Obstetrics 2023

What is the safe lower limit of alcohol intake during pregnancy?

Which of the following answers is the correct sequence of cardinal movements of labor?

Which of the following is a typical risk of epidural analgesia during labor?

Which of the following is not a risk factor for shoulder dystocia?

What is the most important part of repairing a hysterotomy?

 Which of the following cannot be used to confirm an 8-week pregnancy?

When should a pregnant woman be screened for recto-vaginal group B beta streptococcus?

 A 30-year-old G1P0 at gestational age 6 weeks and 3 days by LMP presents with 2 days of light pink vaginal bleeding without any cramps or abdominal pain. Serology tests confirm blood type is A+ and an HCG level of 20,000 mlU/ml. On exam the abdomen is soft, pelvic exam reveals a closed cervical os. A bedside ultrasound confirms intrauterine pregnancy. How would you define this pregnancy?

A 34-year-old G4P3 woman presents for her 18-week antenatal check-up. She has no other past medical history. On vital signs, her blood pressure is 145/100. She does not have glucosuria or proteinuria. If a repeat blood pressure is taken 6 hrs later and is still above 140/90, what should this patient be diagnosed with?

Which of the following is NOT a risk of external cephalic version?

If there is concern for contraction of cytomegalovirus (CMV) during pregnancy, how is it diagnosed?

An 18-year-old female with a past medical history of depression when she was 15, presents for a 2 week follow up after an emergency cesarean section. On exam, she is weepy and disheveled. She reports her baby has been in the NICU since delivery, and since her hospital discharge 1 week ago, she hasn’t visited the baby but figures he is fine with the nurses’ care. She lives with a roommate, is not in contact with the father of the baby, and doesn’t have family support at this time. She denies suicidal ideation, but does feel hopeless and overwhelmed most days. In addition to starting an SSRI, what should you do for this patient’s treatment?

Your 32-year-old G4P3 patient comes to you for her first prenatal appointment at an estimated 22 weeks gestational age. She states that she drinks about 1 glass of wine with dinner a day to feel relaxed enough to go to bed after a stressful day of work. Otherwise, she has never experienced anyone ask her about her drinking, has never felt the need to cut down on her alcohol intake, and has never needed an “eye-opener” in the morning. Is the screening positive for alcohol abuse?

A G3P2 woman at 39 weeks GA with a history of two prior normal spontaneous vaginal deliveries presents to triage for painful contractions. On digital exam, her cervix is 5cm dilated, 60% effaced, and at -2 station. How fast should you expect her cervical dilation to expand if she were to have a normal active phase of labor?

Which of the following is the best definition of spinal analgesia?

What is the most likely cause of a gush of blood during the third stage of labor?

History of which of the following types of uterine incisions is the safest to attempt labor and vaginal delivery (ie. a VTOL) in future pregnancies?

Which of the following is a quantitative measure of beta-human chorionic gonadotropin?

A 27-year-old G1P0 at an estimated gestational age of 10 weeks presents to the emergency room with nausea. She reports that she can hardly keep any food or liquid down and vomits several times a day. She has had a weight loss of about 5 pounds since the beginning of these symptoms. She denies fever, abdominal pain, or diarrhea. She reports she is mildly constipated. On physical exam her heart rate is 95 beats per minute at rest, blood pressure is 105/60. She appears slightly anxious, her oral mucous membranes are dry and she has poor skin turgor. Her abdomen is non-tender to palpation and fetal heart tones are present. Laboratory tests show potassium of 3.1 and a sodium level of 132. What is the best immediate treatment for this patient?

A 27-year-old G1P0 at 8 weeks gestational age by LMP presents with 1 day of vaginal bleeding and intense cramps. Blood tests confirm maternal blood type is B+ and HCG is within the normal range for her gestational age. Bedside ultrasound confirms intrauterine products of conception. Pelvic exam reveals several clots in the vaginal vault and small bits of tissue. How would you categorize this miscarriage?

A 28-year-old G1P0 woman presents at 37 weeks gestation with new-onset swelling in her legs and hands, a 2-day history of headache that won’t go away with rest and acetaminophen, and reports intermittently seeing bright spots. On exam, she is found to have a blood pressure of 162/111, a spot urine protein/creatinine ratio of 0.4. What is the best diagnosis for this patient?

Which of the following is a contraindication to performing external cephalic version?

What is a potential effect of cytomegalovirus (CMV) infection on a fetus?

A 31-year-old woman just delivered her baby at 34 weeks gestation 5 days ago. Her baby boy is in the nursery for phototherapy to treat hyperbilirubinemia but is otherwise healthy. Although the mother was discharged from the hospital, she continues to visit daily to breastfeed her baby and pumps milk in between feedings for the baby to have overnight when she is away. She cries several times a day and especially at night time when she feels guilty that she can not be with her baby. She tells her husband that she is overwhelmed by the whole situation of delivering the baby earlier than anticipated and wishing she could have been more prepared. What is the most likely diagnosis for this patient?

Which of the following best describes the goal of preconception care?

Which of the following is known to put a patient at risk of using illicit drugs during pregnancy?

A G1P0 woman at 40 weeks and 3 days presents to triage in active labor with cervical dilation of 5cm. She received an epidural upon admission, and 4 hours later, her cervix was completely dilated and effaced. She pushed for 2 hours and her infant was delivered, followed by delivery of the placenta 12 minutes later. Was this labor and delivery progression within the normal time-frame?

A 31-year-old G2P1 with a history of a c-section for her first child is admitted to the labor ward at 41 weeks gestation for spontaneous onset of labor. She progressed through the active phase of the first stage of labor over 3 hours and her last cervical exam showed a completely dilated cervix and at -1 station. She was allowed 1 hour for passive descent and then pushed with adequate effort and contractions for 2 hours. Repeat cervical exams during this period demonstrated no change in the station of the fetus. She feels like this baby is about the same size as her last. What is the likely cause of this situation, and what should be the next step in management?

 Which of the following best describes the appropriate method for delivery of the placenta?

What are the advantages of the Pfasnnenstiel incision when compared to a midline skin incision?

A 22-year-old female presents to urgent care with some mild lower abdominal discomfort for the past 2 days. Her last menstrual period was 5 weeks ago, and her periods are usually every 30 days. She is not having any vaginal bleeding now, but did have some spotting that lasted 2 days, a week ago. She has no other medical problems. At the urgent care, a serum beta-human chorionic gonadotropin level is done as a first step and measured to be 600 mlU/ml. A trans-abdominal ultrasound was done, but nothing was seen in the uterus. What should be done next?

 Which of the following is the first line anti-emetic for hyperemesis gravidarum?

A 27-year-old G1P0 presents in the antenatal clinic for her routine 15 week antenatal appointment. She previously had an ultrasound early during this pregnancy to confirm intrauterine pregnancy and gestational age. On review of her first trimester labs, her blood type is O negative and she had a hemoglobin level of 13. She has no complaints, no vaginal bleeding, no abdominal pain or cramps. On first doppler assessment, no fetal heart tones are heard. What is the concern here?

A 24-year-old G1P0 obese woman at 26 weeks gestation is seen for a routine prenatal visit. Her blood pressure is 158/100, her heart rate is normal, and her spot urine test is negative for glucose and protein. She denies any headaches, visual changes, chest pain, or difficulty breathing. A repeat blood pressure done 6 hrs later is 154/105. What is the best diagnosis for this patient?

Which of the following is defined as premature separation of the placenta from the uterus?

A 30-year-old G3P0 woman has a history of genital herpes. She does not have any current lesions. What should her treatment plan be?

How common is postpartum blues among women who have just delivered a baby within 2 weeks?

How would you define gravidity and parity?

Which of the following is NOT part of a routine initial prenatal visit?

A G1PO woman at 41 weeks gestational age is experiencing about 5 contractions within every 10 minutes, and her cervix has dilated from 5 cm to 6cm over the past 3 hours. On cervical exam, fetal sutures are felt and confirmed to be in occiput anterior position at -1 station. What should be the next step in her management?

How long is a multiparous woman with an epidural allowed in the second stage of labor before needing a change in management for protracted or arrest of labor?

Which of the following is the most common cause of primary postpartum hemorrhage?

For which of the following patients a vaginal trial of labor can be an option?

At what quantitative level of beta-HCG would you first expect to a gestational sac on transvaginal ultrasound?

Which of the following can be a complication of IV hydration in patients with hyperemesis gravidarum?

A 28-year-old female presents to the emergency room with 1 day of heavy vaginal bleeding, abdominal pain, and dizziness. The abdominal exam is soft, the pelvic exam shows several clots in the vaginal vault with the cervix open to 1 cm. Her heart rate is 110, and her blood pressure is 90/45. Blood tests show a positive HCG of 10,000, hematocrit of 34%, and blood type is O positive. Bedside ultrasound confirms intrauterine pregnancy. What should be the best choice of management in this patient?

A 20-year-old female G1P0 with a twin-pregnancy at 34 weeks gestational age presents to triage with one day of severe headache. Her blood pressure is 165/110 and her heart rate is 99. Her spot urine protein/creatinine ratio is 1. Her lactate dehydrogenase level is elevated, liver enzymes (AST and ALT) are elevated, and her platelets are 93,000. What is the patient’s diagnosis and the next best step in management?

A 22-year-old G1P0 at 24 weeks gestation presents to the emergency room with painless heavy vaginal bleeding after intercourse. She denies any drug use or medical problems during this pregnancy. She was unable to make it to her anatomy scan 3 weeks ago and had to reschedule the appointment for the ultrasound, which she hasn’t had yet. She has soaked through 4 large pads in the past 1 hour. Her blood pressure is 95/50 with a heart rate of 105 bpm. After starting emergent IV fluids, what is the next step in determining the cause of bleeding?

At what viral load can a woman with HIV deliver via vaginal delivery with a low risk of transmission of the virus to the baby?

Which of the following increases the risk of postpartum depression?

Which abbreviation represents the first day of a patient’s last menstrual period?

 A 28-year-old G2P1 presents to you at 8 weeks GA by LMP for her initial prenatal visit. She has a history of pre-eclampsia during her first pregnancy, but has no other medical problems. What should you advise her at this visit?

A G2P1 woman at 38 weeks gestational age with a past history of a normal vaginal delivery is on the ward in active labor. Her cervical exam has remained unchanged at 6 cm dilation, 60 % effacement, and -3 station. She is feeling painful contractions every 2-3 minutes and an intrauterine pressure catheter measures the power of her contractions as 200 Montevideo units. What should the next step in her management be?

What is the cardinal movement of labor that allows the fetal head to descend under the pubic symphysis?

How much blood can be lost during a spontaneous vaginal delivery before being considered postpartum hemorrhage?

Which of the following physiologic changes occur in the cardiovascular system during pregnancy?

A 24-year-old woman presents to your office for her first prenatal visit. She is certain the first day of her last menstrual period was September 14. She normally has regular cycles. According to Naegele’s rule, when is her estimated due date?

Which of the following is the most accurate, non-invasive screening test for aneuploidy?

What is a risk of Rh-negative maternal sensitization to an Rh-positive fetus?

Which of the following is NOT evidence of HELLP syndrome?

A G2P1 woman with a history of a cesarean section for her first delivery is seven hours into her vaginal trial of labor. Her last cervical exam one hour ago showed a 5 cm dilation with fetal cephalic station 1cm above the ischial spines of the pelvis (-1 station) and Pitocin (oxytocin) augmentation was started at that time. Her nurse calls you in emergently because the patient is experiencing a sudden increase in vaginal bleeding and severe abdominal pain and tenderness. Fetal heart rate has dropped to 90 beats per min and is continuing to drop, you call for an emergency c-section, and as you are rolling the patient into the operating room, your perform a rapid cervical exam to find fetal station is now too high to be reached. What is the likely cause of this obstetrical emergency?

 Hutchinson’s teeth are pathognomonic for which congenital infectious disease?

Which of the following symptoms defines postpartum psychosis?

What does the abbreviation “GA” stand for in obstetrics?

A 22-year-old G1P0 patient presents to your office at 12 weeks gestational age by LMP for her initial prenatal visit. She has a body mass index (BMI) of 32. She has no other known medical problems including no history of hypertension or diabetes. Of the options provided below, which is the best advice to your patient?

Which pelvis shape best allows for the optimum fetal orientation for delivery?

Which of the following is an indication for operative (vacuum or forceps assisted) vaginal delivery?

How much blood can be lost during a cesarean section before being considered a postpartum hemorrhage?

Which of the following changes occurs in the cardiovascular system during pregnancy?

 A 20-year-old woman comes to your office to confirm dates for her pregnancy. She is certain the first day of her last menstrual period was 8 weeks and 5 days ago. On transvaginal ultrasound, the crown-rump length corresponds to an estimated gestational age of 6 weeks and 2 days old. Which gestational age should be used to calculate her estimated due date?

Which of the following tests is done in the first trimester to screen for Down syndrome?

In which of the following circumstances should anti-D immunoglobulin NOT be given to an Rh-negative mother?

Which of the following features distinguishes eclampsia from preeclampsia?

How is fetal growth restriction defined?

Which of the following tests is most diagnostic of rupture of membranes?

What is the treatment for postpartum blues?

At least three months before getting pregnant, a woman with no other risk factors should start taking a minimum daily dose of 400 micrograms of folic acid supplementation. What is the recommended dose of folic acid for women with prior delivery of a baby with a neural tube defect?

 Obesity during pregnancy is NOT known to increase the risk for which of the following?

Which pelvis shape is least likely to allow for fetal engagement into the pelvis?

 Which of the following is a complication of vacuum-assisted vaginal delivery?

Which of the following is NOT a common cause of secondary postpartum hemorrhage?

Which of the following hematological changes occur during pregnancy?

Which of the following statements about ultrasound accuracy in determining gestational age is FALSE?

Which of the following tests is done in the second trimester to confirm fetal Down syndrome?

If embryonic division occurs 4-8 days from conception, what kind of twins are most likely to develop?

What is the definitive treatment for preeclampsia?

 What is the most common infectious cause for fetal growth restriction worldwide?

Which of the following does NOT give a positive nitrazine result?

How effective is natural family planning if used correctly and perfectly?

Which of the following blood pressure medications, if taken by a pregnant woman, is proven to be associated with an increased risk of renal agenesis?

Which of the following best describes stage 1 of labor, from start to finish?

What is the range for a normal baseline fetal heart tracing?

A 21-year-old G1P0 presented to the labor ward in active labor and progressed to complete dilation and stage 2 of labor without complication. She has an epidural in place. After 3 hours of pushing, her last cervical exam demonstrated occiput anterior fetal position at 2+ station, which is unchanged from her exam 6 hours prior. She is tiring out and does not know if she can push anymore. Fetal heart tracing is Category 2 with early decelerations with contractions and several irregularly spaced variable decelerations. What should be the next step in management?

Which of the following is a common cause of uterine atony within the first 24 hours post-partum?

A 28-year-old female is on post-operative day one after an emergency c-section of her term infant. She had no other complications during pregnancy and has no other past medical problems. Which of the following factors puts her at an increased risk of developing a deep vein thrombosis?

A 32-year-old woman presents to your office to determine the gestational age of her pregnancy. She states that her last menstrual period was 8 weeks ago. The crown-rump length on ultrasound is consistent with a gestational age of 7 weeks and 5 days. What is the gestational age of the pregnancy?

A 28-year-old G1P0 women enters prenatal care at 16 weeks gestational age with no other risk factors. Of the following options, which is her best choice for fetal aneuploidy screening?

If embryonic division occurs 0-4 days after conception, what kind of twins are most likely to develop?

Which of the following can be a potential cause of recurrent variable decelerations noted on the fetal heart tracing during labor?

Which of the following is a fetal cause for growth restriction?

When should you give antibiotics to a woman with rupture of membranes after 37 weeks gestational age?

Which of the following statements is true about the hysteroscopic tubal ligation procedure?

Which of the following is not associated with maternal diabetes during pregnancy?

Which of the following is NOT monitored by digital exam during labor?

Which of the following describes an acceleration in the fetal heart tracing in a fetus with a gestational age greater than 32 weeks?

 Which of the following is NOT an indication for a vacuum-assisted vaginal delivery?

A 34-year-old G5P6 female just delivered twins after prolonged labor which resulted in an emergent cesarean section for fetal intolerance of labor. You get a call from the recovery room 1 hour after delivery from the nurse stating that the patient’s heart rate is 120 and her blood pressure is 89/40. She is alert and oriented and denying significant pain, but appears to be bleeding heavily and has lost several large clots. What should be the initial step in your team’s management of this patient?

Which of the following changes occur in the maternal respiratory physiology during pregnancy?

What factors can lead to variability in fetal size in the second and third trimesters?

Which of the following tests is not part of Quad screening?

If embryonic division occurs in an implanted blastocyte 8-14 days after conceptions, what kind of twins are most likely to develop?

Which of the following is the recommended route of delivery for placenta previa?

In the case of fetal growth restriction, what other factor must be regularly monitored every three to four weeks in addition to monitoring interval fetal growth?

What are the effects of steroids given for preterm premature rupture of membranes?

Which of the following physiological changes occur while a woman is breastfeeding and how do they affect her chances of conceiving during that time?

A 26 year-old G0P0 with a history of well-controlled asthma comes to you for preconception counselling. What should you advise her on with regards to her asthma?

Which of the following terms is used to describe the size of the opening of the external os of the cervix?

A 27-year-old female G1P0 at 42 weeks gestational age was admitted for induction of labor. The woman is on Pitocin, and her last cervical exam was unchanged from the one prior; 5cm/ 80% effaced/ -2 station with a category I fetal heart tracing and experiencing contractions every 5-6 minutes. Pitocin infusion was increased to help the progression of labor. 20 minutes later, she is having one contraction every minute. Fetal heart tracing has a baseline of 165 with absent variability and two late deceleration over a 20-minute strip. What category is fetal heart tracing, and what is the next best step in management?

Which of the following statements about shoulder dystocia is FALSE?

A 25-year-old G1P1 with a history of asthma and no other medical problems just delivered her baby by cesarean section after arrest of the first stage of labor after prolonged rupture of membranes. In the operating room, there is a suspicion for chorioamnionitis and difficulty achieving uterine tone after uterine massage, removal of products of placenta and membranous tissues, and closure of the hysterotomy and she is receiving oxytocin infusion. Which of the following treatments should be given immediately to help limit the uterine atony?

Which of the following changes occurs in the pulmonary system during pregnancy?

Which of the following measurements on a second trimester ultrasound factors into calculation of the estimated gestational age of a fetus?

A healthy 36-year-old G3P2 woman at gestational age of 10 weeks 3 days presents to your clinic for routine prenatal care. She has no other risk factors and no prior problems with pregnancy. Her two other children are healthy and well. Which of the following tests is the best screening tool for fetal Down syndrome for this woman?

In a twin-twin transfusion, which of the following is most likely to be seen in the donor twin?

Which of the following is the appropriate mode of delivery for a patient with placenta increta?

 Which of the following would be an indication for delivery of a growth restricted fetus?

When is magnesium sulfate indicated in the case of preterm rupture of membranes?

Which of the following is NOT a mechanism of action of progestin intrauterine contraceptive devices?

 Which of the following statements is true about maternal blood pressures during pregnancy in a mother with a history of chronic hypertension?

What term is used to describe the measurement of the thickness of the cervix?

Which of the following fetal heart tracings is a category II tracing?

A 34-year-old G1P0 with a history of gestational diabetes and a BMI of 32 has just delivered the head of her infant after 3 hours of pushing. The delivering physician notes that immediately after delivery of the head of the baby, the chin is retracted against the perineum. What is the most appropriate next step the physician should take?

Methylergonovine is contraindicated in which of the following medical conditions?

Why is acid reflux a common gastrointestinal symptom during the first trimester of pregnancy?

A 20-year-old G1P0 woman at 6 weeks 6 days gestational age presents to your office for her initial prenatal visit. Which of the following tests is not part of her routine screening at this first trimester visit?

Which of the following non-stress test strips is reassuring?

In what type of twin chorionicity is the complication of twin-twin transfusion MOST likely to occur?

Which of the following placental abnormalities is most associated with antepartum hemorrhage and fetal death?

Which of the following should pregnant women avoid to reduce the risk of toxoplasmosis transmission to a fetus through the placenta?

When should tocolytics be used?

If used correctly, how effective is the barrier plus spermicide method in preventing pregnancy?

Which of the following is NOT a known effect of smoking during pregnancy?

When determining the station of the fetus, the presenting part of the fetus is measured in relation to what structure?

Which of the following is true of a category 3 tracing?

A 30-year-old woman with gestational diabetes just delivered a 4700-gram infant boy after prolonged labor. You are performing the initial newborn examination when you notice the baby’s left arm is rotated inward with the forearm extended and pronated and the baby is not moving it spontaneously like his right arm. What is the most likely injury?

What is an important first step in assuring effective bimanual uterine massage to treat uterine atony?

Why are pregnant women more susceptible to urinary tract infections?

A 27-year-old G3P1 woman who is at a high risk of contracting sexually transmitted infections presents to your office for her routine first trimester screening labs. Of the following labs which are routinely done only in the first trimester, which one should she specifically have repeated in the second AND third trimesters?

 Which of the following is NOT part of a full biophysical profile?

Which of the following is not a common complication of multifetal pregnancies?

Which of the following conditions is best described as placental tissue invading through both the myometrium and serosa of the uterus?

How should the parasitic disease be treated If a pregnant woman is exposed to toxoplasmosis?

Breastfeeding is contraindicated in which of the following patients?

What is the purpose of assigning APGAR scores?

A 23-year-old G1P0 with a 2-year history of smoking a half-pack of cigarettes a day comes to you for her first prenatal appointment at 8 weeks gestational age. What can you advise her with regard to smoking cessation?

When does the active phase of the first stage of labor start?

A 29-year-old G4P3 woman at 40 weeks gestational age was admitted to the labor ward in spontaneous active labor. Her last cervical exam was 7 cm dilation/90% effacement/-2 station with a bulging bag of water (intact membranes) and fetal heart tracing was unremarkable with a baseline heart rate of 140 beats per minute and moderate variability without any decelerations. 30 minutes later she felt a large gush of fluid with her contraction and the fetal heart tracing started displaying regular early decelerations with each contraction. How can this phenomenon be best described?

You and your team have an emergency situation with a shoulder dystocia. So far you have tried McRobert’s Position, adequate suprapubic pressure, internal rotation maneuvers, rotating the patient, and an episiotomy to try to reach in and relieve the posterior arm. Unfortunately, none of these maneuvers have worked so far, so you and your team decide the next best step to avoid further morbidity and mortality is to break the infant’s clavicles to decrease width between the shoulders. What is the recommended method for breaking the clavicle?

How much should a patient’s hemoglobin increase after administering two units of packed red blood cells?

What is a common physiologic change in the renal system during pregnancy?

What routine screening test is done for all pregnancies between 18 weeks and 22 weeks gestational age?

A 24-year-old G1P0 at 38 weeks gestational age presents to the ward for concern over decreased fetal movement for the past 10 hours despite adequate hydration and maternal rest. External fetal monitoring is done for 20 minutes and is not reassuring, so a biophysical profile is performed. After 30 minutes of ultrasound observation, the physician notes the following: a single deepest pocket of amniotic fluid measuring 5.3 cm, 1 episode of fetal breathing lasting 60 seconds, extension and flexion of the fetal arm once, and 2 discrete body movements. The non-stress test is reactive. What is her biophysicial profile score and what should the next step be?

Which of the following patient populations should be screened for gestational diabetes?

A woman G1P0 presents to triage at 40 weeks 1 day gestational age after she experienced a gush of clear fluid loss when she woke up in the morning followed by some intermittent contractions. After the doctor confirmed spontaneous rupture of membranes, and cervical exam demonstrated the cervix dilated to 4 cm and what the physician suspects is brow presentation. Bedside ultrasound confirms mentum posterior brow presentation of the fetus. What should be the recommended route of delivery?

Which of the following negative fetal outcomes can occur if a woman contracts the varicella virus (chickenpox) during pregnancy?

Which of the following is associated with breastfeeding?

Five minutes after delivery, a newborn baby has a pink face and abdomen, cyanotic hands and feet, has a pulse of 140, promptly squirms to stimulation of its feet, is spontaneously moving arms and legs with good tone, and breathing vigorously. What is the 5 minute APGAR score for this baby?

What is the first step in smoking cessation counselling?

Up to how long is the latent phase expected to last in the NORMAL progression of labor for a primiparous woman?

Which of the following is NOT true of a sinusoidal pattern on a fetal heart tracing?

Which of the following options best describes the appropriate method for applying suprapubic pressure?

Which of the following options describes a third-degree laceration?

During pregnancy, by how much do elevated cell turnover and fetal growth increase the maternal basal metabolic rate?

Why is Rhogam given to an Rh-negative G1P0 mom at 28 weeks gestational age?

Which of the following defines a POSITIVE contraction stress test?

Who is exempt from screening for gestational diabetes between 24-28 weeks gestation?

Which of the following presentations is optimal for successful vaginal delivery?

How is the rubella virus typically transmitted to pregnant women?

A 27-year-old mother who just had a baby 3 weeks ago presents to your office with a complaint of almost one week of bilateral breast pain and tenderness. She states she works full time and only gets 10 minutes every 4 hours to pump, so she is unable to completely empty her breasts while at work. She reports a somewhat painful latch when she feeds her newborn daughter in the evenings. She hasn’t noticed any fevers. What is the most likely cause of this woman’s symptoms?