MCQ on normal and abnormal labor for undergraduate

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MCQ On Normal Abnormal Labour For
Undergraduate
Dr Manal Behery Assistant Professor , Zagazig
University 2013
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PART 1 normal labor
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1-Normal labour is the process by which
contractions of the gravid uterus expel the fetus
and the other products of conception

• A-between 37 and 42 weeks from the last menstrual
  period
• B- Before 37 weeks gestation
• C-After 42 weeks gestation
• D- After 24 weeks gestation
• ANSWER A

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Terminology

• Gravidity
• of current and completed pregnancies of any kind
• Parity
• of completed pregnancies 20 weeks
• not delivered infants (e.g. twins)

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Terminology

• Nullipara
• Primipara
• Multipara
• Grand Multipara

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TPAL Nomenclature

• T Term deliveries 37 wksP Preterm
  deliveries lt 37 wksA Abortions (lt 20 wks)L
  Living children

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G3/P1-0-1-1

• 3rd Pregnancy
• 1 Term delivery
• 0 Preterm deliveries
• 1 Abortion
• 1 Living child

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2-G5/P2-1-1-0

• 5th Pregnancy
• 2 Term deliveries
• 1 Preterm delivery
• 1 Abortion
• 0 Living children

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3- G2/P0203

• 2nd Pregnancy
• 0 Term deliveries
• 2 Preterm deliveries
• 0 Abortions
• 3 Living children

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4-Fetal lie refers to

• longitudinal axis of the fetus in relation to
  the oblique axis of the maternal uterus
• longitudinal axis of the fetus in relation to the
  transverse axis of the maternal uterus
• longitudinal axis of the fetus in relation to the
  long axis of the maternal uterus
• longitudinal axis of the fetus in relation to the
  long axis of the maternal pelvis
• ANSWER C

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Fetal lie longitudinal axis of the fetus in
relation to the long axis of the maternal uterus.
assessed by abdominal examination prior to
delivery.

• Logitudinal transverse oblique

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5-Presentation is the part of the fetus that is

• Relates to right or left side of maternal pelvis
• presenting or is the closest in proximity to the
  birthing canal
• Ralated to long axis of mother
• First enter the pelvic cavity
• First felt by vaginal examination
• ANSWER B

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Presentation

• The part of the fetus that is presenting or is
  the closest in proximity to the birthing canal
• Vertex
  Breech

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6-Which is true about Position, attitude of the
fetus in labour

• position is either cephalic or breech
• attitude is either flexion ,OR deflexion
• position is the relationship of a landmark on
  the presenting part to the right or left side of
  the pelvis
• Position is either oblique lognitudinal or
  treasverse
• E .Attuide is landmark on presenting part that
  determine position
• ANSWER C

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Fetal Position
OA
LOA
ROA
LOT
ROT
LOP
ROP
OP

• LOT 40
• ROT 20
• OP 20

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7-Fetal Position
?????
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8-Fetal Position
Left OcciputAnterior
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9-Fetal Position
?????
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10-Fetal Position
Right OcciputPosterior
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11-Fetal Position
?????
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12-Fetal Position
Left OcciputTransverse
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Fetal Station

• The relationship of the fetal presenting part to
  the level of the ischial spines

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Fetal Station
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True onset of labor is defined by which one of
the following

• Passage of bloody show
• Occurance of uterine contraction
• Excessive fetal movement
• Cervical dilation and effacement
• Gush of vaginal fluid
• ANSWER D

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How is true labor defined?

• cervical change
• Effacemant is shortening of the cervical canal
  (from a length of 3 cm to a circular aperture.

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LaborUterine Contractions that cause-

• Progressive dilation and effacement
• of cervix
• Descent of fetus
• Expulsion of fetus and placenta

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13-True contractions characterized by all Except

• A-Occur at regular intervals
• B-Intervals get gradually smaller
• C-Intensity increases
• D-Pain felt in the back and abdomen
• E-Pain stop with sedation
• F-Cervix dilate
• ANSWER E

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14-False contractions characteristics
(Braxton-Hicks) all true Except

• A-Occur At Irregular Intervals
• B-Intensity doesn't change
• C-Pain primarily in lower abdomen
• D-Pain usually relieved with sedation
• E-Cervix dilate
• ANSWER E

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15-Which is true about retraction

• A-Relaxion after uterine contraction
• B-Intensity of uterine contraction in upper and
  lower segment
• C-The myometrium of the upper uterine become
  shorter after contraction
• D- the pacemaker in the right cornu of the uterus
  
• ANSWER C

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16-When do you have your patient call you?

• 5-1-1 contractions approximately every 5 minutes
  lasting for 1 min for 1 hour
• Sudden gush of fluid from the vagina or a
  constant leakage/wetness
• Vaginal bleeding(bloody show)
• D.Decrease in fetal movement
• (kick counts should be 10 kicks
• in 2 hours)
• E All of the above
• ANSWER E

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17-The three components of the cervical exam are

• Dilation ,presention and effacment
• Effacement ,station and position
• Dilation ,effacment ,and station
• Station ,dilation and descent
• Presentation ,station ,and dilation
• ANSWER C

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Cervical dilatation by vaginal examination
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Effacement thinning of the cervix
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How is station measured and recorded?

• -3 3 cm above the ischial spines0 at the
  ischial spines, engaged3 3 cm below the
  ischial spines

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18-Regarding stages of labor

• First stage of labor ends with delivery of fetus
• Second stage of labor is divded into latent and
  active phase
• Third stage of labor lasts one hours
• D.Third stage of labor begins immediately
• after delivery of the infant and ends with
  placental delivery
• ANSWER D

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19-Intrapartum CTG a finding of late
deccleration is

• Relfied by maternal position on left side
• Compression of fetal head mediated by vagus
• Caused by umbilical cord compression
• Is not worrisome if non recurrent
• Is mostly due to placental insufficancy
• ANSWER E

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Early ,Variable ,late deccleration
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20-HR variability, accelerations

• Variability is the result of push pull of
  sympathetic and para sympathetic
• Acceleration is gt 2 elevation of baslind FHR
  above 25 pbm in 30 min period
• Acceleration with absent variability is
  reassuring trace
• Moderate variability and lasck of accleration is
  worrisome
• ANSWER A

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21-Contraction stress test is considered positive
if late deccleration occur in

• 50 or more of contraction
• All of contraction
• 25 or more of contraction
• One out of tree contraction
• ANSWER A

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22-The cardinal movements of labor?all except

• A-engagementB-flexionC-descentD-internal
  rotationE-extensionF-Backword rotation
• ANSWER F

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23-Signs of placental separation include

• A-Gush of blood
• B-Lengthening of umbilical cord
• C-Rebound of the uterus
• D-All of the above
• ANSWER D

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24-Active management of third stage include all
Except

• A-IV oxytocin after
• delivery of ant shoulder.
• B-Controlled cord traction
• C- Suprapubic massage
• D-Uterine massage
• ANSWER C

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25-Progress in labor is determined by which of
the following

• A- Dilation and intensity of contraction
• B-Dilation and effecmant
• C-Dilation and descent
• D,Frequancy of contraction and descent
• E- All of the above
• ANSWER C

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PART 2 Abnormal labor
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1-labor Dystocia2- Fetal lie and fetal
presentation that impair delivery
3-Cephalopelvic disproportion4- Operative
vaginal delivery5- induction of labor

• Part 2 ABNORMAL LABOUR

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Abnormal Labor - Dystocia
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1-All of the following cause labor dystocia
Except

• A-Hydroceplus
• B- Occipto anterior
• C-Face presenation
• D- Occipto Posterior
• E-Ovarian mass
• F- Shoulder dystocia
• Answer B

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2-How long do you let woman push for?

• 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

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3-Labor Assessment Case 1

• 32 yo G1P0 36 weeks presented with contractions.
  Looks uncomfortable, and is contracting every 3
  minutes but cervix is 2 cm and 50 effaced. Was
  seen the previous day with similar complaints and
  findings.
• Diagnosis
• Prolonged latent phase
• Management
• Therapeutic Rest

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4-Labor Assessment Case 2

• 24 yo P1001 39 weeks presented in labor.
  Contracting every 3 minutes but looks
  comfortable. Progressed from 4 to 6 centimeters
  in 6 hours. Membranes intact. Estimated fetal
  weight 3000 grams. Pelvis adequate on
  examination. Vertex presentation.
• Diagnosis
• Protracted active phase likely secondary to
  inadequate labor (insufficient power)
• Management
• Amniotomy, Oxytocin augmentation /- IUPC

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5-Labor Assessment Case 3

• 32 yo P0000 Class C diabetic at 40 weeks
  undergoing labor induction. Contracting every
  2-3 minutes. 7 cm dilation x 4 hours. Confirmed
  adequate labor with intrauterine pressure
  catheter. Membranes ruptured, Estimated fetal
  weight 4200 grams. Pelvis adequate on
  examination. Vertex presentation.
• Diagnosis
• Arrest of dilatation likely secondary to
  cephalopelvic disproportion/fetal macrosomia
  (Passenger too big for pelvis)
• Management
• Cesarean Delivery

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6-Labor Assessment Case 4

• 28 yo P0101 at 42 weeks presented in labor.
  History of previous MVA with pelvic fracture.
  Contracting every 2-3 minutes. 6 cm dilation x 4
  hours. Confirmed adequate labor with
  intrauterine pressure catheter. Membranes
  ruptured, Estimated fetal weight 3200 grams.
  Constricted pelvic inlet with non-engaged fetal
  head. Vertex presentation.
• Diagnosis
• Arrest of dilatation likely secondary to
  cephalopelvic disproportion/abnormal pelvis
  (Pelvis too small for pelvis)
• Management
• Cesarean Delivery

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7-Effects of labor dystocia includes all except

• A-Chorioamnionitis
• B-Uterine rupture
• C-Reassuring FHR trace
• D-Pelvic floor injury
• ANSWER C

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8-Correct manouver of breech delivery is

• 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

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9-Which is wrong in breech delivery mechanism?

• 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

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10-Under what condition is external cephalic
version allowed in breech or transverse
position,?

• A- multiparity
• B-placenta previa
• C- presenting part engagement
• D- CPD
• Ans A

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11-Which is wrong about face presentation?

• 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.
• AnsC

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12-A woman 35 years old- P2 GA of 38 wks -EFW
of 2 kg presents face and posterior shoulder
presentation.How do you manage her delivery?

• A-induction of labor
• B- internal rotation to make mentum ant position
• C- observation to allow spontaneous rotation
• D- C/S
• AnsC

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13-Which is wrong about persistent occiput
posterior?

• A-Forceps can be applied
• B-manual rotation of the head can be done
• C- manual rotation of the head cant be done
• D-there is no place for observation
• AnsD

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14-Clinical pelvimetry possible contracted
pelvis signs ALL except

• 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
• diameterE -Narrow suprapubic arch
• ANSWER B

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Obstetric conjugate and diagonal conjugate

• 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)

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Gynecoid pelvis vs Android pelvis

• -normal female type male
  type- inlet
  triangular or heart-shaped

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Anthropoid pelvis

• -Ape-like type-Anteroposterior
• diameters long,
• Transverse short,
• Sacrum long and narrow,
• Subpubic angle narrow

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platypelloid pelvis-flat female type

• All anteroposterior diameters are short,
• Transverse are long, subpubic angle is wide

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15-Treatments of first stage disordersWhich Is
True ?

• 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

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16-Management of shoulder dystocia include the
following except

• A-McRobert's Maneuversharply flex maternal thigh
• B-Cut episiotomy if needed for more roomC.
  Fundal pressure D-woods screw maneuverE.
  Delivery of the posterior arm
• ANSWER C

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Management of shoulder dystocia
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17-What is Robin maneuver to release shoulder
dystocia?

• A-rotation of post. shoulder to deliver ant.
  shoulder
• B- abduction of shoulders
• C- flex of mothers knees and suprapubic pressure
• D- rotation and extraction of ant. shoulder
• AnsB
• Woods screwA
• McRoberts m.C
• Zavanelli m. repositioning of fetal head back
  into the uterus and C/S

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Robin maneuver Suprapubic pressure
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18-Indications for operative vaginal delivery
all except

• A-Maternal heart disease, pulmonary compromise
• B- prolonged first stage of labor,
• C-maternal exhaustion
• D- non-reassuring fetal heart rate pattern
• ANSWER B

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19-Contraindications to an operative vaginal
delivery all except

• A-inability to definitely determine position of
  fetal vertexB-fetus with presentation other than
  vertex or face with chin anteriorC-fetus not
  engaged or above 2 stationD-CPD inadequate
  pelvis, estimated fetal weight gt4000gE-membranes
  ruptured or cervix fully dilatedF-fetus lt34
  weeks for vacuum delivery
• ANSWER C

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20-All are true about obstetrical lacerations
degrees except

• 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

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Third degree perineal tear
Fourth-degree Perineal tear
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21-A week after NVD episiotomy dehiscence
occurs. When the dehiscence should be repaired?

• A- immediately
• B-3 months later
• C- 6 months later
• D- 9 months later
• AnsA

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22- A 25 years old G3 P11 at 35 wks in second
stage of labor at 2 station Has been pushing for
2 hrs ,maternal exhaustion occurs and you
concerned about fetal distress

• Which of the following is appropriate device
• A- LOW FORCEPS
• B-MID FORCEPS
• C- SOFT CUP VACCUM
• D- PIPER FORCEPS
• ANSWER A

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23- A 26 years old g2p10 at 41 weeks gestation
comes for induction of labor .Cx exam show 1cm
dilated CX,firm ,anterior,50 effaced -2 station

• This patient has a bishop score of
• A- 4
• B-5
• C-6
• D-8
• ANSWER B

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Induction of labour
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24-A few hours in labor induction CTC shows a
late deccleration after episodes of frequent
contraction

• 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

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25-All are indications for C-section except

• A- prior C-section or uterine scar
• B- Face mento anterior
• C- labor dystocia
• D- Breech presentationlt35 WKS
• E- fetal distress
• F- persistent mento posterior
• ANSWER B

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THANK YOU