Obstetrics - 1F Flashcards
Subcellular substance, collagen, connective tissue which results in softening in effacement of the cervix takes place during which functional division of labor?
A. Preparatory division
G1P0, 39 weeks of gestation with mild uterine contractions every 20 to 40 minutes lasting 20 to 30 seconds for 24 hours. IE cervix 2 centimeter dilated 1.5 centimeter long cephalic presentation station minus two into a bag of water, good fetal heart tone, what is the preferred management? A. Bed rest with sedation B. Amniotomy C. Oxytocin augmentation D. CS delivery
A. bed rest with sedation
Latent phase
G1P0 40 weeks AOG admitted with 4cm dilated cervix 60% effaced left occiput anterior, station -1, intact bag of water, estimated fetal weight of 3000 gms, contraction every 4 to 6 minutes moderate intensity, fetal heart rate of 150 per minute, clinically adequate pelvis. After 3 hrs, cervix was 5 cm dilated, 60% effaced, station 0. After 3 hrs, 6 cm dilated, 70% effaced, station 0, contraction every 5 to 7 minutes, moderate good fetal heart tone. Management? A. Sedation B. Observed for another 4 hrs C. Amiotomy followed by oxytocin augmentation D. Amiotomy alone
C. Amiotomy followed by oxytocin
augmentation
(Normal cervical dilatation is 1.2cm/hr)
37 year old G4P3 3003, 40 weeks and three days AOG by amenorrhea came in due to regular uterine contractions. All her previous pregnancies were delivered vaginally without complications. The birth weights were 2.8 and 3 kilos. She was diagnosed with GDM at 26 weeks of gestation. On examination the fundic height was 35 centimeter estimated fetal weight of 3.6 to 3.8 kilograms cephalic with good fetal heart tones. On IE the cervix was 4 centimeters dilated fully effaced the head is at station minus one with intact bag of water. So what is the best management option?
A. Confirm the estimated fetal weight by ultrasound
B. Observe labor
C. Do an outright CS
D. The perform x-ray pelvimetry (not an
accurate measurement of pelvis)
B. Observe labor
25 year old G1P0 came in for labor pain she had unremarkable prenatal check up, her vital signs are normal upon PE focus on the abdomen the fundic height is was 32 centimeters estimated, fetal weight was 2.6 to 2.8 kilograms, fetal heart tones of 140 at the right lower quadrant upon IE cervix was one cm beginning effacement intact membrane station minus three. Resident observed one contractions in 30 minutes. What is the best management for this patient? A. Admit patient B. Do stress test C. Ruptured the membrane D. Send her home
D. Send her home
Which among the cardinal movement is essential for completion of labor?
A. Turning of head that the occiput is gradually moved anteriorly
B. When there is progressive downward movement of fetal head
C. Conversion of the occipitofrontal diameter to suboccipitobregmatic diameter
D. When the biparietal diameter passes
through the pelvic inlet
A. Turning of head that the occiput is gradually moved anteriorly (Internal rotation)
rationale
A. Turning of head that the occiput is gradually moved anteriorly (Internal rotation)
B. When there is progressive downward movement of fetal head (Descent)
C. Conversion of the occipitofrontal diameter to suboccipitobregmatic diameter (Flexion)
D. When the biparietal diameter passes
through the pelvic inlet (Engagement)
Which of the following cardinal movements brings the presenting part to its original position? A. Flexion B. Internal rotation C. External rotation D. Extension
C. External rotation
The resistance of the fetal head whether from the cervix, walls of the pelvis, or pelvic floor, results to which of the following cardinal movements? A. Flexion B. Internal rotation C. Extension D. External rotation
A. Flexion
Which of the following is the correct order? (Cardinal movements)
Engagement, descent, flexion, internal rotation, extension, external rotation, expulsion
A primi patient at 39 weeks came in due to bloody mucoid discharge and hypogastric pain. On a physical exam fundic height was 30 centimeter with good fetal heart tone, IE revealed the cervix at five centimeters fully efface cephalic intact bag of water station minus one. After two hours the cervix was noted to be at seven centimeters fully effaced. At what phase of labor was the patient admitted? A. Latent phase B. Early active phase C. Phase of maximum slope D. Deceleration phase
B. Early active phase (at 5 cm)
A primi patient a 39 weeks came in due to bloody mucoid discharge with fundic height of 30 centimeter, good fetal heart tone, IE cervix at five centimeters fully effaced, cephalic, intact bag of water. After 2 hours the cervix was noted to be at 7 centimeters fully effaced. What can you say about the patient’s IE after 2 hours from the time of admission?
A. Predictive of labor outcome
B. Good measure of the overall efficiency of the machine
C. Reflective of the feto-pelvic relationship
D. Heralds entry to the pelvic division
B. Good measure of the overall efficiency of the machine (phase of maximum slope)
rationale
A. Predictive of labor outcome (acceleration phase)
B. Good measure of the overall efficiency of the machine (phase of maximum slope)
C. Reflective of the feto-pelvic relationship
(deceleration phase)
D. Heralds entry to the pelvic division
(deceleration phase)
Picture of Friedman’s curve given showing ——-
phase of maximum slope
(Picture of labor curve) Primi patient, 38 weeks AOG. At what phase of labor does the abnormality occurred?
Doc Mercado: The patient is at 7 cm for 4 hours. She was admitted at 2 cm. After 2 hours, still at 2 cm. After 1 hr, 4 cm dilated. After 2 hrs, 7 cm for 4 hrs.
Phase of maximum slope.
(Picture of labor curve) G3P2 2002, 38 weeks. What is the best management?
Doc Mercado: So patient was admitted at 1 centimeter. Patient is in latent phase for 16 hours.
A. Oxytocin infusion
B. Amniotomy
C. CS
D. Therapeutic rest
D. Therapeutic Rest
Which of the ffg statements on engagement of fetal head is true?
A. In nulliparas, engagement takes place only at the onset of labor when descent occurs
B. Greatest transverse diameter of the fetal head passes thru the pelvic inlet
C. It occurs when the head is at stage -1 in the presence of 1 cm caput
D. In multiparas, engagement takes place at around 36 weeks
B. Greatest transverse diameter of the fetal head passes thru the pelvic inlet
What is the purpose of fetal head flexion in the process of labor?
A. So that suboccipitobregmatic diameter will present
B. So the fetal chin comes in contact with the fetal chest
C. So the frontooccipital diameter will present
D. This is when fetal head reaches the pelvic
floor
A. So that suboccipitobregmatic diameter will present
Most common position in which the vertex enters the pelvis with sagittal suture lying in the transverse pelvic diameter A. LOT (left occiput transverse) B. ROT (right occiput transverse) C. LOA (left occiput anterior) D. ROA (right occiput anterior)
A. LOT (left occiput transverse)
A 25 year old G1PO at 40 weeks AOG came in due to watery vaginal discharge. Fundic height is 30 cm comes with good FHT. Speculum exam reveals pooling of amniotic fluid. IE cervix was 2 cms, 50% effaced, cephalic, st -1. She has mild to moderate uterine contractions, lasting 30 seconds, interval of 10 minutes, venoclysis was done and oxytocin drip with 10 u oxytocin incorporated in 1L of DSLRS was started. You started with low dose oxytocin but still with irregular contractions. You want to achieve regular contractions. At how many drops of oxytocin will you achieve physiological dose to have regular contractions? A. 8-12 drops B. 30-32 drops C. 16-24 drops D. 2-4 drops
C. 16-24 drops
A 39 year-old multigravida presents for induction at 38 weeks gestation. The patient has a history of two prior vaginal deliveries cholestasis, pregestational diabetes, chronic hypertension requiring two medications, and a history of prior abruption in the setting of preeclampsia with severe features. You place the patient on continuous fetal monitoring. How often should the tracing berated
A. Every 15 minutes in the first stage and every 5 minutes in the second stage.
B. Every 30 minutes in the first stage and every 15 minutes in the second stage
C. Every15 minutes in the first and second stage
D. Every 15 min in the first stage and every 30
minutes in the second stage
A. Every 15 minutes in the first stage and every 5 minutes in the second stage. (remember you have a high risk patient)
Your patient is a 32 year old G3P2 at 40 weeks and 6 days AOG. Her first prenantal visit occurred after 30 weeks AOG. Examination today reveals a 1 cm dilated cervix, cephalic presentation, no ballottement of the head, and good fetal movement. What is the best next step in the management of this patient?
A. Sonographic assessment of amniotic fluid index
B. Oxytocin challenge test
C. Non stress test
D. Labor induction
A. Sonographic assessment of amniotic fluid index
After the cervix is fully dilated, what is the most important force in fetal expulsion?
A. Fetal head descending through the pelvis
B. Uterine contractions
C. Intraabdominal pressure
D. Ruptured bag of water
C. Intraabdominal pressure (doc Mercado: the mother will “push”)
In which mechanism of placental delivery does the placenta leave the body before the retroplacental hematoma? A. Chadwick mechanism B. Duncan mechanism C. Bundle mechanism D. Schultze mechanism
D. Schultze mechanism (S = shiny; no sudden
gush of blood yet)
rationale
A. Chadwick mechanism (vaginal discoloration)
B. Duncan mechanism (D = dirty; sudden gush of
blood)
C. Bundle mechanism (change of shape of uterus)
D. Schultze mechanism (S = shiny; no sudden
gush of blood yet)
In the process of vaginal delivery, as the anterior shoulder is delivered, the obstetrican palpates a loose nuchal cord. What is the best management?
A. Baby is rotated in an attempt to dislodge the cord
B. Cord is clamped and cut before proceeding with the delivery (we do this sometimes if “tight”)
C. Deliver the baby without moving the cord
D. Cord is slipped over the fetal head
D. Cord is slipped over the fetal head
The correct sequence of the 4 Core Steps of the Essential Intrapartum and Newborn Care (EINC) is as follows
A. Non separation cord clamping and cutting drying, skin-to skin contact
B. Cord clamping and cutting skin -to-skin contact non-separation, drying
C. Drying, skin to skin contact, cord clamping and cutting, non separation
D. Skin to skin contact, drying, non separation, cord clamping and cutting
C. Drying (to avoid hypothermia), skin to skin contact, (“properly timed”) cord clamping and cutting, non separation
Which of the following is a correct method of drying?
A. Dry the baby’s feet first
B. Dry the baby’s body in a random manner
C. Dry the baby’s face and head first
D. Dry the baby’s hands first
C. Dry the baby’s face and head first
Identify what part of cardinal movement is being elicited (picture)
External rotation
In EINC, how is the cord being clamped? A. Delayed cord clamping B. Immediate cord clamping C. Properly timed cord clamping D. It is not time bound
C. Properly timed cord clamping
In EINC time bound interventions, when do you
stimulate breathing and provide immediate warmth to the
neonate
A. After through drying
B. Within 90 min
C. up to 3 min
D. Within 30 sec
D. Within 30 sec
In EINC, eye care and injections are being given A. Within 90 minutes B. After through drying C. Up to 3 minutes D. Within 30 seconds
A. Within 90 minutes
In EINC, when do you place identification on the ankle of the neonate? A. Within 30 seconds B. Within 90 minutes C. After thorough drying D. Up to 3 minutes
C. After thorough drying
In EINC, when do you inspect the vagina for lacerations? A. 1-3 min B. First 30 seconds C. At the time of delivery D. 15-90 minutes
B. First 30 seconds
Of the cardinal movements of labor, internal rotation
achieves what goal?
A. Bring the occiput to an anterior position
B. Flexes the fetal neck
C. Bring the anterior fontanel through the pelvic
inlet
D. Extend the fetal head
A. Bring the occiput to an anterior position
Uninterrupted skin to skin contact is observed in which of the following? A. Within 90 minutes of age B. Within 30 seconds C. up to 3 min post delivery D. After through drying
A. Within 90 minutes of age
Which of the following is true of routine episiotomy
vaginal delivery?
A. Increase the risk of first and second degree
lacerations
B. Increases the risk of third and fourth degree
lacerations
C. Is preferred instead of individualized use of
episiotomy
D. Leads to anterior tears involving the urethra and
labia
B. Increases the risk of third and fourth degree
lacerations
The restricted use of episiotomy is associated with which of the following? A. Less anterior perineal tear B. Less posterior perineal tear C. More healing complications D. AOTA
B. Less posterior perineal tear
True of the baseline FHR?
A. Mean FHR rounded to increments of 5 bpm
during a 10-minute segment excluding period
episodic changes (accelerations/decelerations)
B. Includes periods of marked fetal heart tone
variability
C. Must be minimum of 20 minutes in any 30
minutes segment
D. Normal FHR baseline of 110-180 bpm
A. Mean FHR rounded to increments of 5 bpm
during a 10-minute segment excluding period
episodic changes
24 years old, G1P0 pregnant for 32 weeks, admitted
due to preterm labor and was given magnesium sulfate
for fetal neuroprotection and corticosteroids for fetal lung
maturity. What change in the fetal heart rate will you
expect?
A. Fetal tachycardia
B. Fetal bradycardia
C. Increased variability
D. Decrease variability
D. Decrease variability
Short term variability refers to?
A. Time interval between cardiac diastole
B. Changes during 1 minute and results in
waviness of the baseline
C. Instantaneous change in fetal heart rate from
one beat to the next
D. Normal frequency is 3 cycles per 1 minute
C. Instantaneous change in fetal heart rate from
one beat to the next
This type of fetal heart rate pattern is commonly
associated with severe fetal asphyxia, severe fetal
anemia chorioamnionitis and umbilical cord
compression.
A. Saltatory pattern
B. Sinusoidal heart pattern
C. Cardiac arrhythmia
D. Increased variability
B. Sinusoidal heart pattern
Possible etiology of fetal bradycardia? A. Maternal fever B. Abruptio placenta C. Chorioamnionitis D. Administration of betamimetic drugs
B. Abruptio placenta
