Obgyn - Childbirth and complications

Question 1

OBG - 11.2
Which statement is true?
A) In the case of hypotonic inadequate contractions, the uterine basal tone is normal, the contractions occur less frequently, last for a short time with low intensity.
B) In the case of hypertonic inadequate contractions, low amplitude contractions occur frequently, their duration increases, the basal tone is increased.
C) In the case of normotonic inadequate contractions, contractions occur frequently, their amplitude and duration is inadequate.
D) In the case of normotonic inadequate contractions, the uterine basal tone is low.

Answer 1

ANSWER
B) In the case of hypertonic inadequate contractions, low amplitude contractions occur frequently, their duration increases, the basal tone is increased.
EXPLANATION
In the case of hypotonic inadequate contractions, the uterine basal tone is normal, the contractions occur less frequently, last for a short time with low intensity. In the case normotonic inadequate contractions, contractions occur infrequently, are ineffective and duration are inadequate but uterine tone is normal.

Question 2

OBG - 11.3
Which statement is false?
A) Hyperkinetic disorders (too strong contractions) may be caused by increased excitability if uterine muscles.
B) Hyperkinetic disorders (too strong contractions) may be caused by the partial placental abruption.
C) Hyperkinetic disorders (too strong contractions) may be caused by placenta previa
D) Hyperkinetic disorders (too strong contractions) may be caused by cephalopelvic disproportion

Answer 2

ANSWER
C) Hyperkinetic disorders (too strong contractions) may be caused by placenta previa
EXPLANATION
Hyperkinetic abnormalities (too strong contractions) can caused by hyperactivity of uterine muscles, by placental abruption or by cephalopelvic disproportion in order to overcome that events. Placenta previa do not cause hyperkinetic abnormalities.

Question 3

OBG - 11.4
Improper manual revision of the uterine cavity may result in:
A) Complete or incomplete uterine rupture
B) The uterus may be torn from the vaginal fornix (colpaporrhexis).
C) Both
D) None

Answer 3

ANSWER
C) Both
EXPLANATION
There is an adequate technique of the manual removal of the placenta. After grasping the fundus through the abdominal wall with one hand, the other hand is passed in the uterus. By inadequate technique of the removal uterus wall injury or uterine rupture can occur.

Question 4

OBG - 11.4
Improper manual revision of the uterine cavity may result in:
A) Complete or incomplete uterine rupture
B) The uterus may be torn from the vaginal fornix (colpaporrhexis).
C) Both
D) None

Answer 4

ANSWER
C) Both
EXPLANATION
There is an adequate technique of the manual removal of the placenta. After grasping the fundus through the abdominal wall with one hand, the other hand is passed in the uterus. By inadequate technique of the removal uterus wall injury or uterine rupture can occur.

Question 5

OBG - 11.5
What is the Bandl contraction ring?
A) Muscle ring located at the border of the cervix and corpus uteri
B) Retraction ring visible at the border of the active-passive section of the uterus during labor
C) The muscle ring in the vaginal vestibule during labor
D) The contraction ring at the upper third of the vagina when the cervix is fully dilated

Answer 5

ANSWER
B) Retraction ring visible at the border of the active-passive section of the uterus during labor
EXPLANATION
As a result of the thinning of the lower uterine segment and the concomitant thickening of the upper, the boundary between the two is marked by a ridge on the inner uterine surface, the physiological retraction ring. When the thinning of the lower uterine segment is extreme as in obstructed labor or cephalopelvic disproportion the ring is very prominent forming a pathological retraction ring also known as a Bandl ring.

Question 6

OBG - 11.6
What is the Bracht-maneuver?
A) A maneuver used in vaginal delivery in case of breech presentation of the fetus
B) A maneuver used to manage the abrupted but not yet delivered placenta
C) A maneuver used for expelling the arms extended above the head
D) A maneuver used for expelling the stalled shoulders

Answer 6

ANSWER
A) A maneuver used in vaginal delivery in case of breech presentation of the fetus
EXPLANATION
Bracht maneuver used for management of vaginal breech delivery.

Question 7

OBG - 11.8
Which statement is false?
A) Naegele and Litzmann obliquities are included in fetal malpresentations.
B) Asynclitism may be caused by flat pelvis and flabby abdomen.
C) In particular case of synclitism cesarean section should be performed.
D) Synclitism can be recognized after the 30th gestational weeks.

Answer 7

ANSWER
C) In particular case of synclitism cesarean section should be performed.
EXPLANATION
Naegele and Litzmann obliquity are type of asynclitism. At the extreme of posterior asynclitism (Litzmann obliquity) the asynclitism lead to cephalopelvic disproportion and normal vaginal delivery can not take place. Recognition is only during delivery possible.

Question 8

OBG - 11.10
It can be a complication in transverse lie, except:
A) Uterine rupture
B) Fetal hand, shoulder prolapse
C) Umbilical cord prolapse
D) Placenta previa

Answer 8

ANSWER
D) Placenta previa
EXPLANATION
Complications of transverse lie can be neglected shoulder presentation, fetal hand or umbilical cord prolapse, uterine rupture. Placenta previa is not part of the complications.

Question 9

OBG - 11.12
If the placenta is not delivered within 30 minutes in the third stage of labor, what should you do?
A) pull the umbilical cord to remove the placenta
B) intravenous prostaglandin helps to deliver the placenta
C) manual removal of the placenta is recommended
D) intracervical prostaglandin helps to remove the placenta

Answer 9

ANSWER
C) manual removal of the placenta is recommended
EXPLANATION
Separation of the placenta generally occurs within 30 minutes of the end of the second stage of labor. If the patient is at risk of postpartum hemorrhage or by retained placenta a manual removal should be performed. Iv. prostaglandins may cause dangerous hypertension, pulling umbilical cord is inappropiate, intracervical prostaglandin administration is not recommended.

Question 10

OBG - 11.13
What kind of assisted vaginal delivery should be performed in the 32nd week of pregnancy, if the skull has crossed the pelvic entrance, the cervix disappeared, the membrane is ruptured and signs of intrapartum fetal distress occur?
A) Forceps
B) Vacuum extraction
C) Cesarean section
D) By pressing the fundus uteri and intravenous administration of 5 IU of Oxytocin, I would accelerate the delivery

Answer 10

ANSWER
A) Forceps
EXPLANATION
In this case operative delivery should be performed but vacuum extraction is not recommended by preterm birth. Pressing the fundus can cause uterine rupture. Forceps delivery is recommended.

Question 11

OBG - 11.14
Which is characteristic for a partial abruption of the placenta?
A) uterine tenderness “deck hard”
B) heavy fresh bleeding occurs from the uterus
C) the amniotic fluid is pure
D) does not involve blood clotting disorder

Answer 11

ANSWER
A) uterine tenderness “deck hard”
EXPLANATION
Symptoms of placental abruption are sudden abdominal pain, uterine tenderness, the amount of vaginal bleeding can vary greatly, and doesn’t necessarily correspond to how much of the placenta has separated from the inner wall of the uterus. Amniotic fluid may be bloody and blood clotting problems (disseminated intravascular coagulation) occur more often.

Question 12

OBG - 11.15
Placenta previa is characterized by:
A) Pain localized in the uterus
B) The amniotic fluid is tinged by blood
C) The tone of the uterus is increased
D) Few or suddenly heavy, fresh bleeding without any other symptoms

Answer 12

ANSWER
D) Few or suddenly heavy, fresh bleeding without any other symptoms
EXPLANATION
Symptoms of placenta previa are bright red (fresh) vaginal bleeding without pain during the second half of pregnancy

Question 13

OBG - 11.16
A patient with 39 weeks pregnancy has one cesarean section in her history. The premature rupture of membranes occurs without contractions, the cervix is dilated to 3 cm. What to do?
A) Immediately intravenous administration of 5NU Oxytocin to cause contractions
B) In certain cases Oxytocin infusion can be used to amplify contractions
C) If the contractions are regular and the anatomical findings progress,but the first stage last more than 6 hours cesarean section should be performed
D) Immediate cesarean section

Answer 13

ANSWER
B) In certain cases Oxytocin infusion can be used to amplify contractions
EXPLANATION
Iv. Oxytocin administration is allowed in certain cases after previous cesarean section. Provided there are no contraindications, a woman with 1 previous transverse low -segment cesarean section should be offered a trial of labour. Induction of labour with oxytocin may be associated with an increased risk of uterine rupture and should be used carefully after appropriate counselling. Administration of iv. 5 NU (national unit) Oxytocin is not recommended during the first stage of birth to cause contraction, and the first stage can be last more than 6 hours.

Question 14

OBG - 11.17
It can lead to DIC, with the exception of:
A) missed abortion
B) umbilical cord prolapse
C) intrauterine fetal death
D) placental abruption

Answer 14

ANSWER
B) umbilical cord prolapse
EXPLANATION
Umbilical cord prolapse do not cause DIC (diffuse intravascular coagulation), it can occur in any other cases

Question 15

OBG - 11.19
What is the diagnosis if both feet are palpable in breech presentation and the legs are bent in the hip and knees?
A) Footling breech
B) Kneeling breech
C) Complete breech
D) Frank breech

Answer 15

ANSWER
C) Complete breech
EXPLANATION
Complete breech has both thighs flexed and both knees flexed (sitting in squat position). An incomplete (or footling) breech has one or both thight extended and both knees or feet lying below the buttocks.

Question 16

OBG - 11.20
Characteristic for RDS profilaxis:
A) antenatal corticosteroid therapy for fetal pulmonary maturation in preterm infants.
B) administration of 2 mg steroid orally required to reach the optimal effect till the delivery
C) optimal benefit begins 7 days after admnistration
D) by threatened abortion weekly intramuscular injection from the 20. gestation week is required

Answer 16

ANSWER
A) antenatal corticosteroid therapy for fetal pulmonary maturation in preterm infants.
EXPLANATION
Antenatal corticosteroid therapy for fetal pulmonary maturation reduces mortality and the incidence of RDS in preterm infants. Treatment consist of 2 doses of 12 mg bethamethason im 24 hours apart or 4 doses 6 mg dexamethason 12 hours apart. Optimal benefit begins in 24 hours after initiation and lasts for 7 days.

Question 17

OBG - 11.21
Absolute contraindications to regional anesthesia, except:
A) coagulopathy
B) sepsis or infection at needle insertion site
C) uncorrected hypovolemia
D) tricuspidal insufficiency

Answer 17

ANSWER
D) tricuspidal insufficiency
EXPLANATION
Tricuspidal insufficiency is not a contraindication to regional anesthesia.

Question 18

OBG - 11.22
What should be done if the fetus’s arms are extended above the head during vaginal delivery?
A) Using the proper maneuver we deliver the arms of the fetus. (right arm with right hand, left arm with left hand)
B) Immediate cesarean section
C) By pulling the fetus, we change the position of the arms and deliver the fetus
D) We push the fetus back into the uterus, thereby we change the position of the arms and then continue the vaginal delivery

Answer 18

ANSWER
A) Using the proper maneuver we deliver the arms of the fetus. (right arm with right hand, left arm with left hand)
EXPLANATION
One or both fetal arms occasionally is found above the head, in this situation, delivery is more difficult. Differents maneuver should be performed such as „Müller maneuver” to deliver the arms. Any other manipulation such as pulling the fetus hard or pushing back can cause serious life-threating injuries.

Question 19

OBG - 11.23
When are we talking about synclitism?
A) If the fetal sagital suture fits in the anterioposterior diameter of the pelvic brim instead of the transverse diameter.
B) If the fetal sagital suture fits in the transverse diameter of the pelvic inlet with equal distance from the symphisis and promontorium.
C) When the fetal sagital suture fits in the transverse diameter of the pelvic inlet closer to the promontorium or closer to the symphysis.
D) If the fetal sagital suture fits in the oblique diameter of the pelvic inlet.

Answer 19

ANSWER
B) If the fetal sagital suture fits in the transverse diameter of the pelvic inlet with equal distance from the symphisis and promontorium.
EXPLANATION
The fetal head tends to accomodate to the transverse axis of the pelvic inlet, the sagittal suture remaining paralell to that axis and lie exactly midway between the symphisis and the sacral promontory.

Question 20

OBG - 11.24
What is the position of the sagital suture during normal birth in different parts of the pelvic( inlet-canal-outlet) in normal internal rotation?
A) Inlet- transverse, canal-oblique, outlet- anterioposterior
B) Inlet- anterioposterior, canal- transverse, outlet- oblique
C) Inlet- transverse, canal- anterioposterior, outlet- oblique
D) Inlet- oblique, canal- transverse, outlet- anterioposterior

Answer 20

ANSWER
A) Inlet- transverse, canal-oblique, outlet- anterioposterior
EXPLANATION
In the occipitoanterior positions, the fetal head which enters the pelvis in a transverse diameter rotates so that the occiput turns anteriorly towardly the symphisis pubis. During the internal rotation the fetal head passes through the birth canal and the sagital suture rotated from transverse position 45 degree anteriorly to oblique position than into sagital (anterioposterior) position.

Question 21

OBG - 11.26
Complications of induction of labor, especially induction with drugs:
A) Induction failure, weak contractions, prolonged birth
B) Tetanic uterine activity
C) Pelvic canal injuries, uterine rupture
D) All of the above

Answer 21

ANSWER
D) All of the above
EXPLANATION
Complication of labor induction can be prolonged birth, cervical or vaginal injuries, tetanic contractions or also uterine rupture.

Question 22

OBG - 11.27
The most common cause of postpartum hemorrhage:
A) Retained placental tissue
B) Overdistention of the uterus
C) Genital tract trauma
D) Uterine atony
E) Maternal coagulation disorders

Answer 22

ANSWER
D) Uterine atony
EXPLANATION
The majority of postpartum hemorrhages (75%-to 80%) are due to uterine atony.

Question 23

OBG - 11.28
The most important role in postpartum hemorrhage is early detection and prevention. The following conditions prone to postpartum hemorrhage, except:
A) Postpartum hemorrhage in previous delivery
B) Multiple pregnancy
C) Quick detachment and delivery of the placenta
D) Inertia uteri, weak, irregular contraction

Answer 23

ANSWER
C) Quick detachment and delivery of the placenta
EXPLANATION
Factors predisponding to postpartum uterine atony are overdistention of the uterus, multiple gestations, polyhydramnios, previous postpartum hemorrhage. Normal delivery of the placenta is not a predisponding factor.

Question 24

OBG - 11.29
Meaning of IUGR:
A) Mental, growth and developmental retardation of fetus, caused by intrauterine hypoxia.
B) SGA (small for gestational age) fetus diagnosed by ultrasound examinations.
C) birth weight of a newborn infant is below the 10th percentile for a given gestational age
D) EBW (estimated birth weight) is below 2500 g

Answer 24

ANSWER
C) birth weight of a newborn infant is below the 10th percentile for a given gestational age
EXPLANATION
Intrauterine growth restriction (IUGR) occurs when the birth weight of a newborn infant is below the 10th percentile for a given gestational age.

Question 25

OBG - 11.32
In case of vaginal delivery of the fetus in breech presentation, the most vulnerable is the ……. of the fetus. Choose the most appropriate answer.
A) Respiratory system
B) Central nervous system
C) Musculoskeletal system
D) Cardiovascular system
E) Endocrine System

Answer 25

ANSWER
B) Central nervous system
EXPLANATION
During vaginal breech birth the most vulnerable is the fetal central nervous system due to fetal hypoxia or due unsuccesful maneuvers.

Question 26

OBG - 11.33
True for postpartum bleeding, except:
A) The most common cause is uterine atony, retained placental tissue, birth canal injuries
B) The most common site of bleeding is the bed of the placenta or vessels of the pelvic canal
C) Complicated delivery promotes postpartum bleeding
D) The most common cause of acute bleeding after birth is injuries of the vaginal wall or of the cervix
E) Postpartum bleeding may occur before and/or after the delivery of the placenta

Answer 26

ANSWER
D) The most common cause of acute bleeding after birth is injuries of the vaginal wall or of the cervix
EXPLANATION
The majority of postpartum hemorrhages (75%-to 80%) are due to uterine atony. Other predisponding factors are retained placental tissues, overdistension of the uterus (multiple pregnancies, polyhydramnios), oxytocic augmentation of labor, halogenated anesthetics, prolonged labor.

Question 27

OBG - 11.37
In multiple pregnancies, the most common cause of perinatal mortality is:
A) Placenta previa
B) Prolapse of umbilical cord
C) Fetal malformation
D) Placental abruption
E) Premature birth

Answer 27

ANSWER
E) Premature birth
EXPLANATION
The most common cause of increased perinatal mortality in multiple pregnancies is the higher rate of preterm birth and IRDS as consequencies.

Question 28

OBG - 11.38
It may be an indication of cesarean hysterectomy (removal of the uterus at the time of cesarean delivery):
A) severe postpartum hemorrhage
B) uterus pathology, sterilization
C) severe intrapartum fetal infection
D) placenta acreta
E) all of the above

Answer 28

ANSWER
E) all of the above
EXPLANATION
The most common indication for cesarean hysterectomy is abnormal placentation (placenta acreta), severe postpartum hemorrhage, cervical cancer or extreme large leiomyomas, or less common indication is intrapartum severe fetal infections.

Question 29

OBG - 11.39
Possible reason for breech presentation:
A) Oligohydramnion
B) Deformation of the uterine cavity
C) Macrosomia
D) Premature birth
E) All of the above

Answer 29

ANSWER
E) All of the above
EXPLANATION
The major predisponding to breech presentation is prematurity. However fetal structural anomalies (hydrocephalus, macrosomy) may restrict the ability of the fetus to present as a vertex. Other etiologic factors include uterine anomalies, multiple gestation, hydramnios, contracted maternal pelvis can cause breech presentation.

Question 30

OBG - 11.40
Condition for vacuum extraction:
A) Fully dilatated cervix
B) Fetal head engaged into the pelvis
C) Matured fetus
D) Membrane is ruptured
E) All of the above

Answer 30

ANSWER
E) All of the above
EXPLANATION
To perform vacuum extraction the cervix must be fully dilatated, membranes ruptured, and the fetal head engaged into the pelvis. There must be no doubt regarding the position of the fetal head. The vacuum extractor is contraindicated in preterm delivery because the preterm fetal head is more prone to injury from the suction cup.

Question 31

OBG - 11.41
For operative vaginal delivery, forceps should be chosen in the following cases:
A) In the case of a large fetus, to overcome cephalopelvic disproportion
B) In the case of premature birth
C) Dorsoanterior transverse lie
D) Umbilical cord prolapse
E) Dorsoposterior transverse lie

Answer 31

ANSWER
B) In the case of premature birth
EXPLANATION
Vaginal operativ delivery is recommended in case of intrapartum fetal distress, or in preterm birth. The vacuum extractor is contraindicated in preterm delivery because the preterm fetal head is more prone to injury from the suction cup, but forceps delivery is recommended. Cesarean section should be perform by transverse lie or by detection of prolapsed umbilical cord

Question 32

OBG - 11.42
Indication for cesarean section, except:
A) Previous myomectomy / uterine surgery
B) Cephalopelvic disproportion
C) Placenta praevia centralis
D) Low placental implantation
E) Previous two cesarean sections in anamnesis

Answer 32

ANSWER
D) Low placental implantation
EXPLANATION
An absolute indication for cesarean delivery is a previous incision through the myometrium of the uterus. All pregnancies complicated with placenta previa should also be delivered by cesarean. Other indications are: dystocia, repeat cesarean section, breech presentation or fetal distress. Low implantation of the placenta can predispose to postpartum hemorrhage but it does not an indication for cesarean section.

Question 33

OBG - 11.43
In transverse lie of the fetus, the safest method is
(choose the most appropriate answer).
A) Reversal and extraction of the fetus
B) Cesarean section
C) Operative vaginal delivery (forceps, vacuum)
D) External manipulation of the fetus to vertex presentation and operative vaginal delivery (foceps, vacuum)
E) All of the above

Answer 33

ANSWER
B) Cesarean section
EXPLANATION
In general, the onset of active labor in a woman with transverse lie is an indication for cesarean delivery. Any other method may indicate fetal injury and not recommended.

Question 34

OBG - 11.44
Placental abruption may result in:
A) maternal coagulopathy
B) maternal oliguria
C) fetal death
D) maternal hemorrhage
E) all of the above

Answer 34

ANSWER
E) all of the above
EXPLANATION
Placental abruption can cause maternal coagulopathy (DIC), severe hemorrhage, hypovolemic shock, oliguria, and consequent fetal death

Question 35

OBG - 11.45
The most appropriate method for treating coagulopathy during placental abruption is:
A) Fresh Whole Blood transfusion and iv. cristalloid
B) Thrombocyte suspension
C) Fibrinogen administration
D) Red blood cell mass

Answer 35

ANSWER
A) Fresh Whole Blood transfusion and iv. cristalloid
EXPLANATION
Treatment for placental abruption with massive external bleeding and coagulopathy blood plus cristalloid transfusion and prompt delivery to control the hemorrhage are life saving for the mother and for the fetus

Question 36

OBG - 11.46
Risk factors for abruptio placentae except:
A) maternal hypertension, preeclampsia
B) short umbilical cord
C) tobacco use
D) trauma
E) administration of low dose aspirin

Answer 36

ANSWER
E) administration of low dose aspirin
EXPLANATION
Administration of low –dose aspirin does not increase the risk for placental abruption

Question 37

OBG - 11.47
DIC may occur in the following obstetric complication:
A) Amniotic fluid embolism
B) Intrauterine fetal death
C) Praeclampsia
D) Sepsis
E) All of the above

Answer 37

ANSWER
E) All of the above
EXPLANATION
DIC can develop in all of the mentioned obstetrical complication

Question 38

OBG - 11.48
Maternal complications of polyhydramnios:
A) placental abruption
B) hypotonic inadequate contractions
C) postpartum hemorrhage
D) none of the above
E) all of the above

Answer 38

ANSWER
E) all of the above
EXPLANATION
Possible maternal complication of polyhydramnios are placental abruption, dysfunction of uterine contractility and postpartum hemorrhage.

Question 39

OBG - 11.49
What kind of delivery mode is chosen for 38 weeks of pregnancy in the dorsoposterior transversal lie fetus if premature rupture of membrane occurred?
A) acute cesarean section
B) external cephalic version
C) Iv. administration of 5 IU Oxytocin to accelerate delivery
D) Iv. ergometrin is given to accelerate vaginal delivery

Answer 39

ANSWER
A) acute cesarean section
EXPLANATION
After rupture of the membranes, if labor continues, the fetal shoulder is forced into the pelvis and the corresponding arm frequently prolapses. The uterus then contracts vigorously in an unsuccesful attempt to overcome the obstacle. The situation is referred to as a neglected transverse lie. The only appropiate method is immediate cesarean section.

Question 40

OBG - 11.49
What kind of delivery mode is chosen for 38 weeks of pregnancy in the dorsoposterior transversal lie fetus if premature rupture of membrane occurred?
A) acute cesarean section
B) external cephalic version
C) Iv. administration of 5 IU Oxytocin to accelerate delivery
D) Iv. ergometrin is given to accelerate vaginal delivery

Answer 40

ANSWER
A) acute cesarean section
EXPLANATION
After rupture of the membranes, if labor continues, the fetal shoulder is forced into the pelvis and the corresponding arm frequently prolapses. The uterus then contracts vigorously in an unsuccesful attempt to overcome the obstacle. The situation is referred to as a neglected transverse lie. The only appropiate method is immediate cesarean section.

Question 41

OBG - 11.50
Which statement is true?
A) In case of fourth degree perineal laceration the anterior wall of the rectum and the rectal mucosa is ruptured.
B) In case of second degree perineal laceration the anal sphincter is ruptured.
C) In case of a first degree perineal laceration the perineal muscles are ruptured.
D) The case of superficial form of second degree perineal injury is called ruptura frenuli

Answer 41

ANSWER
A) In case of fourth degree perineal laceration the anterior wall of the rectum and the rectal mucosa is ruptured.
EXPLANATION
Perineal lacerations may be classified as follows: 1st degree: vaginal epithelium or perineal skin involved, 2nd degree:laceration extending into the subepithelial tissues of the vagina or perineum with or without involvement of the perineal body muscles. 3rd degree: injury involving the anal sphincter and by 4th degree perineal laceration the rectal mucose is involved.

Question 42

OBG - 11.51
Reasons for fetal intrauterine death, except:
A) placental abruption
B) umbilical cord prolapse
C) false umbilical cord knot
D) placental insufficiency with chronic hypoxia

Answer 42

ANSWER
C) false umbilical cord knot
EXPLANATION
False umbilical cord knots are commonly formed variants in the umbilical cord anatomy. It basically represents, exaggerated looping of the umbilical cord vessels, causing focal dilatation of the umbilical cord vessels.

Question 43

OBG - 11.52
Characteristic for postterm pregnancy, except:
A) delivery happen between the 41st-42th gestational week
B) perinatal mortality is two-three times higher
C) fetal movement may decrease
D) often the accurate dating of the gestation is uncertain

Answer 43

ANSWER
A) delivery happen between the 41st-42th gestational week
EXPLANATION
Postterm pregnancy is one that persist beyond 42 weeks (294 days) from the onset of the last normal menstrual period. Perinatal mortality is two three times hihgher in these prolonged gestation. Oligohydramnion, decreased fetal movement can occur, and often the accurate dating of gestation is in background. The importance of accurate (early) assessment of gestational age is required to avoid unreal prolonged gestation.

Question 44

OBG - 11.53
Characteristic for brow presentation, except:
A) Brow presentation is a type of deflexion presentation
B) In the case of brow presentation, the guiding point is the center of the forehead
C) The presenting diameter is the saggital suture
D) With an external examination, there is an indenture between the extended fetal head and the back

Answer 44

ANSWER
C) The presenting diameter is the saggital suture
EXPLANATION
Brow presentation occurs when presenting part of the fetus is between facial orbits and anterior fontanelle. The presenting diameter is the supraoccipitomental diameter which makes vaginal delivery impossible

Question 45

OBG - 11.54
Relevant in the diagnosis of premature rupture of membranes, except:
A) During the examination, amniotic fluid is leaking from the vagina
B) Ultrasound examination
C) The patient complaints of watery vaginal discharge
D) Determination of vaginal fluid secretion of androstenedione

Answer 45

ANSWER
D) Determination of vaginal fluid secretion of androstenedione
EXPLANATION
To diagnose premature rupture of membranes bimanual and/or ultrasound examination, amnioscopy, and detecting vaginal fluid markers AFP or PRL are appropiate. Vaginal fluid’s androstendione concentration is no marker of premature rupture of membranes.

Question 46

OBG - 11.55
Deflexion presentations are:
1) Brow presentation
2) Occipitoposterior presentation
3) Face presentation
4) Asynclitic presentation

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) all of the answers are correct
E) none of the answers are correct

Answer 46

ANSWER
B) 1st and 3rd answers are correct
EXPLANATION
Deflexion presentation are: brow presentation and if the head is hyperextended face presentation occurs.

Question 47

OBG - 11.56
In the case of transversal lie, the proper care:
1) In case of membranes rupture, an immediate caesarean section should be performed.
2) In case of intact membrane, waiting until the 36th pregnancy week is allowed.
3) At 34 weeks of pregnancy, tocolysis should be managed in case of contractions.
4) In the case of a prolapsed fetal arm, an external positioning of the fetus is to be managed, in case of failure an urgent caesarean section is to be performed.
5) In the case of regular contractions, at 38th week of gestation vaginal delivery can be managed, in case of failure cesarean section should be performed.

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) all of the answers are correct
E) only the 5th answer is correct
F) none of the answers are correct

Answer 47

ANSWER
A) 1st, 2nd and 3rd answers are correct
EXPLANATION
1.After rupture of the membranes, if labor continues, the fetal shoulder is forced into the pelvis and the corresponding arm frequently prolapses. The uterus then contracts vigorously in an unsuccesful attempt to overcome the obstacle. The situation is referred to as a neglected transverse lie. The only appropiate method is immediate cesarean section. 2. , 3. By intact membrane with a preterm pregnancy, the goal is to attempt to obtain fetal maturation (until 36th gestational week) even with tocolysis without compromising the other’s health.

Question 48

OBG - 11.58
Possible treatment in uterine atony:
1) Ligation of hypogastric artery
2) Manual revision (retained placental tissue removal)
3) Bimanual compression and massage of the uterine corpus
4) Supracervical or total hysterectomy
5) Administration of iv. infusion, transfusion of packed red blood cells and FFP

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) all of the answers are correct
E) only the 5th answer is correct
F) none of the answers are correct

Answer 48

ANSWER
D) all of the answers are correct
EXPLANATION
In case of uterine atony rapid continous iv. infusion, transfusion of packed red blood cells, FFP should be given. Bimanual compression and massage of the uterine corpus cause the uterus contract. Packing the uterine cavity (Dührssen tamponade) can control postpartum hemorrhage. Ligation of the uterine arteries and other operative intervention such as supracervical or total hysterectomy are definitive therapies

Question 49

OBG - 11.59
Absolute indication of cesarean section in twin pregnancies:
1) Breech-Vertex presentation of twins (twin “A” is in breech, twin “B” is in cephalic presentation)
2) Vertex-vertex presentation in term
3) Premature twins in transverse-transverse presentation
4) Vertex-Breech presentation (twin A in cephalic, twin B in breech presentation)
5) Multiparous patient, vertex-vertex presentation (twin A in cephalis, twin B in cephalic presentation)

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) all of the answers are correct
E) only the 5th answer is correct
F) none of the answers are correct

Answer 49

ANSWER
B) 1st and 3rd answers are correct
EXPLANATION
Vertex (twin A)-vertex (twin B) twins are managed similarly to singleton vertex presentation. Increased risk of fetal injury exist with delivery of breech fetus, breech-breech and breech- vertex twins are usually delivered by cesaresan section. Preterm delivery or transverse lie of both fetuses are also indication of cesarean section

Question 50

OBG - 11.60
It is true for management of premature birth:
1) Episiotomy is not necessary
2) Vacuum extraction should be carried out to facilitate the second stage of birth
3) Cesarean section should be performed in all premature birth
4) External rotation into cephalic presentation in malpresentations is recommended
5) Forceps may be used during second stage of birth

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) all of the answers are correct
E) only the 5th answer is correct
F) none of the answers are correct

Answer 50

ANSWER
E) only the 5th answer is correct
EXPLANATION
To avoid the injury of the preterm vulnerable sculp an episiotomy may aid in reducing the injury of the head by premature vaginal delivery. External rotation of the fetus is not recommended by premature delivery. Preterm vacuum- assisted birth is contraindicated, forceps is the only option for preterm birth by operative vaginal delivery.

Question 51

OBG - 11.61
It is true for management of premature birth:
1) Vacuum extraction should be carried out to facilitate the second stage of birth
2) Cesarean section should be performed in all premature birth
3) Episiotomy is contraindicated
4) In preterm breech presentation, a vaginal birth is recommended
5) Episiotomy should be performed

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) all of the answers are correct
E) only the 5th answer is correct
F) none of the answers are correct

Answer 51

ANSWER
E) only the 5th answer is correct
EXPLANATION
To avoid the injury of the preterm vulnerable sculp an episiotomy may aid in reducing the injury of the head by premature vaginal delivery. Preterm vacuum- assisted birth is contraindicated, forceps is the recommended option for preterm birth by operative vaginal delivery. In case of preterm pregnancy with breech presentation cesarean section should be performed.

Question 52

OBG - 11.62
Characteristic for macrosomy
1) fetal weight for a term pregnancy is above 90 percentile
2) incidence of shoulder dystocia is higher
3) may result from maternal or gestational diabetes
4) higher rate of perinatal mortality or morbidity

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) all of the answers are correct
E) none of the answers are correct

Answer 52

ANSWER
D) all of the answers are correct
EXPLANATION
A fetus weighing 4500 g or more or the fetal weight in term is above 90 percentile considered to be macrosomy. Macrosomy often result from maternal diabetes or gestational diabetes. The greater the fetal weight the higher the perinatal mortality and morbidity rate. Incidence of fetal injury and shoulder dystocia is higher.

Question 53

OBG - 11.62
Characteristic for macrosomy
1) fetal weight for a term pregnancy is above 90 percentile
2) incidence of shoulder dystocia is higher
3) may result from maternal or gestational diabetes
4) higher rate of perinatal mortality or morbidity

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) all of the answers are correct
E) none of the answers are correct

Answer 53

ANSWER
D) all of the answers are correct
EXPLANATION
A fetus weighing 4500 g or more or the fetal weight in term is above 90 percentile considered to be macrosomy. Macrosomy often result from maternal diabetes or gestational diabetes. The greater the fetal weight the higher the perinatal mortality and morbidity rate. Incidence of fetal injury and shoulder dystocia is higher.

Question 54

OBG - 11.64
Which statements are true for face presentation?
1) incidence is about 1 in 500 deliveries
2) when delivered spontaneous vaginal delivery, perinatal morbidity is similar to vertex presentation
3) if the guiding point (mentum) rotates posteriorly, vaginal delivery is impossible
4) vacuum –assisted vaginal delivery is recommended

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) all of the answers are correct
E) none of the answers are correct

Answer 54

ANSWER
A) 1st, 2nd and 3rd answers are correct
EXPLANATION
The incidence about face presentation is about 1 in 500 deliveries. If the mentum rotates posteriorly, the fetal head will be unable to extend farther to complete the expulsive process and the delivery must be accomplished by cesarean section. When delivered by spontaneous vaginal delivery, perinatal morbidity and mortality are similar those for vertex presentation. Vacuum assisted vaginal birth is absoulte contraindicated in face presentation.

Question 55

OBG - 11.65
Predisposing factors for umbilical cord prolapse are:
1) Malpresentations
2) Long umbilical cord (longer than 80 cm)
3) Polyhydramnion
4) Oligohydramnion

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) all of the answers are correct
E) none of the answers are correct

Answer 55

ANSWER
A) 1st, 2nd and 3rd answers are correct
EXPLANATION
Malpresentations, long umbilical cord, polyhydramnion, twin pregnancy, macrosomy, cephalopelvic disproportion, preterm birth are predisposing factors. Oligohydramnion does not cause umbilical cord prolapse.

Question 56

OBG - 11.66
Maternal consequences of prolonged labor could be:
1) Uterus rupture, obstetric fistulas developing
2) Fetal distress
3) Heavy postpartum haemorrhage
4) Intrauterine fetal demise
5) Fetal brain injury

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) all of the answers are correct
E) only the 5th answer is correct
F) none of the answers are correct

Answer 56

ANSWER
B) 1st and 3rd answers are correct
EXPLANATION
Maternal complication could be uterine atony, postpartum hemorrhage and fistulas may develop

Question 57

OBG - 11.67
The fetal consequences of prolonged labor could be:
1) Intrauterine fetal demise
2) Stillbirth
3) Fetal infection
4) Perinatal exitus
5) Fetal distress

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) all of the answers are correct
E) only the 5th answer is correct
F) none of the answers are correct

Answer 57

ANSWER
D) all of the answers are correct
EXPLANATION
All ot them are possible fetal consequenses of prolonged labor.

Question 58

OBG - 11.68
Types of breech presentation, except:
1) Frank breech presentation
2) Asynclitic presentation
3) Incomplete breech presentation
4) Occipitoposterior presentation
5) Complete breech presentation

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) all of the answers are correct
E) only the 5th answer is correct
F) none of the answers are correct

Answer 58

ANSWER
C) 2nd and 4th answers are correct
EXPLANATION
Types of breech presentation are frank, complete and incomplete or footling breech presentation.

Question 59

OBG - 11.69
Which statement is true of second degree perineal laceration?
1) The perineal muscles could be injured
2) Sphincter ani externus injury
3) The sphincter ani externus remains intact
4) The front wall of the rectum is damaged
5) The mucosa of the intestine is ruptured

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) all of the answers are correct
E) only the 5th answer is correct
F) none of the answers are correct

Answer 59

ANSWER
B) 1st and 3rd answers are correct
EXPLANATION
Second degree of perineal injury means the laceration extending into subepithelial tissues of vagina or perineum with or without involvement of the perineal muscles.

Question 60

OBG - 11.70
What should be done if umbilical cord prolapse is diagnosed?
1) Tocolysis can be considered while preparing for CS
2) Mother adopting the knee-chest position to reduce cord compression
3) It is recommended that the presenting part be elevated manually to prevent cord compression
4) Emergency cesarean section

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) all of the answers are correct
E) none of the answers are correct

Answer 60

ANSWER
D) all of the answers are correct
EXPLANATION
The optimal initial management of cord prolapse: -to prevent cord compression, it is recommended that the presenting part be elevated manually, further mother adopting knee-chest position to reduce the cord compression. Tocolysis can be considered while preparing CS. Cesarean section is recommended mode of delivery in order to prevent hypoxic acidosis.

Question 61

OBG - 11.38
It may be an indication of cesarean hysterectomy (removal of the uterus at the time of cesarean delivery):
A) severe postpartum hemorrhage
B) uterus pathology, sterilization
C) severe intrapartum fetal infection
D) placenta acreta
E) all of the above

Answer 61

ANSWER
E) all of the above
EXPLANATION
The most common indication for cesarean hysterectomy is abnormal placentation (placenta acreta), severe postpartum hemorrhage, cervical cancer or extreme large leiomyomas, or less common indication is intrapartum severe fetal infections.