Free OBGYN Board Review Sample Questions

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Your Free OBGYN Review Question

Which of the following is MOST useful in the evaluation of a stillbirth?

A. Toxicology screen
B. Lupus anticoagulant, anticardiolipin antibodies, β2 glycoprotein antibodies
C. Kleihauer–Betke testing
D. Fetal microarray
E. Examination of the placenta, umbilical cord, and fetal membranes

The Answer and Explanation

Did you get it right? The correct answer is: E

Gross and microscopic examination of the placenta, umbilical cord, and fetal membranes by a pathologist is the most useful component of the evaluation of a stillbirth. 

Stillbirth, defined as an in utero death of a fetus at 20 weeks’ gestation or greater, complicates 1/160 deliveries in the United States. Essential components to evaluation of stillbirths include a thorough maternal history, fetal autopsy, examination of the placenta/cord/membranes, and fetal karyotype evaluation.
Gross evaluation may reveal abruption, umbilical cord thrombosis, velamentous cord insertion, vasa previa, and evidence of infection or genetic abnormalities.

Table Adapted From: ACOG and SMFM Obstetric Care Consensus 10: Management of Stillbirth. 2020.

Incorrect Answer Explanations

Answer A: A toxicology screen should be performed in cases of placental abruption or when drug use is suspected.

Answer B: Antiphospholipid antibody syndrome should be tested for after many stillbirths, especially those involving fetal growth restriction, severe preeclampsia, or other evidence of placental insufficiency. Laboratory testing for antiphospholipid antibody syndrome includes lupus anticoagulant, anticardiolipin IgG and IgM, and β2 glycoprotein antibodies IgG and IgM.

Answer C: Investigation for fetal-maternal hemorrhage should be conducted in cases of unexplained stillbirth.

Answer D: Fetal karyotype or microarray abnormalities are found in 8% of stillbirths.

Bottom Line: Gross and microscopic examination of the placenta, umbilical cord, and fetal membranes by a pathologist is the most useful component of the evaluation of a stillbirth.

For more information, see:
ACOG and SMFM Obstetric Care Consensus 10: Management of Stillbirth. 2020.