COMAT Obstetrics & Gynecology Final Exam Prep (2026-
2027) Exam Blueprint Overview (Based on NBOME
COMAT OB/GYN) QUESTIONS AND ANSWERS ALREADY
GRADED A+
Topic Category Percentage
Normal Obstetrics 12-14%
Abnormal Obstetrics 15-16%
Circulatory & Hematologic Systems (includes Oncology) 10-12%
Genitourinary/Renal System & Breasts 8-10%
Endocrine System & Metabolism 7-10%
Human Development, Reproduction & Sexuality 8-10%
Community Health & Wellness 5-8%
Nervous System & Mental Health 5-8%
Musculoskeletal System 5-8%
Respiratory System 5-7%
GI System & Nutritional Health 5-6%
,Topic Category Percentage
Integumentary System 5-6%
Physician Tasks Weighting:
• History & Physical (includes Diagnosis): 25-30%
• Diagnostic Technologies: 20-30%
• Management: 20-25%
• Scientific Mechanisms of Disease: 10-20%
• Health Promotion/Disease Prevention: 10-15%
Section 1: Normal Obstetrics (Questions 1-15)
Q1. A 28-year-old G2P1 at 38 weeks gestation presents for a routine prenatal visit. Her blood
pressure is 118/72 mmHg, fundal height measures 37 cm, and fetal heart rate is 140 bpm with a
reassuring pattern. She asks about signs that indicate labor is approaching. Which of the
following is a sign of impending labor?
A) Increased fetal movement
B) Weight gain of 2 kg in one week
C) Bloody show (passage of mucus plug)
D) Persistent hypertension
Answer: C – Bloody show (passage of mucus plug)
Rationale: Signs of impending labor include lightening (fetal descent), Braxton-Hicks
contractions becoming more regular, cervical changes (effacement and dilation), and bloody
show (expulsion of the mucus plug with small amount of blood). Increased fetal movement is
not a sign of impending labor; fetal movement may actually decrease slightly. Weight gain of 2
kg in one week suggests fluid retention and is concerning for preeclampsia. Persistent
hypertension is not a normal sign of impending labor.
Q2. A 32-year-old G1P0 at 40 weeks gestation is admitted in active labor. Cervical examination
reveals 6 cm dilation, 100% effacement, and the presenting part is at 0 station. The fetal heart
rate tracing shows a baseline of 130 bpm with moderate variability and no decelerations. She
,requests epidural analgesia for pain relief. Which of the following is a contraindication to
epidural placement?
A) Maternal platelet count of 80,000/μL
B) Cervical dilation of 6 cm
C) Body mass index of 32 kg/m²
D) History of prior cesarean section
Answer: A – Maternal platelet count of 80,000/μL
Rationale: Thrombocytopenia with platelets <100,000/μL is a relative contraindication to
neuraxial anesthesia (epidural or spinal) due to increased risk of epidural hematoma. A platelet
count of 80,000/μL is below the typical threshold of 100,000/μL. Cervical dilation of 6 cm is not
a contraindication; epidurals can be placed at any stage of active labor (though some
anesthesiologists prefer not to place in very advanced labor). Obesity is not a contraindication,
though it may make placement technically more difficult. Prior cesarean section is not a
contraindication to epidural; in fact, epidural can be beneficial if intrauterine resuscitation or
operative delivery becomes necessary.
Q3. A 25-year-old G1P0 at 39 weeks gestation presents with regular contractions every 3
minutes. Cervical examination shows 4 cm dilation, 80% effacement, and the vertex is at -1
station. The fetal heart tracing is category I. She desires a vaginal delivery. According to the
Friedman curve, which of the following best describes the expected progression of labor in a
nulliparous patient?
A) Active phase cervical dilation rate of approximately 0.5 cm/hour
B) Active phase cervical dilation rate of approximately 1-2 cm/hour
C) Second stage should not exceed 1 hour
D) Latent phase should not exceed 30 minutes
Answer: B – Active phase cervical dilation rate of approximately 1-2 cm/hour
Rationale: In nulliparous patients, the active phase of labor (from 6 cm to complete dilation) is
expected to progress at a rate of approximately 1-2 cm/hour. The latent phase (0-6 cm) typically
lasts up to 20 hours in nulliparas and 14 hours in multiparas. The second stage (complete
dilation to delivery) can last up to 3 hours in nulliparas with epidural and 2 hours without
epidural; exceeding these thresholds may prompt evaluation for vacuum or forceps assistance.
, Q4. A 30-year-old G3P2 at 41 weeks gestation is admitted for induction of labor due to post-
term pregnancy. She has a favorable cervix with a Bishop score of 8. Which induction method is
most appropriate for a favorable cervix?
A) Cervical ripening with misoprostol
B) Oxytocin infusion
C) Transcervical Foley catheter placement
D) Stripping of membranes
Answer: B – Oxytocin infusion
Rationale: A Bishop score ≥6 indicates a favorable cervix. For patients with a favorable
cervix, oxytocin infusion alone is appropriate for induction. Cervical ripening agents
(misoprostol, dinoprostone) and mechanical methods (Foley catheter) are used when the cervix
is unfavorable (Bishop score <6). Stripping of membranes may induce labor but is not a reliable
method for formal induction.
Bishop Scoring System:
• Score ≥8: favorable, likely to have successful vaginal delivery
• Score ≤6: unfavorable, cervical ripening recommended
• Components: Dilation, Effacement, Station, Consistency, Position
Q5. A 27-year-old G1P0 delivers a healthy term infant vaginally. The third stage of labor has
lasted 25 minutes. Which of the following is the most appropriate management at this time?
A) Apply fundal pressure to expel the placenta
B) Administer oxytocin and perform controlled cord traction
C) Manually remove the placenta in the operating room
D) Observe for an additional 30 minutes
Answer: B – Administer oxytocin and perform controlled cord traction
Rationale: The third stage of labor (delivery of the placenta) should typically be completed
within 30 minutes. Active management of the third stage includes administration of oxytocin
(to enhance uterine contraction), controlled cord traction (Brandt-Andrews maneuver), and
uterine massage to prevent postpartum hemorrhage. Expectant management beyond 30
minutes increases risk of hemorrhage. Fundal pressure before placental separation can cause
uterine inversion. Manual removal is reserved for retained placenta after 30-60 minutes with
oxytocin administration.
2027) Exam Blueprint Overview (Based on NBOME
COMAT OB/GYN) QUESTIONS AND ANSWERS ALREADY
GRADED A+
Topic Category Percentage
Normal Obstetrics 12-14%
Abnormal Obstetrics 15-16%
Circulatory & Hematologic Systems (includes Oncology) 10-12%
Genitourinary/Renal System & Breasts 8-10%
Endocrine System & Metabolism 7-10%
Human Development, Reproduction & Sexuality 8-10%
Community Health & Wellness 5-8%
Nervous System & Mental Health 5-8%
Musculoskeletal System 5-8%
Respiratory System 5-7%
GI System & Nutritional Health 5-6%
,Topic Category Percentage
Integumentary System 5-6%
Physician Tasks Weighting:
• History & Physical (includes Diagnosis): 25-30%
• Diagnostic Technologies: 20-30%
• Management: 20-25%
• Scientific Mechanisms of Disease: 10-20%
• Health Promotion/Disease Prevention: 10-15%
Section 1: Normal Obstetrics (Questions 1-15)
Q1. A 28-year-old G2P1 at 38 weeks gestation presents for a routine prenatal visit. Her blood
pressure is 118/72 mmHg, fundal height measures 37 cm, and fetal heart rate is 140 bpm with a
reassuring pattern. She asks about signs that indicate labor is approaching. Which of the
following is a sign of impending labor?
A) Increased fetal movement
B) Weight gain of 2 kg in one week
C) Bloody show (passage of mucus plug)
D) Persistent hypertension
Answer: C – Bloody show (passage of mucus plug)
Rationale: Signs of impending labor include lightening (fetal descent), Braxton-Hicks
contractions becoming more regular, cervical changes (effacement and dilation), and bloody
show (expulsion of the mucus plug with small amount of blood). Increased fetal movement is
not a sign of impending labor; fetal movement may actually decrease slightly. Weight gain of 2
kg in one week suggests fluid retention and is concerning for preeclampsia. Persistent
hypertension is not a normal sign of impending labor.
Q2. A 32-year-old G1P0 at 40 weeks gestation is admitted in active labor. Cervical examination
reveals 6 cm dilation, 100% effacement, and the presenting part is at 0 station. The fetal heart
rate tracing shows a baseline of 130 bpm with moderate variability and no decelerations. She
,requests epidural analgesia for pain relief. Which of the following is a contraindication to
epidural placement?
A) Maternal platelet count of 80,000/μL
B) Cervical dilation of 6 cm
C) Body mass index of 32 kg/m²
D) History of prior cesarean section
Answer: A – Maternal platelet count of 80,000/μL
Rationale: Thrombocytopenia with platelets <100,000/μL is a relative contraindication to
neuraxial anesthesia (epidural or spinal) due to increased risk of epidural hematoma. A platelet
count of 80,000/μL is below the typical threshold of 100,000/μL. Cervical dilation of 6 cm is not
a contraindication; epidurals can be placed at any stage of active labor (though some
anesthesiologists prefer not to place in very advanced labor). Obesity is not a contraindication,
though it may make placement technically more difficult. Prior cesarean section is not a
contraindication to epidural; in fact, epidural can be beneficial if intrauterine resuscitation or
operative delivery becomes necessary.
Q3. A 25-year-old G1P0 at 39 weeks gestation presents with regular contractions every 3
minutes. Cervical examination shows 4 cm dilation, 80% effacement, and the vertex is at -1
station. The fetal heart tracing is category I. She desires a vaginal delivery. According to the
Friedman curve, which of the following best describes the expected progression of labor in a
nulliparous patient?
A) Active phase cervical dilation rate of approximately 0.5 cm/hour
B) Active phase cervical dilation rate of approximately 1-2 cm/hour
C) Second stage should not exceed 1 hour
D) Latent phase should not exceed 30 minutes
Answer: B – Active phase cervical dilation rate of approximately 1-2 cm/hour
Rationale: In nulliparous patients, the active phase of labor (from 6 cm to complete dilation) is
expected to progress at a rate of approximately 1-2 cm/hour. The latent phase (0-6 cm) typically
lasts up to 20 hours in nulliparas and 14 hours in multiparas. The second stage (complete
dilation to delivery) can last up to 3 hours in nulliparas with epidural and 2 hours without
epidural; exceeding these thresholds may prompt evaluation for vacuum or forceps assistance.
, Q4. A 30-year-old G3P2 at 41 weeks gestation is admitted for induction of labor due to post-
term pregnancy. She has a favorable cervix with a Bishop score of 8. Which induction method is
most appropriate for a favorable cervix?
A) Cervical ripening with misoprostol
B) Oxytocin infusion
C) Transcervical Foley catheter placement
D) Stripping of membranes
Answer: B – Oxytocin infusion
Rationale: A Bishop score ≥6 indicates a favorable cervix. For patients with a favorable
cervix, oxytocin infusion alone is appropriate for induction. Cervical ripening agents
(misoprostol, dinoprostone) and mechanical methods (Foley catheter) are used when the cervix
is unfavorable (Bishop score <6). Stripping of membranes may induce labor but is not a reliable
method for formal induction.
Bishop Scoring System:
• Score ≥8: favorable, likely to have successful vaginal delivery
• Score ≤6: unfavorable, cervical ripening recommended
• Components: Dilation, Effacement, Station, Consistency, Position
Q5. A 27-year-old G1P0 delivers a healthy term infant vaginally. The third stage of labor has
lasted 25 minutes. Which of the following is the most appropriate management at this time?
A) Apply fundal pressure to expel the placenta
B) Administer oxytocin and perform controlled cord traction
C) Manually remove the placenta in the operating room
D) Observe for an additional 30 minutes
Answer: B – Administer oxytocin and perform controlled cord traction
Rationale: The third stage of labor (delivery of the placenta) should typically be completed
within 30 minutes. Active management of the third stage includes administration of oxytocin
(to enhance uterine contraction), controlled cord traction (Brandt-Andrews maneuver), and
uterine massage to prevent postpartum hemorrhage. Expectant management beyond 30
minutes increases risk of hemorrhage. Fundal pressure before placental separation can cause
uterine inversion. Manual removal is reserved for retained placenta after 30-60 minutes with
oxytocin administration.
