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General Considerations and Maternal Evaluation

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A 20-year-old primigravida at 13 weeks’ gestation presents with nausea, vomiting, and lower abdominal pain for the past 24 hours. On examination, she has mild guarding in the right lower quadrant of her abdomen. Which of the following statements regarding diagnostic evaluation is most accurate?

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a. Magnetic resonance imaging can be used for evaluation of the appendix.

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b. Ultrasound is the preferred method of evaluating the appendix during pregnancy.

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c. Imaging should not be performed until the patient has been observed for 24 hours.

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d. Computed tomography of the maternal abdomen should be avoided because of fetal exposure to ionizing radiation.

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A 20-year-old primigravida at 13 weeks’ gestation presents with nausea, vomiting, and lower abdominal pain for the past 24 hours. On examination, she has mild guarding in the right lower quadrant of her abdomen. The patient undergoes an uncomplicated appendectomy. Which of the following statements is most accurate?

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a. She is not at increased risk for excessive adverse pregnancy outcomes.

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b. Laparotomy is the preferred approach to minimize risk of injury to the gravid uterus.

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c. There is an increased risk of pregnancy loss when surgery is performed in the first trimester.

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d. There is an increase in anesthesia-related complications for surgery performed during early pregnancy.

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The increased neonatal death rate seen in gravidas who undergo nonobstetrical surgery is attributable to higher rates of which of the following?

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a. Preterm birth

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b. Fetal-growth restriction

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c. Congenital anomalies in patients with first-trimester procedures

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d. Fetal metabolic acidemia associated with emergent cesarean delivery

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Which of the following statements regarding anesthetic agents and teratogenicity is most accurate?

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a. There is no evidence that anesthetic agents are harmful.

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b. The evidence is contradictory regarding minimal exposure.

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c. Halogenated agents carry an increased risk of fetal malformations during the first 8 weeks of pregnancy.

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d. Regional anesthesia is the preferred route, as paralytic agents are linked to increased rates of neural-tube defects.

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