Question 1

A newborn developed a collection of blood between the pericranium and flat bones of the skull. What is the medical term for this complication?

Accepted Answer

Cephalohematoma
Cephalohematoma involves hemmoraging between the skull and periosteum of a newborn. Intracranial hemorrhage (ICH) is a rare brain injury that may accompany cephalohematoma. Soft tissue injuries include injury to the scalp, skin rupture and brachial plexus injury. Soft tissue injury is a major complication of prolonged labor.

Question 2

A pregnant woman is suffering from obstructed labor. What can cause obstructed labor?

Accepted Answer

All of the above
Causes of obstructed labor include: 1) contracted pelvis; 2) cephalopelvic disproportion; 3) cervical dystocia; 4) operation scarring; 5) ovarian tumor; and 6) broad ligament fibroid. Cervical dystocia is defined as difficult labor and delivery caused by mechanical obstruction at the cervix. As related to childbirth, "contracted pelvis" refers to an abnormally small pelvis in the pregnant woman. Ovarian tumors occur in the ovaries. Cephalopelvic disproportion occurs when the baby's head is too large to fit through the mother's pelvis during birth.

Question 3

Obstructed labor may be caused by a problem in passage through the birth canal. Which of the following conditions associated with obstructed labor is caused by the fetus?

Accepted Answer

Transverse lie
Transverse lie refers to a sideways position of the baby in the birth canal, and can cause obstructed labor. In transverse lie, the long axis of the fetus lies perpendicular to the maternal spine. Multiparity, prematurity, and/or polyhydramnios may be causes of transverse lie. Ovarian tumor and broad ligament fibroid are maternal factors that can cause obstructed labor.

Question 4

Which of the following is a health record - keeping activity that may aid in preventing a prolonged labor?

Accepted Answer

Partograph
A partograph is a graphic representation of labor, and usually consists of three sections: 1) the fetal record; 2) the labor record; and 3) the maternal record. Use of partographs is especially recommended for use in under - developed countries with limited healthcare resources. Partographs are one of the managerial tools for the prevention of obstructed labor. Other factors that may prevent obstructed labor include antenatal detection of RISJ factors, and change of posture (to other than supine) during labor.

Question 5

Obstructed labor affects both mother and fetus. Which one of the following is most dangerous to the fetus?

Accepted Answer

Asphyxia
In obstructed labor, the fetus is at risk of asphyxia, acidosis, and infection. Deprivation of oxygen (asphyxia) to the baby during birth can result in permanent brain damage or death. This can be caused by a very long or difficult delivery; problems with the placenta separating from the uterus too soon; too little oxygen in the mother's blood before or during birth; and problems with the umbilical cord during delivery.

Question 6

Premature labor is a risk to maternal and fetal health. What percentage of all births are premature?

Accepted Answer

5 - 10%
The incidence of premature birth is considered to be approximately 5 - 10% of all births. A birth is considered to be premature if labor began after less than 37weeks of pregnancy. Babies born at less than 25 weeks are considered extremely preterm; babies born at less than 32 weeks are considered very preterm; and babies born between 34 - 37 weeks are considered late preterm. Babies born prematurely are at higher risk of medical complications. Short - term complications include breathing, heart, brain, temperature control, gastointestinal, blood, metabolism, and immune system problems.

Question 7

A 29 years old female states that her labor started before the 37th week of pregnancy (counting from the first day of her last menstrual cycle). What complication of pregnancy is she experiencing?

Accepted Answer

Premature labor
Labor that starts before the 37th week of pregnancy is termed premature labor. Causes of premature labor include the following:
1) pre - eclampsia
2) cervical incompetence
3) uterine malformations
4) high fever
5) diarrhea
6) acute appendicitis
7) idiopathic cause
8) Diabetes mellitus (DM)
9) bacterial vaginosis
10) chlamydia

Question 8

By taking some precautionary measures, premature labor can be prevented. Which of the following are a predisposing factor of premature labor?

Accepted Answer

All of the above
By treating or managing predisposing factors in pregnant women prior to labor, premature labor may be prevented. Some predisposing factors (and causes) of premature labor include:
1) pre - eclampsia
2) cervical incompetence
3) uterine malformations
4) high fever
5) diarrhea
6) acute appendicitis
7) idiopathic cause
8) Diabetes mellitus (DM)
9) bacterial vaginosis
10) chlamydia

Question 9

Oxytocin is a hormonal treatment which stimulates contractions to induce labor. Which of the following complications is due to oxytocin?

Accepted Answer

Uterine rupture
Uterine rupture is a catastrophic event whereby the myometrial wall is breached; it can be life - threatening for both mother and baby. Oxytocin is used to stimulate contractions to induce labor. However, it needs to be carefully administered to prevent over - stimulation of contractions. Agents that stimulate contractions of the myometrium are frequently termed 'oxytocics'. Uterine rupture, uterine hyperstimulation, water intoxication, and hypotension are maternal complications during labor; fetal distress and hypoxia are fetal complications during labor.

Question 10

A 28 years old female is suffering from premature labor. What complication in the fetus may develop due to premature labor?

Accepted Answer

Hypothermia
Labor that begins before the 37th week of pregnancy (counting from the first day of the last menstrual cycle) is termed premature labor. Fetal complications of premature labor include the following:
1) asphyxia
2) hypothermia
3) pulmonary edema
4) cerebral hemorrhage
5) heart failure
6) oliguria
7) infection
8) dehydration

Question 11

The fetal presentation (other than vertex presentation) is called malpresentation. Which one of the following is an example of malpresentation?

Accepted Answer

All of the above
Abnormal presentation of the fetus includes:
1) Face presentation
2) Brow presentation
3) Breech presentation
4) Transverse lie
5) Oblique lie
6. Unstable lie

Question 12

Malpresentation poses a risk to the fetus/newborn. Which one of the following is a maternal cause of malpresentation?

Accepted Answer

Contracted pelvis
Maternal causes of malpresentation include: 1) contracted pelvis; 2) spinal deformity in the pregnant woman; 3) multiparity; and 4) pelvic neoplasms. Lie, presentation, attitude, and position can all foster malpresentation. Fetal complications that can cause malpresentation include fetal abnormalities (such as hydrocephalus and neural tube defects). Yet another fetal cause of malpresentation is "large baby".

Question 13

An examination reveals that the fetus is in longitudinal lie, with the podalic pole presenting at the pelvic brim. In what position or presentation is the fetus lying?

Accepted Answer

Breech presentation
In breech presentation, the lie is longitudinal and the podalic pole presents at the pelvic brim. It is the most common malpresentation. The incidence of breech presentation is one in every five births (or 20% of all births). Breech presentations are categorized as uncompleted or complete. When there are no other obstetric complications, the breech presentation is termed uncompleted. When the presentation is associated with prematurity, multiparity, or placenta previa, the breech presentation is termed complete.

Question 14

When the long axis of the fetus lies perpendicular to the maternal spine, the position is called transverse lie. Which one of the following is a cause of transverse lie?

Accepted Answer

All of the above
Common causes of transverse lie includes multiparity, prematurity, twins, polyhydramnios, contracted pelvis, placenta praevia, and pelvic tumors. When the long axis of the fetus lies perpendicular to the maternal spine, the position is called transverse lie. When the fetal axis is oblique to the maternal spine, the position is called oblique lie. Positions of transverse lie includes dorso anterior, dorso posterior, dorso superior, and dorso inferior.

Question 15

An examination reveals that the presentation of the fetus is continuously changed (even beyond the 36th weeks of pregnancy) when it should have been in a stabilized position. Which is the the type of malpresentation occurring in this patient?

Accepted Answer

Unstable lie
Unstable lie is a condition where the presentation of the fetus is continuously changed (even beyond 36th week of pregnancy) when it should have been stabilized. Causes includes grand multiparae, polyhydramnios, contracted pelvis, placenta praevia, and pelvic tumors. Risks of unstable lie at a late stage of pregnancy include obstructed labor and umbilical cord prolapse. Cesarean section is performed in the majority of patients with this type of malpresentation.

Question 16

On examination of a pregnant female in labor, the umbilical cord is found to descending alongside (or in advance) of the fetal part in passing through the cervix. Which is term for this abnormal descent of the umbilical cord?

Accepted Answer

Occult prolapse
Occult prolapse is a form of umbilical cord prolapse (UCP), and UCP is considered an obstetrical emergency. In UPC, the cord is descended alongside or below the presenting fetal part. In occult prolapse, the cord is also passing through the cervix. Risk factors for UCP and occult prolapse include fetal malpresentation, fetal anomalies, polyhydramnios, and multiple gestation. Umbilical cord prolapse can be frank or occult, and complications of both types include membrane rupture and fetal hypoxia (resulting in fetal death).

Question 17

Umbilical cord prolapse should be detected early. Which one of the following is the single most crucial reason for early detection of cord prolapse?

Accepted Answer

Prevention of neonatal death
In umbilical cord prolapse, the cord is descended alongside or below the presenting fetal part during the birth process. The importance of early detection of cord prolapse includes prevention of fetal asphyxia (which can cause permanent disability or death) and prevention of membrane rupture in the pregnant woman in labor. Some factors precipitating cord prolapse are malpresentation, contracted pelvis, and polyhydramnios.

Question 18

A pregnant woman (third gravida) at near the 37th week of pregnancy presented with severe pain in lower abdomen. What could be the cause?

Accepted Answer

All of the above
Some possible causes of the severe pain experienced by the patient in her lower abdomen include premature labor pain, abruptio placentae, ruptured uterus, torsion of the uterus, pre - eclampsia, acute appendicitis, and intestinal obstruction. Labor that occurs before the 37th week of pregnancy (from the first day of the last menstrual cycle) is considered premature labor. Disruption in the continuity of the uterine wall at any time beyond 28 weeks of pregnancy is termed rupture of the uterus.

Question 19

Avoiding an unnecessary cesarean section (and delivering subsequent healthy newborns by trial labor) is desirable. However, there are times when trial labor is contraindicated. Which of the following represents a trial labor contraindication?

Accepted Answer

All of the above
Contraindications of trial labor include the following: 1) associated mid pelvic and outlet contraction; 2) presence of complicating factors (such as primigravida, malpresentation, postmaturity, and pre - eclampsia); and 3) where capacity to perform c - section within a facility is not available 24 hours/day.

Question 20

Trial labor is the conduction of spontaneous labor in a moderate degree of cephalopelvic disproportion (CPD) in preparation for a vaginal delivery. Which of the following is a contraindication for trial labor?

Accepted Answer

Umbilical cord prolapse
Trial labor is the conduction of spontaneous labor in a moderate degree of cephalopelvic disproportion (CPD) in the hope and expectation of a vaginal delivery. It is usually associated with subsequent pregnancies following a c - section history. Trial labor may be contraindicated or interrupted if there is cord prolapse, fetal distress, maternal distress, or conversion of vertex presentation into malpresentation.

Quiz 2: Labor Birthand Immediate Postpartum