skip to main content

Intrahepatic cholestasis of pregnancy — USMLE Step 3 MCQ

Instant feedback + full explanation. One question, done properly.

HardOB/GYNIntrahepatic cholestasis of pregnancyUSMLE Step 3

A 36-year-old with three prior cesarean deliveries has complete anterior placenta previa and ultrasound findings strongly suggestive of placenta accreta spectrum. She is stable at 31 weeks without bleeding. Which plan is most appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Plan cesarean hysterectomy at 34–35 weeks with placenta left in situ

The best answer is “Plan cesarean hysterectomy at 34–35 weeks with placenta left in situ”. Suspected placenta accreta spectrum should be managed by a multidisciplinary experienced center. Planned cesarean hysterectomy before labor or bleeding, generally at 34 0/7–35 6/7 weeks, with the placenta left undisturbed reduces catastrophic hemorrhage; forced placental removal is dangerous.

Reference: ACOG Obstetric Care Consensus: Placenta Accreta Spectrum: https://www.acog.org/clinical/clinical-guidance/obstetric-care-consensus/articles/2018/12/placenta-accreta-spectrum