Clinical Expert Series

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CME Quiz for the Clinical Expert Series Credit available through November 2010

Obstet Gynecol 2007;110:1151–64 Page 1 of 4

Clinical Expert Series

Prediction and Prevention of Recurrent Stillbirth Uma M. Reddy, MD, MPH

Obstet Gynecol 2007;110:1151–64

ACCME Accreditation

The American College of Obstetricians and Gynecologists (ACOG) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. (Continuing medical education credit for

“Prediction and Prevention of Recurrent Stillbirth” will be available through November 2010.) AMA PRA Category 1 Credit^TM and ACOG Cognate Credit

The American College of Obstetricians and Gynecologists (ACOG) designates this educational activity for a maximum of 2 AMA PRA Category 1 Credits^TM or up to a maximum of 2 Category 1 ACOG cognate credits. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Disclosure Statement

Current guidelines state that continuing medical education (CME) providers must ensure that CME activities are free from the control of any commercial interest. All authors, reviewers, and contributors have disclosed to ACOG all relevant financial relationships with any commercial interests. The authors, reviewers, and contributors declare that neither they nor any business associate nor any member of their immediate families has financial interest or other relationships with any manufacturer of products or any providers of services discussed in this program. Any conflicts have been resolved through group and outside review of all content.

Before submitting this form, please print a completed copy as confirmation of your program participation.

ACOG Fellows: To obtain credits, complete and return this form by clicking on “Submit” at the bottom of the page. Credit will be automatically recorded upon receipt and online transcripts will be updated twice monthly. ACOG Fellows may check their transcripts online at http://www.acog.org.

Non–ACOG Fellows: To obtain credits, submit the printout of the completed quiz to your accrediting institution. The printout of the completed quiz is documentation for your continuing medical education credits.

1. Following a stillbirth, the relative risk is highest for which of the following complications in a subsequent pregnancy?

A. Placental abruption B. Cesarean delivery C. Preterm delivery D. Low birth weight

2. The largest category of conditions associated with stillbirth is:

A. Inheritable genetic syndromes B. Fetal growth restriction C. Epigenetic syndromes D. Maternal thrombophilias E. Diabetes

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3. The recurrence risk of stillbirth in the subsequent pregnancy is:

A. Not influenced by the gestational age of the prior stillbirth

B. Not increased over the general population risk of stillbirth because of the use of antepartum fetal surveillance

C. Increased threefold for black women compared to white women D. Increased 12- to 20-fold

E. Unknown

4. A woman has a stillborn infant at 36 weeks of gestation during her first pregnancy. The most likely outcome for her next pregnancy is:

A. Recurrent stillbirth

B. Intrauterine growth restriction C. Cesarean delivery

D. Preterm delivery E. Normal term delivery

5. A woman has a stillborn infant at 36 weeks of gestation during her first pregnancy. During her second pregnancy she undergoes a first trimester test of her pregnancy-associated plasma protein A (PAPP-A) that is reported to be below the 5th percentile. This patient’s risk of a stillbirth due to placental dysfunction during this pregnancy is approximately:

A. 2%

B. 22%

C. 42%

D. 62%

E. 82%

6. In the absence of a fetal neural tube or ventral wall defect, the finding of elevated maternal serum alpha fetoprotein (MSAFP) is thought to reflect:

A. Fetal growth restriction B. Abnormal placentation C. Maternal liver dysfunction D. Fetal liver dysfunction E. Fetal renal dysfunction

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7. Which of the following characterizes the changes that uterine spiral arteries undergo to support normal placentation?

A. High resistance, high compliance B. High resistance, low compliance C. Low resistance, high compliance D. Low resistance, low compliance

8. When evaluating a growth restricted fetus, which of the following will indicate declining fetal status first?

A. Umbilical Doppler studies

B. Middle cerebral artery Doppler studies C. Fetal nonstress test

D. Contraction stress test E. Biophysical profile

9. In otherwise healthy women with a history of a prior stillbirth, antenatal testing should be begun at approximately:

A. 26–28 weeks B. 29–31 weeks C. 32–34 weeks D. 35–37 weeks E. 38–40 weeks

10. The use of first- and second-trimester serum analytes to predict the risk of stillbirth is significantly limited by:

A. Lack of studies

B. Need for specialized test interpretation C. Increased cost associated with testing D. Availability of constituent tests E. Poor predictive value

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