Obstetrics - 2M Flashcards
Which of the following describes Pinards
maneuver?
Two fingers of the provider are placed beneath
and then parallel to the femur and knees must be
flexed to bring the foot within reach.
Which of the following studies stated that there is
no excessive morbidity in term breech singletons
delivered vaginally provided strict fetal biometric
and maternal pelvimetry parameters are applied?
Lille Breech Study Group
Regarding breech delivery, which of the following
has Level II-1, Grade A recommendation?
The absence of adequate progress in labor during
the first stage of labor in a patient who is
undergoing a planned vaginal delivery is an
indication for CS.
What is the best indicator of pelvic adequacy for
vaginal breech delivery?
Phase of maximum slope reaching second stage
of labor after 2 hours accompanied by regular
contractions in a multigravida
A 28 yo G5P4 at 38wks AOG came in due to labor
pains. On pelvic examination, you noted that the
foot is already visible at the introitus. The cervix
was seemingly fully dilated and fully effaced.
What is the next most appropriate in the
management?
Immediate CS
A 27 yo G2P1 (1001) at 32 wks AOG has been at
the labor room for 2 wks for the management of
preterm premature rupture of membranes
(PPROM). Her most recent ultrasound showed
an appropriately grown fetus in a footling breech
presentation showing oligohydramnios. The OB
resident refers back the patient because there are
recurrent fetal heart rate decelerations as low as
70bpm on her NST. If you’re the attending
consultant, what is the initial verbal order you give
to the resident when you go to see the patient?
Immediately do internal examination
(A 27 yo G2P1 (1001) at 32 wks AOG has been at
the labor room for 2 wks for the management of
preterm premature rupture of membranes
(PPROM). Her most recent ultrasound showed
an appropriately grown fetus in a footling breech
presentation showing oligohydramnios. The OB
resident refers back the patient because there are
recurrent fetal heart rate decelerations as low as
70bpm on her NST.)
Same patient as #6. On examination, the 2 feet
and loop of umbilical cord was noted at the
vaginal introitus. Patient was brought to the OR.
At the OR, FHR was noted to be recovered after
resuscitation. A repeat examination revealed that
the scapula of the fetus are passed to what
seems to be completely dilated cervix and the
fetal buttocks are at the introitus. Which of the
following is true regarding vaginal breech in this
setting?
There is an increased risk of head entrapment
(A 27 yo G2P1 (1001) at 32 wks AOG has been at
the labor room for 2 wks for the management of
preterm premature rupture of membranes
(PPROM). Her most recent ultrasound showed
an appropriately grown fetus in a footling breech
presentation showing oligohydramnios. The OB
resident refers back the patient because there are
recurrent fetal heart rate decelerations as low as
70bpm on her NST.)
Same patient. How will you best manage the
most common complication?
Do incision at the 2 o’clock and 10 o’clock
position, possibly 6 o’clock position of the cervix
(Duhrssen incision)
(A 27 yo G2P1 (1001) at 32 wks AOG has been at
the labor room for 2 wks for the management of
preterm premature rupture of membranes
(PPROM). Her most recent ultrasound showed
an appropriately grown fetus in a footling breech
presentation showing oligohydramnios. The OB
resident refers back the patient because there are
recurrent fetal heart rate decelerations as low as
70bpm on her NST.)
Same patient. If the procedure that you
performed is not successful, which of the
following may aid in the fetal delivery?
Assisted vaginal delivery using Piper’s forceps
A primigravida patient who underwent CS
because of primi breech at 39 wks AOG followed
up at the clinic for postpartum care. You
explained to her that during the surgery, the
uterus was normal and no anomalies were
identified. She asked you what are the chances
that she will have a breech presentation in her
future pregnancies. How will you answer this
patient?
With one previous breech presentation at term,
the chances that she will have another breech
presentation is 10%.
Application of forceps is appropriate in which of
the following situations?
Mentum anterior, station +3, cervix completely
dilated and membranes ruptures
Anticipating success, an obstetrician has made a
concerted attempt to deliver a patient using
forceps. The attempt fails. How is the procedure
termed?
Failed forceps
A 35 yo G7P6 38 wks pregnant, presents in
advance labor with a frank breech presenting at
the perineum. The vaginal breech delivers
without difficulty until the head becomes
entrapped in the incompletely dilated cervix. To 2
release the head, which of the following should
be done?
Duhrssen incision
- A 28 yo G4P3 at 39 wks came in due to labor
pains. IE was done revealing 5 cm dilated, fully
effaced, +BOW, station -1, cephalic. Labor
progressed up to full cervical dilation. However,
during the 2nd stage of labor, there was
prolongation and you noted that the sagittal
sutures are being palpated. Further descent of
the fetal head at station +2, you palpated the
ears. How is the situation resolved after
placement of forceps?
Pulling and pushing each branch along the long
axis
- What is the most favorable clinical scenario for a
successful vaginal delivery after a CS birth?
Previous vaginal delivery
28 yo G1P0 at 38wks AOG came in due to labor
pains. IE upon admission was 4cm. Labor
progressed until she was at 2nd stage of labor.
After 2 hrs without epidural anesthesia, you noted
that the occiput is at the sacrum, station -3. Which
of the following actions is necessary to rotate a
fetus from this position to appropriate position?
Flexion of the fetal head
(28 yo G1P0 at 38wks AOG came in due to labor
pains. IE upon admission was 4cm. Labor
progressed until she was at 2nd stage of labor.
After 2 hrs without epidural anesthesia, you noted
that the occiput is at the sacrum, station -3.)
Same patient. In this setting, when the occiput is
at the sacrum, correctly placed blades are
equidistant at what landmarks?
Midline of the face and the brow
(28 yo G1P0 at 38wks AOG came in due to labor
pains. IE upon admission was 4cm. Labor
progressed until she was at 2nd stage of labor.
After 2 hrs without epidural anesthesia, you noted
that the occiput is at the sacrum, station -3.)
Same patient. Which of the following pelvic types
is generally associated if the position of the fetal
head persists?
Anthropoid
(28 yo G1P0 at 38wks AOG came in due to labor
pains. IE upon admission was 4cm. Labor
progressed until she was at 2nd stage of labor.
After 2 hrs without epidural anesthesia, you noted
that the occiput is at the sacrum, station -3.)
Same patient. Estimated fetal weight is 3400g.
Considering the presentation of this patient,
which of the following would be associated with
failure of operative delivery?
The occiput posterior position
A 31 yo primigravid undergoing induction of labor
reaches 2nd stage of labor after 36 hrs. Before
beginning to push, she says that she’s too tired
and desires an operative vaginal delivery. You
decided to do a vacuum extraction. Which of the
following is a prerequisite for vacuum extraction
but not for forceps assisted vaginal delivery?
Minimum of 34 wks
A patient presents approximately 10 yrs
postmenopause with complaints of a vulvar mass
which on examination turned out to be a
prolapsed uterus. She is a G10P10 and all her
children were home delivered. Which of the
following pelvic muscles were most likely
compromised during the vaginal delivery?
Levator ani muscles
A 36 yo G3P2 3 mos pregnant develops bleeding,
abdominal cramps, and passes tissues per
vagina. After 2 hrs, she bled profusely hence was
brought to the ER. On admission, the cervix
admits one finger, and tissues were felt within the
os. What is the indicated procedure?
Curettage
A 20 yo primigravid whose LMP was 10 wks ago
presented with scanty vaginal bleeding. TVS
showed the uterus to be 15 wks size with various
sized cystic structures inside the endometrial
cavity. No fetus seen. The cervix was long and
closed. The hCG titer is 10,000IU. What is the
initial step in the indicated procedure?
Slow dilatation of the cervix
A postpartum woman who underwent a
prolonged labor and uneventful vaginal delivery
under epidural anesthesia complained of severe
hypogastric pain 5 hrs postpartum. On
examination, the hypogastrium was distended.
Which of the following is the most probable
diagnosis?
Urinary retention
A 24 yo G3P2 diagnosed to have missed
abortion was undergoing curettage. And just as
the operator was finishing with the procedure,
there was sudden profuse bleeding from the
uterus. Which of the following might be the cause
of the bleeding?
Laceration of the uterine artery
A 31 yo G1P1 consulted due to vaginal bleeding
3 wks postpartum. She claimed that her delivery
was uncomplicated. Which of the following is
considered the first line treatment in a vaginal
bleeding 3 wks postpartum?
Antibiotics
(A 31 yo G1P1 consulted due to vaginal bleeding
3 wks postpartum. She claimed that her delivery
was uncomplicated.)
Same patient. You started your first line
treatment, but still the patient had vaginal 3
bleeding. What will be the next efficacious
treatment for this patient?
Curettage
A 32 yo G3P3 3003 who came in because of
breast tenderness. She delivered via CS 2 wks
ago. She is breastfeeding. She presented with 2
days fever, chills, and breast pain. She cannot
breastfeed on the affected side. On examination,
the breast is warm, red, and tender. Your
considerations were mastitis vs abscess. What is
the best management of this patient after seeing
the ultrasound result? (Doc says the ultrasound
shows abscess)
Give antibiotics, drain abscess, do culture,
pumping or breastfeeding continued for both
breasts
A patient had CS for obstructed labor. Postop,
she had spiking temperature despite antibiotics.
The diagnosis of postpartum pelvic
thrombophlebitis was made and suddenly, she
complained of chestpain and dyspnea. Which of
the following will be the most likely diagnosis?
Pulmonary embolism
18 yo primigravida delivered a 4000g infant
vaginally. Her prenatal course was complicated
by anemia, poor weight gain and maternal
obesity. Her labor was protracted including a 3 hr
second stage. A low forceps delivery was done
with episiotomy that extended to a 3rd degree
perineal tear. Which of the following is the
greatest predisposing cause of puerperal
infection in this patient?
Poor nutrition
Images were not shown, doc only described the
pictures.
Picture A - Normal waveform.
Picture B - Decrease in diastole.
What can you say about the umbilical artery?
SD ratio is greater in B than A
28 yo primigravid diagnosed with GDM at 24 wks.
She was managed with diet and is controlled.
However, at 32 wks, the fundal height was
smaller than AOG. Impression was IUGR.
Doppler velocimetry was requested revealing
these findings (images not shown). Low diastole.
What can you say about the doppler waveform?
There is increased impedance to flow with
abnormally elevated SD ratio
28 yo primigravid diagnosed with GDM at 24 wks.
She was managed with diet and is controlled.
However, at 32 wks, the fundal height was
smaller than AOG. Impression was IUGR.
Doppler velocimetry was requested revealing
these findings (images not shown).
Same patient. What is the implication of the result
of the doppler velocimetry to the fetus?
30% placental occlusion and MR of 5.6%
28 yo primigravid diagnosed with GDM at 24 wks.
She was managed with diet and is controlled.
However, at 32 wks, the fundal height was
smaller than AOG. Impression was IUGR.
Doppler velocimetry was requested revealing
these findings (images not shown).
Same patient as in 33. Doppler velocimetry
showed same results. On checking the MCA, it
has low pulsatility index and resistance index.
What does this imply?
Brain sparing indicative of acute hypoxia.
28 yo primigravid diagnosed with GDM at 24 wks.
She was managed with diet and is controlled.
However, at 32 wks, the fundal height was
smaller than AOG. Impression was IUGR.
Doppler velocimetry was requested revealing
these findings (images not shown).
Same patient. Your decision regarding time of
delivery would be guided by which of the
following?
Ctg and amniotic fluid volume
Which of the following Doppler results warrants
an urgent C section for it may lead to fetal
distress?
Normal umbilical artery pulsatility index+
decreased MCA pulsatility index.
A 38 year old G4P3 (3003) came in due to labor
pain. Fundic height is 35cm. Patient is diagnosed
with GDM. IE was 6cm. Labor progress was until
the second stage of labor. Upon delivery, there
was a recoil of the fetal head at the perinium.
Shoulder dystocia was diagnosed. Which
maneuver will you use for anterior disimpaction of
the shoulder?
Shoulder is pushed to the chest.
(A 38 year old G4P3 (3003) came in due to labor
pain. Fundic height is 35cm. Patient is diagnosed
with GDM. IE was 6cm. Labor progress was until
the second stage of labor. Upon delivery, there
was a recoil of the fetal head at the perinium.
Shoulder dystocia was diagnosed.)
Same patient (37) which is the vaginal approach for anterior shoulder disimpaction?
Rubin’s
What fetal heart abnormality shows cerebral
palsy and indicates prompt intervention?
No specific fetal heart rate pattern
A 47 year old G1P1, had spontaneous vaginal
delivery at 28 weeks, but developed intracranial
hemorrhage. What is the most common etiology?
Hypoxia ischemia
