Reviewer OB Flashcards
(38) G4P3 (3003) with gestational diabetes admitted at 39 weeks in imminent delivery. EFW 4000 grams. There was difficulty in delivering the shoulder 1 minute after delivery of the head. Which of the following maneuvers should be performed initially?
a. Rubin
b. Woods corkscrew
c. McRoberts
d. Zavanelli
(39) G1P0 38 weeks AOG with mild uterine contractions every 10 to 30 minutes lasting for 15 to 20 seconds for more than 20 hours. IE cervix 2 cm dilated, 1 cm long, soft, LOT, station -2, intact BOW, vital signs normal, FHT reassuring. What is the management?
a. Amniotomy
b. Oxytocin augmentation
c. Bed rest with sedation
d. Cesarean delivery for prolonged labor
(55) G1P0 40 weeks AOG in active labor for 14 hours. With contractions of 250 MVU, LOA station +2/5 with 2 cm caput. She has been actively pushing for 3 hours with no progress. What is the management?
a. Oxytocin augmentation
b. Cesarean delivery
c. Vacuum extraction
d. Forceps delivery
(56) The cervix begins to be retracted around the fetal presenting part and then pulled in more cephalad direction during which phase of labor?
a. Second stage
b. Acceleration
c. Maximum slope
d. Deceleration
(62) Clinical pelvimetry of G1P0 at 38 weeks revealed sacral promontory not reached at 11.5 cm, straight sidewalls, spines not prominent, subpubic arch 90 degrees. What is your interpretation?
a. Inlet contraction
b. Midplane contraction
c. Clinically adequate pelvis
d. Outlet contraction
(80) Abnormalities in descent should be diagnosed during which division of labor?
a. Preparatory
b. All divisions of labor
c. Pelvic
d. Dilatational
(81) G1P0 39 weeks AOG admitted with 5 cm dilated cervix 60% effaced, cephalic, station 0, intact BOW, contractions every 6 to 8 minutes, 30 to 40 seconds duration, mild to moderate. Three hours later, cervix 6 cm dilated, station 0, contractions every 5 minutes, 40 seconds duration, mild to moderate. Two hours later, cervix 7 cm dilated, 70% effaced, station 0, contractions every 4 to 5 minutes moderate. What is the labor pattern?
a. Arrest in cervical dilatation
b. Protracted cervical dilatation
c. Prolonged latent phase
d. Normal
(85) A primigravida at 42 weeks AOG: FH - 34 cms, FHT - 150/min; IE: cervix 1 cm dilated, beginning effacement, cephalic intact bag of waters, station 0. What is the next step in management?
a. Await progress of labor
b. Cesarean section
c. CST prior to induction of labor
d. Immediate amniotomy
(86) Abdominal exam of G6P5 (5005) in active labor whose largest baby weighed 3600 grams revealed L1 nodular mass, L2 fetal back on the left, fetal small parts on the right, L3 round hard mass, L4 cephalic prominence on the left. IE palpable facial features with fetal chin directed towards the symphysis pubis. EFW 2800 grams. What is the management?
a. Vacuum extraction
b. Await vaginal delivery
c. Forceps delivery
d. Cesarean delivery
(87) G1P0 40 weeks AOG admitted with 6 cm dilated cervix 60% effaced, LOA station -2, contractions 180 MVU intact membranes. Two hours later, cervix fully dilated, fully effaced, LOA station -1, contractions 280 MVU. Findings remained the same for 3 hours. What is the diagnosis?
a. Prolonged second stage
b. Prolonged deceleration
c. Prolonged deceleration phase with failure of descent
d. Prolonged second stage with failure of descent
(89) G1P0 39 weeks AOG has been at 9 cm cervical dilatation for 4 hours in spite of good uterine contractions. What is the labor pattern?
a. Protracted cervical dilatation
b. Prolonged second stage
c. Arrest in cervical dilatation
d. Prolonged deceleration phase
(2) G2P1 (1001) with fully dilated cervix for 2 hours, ruptured membranes, direct occiput posterior, station +4 with 1 cm caput, with variable decelerations on CTG. What is the management?
a. Cesarean delivery
b. Await spontaneous delivery
c. Forceps extraction as occiput posterior
d. Manual rotation of the head to occiput anterior position followed by forceps extraction
(10) G1P0 40 weeks in active labor for 15 hours stayed at 9 cm dilatation at station 0 for 4 hours. CPD should be suspected at what level of the pelvis?
a. Midplane
b. Inlet
c. Outlet
(11) According to the recommendation of the Obstetric Care Consensus Committee, cesarean delivery for active phase arrest should be reserved for women with ruptured membranes and good contractions with cervical dilatation of 6 cm or more and no progress for
a. 5 hours
b. 2 hours
c. 4 hours
d. 3 hours
(22) Which of the following is a characteristic of hypertonic uterine dysfunction?
a. Contraction of the midsegment of the uterus is stronger than that of the fundus
b. Pressure during a contraction is insufficient to dilate the cervix
c. Occurs during the active phase of labor
d. Managed with uterotonics
(30) Which of the following statements is TRUE regarding the cardinal movements of breech delivery?
a. The fetal head is born by flexion.
b. The posterior hip usually descends more rapidly than the anterior hip.
c. The bi-trochanteric diameter is in the transverse diameter during descent.
d. The back of the fetus is directed posteriorly.
(50) G1 P0 39 weeks AOG in active labor for 12 hours, uterine contractions 160 Montevideo units, IE cervix 5 cm dilated 60% effaced, LOT station -1, intact BOW with clinically adequate pelvis. EFW: 3,000 grams What is the abnormality?
a. Psyche
b. Powers
c. Passenger
d. Passage
A 30-yr-old, G5P2 (0312), 14 weeks AOG consults for prenatal care. She is a non-smoker and non-alcoholic beverage drinker. Pre-pregnancy weight was 120 lbs; present weight is 125 lbs. Which of the following puts her at risk for preterm birth?
a. Lifestyle
b. Weight gain
c. Age
d. Obstetric history
What is the dosage of Betamethasone?
a. 12 mg every 24 hours for 2 doses
b. 6 mg every 24 hours for 4 doses
c. 12 mg every 12 hours for 2 doses
d. 6 mg every 12 hours for 4 doses
How is term pregnancy defined?
a. 37-39 weeks
b. 38-40 weeks
c. 37-42 weeks
d. 39-41 weeks
A G3P2 (2002), 41 weeks AOG, consults for prenatal check-up. FH – 31 cms, FHT – 145/min; IE: cervix is closed, uneffaced, posterior, cephalic, intact bag of waters floating. What is the management?
a. Await spontaneous onset of labor
b. Start labor induction
c. Perform stripping of the membranes
d. Perform BPS and CST
When is the best time to measure fetal fibronectin?
a. 23-27 weeks
b. 8-12 weeks
c. 18-22 weeks
d. 13-17 weeks
Which of the following may cause fetal bone thinning and fractures after prolonged use?
a. Magnesium sulfate
b. Nifedipine
c. Terbutaline
d. Isoxsuprine
G1P0 delivered vaginally after 2 hours of labor. Which of the following maternal complications is LEAST LIKELY to be observed?
a. Extensive lacerations of cervix, vagina, vulva, or perineum
b. Amniotic fluid embolism
c. Uterine rupture
d. Postpartum hemorrhage
A G1P0 PU 35 weeks AOG consults for watery vaginal discharge. Which of the following is LEAST diagnostic of premature rupture of membranes?
a. Clear fluid from the cervical canal
b. Gross vaginal pooling of AF
c. Ultrasonography
d. pH testing
What is the dosage of Dexamethasone?
a. 6 mg every 12 hours for 4 doses
b. 12 mg every 24 hours for 2 doses
c. 12 mg every 12 hours for 2 doses
d. 6 mg every 24 hours for 4 doses
What mechanism is involved in infection-induced preterm labor?
a. Decreased cortisol
b. Decreased placental CRH
c. Increased progesterone
d. Increased prostaglandins
Which term refers to a newborn with recognizable clinical features indicating a pathologically prolonged pregnancy?
a. None of the choices are correct
b. Postdate
c. Postterm
d. Postmature
G1P0 recovered from a severe COVID-19 infection at 14 weeks age of gestation. Fetal biometry at 28 weeks showed EFW 3rd percentile, AC 10th percentile, HC 10th percentile, SVP 2.2cm. Doppler studies showed normal indices of the umbilical artery and middle cerebral artery. Nonstress test was reactive. Which of the following is recommended?
a. Induction of labor at 37 weeks
b. Repeat fetal monitoring every 2 weeks
c. Antenatal steroids then deliver
d. Amino acid supplementation
Which of the following conditions is associated with asymmetric fetal growth restriction?
a. Transverse presentation
b. Gestational diabetes mellitus
c. Chromosomal abnormalities
d. Chronic hypertension
A 33yo G4P3 (3003) with preeclampsia with severe features had an ultrasound showing EFW at 5th percentile with 105 grams interval weight gain in 10 days, HC 25th percentile, AC 9th percentile, SVP 1.5cm. Biophysical profile showed no fetal gross trunk movements and no fetal extremity extension/flexion but with 2 fetal breathing movements in 30 minutes. CTG is shown below. Given these findings, what is the recommended management?
a. Deliver
b. No fetal indication for intervention at this time
c. Repeat testing per protocol
d. Repeat testing the same day then deliver if BPS <6/10
The term small-for-gestational age is generally used to designate newborns whose birthweight is less than what percentile?
a. 15%
b. 3%
c. 10%
d. 5%
G4P0 (0030) with antiphospholipid antibody syndrome was diagnosed with asymmetric fetal growth restriction. Doppler findings at 34 2/7 weeks showed umbilical artery with absent end diastolic flow, middle cerebral artery with decreased indices suggestive of brain sparing. Which of the following is the recommended management?
a. Give antenatal steroids then deliver
b. Repeat sonography for fetal growth every 2 weeks
c. Continue fetal surveillance until 38 weeks then deliver
d. Perform emergency delivery
A neonate with BW of 4600 grams was delivered via low segment cesarean section to a 37yo G1P1 with gestational diabetes. Which of the following complications should be anticipated?
a. Vaginal lacerations
b. Shoulder dystocia
c. Postpartum hemorrhage
d. Uterine rupture
A 38 yo G5P4 (4004) overt diabetic had the following ultrasound findings at 34 weeks: EFW at 92nd percentile for age, AC at 90th percentile, AFI 27.5cm. Which of the following is the likely etiology of these findings?
a. Multiparity
b. Advanced maternal age
c. Overt diabetes
d. Polyhydramnios
A fetus diagnosed with symmetric growth restriction was found to have BPS 6/10 at 28 weeks with a SVP of 1.7cm. Doppler studies showed increased indices of the umbilical artery, normal middle cerebral artery indices. Which of the following is the recommended management?
a. Repeat testing same day and deliver if BPS <6
b. No fetal indication for intervention
c. Deliver immediately
d. Observe and repeat testing per protocol
Which of the following ultrasound findings suggest asymmetric growth restriction?
a. Abdominal circumference bigger than head circumference
b. All biometric parameters are less than the 10th percentile for gestational age
c. Head circumference bigger than abdominal circumference
d. EFW at 15th percentile for gestational age
G4P0 chronic hypertension had an EFW < 10th percentile at 26 weeks. Repeat biometry at 28 weeks showed: EFW at 8th percentile with 90 grams interval weight gain, AC at 5th percentile, HC at 25th percentile. What is the impression?
a. Growth appropriate for gestational age
b. Constitutionally small for gestational age
c. Asymmetric fetal growth restriction
d. Symmetric fetal growth restriction
What is the most commonly used definition of intrauterine growth restriction in terms of estimated fetal weight?
a. < 5th percentile
b. < 3rd percentile
c. < 10th percentile
d. < 15th percentile
What is the definition of fetal macrosomia?
a. EFW > 92nd percentile for age
b. EFW > 90th percentile for age
c. EFW > 95th percentile for age
d. EFW > 97th percentile for age
(91) Repeat biometry at 28 weeks showed EFW at the 8th percentile with 90 grams interval weight gain, AC at 5th percentile, HC at 25th percentile. Doppler ultrasound showed umbilical artery with increased resistance indices, middle cerebral artery with decreased resistance indices. What is the impression?
a. Symmetric fetal growth restriction with brain-sparing
b. Asymmetric fetal growth restriction without brain-sparing
c. Brain-sparing
d. Asymmetric fetal growth restriction with brain-sparing
(93) For a G1P0 with gestational diabetes, ultrasound at 36 weeks showed AC at the 95th percentile for AOG, EFW at the 90th percentile for AOG. Which of the following is the recommended management?
a. Immediate cesarean section
b. Induction of labor at 37 weeks
c. Observe and await spontaneous labor
d. Elective cesarean section at 38 weeks
Which diameter of the fetal head corresponds to the greatest distance between the appropriately applied blades?
a. Occipito-mental
b. Biparietal
c. Sub-occipitobregmatic
d. Bitemporal
G2P1 (1001) 39 weeks with mild uterine contractions occurring every 10 to 15 min lasting for 20 to 30 seconds for 15 hours, cervix 3 cm dilated 1 cm long, cephalic presentation station -2, intact BOW, vital signs normal, FHR reassuring. What is the diagnosis?
a. Protracted cervical dilatation
b. False labor
c. Prolonged latent phase
d. Arrest in cervical dilatation
Abnormalities of descent should be diagnosed during which functional division of labor?
a. Preparatory
b. All divisions of labor
c. Dilatational
d. Pelvic
Which of the following is a characteristic of hypertonic uterine dysfunction?
a. Pressure during a contraction is insufficient to dilate the cervix
b. Managed with oxytocin
c. Incoordinate uterine contraction
d. Occurs during the active phase of labor
G1P0 40 weeks had good progression of cervical dilatation from 5 to 9 cm, ruptured BOW, contractions 260 MVU, LOT, station 0. Findings remained the same for 4 hours. What is the diagnosis?
a. Prolonged second stage with arrest of descent
b. Prolonged deceleration phase with failure of descent
c. Prolonged second stage with failure of descent
d. Prolonged deceleration phase with arrest of descent
Which complication has a higher incidence in vacuum compared to forceps delivery?
a. Maternal blood loss
b. Facial injury
c. Shoulder dystocia
d. Vaginal lacerations
What maneuver for shoulder dystocia entails reversal of the cardinal movements of labor and cephalic replacement into the pelvis followed by cesarean section?
a. Gaskin
b. Mazzanti
c. Zavanelli
d. Hibbard
What phase of labor is marked by the upswing in dilatation?
a. Deceleration
b. Latent
c. Acceleration
d. Maximum slope
A 23-year-old, G1P0, term, had the following findings: cervix fully dilated, ruptured bag of waters, mentum posterior, station +2 for 2 hours. Which finding will contraindicate the use of the forceps?
a. Prolonged 2nd stage
b. Station
c. Presentation
d. Cervical dilatation
G1P0 40 weeks had good progress of labor up to 6 cm dilatation, 80% effaced, LOA, station 0, ruptured BOW, contractions 240 MVU. Findings remained the same for 4 hours. What is management?
a. Give oxytocin
b. Give sedation
c. Observe for another hour
d. Cesarean delivery
G1P0 40 weeks with cervix fully dilated for 2 hours, ROP station 0 with molding and 2 cm caput. What is the management?
a. Manual rotation to occiput anterior
b. Cesarean delivery
c. Forceps delivery as occiput posterior
d. Vacuum extraction
Which of the following is NOT a risk factor for persistent occiput posterior position?
a. Prior occiput posterior delivery
b. Epidural analgesia
c. Multiparity
d. Greater fetal weight
Persistent occiput posterior position is more common in what type of pelvis?
a. Gynecoid
b. Platypoid
c. Anthropoid
d. Android
Vacuum extraction is contemplated for a G1P0, term, in labor, with an estimated fetal weight of 3400-3800 grams. What is the probable complication to be anticipated?
a. Facial injury
b. Vaginal lacerations
c. Maternal blood loss
d. Shoulder dystocia
Clinical pelvimetry of a G1P0 38 weeks, revealed sacral promontory reached at 11.5 cm, ischial spines prominent intertuberous diameter 10 cm. What is your interpretation?
a. Midplane contraction
b. Inlet contraction
c. Normal
d. Outlet contraction
G1P0 40 weeks in active labor for 12 hours, with contractions 230 MVU, cervix 7 cm dilated 80% effaced, LOT with marked anterior asynclitism, station 0, with clinically adequate pelvis. What abnormality is present?
a. Power
b. Passage
c. Passenger
d. Psyche
A primigravida at 42 weeks AOG, FH - 34 cms, FHT - 150/min, IE: Cervix - 1 cm dilated, beginning effacement, cephalic, BOW (+), station 0. What is management?
a. CST prior to induction of labor
b. Cesarean section
c. Await progress of labor
d. Immediate amniotomy
Which of the following complications is NOT increased in Cesarean delivery?
a. Infection
b. Thromboembolism
c. Stress incontinence
d. Hemorrhage
G1P0 39 weeks with 9 cm dilated cervix 90% effaced, LOT station -1 for 4 hours with contractions of 280 MVU. CPD should be suspected at what level of the pelvis?
a. Outlet
b. Inlet
c. Midplane
In Term PROM, what is the management?
a. Administer MgSO4 before CS
b. Expectant management
c. Administer corticosteroids before inducing labor
d. Induce labor
G1P0 40 weeks with mild contractions every 10 to 15 min lasting 20 to 30 seconds for 20 hours, cervix 2 cm dilated 60% effaced, cephalic station -1 intact BOW, FHT 150/min, vital signs normal. What is the preferred management?
a. Amniotomy
b. Observation and rest
c. Cesarean delivery
d. Oxytocin augmentation
On vaginal examination of a woman in labor, the frontal sutures, orbital ridges, eyes and root of the nose are palpated. What is the presentation?
a. Brow
b. Vertex
c. Sinciput
d. Face
G1P0 40 weeks, with fully dilated cervix for 3 hours with contractions of 275 MVU, ROA station +1, with 2 cm caput, has been pushing for 2 hours. What is the management?
a. Oxytocin augmentation
b. Cesarean delivery
c. Forceps delivery
d. Vacuum extraction
Compared with nondiabetic controls, newborns of diabetic mothers were found to have the following characteristic/s:
a. Larger shoulder and extremity circumferences
b. Decreased head to shoulder ratio
c. Higher body fat and thicker upper extremity skin folds
d. All the choices are correct
A 23-year-old, G1P0, term, with BP of 160/100 mmHg; cervix was fully dilated, ruptured bag of waters, mentum anterior, station +3. Which finding will NOT allow vacuum extraction?
a. Presentation
b. Station
c. Blood pressure
d. Cervical dilatation
G1P0 40 weeks, with the cervix fully dilated for 2 hours, ROP station 0 with molding and 2 cm caput. What is the management?
a. Manual rotation to occiput anterior
b. Cesarean delivery
c. Forceps delivery as occiput posterior
d. Vacuum extraction
Which of the following is NOT a risk factor for persistent occiput posterior position?
a. Prior occiput posterior delivery
b. Epidural analgesia
c. Multiparity
d. Greater fetal weight
Second trimester fetal growth is characterized by:
a. Predominantly cellular hypertrophy
b. Both cellular hyperplasia and hypertrophy
c. Predominantly cellular hyperplasia
d. None of the choices is correct
Which of the following newborns has macrosomia?
a. All choices are correct
b. Birthweight 3SD above the mean
c. Birthweight at 97th percentile for age
d. Birthweight 4800 grams
An 18 yo G1P0 with documented rubella infection at 10 weeks was noted to have the following findings on repeat scan at 28 weeks: EFW at the 8th percentile with normal interval weight gain, decreased HC, decreased AC, normal AFI, normal umbilical artery Doppler. What is the impression?
a. Symmetrical growth restriction
b. Asymmetrical growth restriction
c. Normal fetal growth
d. Fetal overgrowth
A fetus at 31 weeks AOG was noted to have asymmetric growth restriction, normal amniotic fluid volume, increased umbilical artery resistance indices, normal CTG. Which of the following is the recommended management?
a. Give steroids then deliver
b. Await spontaneous delivery
c. Repeat Doppler after 1 week
d. Emergency cesarean delivery
A fetus with chromosomal anomaly is noted to have EFW at 8th percentile for gestational age. Which of the following findings in the fetal biometry is expected?
a. Decreased HC / decreased AC
b. Decreased HC / normal AC
c. Normal HC / normal AC
d. Normal HC / decreased AC
A G1P0 with severe preeclampsia was noted to have the following: EFW at 8th percentile with suboptimal interval weight gain, SVP 1.8cm, 2x Fetal breathing, 4x fetal gross movement, 2x extension/flexion of fetal arm, NST reactive. Which of the following reflects the fetal status at the time of scan?
a. Possible fetal asphyxia
b. Normal non-asphyxiated fetus
c. Chronic fetal asphyxia suspected
d. Almost certain fetal asphyxia
Which of the following BEST differentiates true (pathologic) fetal growth restriction from small for gestational age?
a. Fetal growth of 5g/day in the second trimester
b. Fetal abdominal circumference less than the 10th percentile for gestational age
c. Umbilical artery Doppler resistance indices within normal range
d. Fetal weight less than the 10th percentile for age
At 34 weeks, UTZ of a Monochorionic-Diamnionic twins showed TWIN A BREECH: compatible with 34 weeks with EFW appropriate for gestational age. TWIN B CEPHALIC: compatible with 30 weeks with an estimated fetal weight that is below the 10th percentile for age. Both SVP is normal. What is the next BEST step in the management?
a. Follow up every 2 weeks
b. Expectant management up to 37 weeks
c. Doppler velocimetry, NST, BPS
d. Deliver now by CS
Which of the following findings is suggestive of preferential shunting of oxygen and nutrients to the brain as a response to uteroplacental insufficiency in a growth restricted fetus?
a. Increased resistance to uterine artery
b. Absent fetal heart rate variability
c. Decreased resistance in middle cerebral artery
d. Amniotic fluid index of 4.0 cm
An 18 yo G1P0 with history of documented rubella infection at 10 weeks was noted to have fetal growth restriction at 29 weeks. Which of the following is the most likely cause of the condition?
a. Young age
b. Primiparity
c. Rubella infection
d. All choices are correct
A 30-year-old G1P0, apparently well woman at 30 weeks was noted to have fundic height of 25cm. What is the next BEST step in diagnosing fetal growth restriction?
a. Request congenital anomaly scan
b. Do abdominal palpation
c. Establish the gestational age
d. Repeat fundic height measurement
What is the recommended management for fetal growth restriction diagnosed at 23 weeks age of gestation?
a. Terminate pregnancy
b. Await spontaneous delivery
c. Repeat sonography every 3 to 4 weeks
d. Give steroids then deliver
