LE3 Reviewer POST-Term

Question 1

Which of the following cytokines is most commonly involved in infection-driven inflammation that leads to spontaneous preterm labor?

A. IL-1

B. IL-2

C. IL-4

D. TNF-β

Answer 1

A. IL-1

Discussion: IL-1 is a pro-inflammatory cytokine that plays a key role in the inflammatory response associated with spontaneous preterm labor. Infection in the genital tract can lead to an increase in IL-1, which stimulates the production of prostaglandins, leading to uterine contractions, cervical ripening, and membrane rupture.

Question 2

Which condition increases mechanical stress on the uterus and may lead to preterm labor due to overdistension?

A. Oligohydramnios

B. Polyhydramnios

C. Placenta previa

D. Cervical incompetence

Answer 2

B. Polyhydramnios

Discussion: Polyhydramnios refers to an excessive amount of amniotic fluid, which can lead to overdistension of the uterus. This increased mechanical stress can trigger uterine contractions and lead to preterm labor. Multiple gestation and certain fetal anomalies can also contribute to overdistension.

Question 3

The release of thrombin during decidual hemorrhage leads to which of the following actions in the context of preterm labor?

A. Inhibits prostaglandin production

B. Increases protease activity and matrix degradation

C. Increases progesterone action

D. Stimulates uterine relaxation

Answer 3

B. Increases protease activity and matrix degradation

Discussion: Decidual hemorrhage can lead to the release of thrombin, which in turn activates proteases that degrade the extracellular matrix. This weakening of the fetal membranes can lead to their rupture and the onset of preterm labor.

Question 4

Activation of the maternal or fetal hypothalamic-pituitary-adrenal (HPA) axis can lead to increased production of which hormone, contributing to preterm labor?

A. Corticotropin-releasing hormone (CRH)

B. Oxytocin

C. Progesterone

D. Estrogen

Answer 4

A. Corticotropin-releasing hormone (CRH)

Discussion: Activation of the HPA axis, often due to maternal or fetal stress, leads to increased production of CRH. Elevated CRH levels stimulate the production of prostaglandins, which promote uterine contractions and cervical ripening, contributing to preterm labor.

Question 5

Premature rupture of membranes (PROM) is primarily caused by which of the following mechanisms?

A. Increased collagen synthesis

B. Increased matrix metalloproteinase (MMP) activity

C. Increased oxytocin production

D. Decreased amniotic fluid volume

Answer 5

B. Increased matrix metalloproteinase (MMP) activity

Discussion: PROM occurs when the fetal membranes rupture before labor begins. Increased MMP activity leads to the breakdown of collagen in the membranes, weakening them and making them more prone to rupture, which can result in PROM and potentially preterm labor.

Question 6

Case Scenario: A 28-year-old woman at 30 weeks gestation presents with painful contractions and lower abdominal discomfort. On examination, she is found to have cervical dilation and evidence of chorioamnionitis. The patient reports a recent history of urinary tract infection.

Question: What is the most likely mechanism leading to her preterm labor?

A. Overdistension of the uterus

B. Infection and inflammation with release of pro-inflammatory cytokines

C. Activation of the HPA axis

D. Genetic predisposition

Answer 6

B. Infection and inflammation with release of pro-inflammatory cytokines

Discussion: Chorioamnionitis is an intrauterine infection that triggers an inflammatory response. The release of pro-inflammatory cytokines, such as IL-1 and TNF-α, leads to increased prostaglandin production, which promotes uterine contractions and cervical changes, ultimately resulting in preterm labor.

Question 7

Case Scenario: A 32-year-old pregnant woman, carrying twins, presents at 29 weeks gestation with regular uterine contractions. Ultrasound examination reveals polyhydramnios.

Question: Which mechanism is most likely responsible for the onset of her preterm labor?

A. Activation of the maternal HPA axis

B. Overdistension of the uterus

C. Decidual hemorrhage

D. Genetic predisposition

Answer 7

B. Overdistension of the uterus

Discussion: The presence of polyhydramnios, especially in a multiple gestation pregnancy, leads to overdistension of the uterus. This increased mechanical stress can initiate uterine contractions and result in preterm labor.

Question 8

A 24-year-old pregnant woman at 33 weeks presents with painless vaginal bleeding. Ultrasound shows partial placental abruption. She is experiencing mild contractions.

Question: What factor is most likely responsible for triggering preterm labor in this patient?

A. Infection and inflammation

B. Decidual hemorrhage with thrombin release

C. Activation of the fetal HPA axis

D. Premature activation of proteases

Answer 8

B. Decidual hemorrhage with thrombin release

Discussion: Partial placental abruption leads to decidual hemorrhage, which results in thrombin release. Thrombin promotes the activation of proteases and prostaglandins, leading to uterine contractions and cervical changes that can trigger preterm labor.

Question 9

A 27-year-old woman at 31 weeks gestation is admitted with signs of preterm labor. She reports severe emotional stress at home. Examination reveals a slightly dilated cervix but no signs of infection.

Question: Which mechanism is likely contributing to her preterm labor?

A. Premature activation of proteases

B. Uterine overdistension

C. Activation of the maternal HPA axis

D. Decidual hemorrhage

Answer 9

C. Activation of the maternal HPA axis

Discussion: Emotional stress can activate the maternal HPA axis, leading to increased levels of CRH. CRH stimulates prostaglandin production, which can result in uterine contractions and cervical changes, contributing to preterm labor.

Question 10

A 30-year-old woman at 34 weeks gestation presents with rupture of membranes and is subsequently diagnosed with PROM. She has no contractions at this point.

Question: Which of the following mechanisms is most likely responsible for the PROM?

A. Increased prostaglandin production

B. Increased matrix metalloproteinase (MMP) activity

C. Genetic predisposition

D. Activation of the fetal HPA axis

Answer 10

B. Increased matrix metalloproteinase (MMP) activity

Discussion: PROM is often associated with increased MMP activity, which leads to the breakdown of collagen in the fetal membranes. This weakens the membranes, making them more susceptible to rupture, even in the absence of contractions.

Question 11

Which of the following is a major maternal complication associated with post-term pregnancy?

A. Oligohydramnios

B. Preterm labor

C. Placenta previa

D. Polyhydramnios

Answer 11

A. Oligohydramnios

Discussion: Oligohydramnios is a common complication in post-term pregnancies due to the decline in placental function. Reduced amniotic fluid volume can lead to cord compression, fetal distress, and complications during labor.

Question 12

Fetal macrosomia is a risk factor for which of the following complications during labor?

A. Shoulder dystocia

B. Preterm birth

C. Placental abruption

D. Polyhydramnios

Answer 12

A. Shoulder dystocia

Discussion: Fetal macrosomia, or an excessively large baby, increases the risk of shoulder dystocia, where the baby’s shoulder becomes lodged behind the mother’s pubic bone during delivery, making vaginal delivery challenging.

Question 13

Which of the following perinatal complications is associated with prolonged gestation and reduced placental efficiency?

A. Stillbirth

B. Preterm delivery

C. Polyhydramnios

D. Fetal anemia

Answer 13

A. Stillbirth

Discussion: Prolonged gestation can lead to an aging placenta, which may not adequately deliver nutrients and oxygen to the fetus, increasing the risk of stillbirth.

Question 14

A post-term pregnancy is more likely to result in which maternal complication due to a larger fetus?

A. Postpartum hemorrhage

B. Preterm labor

C. Placenta previa

D. Polyhydramnios

Answer 14

A. Postpartum hemorrhage

Discussion: A larger fetus increases the risk of uterine overdistension, which can lead to poor uterine contraction (uterine atony) after delivery, resulting in postpartum hemorrhage.

Question 15

Which condition is characterized by fetal malnutrition, loss of fat, dry skin, and meconium staining in post-term infants?

A. Postmaturity syndrome

B. Preterm syndrome

C. Respiratory distress syndrome

D. Neonatal sepsis

Answer 15

A. Postmaturity syndrome

Discussion: Postmaturity syndrome occurs in post-term infants due to prolonged exposure in the womb and declining placental function. It is characterized by fetal malnutrition, loss of fat, dry or peeling skin, and meconium staining.

Question 16

A 40-year-old woman at 42 weeks gestation presents for a routine check-up. Ultrasound reveals a decreased amniotic fluid index (AFI) and reduced fetal movement.

Question: What is the primary concern in this post-term pregnancy?

A. Fetal macrosomia

B. Oligohydramnios leading to cord compression

C. Placenta previa

D. Preterm labor

Answer 16

B. Oligohydramnios leading to cord compression

Discussion: In post-term pregnancies, decreased amniotic fluid can lead to oligohydramnios, which increases the risk of cord compression and fetal distress. Close monitoring or intervention may be required.

Question 17

A 35-year-old pregnant woman at 43 weeks gestation is admitted for labor induction. The estimated fetal weight is 4,200 grams. During labor, the baby’s shoulder becomes lodged after the head is delivered.

Question: Which complication is this patient experiencing?

A. Shoulder dystocia

B. Preterm labor

C. Placental abruption

D. Cord prolapse

Answer 17

A. Shoulder dystocia

Discussion: Shoulder dystocia is a common complication in cases of fetal macrosomia, where the baby’s shoulder gets stuck behind the mother’s pubic bone during delivery, posing risks for both mother and baby.

Question 18

A 29-year-old woman at 41 weeks gestation is brought to the hospital with decreased fetal movements. On examination, fetal heart tones are absent. Ultrasound confirms intrauterine fetal demise.

Question: What is the most likely cause of this complication in a post-term pregnancy?

A. Placenta previa

B. Stillbirth due to placental insufficiency

C. Preterm labor

D. Uterine rupture

Answer 18

B. Stillbirth due to placental insufficiency

Discussion: In post-term pregnancies, the aging placenta may fail to deliver adequate nutrients and oxygen to the fetus, leading to fetal demise (stillbirth). Close monitoring is essential in late-term pregnancies to prevent such outcomes.

Question 19

A 33-year-old woman at 42 weeks gestation delivers a baby with peeling skin, decreased fat, and signs of meconium staining. The infant appears thin and is transferred to the NICU for observation.

Question: What condition does this newborn likely have?

A. Postmaturity syndrome

B. Neonatal sepsis

C. Respiratory distress syndrome

D. Hypoxic-ischemic encephalopathy

Answer 19

A. Postmaturity syndrome

Discussion: Postmaturity syndrome occurs in post-term infants who experience malnutrition and decreased fat stores due to prolonged gestation and reduced placental function. The infant often appears thin with peeling skin and may have meconium staining.

Question 20

A 31-year-old woman at 42 weeks gestation presents in active labor. During delivery, the baby is noted to have a weak cry, poor muscle tone, and requires resuscitation. The history reveals meconium-stained amniotic fluid.

Question: Which perinatal complication is most likely responsible for the newborn’s condition?

A. Meconium aspiration syndrome

B. Neonatal sepsis

C. Preterm birth

D. Placenta previa

Answer 20

A. Meconium aspiration syndrome

Discussion: Meconium aspiration syndrome occurs when the fetus passes meconium into the amniotic fluid, which is then inhaled. This can lead to respiratory distress and poor adaptation at birth, requiring immediate medical intervention.

Question 21

Which of the following is a common cause of fetal distress due to cord compression?

A. Polyhydramnios

B. Oligohydramnios

C. Placenta previa

D. Fetal anemia

Answer 21

B. Oligohydramnios

Discussion: Oligohydramnios, or low amniotic fluid, reduces the cushioning effect around the umbilical cord, making it more vulnerable to compression during fetal movements or contractions, which can lead to fetal distress.

Question 22

What is the primary effect of umbilical cord compression on the fetus?

A. Increased nutrient supply

B. Increased fetal heart rate

C. Reduced blood flow and oxygen supply

D. Increased amniotic fluid volume

Answer 22

C. Reduced blood flow and oxygen supply

Discussion: Umbilical cord compression restricts blood flow through the umbilical vein and arteries, reducing the supply of oxygen and nutrients to the fetus and impairing the removal of carbon dioxide, leading to hypoxia and fetal distress.

Question 23

Which fetal heart rate pattern is commonly associated with umbilical cord compression?

A. Sinusoidal pattern

B. Variable decelerations

C. Early decelerations

D. Accelerations

Answer 23

B. Variable decelerations

Discussion: Variable decelerations are characterized by abrupt drops in fetal heart rate and are commonly associated with umbilical cord compression, indicating transient reductions in blood flow to the fetus.

Question 24

What physiological response does the fetus exhibit to preserve vital organ function during hypoxia caused by cord compression?

A. Bradycardia

B. Brain-sparing effect

C. Tachycardia

D. Polycythemia

Answer 24

B. Brain-sparing effect

Discussion: During hypoxia, the fetus redistributes blood flow to essential organs such as the brain, heart, and adrenal glands. This compensatory mechanism is known as the “brain-sparing effect” and helps protect these vital organs during periods of reduced oxygen supply.

Question 25

Which of the following is a potential consequence of prolonged umbilical cord compression?

A. Fetal anemia

B. Intrauterine growth restriction (IUGR)

C. Polyhydramnios

D. Increased fetal movements

Answer 25

B. Intrauterine growth restriction (IUGR)

Discussion: Prolonged umbilical cord compression can lead to chronic hypoxia and reduced nutrient supply, resulting in intrauterine growth restriction (IUGR), where the fetus does not grow at the expected rate.

Question 26

A 30-year-old woman at 38 weeks gestation presents with decreased fetal movements. Ultrasound shows oligohydramnios, and fetal heart rate monitoring reveals variable decelerations.

Question: What is the most likely cause of the fetal distress in this scenario?

A. Polyhydramnios

B. Cord compression due to oligohydramnios

C. Placenta previa

D. Fetal anemia

Answer 26

B. Cord compression due to oligohydramnios

Discussion: Oligohydramnios reduces the amniotic fluid volume, decreasing the cushioning effect around the umbilical cord and making it more prone to compression, leading to variable decelerations and fetal distress.

Question 27

A 28-year-old woman at 37 weeks gestation presents with signs of fetal distress. Fetal heart rate monitoring shows variable decelerations, and the provider suspects cord compression. The patient is offered amnioinfusion.

Question: What is the purpose of amnioinfusion in this context?

A. To increase uterine contractions

B. To relieve umbilical cord compression

C. To induce labor

D. To reduce fetal movements

Answer 27

B. To relieve umbilical cord compression

Discussion: Amnioinfusion involves the infusion of sterile fluid into the amniotic sac to increase amniotic fluid volume. This helps to relieve umbilical cord compression by providing additional cushioning around the cord, reducing the risk of fetal distress.

Question 28

A 32-year-old pregnant woman is admitted for reduced fetal movements at 39 weeks gestation. Fetal heart rate monitoring shows prolonged bradycardia, and ultrasound reveals a loop of umbilical cord compressed between the fetus and the uterine wall.

Question: What is the immediate management for this patient?

A. Observation and repeat monitoring

B. Emergency cesarean section

C. Induction of labor

D. Administration of corticosteroids

Answer 28

B. Emergency cesarean section

Discussion: Prolonged bradycardia due to umbilical cord compression indicates significant fetal distress. An emergency cesarean section is often necessary to prevent hypoxic injury and ensure a safe delivery for the fetus.

Question 29

A 29-year-old woman at 40 weeks gestation is in active labor. Fetal heart rate monitoring reveals recurrent variable decelerations. The provider suspects cord compression but notes that the fetus appears to be compensating well.

Question: Which physiological mechanism is helping the fetus compensate for the reduced oxygen supply?

A. Increased amniotic fluid production

B. Brain-sparing effect

C. Increased fetal movements

D. Polycythemia

Answer 29

B. Brain-sparing effect

Discussion: The brain-sparing effect is a compensatory mechanism where blood flow is redirected to vital organs such as the brain, heart, and adrenal glands during hypoxia. This helps the fetus maintain oxygen delivery to critical areas during periods of reduced oxygen supply.

Question 30

A 34-year-old woman at 41 weeks gestation presents with rupture of membranes and signs of fetal distress. Fetal heart rate monitoring shows variable decelerations, and the provider diagnoses oligohydramnios.

Question: What is the most appropriate next step in management if fetal distress persists despite initial measures?

A. Induction of labor with oxytocin

B. Amnioinfusion

C. Emergency cesarean section

D. Administration of tocolytics

Answer 30

C. Emergency cesarean section

Discussion: If fetal distress persists despite initial measures like amnioinfusion, an emergency cesarean section is indicated to prevent further hypoxic injury to the fetus and ensure a safe delivery.

Question 31

Which of the following is the primary purpose of membrane sweeping in a full-term pregnancy?

A. To prevent premature rupture of membranes

B. To release prostaglandins and stimulate labor

C. To decrease the risk of fetal macrosomia

D. To monitor fetal heart rate

Answer 31

B. To release prostaglandins and stimulate labor

Discussion: Membrane sweeping is done to release natural prostaglandins, which help soften the cervix and potentially initiate labor in full-term or post-term pregnancies.

Question 32

Membrane sweeping is typically offered at what stage of pregnancy?

A. 28-32 weeks

B. 32-36 weeks

C. 38-41 weeks

D. 42-44 weeks

Answer 32

C. 38-41 weeks

Discussion: Membrane sweeping is typically offered between 38-41 weeks of gestation to stimulate labor, particularly in pregnancies approaching or beyond full-term.

Question 33

Which of the following conditions may be a reason for offering membrane sweeping?

A. Preterm labor

B. Hypertension in pregnancy

C. Placenta previa

D. Pre-eclampsia at 32 weeks

Answer 33

B. Hypertension in pregnancy

Discussion: Membrane sweeping may be offered to women at higher risk of complications from prolonged pregnancy, such as those with hypertension, gestational diabetes, or pregnancies beyond 41 weeks.

Question 34

Which of the following is a potential side effect of membrane sweeping?

A. Severe bleeding

B. Rupture of membranes

C. Increased amniotic fluid

D. Uterine rupture

Answer 34

B. Rupture of membranes

Discussion: Membrane sweeping may cause some discomfort, spotting, cramping, and in rare cases, it can lead to the rupture of membranes (water breaking).

Question 35

What is the main benefit of membrane sweeping compared to medical induction?

A. It is completely risk-free

B. It requires no hospital stay

C. It is less invasive and often stimulates labor naturally

D. It guarantees labor within 12 hours

Answer 35

C. It is less invasive and often stimulates labor naturally

Discussion: Membrane sweeping is a less invasive way to encourage labor without the use of medications like Pitocin or prostaglandin gels, and it can potentially help avoid the need for medical induction.

Question 36

A 39-year-old woman at 40 weeks gestation presents for a routine check-up. She expresses her desire to avoid a formal induction with medication. The healthcare provider suggests membrane sweeping.

Question: What is the mechanism by which membrane sweeping may help initiate labor?

A. It increases uterine contractions through oxytocin release

B. It separates the amniotic sac membranes, releasing prostaglandins

C. It induces stress in the fetus, causing labor

D. It breaks the water, leading to labor onset

Answer 36

B. It separates the amniotic sac membranes, releasing prostaglandins

Discussion: Membrane sweeping involves gently separating the amniotic sac membranes from the cervix, which leads to the release of natural prostaglandins that can help soften the cervix and initiate labor.

Question 37

A 28-year-old pregnant woman at 41 weeks gestation is offered membrane sweeping to avoid medical induction. She asks about potential side effects.

Question: Which of the following side effects should be explained to the patient?

A. Severe hemorrhage

B. Spotting and cramping

C. Complete placental detachment

D. Preterm labor

Answer 37

B. Spotting and cramping

Discussion: Membrane sweeping can lead to mild side effects such as spotting, cramping, and discomfort. These are generally mild and temporary but should be discussed with the patient beforehand.

Question 38

A 35-year-old woman at 39 weeks gestation with gestational diabetes is considering membrane sweeping to avoid post-term complications. She is concerned about the risks of a prolonged pregnancy.

Question: What is one of the potential benefits of membrane sweeping in her situation?

A. Reduces risk of gestational diabetes complications

B. Increases risk of fetal macrosomia

C. Guarantees delivery within 24 hours

D. Prevents spontaneous rupture of membranes

Answer 38

A. Reduces risk of gestational diabetes complications

Discussion: Membrane sweeping can help initiate labor, potentially reducing the risk of complications from a prolonged pregnancy, such as fetal macrosomia and increased risk of cesarean delivery, particularly important for women with gestational diabetes.

Question 39

A 30-year-old woman at 40 weeks gestation undergoes membrane sweeping. Two days later, she experiences mild contractions and irregular bleeding.

Question: What is the most appropriate next step for the patient?

A. Immediate induction with Pitocin

B. Observation and supportive care

C. Emergency cesarean section

D. Administration of tocolytics

Answer 39

B. Observation and supportive care

Discussion: Mild contractions and irregular bleeding are common after membrane sweeping. The appropriate next step is to provide supportive care and monitor for the progression of labor.

Question 40

: A 29-year-old woman at 41 weeks gestation undergoes membrane sweeping. She wants to know how soon labor might begin.

Question: What timeframe should the healthcare provider give for the potential onset of labor?

A. 12 hours

B. 24 to 48 hours

C. 5-7 days

D. 1 week

Answer 40

B. 24 to 48 hours

Discussion: Membrane sweeping can help initiate labor, often within 24 to 48 hours. However, the exact timing can vary, and it is not guaranteed that labor will start within this timeframe.

Question 41

Which of the following parameters is NOT part of the Biophysical Profile (BPP)?

A. Fetal breathing movements

B. Gross fetal movements

C. Fetal weight estimation

D. Amniotic fluid volume

Answer 41

C. Fetal weight estimation

Discussion: The BPP consists of five parameters: fetal breathing movements, gross fetal movements, fetal tone, amniotic fluid volume, and a non-stress test. Fetal weight estimation is not part of the BPP.

Question 42

Which score range on the BPP is considered indicative of a healthy fetus?

A. 4 or less

B. 6 to 8

C. 8 to 10

D. 2 to 4

Answer 42

C. 8 to 10

Discussion: A score of 8 to 10 on the BPP indicates that the fetus is in good health, with no immediate cause for concern.

Question 43

Which of the following indicates a normal result for fetal breathing movements in the BPP?

A. No breathing movements within 30 minutes

B. One episode of rhythmic breathing lasting at least 30 seconds within 30 minutes

C. Three episodes of breathing lasting 10 seconds each

D. Continuous breathing for 10 minutes

Answer 43

B. One episode of rhythmic breathing lasting at least 30 seconds within 30 minutes

Discussion: A normal score for fetal breathing movements is given when there is at least one episode of rhythmic breathing lasting at least 30 seconds within 30 minutes.

Question 44

What is the significance of a BPP score of 4 or less?

A. Normal fetal well-being

B. Requires close monitoring

C. Indicates fetal distress or hypoxia

D. Indicates the need for increased maternal nutrition

Answer 44

C. Indicates fetal distress or hypoxia

Discussion: A BPP score of 4 or less indicates that the fetus may be experiencing distress or hypoxia, and further intervention such as induction of labor or cesarean delivery may be necessary.

Question 45

Which two components are assessed in the Modified Biophysical Profile (mBPP)?

A. Fetal breathing movements and amniotic fluid volume

B. Gross fetal movements and non-stress test

C. Non-stress test and amniotic fluid index (AFI)

D. Fetal tone and gross fetal movements

Answer 45

C. Non-stress test and amniotic fluid index (AFI)

Discussion: The modified BPP includes the non-stress test (NST) and the amniotic fluid index (AFI). A normal result for both suggests the fetus is well-oxygenated.

Question 46

A 28-year-old pregnant woman with gestational diabetes at 38 weeks gestation presents for a routine check-up. The healthcare provider orders a Biophysical Profile (BPP) to assess fetal well-being.

Question: Which parameter would indicate an abnormal finding in the BPP?

A. One episode of fetal breathing lasting 30 seconds

B. Two fetal heart rate accelerations within 20 minutes

C. Largest pocket of amniotic fluid measuring 1 cm in depth

D. Three limb movements within 30 minutes

Answer 46

C. Largest pocket of amniotic fluid measuring 1 cm in depth

Discussion: An amniotic fluid pocket measuring less than 2 cm is considered abnormal and may indicate oligohydramnios, which is a concerning finding in the BPP.

Question 47

: A 35-year-old woman at 40 weeks gestation presents with reduced fetal movement. A Biophysical Profile (BPP) is performed, and the score is 6.

Question: What is the most appropriate next step in management?

A. Immediate delivery

B. Repeat the BPP in 24 hours

C. Perform an amniocentesis

D. Administer corticosteroids

Answer 47

B. Repeat the BPP in 24 hours

Discussion: A BPP score of 6 is borderline, and the appropriate management often involves repeating the test within 24 hours to determine if the fetus is stable or if further intervention is needed.

Question 48

A 29-year-old woman at 41 weeks gestation undergoes a BPP, which reveals a score of 4. The non-stress test is non-reactive, and amniotic fluid volume is low.

Question: What is the most likely recommendation for this patient?

A. Repeat BPP in 1 week

B. Immediate induction of labor or cesarean delivery

C. Administer IV fluids to increase amniotic fluid

D. Observation and discharge home

Answer 48

B. Immediate induction of labor or cesarean delivery

Discussion: A BPP score of 4 indicates fetal distress, especially when accompanied by a non-reactive NST and low amniotic fluid. Immediate delivery is usually recommended to prevent further complications. B. Immediate induction of labor or cesarean delivery

Discussion: A BPP score of 4 indicates fetal distress, especially when accompanied by a non-reactive NST and low amniotic fluid. Immediate delivery is usually recommended to prevent further complications.

Question 49

A 32-year-old woman at 39 weeks gestation presents for a BPP due to hypertension. The BPP score is 8 with a reactive NST, but amniotic fluid is at the lower end of normal.

Question: What is the significance of this BPP score?

A. The fetus is in distress and needs immediate delivery

B. The fetus is in good health, but monitoring should continue

C. The mother should be admitted for observation

D. The BPP should be repeated immediately

Answer 49

B. The fetus is in good health, but monitoring should continue

Discussion: A BPP score of 8 with a reactive NST generally indicates good fetal health. However, given the mother’s hypertension and borderline amniotic fluid levels, continued monitoring is advisable.

Question 50

A 30-year-old woman at 36 weeks gestation with decreased fetal movements undergoes a modified BPP, which reveals a normal AFI but a non-reactive NST.

Question: What is the next best step in management?

A. Perform a full Biophysical Profile (BPP)

B. Immediate induction of labor

C. Administer corticosteroids

D. Schedule follow-up in 1 week

Answer 50

A. Perform a full Biophysical Profile (BPP)

Discussion: A non-reactive NST in a modified BPP warrants further evaluation with a complete BPP to assess additional parameters of fetal well-being before deciding on further intervention.

Question 51

Which of the following is a key component of the Bishop score?

A. Fetal heart rate variability

B. Cervical dilation

C. Amniotic fluid volume

D. Placental location

Answer 51

B. Cervical dilation

Discussion: The Bishop score is used to assess cervical readiness for labor induction and includes cervical dilation, effacement, consistency, position, and fetal station.

Question 52

What is the significance of a Bishop score of 7 or more?

A. The cervix is not ready for labor induction

B. Labor induction is likely to be successful

C. Cesarean section is required

D. Fetal distress is present

Answer 52

B. Labor induction is likely to be successful

Discussion: A Bishop score of 7 or more indicates that the cervix is favorable, meaning that labor induction or augmentation is likely to be successful.

Question 53

Which of the following uterotonic agents is commonly used to augment labor when the Bishop score is favorable?

A. Misoprostol

B. Oxytocin

C. Magnesium sulfate

D. Nifedipine

Answer 53

B. Oxytocin

Discussion: Oxytocin is commonly used to augment or induce labor when the Bishop score indicates a favorable cervix (≥ 7), helping to promote contractions and labor progression.

Question 54

Which aspect of the cervix is assessed as part of the Bishop score to determine its readiness for labor?

A. Length of the cervix

B. Position of the cervix

C. Presence of cervical mucus

D. Fetal presentation

Answer 54

B. Position of the cervix

Discussion: The Bishop score evaluates the position of the cervix (anterior, mid-position, or posterior) as one of the factors to determine cervical readiness for labor.

Question 55

What is the main role of cervical ripening agents in labor induction?

A. To increase uterine contractions

B. To soften and efface the cervix

C. To reduce fetal heart rate variability

D. To decrease maternal blood pressure

Answer 55

B. To soften and efface the cervix

Discussion: Cervical ripening agents, such as prostaglandins, are used to soften and efface (thin) the cervix, preparing it for labor induction.

Question 56

A 28-year-old woman at 39 weeks gestation is scheduled for labor induction due to gestational hypertension. Her Bishop score is 8.

Question: What does this Bishop score indicate regarding labor induction?

A. The cervix is unfavorable for induction

B. Labor induction is likely to be successful

C. Immediate cesarean section is recommended

D. The patient should wait another week

Answer 56

B. Labor induction is likely to be successful

Discussion: A Bishop score of 8 suggests that the cervix is favorable, meaning that labor induction is likely to be successful without the need for further cervical ripening.

Question 57

A 30-year-old pregnant woman at 41 weeks gestation has a Bishop score of 5. The healthcare provider recommends using a prostaglandin agent.

Question: What is the purpose of using a prostaglandin agent in this situation?

A. To induce uterine contractions

B. To soften and ripen the cervix

C. To decrease fetal heart rate

D. To treat maternal hypertension

Answer 57

B. To soften and ripen the cervix

Discussion: A Bishop score of 5 indicates that the cervix is not yet favorable for induction. Prostaglandins can help soften and ripen the cervix to improve the likelihood of successful labor induction.

Question 58

A 32-year-old woman at 40 weeks gestation is admitted for labor augmentation. Her Bishop score is 9, and oxytocin is started.

Question: What is the most likely reason for starting oxytocin in this patient?

A. To increase cervical effacement

B. To induce contractions and promote labor progression

C. To treat fetal bradycardia

D. To prevent uterine rupture

Answer 58

B. To induce contractions and promote labor progression

Discussion: With a favorable Bishop score of 9, oxytocin is used to augment labor by increasing uterine contractions, which helps to progress labor.

Question 59

A 27-year-old woman at 38 weeks gestation is being evaluated for possible labor induction. The Bishop score is 3, and the cervix is firm and posterior.

Question: What is the best next step in management?

A. Immediate induction with oxytocin

B. Cervical ripening with a prostaglandin agent

C. Perform an emergency cesarean section

D. Observe and discharge home

Answer 59

B. Cervical ripening with a prostaglandin agent

Discussion: A Bishop score of 3 indicates that the cervix is unfavorable for labor induction. Cervical ripening with a prostaglandin agent is recommended to help prepare the cervix for induction.

Question 60

A 35-year-old woman at 39 weeks gestation with a Bishop score of 7 is scheduled for labor induction. The healthcare provider decides to use oxytocin.

Question: What does the Bishop score indicate regarding the use of oxytocin?

A. The cervix is unfavorable, and oxytocin should not be used

B. The cervix is favorable, and oxytocin can be used to induce labor

C. Oxytocin is contraindicated in this patient

D. A cesarean section should be planned

Answer 60

B. The cervix is favorable, and oxytocin can be used to induce labor

Discussion: A Bishop score of 7 indicates that the cervix is favorable for induction, making oxytocin an appropriate choice to initiate or augment labor.