Question 1

A primigravida has experienced labor pain for 18 hours, and examination reveals that the fetal head is at the level of the ischial spine. Which of the following is possible cause?

Accepted Answer

All of the above
This is a case of a primigravida with prolonged labor due to deep transverse arrest. Causes of deep transverse arrest include:
1. Faulty pelvic architecture
2. Deflexion of the fetal head
3. Weak uterine contraction
4. Laxity of the pelvic floor muscle

Question 2

A woman (second gravida) presents with labor pain. Examination reveals that her cervix is fully dilated, and the fetal sagittal suture is transversely placed. Of the following, which may be the recommended management of this woman?

Accepted Answer

All of the above
This is a case of a second gravida in labor with deep transverse arrest. The following is the probable management of this patient with deep transverse arrest. If her pelvis is adequate (and there is a determination of good fetal condition), the management may include:
1. Ventouse delivery
2. Manual rotation and application of foeceps
3. Forceps rotation and delivery
If there is cephalopelvic disproportion and/or a determination of "large baby", the probable management is a cesarean section.

Question 3

In a breech presentation, the lie is longitudinal and the podalic pole presents at the pelvic brim. How many methods are used to perform vaginal breech delivery?

Accepted Answer

3
There are three methods for vaginal breech delivery:
1. Spontaneous: Expulsion of the fetus occurs with very little assistance. This is not preferred.
2. Assisted breech delivery: The delivery of the fetus is by assistance from beginning to end.
3. Breech extraction: When entire body of the fetus is extracted, it is called breech extraction.

Question 4

A breech extraction refers to a delivery of a baby in malpresentation in the birth canal. Which of the following can be a complication of vaginal breech delivery?

Accepted Answer

All of the above
In breech presentation, the lie is longitudinal and the podalic pole presents at the pelvic brim. It is the most common malpresentation. Complications of vaginal breech delivery include:
1. Arrest of labor in the first stage of labor
2. Fetal distress
3. Cord prolapse
Three methods for vaginal breech delivery are:
1. Spontaneous: Expulsion of the fetus occurs with very little assistance.
2. Assisted breech delivery: The delivery of the fetus is with assistance from beginning to end.
3. Breech extraction: When entire body of the fetus is extracted by forceps (or some other method), the delivery is called breech extraction.

Question 5

When the long axis of the fetus lies perpendicular to the maternal spine, it is called transverse lie. In a full-term delivery scenario, which of the following statements is true about the management of transverse lie? (Choose all that apply)

Accepted Answer

External cephalic version and B - If external cephalic version fails, then deliver by cesarean section
When the long axis of the fetus lies perpendicular to the maternal spine, it is called transverse lie. There are 4 positions of transverse lie as follows:
· Dorso-anterior
· Dorso-posterior
· Dorso-superior
· Dorso-inferior
Management of transverse lie includes:
1. Performing external cephalic version
2. If external cephalic version fails, then deliver by cesarean section
3. If baby is stillborn, perform vaginal delivery

Question 6

A 2nd gravida at 38 weeks of pregnancy developed a condition whereby the fetal presentation was continuously in transition instead of stabilized. Which of the following is the probable reason?

Accepted Answer

Unstable lie
Unstable lie is a condition whereby the fetal presentation is continuously in transition instead of stabilized at 9 months of the pregnancy. Causes of unstable lie include:
1. Grand multiparity
2. Polyhydramnios
3. Contracted pelvis
4. Placenta previa
Management of unstable lie includes:
1. Exclusion of placenta previa and contracted pelvis by ultrasound
2. Vaginal delivery if condition is stable
3. Cesarean section if any complicating factors are present

Question 7

A multigravida woman is determined to have obstetric abnormalities. Examination reveals a case of unstable lie. Which of the following is a possible management for her?

Accepted Answer

All of the above
Unstable lie is a condition whereby the fetal presentation is continuously in transition instead of stabilized at 9 months of the pregnancy. Causes of unstable lie include:
1. Grand multiparity
2. Polyhydramnios
3. Contracted pelvis
4. Placenta previa
Management of unstable lie includes:
1. Exclusion of placenta previa and contracted pelvis by ultrasound
2. Vaginal delivery if condition is stable
3. Cesarean section if any complicating factors are present

Question 8

The cord lying inside the vagina (or outside the vulva) following rupture of the placental membranes is called______.

Accepted Answer

Cord prolapse
The umbilical cord lying inside the vagina (or outside the vulva) following rupture of the placental membranes is called cord prolapse. If the umbilical cord is placed by the side of the presenting part (and is not felt by the fingers on internal examination), it is called occult prolapse. When the cord is slipped down below the presenting part (and is felt lying in the intact bag of membranes), it is called cord presentation.

Question 9

A pregnant woman is in labor. If the umbilical cord is placed by the side of the presenting fetal part (and is not felt by the fingers on internal examination), this complication is called______.

Accepted Answer

Occult prolapse
If the umbilical cord is placed by the side of the presenting part (and is not felt by the fingers on internal examination), this is called occult prolapse. When the cord is slipped down below the presenting part (and is felt lying in the intact bag of membranes), it is called cord presentation. If the cord is lying inside the vagina (or outside the vulva) following rupture of the placental membrane, this is called cord prolapse.

Question 10

A pregnant woman is in labor. When the cord is slipped down below the presenting fetal part (and is felt lying in the intact bag of membranes), this complication is called______.

Accepted Answer

Cord presentation
When the cord is slipped down below the presenting part (and is felt lying in the intact bag of membranes), it is called cord presentation. If the cord is lying inside the vagina (or outside the vulva) following rupture of the placental membrane, this is called cord prolapse. If the umbilical cord is placed by the side of the presenting fetal part (and is not felt by the fingers on internal examination), this is called occult prolapse. Unstable lie is a condition where the presentation of the fetus is continuously in transition-even beyond 36th weeks of pregnancy-when it should be stabilized.

Question 11

A 25 year old pregnant female is in the 2nd stage of labor. Examination reveals that it is a case of umbilical cord prolapse. Which of the following can be proper management for her?

Accepted Answer

All of the above
This is a case of umbilical cord prolapse. Management of cord prolapse includes:
1. I/V fluid
2. Oxygen inhalation
3. Bladder attention (filling)
4. Lifting up the presenting part of the cord
5. Replacement of the cord into the vagina to minimize vasospasm

Question 12

The disparity in the relation between the head and the pelvis is called cephalopelvic disproportion (CPD). Which of the following is the recommended management of CPD? (Choose all that apply)

Accepted Answer

Trial labor and C - Elective c-section at full-term
Cephalopelvic disproportion is the term used to describe when a baby's head or body is too large to fit through the pregnant mother's pelvis.Management of CPD can include:
1. Preterm induction of labor
2. Elective c-section at term
3. Trial labor

Question 13

Trial labor in an institution under supervision (with watchful expectancy) may be attempted in a patient with cephalopelvic disproportion. Which of the following statements is true about the conduction of trial labor?

Accepted Answer

All of the above
In a pregnant woman with a moderate degree of cephalopelvic disproportion (CPD, trial labor may be attempted in an institution under supervision (and with watchful expectancy). However, arrangements should be made for operative delivery (if trial labor is a failure and c-section is necessary).
In trial labor with the goal of vaginal delivery:
1. Labor should ideally be spontaneous in onset
2. Prevention of rupture is needed
3. Progressive dilation of the cervix is entailed
4. Diagnosis excluding cord prolapse is necessary

Question 14

In terms of moderate cephalopelvic disproportion (CPD), which of the following is a disadvantage in deciding upon a trial labor for a patient with this condition?

Accepted Answer

Test of disproportion remains unproven
In a pregnant woman with a moderate degree of cephalopelvic disproportion (CPD, trial labor may be attempted in an institution under supervision (and with watchful expectancy). However, arrangements should be made for operative delivery (if trial labor is a failure and c-section is necessary).
Disadvantages of trial labor include:
1. Test of disproportion remains unproven
2. increased perinatal morbidity or mortality
3. Increased risk of maternal mortality

Question 15

Contracted pelvis is considered when the essential diameters of one or more planes are shortened by 0.5 cm. Which of the following is a maternal complication of contracted pelvis? (Choose all that apply)

Accepted Answer

Umbilical cord prolapse and C - Obstructed labor
Contracted pelvis is considered when the essential diameters of one or more planes are shortened by 0.5 cm. Maternal complications of contracted pelvis include:
1. Rupture of the membrane
2. Prolonged labor
3. Injuries to the genital tract
4. Umbilical cord prolapse
5. Obstructed labor

Question 16

Puerperium is the approximately six-week period following childbirth, during which the mother's reproductive organs revert back to the pre-pregnant state. Which of the following statements is true about normal puerperium?

Accepted Answer

Pulse returns to normal
In normal puerperium, the following occurs:
1. Pulse returns to normal
2. BP returns to normal
3. Temperature returns to normal

Question 17

Puerperium is the approximately six-week period following childbirth, during which the mother's reproductive organs revert back to the pre-pregnant state. Which of the following statement is true about the management of puerperium?

Accepted Answer

All of the above
Puerperium is the approximately six-week period following childbirth, during which the mother's reproductive organs revert back to the pre-pregnant state. Management recommendations for the period of puerperium includes:
1. Proper diet
2. Proper sleep
3. Care of the bladder
4. Care of the breasts
5. Care of the bowel
6. Rest and ambulation
7. Postpartum healthcare

Question 18

Lochia is the vaginal discharge that occurs after giving birth, and this discharge can continue for 4-6 weeks following delivery.Which of the following statements is false about lochia?

Accepted Answer

Lochia from the uterus is alkaline
The vaginal discharge following delivery is called lochia. The lochia consists of fibrinous products, decidual cells, red blood cells and leucocytes. It typically lasts no longer than 3 to 5 days after birth..
There are three types of lochial discharge as follows:
1. Lochia rubra -red in color because of the large amount of blood it contains. It typically lasts no longer than 3 to 5 days after birth.
2. Lochia serosa -brownish or pink in color, this contains serous exudate, leukocytes, erythrocytes, and cervical mucous.
3. Lochia alba -whitish or yellowish-white discharge occuring from the 2nd through the 3rd to 6th week following vaginal delivery.

Question 19

Immediately after delivery, the breast milk (called colostrum) is yellowish-or a cream color-and sticky. Which of the following statements is true about colostrum?

Accepted Answer

There are immunoglobulins in colustrum
Immediately after delivery, breast milk is often yellowish and sticky. This breast milk is called colostrum. Colostrum is the first stage of breast milk; it lasts for several days after the birth of the baby. It is followed by transitional milk, which lasts approximately two weeks. Following transition milk, mature milk is produced. Colostrum is high in protein, fat-soluble vitamins, minerals, and immunoglobulins. Colustrum is also much thicker than transitional or mature breast milk.

Question 20

Immediately after delivery, the breast milk (called colustrum) is yellowish-or a cream color-and sticky. Which of the following is an advantage for the newborn of colostrum? (Choose all that apply)

Accepted Answer

Colostrum enables the baby's passive immunity due to immunoglobulins and C. Helps in preventing jaundice
Advantages of colostrum:
1. Colostrum provides baby's first immunity (passive immunity)
2. Colustrum contains immunoglobulins
3. Colustrum helps in preventing jaundice
4. Colustrum is laxative and helps the baby to pass meconium

Quiz 6: The Postpartum-Period