Obstetrics Flashcards
- Conjugata Vera can be determined with the use of:
- C. externa
- C. diagonale
- Vertical diameter of Michaelis rhomboid
- Frank’s diameter
- 1.C. externa
* 2.C. diagonale
* 3.Vertical diameter of Michaelis rhomboid
* 4.Frank’s diameter
- Fetal Lie is defined as:
- Relation of fetus to left and right uterine walls
- Relation of longitudinal fetal axis to longitudinal uterine axis
- Location of a fetus in the lower or upper part of uterine cavity
- Relation of the head and extremities to the fetal trunk
- Relation of the fetal spine to anterior or posterior walls of the uterus
- 1.Relation of fetus to left and right uterine walls
* 2.Relation of longitudinal fetal axis to longitudinal uterine axis
- Position is defined as:
- Relation of longitudinal fetal axis to longitudinal uterine axis
- Relation of the fetal spine to anterior or posterior walls of the uterus
- Location of a fetus in the left or right part of uterine cavity
- Relation of the fetal spine to left or right walls of the uterus
- Relation of a fetus to the lower or upper part of uterine cavity
*4.Relation of the fetal spine to left or right walls of the uterus
- Visus is defined as:
- Relation of the fetal spine to left or right walls of the uterus
- Fetal location closer to anterior or posterior uterine wall
- Relation of longitudinal fetal axis to longitudinal uterine axis
- Relation of the fetal spine to anterior or posterior walls of the uterus
- Relation of the head and extremities to the fetal trunk
- 1.Relation of the fetal spine to left or right walls of the uterus
* 4.Relation of the fetal spine to anterior or posterior walls of the uterus
- Check all possible variants of fetal lie:
- Oblique and transverse
- Cephalic and breech
- Anterior and posterior
- Longitudinal, transverse, oblique
- Flexed and extended
*4.Longitudinal, transverse, oblique
- Bone pelvis is divided on:
- Large and small pelvis
- Inlet, wide part, narrow part, outlet
- Large pelvis, small pelvis and pelvic cavity
- Inlet, pelvic cavity, outlet
- Wide part and narrow part
*1.large and small pelvis
- Sutures which form fonticulus major are:
- Sagittal and lambdoid
- Sagittal, frontal
- Sagittal, coronal
- Coronal, lambdoid
- Sagittal, frontal, coronal
*5.sagittal, frontal, coronal
- Landmarks of the small pelvis inlet include:
- Upper-inner brim of symphysis, linea innominata, sacral prominence
- Middle point of inner symphyseal surface, linea innominata, sacral prominence
- Upper brim of symphysis, middle points of lamina acetabule, sacral prominence
- Upper brim of symphysis, linea innominata, first sacral vertebral bone
- Lower brim of symphysis, fossae iliacae, sacral promontory
*1.upper-inner brim of symphysis, linea innominata, sacral prominence
- Inner muscular layer of the pelvic floor includes:
- m. Transversus Perinei Profundus
- m. Bulbocavernosus
- m. Obturatorius Internus
- m. Iliacus Internus
- m. Levator Ani
*5.m. Levator Ani
- Middle muscular layer of the pelvic floor includes:
- m. Levator Ani
- m. Piriformis
- m. Psoas Major
- m. Transversus Perinei Profundus
- m. Ischiocavernosus
*4.m. Transversus Perinei Profundus
- Middle point of inner symphyseal surface and junction of the 2-nd and 3-rd sacral vertebral bones are connected with:
- Transverse diameter of the narrow part plane of small pelvis
- Anteroposterior diameter of the narrow part plane of small pelvis
- Anteroposterior diameter of the wide part plane of small pelvis
- Transverse diameter of the wide part plane of small pelvis
- Anteroposterior diameter of the small pelvis outlet
*3.anteroposterior diameter of the wide part plane of small pelvis
- through ischial spines goes:
- Transverse diameter of the wide part plane of small pelvis
- Transverse diameter of the narrow part plane of small pelvis
- Transverse diameter of the small pelvis outlet
- anteroposterior diameter of the narrow part plane of small pelvis
- anteroposterior diameter of the wide part plane of small pelvis
*2.transverse diameter of the narrow part plane of small pelvis
- Through middle points of both laminae acetabuli goes:
- Transverse diameter of the wide part plane of small pelvis
- Transverse diameter of the small pelvis inlet
- Transverse diameter of the narrow part plane of small pelvis
- anteroposterior diameter of the wide part plane of small pelvis
- anteroposterior diameter of the narrow part plane of small pelvis
*1.transverse diameter of the wide part plane of small pelvis
- Small oblique diameter (diameter suboccipitobregmaticus) of the fetal head goes from:
- Anterior angle of the anterior fontanel to the undersurface of the occipital bone
- The middle point of anterior fontanel to the undersurface of the occipital bone
- Glabella to occipital tubercle
- The central part of os hyoideus to anterior angle of anterior fontanel
- The chin to the most prominent portion of the occipital bone
*2.the middle point of anterior fontanel to the undersurface of the occipital bone
- Large oblique diameter (diameter mentooccipitalis) of the fetal head goes from:
- The middle point of anterior fontanel to the undersurface of the occipital bone
- Anterior angle of anterior fontanel to the undersurface of the occipital bone
- Glabella to occipital tubercle
- Central part of os hyoideus to anterior angle of anterior fontanel
- The chin to the most prominent portion of the occipital bone
*5.the chin to the most prominent portion of the occipital bone
- Direct diameter (diameter frontooccipitalis) of the fetal head goes from:
- The middle point of anterior fontanel to the undersurface of the occipital bone
- Anterior angle of anterior fontanel to the undersurface of the occipital bone
- Glabella to occipital tubercle
- The chin to the most prominent portion of the occipital bone
- The central part of os hyoideus to anterior angle of fonticulus major
*3.glabella to occipital tubercle
- Conjugata Diagonalis – is the distance from:
- Upper brim of symphysis bone to sacral promontory
- Lower brim of symphysis to the middle point of sacral promontory
- Middle point of inner symphysis pubis surface to sacral promontory
- Lower brim of symphysis pubis to the point under processus spinosus of the 5-th lumbar vertebral bone
- Lower brim of symphysis pubis to the junction of the 2-nd and 3-rd sacral vertebral bones
*2.lower brim of symphysis to the middle point of sacral promontory
- Conjugata Externa - is the distance between:
- Upper brim of symphysis bone and processus spinosus of the 4-th lumbar vertebral bone
- Upper brim of symphysis bone and the upper angle of the Michaelis rhomboid
- Lower brim of symphysis bone and the middle point of sacral promontory
- Lower brim of symphysis bone and the upper angle of the Michaelis rhomboid
- The most outstanding points of iliac crests
*2.upper brim of symphysis bone and the upper angle of the Michaelis rhomboid
- Conjugata Vera - is the distance from the:
- Middle of upper-inner brim of symphysis bone and the middle point of sacral promontory
- Upper brim of symphysis bone to sacral promontory
- Upper brim of symphysis bone to processus spinosus of the 5-th lumbar vertebral bone
- Lower brim of symphysis to the middle point of sacral promontory
- Middle of inner surface of symphysis bone to sacral promontory
*1.middle of upper-inner brim of symphysis bone and the middle point of sacral promontory
- Dimensions of the small pelvis inlet plane are:
- Direct - 11 cm, transverse - 13 cm
- Direct - 10 cm, transverse - 12 cm
- Direct - 11 cm, transverse - 13 cm, oblique - 12 cm
- Direct - 11 cm, transverse - 12 cm, oblique - 11 cm
- Direct - 10 cm, transverse - 13 cm, oblique - 12 cm
*3.direct - 11 cm, transverse - 13 cm, oblique - 12 cm
- The least dimension of the small pelvis is:
- Direct diameter of the small pelvis inlet
- Anteroposterior diameter of the narrow part plane of the small pelvis
- Anteroposterior diameter of the narrow part plane of the small pelvis
- Transverse diameter of the narrow part plane of the small pelvis
- Transverse diameter of the small pelvis outlet
- Oblique diameters of the small pelvis inlet
- 2.anteroposterior diameter of the narrow part plane of the small pelvis
* 3.anteroposterior diameter of the narrow part plane of the small pelvis
- The largest dimension of the small pelvis is:
- Anteroposterior diameter of the wide part plane of the small pelvis
- Transverse diameter of the wide part plane of the small pelvis
- Transverse diameter of the small pelvis inlet
- Oblique diameters of small the pelvis inlet
- Anteroposterior diameter of the small pelvis outlet
*3.transverse diameter of the small pelvis inlet
- Average circumference of the wrist is:
- 12 cm; is used for determination of the pelvic shape
- 14 cm; is used for determination of the pelvic bones thickness
- 16 cm; is used for determination of the pelvic dimensions
- 18 cm; is used for determination of the external conjugate
- 20 cm; is used for determination of the diagonal conjugate
*2.14 cm; is used for determination of the pelvic bones thickness
- Conjugata Vera is determined:
- with pelvimeter
- with internal obstetric investigation
- through measurement of external conjugate, diagonal conjugate, vertical diameter of Michaelis rhomboid and Frank’ diameter
- by measurement of external dimensions of the large pelvis
- with the use of Soloviev index
*3.through measurement of external conjugate, diagonal conjugate, vertical diameter of Michaelis rhomboid and Frank’ diameter
- Diagonal conjugate is measured for determination of:
- External conjugate
- Anatomical conjugate
- Obstetrical conjugate
- Anteroposterior diameter of the narrow part plane of the small pelvis
- Station level of the presenting part
*3.obstetrical conjugate
- Normal size of the diagonal conjugate is:
- 14 cm
- 11 cm
- 13 cm
- 10 cm
- 9 cm
*3.13 cm
- In OP (occiput posterior), flexed attitude:
- At the level of pelvic inlet the head performs deflexion
- At the level of pelvic outlet the head performs flexion and then deflexion
- In time of crowning distention of vulvar ring achieves 35 cm in circumference
- Caput succedaneum (cephalic birth tumor) is formed in the region of anterior fontanel
- The centre of forehead serves as a leading point
*2.at the level of pelvic outlet the head performs flexion and then deflexion
- In brow presentation at the level of pelvic outlet the head performs:
- Flexion
- Deflexion
- Internal rotation
- Flexion and then deflexion
- Maximal deflexion
*4.flexion and then deflexion
- In OA (occiput anterior), flexed attitude:
- Anterior fontanel serves as a leading point
- At the level of pelvic inlet the head performs deflexion
- Occipital tubercle serves as a fixation point
- Caput succedaneum (cephalic birth tumor) is formed in the region of posterior parietal bone
- Fetal head is delivered due to deflexion
*5.fetal head is delivered due to deflexion
- The shape of the head in fetuses delivered in breech presentation is:
- Dolichocephalic
- Ball-like
- Brachiocephalic
- Abnormal
- Tower-like
*2.ball-like
- Internal rotation of the head occurs:
- in the wide part plane of the small pelvis
- at the level of pelvic floor
- begins in the wide part plane of the small pelvis and ends at the level of pelvic floor
- at the level of pelvic inlet
- begins at the level of pelvic inlet and ends at the level of pelvic floor
*3.begins in the wide part plane of the small pelvis and ends at
- Umbilical cord compression in breech delivery occurs after:
- Delivery of umbilical ring
- Delivery of fetal buttocks
- Trunk delivery to the level of lower angle of anterior scapula
- Internal cephalic rotation
- Crowning of the fetal buttocks
*3.trunk delivery to the level of lower angle of anterior scapula
- Anterior fontanel serves as a leading point in:
- OA; flexed attitude
- First degree head deflexion
- OP; flexed attitude
- Brow presentation
- Face presentation
*2.first degree head deflexion
- Fetal head is delivered with circumference which corresponds to frontooccipital diameter in:
- The first degree head deflexion
- OP; flexed attitude
- Face presentation
- OA; flexed attitude
- Brow presentation
*1.the first degree head deflexion
- Caput succedaneum (cephalic birth tumor) means:
- Haemorrhage to the scalp soft tissues
- Haemorrhage under periosteal capsule of the cranial bone
- Changes of cranium shape due to cephalic molding
- Serous-blood imbibition of soft tissues of the presenting part due to venous stasis beneath the apposition girdle
- Haemorrhage to subcutaneous fat tissue
*4.serous-blood imbibition of soft tissues of the presenting part due to venous stasis beneath the apposition girdle
- The optimal date for the first visit to antenatal clinic is before:
- 5 weeks
- 12 weeks
- 14 weeks
- 16 weeks
- 20 weeks
*2.12 weeks
- Perinatal period lasts:
- from 12 weeks until delivery
- from 20 weeks until 7-th day after delivery
- from 28 weeks until 56-th day after delivery
- from 22 weeks until 7-th day after delivery
- from 32 weeks until 7-th day after delivery
*4.from 22 weeks until 7-th day after delivery
- Wasserman reaction during pregnancy is to be performed (in Russia):
- Once
- Every other month
- Monthly
- Three times
- Twice in each trimester
*4.three times
- In the frame of antenatal care vaginal investigation in the second trimester of pregnancy should be performed:
- in case of suspicion on placenta praevia
- for accurate determination of presenting part
- at every visit
- once in a trimester
- only with indications
*5.only with indications
- for accurate determination of gestational age at 30 weeks one can use:
- X-ray
- Ultrasonography
- cardiotocography
- Amnioscopy
- Cytology
*2.ultrasonography
- Cessation of menstruation as a sign of early pregnancy is included to the group of:
- Probable pregnancy signs
- Supposed pregnancy signs
- Uncertain pregnancy signs
- Certain pregnancy signs
*1.probable pregnancy signs
- Doubtful signs of pregnancy include:
- Palpation of the fetal parts, auscultation of the fetal heart beats
- Ultrasonic and X-ray imaging of the fetus, detection of the fetal heart activity
- Cessation of menstruation, vaginal mucosa cyanotic discoloration, changes of uterine size, shape and consistency
- Changes of appetite, smell sensations, morning sickness, unstable mood
- Positive biological and immunological pregnancy tests results
*4.changes of appetite, smell sensations, morning sickness, unstable mood
- Immunological pregnancy test (at early stages) is based on the reaction of antiserum with:
- Progesterone in blood
- Chorionic gonadotropin in urine
- pregnandiol
- Oestrogen
- Placental lactogen
*2.chorionic gonadotropin in urine
- Maximal symhysiofundal height (SFH) is observed at:
- 36 weeks
- 38 weeks
- 39 weeks
- 40 weeks
- at the onset of the first stage of labor
*1.36 weeks
- The third Leopold maneuver is used to determine:
- symhysiofundal height
- presenting fetal part
- fetal position
- visus
- free balloting of the head
- 2.presenting fetal part
* 5.free balloting of the head
- The fourth Leopold maneuver is used to determine:
- fetal lie
- Position
- visus
- Relation of the presenting part to the small pelvis inlet
*4.relation of the presenting part to the small pelvis inlet
- Labor is divided on several periods:
- Preliminary
- Dilation
- Decent
- Placental separation and expulsion
- Postpartum
- 2.dilation
* 3.decent
* 4.placental
- One should regard as the onset of labor:
- Rupture of membranes (leakage of amniotic fluid)
- Descent of the fetus down through birth channel
- Onset of uterine contractions with an interval of 15-20 m
- Engagement of the head
- Onset of regular contractions leading to structural changes of the uterine cervix
*5.onset of regular contractions leading to structural changes of the uterine cervix
- Bearing down (pushing) differs from uterine contractions (pains) with:
- Higher rate of uterine contractions
- Higher amplitude of uterine contractions
- With addition of muscle contraction of abdominal wall, diaphragm, pelvic floor
- With addition of contractions of the muscles, covering internal pelvic surface
- Due to increased frequency, strength and duration of uterine contractions
*3.with addition of muscle contraction of abdominal wall, diaphragm, pelvic floor
- The name of the first period of labor is:
- Preliminary period
- Period of dilation
- Period of descent (expulsion)
- Latent period
- Period of cervical effacement
*2.period of dilation
- The first period of labor lasts from the:
- Onset of regular contractions until cervical effacement
- Onset of regular contractions until delivery of a fetus
- Onset of regular contractions until full dilation of the uterine os
- Onset of regular contractions until engagement of the fetal head
- Onset of gripping pains in the lower abdomen until uterine os opening will achieve 7-8
*3.onset of regular contractions until full dilation of the uterine os
- The root distinction of the first period contractions from preliminary (prelabor) contractions is based on differences in:
- Duration of intervals between contractions
- Intensity of contractions
- Presence or absence of structural changes of the cervix
- Duration of contractions
- Intensity of pain
*3.presence or absence of structural changes of the cervix
- The second period of labor lasts from:
- Rupture of membranes until delivery of a fetus
- Full dilation until delivery of a fetus
- Head engagement until delivery of a fetus
- Effacement of cervix until delivery of a fetus
- Onset of pushing movements until delivery of a fetus
*2.full dilation until delivery of a fetus
- FHR (fetal heart rate) in the second period of labor should be checked:
- After each “pushing down”
- Every 15 minutes
- Every 10 minutes
- Every 5 minutes
- In time of the fetal head crowning
*1.after each “pushing down”
- The third period of labor lasts from:
- from separation of placenta until its expulsion
- from delivery of a fetus until expulsion of placenta and membranes
- from delivery of a fetus until placental separation
- from full dilation of uterine os until expulsion of placenta and membranes
- for two hours after expulsion of placenta and membranes
*2.from delivery of a fetus until expulsion of placenta and membranes
- Early rupture of membranes means that it occurred:
- before onset of labor
- before onset of the second period of labor
- before 5cm dilation of uterine os
- before 7cm dilation of uterine os
- before onset of pushing movements
*4.before 7cm dilation of uterine os
- Prelabor rupture of membranes means that it occurred:
- before onset of labor
- during the first period of labor
- before 38 weeks of pregnancy
- before 7 cm dilation of uterine os
- after 5 cm dilation to the full
*1.before onset of labor
- Preterm rupture of membranes leads to increased risk of:
- Maternal obstetrical trauma
- Preterm detachment of the placenta
- Septic complications
- Obstetrical trauma of a fetus
- Precipitate labor
*3.septic complications
- Retarded rupture of membranes leads to increased risk of:
- Septic complications
- Weak labor activity
- Preterm detachment of the placenta
- Maternal obstetrical trauma
- Obstetrical trauma of a fetus
*3.preterm detachment of the placenta
- In breech presentation one should begin to perform maneuver:
- after full dilation of uterine os
- when buttocks will descent to the small pelvic cavity
- in time of buttocks crowning
- after delivery of the fetal trunk until umbilical ring
- after onset of pushing activity
*3.in time of buttocks crowning
- The newborn assessment according to Apgar score:
- Is based on assessment of 5 parameters
- Includes data about acid-alkaline balance [ÊÙÑ]
- Affords to assess the degree of IUGR
- Should be performed once at the first minute after birth
- Should be performed by neonatologist daily
*1.is based on assessment of 5 parameters
- Fetus is regarded as large when the birth weight is more or equals:
- 3000 g
- 3500 g
- 3800 g
- 4000 g
- 4500 g
*4.4000 g
- APGAR score includes assessment of:
- Birth weight, length, gestational age
- Heart rate, respiration movements rate, skin color, reflexes, tonus of muscles
- Heart rate, respiration movements rate, skin color
- Consciences, degree of depression
- Heart rate, general condition
*2.heart rate, respiration movements rate, skin color, reflexes, tonus of muscles
- Weekly weight gain in the second half of pregnancy should not be more than:
- 100-150 g
- 150-200 g
- 200-300 g
- 300-400 g
- 400-500 g
*4.300-400 g
- Signs of pregestosis in the second half of pregnancy are:
- Nonstability and asymmetry of BP,
- Decrease of 24 h diuresis until 600-500 ml
- Oedema of ankles and proteinuria
- Levels of proteinuria achieve 0,033 - 0,066 g/l
- Retinopathy, angiopathy of retinal vessels
*1.nonstability and asymmetry of BP,
- Frequent forms of early toxicosis are:
- Oedema, pregnancy associated hypertension
- Hypersalivation (ptyalism)
- Pregnancy associated hypertension, preeclampsia
- Dermatoses, chorea
- Emesis gravidarum
- 2.hypersalivation (ptyalism)
* 5.emesis gravidarum
- Pure forms of gestosis are:
- oedema, pregnancy associated hypertension
- gestosis which occurred in uncomplicated pregnancy
- gestosis which occurred in the absence of extragenital diseases
- gestosis which occurred in the absence of genital diseases
- preeclampsia and eclampsia
*3.gestosis which occurred in the absence of extragenital diseases
- Monosymptomatic forms of gestosis include:
- pregnancy associated oedema
- Preeclampsia
- Pregnancy associated nephropathy
- eclampsia
- pregnancy associated hypertension
- 1.pregnancy associated oedema
* 5.pregnancy associated hypertension
- Polysymptomatic forms of gestosis include:
- Pregnancy associated oedema
- Pregnancy associated hypertension
- Pregnancy associated nephropathy
- Preeclampsia
- Eclampsia
- 3.pregnancy associated nephropathy
* 4.preeclampsia
* 5.eclampsia
- Nephropathy is assessed as a first degree state when:
- BP = 150/90, proteinuria = 0, 99 g/l, oedema of ankles and abdominal wall, retinal oedema
- BP = 130/90, proteinuria = 3, 3 g/l, oedema of ankles, abdominal wall and face, retinal oedema
- BP = ÀÄ 140/100, proteinuria = 1, 65 g/l, oedema of ankles and abdominal wall, irregular diameter of the retinal vessels
- BP = 140/90, proteinuria = 0, 66 g/l, oedema of ankles, irregular diameter of the retinal vessels
- BP = 170/100, proteinuria = 1, 32 g/l, oedema of ankles and abdominal wall, retinal oedema
*4.BP = 140/90, proteinuria = 0, 66 g/l, oedema of ankles, irregular diameter of the retinal vessels
- Nephropathy is assessed as a second degree state when:
- BP = 140/80, proteinuria = 0, 66 g/l, oedema of ankles, irregular diameter of the retinal vessels
- BP = 160/90, proteinuria = 1, 65 g/l, oedema of ankles and abdominal wall, retinal oedema
- BP = 150/90, proteinuria = 3, 3 g/l, oedema of ankles and abdominal wall, retinal haemorrhages
- BP = 180/120, proteinuria = 0, 99 g/l, oedema of lower extremities, retinal oedema
- BP = 130/80, proteinuria = 0,132 g/l, mild oedema of ankles, retinal vessels - unchanged
*2.BP = 160/90, proteinuria = 1, 65 g/l, oedema of ankles and abdominal wall, retinal oedema
- for correction of hypoproteinemia and hypovolemia in pregnancies complicated with gestosis one can use:
- 5 % glucose solution, haemodes, glucose-novocaine solution
- neocompensan, reopolyglukin, polyfer
- haemodes, Ringer-Lock solution, lactasole, blood transfusion
- poliglukin, Natrii bicarbonates solution, mannitol
- albumin, protein, conserved plasma
*5.albumin, protein, conserved plasma
- Zangemeister triad includes:
- hypovolemia
- vascular spasm, increased vascular walls permeability
- oedema
- proteinuria
- hypertension
- 3.oedema
* 4.proteinuria
* 5.hypertension
- If the classical Zangemeister triad (arterial hypertension, edema, and proteinuria) is present, diagnosis of preeclampsia can be made after detection of:
- Irregular diameter of the retinal vessels
- BP over 190/110
- Complaints of pains in epigastrium
- Proteinuria over 3, 3 g/l
- Retinal oedema
*3.complaints of pains in epigastrium
- Which stage of eclamptic attack is characterized with tonic convulsions?
- 1-st
- 2-nd
- 3-rd
- 4-th
- 2-nd and 3-rd
*2. 2-nd
- Which stage of eclamptic attack is characterized with clonic convulsions?
- 1-st
- 2-nd
- 3-rd
- 4-th
- 2-nd and 3-rd
*3.3-rd
- The need for routine intensive observation in early postpartum period in labor ward can be explained with increased risk of development of:
- Acute heart failure
- Hypotonic bleeding
- Infectious-toxic shock
- Acute respiratory failure
- Eclampsia
*2.hypotonic bleeding
- Substantial engorgement of mammary glands usually occurs:
- in pregnancy
- on 1-2 day of puerperium
- on 3-4 day of puerperium
- on 4-5 day of puerperium
- on 5-6 day of puerperium
*3.on 3-4 day of puerperium
- Secretory activity of mammary glands is regulated by:
- Oestrogens
- Progesterone
- Oxytocin
- LH
- Prolactin
*5.prolactin
- On the 1-st day of puerperium uterine fundal height is at the level of:
- Umbilicus
- Fingers above the umbilicus
- Fingers beneath the umbilicus
- at the midpoint between umbilicus and symphysis
- Fingers above the umbilicus
*1.umbilicus
- On the 5-th day of puerperium uterine fundal height is at the level of:
- Finger beneath the umbilicus
- Fingers beneath the umbilicus
- Finger above symphysis
- Fingers beneath the umbilicus
- At the midpoint between umbilicus and symphysis
*5.at the midpoint between umbilicus and symphysis
- Average uterine mass immediately after labor is:
- 50-80 g
- 150-200 g
- 300-500 g
- approximately 1000 g
- approximately 2000 g
*4.approximately 1000 g
- In normal uncomplicated puerperium proper restoration of internal os of cervical channel is completed by the:
- 3rd day
- 10th day
- 30th day
- 21st day
- at the end of postpartum period
*2.10th day
- At the early postpartum period normal discharge from uterus should be:
- To some extent bloody
- Bloody
- Serous
- In moderate amount
- Abundant
- 2.bloody
* 4.in moderate amount
- Verification of normal involution of the uterus is based on the assessment of the:
- State of external cervical os
- General condition of puerpera
- Results of vaginal investigation
- Uterine size and consistence
- Character and amount of lochia
- 4.uterine size and consistence
* 5.character and amount of lochia
- On the 3rd-4th day of puerperium lochia usually are:
- Bloody-serous
- Serous-bloody
- Serous
- mucus-like
- Absent
*1.bloody-serous
- Full postpartum restoration of endometrium structure occurs:
- from the 10th-15th day
- during 2-3 week
- during 4-5 week
- during 6 week
- during 8-10 week
*4.during 6 week
- Restoration of epithelial lining in the region of placental bed should be completed during the:
- 1-st week of puerperium
- 2-nd week of puerperium
- 6-th week of puerperium
- 3-rd week of puerperium
- 4-th week of puerperium
*3.6-th week of puerperium
- At the end of the 1-st day of puerperium width of internal os equals:
- Width of hand
- 4 fingers
- 2 fingers
- 1 fingers
- Finger tip
*3.2 fingers
- Retarded restoration of normally sized nonpregnant uterus in puerperium is called:
- Uterine subinvolution
- Lochiometra
- Hematomata
- Endometritis
- Metroendometritis
*1.uterine subinvolution
- Which of the following puerpurae are to be moved to the observational (2nd) post-delivery division?
- puerperae after operative delivery
- infected puerpera
- puerperas with perineal sutures
- puerperas with high risk of septic complications
- puerperas after complicated labor
*2.infected puerpera
- Most frequent causes for bleeding in the 1-st trimester of pregnancy include:
- Varicose dilation of vaginal veins
- Placenta praevia
- Threatened abortion
- Uterine rupture
- Ectopic pregnancy
- 3.threatened abortion
* 5.ectopic pregnancy
- Most frequent causes for bleeding at the late stages of pregnancy include:
- Threatened abortion
- Uterine rupture
- Placenta praevia
- Molar pregnancy
- Preterm separation of placenta
- 3.placenta praevia
* 5.preterm separation of placenta
- Basic clinical manifestations of placenta praevia include:
- Pain in lower abdominal region
- Bleeding in the 2-nd or 3-rd trimesters of pregnancy
- External bleeding in labor
- IUGR
- Fetal malposition
- 2.bleeding in the 2-nd or 3-rd trimesters of pregnancy
* 3.external bleeding in labor
* 5.fetal malposition
- In case of placental praevia external obstetrical investigation reveals:
- Increased uterine tonus
- Painful palpation of lower uterine segment
- Normal uterine tonus
- Fetal malposition, high station of presenting part
- Abnormal uterine contours
- 3.normal uterine tonus
* 4.fetal malposition, high station of presenting part
- Main prerequisite for performing vaginal investigation in case of suspecting placenta praevia has:
- Intact amniotic membranes
- Maintained rules of aseptics
- Adequate analgesia
- FHR (fetal heart rate) monitoring
- Prepared operational theater
*5.prepared operational theater
- Separation of normally located placenta is defined as preterm if it occurred:
- in the 1-st period of labor
- during pregnancy
- in the 2-nd period of labor
- in the preliminary period
- in the 3-rd period of labor
- 1.in the 1-st period of labor
* 2.during pregnancy
* 3.in the 2-nd period of labor
* 4.in the preliminary period
- Preterm separation of normally located placenta:
- May be the result of abdominal trauma
- Most frequently occurs as the result of vascular lesions due to gestosis, chronic hypertension, and renal disease
- Leads to IUGR
- May occurs in the 2-nd period of labor due to retarded rupture of membranes
- Occurs more frequently with oligohydramnios than with polyhydramnios
- 1.may be the result of abdominal trauma
* 2.most frequently occurs as the result of vascular lesions due to gestosis, chronic hypertension, and renal disease
* 4.may occurs in the 2-nd period of labor due to retarded rupture of membranes
- Etiological factors for preterm separation of placenta include:
- short umbilical cord
- retarded rupture of fetal membranes
- preterm rupture of membranes (PROM)
- rapid outflow of amniotic fluid in case of polyhydramnios
- pathological preliminary period
- 1.short umbilical cord
* 2.retarded rupture of fetal membranes
* 4.rapid outflow of amniotic fluid in case of polyhydramnios
- Manifestations of preterm separation of placenta may include:
- Severe abdominal pains
- Profuse external bleeding
- Uterine tetanus
- Intrauterine hypoxia or death
- Squeezing pains in lower abdomen
- 1.severe abdominal pains
* 3.uterine tetanus
* 4.Intrauterine hypoxia or death
- Complete placenta praevia is indication for caesarean section:
- Only in combination with other relative indications
- Only if birth passage is not ready for delivery
- Only in combination with bleeding
- Only if the fetus is alive
- It is absolute indication for CS
*5.it is absolute indication for CS
- In case of complete placenta praevia CS is performed only:
- If fetus is alive
- In lower uterine segment
- If there is threat to life
- In case of bleeding
- CS should be elective
*5.CS should be elective
- Progressive preterm separation of placenta during pregnancy is indication for:
- CS
- Induction of labor
- Delivery per vias naturals (vaginal labor)
- Supravaginal uterine amputation (subtotal hysterectomy)
*1.CS
- The term “Placenta adhaerens” means:
- Slight invasion of villous chorion to miometrium
- Insufficient adhesion of villous chorion to decidua
- Growth of villous chorion through basal layer of endometrium
- Villous chorion has reached serous membrane (perimetrium)
- Deep invasion of villous chorion to miometrium
*3.growth of villous chorion through basal layer of endometrium
- Placenta Adhaerens:
- Is more frequent in postterm pregnancy and in gestoses
- Is the result of structural-morphological changes of endometrium
- Is characterized with partial invasion of villous chorion to miometrium
- Is characterized with close attachment of villous chorion to decidua
- Is indication for hysterectomy
- 2.is the result of structural-morphological changes of endometrium
* 4.is characterized with close attachment of villous chorion to decidua
- Placenta accreta
- Is a common finding in gestosis
- May be complete and incomplete (partial)
- Is indication for manual separation and removal of placenta
- Is the result of structural-morphological changes of endometrium
- Is indication for hysterectomy
- 2.may be complete and incomplete (partial)
3. Is indication for manual separation and removal of placenta
* 4.is the result of structural-morphological changes of endometrium
* 5.is indication for hysterectomy
- True placenta accreta means:
- Close attachment of villous chorion to decidua
- Invasion of villous chorion to miometrium
- Villous chorion reaching serous membrane (perimetrium)
- Villous chorion developing in spongy layer of decidua
- 2.invasion of villous chorion to miometrium
* 3.villous chorion reaching serous membrane (perimetrium)
- In case of total placenta accreta
- Spontaneous separation of placenta is impossible
- Invasion of villous chorion to miometrium occurrs
- Bleeding is usually absent
- It is always associated with bleeding in the 3-rd period of labor
- Hysterectomy is indicated
- 1.spontaneous separation of placenta is impossible
* 2.invasion of villous chorion to miometrium occurrs
* 3.bleeding is usually absent
* 5.hysterectomy is indicated
- Major etiological factors of placenta adhaerens and placenta accreta include:
- Post term pregnancy
- Gestosis
- Structural-morphological changes of endometrium
- Chronic hypertension, renal disease
- Increased proteolytic chorionic activity
- 3.structural-morphological changes of endometrium
* 5.increased proteolytic chorionic activity
- Indications for hysterectomy include:
- Placenta adhaerens
- Partial placenta accreta
- Placenta praevia
- Uterine atonic bleeding
- 2.partial placenta accreta
* 4.uterine atonic bleeding
- Bleeding in early postpartum period may be due to:
- Soft tissues lacerations of the birth channel
- Hypotonic or atonic uterus
- Preterm detachment of normally located placenta
- Placenta praevia
- Congenital or acquired coagulopathy
- 1.soft tissues lacerations of the birth channel
* 2.hypotonic or atonic uterus
* 5.congenital or acquired coagulopathy
- Necessary steps in case of bleeding in early postpartum period are:
- To empty urinary bladder
- To begin restoration of the lost blood volume
- To perform manual exploration of the uterine cavity and outer-inner massage
- To use uterotonics
- Immediately to perform laparotomy in case of atony
- 1.to empty urinary bladder
* 2.to begin restoration of the lost blood volume
* 3.to perform manual exploration of the uterine cavity and outer-inner massage
* 4.to use uterotonics
* 5.immediately to perform laparotomy in case of atony
- Prolonged missed labor (intrauterine fetal death)
- May lead to hypotonic bleeding
- May cause anomalous placental attachment
- Can lead to maternal intoxication
- May lead to transition of tissue thromboplastin substances to maternal blood circulation
- May be etiological factor of coagulopatic haemorrhage
- 4.may lead to transition of tissue thromboplastin substances to maternal blood circulation
* 5.may be etiological factor of coagulopatic haemorrhage
- Bi-manual massage of the uterus (fist massage)
- Is performed in case of hypotonic bleeding
- Is used in case of uterine rupture
- Is one of the methods for restoration of contractile uterine capacity
- Is used in the cases of pathological placental attachment
- Ensures the process of placental separation
- 1.is performed in case of hypotonic bleeding
* 3.is one of the methods for restoration of contractile uterine capacity
- Abuladze (Bayer) maneuver
- Is indicated in case of placenta adherens
- Should be performed after external massage of the uterus
- Is used in case of hypotonic hemorrhage
- Is to be used for delivery of placenta if signs of placental separation are positive
- Is one of the methods for assisted placental delivery
- 4.is to be used for delivery of placenta if signs of placental separation are positive
* 5.is one of the methods for assisted placental delivery
- Operation “Manual exploration of the uterine cavity walls” is indicated in case:
- Of vaginal bleeding in combination with negative signs of placental separation
- 30 m after postpartum period if signs of placental separation are negative
- Hypotonic hemorrhage
- Of retained placental fragments
- Suspicion on retained placental fragment
- 3.hypotonic hemorrhage
* 4.of retained placental fragments
* 5.suspicion on retained placental fragment
- Pregnant women with the uterine scars should be hospitalized:
- at the first antenatal visit
- at the age of 26-28 wks
- at 32-34 wks
- not less than 2 wks before expected date of delivery
*4.not less than 2 wks before expected date of delivery
- Symptoms of threatened uterine rupture in case of cephalo-pelvic disproportion include:
- Uneasy behavior
- Sudden cessation of uterine contractions
- Oedema of the anterior cervical “lip”
- Difficulties of spontaneous micturition
- Contraction ring at the level of umbilicus (navel)
- 1.uneasy behavior
* 3.oedema of the anterior cervical “lip”
* 4.difficulties of spontaneous micturition
* 5.contraction ring at the level of umbilicus (navel)
- Actual complete uterine rupture is characterized with:
- Development of flabbiness, lethargy
- Difficulty in palpation of small fetal parts
- Abdominal distention
- Intrauterine fetal death
- Hypertonic uterine dysfunction
- 1.development of flabbiness, lethargy
* 3.abdominal distention
* 4.intrauterine fetal death
- Perineal laceration:
- Usually occurs suddenly
- Is impossible to forecast
- Commonly begins from the region of fourchette
- Is more common in primiparas
- May lead to serious consequences for women’s health
- 3.commonly begins from the region of fourchette
* 4.is more common in primiparas
* 5.may lead to serious consequences for women’s health
- Perineal lacerations occur:
- Most commonly in the 3rd degree
- Approximately in 20-30% of all labors
- More frequently in cases of ‘high’ perineum
- More commonly in elderly primiparas (> 30 yr)
- More frequently in postterm delivery
- 3.more frequently in cases of ‘high’ perineum
* 4.more commonly in elderly primiparas (> 30 yr)
* 5.more frequently in postterm delivery
- Perineal damage is defined as the 2-nd degree laceration if it involves:
- The fourchette and perineal skin
- The mucosa, the skin, the fascia and muscles of the perineal body
- The rectal mucosa
- The anal sphincter
- If the length of laceration exceeds 3 cm
*2. The mucosa, the skin, the fascia and muscles of the perineal body
- Perineal damage is defined as the 3-rd degree laceration if:
- The length of laceration exceeds 3 cm
- The mucosa, the skin, the fascia and muscles of the perineal body are involved
- The rectal mucosa is involved
- If laceration goes deeply to paravaginal fat tissue
*3.the rectal mucosa is involved
- Cervical lacerations are more common for:
- Precipitate labors
- Cervical dystocia
- For primiparas of 20-24 yr
- Labors of LOA (left occipitum anterior) variants
- For contracted pelvises
- 1.precipitate labors
* 2. Cervical dystocia
- Cervical lacerations may cause:
- Uterine prolapse
- Puerperal sepsis
- Preterm labors
- Development of precancerous lesions of cervix
- Fetal malpositions during next gestations
- 2.puerperal sepsis
* 3.preterm labors
* 4.development of precancerous lesions of cervix
- Vaginal wall lacerations:
- Are more common for precipitate labors
- Are more common with large fetuses
- More frequently occur in the upper third part of vagina
- May lead to profuse hemorrhages
- Are repaired with silk sutures
- 1.are more common for precipitate labors
* 2.are more common with large fetuses
* 4.may lead to profuse hemorrhages
- In modern obstetrics the most common variant of CS is:
- Corporal CS
- CS in lower uterine segment
- Vaginal CS
- Extraperitoneal CS
- Sectio caesarea parva
*2.CS in lower uterine segment
- Delivering obstetrical operations include:
- CS
- Perineotomy
- Application of the forceps or vacuum-extraction
- Craniotomy
- Amniotomy
- 1.CS
* 2.perineotomy
* 3.application of the forceps or vacuum-extraction
- Indications for CS include:
- Complete placenta praevia
- Breech presentation
- Contracted pelvis of 3-4 degree
- Uterine scar insufficiency
- Threatened uterine rupture
- 1.complete placenta praevia
* 3.contracted pelvis of 3-4 degree
* 4.uterine scar insufficiency
* 5.threatened uterine rupture
- Obstetrical forceps:
- Are used for finishing labors
- May be used at the end of the 1-st period of labor
- Afford to exclude the need for bearing down
- Are used for correction of the head engagement
- Afford to change fetal position and visus
- 1.are used for finishing labors
* 3.afford to exclude the need for bearing down
- Among the prerequisites for forceps applications are:
- Alive fetus
- Intact fetal membranes
- Large fetal head segment engaged to the small pelvis inlet
- Full dilation of the uterine os
- Normal pelvic dimensions
- 1.alive fetus
* 4.full dilation of the uterine os
* 5.normal pelvic dimensions
- Indications for the forceps application may include:
- Cephalo-pelvic disproportion
- Intrauterine fetal death
- Secondary hypotonic uterine dysfunction
- Preeclampsia
- Preterm labor
- 2.intrauterine fetal death
* 3.secondary hypotonic uterine dysfunction
* 4.preeclampsia
- The trial traction during forceps application
- Affords to determine necessary traction force to be applied
- Is performed to determine the level of the head station
- Affords to determine the correctness of the forceps application
- Requires special localization of the operator’s hands
- 3.affords to determine the correctness of the forceps application
* 4.requires special localization of the operator’s hands
- Indications for perineotomy include:
- Threatened perineal rupture
- Fetal hypoxia
- Secondary hypotonic uterine dysfunction
- Intranatal fetal death
- Cephalo-pelvic disproportion
- 1.threatened perineal rupture
* 2.fetal hypoxia
* 3.secondary hypotonic uterine dysfunction
- Indications for decapitation are:
- Neglected transverse fetal lie
- Transverse fetal lie complicated with threatened uterine rupture
- Breech presentation complicated with intranatal fetal death
- Hydrocephaly
- Antenatal death of the fetus in cephalic presentation
*1.neglected transverse fetal lie
- The 1-st elective hospitalization in gestations complicated with cardiovascular disease is indicated:
- In the I trimester (before 12 wks)
- In case of aggravation of the condition
- If there is some associated obstetrical complication
- At the age of 28-32 wks
- If there are signs of cardiovascular insufficiency
*1.in the I trimester (before 12 wks)
- In women where pregnancies are associated with chronic hypertension there is increased risk of:
- Early toxicosis
- Gestosis
- Spontaneous preterm pregnancy termination
- Intrauterine growth restriction
- Anomalous placental attachment
- 2.gestosis
* 3.spontaneous preterm pregnancy termination
* 4.intrauterine growth restriction
- Postural hypotensive syndrome (Vena cava inferior- syndrome):
- is more common in primigravidas
- May be cured with caffeine, cordiamine, mesaton
- Is manifested with severe fall of BP, tachycardia, and skin pallor
- Occurs at the late stages of pregnancy in the position on the back
- Is relieved in the left recumbent position
- 3.is manifested with severe fall of BP, tachycardia, and skin pallor
* 4.occurs at the late stages of pregnancy in the position on the back
* 5.is relieved in the left recumbent position
- Proper management of labor in pregnancies complicated with chronic hypertension includes:
- Preterm amniotomy
- Term amniotomy
- Labor analgesia
- I/V use of the magnesium sulphate
- Use of uterotonics
- 1.preterm amniotomy
* 3.labor analgesia
- Etiological factors of the fetal malposition include:
- Contracted pelvis
- Polyhydramnios
- Mullerian duct anomalies
- Multifetal pregnancy
- Placenta praevia
- 1.contracted pelvis
* 2.polyhydramnios
* 3.Mullerian duct anomalies
* 4.multifetal pregnancy
* 5.placenta praevia
- Symptoms of the fetal malposition are:
- Excessive symhysiofundal height
- High station of the presenting fetal part
- Absence of the presenting part above the small pelvis inlet
- fetal head palpated at the uterine fundus
- Enlargement of the uterine transverse dimensions
- 3.absence of the presenting part above the small pelvis inlet
* 5.enlargement of the uterine transverse dimensions
- Classical maneuvers for breech deliveries:
- Are not used in modern obstetrics
- Include two steps: assisted delivery of arms followed by delivery of the head
- Are performed in time of buttocks crowning
- Are performed only with maternal indications
- Are performed after delivery of lower angle of the anterior scapula if pushing down activity is ineffective
- 2.include two steps: assisted delivery of arms followed by delivery of the head
- 5.are performed after delivery of lower angle of the anterior scapula if pushing down activity is ineffective
- Tzovjanoff manoeuvre in clear breech presentation:
- Affords to prevent fetal expulsion until full uterine os dilation
- Allows to maintain normal fetal attitude
- allows to convert clear breech presentation into mixed or leg (footling) presentation
- Does not require perineotomy
- Allows to prevent extension of the arms
- 2.allows to maintain normal fetal attitude
* 5.allows to prevent extension of the arms
- Tzovjanoff maneuver in footling breech presentation
- Allows maintaining normal fetal attitude
- Affords to prevent preterm delivery of the legs
- Allows to convert footling breech presentation into mixed presentation
- Reduces the rate of fetal obstetrical traumas
- Affords to prevent extension of the arms
- 2.affords to prevent preterm delivery of the legs
* 3.allows to convert footling breech presentation into mixed presentation
* 4.reduces the rate of fetal obstetrical traumas
- Classical inner-outer (bimanual) obstetrical version on the leg may be performed only in case of:
- Full dilation of the uterine os
- Ruptured fetal membranes
- Intact fetal membranes
- Sufficient motility of the child
- Fetal size being relevant to the pelvic size (adequate)
- 1.full dilation of the uterine os
* 2.ruptured fetal membranes
* 4.sufficient motility of the child
* 5.fetal size being relevant to the pelvic size (adequate)
- Etiological factors of transverse fetal lie include:
- Mullerian duct anomalies
- Contracted pelvis
- Gestosis
- Polyhydramnios
- Contracted pelvis
- 1.Mullerian duct anomalies
* 2.contracted pelvis
* 4.polyhydramnios
* 5.contracted pelvis
- In case of transversal lie:
- Uterine fundus is higher than in longitudinal lie
- Uterine fundus is lower than in longitudinal lie
- Uterus is elongated in the transverse or oblique direction
- Fetal head is lower than iliac crest
- Presenting part is absent
- 2.uterine fundus is lower than in longitudinal lie
* 3.uterus is elongated in the transverse or oblique direction
* 5.presenting part is absent
- In case of neglected transverse lie of the dead fetus
- Uterine rupture is possible
- There is a high risk of septic complications
- General narcosis is essential
- The only mode of delivery - CS
- Fetus-destructive operation is indicated
- 1.uterine rupture is possible
* 2.there is a high risk of septic complications
* 3.general narcosis is essential
* 5.fetus-destructive operation is indicated
- Maurecau-Levret maneuver:
- Is used in the frame of classical maneuver
- Is used for assisted delivery of the arms and head
- Is used for delivery of aftercoming head in breech presentations
- Is part of the Tzovjanoff maneuver
- 1.is used in the frame of classical maneuver
* 3.is used for delivery of aftercoming head in breech presentations
- Anterior asinclitism:
- Is defined as A. of Litzmann
- Is defined as A. of Negele
- Occurs during labor in women with plane pelvises
- Is diagnosed when sagittal suture has deviated anteriorly
- Is diagnosed at the time of crowning
- 2.is defined as A. of Negele
* 3.occurs during labor in women with plane pelvises
- Anomalous uterine activity includes:
- Primary hypotonic dysfunction of labor forces
- Secondary hypotonic dysfunction of labor forces
- Precipitate labor
- Discoordinated uterine function
- Pathological preliminary period
- 1.primary hypotonic dysfunction of labor forces
* 2.secondary hypotonic dysfunction of labor forces
* 3.precipitate labor
* 4.discoordinated
- Primary hypotonic dysfunction:
- Can be an indicaton for CS
- Is usually diagnosed in the first period of labor
- Can be an indication for labor stimulation
- Can be associated with retarded rupture of amniotic membranes
- Can be diagnosed within 2 hours from the labor onset
- 1.can be an indicaton for CS
* 2.is usually diagnosed in the first period of labor
* 3.can be an indication for labor stimulation
- Secondary hypotonic uterine dysfunction:
- Can be often seen in case of preterm labor
- Is mostly seen in case of large fetus
- Can be complicated with fetal hypoxia
- Is a common complication in case of flexed attitude
- Can be complicated with tissue necrosis
- 2.is mostly seen in case of large fetus
* 3.can be complicated with fetal hypoxia
* 5.can be complicated with tissue necrosis
- Precipitate labor
- Is the most often seen type of abnormal uterine activity
- Results in uterine-placental blood flow disorders
- Can result in fetal intracranial injuries
- Can be complicated with hypotonic haemorrhage in early puerperal period
- 2.results in uterine-placental blood flow disorders
* 3.can result in fetal intracranial injuries
* 4.can be complicated with hypotonic haemorrhage in early puerperal period
- Discoordinated uterine function
- is rarely diagnosed
- can manifest as a lower uterine section dominance
- can manifest as cervical dystocia
- manifests in dilation arrest
- requires administration of uterotonics
- 1.is rarely diagnosed
* 2.can manifest as a lower uterine section dominance
* 3.can manifest as cervical dystocia
* 4.manifests in dilation arrest
- For labor stimulation, which of the following can be used?
- Intravenous bolus injection of 5 units’ oxytocin with 20 ml 40 % glucose solution
- Intravenous drop by drop injection of 20 units oxytocin with 500 ml 5 % glucose solution
- Intravenous drop by drop injection of 5 units oxytocin with 500 ml 5 % glucose solution, starting with 8-10 drops per minute
- Intravenous injection of 1ml 0, 02% methylergometrin solution
- Intravenous drop by drop injection of 0,5mg enzaprost with 300-500 ml 0, 9% NaCl, starting with 8-10 drops per minute
- 3.intravenous drop by drop injection of 5 units oxytocin with 500 ml 5 % glucose solution, starting with 8-10 drops per minute
* 5.intravenous drop by drop injection of 0,5mg enzaprost with 300-500 ml 0, 9% NaCl, starting with 8-10 drops per minute
- Narcotics usage
- Is indicated for some types of hypotonic dysfunction treatment
- Is indicated for precipitate labor treatment
- Is indicated for the second period of labor analgesia
- Can influence the fetus state
- 1ml 2% solution of promedol can fully stop the labor activity
- 1.is indicated for some types of hypotonic dysfunction treatment
* 2.is indicated for precipitate labor treatment
* 4.can influence the fetus state
- Cephalo-pelvic disproportion (clinically contracted pelvis) is usually diagnosed:
- at the onset of the first period of labor
- in case of negative Vasten sign
- during pregnancy
- at the moment of total or nearly total dilation
- on detecting the specific uterine shape
*4.at the moment of total or nearly total dilation
- The cephalo-pelvic disproportion (clinically contracted pelvis) diagnosis is based on:
- The results of external pelvic diameters measurement
- Diagonal conjugate measurement
- Diameters of Michaelis rhomboid measurement
- Internal pelvic surfaces palpation
- X-ray pelvimetry
- 1.the results of external pelvic diameters measurement
* 2.diagonal conjugate measurement
* 3.diameters of Michaelis rhomboid measurement
* 4.internal pelvic surfaces palpation
* 5.X-ray pelvimetry
- Pregnant women with signs of cephalo-pelvic disproportion (clinically contracted pelvis):
- Should be hospitalized in obstetrical in-patient department 2 weeks before labor
- Can be delivered only with CS
- Should be kept under maternity welfare centre observation before labor
- Pregnancy in these women must be interrupted at early stages
- Should undergoes ultrasound before labor
- 1.should be hospitalized in obstetrical in-patient department 2 weeks before labor
* 5.should undergoes ultrasound before labor
- Anatomically contracted pelvis can be diagnosed if:
- C. vera is 10 cm or less
- C. diagonalis is 13 cm
- C. externa is 20-21cm
- Vertical diameter of Michaelis rhomboid is 11cm
- All the large pelvis diameters are 2 cm less than normal
- 1.C. vera is 10 cm or less
* 5.all the large pelvis diameters are 2 cm less than normal
- Labor management in women with anatomically contracted pelvis requires:
- Pelvis shape and degree of contraction assessment
- Average circumference of the wrist (Solovev’s index) determination
- Determination of the expected birth weight
- Early amniotomy
- Vasten sign determination
- 1.pelvis shape and degree of contraction assessment
* 2.average circumference of the wrist (Solovev’s index) determination
* 3.determination of the expected birth weight
* 5.Vasten sign determination
- In case of anatomically contracted pelvis the fetus can have the following complications in labor:
- Cephalohaematoma
- Pathologic head configuration
- Fetal hypoxia
- Intracranial injury
- Respiratory distress syndrome (RDS)
- 1.cephalohaematoma
* 2. Pathologic head configuration
* 3.fetal hypoxia
* 4.intracranial injury
- Simple flat pelvis is characterized by:
- Direct small pelvis inlet diameter decreased
- All pelvic diameters decreased
- All direct diameters decreased
- Transverse small pelvis outlet diameter decreased
- Normal transverse small pelvis diameters
- 3.all direct diameters decreased
* 5.normal transverse small pelvis diameters
- Anatomically contracted pelvis can result from:
- rickets
- congenital abnormalities of the pelvic bones
- poliomyelitis
- bone tuberculosis
- vertebral column injury
- 1.rickets
* 2.congenital abnormalities of the pelvic bones
* 3.poliomyelitis
* 4.bone tuberculosis
* 5.vertebral column injury
- Labor in case of anatomically contracted pelvis is characterized by:
- High frequency of intracranial injuries in newborns
- High per cent of surgical interference
- High incidence of prenatal death
- High frequency of tissue injuries
- Prolonged duration
- 1.high frequency of intracranial injuries in newborns
* 2.high per cent of surgical interference
* 4.high frequency of tissue injuries
* 5.prolonged duration
- CS is indicated in case of the first degree pelvic contraction associated with:
- Post-term pregnancy
- Large fetus
- Young primipara
- IUGR
- Breech presentation
- 1.post-term pregnancy
* 2.large fetus
3. Young primipara
4. IUGR
* 5.breech presentation
- In case of the third degree pelvic contraction one of the following is indicated:
- CS
- Application of obstetrical forceps
- Perforation of the head (craniotomy)
- Perineotomy
- Vacuum extraction of the fetus
*1.CS
- Cephalo- pelvic disproportion can result from
- large fetus
- abnormal cephalic engagement (attitude)
- placenta praevia
- uterine scar
- hydrocephaly
- 1.large fetus
* 2.abnormal cephalic engagement (attitude)
* 5.hydrocephaly
- the most common signs of cephalo-pelvic disproportion include:
- lack of fetus head movement after complete uterine cervix dilation
- hypotonic dysfunction
- positive or equivocal Vasten sign
- difficulties of micturition
- 1.lack of fetus head movement after complete uterine cervix dilation
* 3.positive or equivocal Vasten sign
* 4.difficulties of micturition
- Vasten sign should be assessed
- at the onset of labor
- after rupture of amniotic membrane
- when uterine cervix dilation is 4 cm
- when uterine dilation is complete or almost complete
- when the fetal head is fixed to the small pelvis inlet
- 2.after rupture of amniotic membrane
* 4.when uterine dilation is complete or almost complete
* 5.when the fetal head is fixed to the small pelvis inlet
- In case of immunological conflict between mother and fetus labor can be complicated with:
- Preterm rupture of membranes
- Uterine rupture
- Bleeding in the third period of labor
- Intranatal fetal death
- Fetal hypoxia
- 4.intranatal fetal death
* 5.fetal hypoxia
- Fetal hypoxia can be diagnosed with the help of
- auscultation 2. cardiotocography
- zaling test
- x-ray
- 1.auscultation
- 2.cardiotocography
* 3.Zaling test
- 2.cardiotocography
- Neonatal hemolytic disease is characterized by:
- hyperbilirubinaemia
- narrowed cranial sutures and fontanel
- general oedema
- paleness and/or jaundice
- cardiovascular and respiratory disorders
- 1.hyperbilirubinaemia
* 3.general oedema
* 4.paleness and/or jaundice
* 5.cardiovascular and respiratory disorders
- Basic resuscitation measures for infants born in asphyxia include:
- Airways toilet
- Intubation and artificial lung ventilation
- Oxygenotherapy
- Drugs injection
- External cardiac massage
- 1.airways toilet
* 2.intubation and artificial lung ventilation
* 3.oxygenotherapy
4. Drugs injection
* 5.external cardiac massage
- Neonatal haemolytic disease results from
- AB0 system antigens sensitization
- Intrauterine infection
- Chronic fetal hypoxia in case of gestosis
- Leucocytes antigens sensitization
- Rhesus-antigenes sensitization
- 1.AB0 system antigens sensitization
* 5.rhesus-antigenes sensitization
- Fetal hemolytic disease is characterized by:
- total bilirubin elevation
- total protein decrease
- haemoglobin reduction
- erythroblastosis
- increased in erythrocytes
- 1.total bilirubin elevation
* 2.total protein decrease
* 3.haemoglobin reduction
* 4.erythroblastosis
- To assess the fetal state in rhesus-negative women you can use:
- amniotic fluid evaluation
- ultrasonography
- cardiomonitoring
- amnioscopy
- colposcopy
- 1.amniotic fluid evaluation
* 2.ultrasonography
* 3.cardiomonitoring
* 4.amnioscopy
- Infectiouse deseases of the newborns include:
- Pyoderma
- Folliculitis
- Pemphigus
- Omphalitis
- Toxic erythema
- 1.pyoderma
* 2.folliculitis
* 3.pemphigus
* 4.omphalitis
- the most common types of fetal birth injury include:
- Dushenn-Erb paralysis
- Fractured clavicle
- Cephalohaematoma
- Auditory nerve injury
- Facial nerve palsy
- 1.Dushenn-Erb paralysis
* 2.fractured clavicle *3.cephalohaematoma
* 5.facial nerve palsy
- The first stage of puerperal septic process according to Sazonov-Bartels classification includes:
- Endometritis
- Pelvic trombophlebitis
- Parametritis
- Lower extremities veins trombophlebitis
- Puerperal ulcer
- 1.Endometritis
* 5.puerperal ulcer
- The second stage of puerperal septic process according to Sazonov-Bartels classification includes:
- puerperal ulcer
- parametritis
- pelvic trombophlebitis
- salpingoophoritis
- pelvioperitonitis
- 2.parametritis
* 3.pelvic trombophlebitis
* 4.salpingoophoritis
* 5.pelvioperitonitis
- The typical symptoms of serous mastitis include:
- acute onset
- manifestation on the 6-8 week of the puerperium
- general malaise, headache
- mammary gland engorgement and involvement in the process
- pain in mammary gland
- 1.acute onset
* 3.general malaise, headache
* 4.mammary gland engorgement and involvement in the process
* 5.pain in mammary gland
- Infiltrative form of mastitis:
- Results from serous mastitis in 2-3 weeks
- Can be diagnosed in case of fluctuation in the mammary gland tissue
- Is characterized only by local symptoms
- Is an indication for surgical treatment
- Often results from inadequate therapy of serous mastitis
*5.often results from inadequate therapy of serous mastitis
- Lactation supression is indicated in:
- mastitis gangrenosa
- relapsing forms of mastitis
- infiltrative form of mastitis
- mammary gland abscess
- rapid progression of mastitis
- 1.mastitis gangrenosa
* 2.relapsing forms of mastitis
* 4.mammary gland abscess
* 5.rapid progression of mastitis
- the most adequate medication for lactation supression is:
- spironolactone
- monobromated camphor
- parlodel
- synaestrol
- progesterone
*3.parlodel
- The term “puerperal ulcer” can be used for contaminated:
- perineum wounds
- uterine cervix injuries
- vaginal injuries
- laparotomy wounds
- nipple cracks
- 1.perineum wounds
* 2.uterine cervix injuries
* 3.vaginal injuries
- Mini-abortion:
- Can be performed in the out-patient unit
- Can be performed in case of less than 3 weeks delay of menstruation
- Can be performed after cervical channel dilation with Hegar dilator ¹8
- Is performed with curette ¹2
- isn’t associated with any complications
- 1.can be performed in the out-patient unit
* 2.can be performed in case of less than 3 weeks delay of menstruation
- A doctor can refuse to perform an abortion in case of:
- Cervical ectopy
- Uterine fibroid
- HIV-carrier
- Gonococcus determined in cervical smear
- Chronic infection of any localization
*4.gonococcus determined in cervical smear
- Prolonged pregnancy is characterized by:
- Duration above 280 days from the ovulation
- Fetoplacental insufficiency detected
- Immature baby birth
- Polyhydramnios
- Oligohydramnios
*1.duration above 280 days from the ovulation
- To diagnose post term pregnancy one can use:
- pregnancy age determination according to the anamnesis
- oxytocin Smith test
- ultrasound
- colpocytology
- 1.pregnancy age determination according to the anamnesis
* 3.ultrasound
* 4.colpocytology
- Classical post mature baby syndrome includes:
- Palm and feet skin maceration
- Vernix caseosa absence
- Long nails
- Cellular tissue oedema
- Cranial sutures and fontanel narrowed
- 1.palm and feet skin maceration
* 2.vernix caseosa absence
* 3.long nails
4. Cellular tissue oedema
* 5.cranial sutures and fontanel narrowed
- Post term delivery is characterized by:
- untimely rupture of the amniotic membranes
- cephalo-pelvc disproportion
- precipitate labor
- fetal hypoxia
- maternal trauma
- 1.untimely rupture of the amniotic membranes
* 2.cephalo-pelvc disproportion
* 4.fetal hypoxia
* 5.maternal trauma
- Glomerulonephritis in pregnancy
- Is usually seen in acute forms
- Is one of the etiological factors of placenta praevia
- Is complicated with gestosis at early stages of gestation
- Isn’t usually followed with IUGR
*3.is complicated with gestosis at early stages of gestation
- Gestational pyelonephritis
- is usually seen in the second part of pregnancy
- is more common on the left side
- is usually due to streptoccocus
- Doesn’t affect erythropoesis
*1.is usually seen in the second part of pregnancy
- A medication that is ungrounded and contraindicated for the treatment of threatened preterm termination of pregnancy:
- dexamethasone
- magnesium sulphate
- gynipral (B-mymetics)
- seduxen
- ovidone
*5.ovidone
- Resuscitation measures in case of amniotic fluid embolism include:
- Artificial lung ventilation
- Massive antibiotic therapy
- DIC syndrome prevention
- Pulmonary edema prevention
- High doses of corticosteroids
- 1.artificial lung ventilation
2. Massive antibiotic therapy
* 3.DIC syndrome prevention
* 4.pulmonary edema prevention
* 5.high doses of corticosteroids
- Pregnant women with diabetes can:
- Have insulin therapy
- Have preparations of sulfur group
- Take biguanids (áèãóàíèäû)
- Follow a diet with reduction in proteins
- Follow a diet with reduction in fats and carbohydrates
- 1.have insulin therapy
* 5.follow a diet with reduction in fats and carbohydrates
- the most common forms of fetal hemolytic disease are:
- Oedematic
- Icteric
- Anemic
- Haemorrhagic
- Convulsive
- 1.oedematic
* 2.icteric
* 3.anemic
- In case of no signs of placental separation and absence of bleeding one should attempt to perform manual separation and removal of the placenta after:
- 2 h
- 1,5 h
- 1 h
- 30 m
- 15
*4.30 m