9. -Nulliparous: NOdilation >2hr, no descent >1hr
-Multiparous: NO dilation >2hr, no descent >1hr
10. A-1 hr if multi,2hrs if nulli ,add 1hrs if
epidural
B-2 hrs if mulli,3 hrs if nulli ,add 1hrs if
epidural
C-1.5 hr if multi ,2.5 hrs, add 1 hr if epidural
ANSWER A
12. A-Power: uterine contractions
B-Passenger: the baby
C-Passage: the patient's pelvis, pelvic floor
13. During first stage of labor, you are
concerned with the power of the uterine
contractions
During the second stage of labor, you are
concerned with the power of the patient's
pushing efforts
14. -External tocodynamometry or an
intrauterine pressure catheter (IUPC)
For IUPC, patient must be ruptured and
increased the risk of infection
15. Strong enough to cause cervical change
Optimal frequency is a minimum of three
contractions in a 10 min period (ideal is every
2 min)
Greater than or equal to 200 Montevideo units
16. -If contraction pattern is irregular or less
than 3 in 10 minutes or if MVU's are less
than 200, use Pitocin to increase intensity
and frequency of contractions.
17. 1) Allow patient to rest through a few contractions
to catch her breath.
2) Try different positions for more effective
pushing
3) If everything fails, operative vaginal delivery or
Cesarean section
•
19. -Fetal lie: non-longitudinal presentation-
transverse, oblique or shoulder
-Fetal presentation: breech, face (1 in 600),
or brow (1 in 3000), compound presentation
(1 in 700)-hand or arm prolapses along fetal
head
Asynclitism-lateral deflection of the head to a
more anterior or posterior position in pelvis
•
20. frank breech: legs are piked
-complete breech: indian style or curled legs
-footling breech: one leg down, monitor for if
umbilical cord falls through pelvis
21. A- Pinard manouverto deliver leg,rotate sacrum
anterior,wrap trunk in tawel,deliver arm when scapula
visible,downward pr on maxilla to deliver the head
B- Pinard manouverto deliver leg,rotate sacrum
anterior,wrap trunk in tawel,deliver arm when scapula
visible,downward pr on mandible to deliver the head
C- Pinard manouverto deliver leg,rotate sacrum
posterior,wrap trunk in tawel,deliver arm when scapula
visible,downward pr on mandible to deliver the head
ANSWER B
22. A-ant hip has a more rapid decent than post hip
B- ant hip is beneath the symphysis pubis and
intertrochanteric diameter rotates around a 45
degree axis
C- if post hip is beneath the symphysis pubis it has
to go through 225 degree axis rotation
D-for sacrum ant or post position, the axis of
rotation is around 45 degrees
Ans: C
24. A- This is a rare presentation above inlet
B-brow presentation most of the time changes to face
presentation
C- decent mechanism is completely different from
vertex presentation
D-delivery is possible if mentum appears beneath the
symphysis.
Ans:C
25. A-induction of labor
B- internal rotation to make mentum ant position
C- observation to allow spontaneous rotation
D- C/S
Ans:C
26. A-Forceps can be applied
B-manual rotation of the head can be done
C- manual rotation of the head can’t be done
D-there is no place for observation
Ans:D
27. -Macrosomia is defined as an infant
weighing greater than 4,000-4,500 g
Risk factors include maternal obesity,
diabetes, multiparity, excessive maternal
weight gain, prolonged gestation and a
history of a macrosomic infant
•
28. -Hydrocephalus
large fetal abdomen from tumor
Ascites
distended bladder
Conjoined twins
29. • -not much we can do about fetal weight or
anomalies
-external cephalic version prior to labor can
be performed to convert breech or transverse
to vertex
-rotation of fetal head to direct OA
presentation manually or with forceps
•
30. -The size of the maternal pelvis is
inadequate to the size of the presenting
part of the fetus
31. -manual evaluation of the diameters of the
pelvis
32. • A-Ability to touch sacral promontory with index finger
•
B-Significant divergence of the pelvic side wall
•
C-Forward inclination of a straight sacrum
•
D-Sharp ischial spines with a narrow interspinous
• diameter
E -Narrow suprapubic arch
ANSWER B
•
33. Obstetric: shortest anteroposterior diameter
of pelvis
Diagonal: distance from the lower margin of
the symphysis to the promontory of the sacrum
and subtracting 1.5cm (you want diagonal
conjugate to be greater than 11.5cm)
34. -normal female type male type
- inlet triangular or heart-shaped
35. -Ape-like type
-Anteroposterior
diameters long,
Transverse short,
Sacrum long and narrow,
Subpubic angle narrow
36. All anteroposterior diameters are short,
Transverse are long, subpubic angle is wide
37. A-Prolonged latent phase: question if false labor,
treat with observation and sedation if needed
B-Protraction disorder of active phase: augment
with amniotomy or oxytocin
C-Arrest disorder with adequate contractions: C-
section
D- All of the above
Answer D
38. -Rotate fetal head if necessary
Change positions
Operative delivery
39. -If placenta not delivered w/in 30 min:
manual sweep should be performed
40. -Fetal head delivers but the shoulder is
impacted behind the pubic symphysis
Risk factors: fetal macrosomia, diabetes,
operative delivery
41. • A-McRobert's Maneuver:sharply flex
maternal thigh
• B-Cut episiotomy if needed for more room
C. Fundal pressure
D-woods screw maneuver
E. Delivery of the posterior arm
ANSWER C
42.
43. A-rotation of post. shoulder to deliver ant.
shoulder
B- abduction of shoulders
C- flex of mother’s knees and suprapubic
pressure
D- rotation and extraction of ant. shoulder
Ans:B
Woods screw=A
McRoberts m.=C
Zavanelli m.= repositioning of fetal head back
into the uterus and C/S
44.
45. 1. get help
2. be sure bladder is drained
3. cut episiotomy if needed for more room
4. suprapubic pressure
5. McRobert's Maneuver:sharply flex
maternal thigh
6. woods screw maneuver:turn shoulders to a
more direct AP position
7. delivery of the posterior arm
8. fracture clavicle or humerus
9. zavanelli maneuver: flex and reinsert fetal
head and do C-section
46. A-Maternal heart disease, pulmonary
compromise
B- prolonged first stage of labor,
C-maternal exhaustion
D- non-reassuring fetal heart rate pattern
ANSWER B
•
47. • A-inability to definitely determine position of
fetal vertex
B-fetus with presentation other than vertex or
face with chin anterior
C-fetus not engaged or above +2 station
D-CPD: inadequate pelvis, estimated fetal weight
>4000g
E-membranes ruptured or cervix fully dilated
F-fetus <34 weeks for vacuum delivery
• ANSWER C
50. A-1st degree: involve the forchette, perineal
skin and vaginal mucous membrane
B-2nd degree: the fascia and muscles of the
perineal body
C-3rd degree: involve the anal CANAL
D-4th degree: extends through the rectal
mucosa to expose the lumen of the rectum
• ANSWER C
•
55. • -Caput succedaneum: subcutaneous bleeding
and swelling
-Cephalohematoma: bleeding beneath the
periosteum and therefore does not cross
suture lines unless there is a skull fracture
•
58. The most like explanation of deccleration is
A- Maternal position on left lateral side
B- Uterine hyperstimulation from cervical
ripening agent
C- Compression of the fetal head mediated by
vagus
D- Umbilical cord compression
ANSWER B
59. A- prior C-section or uterine scar
B- Face mento anterior
C- labor dystocia
D- Breech presentation<35 WKS
E- fetal distress
F- persistent mento posterior
• ANSWER B
•
