Labour and delivery Flashcards
Of the four phases of parturition, phase 2 is characterized by which of the following?
a. Uterine activation, cervical ripening
b. Uterine quiescence, cervical softening
c. Uterine involution, cervical remodelling
d. Uterine contraction, cervical dilatation
a
Cervical softening in phase 1 of parturition results in part from which of the following?
a. Stromal atrophy
b. Increased stromal vascularity
c. Increased collagen monomer cross-linking
d. all of the above
b. Increased stromal vascularity
Contraction-associated proteins (CAPs) within uterine smooth muscle prepare it to contract during labor. CAP concentrations increase during phase 2 of parurition and include all EXCEPT which of the following proteins?
a. connexin 43
b. oxytocin receptor
c. progesterone receptor A
d. prostaglandin F receptor
c. progesterone receptor A
Compared with the uterine body, the cervix has a significantly lower percentage of which of the following?
a. collagen
b. proteoglycans
c. smooth muscle
d. glycosaminoglycans
c. smooth muscle
All EXCEPT which of the following mechanisms lead in part to the cervical ripening that is characteristic of phase 2 of parturition?
a. decreased collagen fibril diameter
b. increased spacing between collagen fibrils
c. Altered levels of decorin and biglycan, which are proteoglycans
d. Increased expression of the enzymes responsible for synthesis of hyaluronan, which is a glycosaminoglycan
a. decreased collagen fibril diameter
- Which of the following best defines the Ferguson reflex?
a. mechanical stretch of the cervix enhances uterine activity
b. maternal ambulation augments contraction intensity and frequency
c. fetal scalp stimulation leads to fetal heart rate acceleration
d. maternal shifting to the left lateral recumbent position increases venous return
a. mechanical stretch of the cervix enhances uterine activity
- Extreme development of both upper and lower uterine segments may be seen with obstructed labour and clinically may be reflected by which of the following?
a. Hegar sign
b. Bandl ring
c. Bloody show
d. Chadwick sign
b. Bandl ring
- There are stresses on the pelvic floor caused by fetal head delivery during phase 3 of parturition. All EXCEPT which is true?
a. The anus may dilate up to 3cm
b. The perineal body becomes attenuated
c. The puborectalis muscle is markedly stretched
d. The coccygeus muscle receive the bulk of expulsive forces
d. The coccygeus muscle receive the bulk of expulsive forces
- Which of the following can bring about myometrial contractions?
a. extracellular magnesium
b. actin-tubulin protein pairs
c. G-protein coupled receptors
d. Gap junctions composed of decorin subunits
c. G-protein coupled receptors
- There are stresses on the pelvic floor caused by fetal head delivery during phase 3 of parturition. All EXCEPT which is true?
a. The anus may dilate up to 3cm
b. The perineal body becomes attenuated
c. The puborectalis muscle is markedly stretched
d. The coccygeus muscle receive the bulk of expulsive forces
d. The coccygeus muscle receive the bulk of expulsive forces
b. prolonged gestation
- Which of the following can bring about myometrial contractions?
a. extracellular magnesium
b. actin-tubulin protein pairs
c. G-protein coupled receptors
d. Gap junctions composed of decorin subunits
. G-protein coupled receptors
Once bound to its receptor, oxytocin promotes contraction through which of the following mechanisms?
a. opens calcium channels
b. generates nitric oxide
c. degrades 15- hydroxyprostaglandin dehydrogenase
d. activates the gene promotor region of the myosin light-chain kinase gene
a. opens calcium channels
In many mammals, suspension of the quiescence seen in phase 2 of parturition is due to which of the following?
a. cortisol withdrawal
b. progesterone withdrawal
c. inflammatory cell activation
d. increased oxytocin receptor concentration
b. progesterone withdrawal
For women with a prior preterm birth delivered at <37 weeks gestation, 17a-hydroxyprogesterone caproate may be used to prevent recurrent preterm birth. One mechanism by which progesterone maintains uterine quiescence is its ability to decrease expression of the which of the following?
a. Adenyl cyclase
b. Progesterone receptor A
c. Progesterone receptor B
d. Contraction- associated proteins.
d. Contraction- associated proteins.
Your patient presents at 39 weeks gestation with a breech-presenting fetus. After a discussion of the risks and benefits, she agrees to an ECV. Prior to initiation, you administer 0.25mg of terbutline s/c. This drug binds to beta-adrenergic receptors to create which of the following cellular responses to cause uterine relaxation?
a. Increased extracellular Mg2+ levels
b. Increased Intracellular Ca2+ levels
c. Increased cyclic adenosine monophosphate (cAMP) levels
d. Decreased cyclic guanosine monophosphate (cGMP) levels
c, Increased cyclic adenosine monophosphate (cAMP) levels
hCG shares the exact same receptor with which of the following hormones? Because of this, the high hCG levels seen with complete hydatifrom moles may lead to ovarian stimulation and formation of the theca-lutein cysts.
a. LH
b. TSH
c. FSH
d. none of the above
a. LH
Indomethacin, a NSAID, has some tocolytic actions. As a group, NSAIDS target which enzyme in prostaglandin production?
a. cyclooxygenase-1
b. Phosphlipase A2
c. Prostaglandin isomerase
d. prostaglandin dehydrogenase
a. cyclooxygenase-1
During phases 1 and 2 of parturition, uterine quiescence is maintained in part through inhibition of smooth muscle’s response to oxytocin. Which of the following is a primary regulator of oxytocin receptor expression?
a. calcium
b. progesterone
c. prostaglandin dehydrogenase
c. corticotropin-releasing hormone
b. progesterone
Corticotropin-releasing hormone (CRH) is suggested to promote parturition progression. Which of the following is the main contributor to CRH levels in pregnancy?
a. Placenta
b. Fetal adrenal
c. Fetal hypothalamus
d. Maternal hypothalamus
a. Placenta
What percentage of foetuses are breech at 28 weeks?
a- 1%
b- 10%
c- 25%
d- 50%
c- 25%
When the anterior fontanel is the presenting part, which term is used?
Brown
Face
Vertex
Sinciput
Sinciput
Which of the following could inhibit performance of Leopold maneuvers?
A Oligohydramnios
B Maternal obestity
C Posterior placenta
D Supine maternal positioning
B- maternal obesity
Which of the following is the correct order for the cardinal movements of labour?
a. Descent, engagement, internal fixation, flexion, extension, external rotation, expulsion
b. Descent, flexion, engagement, external fixation, extension, internal rotation, expulsion
c. Engagement, descent, flexion, internal rotation, extension, external rotation, and expulsion
d. Engagement, flexion, descent, internal rotation, straightening, extension, and expulsion
c. Engagement, descent, flexion, internal rotation, extension, external rotation, and expulsion
Regarding engagement of the fetal head, which of the following statements is true?
a. IT does not occur until labor commences
b. Engagement prior to the onset of labor does not affect vaginal delivery rates
c. It is the mechanism by which the biparietal diameter passes through the pelvic outlet
d. A normal-sized head usually engages with its sagittal suture directed anterioposteriorly
b. Engagement prior to the onset of labor does not affect vaginal delivery rates
In what percentage of labors does the fetus enter the pelvis in an OP position?
a. 0.5%
b. 5%
c. 20%
d. 33%
c. 20%
- Which of the following is not a risk factor for incomplete rotation of the posterior occiput?
a. Macrosomia
b. poor contractions
c. lack of analgesia
d. inadequate head flexion
c. lack of analgesia
. A 20-year-old G1P0 at 39/40 presents complaining of strong contractions. Her cervix is dilated 1cm. She is given sedation, and 4h later her contractions have stopped. Her cervix is still 1cm dilated. Which of the following is the most likely diagnosis?
a. False labor
b. Prolonged latent phase of labor
c. Arrest of the latent phase of labour
d. Arrest of the active phase of labor
a. False labor
According to Friedman, the minimum normal rate of active-phase labor in a multipara is which of the following?
a. 1cm/h
b. 1.2cm/h
c. 1.5cm/h
d. 3.4cm/h
c. 1.5cm/h
When evaluating a pregnant woman for rupture of membranes, which of the following has been associated with a false-positive nitrazine test result?
a. Blood
b. Semen
c. Bacterial vaginosis
d. All of the above
d. All of the above
When performing a bimanual examination on a pregnant woman, the position of the cervix is determined by the relationship of the cervical os to which of the following?
a. rectum
b. uterus
c. fetal head
d. pubic symphysis
c. fetal head
A 20-year-old G2P1 presents in active labor at term. The patient requires augmentation with oxytocin during her labor course. She has a forceps-assisted vaginal delivery and sustains a second-degree laceration. Which of the following is not a risk factor for urinary retention in this patient?
a. Multiparity
b. Perineal laceration
c. Oxytocin-augmented labor
d. operative vaginal delivery
a. Multiparity
What is the median duration of second-stage labor in nulliparas without conduction analgesia?
a. 20 minutes
b. 40 minutes
c. 50 minutes
d. 90 minutes
c. 50 minutes
What is the median duration of the second-stage labor in multiparas without conduction analgesia?
a. 20 minutes
b. 40 minutes
c. 50 minutes
d. 90 minutes
a. 20 minutes
D- ischaemic necrosis of the presenting forearm
A- Brow presentation
Which of the following is true regarding cephalopelvic disproportion?
A- It currently is responsible for 34% of dystocia cases
B- It is a term that originated in the 1960s to describe abnormal bony pelves
C- It was defined during a time when dystocia developed secondary to vitamin D deficiency or rickets, which is now rare in developed countries
D- B and C
C- It was defined during a time when dystocia developed secondary to vitamin D deficiency or rickets, which is now rare in developed countries
Which of the following is among the advances in labor dysfunction management?
A- Use of oxytocin
B- Reliance of midforceps deliveries for transverse arrest
C- Realization that undue prolongation of labor leads to increased perinatal mortality
D- A and C
D- A and C
The Montevideo gropu concluded that which of the following was the lowest contraction pressure necessary to cause cervical dilation?
15mmHg
25mmHg
35mmHg
45mmHg
15mmHg
Which of the following is true regarding coached maternal pushing efforts during second-stage labor?
A- It has no effect on second-stage length
B- It significantly shortens the second stage
C- It shortens the second stage but has no effect on maternal or neonatal morbidity rates
D- B & C
C- It shortens the second stage but has no effect on maternal or neonatal morbidity rates
Compared with recumbent positioning, upright positions during second-stage labor are associated with which of the following?
A- Less pain
B- Slightly shorter labour duration
C- Higher rates of blood loss exceeding 500mL
D- All of the above
D- All of the above
Laboring in a birthing tub is associated with higher rates of which adverse neonatal outcomes?
A- Waterborne infection
B- Neonatal hypocalcemia
C- Neonatal intensive care admission
D- A & C
D- A & C
Which of the following is true regarding precipitous labour?
a. Defined as delivery within 3h of labour onset
b. May result from diminished pelvic soft-tissue resistance
c. May result from a decreased sensation and awareness of active labour
d. All of the above
d. All of the above
In obstetrics, which of the following defines a contracted pelvic inlet?
a. A transverse diameter <12cm
b. A diagonal conjugate <11.5cm
c. An anteroposterior diameter <10cm
d. All of the above
d. All of the above
Which interischial tuberous diameter measurement serves as the threshold to define pelvic outlet contraction?
7cm
8cm
9cm
10cm
8cm
Which of the following is a risk factor for face presentation?
a- prematurity
b- multiparity
c- anencephaly
d- all of the above
d- all of the above
