LE3 OB Flashcards
- A 28 year old primigravid in the Delivery Room has these internal exam (IE) findings : cervix 4 cms. dilated, 60% effaced, intact bag of water. What Phase of Parturition is she in ?
A. Quiescence
B. Activation
C. Stimulation
D. Involution
B. Activation
Rationale: The activation phase of parturition involves the early stages of labor where there is progressive dilation and effacement of the cervix. This is when the body prepares for the active labor process, typically characterized by cervical dilation up to 6 cm.
- A G3P3 patient is in the ward, with baby breastfeeding. What phase of parturition is she in ?
A. Quiescence
B. Activation
C. Stimulation
D. Involution
D. Involution
Rationale: The involution phase of parturition refers to the period after the delivery of the placenta, where the uterus begins to return to its pre-pregnancy size and state. Breastfeeding can also help accelerate this process as it stimulates the release of oxytocin, which aids in uterine contractions.
- A G3P3 patient comes at 28 weeks with occasional hypogastric pains, internal exam revealed a closed, uneffaced cervix.. What phase of parturition is she in?
A. Quiescence
B. Activation
C. Stimulation
D. Involution
A. Quiescence
Rationale: The quiescence phase of parturition is the period during pregnancy when the uterus is relatively inactive, marked by a lack of significant cervical changes (dilation and effacement). This phase lasts until labor begins or any pre-labor activity starts.
- A primigravid at 38 weeks says she now “breathes better, as there is more space below her ribs” What phase of parturition is she in?
A. Quiescence
B. Activation
C. Stimulation
D. Involution
B. Activation
Rationale: This situation likely describes the phenomenon known as “lightening” or “dropping,” where the fetal head descends into the pelvis, preparing for birth. This occurs during the late quiescence transitioning into the activation phase, making it easier for the mother to breathe as the baby no longer presses against the diaphragm.
- In the recovery room one hour after delivery, a patient complains of moderate vulvar pain. What stage of labor is she in?
A. Stage I
B. Stage II
C. Stage III
D. Fourth stage
D. Fourth stage
Rationale: The fourth stage of labor refers to the first few hours after delivery, where the focus is on the mother’s recovery and observation for any complications such as excessive bleeding. Vulvar pain could be associated with post-delivery swelling or a perineal tear.
- A G2P2 patient is In the delivery room, with the placenta and umbilical cord visible at the introitus. What stage of labor is the patient in ? *
A. Stage 1
B. Stage 2
C. Stage 3
D. “Fourth Stage”
C. Stage 3
Rationale: Stage 3 of labor involves the delivery of the placenta. Since the placenta and umbilical cord are visible at the introitus, this indicates that the patient is in the process of completing the third stage of labor.
- A G1P0 patient in the labor room is in lithotomy position, with the obstetrician ready to do an episiotomy. What stage of labor is she in?
a. Stage 1
b. Stage 2
c. Stage 3
d. “Fourth Stage”
B. Stage 2
Rationale: Stage 2 of labor is characterized by the period from full cervical dilation to the delivery of the baby. The preparation for an episiotomy, typically performed to enlarge the vaginal opening for delivery, indicates that the baby’s delivery is imminent.
- The mechanism by which the uterus can accommodate the enlarging fetus is ____?
A. Addition of more myometrial fibers as pregnancy advances
B. Increasing hydrostatic pressure of the amniotic fluid
C. Stretching of uterine muscle fibers
D. Increased mitotic division among uterine muscle fibers
C. Stretching of uterine muscle fibers
Rationale: As the pregnancy progresses, the primary mechanism allowing the uterus to accommodate the growing fetus is the stretching of existing uterine muscle fibers. This stretching allows the uterus to expand significantly to hold the fetus, amniotic fluid, and placenta.
- Who among the following patients is in the activation phase of parturition?
A. G2P1 patient with cervix 6 cms, dilated, 80% effaced
B. G1P0 patient requesting for epidural anesthesia at 5cms
C. G4P3 patient at 34 weeks with irregular uterine contractions
D. G5P5 patient in the recovery room with the baby sulking on the breast
A. G2P1 patient with cervix 6 cms dilated, 80% effaced
Rationale: The activation phase of parturition involves the early stages of labor, characterized by cervical changes leading up to more intense labor. A cervix that is 6 cm dilated and 80% effaced indicates active labor, which is the later part of the activation phase, moving towards full dilation.
- The hormone which promotes parturition is ______
A. Estrogen
B. Progesterone
C. Oxytocin
D. Cortisol
C. Oxytocin
Rationale: Oxytocin is a key hormone that promotes parturition. It stimulates uterine contractions, which are crucial for the progression of labor and the delivery of the baby. Oxytocin release is also enhanced by feedback mechanisms during labor, particularly through the stimulation of the nipples and the stretching of the cervix.
- The mechanism by which the uterine myometrium helps maintain pregnancy is due to?*
A. the myometrial cells rendered non-responsive to stimuli
B. the effect of bed rest
C. changes in extracellular matrix
D. increased vascularity
A. the myometrial cells rendered non-responsive to stimuli
Rationale: During pregnancy, progesterone plays a crucial role in maintaining uterine quiescence by rendering the myometrial cells less responsive to contractile stimuli. This hormonal influence helps prevent premature contractions and supports the continuation of pregnancy until term.
12 Which mechanism initiates uterine contractions? *
A. Activation of ATPase
B. Phosphorylation of myosin light chain kinase
C. Intracellular calcium combines with the protein calmodulin
D. Hydrolysis of ATP
C. Intracellular calcium combines with the protein calmodulin
Rationale: Uterine contractions are primarily initiated by the increase in intracellular calcium levels, which combine with calmodulin. This complex then activates myosin light chain kinase, leading to muscle contraction through phosphorylation processes. This is a critical step in initiating uterine contractions during labor.
13 The graphic analysis of labor considers 2 parameters which include
A. Uterine contractions and hours in labor
B. Fetal head descent versus cervical dilatation
C. hours in labor and cervical dilatation
D. cervical dilatation and uterine contractions
C. hours in labor and cervical dilatation.
The Friedman labor curve is a graphical representation that tracks the progress of labor, specifically looking at the relationship between cervical dilatation and the duration of labor. This curve is used to evaluate whether labor is progressing normally by showing how the cervix dilates over time.
- A 22 year old primigravid comes at 37 weeks for recurring lower abdominal discomfort, with no associated watery nor bloody discharge. The cervix was long and closed on examination. What advice can be given to this patient ?
A. She must be admitted.
B. Labor has begun and delivery is expected within the day.
C. She is in false labor.
D. If symptoms disappear spontaneously she should be readmitted in 2 weeks for induction of labor.
C. She is in false labor.
Rationale: The symptoms described, such as lower abdominal discomfort with a long and closed cervix, are indicative of false labor (Braxton Hicks contractions). These contractions are irregular and do not lead to cervical changes, which differentiates them from true labor contractions that are more regular, painful, and cause cervical dilation and effacement.
- One of the following processes occurs in the Phase of Stimulation
A. Increase in oxytocin receptors
B. Pain elicited with cervical stretching
C. Lactogenesis
D. Stromal hypertrophy of myometrium
B. Pain elicited with cervical stretching
This choice directly correlates with the physiological events occurring in the first stage of the Phase of Stimulation, where cervical dilation and effacement are crucial, and the pain associated with these processes is significant and impactful.
- A G4P4 patient delivered 5 weeks ago. She did not breastfeed, and had her menstruation 2 days ago. What phase of parturition is she in?
A. Quiescence
B. Activation
C. Stimulation
D. Involution
D. Involution.
Involution is the process by which the uterus returns to its pre-pregnancy size and condition. This typically takes about 6-8 weeks. The fact that the patient has already menstruated indicates that her reproductive system is returning to its pre-pregnancy state, aligning with the phase of involution.
- A primigravid comes at 11:00 am with cervix 4 cms. dilated. When is her cervix expected to be fully dilated ?
A. 3:00 pm
B. 4:00 pm
C. 5:00 pm
D. 6:00 pm
A. 3:00 pm
Active Phase Details:
Cervical Dilatation Rate: The cervical dilatation rate in a primigravida during the active phase ranges from 1.2 to 6.8 cm/hour.
Mean Duration: The mean duration for the active phase in primigravida is approximately 4.9 hours.
- Placental separation is initiated usually as a result of
A. Maternal expulsive efforts
B. Diminution of the placental site
C. Administration of uterotonics
D. Massage of the uterine fundus
B. Diminution of the placental site.
After delivery, as the uterus contracts, the placental site on the uterine wall diminishes in size, which leads to the placenta detaching. This is a natural consequence of uterine contraction rather than being primarily induced by the factors listed in the other options.
19.In which functional division of labor is the relationship of the fetal head and pelvis apparent
A. Preparatory
B. Dilatational
C. Pelvic
D. Latent Phase
C. Pelvic.
The pelvic phase (or division) of labor refers to the stage where the mechanics of how the fetal head navigates through the maternal pelvis become apparent. This phase includes engagement, descent, and the necessary rotations of the fetal head.
- A G1P0 patient inquires as to how exactly bleeding is controlled after the baby is delivered. How should she be advised ? *
A. Bleeding is an expected consequence after the baby is delivered.
B. Large blood vessels of the uterus are compressed after delivery.
C. Endogenous oxytocin helps stop the bleeding.
D. Control of bleeding depends on the birth attendant’s skill.
C. Endogenous oxytocin helps stop the bleeding.
This option specifically addresses the physiological mechanism by which the body naturally controls bleeding after the delivery of a baby. Endogenous oxytocin release during and after delivery stimulates strong uterine contractions, which help to compress the blood vessels at the site where the placenta was attached, reducing blood loss. This natural hormonal response is critical for promoting hemostasis and is a fundamental aspect of the postpartum period.
- All of the following processes describe a patient in the Stimulation Phase of Parturition, except one:
A. Increase in the amount of contraction-assisted proteins
B. Increase in collagen solubility
C. Increase in responsiveness to uterotonins
D. Increase in oxytocin receptors
B. Increase in collagen solubility
Rationale: The stimulation phase of parturition involves preparing the uterus for labor, characterized by physiological changes that enhance uterine contractility. These changes include increases in contraction-assisted proteins, responsiveness to uterotonins, and oxytocin receptors, all aimed at promoting effective labor contractions. However, the increase in collagen solubility, while related to the preparation for labor, is primarily involved in the process of cervical ripening rather than the stimulation of uterine contractility. Therefore, option B, “Increase in collagen solubility,” does not describe a process in the Stimulation Phase directly linked to enhancing uterine contraction capabilities, making it the exception in this list.
- In the Friedman Labor Curve, which part illustrates when the cervix becomes soft and is preparing to dilate?
A. Latent Phase
B. Active Phase: Acceleration
C. Active Phase: Phase of Maximum Slope
D. Active Phase: Deceleration
A. Latent Phase
Rationale: The Friedman Labor Curve is a graphical representation of the stages and progress of labor. The Latent Phase illustrated in the curve is when the cervix is softening, thinning (effacing), and gradually dilating up to about 3-4 cm. This phase is characterized by less intense, more irregular contractions that are necessary to prepare the cervix for the more rapid dilation that occurs in the subsequent active phase. Thus, the Latent Phase is the correct answer, as it represents the initial cervical changes leading up to more significant dilation.
- As the clinical clerk assigned in the recovery room, what should you closely monitor after the patient has delivered?
Your primary responsibilities in the recovery room include monitoring:
A. Ensure that the uterus is well-contracted.
B. Check that the intravenous fluids are running as scheduled.
C. Observe if the baby is latched on properly to mother’s breast.
D. Verify if the nurse has administered oral analgesics.
A. Ensure that the uterus is well-contracted
Rationale: In the immediate postpartum period, one of the most critical aspects to monitor is the contraction status of the uterus. Effective uterine contractions are essential to control bleeding from the site where the placenta was attached. Ensuring that the uterus is well-contracted helps prevent postpartum hemorrhage, a significant risk following delivery. This makes it the most important task to prioritize in the recovery room immediately after the patient has delivered.
- A 25-year-old primigravida at 38 weeks’ gestation comes for blood-tinged, mucoid vaginal discharge, associated with lumbosacral and hypogastric pains noted 4 hours prior. She is in the stage of labor.
A. First
B. Second
C. Third
D. Fourth
A. First
Rationale: The description of a blood-tinged, mucoid vaginal discharge along with lumbosacral and hypogastric pains in a primigravida at 38 weeks’ gestation are indicative of early labor signs. The bloody show and initial pains are characteristic of the first stage of labor, which encompasses cervical changes from the beginning of cervical dilation up to full dilation at 10 cm. This is the stage where labor is established and progresses until the cervix is fully dilated, ready for the baby to pass through the birth canal.
- A 25-year-old primigravida at 38 weeks’ gestation in the ER is concerned about the blood-tinged, mucoid vaginal discharge, associated with lumbosacral and hypogastric pains noted 4 hours prior. What should she be advised?
A. She is in the early part of labor.
B. Reassure that it is normal at this age of pregnancy.
C. It is an indication for immediate abdominal delivery.
D. She should stop taking any food from thereon.
A. She is in the early part of labor
Rationale: Advising that she is in the early part of labor is the most appropriate response, given her symptoms of blood-tinged, mucoid vaginal discharge and early labor pains. This advice provides clear information about her current state, confirming that her symptoms are typical for the onset of labor and educating her on what to expect as labor progresses. This guidance is crucial for managing expectations and preparing her for the birth process.
- The process of placental separation wherein blood from the placental site pours into the membrane sac and does not escape until after extrusion of the placenta
A. Duncan mechanism
B. Schultze mechanism
C. Mauriceau maneuver
D. Leopolds maneuver
B. Schultze mechanism
Rationale: According to Williams’ Obstetrics, the Schultze mechanism of placental separation is characterized by the central separation of the placenta, wherein the blood from the placental site collects in the membrane sac and does not escape externally until the placenta is expelled. This mechanism is distinguished by the shiny fetal surface of the placenta appearing first as it emerges. This contrasts with the Duncan mechanism, where separation begins peripherally and blood often escapes alongside the emerging placenta.
- This describes the descent of the fetal biparietal diameter in relation to a line drawn between maternal ischial spines
A. Dilatation
B. Descent
C. Station
D. Effacement
C. Station
Rationale: In obstetrics, the station refers to the descent of the fetal head (measured by the biparietal diameter) in relation to the ischial spines of the maternal pelvis. This measurement is crucial for assessing the progress of labor and determining how far the head has descended into the birth canal. It is expressed in negative, zero, or positive numbers. Zero station indicates that the leading part of the fetus is at the level of the ischial spines, with negative numbers indicating it is above, and positive numbers below, the spines.
- The umbilical cord is cut between two clamps 5 cms from the fetal abdomen and later an umbilical clamp is applied at this length from its insertion into the fetal abdomen *
A. 1 cm
B. 4-5 cms
C. 2 cms
D. 3 cms
C. 2 cms.
After the umbilical pulsations have ceased, the proper procedure involves placing an umbilical clamp or tie approximately 2 cm from the insertion of the cord into the fetal abdomen. This is followed by placing another clamp at 5 cm from the base, and then cutting the cord close to the first clamp. This method ensures safe and effective cord clamping, minimizing risks and promoting healthy outcomes for the newborn.
- An episiotomy technique, fingers are insinuated between the crowning head and the perineum and the scissors are positioned at the 6 o’ clock on the vaginal opening and directed posteriorly *
A. Mediolateral episiotomy
B. Lateral episiotomy
C. Horizontal episiotomy
D. Median episiotomy
D. Median episiotomy
Rationale: A median episiotomy involves a straight incision made at the midline, starting at the vaginal opening and directed posteriorly towards the anus but typically does not extend all the way to it. This type of episiotomy is designed to enlarge the vaginal orifice to facilitate childbirth, reduce the risk of irregular tearing, and is easier to repair than other types, although it may be associated with a higher risk of extending into the anal area. This technique contrasts with mediolateral, lateral, or horizontal episiotomies, which are angled away from the midline.
- The most common maternal indication for operative vaginal delivery *
A. Heart disease
B. Maternal exhaustion
C. Per request of the mother
D. Intrapartum infection
B. Maternal exhaustion
Rationale: The most common maternal indication for operative vaginal delivery, such as using forceps or a vacuum extractor, is maternal exhaustion. Maternal exhaustion can impair a woman’s ability to effectively push during the later stages of labor, especially if she has been in labor for an extended period. This condition can compromise the progress of labor, leading to potential risks for both the mother and the fetus. While other options like heart disease or intrapartum infection might necessitate expedited delivery, maternal exhaustion specifically impacts the ability to conduct a normal delivery, thus often necessitating operative intervention.
- The sloughing of decidual tissues which contains erythrocytes, shredded decidual, epithelial cells and bacteria usually pale in color discharged 3 to 4 days after delivery is called: *
A. Lochia rubra
B. Lochia alba
C. Lochia serosa
D. Lochia albinica
C. Lochia serosa
Rationale: Lochia serosa is the term used to describe the vaginal discharge that occurs approximately 3 to 4 days postpartum, following the lochia rubra phase. Lochia serosa is typically pale or pink in color and consists of old blood, serum, leukocytes, and debris from the decidual and remaining placental tissues. This phase is distinct from lochia rubra, which is primarily blood and occurs immediately after birth, and from lochia alba, which is the later creamy white or light yellow discharge that follows lochia serosa.
- Duration of the latent phase in a multigravida is
A. 1-2 hours
B. 2-4 hours
C. 4-6 hours
D. 7-8 hours
C. 4-6 hours
Rationale: The duration of the latent phase in a multigravida (a woman who has been pregnant more than once) is typically shorter than in primigravidas. The latent phase, which involves early labor with cervical effacement and dilation up to about 3-4 cm, usually lasts between 2-4 hours in multigravidas. This shorter duration is due to the cervix often responding more quickly in subsequent pregnancies because of prior stretching.
- Total bishop score is
A. 10
B. 11
C. 12
D. 13
D. 13
Rationale: The Bishop score is used to evaluate the readiness of the cervix for induction of labor and involves scoring the cervix based on five criteria: dilation, effacement, consistency, position, and fetal station. Each criterion is scored from 0 to 3, except for cervical position which is scored from 0 to 2. The total Bishop score can thus reach a maximum of 13 points, but typically a score of 12 is used as a practical upper limit in many scoring interpretations, with higher scores indicating a more favorable cervix for induction.
- A primipara is in labor and an episiotomy is about to be done. Compared with a midline episiotomy, which of the following is an advantage of mediolateral episiotomy?
A. Easy to repair
B. Less prone to infection
C. Less blood loss
D. Less extension of the incision
D. Less extension of the incision
Rationale: A mediolateral episiotomy, compared to a midline episiotomy, has a lower risk of extending into the anal sphincter or rectal mucosa. While a mediolateral episiotomy may be more painful and difficult to repair than a midline episiotomy, its primary advantage is preventing severe perineal trauma, especially protecting the anal sphincter.
- This appears to lengthen the second stage of labor
A. Paracervical block
B. Spinal block
C. Pudendal block
D. Epidural block
D. Epidural block
Rationale: An epidural block can lengthen the second stage of labor. This regional anesthesia provides pain relief but can also decrease the mother’s ability to feel and push effectively during contractions, which may prolong the duration of the second stage. The other options listed typically do not have a significant impact on the length of the second stage of labor.
- This method hastens labor by about two hours:
A. Membrane stripping
B. Epidural anesthesia
C. Intentional amniotomy
D. Oxytocin
C. Intentional amniotomy
Rationale: Intentional amniotomy, or artificially rupturing the membranes, is a method used to hasten labor. By breaking the water, it can increase the efficiency of contractions and potentially shorten the labor duration by about two hours. This intervention directly affects the mechanics of labor progression.
- A primigravida underwent spontaneous vaginal delivery. A median episiotomy was done. On inspection of the vagina, the tear involved the left anal sphincter but did go through the rectal mucosa. What is the degree of laceration incurred?
A. First degree
B. Second degree
C. Third degree
D. Fourth degree
D. Fourth degree.
This is because the tear described in the scenario involved both the left anal sphincter and extended through the rectal mucosa, which precisely defines a fourth-degree laceration. This degree of tear is the most severe, involving both the anal sphincter and the rectal mucosa, requiring careful surgical repair to prevent long-term complications such as fecal incontinence.
41 A 37 year old G2P1(1001) at 38 weeks in labor handled by a midwife came in the ER. After delivery of the baby, there was tear noted from the vaginal mucosa down to the rectal mucosa, what is the degree of laceration?
A. First degree
B. Second degree
C. Third degree
D. Fourth degree
D. Fourth degree
Rationale: A fourth-degree laceration is the most severe form of perineal tear, extending through the vaginal mucosa, perineal body, anal sphincter, and the rectal mucosa. The description of a tear from the vaginal mucosa down to the rectal mucosa clearly indicates a fourth-degree tear, involving all layers, including the anal and rectal mucosa. This requires careful surgical repair to ensure proper healing and function.
- At what point does one initiate episiotomy? *
A. When the head is at station +2
B. When the head is visible at about 3 to 4 cms in diameter
C. When the head is palpated at station 0
D. When tufts of hair becomes visible in between the labia minora
B. When the head is visible at about 3 to 4 cms in diameter
Rationale: An episiotomy is typically performed when the fetal head stretches the perineum and is visible at about 3 to 4 cms in diameter during a contraction. This timing helps ensure the episiotomy is done late enough in the second stage of labor to be effective in preventing severe perineal tearing, facilitating a controlled and timely extension of the vaginal opening to accommodate the delivery of the head.
- The vaginal examination of a primigravid revealed 6 cms, 50% effaced, cephalic, intact bag of waters, station -1. How will you interpret this information?
A. Effacement is 1/3 from completion
B. Dilatation is 50% completed
C. The fetus has passed through the level of the ischial spines
D. The fetal presenting part is 1 cm above the ischial spines
D. The fetal presenting part is 1 cm above the ischial spines
Rationale: In obstetric measurements, the station of the fetus refers to the position of the presenting part relative to the ischial spines of the maternal pelvis. A station of -1 indicates that the presenting part (typically the fetal head in a cephalic presentation) is 1 cm above the level of the ischial spines.
- When is the end of the puerperium
A. 2 wks
B. 3 wks
C. 4 wks
D. 6 wks
D. 6 wks
Rationale: The puerperium or postpartum period traditionally extends until about 6 weeks after childbirth. This time allows for the physiological changes of pregnancy to reverse and the reproductive organs, particularly the uterus, to return to their pre-pregnant state.
- What do you call the bloody discharge upon placental separation
A. Lochia serosa
B. Lochia rubra
C. Lochia alba
D. Lochia verde
B. Lochia rubra
Rationale: Lochia rubra is the term used for the bloody discharge that typically occurs immediately after placental separation and continues for the first few days postpartum. It consists of blood, decidual tissue, and trophoblastic debris.
- Where milk production first occurs in the breast anatomy?
A. Alveoli
B. Ducts
C. Lobules
D. Nipple
A. Alveoli
Rationale:
Milk production begins in the alveoli, which are small glandular structures within the breast. Each alveolus is a milk-producing gland that is part of a larger grouping called a lobule. The lobules are connected to a network of ducts that transport the milk toward the nipple. The alveoli are lined with milk-secreting epithelial cells and are crucial for the synthesis and secretion of milk. Thus, the alveoli are the site where milk production first occurs, making option A the correct answer based on the anatomy of the breast as described in typical medical resources including Williams’ Obstetrics.
