her periods have not returned. She asks whether breastfeeding alone can provide contraception. Which statement is correct?

    1. AIt remains reliable until 12 months postpartum if she keeps breastfeeding
    2. BIt is about 98% effective until 6 months postpartum if all criteria remain met
    3. CBreastfeeding provides no contraceptive protection after 6 weeks
    4. DIt is only effective when combined with a progestogen-only pill
    Show answer and explanation▾

    Answer: B. It is about 98% effective until 6 months postpartum if all criteria remain met

    The lactational amenorrhoea method is over 98% effective when the woman is fully or nearly fully breastfeeding, is amenorrhoeic and is less than 6 months postpartum. Once any criterion is no longer met, such as menses returning, supplementary feeds or reaching 6 months, another method is needed. It does provide protection beyond 6 weeks when these criteria are met.

Last reviewed September 2026. Questions are original and written to the published exam blueprint; they are not taken from any real paper.