Text Q and A Flashcards
Which is the best predictor of successful vaginal birth?
Descent of the presenting part during labor
A 30 year old primigravid patient at term progresses from 4cm dilation to 7 cm in 5 hours. How would this labor be described?
A protraction disorder
A 22 year old multiparous patient has been pushing for 2 hours resulting in no descent of the presenting part. This would be classified as
An arrest disorder
Which of the following maternal factors can prevent accurate clinical assessment of uterine contractions?
Obesity
For a patient in active labor, which of the following provides a quantitative measurement of the strength of her uterine contractions
Intrauterine pressure catheter
Which of the following presentations typically converts to either a vertex or brow presentation?
Compound
Normal fetal heart rate variability is characterized by an amplitude range that is
6-25 bpm
Marked fetal heart rate variability is characterized by an amplitude range that is
> 25 bpm
Which of the following presentations usually resolves spontaneously as labor continues?
Compound
A 22 year old G1P0 patient presents at term with complaints of contractions for many hours. Her cervix is 100% effaced and is dilated to 3 cm. In a nulliparous patient, the latent phase of labor is defined as prolonged if it lasts longer than
20 hours
A 37 year old G4P3 patient reports having contractions “all day”. In Multiparous paitients, the latent phase is defined as prolonged if it lasts more than
14 hours
A 30 year old G2P1 at term is in adequate active labor with cervical dilation unchanged at 6cm as documented by several examiners. There has been secondary arrest of dilation when cervical dilation during the active phase of labor stops for at least
2 hours
Which of the following is the appropriate management of a prolonged latent phase?
Sedation
Which of the following is a selection criterion that would allow for the external cephalic version?
Normal fetus with reassuring fetal heart tracing
Outlet forceps-assisted vaginal delivery is appropriately considered with fetal head at what station?
at the pelvic floor
Low forceps assisted vaginal delivery occurs with the fetal head at what station?
At the 2+ station
A patient has been in the second stage of labor for 2.5 hours. Fetal heart tones are reassuring and there is no clinical evidence of cephalopelvic disproportion. The next step in management of this patient should be
Oxytocin administration if uterine contractions are inadequate
Vibroacoustic stimulation is used to elicit what type of fetal heart rate response?
Acceleration
Amnioinfusion to relieve umbilical cord compression is useful in cases of
Variable fetal heart rate deceleration
If a fetus experiences progressive and sustained hypoxia, the mixed metabolic and respiratory acidosis that may ensue typically results from
Anaerobic glycolysis
In high risk patients, intermittent fetal heart rate auscultation to monitor fetal well being should be employed at least how often during the active phase of labor?
Every 15 minutes
In high risk patients, intermittent fetal heart rate auscultation to monitor fetal well being should be employed at least how often during the second stage of labor?
Every 5 minutes
Baseline fetal tachycardia is defined as a heart rate greater than how many beats per minute?
160
The most common cause of fetal tachycardia
Chorioaminionitis
Baseline fetal bradycardia is defined as a heart rate less than how many beats per minute?
110
A fetal heart rate below how many beats per minute is an ominous sign that may presage fetal death?
80
Fetal heart accelerations associated with
Reassuring fetal status
Early fetal heart rate decelerations are associated with
Pressure on the fetal head
Variable fetal heart rate decelerations are associated with
Umbilical cord compression
Late fetal heart rate decelerations are associated with
Uteroplacental insufficiency
Repetitive late fetal heart rate decelerations are considered particularly ominous with respect to fetal well being if associated with
Decreased FHR variability
The single most reliable indicator of fetal status using electronic fetal monitoring is fetal heart rate
Variability
A 39 year old multiparous patient has repetitive late decelerations. She is dilated to 5 cm. Which of the following maneuvers is potentially useful in an attempt to resuscitate the fetus in utero?
Change the maternal position to left lateral
In normal labor pattern, which of the following describes “adequate” labor?
3 contractions in 10 minutes
A 30 year old term pregnant patient is found to have a fetus with persistent occiput position during the second stage of labor. She has been pushing for 30 minutes. Fetal heart rate is reassuring. Which of the following is appropriate management?
Continue pushing
Amniotomy is associated with which of the following risks?
Chorioaminonitis
Which of the following is an essential criterion which defines acute intrapartum hypoxia sufficient to cause cerebral palsy?
pH
Which of the following has been associated with antepartum or intrapartum interruption of fetal blood supply?
Spastic quadriplegia
Which of the following is characteristic of a category 3 fetal heart tracing?
Sinusoidal pattern
Intrauterine growth restriction is defined as birth weight less than the _____ percentile
10th
About what proportion of stillborn infants are found to be growth restricted?
25%
The normal fetus grows throughout pregnancy, but the rate of growth usually declines after what gestational age?
37 weeks
A fetus with IUGR is at higher risk for
Hypothermia
Early onset IUGR may be associated with
Irreversible reduction in organ size
Late onset IUGR is commonly associated with
Uteroplacental insufficiency
Maternal viral infections associated with IUGR include
Rubella
Between 20 and 36 weeks GA, the fundal height should increase approximately
1 cm per week
An efficient screening procedure for IUGR is
Fundal height measurements
Most useful tool to evaluate IUGR is serial
OB US examinations
Which testing procedure is included in the routine evaluation of IUGR?
Doppler velocimetry
Evaluation of fetal-placental circulation is best assessed with Doppler velocimetry of which vessel?
Umbilical artery
The fetal response to reduced placental perfusion results in decreased blood flow to the
Kidney
Which of the following treatments has been shown to improve IUGR?
No therapy has been shown to result in improvement
Hyperviscosity syndrome associated with IUGR is defined as fetal Hct of more than
65%
Hyperviscous syndrome in IUGR is associated with
Heart failure
Growth restricted newborns have difficulty maintaining euglycemia because they have
Less fat deposition in late pregnancy
Macrosomia increases the risk of
Both maternal and neonatal morbidity
The most common medical condition associated with macrosomia is
DM
During the delivery process, the fetus with macrosomia is at increased risk for
Shoulder dystocia
A neonate with macrosomia associated with maternal diabetes is at higher risk for
Hypoglycemia
Macrosomia is associated with later life
Obesity
Recommendations for cesarean delivery for a mother without diabetes when the fetus exceeds
5,000g
Which of the following is a risk factor for fetal macrosomia?
Muliparity
What is the incidence in general population of twinning?
1 in 90 pregnancies
What is the incidence in general population of monozygotic twinning
1 in 250
In twin-twin transfusion syndrome, hyervolemia in the recipient twin can lead to
Hydraminos
In multifetal gestations, assessment of fetal well being though daily kick counts should be begun at about
30-32 weeks
Which about the following statements about dizygoitic twinning is correct?
The increasing maternal age is an independent risk factor
Twinning within 3 days of fertilization will likely result in what organization of the fetal membranes?
Diamniotic/dichorionic
Twinning between 4 and 8 days of fertilization will likely result in what organization of the fetal membranes?
Diamniotic/monochorionic
Approximately what percentage of twin pregnancies detected in the first trimester result in a delivery of viable twins?
50%
In monozygotic twins, oligohydraminos and anemia of one twin and hydraminos and polycythemia of the other twin are the result of
Vascular anastomoses between the fetuses
The average time of delivery in a singleton pregnancy is
40 weeks
The average time of delivery in a twin pregnancy is
35 weeks
A twin pregnancy in which one twin is characterized by impaired growth, anemia and hypovolemia and the other twin by hypervolemia, hypertension, polycythemia and CHF is defined as
Twin-twin transfusion syndrome
Diagnosis of multiple gestation is usually made by
US
What is the chief antenatal assessment means to evaluate the progress of the twin pregnancy?
Serial US
In multiple gestation, periodic US is done approximately every 4 weeks beginning at about
16 weeks
Intrapartum management of twin pregnancies at term is usually determined by
Presentation of twins
What percentage of twin gestations is each member of the twin pair in the cephalic presentation at the beginning of labor?
40%
Chorionicity can first be determined at approximately how many weeks GA?
9-10
Vanishing twin syndrome is seen in approximately what percent of twin pregnancies detected by US early in 1st trimester?
50
A 34 year old woman in her first pregnancy presents for her first prenatal visit at 18 weeks. Her PMH is negative. Her family history is negative except for a history of siblings who were fraternal twins and a grandmother who was a fraternal twin. You perform a sonogram at the bedside-which reveals a twin gestation. You tell her that this type of twin pregnancy is most likely
Dizygotic
A 31 year old woman in her 1st pregnancy presents at 12 weeks gestations for a routine visit. She recently had an US done, which revealed a twin gestation. You describe that there appears to be an amnion and a chorion surrounding each fetus. This type of chrionicity is also known as
Diamniotic/dochorionic
38 year old woman with twi gestations presents at 22 weeks for routine visit. Her prenatal course has been uncomplicated except for an US exam that revelas that one fetus has hydraminos and an estimated fetal weight greater than the 95th percentile; the other twin has an estimated fetal weight less than 5th percentile and has oligohydraminos. The fetuses appear to be the same gender. The most likely diagnosis is
Twin-to-twin transfusion syndrome
A 36 year old woman presents at 16 weeks with twin gestation for a routine prenatal visit. Her prenatal course has been uncomplicated and she has no medical problems. She has recently found out about her twin gestation and you would like to inform her of the risks of a twin gestation compared with a singleton gestation. You counsel her that which of the following is increased?
Preterm birth
Women with twin gestation are at increased risk for postpartum
Hemorrhage
Premature rupture of membranes is defined as the rupture of the chorioamnionic membrane before what event?
Onset of labor
How is amniotic fluid primarily produced by the fetus
Urination
PROM is associated with about what percentage of preterm pregnancies?
8%
What is the difference in frequency of PROM in term pregnancies compared with preterm deliveries?
400% increase in preterm deliveries
Midtrimester PPROM (between 16 and 26 weeks GA) may be associated with
Genetic amniocentesis
Which of the following is the most serious consequesnce of PPROM?
Preterm delivery
What is the relationship between the length of latency period and GA in cases of PROM?
Latency period is inversely related to GA
22 year old patient at 23 weeks gestation describes a sudden gush of fluid from the vagina. Which of the following can give a flase-negative Nitrazine test?
ROM with no residual fluid
25 y.o patient at 20 weeks gestation is concerned about loss of amniotic fluid associated with coitus last night. Which of the following can produce a false positive nitrazine test?
Semen
Which of the following presentations is most likely to be confused with PROM at term?
Intermittent urinary leakage
The nitrazine test is used to assess for PROM based on what property of amniotic fluid?
Higher pH than vaginal secretions
Of the following, which is the best indicator of intrauterine infection associated with PROM?
Bacteria on gram stain of amniotic fluid
Which of the following should be avoided in a patient with presumed PROM?
Digital exam
Premature rupture of the membranes presents a significant risk of pulmonary hypoplasia and skeletal malformations before what gestational age?
22 weeks
Delivery generally is recommended PROM occurs after how many weeks of gestation?
34 weeks
A 30 year old patient at 35 weeks of gestational age has premature rupture of membranes. The fetus is in vertex presentation. Which of the following is the most appropriate next step in management.
Induction of labor
A 32 year old patient at 30 weeks of gestational age has premature spontaneous rupture of membranes. The fetus is in breech presentation. Which of the following is most appropriate next step in management?
Admin of corticosteroids
A 30 year old primigravid patient at 39 weeks of gestational age rupture of the membranes yesterday.
Spontaneous labor
Betamethasone therapy in cases of PPROM is most useful to prevent what condition?
Respiratory distress syndrome
Which of the following provides the most reliable evidence of ruptured membranes?
Ferning of dried fluid on microscope slide
A 28 year nulliparous woman at 28 weeks with a complaint of leaking fluid. A nitrazine test confirms ROM. The fetal heart rate is reassuring and there are no contractions. Her vital signs are normal. The most likely complications that this patient could experience is
Chorioamnionitis
A 36 year old woman presents at 32 weeks gestation with leaking fluid from her vagina. She smokes a pack of cigarettes per day. Her prenatal course has been uncomplicated except for the diagnosis of GDM. On a proper diet, her BG values have been normal. A recent sonogram revealed a normally grown fetus in the breech position with normal amniotic fluid volume. The factor that increases her risk of PROM the most is
Smoking
A 32 year old woman presents at 28 weeks gestation with a complaint of leaking fluid from her vagina. A speculum exam reveals a small amount of fluid in the posterior portion of the vagina. The nitrazine test is negative. What further test would be beneficial in this patient’s management?
US
A 41 year old presents at 39 weeks gestation with PROM. Her vital signs are normal. External fetal monitoring reveals a reassuring fetal heart rate and occasional uterine contractions. She desires expectant management. Which of the following is most appropriate?
Intermittent auscultation of fetal heart rate
A 19 year old woman presents at 24 weeks of gestations with a complaint of leaking fluid from her vagina. Her blood pressure is 100/60 mm Hg, pulse is 120, RR is 22, and temperature is 40 C. A fluid in the vagina is positive for ferning and nitrazine. Sonogram reveals a normally grown fetus at 24 weeks of gestation with oligohydraminos. Her uterus is moderately tender to palpation. Of the following, which is the most appropriate next step?
Delivery
A 29 year old presents at 28 weeks gestation with a complaint of leaking fluids from her vagina. Her prenatal course has been uncomplicated. Her vital signs are normal. A speculum examination reveals pooling of amniotic fluid and is positive for ferning and nitrazine. Sonogram revelas a normally grown fetus with oligohydraminos, Her uterus in nontender. Which of the following is most appropriate next step?
Expectant management
Which is the best predictor of successful vaginal birth?
Descent of the presenting part during labor
A 30 year old primigravid patient at term progresses from 4cm dilation to 7 cm in 5 hours. How would this labor be described?
A protraction disorder
A 22 year old multiparous patient has been pushing for 2 hours resulting in no descent of the presenting part. This would be classified as
An arrest disorder
Which of the following maternal factors can prevent accurate clinical assessment of uterine contractions?
Obesity
For a patient in active labor, which of the following provides a quantitative measurement of the strength of her uterine contractions
Intrauterine pressure catheter
Which of the following presentations typically converts to either a vertex or brow presentation?
Compound
