Top Banner
1. The relation of the fetal long axis to that of the mother is termed which of the following? a. Fetal lie b. Fetal angle c. Fetal position d. Fetal polarity The relation of the fetal long axis to that of the mother is termed fetal lie and is either e longitudinal or l transverse.Occasionally, the fetal and the maternal axes may cross at a 45-degree angle, forming an oblique lie. his lie is unstable and becomes longitudinal or transverse during labor. A longitudinal lie is present in more than 99 percent of labors atterm. Predisposing factors for transverse fetal position include multiparity, placenta previa, hydramnios, and uterine anomalies. 2. Which of the following is not a predisposing factor for transverse fetal lie? a. Multiparity b. Oligohydramnios c. Placenta previa d. Uterine anomalies Predisposing factors for transverse fetal position include multiparity, placenta previa, hydramnios, and uterine anomalies. 3. Which of the following fetal presentations is the least common? a. Breech b. Cephalic c. Compound d. Transverse lie
23
Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Page 1: Chapter 22

1. The relation of the fetal long axis to that of the mother is termed which of the following?

a. Fetal lie b. Fetal angle c. Fetal position d. Fetal polarity

The relation of the fetal long axis to that of the mother is termed fetal lie and is either e longitudinal or l transverse.Occasionally, the fetal and the maternal axes may cross at a 45-degree angle, forming an oblique lie. his lie is unstable and becomes longitudinal or transverse during labor. A longitudinal lie is present in more than 99 percent of labors atterm. Predisposing factors for transverse fetal position include multiparity, placenta previa, hydramnios, and uterine anomalies.

2. Which of the following is not a predisposing factor for transverse fetal lie?

a. Multiparity b. Oligohydramnios c. Placenta previa d. Uterine anomalies

Predisposing factors for transverse fetal position include multiparity, placenta previa, hydramnios, and uterine anomalies.

3. Which of the following fetal presentations is the least common?

a. Breech b. Cephalic c. Compound d. Transverse lie

The presenting part is that portion of the fetal body that is either foremost within the birth canal or in closest proximity to it. It typically can be felt through the cervix on vaginal examination. Accordingly, in longitudinal lies, the presenting part is either the fetal head or breech, creating cephalic and c breech presentations, respectively. When the fetus lies with the long axis transversely, the shoulder is the presenting part..

4. What percentage of fetuses are breech at 28 weeks' gestation?

a. 1 %b. 10 % c. 25 % d. 50 %

Page 2: Chapter 22

If presenting by the breech, the fetus often changes polarity to make use of the roomier fundus for its bulkier and more mobile podalic pole. The incidence of breech presentation decreases with gestational age. It approximates 25 percent at 28 weeks, 17 percent at 30 weeks, 11 percent at 32 weeks, and then decreases to approximately 3 percent at term.

5. When the anterior fontanel is the presenting part, which term is used?

a. Brow b. Face c. Vertex d. Sinciput

The fetal head may assume a position between these extremes,partially lexed in some cases, with the anterior (large) fonta-nel, or bregma, presenting (sinciput presentation)

Longitudinal lie. Cephalic presentation. Differences in attitude of the fetal body in (A) vertex, (B) sinciput, (C) brow, and (D) face presentations. Note changes in fetal attitude in relation to fetal vertex as the fetal head becomes less flexed

Page 3: Chapter 22

6. This drawing shows a fetal head in which position?

a. Left occiput anterior (LOA) b. Left occiput posterior (LOP) c. Right occiput anterior (ROA) d. Right occiput posterior (ROP)

Longitudinal lie. Vertex presentation. A. Left occiput anterior (LOA). B. Left occiput posterior (LOP).

Page 4: Chapter 22

Longitudinal lie. Vertex presentation A. Right occiput posterior (ROP). B. Right occiput transverse (ROT).

7. The face presentation in this drawing is described as which of the following?

a. Left mento-anterior b. Left mento-posterior c. Right mento-anterior d. Right mento-posterior

Page 5: Chapter 22

8. The fetus in this drawing is breech. His position is best described as which of the following?

a. Left sacrum anterior b. Left sacrum posterior c. Right sacrum anterior d. Right sacrum posterior

Page 6: Chapter 22

Longitudinal lie. Breech presentation. Left sacrum posterior (LSP).

9. The fetus in this drawing has a transverse lie. The position is best described as which of the following?

a. Left acromidorsoanterior (LADA) b. Left acromidorsoposterior (LADP) c. Right acromidorsoanterior (RADA) d. Right acromidorsoposterior (RADP)

Page 7: Chapter 22

Pic Transverse lie. Right acromiodorsoposterior (RADP). The shoulder of the fetus is to the mother’s right, and the back is posterior.

In shoulder presentations, the acromion (scapula) is the portion of the fetus arbitrarily chosen for orientation with the maternal pelvis. One example of the terminology sometimes employed for this purpose is illustrated by pic above .The acromion or back of the fetus may be directed either posteriorly or anteriorly and superiorly or inferiorly. Because it is impossible to diferentiate exactly the several varieties of shoulder presentation by clinical examination and because such specific diferentiation serves no practical purpose, it is customary to refer to all transverse lies simply as shoulder presentations.Another term used is transverse lie, with back up or back down,which is clinically important when deciding incision type for cesarean delivery

Page 8: Chapter 22

10. In shoulder presentations, the portion of the fetus chosen for orientation with the maternal pelvis is which of the following?

a. Head b. Breech c. Scapula d. Umbilicus

In shoulder presentations, the acromion (scapula) is the portion of the fetus arbitrarily chosen for orientation with the maternal pelvis

11. Which of the following could inhibit performance of Leopold maneuvers?

a. Oligohydramnios b. Maternal obesity c. Posterior placenta d. Supine maternal positioning

Leopold maneuvers may be dificult if not impossible to perform and interpret if the patient is obese, if there is excessive amnionic luid, or if the placenta is anteriorly implanted.

12. Which of the following is the correct order for the cardinal movements of labor?

a. Descent, engagement, internal fixation, flexion, extension, external rotation, expulsion

b. Descent, flexion, engagement, external fixation, extension, internal rotation, expulsion

c. Engagement, descent, flexion, internal rotation, extension, external rotation, and expulsion

d. Engagement, flexion, descent, internal rotation, straightening, extension, and expulsion

The cardinal movements of labor are engagement, descent, flexion, internal rotation, extension, external rotation, and expulsion. Pic below is illustrated abaout cardinal movement of labor

Page 9: Chapter 22
Page 10: Chapter 22

13. Regarding engagement of the fetal head, which of the following statements is true?

a. It does not occur until labor commences. b. Engagement prior to the onset of labor does not affect vaginal delivery rates. c. It is the mechanism by which the biparietal diameter passes through the pelvic

outlet. d. A normal-sized head usually engages with its sagittal suture directed

anteroposteriorly.

The mechanism by which the biparietal diameter—the greatest transverse diameter in an occiput presentation—passes throught the pelvic inlet is designated engagement. he fetal head may engage during the last few weeks of pregnancy or not until after labor commencement. In many multiparous and some nulliparous women, the fetal head is freely movable above the pelvic inlet at labor onset. In this circumstance, the head is sometimes referred toas “loating.” A normal-sized head usually does not engage with its sagittal suture directed anteroposteriorly. Instead, the fetal head usually enters the pelvic inlet either transversely or obliquely. Segel and coworkers (2012) analyzed labor in 5341 nulliparous women and found that fetal head engagement before labor onset did not afect vaginal delivery rates in either spontaneous or induced labor.

14. On palpation of the fetal head during vaginal examination, you note that the sagittal suture is transverse and close to the pubic symphysis. The posterior ear can be easily palpated. Which of the following best describes this orientation?

a. Anterior asynclitism b. Posterior asynclitism c. Mento-anterior position d. Mento-posterior position

The sagittal suture frequently is delected either posteriorly toward the promontory or anteriorly toward the symphysis. Such lateral delection to a more anterior or posterior position in the pelvis is called asynclitism. If the sagittal sutureapproaches the sacral promontory, more of the anterior parietal bone presents itself to the examining ingers, and the conditionis called anterior asynclitism. If, however, the sagittal suture lies close to the symphysis, more of the posterior parietal bone will present, and the condition is called posterior asynclitism. Withextreme posterior asynclitism, the posterior ear may be easily palpated.

15. Of the cardinal movements of labor, internal rotation achieves what goal?

a. Flexes the fetal neck b. Brings the occiput to an anterior position c. Brings the anterior fontanel through the pelvic inlet d. None of the above

Page 11: Chapter 22

This movement consists of a turning of the head in such a manner that the occiput gradually moves toward the symphysispubis anteriorly from its original position or, less commonly,posteriorly toward the hollow of the sacrum. Internal rotation is essential for completion of labor, except when the fetus is unusually small.

16. In what percentage of labors does the fetus enter the pelvis in an occiput posterior position?

a. 0.5% b. 5% c. 20% d. 33%

In approximately 20 percent of labors, the fetus enters the pelvis in an occiput posterior (OP) position (Caldwell, 1934). The right occiput posterior (ROP) is slightly more common than the left (LOP).

17. Which of the following is not a risk factor for incomplete rotation of the posterior occiput?

a. Macrosomia b. Poor contractions c. Lack of analgesia d. Inadequate head flexion

In perhaps 5 to 10 percent of cases, however, rotation may be incomplete or may not take place at all, especially if the fetus is large (Gardberg, 1994b). Poor contractions, faulty head lexion, or epidural analgesia, which diminishes abdominal muscular pushing and relaxes pelvic loor muscles, may predispose to incomplete rotation. If rotation is incomplete, transverse arrest may result. If no rotation toward the symphysis takes place, the occiput may remain in the direct occiput posterior position, a condition known as persistent occiput posterior. Pic above show mechanism of labor for right occiput posterior position showing anterior rotation.

Page 12: Chapter 22

18. This photograph demonstrates which of the following?

a. Hydrocephalus b. Plagiocephaly c. Craniosynostosis d. Caput and molding

In vertex presentations, labor forces alter fetal head shape.In prolonged labors before complete cervical dilatation, the portion of the fetal scalp immediately over the cervical os becomes edematous. This swelling, known as the caput succedaneum. In addition to soft tissue changes, the bony fetal head shape is also altered by external compressive forces and is referred to as molding. Possibly related to Braxton Hicks contractions, some molding develops before labor.Most studies indicate that there is seldom overlapping of theparietal bones. A “locking” mechanism at the coronal and lambdoidal connections actually prevents such overlapping (Carlan, 1991). Molding results in a shortened suboccipital to bregmatic diameter and a lengthened mentovertical diameter. These changes are of greatest importance in women with contracted pelves or asynclitic presentations. In these circumstances, the degree to which the head is capable of molding may make the diference between spontaneous vaginal delivery and an operative delivery.

19. Which of the following statements regarding the preparatory division of labor is true?

a. The cervix dilates very little. b. Connective tissue components of the cervix change considerably. c. Sedation and conduction analgesia are capable of arresting this labor division. d. All of the above

Page 13: Chapter 22

Friedman developed the concept of three functional labor divisions to describe the physiological objectives of each division as shown in . First, during the preparatory division, although the cervix dilates little, its connective tissue components change considerably. Sedation and conduction analgesia are capable of arresting this labor division. The dilatational division, during which dilatation proceeds at its most rapid rate,is unafected by sedation. Last, the pelvic division commences with the deceleration phase of cervical dilatation.

20. When does the latent phase of labor end for most women?

a. 1-2 cm b. 2-3 cm c. 3-5 cm d. 7-8 cm

The onset of latent labor, as deined by Friedman (1972), is the point at which the mother perceives regular contractions. The latent phase for most women ends once dilatation of 3 to 5 cm is achieved. his threshold may be clinically useful, for it deines dilatation limits beyond which active labor can be expected.

21. A 20-year-old G1PO at 39 weeks' gestation presents complaining of strong contractions. Her cervix is dilated 1 cm. She is given sedation, and 4 hours later, her contractions have stopped. Her cervix is still 1 cm dilated. Which of the following is the most likely diagnosis?

a. False labor b. Prolonged latent phase of labor c. Arrest of the latent phase of labor d. Arrest of the active phase of labor

Factors that afected latent phase dura-tion include excessive sedation or epidural analgesia; unfavorable cervical condition, that is, thick, unefaced, or undilated; and false labor. In those who had been administered heavy sedation, 85 percent of women eventually entered active labor. In another 10 percent, uterine contractions ceased, suggesting that they had false labor.

22. According to Friedman, the minimum normal rate of active-phase labor in a multipara is which of the following?

a. 1 cm/hr b. 1.2 cm/hr c. 1.5 cm/hr d. 3.4 cm/hr

Page 14: Chapter 22

Turning again to Friedman (1955), the mean duration of active-phase labor in nulliparas was 4.9 hours. But the standard deviation of 3.4 hours is large, hence, the active phase was reported to have a statistical maximum of 11.7 hours. Indeed, rates of cervical dilatation ranged from a minimum of 1.2 up to 6.8 cm/hr. Friedman (1972) also found that multiparas progress somewhat faster in active-phase labor, with a minimum normal rate of 1.5 cm/hr.

23. Which stage of labor begins with complete cervical dilatation and ends with delivery of the fetus?

a. First stage b. Second stage c. Third stage d. Fourth stage

Second stage begins with complete cervical dilatation and ends with fetal delivery. he median duration is approximately 50 minutes for nulliparas and about 20 minutes for multiparas, but it is highly variable (Kilpatrick, 1989).

24. A 24-year-old G1PO at 27 weeks' gestation presents in active preterm labor to a hospital without delivery services or a neonatal intensive care unit. The physician in the emergency department evaluates the patient. He determines that her cervix is approximately 4 cm dilated and membranes are intact. He would like to transfer her to you because you are at the nearest hospital with obstetric and neonatal services qualified to handle this patient's complications. According to the Emergency Medical Treatment and Labor Act (EMTALA), which of the following is true?

a. A woman complaining of contractions is not considered an emergency. b. A screening examination is not required because it will unreasonably slow the

transfer of the patient. c. The patient cannot be transferred because a woman in true labor is considered

"unstable" for interhospital transfer. d. This patient can be transferred if the physician certifies that the benefits of

treatment at your facility outweigh the transfer risks.

The deinition of an emergency condition makes speciicreference to a pregnant woman who is having contractions.Labor is deined as “the process of childbirth beginning with the latent phase of labor continuing through delivery of theplacenta. A woman experiencing contractions is in true labor unless a physician certiies that after a reasonable time of observation the woman is in false labor.” A woman in truelabor is considered “unstable” for interhospital transfer pur-poses until the newborn and placenta are delivered. An unstable woman may, however, be transferred at the direction of the patient or by a physician who certiies that the beneits of treatment at another facility outweigh the transfer risks.

Page 15: Chapter 22

25. When evaluating a pregnant woman for rupture of membranes, which of the following has been associated with a false-positive nitrazine test result?

a. Blood b. Semen c. Bacterial vaginosis d. All of the above

The use of the indicator nitrazine to identify ruptured membranes is a simple and fairly reliable method. Test papers are impregnated with the dye,and the color of the reaction between these paper strips and vaginal luids is interpreted by comparison with a standard color chart. A pH above 6.5 is consistent with ruptured membranes. False-positive test results may occur with coexistent blood, semen, or bacterial vaginosis, whereas false-negative tests may result with scant luid

26. When performing a bimanual examination on a pregnant woman, the position of the cervix is determined by the relationship of the cervical os to which of the following?

a. Rectum b. Uterus c. Feta1 head d. Pubic symphysis

The position of the cervix is determined by the relationship of the cervical os to the fetal head and is categorized as posterior, mid-position, or anterior. Along with position, the consistency of cervix is determined to be soft, firm, or intermediately between these two.

27. Station describes the relationship between which of the following?

a. The biparietal diameter and the pdvic oudet b. The biparietal diameter and the ischial spines c. The lowermost portion of the presenting fetal part and the pelvic inlet d. The lowermost portion of the presenting fetal part and the ischial spines

The level (or station) of the presenting fetal part in the birth canal is

described in relationship to the ischial spines, which are halfway between the pelvic inlet and the pelvic outlet.

Page 16: Chapter 22

28. A 20-year-old G2Pl presents in active labor at term. The patient requires augmentation with oxytocin during her labor course. She has a forceps-assisted vaginal delivery and sustains a second-degree laceration. Which of the following is not a risk factor for urinary retention in this patient?

a. Multiparity b. Perineal laceration c. Oxytocin-augmented labor d. Operative vaginal delivery

Risk factors for retention were primiparity, oxytocin-induced or -augmented labor, perineal lacerations, operative vaginal delivery, catheterization during labor, and labor duration > 10 hours.

29. What is the median duration of second-stage labor in nulliparas without conduction analgesia?

a. 20 minutes b. 40 minutes c. 50 minutes d. 90 minutes

The median duration of the second stage is 50 minutes in nulliparas and 20 minutes in multiparas, although the interval can be highly variable

30. What is the median duration of the second-stage labor in multiparas without conduction analgesia?

a. 20 minutes b. 40 minutes c. 50 minutes d. 90 minutes

The median duration of the second stage is 50 minutes in nulliparas and 20 minutes in multiparas, although the interval can be highly variable

31. A 25-year-old G lPO at 39 weeks' gestation presents in active labor. Her cervix is dilated 4 cm and is completely effaced, and the presenting fetal part has reached 0 station. Membranes are intact. With examination 2 hours later, you note that the cervix is still 4 cm dilated. At this point, which of the following is the best management?

a. Cesarean delivery b. Rupture of membranes c. Insertion of a bladder catheter to assist fetal head descent d. Rupture of membranes, placement of internal monitors, and oxytocin augmentation

Page 17: Chapter 22

Women are admitted if active labor (defined as cervical dila-tation of 3 to 4 cm or more in the presence of uterine contractions) is diagnosed or if ruptured membranes are confirmed. stipulate that a pelvic examination be performed approximately every 2 hours. Inefective labor is suspected when the cervix does not dilate within approximately 2 hours of admission. Amniotomy is then performed, and labor progress determined at the next 2-hour evaluation. In women whose labors do not progress, an intrauterine pressure catheter is placed to assess uterine function. Hypotonic contractions and no cervical dilatation after an additional 2 to 3 hours result in stimulation of labor using the high-dose oxytocin regimen. Pic below is management guidelines summarized

32. A 19-year-old G1P0 at term presents in active labor. Her cervix is 5 cm dilated, and fluid is leaking from spontaneously ruptured membranes. You examine her 2 hours later, and the cervix is still 5 cm dilated. At this point, which of the following is the best management?

a. Cesarean delivery b. Placement of internal monitors and reassessment in 2 hours c. Placement of internal monitors, oxytocin augmentation, and reassessment in 2 hours d. Placement of internal monitors, oxytocin augmentation, antibiotics for prolonged

rupture of membranes, and reassessment in 2 hours

See pic above