Obstetrics- Labor & Delivery

Question 1

Fetal HR tracing Category I

Answer 1

Baseline: 110-160
Moderate variability (6-25)
No late/ variable decelerations 
± Early decelerations 
± Accelerations

Question 2

Fetal HR tracing Category III

Answer 2

Absent variability + ≥1 of the following:

• Recurrent late decelerations
• Recurrent variable decelerations
• Bradycardia

OR

Sinusoidal Pattern

Question 3

Significance of FHR cat I vs III

Answer 3

FHR category I: low risk for fetal hypoxia

Category III: ↑Risk severe fetal hypoxia, hypoxic brain injury or demise

Question 4

Management of Fetal HR tracing Category !!! findings:

Answer 4

Initial: maternal repositioning, intrauterine resuscitative interventions (O2, IV fluids, stop uterotonics)

Not responsive: Vacuum -assisted delivery (complete dilation) or Csec

Question 5

Why should uterotonic de discontinued in FHR category III

Answer 5

They augment strength and frequency of contractions, worsening uteroplacental blood flow and further comporting fetal oxygenation.

Question 6

When is amnioinfusion appropriate treatment for FHR category III

Answer 6

In recurrent variable decelerations

Amnioinfusion relieved umbilical cord compression that causes variable decelerations.

Question 7

Describe variable decelerations

Answer 7

± Association w/ contractions
Abrupt ( <30sec from onset to nadir)
Duration: 15sec-2min
Frequency: ≥ 15min

Question 8

Causes of variable decelerations

Answer 8

Cord compression
Oligohydramnios
Cord Prolapse

Question 9

Describe Early decelerations

Answer 9

Due to compression of head during contraction.

Onset to Nadir ≥ 30 sec
Nadir aligns with peak contraction

Question 10

Describe Late decelerations

Answer 10

Deceleration begins after peak contraction

Onset to Nadir ≥30sec

Question 11

Cause of absent or minimal variability

Answer 11

Fetal metabolic acidosis
Opioids (transient)
Fetal hypoxia
Intraamniotic Fluid infection

Question 12

Opioids and fetal changes

Answer 12

Fetal CNS depression
Decreased frequency of accelerations
Transient absent/ minimal variability

Question 13

Fetal occiput posterior position and FHR tracing changes

Answer 13

Increases rate of early decelerations of to greater head compression (face up to pelvic bone)

Question 14

Evaluation of possible preterm pre labor rupture of membranes

Answer 14

Evaluate fetal well being with a non stress test (NST). Normal NST is ≥2 FHR accelerations. A nonreactive NST requires Biophysical profile.

Question 15

Biophysical Profile

Answer 15

1. NST plus
U/S assessment of: 
2. Amnio volume 
3. Fetal Breathing movement 
4. Fetal movement
5. Fetal tone 

0 or 2 points per category. 8+ = normal

Question 16

Management of Nonreactive NST and a 8 biophysical profile

Answer 16

reassurance and routine care

Question 17

What patentees require 24hr continuers monitoring

Answer 17

pts at continued risk for acute fetal deteriorations.
Maternal Abd trauma
Bleeding Placenta previa

Question 18

Equivocal biophysical profile and management

Answer 18

score of 6/10

Use contraction stress test to asses fetal well-being.

Question 19

Shoulder dystocia

Answer 19

inability to deliver the fetal shoulders with usual obstetric maneuvers after fetal head delivers

Question 20

Complications of shoulder dystocia

Answer 20

**obstetric emergency**
Neonatal brachial plexus injury
Clavicular and humeral facture
Hypoxic brain injury
Death

Question 21

Risk factors for shoulder dystocia

Answer 21

Major risk factor: Fetal macrosomia

Other factors (↑ fetal weight): 
post-term pregnancy 
maternal obesity
gestational DM
XS pregnancy weight gain

Question 22

Warning signs of shoulder dystocia

Answer 22

Prolonged first or second stage of labor 
Turtle sign (retraction of fetal head into perineum after delivery)