What is the main reason why a woman who is older than 35 years may have difficulty achieving pregnancy?

Choice A reason: Infection is not the greatest risk for a woman with marginal placenta previa, as it is not directly related to the condition. Marginal placenta previa is a type of placenta previa where the edge of the placenta is near the cervical os but does not cover it. It can cause painless bleeding during pregnancy or labor, but it does not increase the risk of infection.

Choice B reason: Hemorrhage is the greatest risk for a woman with marginal placenta previa, as it can occur due to the separation of the placenta from the uterine wall during labor or delivery. The bleeding can be profuse and life-threatening, and it requires prompt intervention and monitoring.

Choice C reason: Urinary retention is not the greatest risk for a woman with marginal placenta previa, as it is not directly related to the condition. Urinary retention is the inability to empty the bladder completely, and it can occur due to various factors such as anesthesia, trauma, or medication. It can cause discomfort, infection, or bladder distension, but it is not as serious as hemorrhage.

Choice D reason: Thrombophlebitis is not the greatest risk for a woman with marginal placenta previa, as it is not directly related to the condition. Thrombophlebitis is the inflammation of a vein due to a blood clot, and it can occur due to prolonged bed rest, dehydration, or injury. It can cause pain, swelling, or redness in the affected area, and it can lead to pulmonary embolism if the clot dislodges and travels to the lungs. However, it is not as common or as severe as hemorrhage.

The correct answer is d. Amenorrhea.

Choice A: Chadwick’s sign is a non-specific, early sign of pregnancy that is typically characterized by a bluish discoloration of the cervix, vagina, and vulva. The Chadwick sign can typically be observed as early as six to eight weeks after conception, and commonly disappears shortly after birth. However, it’s not a definitive indication of pregnancy, and the absence of it on physical exam does not exclude a potential pregnancy.

Choice B: Hegar’s sign is a non-specific indication of pregnancy that is characterized by the compressibility and softening of the cervical isthmus (i.e., the portion of the cervix between the uterus and the vaginal portion of the cervix). It typically presents between the fourth and sixth week of pregnancy and may be present until the 12th week of pregnancy. However, the Hegar sign is not a definitive indication of pregnancy, and the absence of it does not exclude a potential pregnancy.

Choice C: A positive pregnancy test By 10 weeks, a home pregnancy test would almost certainly show a positive result if the woman is pregnant. This is because the hormone human chorionic gonadotropin (hCG), which is produced by the placenta after implantation of the embryo into the uterine wall, would be present in high enough levels to be detected by the test. However, a positive pregnancy test is not a presumptive sign of pregnancy, but rather a probable one.

Choice D: Amenorrhea, or the absence of menstrual periods, is often considered the most presumptive sign of pregnancy. This is because it’s one of the first noticeable signs of pregnancy for many women. By 10 weeks of gestation, the woman would likely have missed two menstrual periods if she usually has regular cycles. However, while amenorrhea is a common early sign of pregnancy, it can also be caused by various other conditions or factors such as stress, significant weight loss or gain, or certain medical conditions. Therefore, a missed period should be followed up with a pregnancy test to confirm pregnancy.