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OBSTETRICS and GYNE > PRENATAL CARE > Flashcards

PRENATAL CARE Flashcards

1
Q

Complications of cordocentesis

A

Cord vessel bleed
Fetal maternal bleed
Fetal bradycardia
Fetal loss

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2
Q

Amniocentesis complications

A

Fetal loss

Amniotic leak

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3
Q

Chorionic villous sampling indication

A

Karyotyping

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4
Q

Chorionic villous sampling complications

A

Fetal loss
Limb reduction defects
Oromandibular limb hypoplasia

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5
Q

Amniocentesis (15-20 wks) indications

A

Karyotyping
FISH
Relieves hydramnios

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6
Q

Fetal blood sampling (cordocentesis) indication

A

Fetal anemia

Tx of platelet alloimmunization

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7
Q

Conditions which increased hCG

A 
Multiple pregnancy
Molar pregnancy 
Exogenous injection
Impaired renal clearance
hCG secreting tumors from GI, ovary, bladder, lungs
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8
Q

What produced hCG

A

Syncytiotrophoblasts

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9
Q

Sonographic recognition of gestation sac begins at

A

4-5 weeks

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10
Q

Sonographic recognition of yolk sac begins at

A

5-6 weeks

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11
Q

What does the presence of fetal Yolk sac indicate?

A

Intrauterine location

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12
Q

Sonographic recognition of embryonic pole with cardiac motion begins at

A

6 weeks

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13
Q

Sonographic recognition of crown-rump length begins at

A

Up to 12 weeks

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14
Q

What does crown-rump length indicate?

A

AOG within 4 days

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15
Q

Most accurate tool for gestational age assignment

A

Crown-rump length

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16
Q

Fetal heart sounds can be heard by doppler at

A

10 weeks

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17
Q

Fetal heart sounds can be heard with stethoscope at

A

16 weeks

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18
Q

Recommended weight gain for underweight (BMI <18.5)

A

12.5 to 16 kgs
28 to 40 lbs
1 lb/week

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19
Q

Recommended weight gain for Normal (BMI 18.5 to 24.9)

A

11.5 to 16 kgs
25 to 35 lbs
1 lb/week (0.8-1 kg)

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20
Q

Recommended weight gain for Overweight (BMI 25-29.9)

A

7 to 11.5 kg
15 to 25 lb
0.6 lb/week

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21
Q

Recommended weight gain for Obese (BMI 30 and up)

A

5 to 9.1 kg
11 to 20 lb
0.5 lb/wk

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22
Q

RDA calories

A

100-300 kcal/day

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23
Q

RDA protein

A

5-6 g/day

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24
Q

RDA iron

A

27 mg/day (low risk)

60-100 mg/day in large women, twin, anemia

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25
Q

RDA iodine

A

220 ug/day

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26
Q

Cretinism is associated with which mineral deficiency?

A

Iodine

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27
Q

RDA calcium

A 
900 mg (quart of milk)
1000 mg (ages 19-50)
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28
Q

RDA folate for all women

A

400 mcg to prevent NTD

0.4 to 0.8 mg for ALL women

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29
Q

RDA folate for women with previous NTD baby

A

4 mg

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30
Q

RDA vitamin C

A

80-85 mg

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31
Q

Frequency of prenatal check up

A

Monthly until 28 wks
Every 2 wks until 36 wks
Every wk until term

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32
Q

Total weight gain in Underweight (BMI <18.5)

A

Single - 28-40

Twins

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33
Q

Total weight gain in normal (BMI <18.5 to 24.9)

A

Single: 25 to 35 lbs
Twins: 37 to 54 lbs

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34
Q

Total weight gain in Overweight (BMI 25 to 29.9)

A

Single: 15 to 25 lbs
Twins: 31 to 50 lbs

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35
Q

Total weight gain in Obese (BMI 30)

A

Single 11 to 20

Twin: 25 to 42 lbs

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36
Q

Average weight gain in pregnancy

A
  1. 6 lbs

4. 8 kg

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37
Q

Weight loss at delivery

A

12 lbs

5.5 kg

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38
Q

Weight loss 2 to 6 wks postpartum

A
  1. 5 lbs

2. 5 kg

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39
Q

Weight loss 2 wks postpartum

A

9 lbs

4 kg

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40
Q

Average retained weight

A

3 lbs

1.4 kg

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41
Q

Caffeine intake

A

3 cups of 5 oz percolated coffee

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42
Q

Safe to travel until when?

A

36 wks AOG

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43
Q

Immunization schedule in pregnancy

A

Tdap (inactivated)
Influenza
Hep B

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44
Q

Vaccines contraindicated in pregnancy

A 
Measles
Mumps
Rubella
Varicella
HPV
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45
Q

Safe vaccines

A 
Rabies (killed)
Hep A
Pneumococcus (for asplenia, cardiac dse)
Meningococcus (outbreaks)
Varicella Ig (post exposure)
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46
Q

OGTT 75 is done at?

A

24 to 48 eeks

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47
Q

Hormon e which causes insulin resistance lipolysis, increased fatty acids

A

HPL

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48
Q

When to ask for BPP

A

24-28 weeks

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49
Q

Test of fetal health

A

Non stress test

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50
Q

Test of uteroplacental function

A

Contraction stress test

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51
Q

Negative NST

A

normal

Fetal heart acceleration in respons to fetal movement

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52
Q

Positive NST

A

Late decelerations following 50% or more of contractions

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53
Q

Negative CST

A

3 or more contractions
40 sec or more
10 mins
No late decelerations

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54
Q

What are the five components of BPP?

A 
Nonstress test
Fetal breathing
Fetal movement
Fetal tone
Amniotic fluid volume
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55
Q

Which component of the BPP may be omitted if the other four are normal

A

Nonstress test

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56
Q

Which component of BPP requires further evaluation, if abnormal, regardless of the BPP composite score?

A

Amniotic fluid volument

If largest vertical amniotic fluid pocket is less than 2 cm (score 0)

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57
Q

BPP scores

A

0 or 2

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58
Q

BPP interpretation

BPP score: 10

A

Normal, non-asphyxiated fetus

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59
Q

BPP interpretation

BPP score: 8/10 (normal AFV)

A

Normal, non-asphyxiated fetus

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60
Q

BPP interpretation

BPP score: 8/8 (NST not done)

A

Normal, non-asphyxiated fetus

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61
Q

BPP interpretation

BPP score: 8/10 (decreased AFV)

A

Chronic fetal asphyxia — DELIVER

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62
Q

BPP interpretation

BPP score: 6

A

Possible fetal asphyxia

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63
Q

BPP interpretation
BPP score: 6
AFV abnormal
What is the next best step?

A

Deliver

Possible fetal asphyxia

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64
Q 
BPP interpretation
BPP score: 6
AFV normal 
>36 wks AOG with favorable cervix
What is the next best step?
A

Deliver

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65
Q

BPP interpretation
BPP score: 6
REPEAT TEST 6 or Less
What is the next best step?

A

DELIVER

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66
Q

BPP interpretation
BPP score: 6
REPEAT TEST: >6
What is the next best step?

A

Observe and repeat
Weekly
TWICE weekly In DM and postterm

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67
Q

BPP score: 4
interpretation?
Intervention?

A

Probable fetal asphyxia

Repeat on the same day

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68
Q 
BPP score: 4 
Repeat test (same day): 6 or less
A

Deliver

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69
Q

BPP score 0-2

A

Almost certain asphyxia

Deliver

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70
Q

Hypoxia cascade in Biophysical score activity

A

Fetal heart reactivity *1st
Fetal breathing
Fetal movement
Fetal tone *last

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71
Q

Normal FHR

A

110-160 bpm

min of 2 minutes

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72
Q

Normal baseline variability

A

6-25 bpm (moderate)

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73
Q

Normal acceleration

At <32 weeks AOG

A

Acceleration more than 10 bpm from baseline
lasts for 10 secs
But <2 mins from onset

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74
Q

Normal Acceleration

At 32 weeks or more AOG

A

Acceleration more than 15 bpm from baseline
lasts for >15 secs
But <2 mins from onset

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75
Q

Prolonged acceleration

A

Lasts >2 minutes but <10

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76
Q

Baseline change

A

Acceleration lasts 10 mins or more

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77
Q

Early deceleration indicates

A

Fetal head compression

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78
Q

Late deceleration indicates

A

Uteroplacental insufficiency

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79
Q

Variable deceleration indicates

A

Umbilical cord occlusion

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80
Q

CTG tracing with onset, nadir and recovery of decelerations coincident with the beginning, peak and ending of a contraction, respectively

A

Early deceleration

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81
Q

Most common deceleration pattern

A

Variable

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82
Q

Describe a prolonged deceleration

A

Decrease in FHR if 15 bpm or more
Lasting 2 minutes or more
But less than 10 mins

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83
Q

CTG tracing with onset, nadir and recovery of decelerations varying with successive uterine contractions

A

Variable deceleration

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84
Q

CTG tracing with onset, nadir and recovery of decelerations occuring after the beginning, peak and ending of a contraction, respectively

A

Late deceleration

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85
Q

Increases ICP leading to deceleration

A

Fetal head compression

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86
Q

Stimulates chemoreceptors leading to decelerations

A

Decrease in uteroplacental O2 transfer

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87
Q

Visually apparent, smooth, sine wave like undulating pattern in FHR baseline with a cycle frequency if 3-5 bom which persists for 20 mins or more

A

Sinusoidal pattern

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88
Q

Category I CTG intervention

A

Routine monitoring

Normal fetal acid base status

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89
Q

Category II CTG intervention

A

Improve fetal O2 and uteroplacental blood floow
Diminish uterine activity
Relieve umbilical cord compression

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90
Q

Category III CTG intervention

A

Improve fetal O2 and uteroplacental blood floow
Diminish uterine activity
Relieve umbilical cord compression

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91
Q

Interventions to improve fetal oxygenation and uteroplacental blood flow involve

A

Lateral decubitus positioning
Maternal O2
Administer IV fluid bolus
Decrease oxytocin to reduce uterine contraction frequency

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92
Q

Interventions to diminish uterine activity

A

Discontinue oxytocin or prostaglandins
Give tocolytics
— terbutaline
— MgSO4

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93
Q

Interventions to relieve cord compression

A

Reposition mother
Amnioinfusion
If with prolapse, manually elevate the presenting part while preparing for immediate delivery

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94
Q

Of the four phases of parturition, phase 3 is characterized by which of the following?
A. Uterine activation, cervical ripening
B. Uterine contraction, cervical dilatation
C. Uterine quiescence, cervical softening
D. Uterine involution, cervical remodeling

A

B. Phase 3 Stimulation

A. 2 - activation
C. 1 - quiescence
D. 4 - parturient recovery

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95
Q

Which of the following cervical functions and events take place during phase 1 of parturition, EXCEPT?
A. Maintenance of cervical competence despite growing uterine weight
B. Maintenance of barrier between uterine contents and vaginal bacteria
C. Alteration in extracellular matrix to gradually increase cervical tissue compliance
D. Alteration of cervical collagen to stiffen the cervix

A

D. Alteration of cervical collagen to stiffen the cervix

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96
Q

Which stage of parturition corresponds to the clinical stages of labor

A

Phase 3

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97
Q

Lower segment thinning with concomitant upper segment thickening

A

Physiologic retraction ring

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98
Q

Bandl ring

A

Pathologic retraction ring

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99
Q

When thinning of the lower uterine segment is extreme

A

Bandl ring

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100
Q

Stage of fetal descent

10 cm to delivery

A

Second stage

101
Q

Weakest layer of placenta

A

Decidua spongiosa

102
Q

placental expulsion mechanism wherein blood from the placental site pours into the membrane sac and does not escape externally until extrusion of the placenta

A

Schultze mechanism

103
Q

placental expulsion mechanism wherein placenta separates first at the periphery and blood collects between the membranes and
escapes from the vaginal. The placenta descends sideways and its maternal surface appears first.

A

Duncan mechanism

104
Q

Signs of placental separation

A
  • fundus becomes globular and firm (Calkins sign)
  • Sudden gush of blood
  • elongation of cord
  • Uterus rises in the abdomen
105
Q 
A 39 week AOG patient with a breech presenting fetus agrees to an externwl cephalic version. Prior to performing the maneuver, 0.25 mg terbutaline subcutaneously was administered. The drugs binds to B adrenergic receptors to cause which of the following cellular reactions to cause uterine relaxation?
A. Increased ecf Mg 
B. Increased iCa
C. Increased cAMP
D.  Increased cGMP
A

C. Increased cAMP

106
Q 
Changes in maternal blood flow and cardiac output in pregnancy mimic which of the following disease states?
A. Hypertension
B. Thyrotoxicosis
C. Diabetes insipidus
D. Chronic renal disease
A

B. Thyrotoxicosis

107
Q

Between which ages of gestation does the fundic height (in cm)correlate closely with gestational age?

A

Between 20-34 weeks

108
Q

When does the uterus become abdominal?

A

12 weeks AOG

109
Q

When is the fundus located midway between the pubis symphysis and umbilicus?

A

16 wks

110
Q

Fundus ia at the level of the umbilicus

A

20 weeks

111
Q

Which leopold maneuver answer the question, what fetal pole occupies the fundus?

A

Fundal grip - L1

112
Q

Which leopold maneuver answer the question, on which side is the fetal back?

A

Umbilical grip - L2

113
Q

Which leopold maneuver answer the question, what fetal part lies above the pelvic inlet?

A

Pawlicks grip - L3

114
Q

Which leopold maneuver answer the question,on which side is the fetal prominence?

A

Pelvic Grip - L4

115
Q

Fetal posture or habitus?

A

Fetal attitude

116
Q

Predisposing factors for transverse lie

A

Multiparity
Placenta previa
Hydramnios
Uterine anomalies

117
Q

Predisposing factors for face presentation

A 
Fetal malformation (anencephaly)
Cord coil
High parity (lax abdomen)
118
Q

Vertex

A

Occiput

119
Q

Face

A

Mentum

120
Q

Breech

A

Sacrum

121
Q

Shoulder

A

Scapula

Back up, back down

122
Q

Local edema

A

Caput succedaneum

123
Q

Bony changes in fetal head which result in shortened suboccipitobregmatic diameter

A

Molding

124
Q

both hips flexed and both knees extended and the feet close to the head.

A

Frank breech

125
Q

Most common type of breech presentation

A

Frank breech

126
Q

Hips flexed, knees flexed

A

Complete breech, canonball position

127
Q

What are the cardinal fetal movements in correct order?

A 
Engagement. 
Descent
Flexion
Internal rotation
Extension
External rotation
Expulsion
128
Q 
A 20 year old G1P0 at 39 weeks aog presents complaining of strong contractions. Her cervix is dilated 1 cm. She is given sedation and 4 hours later contractions have stopped. Her cervix is still 1 cm dilated, which of the following is the most likely diagnosis?
A. False labor
B. Prolonged latent phase of labor
C. Arrest of latent phase
D. Arrest of active phase
A

A. False labor

129
Q

Factors affecting latent phase duration

A

Excess sedation or epidural
Unfavorable cervix
False labor

130
Q

1st stage of labor is the latent phase which encompasses

A

Onset of labor to 3-5 cm

131
Q

In nulliparous women, when is latent phase considered prolonged?

A

> 20 hours

132
Q

In a G3P2 (2002) woman, when is latent phase considered prolonged?

A

> 14 hours

133
Q

Active phase of labor begins at:

A

3 to 5 cm up to full dilatation

134
Q

What is the normal rate of cervical dilatation in a G1P0 woman?

A

1.2 cm/hr

135
Q

What is the normal rate of cervical dilatation in a G3P2 woman?

A

1.5 cm/hr

136
Q

Which factors increase the duration of the active phase?

A

Epidural anesthesia - up to 1 hour
Maternal obesity - up to 30 to 60 mins
Maternal fear - up to 45 mins

137
Q

Greatest transverse diameter in occiput presentation

A

Biparietal diameter

138
Q

Lateral deflection of the sagittal suture either posteriorly toward the promontory or anteriorly toward the symphysis

A

Asynclitism

139
Q

Sagittal suture lies close to the symphysis, more of the posterior parietal bone will present.

A

Posterior asynclitism

140
Q

Sagittal suture approaches the sacral promontory, more of the anterior parietal bone presents itself to the examining fingers

A

Anterior asynclitism

141
Q

This measurement involves the promontory to the upper margin of symphysis

A

True/anatomic conjugate

142
Q

Normal diameter for true/anatomic conjugate

A

11 cm

143
Q

This is measured manually from promontory to lower margin of symphysis

A

Diagonal conjugate

144
Q

Normal diagonal conjugate

A

> 11.5 cm

145
Q

This is measured indirectly by subtracting 1.5 to 2 cm from the diagonal conjugate

A

Obstetric conjugate

146
Q

This is a measurement of the promontory to the posterior symphysis

A

Obstetric conjugate

147
Q

Mechanical stretching of the cervix enhances uterine activity

A

Ferguson reflex

148
Q 
Contractions are painful possible because of the following except?
A. Hypoxia of the myometrium
B. Compression of the nerve ganglia
C. Cervical stretching during dilatation
D. None of the above
A

D. None of the above

A. Hypoxia of the myometrium
B. Compression of the nerve ganglia
C. Cervical stretching during dilatation

And stretching of the peritoneum overlying the fundus

149
Q

The most important force in fetal expulsion is produced by?

A

Maternal intraabdominal pressure

150
Q

Describes the descent of the fetal biparietal diameter in relation to a line drawn between two maternal ischial spines

A

Station

151
Q 
This is the first requisite for the birth of a newborn 
A. Flexion
B. Engagement
C. Descent
D. Extension
A

C. Descent

152
Q

The appreciably shorter suboccipitobregmaric diameter is substituted for the longer occipitofrontal diameter

A

Flexion

153
Q 
This is essential for completion of labor
A. Extension
B. Flexion
C. Descent
D. Internal rotation
A

Internsl rotstion

154
Q 
On palpation of the fetsl head during vaginal examination, you note that the sagittal suture is transverse and close to the pubic symphysis. The posterior ear can be easily palpated. Which of the following best describes this orientation?
A. Anterior asynclitism
B. Posterior asynclitism
C. Mento-anterior position
D. Mento-posterior position
A

B. Posterior asynclitism

155
Q 
Goals of a successthird stage of labor include which of the following?
A. Prevention of uterine inversion
B. Prevention of shoulder dystocia
C. Completion of episiotomy repair
D. All of the above
A

A. Prevention of uterine inversion

156
Q 
Goals of a successthird stage of labor include all of the following, EXCEPT?
A. Prevention of uterine inversion
B. Prevention of postpartum hemorrhage
C. Delivery of an intact placenta
D. None of the above
A

D. None of the above

157
Q

Components of Unang Yakap

A

Immediate and thorough drying
Early skin to skin contact
Properly timed cord clamping
Non separation for early breastfeeding

158
Q

Identify the degree of perineal laceration

Extension of laceration through skin mucous membrane, perineal body, and anal sphincter

A

Third degree

159
Q

Identify the degree of perineal laceration Laceration extends from skin and mucous membrane to the fascia and muscles of the perineal body

A

2nd degree

160
Q

Identify the degree of perineal laceration

Fourchette, perineal skin, vaginal mucous membrane but no the underlying fascia and muscle

A

1st degree

161
Q

Identify the degree of perineal laceration

Extension of laceration through the rectal mucosa to expose the lumen of the rectum

A

4th degree

162
Q 
The functional divisions of labor include all of the following except
A. Preparatory
B. Dilatational
C. Acceleration
D. None of the above
A

C. Acceleration

Functional divisions of labor include:
Preparatory
Dilatational
Pelvic

163
Q

Effective first line uterotonic prophylactic drug

A

Oxytocin

164
Q

This uterotonic is contraindicated in hypertensive patients

A

Mergonovine (ergot alkaloids)

165
Q 
The following criteria must be met prior to vaginal delivery:
A. Membranes ruptured
B. Cervix completely dilated
C. Regional anesthesia placed
D. Fetal head position determined
A

C. Regional anesthesia

166
Q

Which of the following describes forceps that are applied to the fetal head with the scalp visible at the introitus without manual separation of the labia?

A. Low
B. Mid
C. High
D. Outlet

A

D. Outlet

167
Q

The following are indications for operative vaginal delivery except?
A. Prolonged second stage
B. Suspicion of immediate or potential fetal compromise
C. Shortening of the 2nd stage for maternal benefit
D. None of the above

A

D, none of the above

168
Q

Criteria for outlet forceps (5)

A
  • scalp is visible at introitus without separating the labia
  • fetal skull has reached the pelvic floor
  • sagittal suture is in AP diameter or ROA/LOA or ROP/LOP
  • fetal head is at or on perineum
  • rotation does not exceed 45 degrees
169
Q 
Which of the following is applied to reduce the nuchal arm in breech delivery?
A. Loveset maneuver
B. Zavanelli maneuver
C. McRobert maneuver
D. Piper forceps maneuver
A

A. Loveset maneuver

170
Q

The following describes the cardinal movements of breech delivery except
A. The fetal head is born by flexion
B. The back of the fetus is directed posteriorly
C. The anterior hip usually descends more rapidly than the posterior hip
D. Engagement and descent usually occur with the bitrochanteric diameter in an oblique plane

A

B. The back of the fetus is directed posteriorly

171
Q 
Which of the following best describes a breech fetus that delivers spontaneously up to the umbilicus, but whose remaining body is delivered with operator traction?
A. Breech decomposition
B. Total breech extraction
C. Partial breech extraction
D. Spontaneous breech delivery
A

C. Partial breech extraction
— breech spontaneously delivered up to umbilicus
— posterior hip will deliver from 6 o’clock position
— anterior hip delivers next
— external rotation to sacrum anterior
— fetal bony pelvis grasped with both hands, using cloth towel

172
Q 
A patient presents in preterm labor at 32 weeks gestation. Her cervix is completely dilated, and the fetus is breech. You are unable to deliver the fetal head. What procedure is applied to resolve this complication?
A. Symphysiotomy
B. Zavanelli maneuver
C. Duhrssen incision
D. Mauriceau maneuver
A

C. Duhrssen incision
— incision on cervix at 2 and 10 o’clock
— or additional at 6

(Symphysiotomy is done for delivery of entrapped aftercoming head. Divides symphyseal cartilage up to 2.5 cm

173
Q

The following criteria must be met prior to planned vaginal breech extraction, except?
A. Oxytocin induction if with hypotonic uterine dysfunction
B. Passive 2nd stage without active pushing for 90 minutes
C. Continuous EFM
D. none of the above

A

A. Oxytocin induction if with hypotonic uterine dysfunction

Criteria for planned vaginal breech
A. Oxytocin AUGMENTATION if with hypotonic uterine dysfunction. INDUCTION is NOT recommended
B. Passive 2nd stage without active pushing for 90 minutes to allow breech to descend into pelvis
C. Continuous EFM
D. EFW 2.5 to 4kg
E. Skilled OB with facilities for cs

CS is recommended when active pushing commences and delivery is not imminent within 60 MINUTES

174
Q

Cardinal movements in BREECH

A
  • Extension
  • Descent
  • Internal Rotation (45 degree rotation of hip; anterior hip toward the pubic arch; bitrochanteric diameter in AP diameter of outlet)
  • Lateral flexion (posterior hip over perineum)
  • External rotation (fetal back turns anteriorly)
  • Internal rotation (bisacromial diameter in ap plane)
  • Expulsion (posterior neck under symphysis, head born in flexion)
175
Q

Pinard maneuver

A

In breech decomposition, 2 fingers will push knee away from midline, after spontaneous flexion

Lateral rotation of thighs
Flex knees

176
Q

In the cardinal movements of breech, the bitrochanteric diameter in oblique diameter and the anterior hip descends more rapidly. Which step is described?

A

Engagement and descent

177
Q

After delivery of the aftercoming head, the assistant applies suprapubic pressure to favor flexion and engagement of the fetal head. Which maneuver is applied?

A. Loveset maneuver
B. Zavanelli maneuver
C. Duhrssen incision
D. Mauriceau maneuver

A

D. Mauriceau-Smellie-Veit

178
Q

Between which ages of gestation does the fundic height (in cm)correlate closely with gestational age?

A

Between 20-34 weeks

179
Q

When does the uterus become abdominal?

A

12 weeks AOG

180
Q

When is the fundus located midway between the pubis symphysis and umbilicus?

A

16 wks

181
Q

Fundus ia at the level of the umbilicus

A

20 weeks

182
Q

Which leopold maneuver answer the question, what fetal pole occupies the fundus?

A

Fundal grip - L1

183
Q

Which leopold maneuver answer the question, on which side is the fetal back?

A

Umbilical grip - L2

184
Q

Which leopold maneuver answer the question, what fetal part lies above the pelvic inlet?

A

Pawlicks grip - L3

185
Q

Which leopold maneuver answer the question,on which side is the fetal prominence?

A

Pelvic Grip - L4

186
Q

Fetal posture or habitus?

A

Fetal attitude

187
Q

Predisposing factors for transverse lie

A

Multiparity
Placenta previa
Hydramnios
Uterine anomalies

188
Q

Predisposing factors for face presentation

A 
Fetal malformation (anencephaly)
Cord coil
High parity (lax abdomen)
189
Q

Vertex

A

Occiput

190
Q

Face

A

Mentum

191
Q

Breech

A

Sacrum

192
Q

Shoulder

A

Scapula

Back up, back down

193
Q

Local edema

A

Caput succedaneum

194
Q

Bony changes in fetal head which result in shortened suboccipitobregmatic diameter

A

Molding

195
Q

both hips flexed and both knees extended and the feet close to the head.

A

Frank breech

196
Q

Most common type of breech presentation

A

Frank breech

197
Q

Hips flexed, knees flexed

A

Complete breech, canonball position

198
Q

What are the cardinal fetal movements in correct order?

A 
Engagement. 
Descent
Flexion
Internal rotation
Extension
External rotation
Expulsion
199
Q

After delivery of the aftercoming head, the assistant applies suprapubic pressure to favor flexion and engagement of the fetal head. Which maneuver is applied?

A. Loveset maneuver
B. Zavanelli maneuver
C. Duhrssen incision
D. Mauriceau maneuver

A

D. Mauriceau-Smellie-Veit

200
Q

In the cardinal movements of breech, the bitrochanteric diameter in oblique diameter and the anterior hip descends more rapidly. Which step is described?

A

Engagement and descent

201
Q

Pinard maneuver

A

In breech decomposition, 2 fingers will push knee away from midline, after spontaneous flexion

Lateral rotation of thighs
Flex knees

202
Q

Cardinal movements in BREECH

A
  • Extension
  • Descent
  • Internal Rotation (45 degree rotation of hip; anterior hip toward the pubic arch; bitrochanteric diameter in AP diameter of outlet)
  • Lateral flexion (posterior hip over perineum)
  • External rotation (fetal back turns anteriorly)
  • Internal rotation (bisacromial diameter in ap plane)
  • Expulsion (posterior neck under symphysis, head born in flexion)
203
Q

The following criteria must be met prior to planned vaginal breech extraction, except?
A. Oxytocin induction if with hypotonic uterine dysfunction
B. Passive 2nd stage without active pushing for 90 minutes
C. Continuous EFM
D. none of the above

A

A. Oxytocin induction if with hypotonic uterine dysfunction

Criteria for planned vaginal breech
A. Oxytocin AUGMENTATION if with hypotonic uterine dysfunction. INDUCTION is NOT recommended
B. Passive 2nd stage without active pushing for 90 minutes to allow breech to descend into pelvis
C. Continuous EFM
D. EFW 2.5 to 4kg
E. Skilled OB with facilities for cs

CS is recommended when active pushing commences and delivery is not imminent within 60 MINUTES

204
Q 
A patient presents in preterm labor at 32 weeks gestation. Her cervix is completely dilated, and the fetus is breech. You are unable to deliver the fetal head. What procedure is applied to resolve this complication?
A. Symphysiotomy
B. Zavanelli maneuver
C. Duhrssen incision
D. Mauriceau maneuver
A

C. Duhrssen incision
— incision on cervix at 2 and 10 o’clock
— or additional at 6

(Symphysiotomy is done for delivery of entrapped aftercoming head. Divides symphyseal cartilage up to 2.5 cm

205
Q 
Which of the following best describes a breech fetus that delivers spontaneously up to the umbilicus, but whose remaining body is delivered with operator traction?
A. Breech decomposition
B. Total breech extraction
C. Partial breech extraction
D. Spontaneous breech delivery
A

C. Partial breech extraction
— breech spontaneously delivered up to umbilicus
— posterior hip will deliver from 6 o’clock position
— anterior hip delivers next
— external rotation to sacrum anterior
— fetal bony pelvis grasped with both hands, using cloth towel

206
Q

The following describes the cardinal movements of breech delivery except
A. The fetal head is born by flexion
B. The back of the fetus is directed posteriorly
C. The anterior hip usually descends more rapidly than the posterior hip
D. Engagement and descent usually occur with the bitrochanteric diameter in an oblique plane

A

B. The back of the fetus is directed posteriorly

207
Q 
Which of the following is applied to reduce the nuchal arm in breech delivery?
A. Loveset maneuver
B. Zavanelli maneuver
C. McRobert maneuver
D. Piper forceps maneuver
A

A. Loveset maneuver

208
Q

Criteria for outlet forceps (5)

A
  • scalp is visible at introitus without separating the labia
  • fetal skull has reached the pelvic floor
  • sagittal suture is in AP diameter or ROA/LOA or ROP/LOP
  • fetal head is at or on perineum
  • rotation does not exceed 45 degrees
209
Q

The following are indications for operative vaginal delivery except?
A. Prolonged second stage
B. Suspicion of immediate or potential fetal compromise
C. Shortening of the 2nd stage for maternal benefit
D. None of the above

A

D, none of the above

210
Q

Which of the following describes forceps that are applied to the fetal head with the scalp visible at the introitus without manual separation of the labia?

A. Low
B. Mid
C. High
D. Outlet

A

D. Outlet

211
Q 
The following criteria must be met prior to vaginal delivery:
A. Membranes ruptured
B. Cervix completely dilated
C. Regional anesthesia placed
D. Fetal head position determined
A

C. Regional anesthesia

212
Q

This uterotonic is contraindicated in hypertensive patients

A

Mergonovine (ergot alkaloids)

213
Q

Effective first line uterotonic prophylactic drug

A

Oxytocin

214
Q 
The functional divisions of labor include all of the following except
A. Preparatory
B. Dilatational
C. Acceleration
D. None of the above
A

C. Acceleration

Functional divisions of labor include:
Preparatory
Dilatational
Pelvic

215
Q

Identify the degree of perineal laceration

Extension of laceration through the rectal mucosa to expose the lumen of the rectum

A

4th degree

216
Q

Identify the degree of perineal laceration

Fourchette, perineal skin, vaginal mucous membrane but no the underlying fascia and muscle

A

1st degree

217
Q

Identify the degree of perineal laceration Laceration extends from skin and mucous membrane to the fascia and muscles of the perineal body

A

2nd degree

218
Q

Identify the degree of perineal laceration

Extension of laceration through skin mucous membrane, perineal body, and anal sphincter

A

Third degree

219
Q

Components of Unang Yakap

A

Immediate and thorough drying
Early skin to skin contact
Properly timed cord clamping
Non separation for early breastfeeding

220
Q 
Goals of a successthird stage of labor include all of the following, EXCEPT?
A. Prevention of uterine inversion
B. Prevention of postpartum hemorrhage
C. Delivery of an intact placenta
D. None of the above
A

D. None of the above

221
Q 
Goals of a successthird stage of labor include which of the following?
A. Prevention of uterine inversion
B. Prevention of shoulder dystocia
C. Completion of episiotomy repair
D. All of the above
A

A. Prevention of uterine inversion

222
Q 
On palpation of the fetsl head during vaginal examination, you note that the sagittal suture is transverse and close to the pubic symphysis. The posterior ear can be easily palpated. Which of the following best describes this orientation?
A. Anterior asynclitism
B. Posterior asynclitism
C. Mento-anterior position
D. Mento-posterior position
A

B. Posterior asynclitism

223
Q 
This is essential for completion of labor
A. Extension
B. Flexion
C. Descent
D. Internal rotation
A

Internsl rotstion

224
Q

The appreciably shorter suboccipitobregmaric diameter is substituted for the longer occipitofrontal diameter

A

Flexion

225
Q 
This is the first requisite for the birth of a newborn 
A. Flexion
B. Engagement
C. Descent
D. Extension
A

C. Descent

226
Q

Describes the descent of the fetal biparietal diameter in relation to a line drawn between two maternal ischial spines

A

Station

227
Q

The most important force in fetal expulsion is produced by?

A

Maternal intraabdominal pressure

228
Q 
A 20 year old G1P0 at 39 weeks aog presents complaining of strong contractions. Her cervix is dilated 1 cm. She is given sedation and 4 hours later contractions have stopped. Her cervix is still 1 cm dilated, which of the following is the most likely diagnosis?
A. False labor
B. Prolonged latent phase of labor
C. Arrest of latent phase
D. Arrest of active phase
A

A. False labor

229
Q 
Contractions are painful possible because of the following except?
A. Hypoxia of the myometrium
B. Compression of the nerve ganglia
C. Cervical stretching during dilatation
D. None of the above
A

D. None of the above

A. Hypoxia of the myometrium
B. Compression of the nerve ganglia
C. Cervical stretching during dilatation

And stretching of the peritoneum overlying the fundus

230
Q

Mechanical stretching of the cervix enhances uterine activity

A

Ferguson reflex

231
Q

This is a measurement of the promontory to the posterior symphysis

A

Obstetric conjugate

232
Q

This is measured indirectly by subtracting 1.5 to 2 cm from the diagonal conjugate

A

Obstetric conjugate

233
Q

Normal diagonal conjugate

A

> 11.5 cm

234
Q

This is measured manually from promontory to lower margin of symphysis

A

Diagonal conjugate

235
Q

Normal diameter for true/anatomic conjugate

A

11 cm

236
Q

This measurement involves the promontory to the upper margin of symphysis

A

True/anatomic conjugate

237
Q

Sagittal suture approaches the sacral promontory, more of the anterior parietal bone presents itself to the examining fingers

A

Anterior asynclitism

238
Q

Sagittal suture lies close to the symphysis, more of the posterior parietal bone will present.

A

Posterior asynclitism

239
Q

Lateral deflection of the sagittal suture either posteriorly toward the promontory or anteriorly toward the symphysis

A

Asynclitism

240
Q

Greatest transverse diameter in occiput presentation

A

Biparietal diameter

241
Q

Which factors increase the duration of the active phase?

A

Epidural anesthesia - up to 1 hour
Maternal obesity - up to 30 to 60 mins
Maternal fear - up to 45 mins

242
Q

What is the normal rate of cervical dilatation in a G3P2 woman?

A

1.5 cm/hr

243
Q

What is the normal rate of cervical dilatation in a G1P0 woman?

A

1.2 cm/hr

244
Q

Active phase of labor begins at:

A

3 to 5 cm up to full dilatation

245
Q

In a G3P2 (2002) woman, when is latent phase considered prolonged?

A

> 14 hours

246
Q

In nulliparous women, when is latent phase considered prolonged?

A

> 20 hours

247
Q

1st stage of labor is the latent phase which encompasses

A

Onset of labor to 3-5 cm

248
Q

Factors affecting latent phase duration

A

Excess sedation or epidural
Unfavorable cervix
False labor

OBSTETRICS and GYNE (5 decks)

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