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MCQ on normal and abnormal labor for undergraduate

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Undergraduate course lectures in Obstetrics&Gynecology .Prepared by DR Manal Behery .Faculty of Medicine,Zagazig University – PowerPoint PPT presentation

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Title: MCQ on normal and abnormal labor for undergraduate


1
MCQ On Normal Abnormal Labour For
Undergraduate
Dr Manal Behery Assistant Professor , Zagazig
University 2013
2
PART 1 normal labor
3
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

4
Terminology
  • Gravidity
  • of current and completed pregnancies of any kind
  • Parity
  • of completed pregnancies 20 weeks
  • not delivered infants (e.g. twins)

5
Terminology
  • Nullipara
  • Primipara
  • Multipara
  • Grand Multipara

6
TPAL Nomenclature
  • T Term deliveries 37 wksP Preterm
    deliveries lt 37 wksA Abortions (lt 20 wks)L
    Living children

7
G3/P1-0-1-1
  • 3rd Pregnancy
  • 1 Term delivery
  • 0 Preterm deliveries
  • 1 Abortion
  • 1 Living child

8
2-G5/P2-1-1-0
  • 5th Pregnancy
  • 2 Term deliveries
  • 1 Preterm delivery
  • 1 Abortion
  • 0 Living children

9
3- G2/P0203
  • 2nd Pregnancy
  • 0 Term deliveries
  • 2 Preterm deliveries
  • 0 Abortions
  • 3 Living children

10
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

11
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

12
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

13
Presentation
  • The part of the fetus that is presenting or is
    the closest in proximity to the birthing canal
  • Vertex
    Breech

14
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

15
Fetal Position
OA
LOA
ROA
LOT
ROT
LOP
ROP
OP
  • LOT 40
  • ROT 20
  • OP 20

16
7-Fetal Position
?????
17
8-Fetal Position
Left OcciputAnterior
18
9-Fetal Position
?????
19
10-Fetal Position
Right OcciputPosterior
20
11-Fetal Position
?????
21
12-Fetal Position
Left OcciputTransverse
22
Fetal Station
  • The relationship of the fetal presenting part to
    the level of the ischial spines

23
Fetal Station
24
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

25
How is true labor defined?
  • cervical change
  • Effacemant is shortening of the cervical canal
    (from a length of 3 cm to a circular aperture.

26
LaborUterine Contractions that cause-
  • Progressive dilation and effacement
  • of cervix
  • Descent of fetus
  • Expulsion of fetus and placenta

27
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

28
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

29
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

30
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

31
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

32
Cervical dilatation by vaginal examination
33
Effacement thinning of the cervix
34
How is station measured and recorded?
  • -3 3 cm above the ischial spines0 at the
    ischial spines, engaged3 3 cm below the
    ischial spines

35
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

36
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

37
Early ,Variable ,late deccleration
38
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

39
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

40
22-The cardinal movements of labor?all except
  • A-engagementB-flexionC-descentD-internal
    rotationE-extensionF-Backword rotation
  • ANSWER F

41
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

42
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

43
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

44
PART 2 Abnormal labor
45
1-labor Dystocia2- Fetal lie and fetal
presentation that impair delivery
3-Cephalopelvic disproportion4- Operative
vaginal delivery5- induction of labor
  • Part 2 ABNORMAL LABOUR

46
Abnormal Labor - Dystocia
47
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

48
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

49
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

50
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

51
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

52
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

53
7-Effects of labor dystocia includes all except
  • A-Chorioamnionitis
  • B-Uterine rupture
  • C-Reassuring FHR trace
  • D-Pelvic floor injury
  • ANSWER C

54
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

55
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

56
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

57
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

58
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

59
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

60
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

61
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)

62
Gynecoid pelvis vs Android pelvis
  • -normal female type male
    type- inlet
    triangular or heart-shaped

63
Anthropoid pelvis
  • -Ape-like type-Anteroposterior
  • diameters long,
  • Transverse short,
  • Sacrum long and narrow,
  • Subpubic angle narrow

64
platypelloid pelvis-flat female type
  • All anteroposterior diameters are short,
  • Transverse are long, subpubic angle is wide

65
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

66
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

67
Management of shoulder dystocia
68
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

69
Robin maneuver Suprapubic pressure
70
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

71
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

72
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

73
Third degree perineal tear
Fourth-degree Perineal tear
74
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

75
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

76
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

77
Induction of labour
78
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

79
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

80
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