Question 1

A pregnant patient at 38 weeks of pregnancy was admitted with lower abdominal pain. On P/V examination, the cervix was 4 cm dilated with 100% effacement (membrane intact and bulged). How will you manage this patient?

Accepted Answer

All of the above
This is a case of a woman in the first stage of labor at 38 weeks of pregnancy. The first stage starts from the onset of true labor pain, and ends with full dilatation of cervix. Therefore, patient management includes reassurance and encouragement, company and privacy, strict maintenance of hygiene, rest and ambulation, bladder care, relief of pain, and liquid diet. Constant supervision is a very important component of management in the first stage of labor.

Question 2

A pregnant woman is suffering from a delay in the 2nd stage of labor. Which of the following might cause this delay?

Accepted Answer

Uterine inertia
Common causes of delay in the second stage of labor are uterine inertia, inability to bear down, constriction ring, pelvic tumor, malposition, epidural analgesia, cephalo - pelvic disproportion, and android pelvis. Additional causes of delay in the second stage are malpresentation, "big baby", or congenital malformation of the fetus-as well as undue resistance of the pelvic floor (or perineum) due to spasm, and scarring may be a cause of this problem.

Question 3

A primigravida arrived with labor pain over 18 hours. She is suffering from prolonged labor. What is the fetal complication of prolonged labor? (Choose all that apply)

Accepted Answer

Hypoxia and C. Acidosis
Fetal complications of prolonged labor include hypoxia, intrauterine infection, operative delivery, and fetal acidosis. Distress and trauma can also affect the pregnant woman. Various things can cause prolonged labor (e.g., uterine inertia, cervical dystocia, pelvic tumor, malpresentation, and malposition). Labor is generally considered to be prolonged when the combined duration of the first and second stages of labor are more than approximately 18 hours.

Question 4

A woman with severe labor pain was treated with prostaglandin to induce labor pain. How will you monitor this patient?

Accepted Answer

All of the above
After giving prostaglandin, the patient should be monitored by P/V for bleeding, itching, rash, convulsion, pulse and blood pressure, temperature, respiratory rate, and urine output. Prostaglandins can be used to induce labor or in the management of atonic postpartum hemorrhage (PPH). Prostaglandin has a powerful oxytocic action, inducing contraction of uterine smooth muscle.

Question 5

A 26 years old pregnant woman developed labor pain. She was in the first stage of labor. State the appropriate dietary advice for her. (Choose all that apply)

Accepted Answer

Diet should be liquid and B. If operative intervention is a possibility, she should be kept on nothing by mouth
The first stage of labor starts from the onset of true labor pain and ends with full dilation of the cervix. In the first stage of labor, dietary advice is the following: 1) diet should be liquid; 2) food and oral fluids should be withheld in active labor; 3) if operative intervention is a possibility, patient should be kept on nothing by mouth; and 4) foods rich in protein and lipid should be avoided.

Question 6

A 29 year old female developed labor pain in the second stage of labor. Which of the following measures is necessary?

Accepted Answer

Patient should be in bed
The second stage of normal labor begins at full dilatation of the cervix, and ends with expulsion of fetus. Management of the second stage of labor includes: 1) patient should be in bed; 2) constant supervision; 3) vaginal examination; and 4) inhalation analgesics.

Question 7

Which kind of cloth is suitable for newborns?

Accepted Answer

Cotton
The most common material used for newborn blankets is cotton. Cotton remains dry in moist and hot weather conditions and protects the skin by separating it from any liquid.

Question 8

A 27 year old female is giving birth, and you are assisting with delivery. In which position will you attempt to bring the newborn out of the vaginal orifice?

Accepted Answer

Head should be directed downwards
A newborn should be delivered in the position of head downwards. It facilitates the drainage of mucous in the tracheobronchial tree by gravity. Projecting the head downwards also helps in proper circulation of blood into the brain.

Question 9

A 26 years old female is in the second stage of normal labor. Which of the following "pairs of phases" are those that occur within the second stage of labor?

Accepted Answer

Propulsive phase and expulsive phase
The second stage of labor starts at full dilation of the cervix, and ends with expulsion of the fetus. The second stage of labor includes the propulsive and expulsive phase. The propulsive phase starts at full dilation of the cervix, and the expulsive phase is determined by maternal bearing down effort and delivery of the baby.

Question 10

The "stage of observation" lasts at least one hour after expulsion of the after - birth. In which stage of labor does the "stage of observation" occur?

Accepted Answer

4th stage
The fourth stage is also called the stage of observation. This stage of labor requires observation of the postpartum patient for at least one hour after expulsion of the after - birth. During this time period, the general condition of the patient and behavior of the uterus need to be carefully monitored. Only when the pulse and BP are steady, the uterus is well contracted, and the patient's general condition is good, should the status of the patient be determined as "safe".

Question 11

Hormones play a very important role in the human system. Which of the following hormones play a role in labor?

Accepted Answer

All of the above
Estrogen increases release of oxytocin from the pituitary gland. Estrogen also promotes the synthesis of the receptor for oxytocin in myometrium, and accelarates lysosomal disintegration in amnion cells (resulting in prostaglandin synthesis). Before onset of labor, the progesterone level falls (due to increased fetal production of DHEA - S). Prostaglandins are important factors which initiate and maintain labor.

Question 12

A 25 years old pregnant female reports that she is having 3 - 4 contractions every 10 minutes. Which stage of labor is she experiencing?

Accepted Answer

2nd stage
In the second stage of labor, the labor pain occurs at intervals of 2 - 3 minutes, with 3 - 4 contractions every 10 minutes. The duration of pain increases from that in the first stage. The second stage starts at full dilatation of cervix, and ends with expulsion of the fetus. The second stage of labor includes the propulsive phase and expulsive phase.

Question 13

A woman in the fourth stage of labor is experiencing delayed clamping. What is the effect of delayed clamping?

Accepted Answer

Sometimes beneficial to newborn
Delay in clamping for 2 - 3 minutes (or until cessation of the cord pulsation) facilitates transfer of 80 - 100 ml of blood from the compressed placenta to the baby. This is sometimes beneficial to a newborn, but may be deleterious to a premature newborn.

Question 14

Clamping of the umbilical cord needs to be done soon after delivery. Why is this necessary?

Accepted Answer

All of the above
Early clamping of the cord should be done in case of Rh incompatibility (to prevent antibody transfer from the postpartum mother to the newborn). Rh incompatibility may lead to Erythroblastosis fetalis,which can cause fatality of the baby. Additionally, early clamping should be done to prevent the newborn from asphyxiating on the cord. Early clamping should also be performed to reduce risk to newborn from postpartum diabetic mother.

Question 15

A 29 years old female is in the third stage of labor. Which of the following is an event associated with the third stage of labor?

Accepted Answer

All of the above.
The third stage of labor includes the phase of placental separation, its descent to the lower uterine segment, and placental expulsion with the membranes. The third stage of labor begins after expulsion of the fetus, and ends with expulsion of the placenta and the membranes.

Question 16

Which stage of labor is the most critical stage?

Accepted Answer

3rd stage
The third stage of labor is the most critical stage, so management of this stage requires vigilance. An uneventful first and/or second stage of labor can become abnormal quickly with dire consequences. The third stage of labor begins after expulsion of the fetus, and ends with expulsion of the placenta and the membranes.

Question 17

Which of the following is a complication associated with the third stage of labor? (Choose all that apply)

Accepted Answer

Postpartum hemorrhage and D. Pulmonary embolism
The following are complications of the third stage of labor: 1) postpartum hemorrhage; 2) retained placenta; 3) obstetrics shock; 4) pulmonary embolism; and 5) uterine inversion. Complications of the second stage of labor include fetal distress and intrapartum eclampsia.

Question 18

A 27 years old pregnant female developed complications in the third stage of labor. Which precaution could have potentially prevented the complication from occuring?

Accepted Answer

All of the above
The precautions in the third stage of labor that should be taken to prevent complications include: 1) proper antenatal check - up; 2) Typing and cross - matching of blood; and 3) blood units ready for utilization if transfusion is needed.

Question 19

Birth injuries may be serious enough to cause neonatal death. Which is a common birth injury to a newborn?

Accepted Answer

Cephalohematoma
Cephalohematoma is a hemorrhage of blood between the skull and periosteum of a newborn. Other injures include: 1) scalp injury; 2) skin rupture; 3) other intracranial injuries; 4) brachial plexus injury; and 5) clavicle, humerus, or femur fracture.

Question 20

A pregnant woman is suffering from prolonged labor. In terms of potential neonate injury, which of the following injuries is most likely to occur during birth to the baby?

Accepted Answer

Soft tissue injury
Some soft tissue injuries include cephalohematoma, scalp injury, skin rupture, intracranial injury, and brachial plexus injury. Nerve damage can occur in fetal macrosomia; visceral damage may occur in case of abnormal presentation, and bone fracture can occur in manipulative delivery. In terms of bone injuries, clavicle, humerus or femur injury are among the most common.

Quiz 2: Labor Birthand Immediate Postpartum

A pregnant patient at 38 weeks of pregnancy was admitted with lower abdominal pain. On P/V examination, the cervix was 4 cm dilated with 100% effacement (membrane intact and bulged) . How will you manage this patient?