Labor And Delivery; Anesthesia

Question 1

Quantifiable method used to predict labor induction outcomes

Answer 1

Bishop score

Question 2

Bishop score components

Answer 2

SPCED Station Position Consistency Effacement Dilation

Question 3

Safest drug for induction

Answer 3

Oxytocin

Question 4

What term is used when the anterior fontanel is the presenting part?

Answer 4

Sinciput

Question 5

Rate of cervical dilatation in nullipara and multipara

Answer 5

Nullipara-1.2 cm per hour Multipara- 1.5 cm per hour

Question 6

Prolonged latent phase in nullipara

Answer 6

20 hrs

Question 7

Prolonged latent phase in multipara

Answer 7

14 hours

Question 8

Postion of fetus upon entering the maternal pelvis

Answer 8

LOT

Question 9

Greatest transverse diameter in an occiput presentation

Answer 9

Biparietal diameter

Question 10

Pelvic inlet corresponds to this structure

Answer 10

Linea terminalis

Question 11

Lateral deflection of the saggital suture either posteriorly toward the promontory or anteriorly toward the symphysis

Answer 11

Asynclitism

Question 12

The linea terminalis consists of 3 structures

Answer 12

Pubic crest Pectineal line Arcuate line

Question 13

Promontory to upper margin of symphysis is what diameter

Answer 13

True/Anatomic conjugate

Question 14

True conjugate measures

Answer 14

11cm

Question 15

Promontory to the posterior symphysis is what diameter

Answer 15

Obstetric conjugate

Question 16

The obstetric conjugate is measured by

Answer 16

Subtract 1.5-2 cm from diagonal conjugate

Question 17

Obstetric conjugate is normally

Answer 17

>10cm

Question 18

The only conjugate that is measured manually

Answer 18

Diagonal conjugate

Question 19

Diameter that is from the promontory to the lower margin of the symphysis

Answer 19

Diagonal conjugate

Question 20

What is the normal value of the diagonal conjugate

Answer 20

11.5cm

Question 21

This diameter measures the greatest diameter between the linea terminalis

Answer 21

Transverse conjugate

Question 22

Normal transverse conjugate

Answer 22

13cm

Question 23

First requisite for birth of the newborn

Answer 23

Descent

Question 24

Cardinal movement that is essential for the completion of labor

Answer 24

Internal rotation

Question 25

The goal of the third stage of labor is

Answer 25

Prevent uterine inversion

Question 26

Signs of placental separation

Answer 26

Globular fundus Sudden gush of blood Lengthening of cord Rise of uterus in the abdomen

Question 27

Perineal laceration up to the perineal body

Answer 27

2nd degree

Question 28

Perineal laceration up to the anal sphincter

Answer 28

3rd degree

Question 29

Perineal laceration up to the rectal mucosa

Answer 29

4th degree

Question 30

Must give oxytocin 10 units IM after the delivery of

Answer 30

Anterior shoulder

Question 31

Indication of operative vaginal delivery includes

Answer 31

Prolonged second stage

Question 32

Forceps is properly handled by

Answer 32

Pencil grip Vertical insertion Right thumb directing

Question 33

Engagement and descent of breech include that the _____ diameter is in the oblique diameter

Answer 33

Bitrochanteric

Question 34

Does the anterior or posterior hip descend more rapidly in breech?

Answer 34

Anterior

Question 35

Frank breech decomposition is also called this maneuver

Answer 35

Pinard

Question 36

Breech extraction where both feet are grasped through the vagina

Answer 36

Complete breech extraction

Question 37

In partial breech extraction, the fetus is allowed to spontaneously deliver up to the level of the

Answer 37

Umbilicus

Question 38

Incision on the cervix at 2 and 10 o clock position to minimize bleeding from the uterine artery branches

Answer 38

Dührssen incision

Question 39

Delivery of the aftercoming head is done through this maneuver

Answer 39

Mauriceau

Question 40

What is the direct cause of most maternal deaths involving regional anesthesia

Answer 40

High spinal blockade

Question 41

What anesthetic is associated with neurotoxicity and cardiotoxicity in the same serum levels?

Answer 41

Bupivacaine

Question 42

What is the most common complication encountered during epidural anesthesia?

Answer 42

Hypotension

Question 43

Bichop scoring

Answer 43

Question 44

LABOR: CRITERIA FOR DIAGNOSIS

Answer 44

* Uterine contractions (**1 in 10 mins; 4 in 20 mins)** by direct observation or by electronic fetal monitor. * At least **200** Montevideo units (MVU) * Documented progressive **changes in cervical dilatation & effacement** * Cervical effacement of **\>70-80%.** * Cervical dilatation **\>3 cm.**

Question 45

INDICATIONS FOR INDUCTION OF LABOR

Answer 45

* Gestational hypertension * Preeclampsia, eclampsia * Prelabor rupture of membranes (PROM) * Maternal medical conditions (e.g. DM, renal disease, infertility, APAS) * Gestation \> 41 1/7 weeks * Fetal compromise (e.g. FGR) * Fetal demise * Logistic factors for term pregnancy (e.g. history or rapid labor, proximity from hospital, psychosocial indications) * Intraamniotic infection

Question 46

CONTRAINDICATIONS FOR INDUCTION OF LABOR

Answer 46

* Malpresentation (e.g. breech) * Absolute cephalo-pelvic disproportion * Placenta previa * Previous major uterine surgery (e.g. classical CS, myomectomy) * Invasive carcinoma of cervix * Cord presentation * Active genital herpes * Gynecological, obstetrical, or medical conditions that preclude vaginal birth * Physician’s convenience

Question 47

Signs of uterine hyperstimulation

Answer 47

§ **Five (5) contractions in 10 minutes** or more than 1**0 contractions in 20 minutes.** § **Hypertonus** – contraction(s) lasting **more than 120 seconds** § Excessive uterine activity with an atypical or abnormal fetal heart rate.

Question 48

3 functional divisions of labor.

Answer 48

* **Preparatory division** – the cervix dilates little, but the connective tissue components change considerably. *_Sedation and conduction analgesia are capable of arresting this division._* * **Dilatational division** – dilation proceeds at its most rapid rate; *_unaffected by sedation_* * **Pelvic division** – commences with the deceleration phase of cervical dilatation. The classic labor mechanisms that involve the cardinal fetal movements of the cephalic presentation takes place principally in this division.

Question 49

Sagittal suture approaches the sacral promontory, more of the anterior parietal bone presents itself to the examining fingers.

Answer 49

o Anterior asynclitism

Question 50

Sagittal suture lies close to the symphysis, more of the posterior parietal bone will present.

Answer 50

o Posterior asynclitism