Abnormal Labor

Question 1

Protracted active phase dilatation is when the mother has regular contractions and the rate of cervical dilation is

Answer 1

<1.2cm/hr: Nulli

<1.5cm/hr: Multi

Question 2

A diagnosis of arrest disorder can be made when the mother is in active phase with at least how much cervical dilation?

Answer 2

3-4cm

Question 3

Criteria for arrest of 2nd stage of labor is how many hours with and without epidural?

Answer 3

>4 hours no progress with epid >3 hours no progress without epid

Question 4

Prolonged latent phase in an nulli and multigravid (0-3cm)

Answer 4

>20 hours in nulli >14 hours in multi

Question 5

Intervention for prolonged latent phase

Answer 5

Bed rest Oxytocin

Question 6

Prolonged deceleration phase (8-10cm) is how many hours in a nulli and multigravid?

Answer 6

>3 hours nulli >1 hour multi

Question 7

Secondary arrest in dilatation (max slope) occurs after

Answer 7

>2 hours

Question 8

Arrest of descent happens if the fetus is in what level for more than 1 hour?

Answer 8

Station +1 onwards

Question 9

Criteria for arrest disorder: Beyond latent phase Uterine contraction >200 Montevideo units for ___ hours without cervical change

Answer 9

2 hours

Question 10

CONSIDER CS, IF WITH:

• ______ of uterine contractions of >200 MVU without cervical change
• ______ of oxytocin augmentation for inadequate contractions

Answer 10

4 hours

6 hours

Question 11

This describes the number of contractions x average uterine pressure in a 10 min strip

Answer 11

Montevideo unit

Question 12

Inappropriate leg positioning in stirrups in prolonged second stage may be die to compression of what nerve?

Answer 12

Common peroneal nerve

Question 13

Zavanelli maneuver requires restoring the fetal head back into this position

Answer 13

Occiput anterior or posterior

Question 14

Shoulder dystocia happens when the anterior shoulder becomes wedged behind this structure in the pelvis

Answer 14

Symphysis pubis

Question 15

Head to body delivery time of more than ____ seconds indicates shoulder dystocia

Answer 15

>60 seconds

Question 16

Lifting the legs in McRobert’s maneuver increases

Answer 16

AP diameter

Question 17

This maneuver attemps anterior shoulder disimpaction by applying suprapubic pressure over posterior aspect of anterior shoulder

Answer 17

Mazzanti

Question 18

This maneuver attemps anterior shoulder disimpaction by inserting 2 fingers vaginally and pushing the posterior shoulder toward the chest

Answer 18

Rubin

Question 19

This maneuver puts 2 fingers on the anterior aspect of the posterior shoulder to rotate obliquely

Answer 19

Wood corkscrew

Question 20

This maneuver puts patient into all fours, grasp posterior arm of the fetus, sweeps against chest and deliver

Answer 20

Gaskin

Question 21

Which maneuver is applied to reduce the nuchal arm in breech delivery

Answer 21

Loveset maneuver

Question 22

This maneuver in breech delivery is where the assistant applies suprapubic pressure to favor flexion and engagement of fetal head

Answer 22

Mauriceau-Smellie-Veit maneuver

Question 23

Intervals shorter than how many months between pregnancies have been associated with an increased risk for preterm birth?

Answer 23

18 months

Question 24

One of the most common causes for indicated preterm birth

Answer 24

Placenta previa

Question 25

Indomethacin as tocolytic promotes this effect on the fetus

Answer 25

Premature closure of the ductus arteriosus

Question 26

Neonate that has the function expected of a newborn at <37 weeks with underdeveloped organ functions

Answer 26

Premature

Question 27

One of the contributing factors to preterm birth is a threatened abortion during this period

Answer 27

6-13 weeks AOG

Question 28

Intervals LONGER than how many months between pregnancies have been associated with an increased risk for preterm birth?

Answer 28

59 months

Question 29

Infection usually associated with preterm birth

Answer 29

Bacterial vaginosis

Question 30

Single most powerful predictor of preterm birth

Answer 30

Transvaginal sonogram

Question 31

One of the sonographic signs of preterm birth is shortening of cervix to less than 25mm at how many weeks AOG?

Answer 31

16-24 weeks

Question 32

Loading dose of magnesium sulfate for preterm labor

Answer 32

4g slow IV push over 20 mins

Question 33

Antidote for Magnesium Sulfate toxicity

Answer 33

Calcium gluconate

Question 34

Tocolytic agent of choice for preterm birth

Answer 34

Nifedipine 10mg Q6

Question 35

Prophylactic cerclage is done during

Answer 35

10-12 weeks AOG

Question 36

Corticosteroid can also be given for preterm birth during

Answer 36

24-34 weeks AOG

Question 37

Only reliable indicator for chorioamnionitis

Answer 37

Maternal fever

Question 38

Criteria for chorioamnionitis include maternal fever plus one of the ff

Answer 38

Fetal tachycardia Uterine tenderness Purulent or foul smelling discharg Incresed ESR Leukocytosis

Question 39

Management of chorioamnionitis

Answer 39

• Seven (7) day regimen:
  
  • First 48 hours: Ampicillin 2 grams/IV q6, Erythromycin 250 mg q6
  • After 48 hours: Oral amoxicillin 250 mg q8, Erythromycin 250 mg q8
• Three (3) day regimen:
  • Ampicillin or Ampicillin-Sulbactam
  • Ampicillin IV q6 and Gentamicin q8 until delivery
  • Clindamycin or Metronidazole q8 added for anaerobic coverage

*Amoxicillin-clavulanate not recommended due to the increased incidence of NEC.

Question 40

Birth must be delayed for this amount of time after initiation of corticosteroid therapy to reduce rates of respiratory distress

Answer 40

24 hours after last dose

Question 41

Reversible complication of indomethacin

Answer 41

Oligohydramnios

Question 42

Administration of magsul to preterm birth can reduce rates of which neonatal outcome?

Answer 42

Cerebral palsy