OB 2 Flashcards by Abby David

Which of the following is an absolute contraindication for external cephalic version?

A. Early labor
B. Twin gestation
C. Oligohydramnios
D. Fetal-growth restriction

B. Twin gestation
Best answer; internal podalic version for the second twin

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Maternal morbidity with forceps delivery is most closely predicted by?

A. Fetal station
B. Maternal parity
C. Length of second stage
D. Fetal gestational age

A. Fetal station

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A 32-year-old primigravida undergoing induction of labor reaches the 2nd stage of labor after 36 hours. Before beginning to push she says she is too tired and desires operative vaginal delivery. Which of the following precludes her from having an operative vaginal delivery?

A. Head station is at station +1
B. Head in occiput anterior position
C. Scalp is visible in introitus without labial separation
D. Head station is at station +3

A. Head station is at station +1

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A 35-year-old multigravida with an epidural in place has been pushing for 2 hours. Fetal head is at station +2 but has not reached the pelvic floor and is at left occiput posterior. Forceps delivery for this patient would be classified as

A. high
B. outlet
C. low
D. midpelvic

C. low

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A primigravid is already pushing for 3h with the fetal scalp visible at the introitus without separating the labia. What type of forceps delivery is applicable on this patient?

A. Low
B. Midpelvic
C. High
D. Outlet

D. Outlet

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Which of the following is not an acceptable indication for operative vaginal delivery?

A. Aortic stenosis
B. Maternal exhaustion
C. Pelvic floor protection
D. Shorten 2nd stage of labor

C. Pelvic floor protection

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The most important determinant of success in vacuum extraction

A. Proper cup placement
B. Expertise of the operator
C. Negative pressure of 0.8 kg/cm2 is reached
D. Gentle intermittent tractions coordinated with maternal expulsive efforts

A. Proper cup placement

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A 27-year-old multigravida at 40 weeks AOG is already at 6 cm. On repeat exam 4 hours later, she is still at 6 cm. What information would you like to determine your next step?

A. If contractions are adequate
B. If analgesia was given
C. The estimate fetal weight
D. If membranes were ruptured

A. If contractions are adequate

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Which of the following statements is true of face mentum posterior presentations?

A. Most will convert to mentum anterior even in late labor
B. Oligohydramnios is the biggest risk factor
C. Prematurity is a predisposing factor
D. A mentum posterior is never deliverable

A. Most will convert to mentum anterior even in late labor

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A 25 yo multigravida at 41 weeks with BMI of 38 progresses through the first stage of labor. She pushes for about 3 hours under epidural anesthesia. She delivers a 3400-gram infant via forceps. The next day she reports lower extremity weakness with foot drop and pain. What is the most likely cause?

A. Obesity
B. Prolonged second stage
C. Big baby
D. Anesthesia complication

B. Prolonged second stage

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What is the best indicator of pelvic adequacy for vaginal breech delivery?

A. Adequate x-ray pelvimetry
B. Sonographic fetal biometry
C. Satisfactory progress in labor
D. Inability to reach sacral promontory in clinical pelvimetry

C. Satisfactory progress in labor

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A multigravida patient at 39 weeks AOG came in for labor pains. Fundic HT is 30 cm, FHT 142/min. Internal exam revealed cervix dilation of 8 cm, 100% effaced, frank breech presentation. Uterine contractions 3-4 in 10 mins strong, 50-55 secs duration. What important factor should be assessed before contemplating a vaginal delivery on this patient?

A. Previous weights of her babies
B. Assessment of head flexion
C. Fetal heart tone
D. Presence of cord prolapse

B. Assessment of head flexion

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Which of the following is a prerequisite of vacuum extraction, but not with forceps-assisted vaginal delivery?

A. Position of fetal head must be precisely known
B. No CPD
C. Ruptured membranes
D. At least 34 weeks AOG

D. At least 34 weeks AOG

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Which of the following will not cause uterine dysfunction?

A. Chorioamnionitis
B. Ambulation during labor
C. General anesthesia
D. Squatting during 2nd stage of labor

C. General anesthesia

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A G1P0 at 38 weeks AOG came in due to hypogastric pain. FH 28 cm, FHT 148/min. Internal evaluation revealed 3 cm dilated cervix, 50% effaced, cephalic -3, intact membranes. 2h after, patient had the urge to bear down. IE revealed fully dilated cervix and she subsequently delivered after 30 minutes. What fatal condition is associated with this type of delivery?

A. Uterine atony
B. Uterine rupture
C. Extensive lacerations of cervix, vagina, vulva, and perineum
D. Amniotic fluid embolism

D. Amniotic fluid embolism

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Which of the following malpresentations can be delivered vaginally in term fetuses?

A. Face – mentum anterior
B. Face – mentum posterior
C. Shoulder presentation
D. Footling breech

A. Face – mentum anterior

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A G5P4 (4004) at 38 wks AOG, came in due to hypogastric pain. FH 31 cm, FHT 142/min. On evaluation, the cervix is 5 cm dilated, 50% effaced with shoulder palpated. What is the cause of the malpresentations in this case?

A. High parity
B. Preterm baby
C. Placenta previa
D. CPD

A. High parity

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Type of breech presentation that may be delivered vaginally

A. Frank breech
B. Footling breech
C. Complete breech
D. Incomplete breech

A. Frank breech

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A G2P1 (1001) came in at the ER for a scheduled cesarean section due to footling breech presentation. What type of breech delivery is used to deliver the baby?

A. Total breech extraction
B. Partial breech extraction
C. Spontaneous breech delivery
D. Combined partial and spontaneous delivery

A. Total breech extraction

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This maneuver is done during vaginal breech delivery to deliver a fetus whose trunk failed to rotate anteriorly

A. Loveset maneuver
B. Pinard maneuver
C. Modified Prague maneuver
D. Mauriceau maneuver

C. Modified Prague maneuver

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This maneuver involves breech decomposition to bring the fetal feet within reach of the operator

A. Loveset maneuver
B. Pinard maneuver
C. Modified Prague maneuver
D. Mauriceau maneuver

B. Pinard maneuver

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This maneuver of the delivery of the aftercoming head shows that the index and middle fingers of one hand is applied on the maxilla to maintain head flexion while the body of the fetus is straddled on the operator’s forearm

A. Loveset maneuver
B. Pinard maneuver
C. Prague maneuver
D. Mauriceau maneuver

D. Mauriceau maneuver

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Type of forceps used for delivery of the aftercoming head

A. Simpson
B. Kieland
C. Piper
D. Mauriceau

C. Piper

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A G3P2 (2002) at 38 weeks AOG came in due to hypogastric pain. IE revealed a 3-cm dilated cervix, 50% effaced with a foot palpated. Which of the following factors would favor a CS delivery in this case?

A. Healthy and term baby
B. Fetus <3800 to 4000 grams
C. Frank breech
D. Hyperextended head

D. Hyperextended head

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A G1 came in already fully dilated. After delivery of the fetal head, the remainder of the body didn’t follow with the anterior shoulder wedged behind the symphysis pubis. To release it, the resident progressively rotated the posterior shoulder 180 degrees to release the impacted shoulder. What maneuver was done? A. Rubin maneuver B. Wood’s corkscrew maneuver C. Hibbard maneuver D. McRoberts maneuver

B. Wood’s corkscrew maneuver

This maneuver involves cephalic replacement into the pelvis followed by CS delivery in an entrapped aftercoming head A. Rubin maneuver B. Zavanelli maneuver C. Hibbard maneuver D. Woods corkscrew maneuver

B. Zavanelli maneuver

This maneuver involves application of pressure on the fetal jaw and neck in the direction of the maternal rectum, with strong fundal pressure applied by an assistant as the anterior shoulder is freed A. Rubin maneuver B. Zavanelli maneuver C. Hibbard maneuver D. Woods corkscrew maneuver

C. Hibbard maneuver

To prevent undue head compression, how should traction be applied in forceps delivery? A. Gentle intermittent traction with uterine contractions B. Strong steady traction C. Strong but intermittent along with uterine contractions D. Gentle but steady

A. Gentle intermittent traction with uterine contractions

A G1 had been pushing for 2h already and is already exhausted. Vacuum delivery was done. Which of the following complications may result from using metal cup instruments? A. Hyperbilirubinemia B. Fetal coagulopathy C. Shoulder dystocia D. Erb’s palsy

A. Hyperbilirubinemia

This maneuver for shoulder dystocia is associated with higher incidence of orthopedic & neurological damage A. Suprapubic pressure B. McRobert’s maneuver C. Hibbard maneuver D. Woods corkscrew

C. Hibbard maneuver

The phase of maximum slope of the active phase of labor is a reflection of A. the ultimate outcome of labor B. the overall efficiency of machine C. fetopelvic relationships D. pelvis and presenting part relationship

B. the overall efficiency of machine

Anna, a 20-year-old G1 on her 40 weeks’ age of gestation, came in due to bloody show. On admission, uterine contractions were 1 every 10 minutes, lasting 20 seconds with mild intensity. IE done revealed 4 cm cervical dilatation, 100% effaced, cephalic, station -2, with clear amniotic fluid. After 4 hours, still with the same findings. What is the next step in management? A. Watchful waiting, still in the latent phase of labor B. Do amniotomy C. Administer oxytocin D. Schedule the patient for cesarean section

C. Administer oxytocin

Marina, a 28-year-old G3P2 (2002), on her 39 weeks’ age of gestation was admitted with uterine contraction of 3 in 10 minutes, lasting 40 seconds with moderate to strong intensity. IE revealed 6 cm cervical dilatation, 100% effaced, cephalic, station -1, clear amniotic fluid. After 2 hours, still with the same IE findings. After 2 hours, uterine contractions were now strong, IE revealed 7 cm cervical dilatation, station -1, with thinly stained amniotic fluid. Fetal monitoring showed variable decelerations. Hydration was done, fetal heart rate improved. After an hour IE now revealed full cervical dilatation, station +1, with thinly stained fluid. After an hour, still with the same IE findings, fetal heart tone at 110 bpm. What is the next best step in the management of this patient? A. Administer oxytocin to hasten delivery B. Monitor fetal heart rate every 5 minutes C. Schedule for cesarean section D. Observe for another hour

C. Schedule for cesarean section

Glenda, a 34-year-old G1 on her 41 weeks’ age of gestation was admitted on her 10th hour of labor with IE findings of 6 cm cervical dilatation, 100% effaced, cephalic, station -1, clear amniotic fluid. After 2 hours, still with the same IE findings. Oxytocin drip was administered. After 2 hours, still with the same IE findings. She was then scheduled for cesarean section. Which of the following findings may be true for this patient? A. Diagonal conjugate <11.5 cm B. Anteroposterior diameter <10.5 cm C. Interspinous and posterior sagittal diameters D. Interspinous diameter <8 cm

A. Diagonal conjugate <11.5 cm

Estimation of the pelvic outlet includes the following, except A. Suprapubis angle of 90 degrees B. Bituberous diameter admits closed fist of the hand C. Anteroposterior diameter of the outlet from the tip of the sacrum to the inferior edge of the symphysis >11.0 cm D. Mobility of the coccyx by pressing firmly on it cannot determine its mobility

D. Mobility of the coccyx by pressing firmly on it cannot determine its mobility

SD, G1P0 is already 9 cm dilated, 100% effaced, cephalic, RBOW clear, station +1. Repeat IE done after 3 hours still at station +1. What is the labor disorder noted? A. Failure of descent B. Arrest of descent C. Prolonged labor D. Arrest of cervical dilatation

B. Arrest of descent

BM, G2P1 (1001) is already at 10 cm dilated, 100% effaced, cephalic, station -1, RBOW clear. Repeat IE done after 2 hours revealed still at station -1 despite patient kept on pushing. What is the labor disorder noted? A. Failure of descent B. Arrest of descent C. Prolonged labor D. Arrest of cervical dilatation

A. Failure of descent

PW, 28yo, G1 came at 4pm due to labor pains. FHT 145/min. IE showed 4 cm, 80% effaced, cephalic, station 0, intact membranes with uterine contractions 3/10 with moderate intensity, 45 sec duration. What are the findings on Leopold’s? A. L1 breech; L2 cephalic, engaged; L3 negative; L4 fetal back on maternal right B. L1 breech; L2 negative; L3 fetal back on maternal right; L4 cephalic, engaged C. L1 breech; L2 fetal back on maternal right; L3 cephalic, engaged; L4 negative D. L1 breech, L2 negative, L3 cephalic, engaged; L4 fetal back on maternal right

C. L1 breech; L2 fetal back on maternal right; L3 cephalic, engaged; L4 negative

Clinical index that increases suspicion of potential disproportion during labor A. Sacrum is flat B. Ischial spines not prominent C. Subpubic arch >90-1000 D. Sacral promontory not easily reached

A. Sacrum is flat

The station where engagement occurs A. Station +2 B. Station +1 C. Station 0 D. Station -1

C. Station 0

Vertical incision is indicated in this position of a transverse lie A. Dorsoposterior B. Dorsoanterior C. Dorsoposterior D. Dorsolateral

B. Dorsoanterior

Contracted pelvic inlet is considered if A. greatest transverse diameter is >12 cm B. greatest transverse diameter is <12 cm C. shortest anteroposterior diameter is >10 cm D. diagonal conjugate >11.5 cm

B. greatest transverse diameter is <12 cm

If vaginal delivery is contemplated in breech presentation, what must be done to prevent extension of the head? A. Fundal pressure B. Suprapubic pressure C. Mauriceau maneuver D. Duhrssen incision

B. Suprapubic pressure

A condition where the fetus doubled upon itself where the head and the thorax will pass through the pelvic cavity at the same time A. Conduplicato corpore B. Corpore conduplicato C. Neglected transverse lie D. Compound presentation

A. Conduplicato corpore

Contraction in this part of the pelvis is responsible for malpresentations A. Inlet B. Midpelvis C. Outlet D. Iliac fossa

A. Inlet

A prolapsed extremity alongside the presenting part and both present simultaneously in the pelvis A. Cord prolapse B. Compound presentation C. Incomplete breech D. Frank breech

B. Compound presentation

A G1 presents in labor at 32 weeks’ gestation. Her cervix is completely dilated, and the fetus is breech. You are unable to deliver the fetal head. What procedure is applied to resolve this complication? A. Symphysiotomy B. Zavanelli maneuver C. Duhrssen incision D. Mauriceau maneuver

C. Duhrssen incision

Which of the following factors will not influence the progress of the first stage of labor? A. Uterine contractions B. Size of the fetus C. Cervical resistance D. Forward pressure by the presenting part

B. Size of the fetus

The disproportion of the fetus and the pelvis will be seen in this stage A. First stage B. Second stage C. Third stage D. Fourth stage

B. Second stage

Type of vaginal delivery where the entire fetal body is extracted by the operator: A. Total-breech extraction B. Partial breech extraction C. Spontaneous delivery D. Forceps delivery

A. Total-breech extraction

Type of vaginal breech delivery where the fetal body is delivered spontaneously until the umbilicus and the remainder is delivered by the provider. A. Partial breech extraction B. Total breech extraction C. Spontaneous delivery D. Forceps delivery

A. Partial breech extraction

Which is not a characteristic of hypertonic uterine contraction? A. Distorted pressure gradient B. Elevated basal tone C. Relieved by sedation D. Normal gradient pattern

D. Normal gradient pattern

What is the management of choice for a multigravida who is in second stage of labor for 2 hours and is already exhausted in pushing? A. Immediately schedule for C section. B. Apply assisted fundal pressure timed with the peak of contractions. C. Prepare for assisted vaginal delivery via forceps or vacuum extraction. D. Reassure the mother and give her another hour to rest the continue pushing.

C. Prepare for assisted vaginal delivery via forceps or vacuum extraction.

A G1P0 at 40 weeks AOG has good progression of cervical dilatation from 5 cm to 8 cm and descent from station - 1 to 0 after amniotomy and oxytocin augmentation. EFW 3500 grams with slightly prominent ischial spines and slightly convergent sidewalls. Findings remained the same for 4 hours with uterine intensity of 280 MVU. What is the management? A. Operative vaginal delivery B. Increase the dose of oxytocin. C. Observe for another 2 hours. D. Cesarean section

D. Cesarean section

A G1P0 at 39 weeks is in active labor for 10 hours has good progress of cervical dilatation up to 7 cm, ROA, station 0. No further progress was noted thereafter for 2 hours. What is the diagnosis? A. Arrest in descent B. Protracted cervical dilatation C. Arrest in cervical dilatation D. Failure of descent

B. Protracted cervical dilatation Dapat C

A G1PO 38 weeks AOG came in with mild uterine contractions occurring every 10 to 40 minutes lasting for 20 to 30 seconds for more than 20 hours now. On IE, cervix soft, 1 cm dilated, 1.5 cm long, cephalic presentation, station -2, intact BOW. Vital signs normal, FHR reassuring. What is the management? A. Amniotomy B. Bed rest with sedation C. Oxytocin augmentation D. Cesarean delivery

C. Oxytocin augmentation

A G2P0(0010) 41yo at 40w AOG came in for hypogastric pains. PNC was unremarkable. Vital signs were within normal. Uterine contractions were adequate. FH 28cm, FHT 145 RLQ. IE: cervix 4cm dilated, fully effaced, nodular, and bony structures palpable (2 elongated bony structures flexed with nodularities grasping the examining fingers.) With these data, which is true? A. The shoulder is usually positioned over the pelvic inlet where the head occupies one iliac fossa, and the breech the other. B. Forceps or vacuum delivery is the management of choice. C. The lower extremities are flexed at the hips and extended at the knees, and thus the feet lie in close proximity to the head. D. Vaginal delivery is possible at this time.

A. The shoulder is usually positioned over the pelvic inlet where the head occupies one iliac fossa, and the breech the other.

The least anticipated neonatal complication in shoulder dystocia. A. Acidosis leading to hypoxic ischemic encephalopathy B. Neuromusculoskeletal injury C. Postpartum hemorrhage from uterine atony D. Brachial plexus injury

A. Acidosis leading to hypoxic ischemic encephalopathy

The most dreaded complication that can arise when uterine contractions are hypertonic as a result of injudicious use of oxytocin is: A. Genital tract laceration B. Infection C. Uterine rupture D. Precipitate labor

C. Uterine rupture

Which of the following is true regarding maternal complications of shoulder dystocia? A. Tissues of the birth canal lying between the leading part and the pelvic wall may be subjected to excessive pressure resulting to vesicovaginal, vesicocervical, or rectovaginal fistulas. B. Pathological retraction ring of Bandl is associated with marked stretching and thinning of the uterine corpus which signifies impending rupture of the lower uterine segment. C. Pelvic floor injury during childbirth leads to urinary incontinence and to pelvic organ prolapse. D. Abnormal thinning of the lower uterine segment creates a serious danger during prolonged labor leading to uterine rupture.

D. Abnormal thinning of the lower uterine segment creates a serious danger during prolonged labor leading to uterine rupture.

A G1P0 at 41 weeks AOG was admitted with IE of 4 cm dilated cervix, 60% effaced, cephalic, station 0, intact BOW, contractions every 4 to 6 minutes mild to moderate, 30 to 40 seconds duration. Two hours later, cervix 5 cm dilated, station 0, contractions every 3 to 5 min 40 second duration, moderate to strong. Two hours later, cervix 6 cm dilated, 70% effaced, station 0, contractions every 2 to 3 min moderate to strong. What is the labor pattern? A. Normal B. Prolonged latent phase C. Arrest in cervical dilatation D. Protracted cervical dilatation

D. Protracted cervical dilatation

A 30-year-old G1P0 39 weeks AOG was admitted on the 4th hour of labor with 3 cm dilated cervix, 60 % effacement, cephalic, station -1. intact BOW. moderate contractions every 3-4 minutes. IE done at 2-hour intervals revealed progression of cervical dilatation to 4.5 and 6 cm. what is the pattern of labor? A. Normal labor B. Failure in descent C. Arrest in cervical dilatation D. Protracted cervical dilatation

D. Protracted cervical dilatation

Type of forceps commonly used to rotate fetal head position. A. Tucker McLane B. Simpsons C. Piper D. Kielland

D. Kielland

AA, a 16yo, G2P0(0010), 37w AOG by early UTZ, came to the er due to labor pains. 2H from admission, IE is 6cm dilated cervix, 100%effaced, cephalic presentation, station 0, ruptured BOW (thinly meconium-stained AF). Uterine contractions were adequate, fetal heart status is reassuring. 5H from admission IE: 9cm dilated cervix, 100%effaced, cephalic presentation, station 0, ruptured BOW (thinly meconium-stained AF). Uterine contractions were adequate, fetal heart status is reassuring. 7H from admission, same findings were noted. Describe the progress of labor. A. There is arrest in descent. B. There is arrest in cervical dilatation. C. There is prolonged deceleration phase. D. There is protraction of the active phase.

C. There is prolonged deceleration phase.

Which of the following type of forceps is not paired with its function? A. Kielland: rotation of occiput transverse B. Piper-Laufe: delivery of aftercoming head C. Simpsons: molded head and rotation of flexed head D. Tucker-McLane: Rotation of extended head

A. Kielland: rotation of occiput transverse

A 28-year-old G2P1 (1001) delivered less than 3 hours of labor is at risk for developing this complication. A. Rectovaginal fistula B. Chorioamnionitis C. Dehydration and exhaustion D. Postpartum atony

D. Postpartum atony

Type of forceps delivery when the head is at station >+2, sagittal suture at left occiput anterior position. A. Outlet Forceps Delivery B. Low Forceps Delivery C. High forceps delivery D. Mid forceps Delivery

B. Low Forceps Delivery

A 38yo G3P2(1101) at 38 weeks AOG has the following findings for 2 hours: cervix fully dilated and effaced, station +4, thinly stained amniotic fluid. CTG were all reassuring. She has been exhausted already. What is the labor abnormality? A. Protracted descent B. Prolonged deceleration phase C. Prolonged second stage of labor D. Arrest in descent

D. Arrest in descent

A G1P0 at 40 weeks AOG was admitted at 8 cm dilated cervix 100% effaced, cephalic, station 0. Amniotomy done followed by oxytocin augmentation. After 2 hours, cervix 8 cm dilated, 100% effaced, LOA, station 0. After 2 hours cervix fully dilated fully effaced, LOA, station +1. Findings remained the same for 3 hours. What is the management? A. Observe for another 2 hours. B. Cesarean delivery C. Forceps delivery D. Increase dose of oxytocin

C. Forceps delivery

Which of the following conditions favors Outlet Forceps delivery? A. Fetal head is in occiput transverse position. B. Patient is actively bearing down. C. Station +1 D. Head is almost crowning.

D. Head is almost crowning.

A G1P0 at 40 weeks AOG has been at 9 cm cervical dilatation at station 0 for four hours in spite of good uterine contractions. What is the management? A. Cesarean section B. Do forceps delivery. C. Give oxytocin. D. Observe for another hour

A. Cesarean section

When do you allow vaginal delivery in a hydrocephalus? A. BPD <13 cm, HC <34 cm B. BPD <12 cm. HC <38 cm C. BPD <10 cm, HC <36 cm D. BPD <11 cm, HC <37 cm

C. BPD <10 cm, HC <36 cm

Cesarean delivery is indicated in a suspected macrosomia in which of the following? A. Overt diabetes with EFW of 4500 grams B. Overt diabetic with EFW of 5000 grams C. Non-diabetic with EFW of 4000 grams D. Non-diabetic with EFW of 6000 grams

A. Overt diabetes with EFW of 4500 grams D. Non-diabetic with EFW of 6000 grams

The clinical pelvimetry of a G1P0 at 38 weeks revealed sacral promontory not reached at 11.5 cm, convergent sidewalls, prominent ischial spines, narrowed sacrosciatic notches, intertuberous diameter 11 cm. What is the interpretation? A. Adequate pelvic B. Midplane contraction C. Generalized contraction D. Inlet contraction

B. Midplane contraction

A 35yo G6P5(4105) at 40 weeks AOG came due to hypogastric pain. Vital signs were within normal. Uterine contractions were adequate. FH 28cm, FHT 145 LUQ. Upon opening her undergarments, both fetal feet were out of the introitus with cervix fully dilated and fully effaced. What should be done? A. For double footling presentations in imminent delivery, a C section with vertical incision is typically indicated. B. After exclusion of fetal neck hyperextension, the fetus is delivered spontaneously as far as the umbilicus, but the remainder of the body is extracted or delivered with operator traction and assisted maneuvers, with or without maternal expulsive efforts. C. Prepare for forceps or vacuum delivery. D. The prolapsed fetal feet should be left alone because most often them will not interfere with labor.

A. For double footling presentations in imminent delivery, a C section with vertical incision is typically indicated.

Which of the following is a least indication for doing a vacuum delivery? A. Abnormal implantation of the placenta B. Premature separation of the placenta C. Non-reassuring metal heart rate pattern D. Maternal exhaustion

A. Abnormal implantation of the placenta

In a G1PO who came in due to watery vaginal discharges at 4cm, labor was monitored by the OB resident. To ascertain if there is a pelvic contraction, which of the following should be done? A. Trial of labor should be done to diagnose contracted pelvic capacity, singly or in combination. B. Expected fetal weight should be known to determine the need for abdominal delivery. C. Clinical pelvimetry is sufficient to diagnose dystocia and guides the need for abdominal delivery especially if done prior to onset of active labor. D. X-ray pelvimetry and clinical pelvimetry are sufficient to diagnose dystocia.

A. Trial of labor should be done to diagnose contracted pelvic capacity, singly or in combination.

A G1P0 at 40 weeks AOG was admitted with IĘ findings of 5 cm dilated cervix, 60% effaced, cephalic presentation, station 0, intact BOW, contractions every 4 to 6 minutes, mild to moderate, 30 to 40 seconds duration. Three hours later, cervix 6 cm dilated, station 0, contractions every 3 to 5 min, 40 seconds duration, mild to moderate. Two hours later, cervix is 7 cm dilated, 70% effaced, station 0, contractions every 4 to 5 min moderate. What is the labor pattern seen? A. Arrest in descent B. Protracted cervical dilatation C. Arrest in cervical dilatation D. Normal

B. Protracted cervical dilatation

A 38yo G3P1, known diabetic, came to the er for hypogastric pains. Pertinent PE showed the following: FH 38cm, FHT 145 LLQ. After delivery of the fetal head, the neck was noted to recoil back. What is the initial management of this case? A. Do Gaskin Maneuver to effectively pull the shoulder. B. Call for help. C. Ask an assistant to perform suprapubic pressure D. Immediately do McRoberts maneuver then call for help.

B. Call for help.

A 38-year-old G5P4 (4004) at 39 weeks AOG came in due to labor pains. On abdominal examination, no fetal pole on the fundus and a ballotable structure in one iliac fossa were noted. What is the fetal lie? A. Transverse lie B. Breech C. Cephalic D. Longitudinal lie

A. Transverse lie

A fetal position which warrants a cesarean delivery. A. Occiput Anterior B. Occiput Posterior C. Mentum Anterior D. Mentum Posterior

D. Mentum Posterior

What maneuver is exhibited when the operator uses both hands simultaneously and in tandem to exert continuous downward gentle traction on the fetal neck and on the maxilla? A. Mauriceau's maneuver B. Zavanelli's maneuver C. McRobert's maneuver D. Rubin's maneuver

A. Mauriceau's maneuver

Which of the following is a least likely complication of dystocia? A. Postpartum endometritis B. Precipitous delivery C. Uterine rupture D. Chorioamnionitis

B. Precipitous delivery

The six-cm rule in dystocia applies most likely in which condition? A. More than or 200 Montevideo units in a 10 min for more than 2 hours without cervical change B. Latent phase not completed after 6 hours C. 6 cm with ruptured membrane who fails to progress during 4 hours adequate uterine contractions, 6 cm of oxytocin with inadequate uterine contraction with no cervical change D. More or 4 cm cervical dilatation

C. 6 cm with ruptured membrane who fails to progress during 4 hours adequate uterine contractions, 6 cm of oxytocin with inadequate uterine contraction with no cervical change

A G6P5 (4105) 35yo at 40 weeks AOG came due to hypogastric pains. Vital signs were within normal. Uterine contractions were adequate. FH 30cm, FHT 145 LUQ. IE: cervix 8cm dilated, fully effaced, soft, and bony structure palpable (2 bony prominences forming a line with a hole-like depression). Ruptured clear membranes. With these data, which is true? A. The prolapsed part should be left alone because most often it will not interfere with labor. B. The possible fetal habitus is that the lower extremities are flexed at the hips and extended at the knees, and thus the feet lie in close proximity to the head. C. For dorsoanterior presentations, a C section with vertical incision is typically indicated. D. Prepare for forceps or vacuum delivery.

B. The possible fetal habitus is that the lower extremities are flexed at the hips and extended at the knees, and thus the feet lie in close proximity to the head.

In partial breech extraction, how is the delivery of the after coming head accomplished? A. With-fetal trunk positioned anteriorly, pressure on the maxilla is applied simultaneously by the operator as upward and outward traction is exerted while flexion of the fetal head is maintained by suprapubic pressure provided by an assistant. B. Pinard maneuver is necessary prior delivery of the fetal extremities. C. With the fetal occiput in close proximity with the maternal sacrum, rotation is accomplished by using Piper forceps. D. With the fetal occiput in close proximity with the maternal sacrum, the modified Mauriceau maneuver necessitated is by failure of the fetal trunk to rotate anteriorly.

A. With-fetal trunk positioned anteriorly, pressure on the maxilla is applied simultaneously by the operator as upward and outward traction is exerted while flexion of the fetal head is maintained by suprapubic pressure provided by an assistant.

Which of the following would favor a vaginal delivery for breech presentation? A. Incomplete or footling breech presentation B. Severe fetal growth restriction C. Large fetus >3800 to 4000 g D. Frank breech with hyperflexed head in a multipara

D. Frank breech with hyperflexed head in a multipara

Which of the following pre-requisite should be least likely satisfied? A. The cervix must be completely dilated. B. The head must be engaged taking into account extensive caput succedaneum formation and molding. C. The fetus must present as the face with the mentum posterior. D. The membranes must be ruptured.

C. The fetus must present as the face with the mentum posterior.

A 25-year-old G1P0 at 40 weeks AOG came in at the ER for hypogastric pain. On internal examination, cervix is 4 cm dilated, 80% effacement, cephalic, ruptured bag of water, station -2. Clinical pelvimetry revealed prominent ischial spines, convergent pelvic sidewalls and narrow sacrosciatic notch. What plane is possibly contracted? A. Outlet B. Pelvic inlet C. Midpelvis D. Adequate pelvimetry

C. Midpelvis

Accepted maternal indications for operative vaginal delivery, EXCEPT which of the following? A. Mitral stenosis B. Second-stage labor lasting more than 2 hours in a multipara C. Pelvic floor protection D. Spinal cord injury

C. Pelvic floor protection

Precipitous labor terminates in expulsion of the fetus in A. 4 hours B. 1 hour C. 2 hours D. 3 hours

D. 3 hours

What is the most important function of both forceps and vacuum devices? A. Traction B. Avoid pelvic floor injury C. Rotation D. Prevent fetal intracranial hemorrhage

A. Traction

Fetus with breech presentation is delivered via cesarean delivery. Which maternal complication will most likely occur? A. Extended hysterectomy incision B. Uterine atony C. Cervical laceration D. Uterine rulture

A. Extended hysterectomy incision

Patient expresses that she prefers to have a vaginal delivery. However, you find out that the fetus is breech presentation. Which of the following could indicate that a cesarean delivery is warranted? A. Fetus with complete breech presentation B. Fetus weighing less than 3800g C. Fetus with a hyperextended head D. Patient with no history if prior cesarean delivery

C. Fetus with a hyperextended head