Question 1

Examination of a primigravida at 39 weeks of pregnancy revealed globular head in the fundus. What type of presentation does this represent?

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 5 births (or 20% of all births). Breech presentation is categorized as uncompleted and complete. When there are no other obstetric complications apart from the breech, it is termed uncompleted. When the presentation is associated with complications (such as prematurity, twins, or placenta previa), the breech is termed complete breech presentation.

Question 2

Examination of a second gravida at her 37th week of pregnancy revealed fetal head at fundus (and podalic pole in pelvic grip). In this circumstance, which of the following can cause fetal asphyxia?

Accepted Answer

All of the above.
This is descriptive of a case of breech presentation. In breech presentation, the lie is longitudinal and the podalic pole presents at the pelvic brim. It is the most common malpresentation. Fetal asphyxia can occur if umbilical cord compression occurs. Fetal asphyxia can also occur if there is retraction of the placental site, premature attempt at respiration while the head is still inside the vaginal canal, delayed delivery, or cord prolapse. Breech presentation can be categorized as complete or uncomplete.

Question 3

A second gravida is at 41 weeks of pregnancy. Oxytocin has been administered to induce labor pain. Which one of the following maternal (as opposed to fetal) complications can occur due to the oxytocin?

Accepted Answer

Psychological upset
The drugs that hasten evacuation of the uterus by stimulating contraction of the myometrium are called oxytocics. Maternal complications of induction of labor by oxytocin include the following:
1) Prolonged labor and obstructed labor
2) Increased need of analgesia
3) Increased operative interference
4) Psychological upset
Hypoxia and prematurity are potential complications of the fetus.

Question 4

Hormones normally mediate one of the complex biochemical changes affecting the cervix. Which of the following describes this biochemical change?

Accepted Answer

Cervical ripening
Cervical ripening is the result of a series of hormonally - mediated, biochemical changes in the cervix. Cervical ripening refers to the softening of the cervix. This change typically begins prior to the beginning of labor contractions; cervical ripening is necessary for cervical dilation and, subsequently, the passage of the fetus.

Question 5

A suitable place for delivery is important in order to ensure safety of mother and newborn. Which one of the following best meets the criteria of a safe place for delivery?

Accepted Answer

A place where obstetrical facilities are available
All pregnant women (ideally) should deliver the newborn at a hospital or healthcare facility where obstetrical facilities are available. The pregnant woman can give birth where she feels comfortable and safe. This is especially important to ensure the capacity to respond to a crisis or emergency.

Question 6

Assisted vaginal breech delivery requires specific actions to be successful. Which of the following describes a method of delivery after appearance of the head in a breech delivery?

Accepted Answer

All of the above
The methods of assisted vaginal breech delivery include Burns - Marshall method, forceps delivery, and malar flexion and shoulder traction. Of these, the Burns - Marshall method is the most preferable. C - sections are often performed if breech presentation is recognized in order to avoid serious complications, such as umbilical cord prolapse.

Question 7

Transverse lie is not necessarily harmful to the fetus. Which one of the following is a favorable outcome of transverse lie?

Accepted Answer

Spontaneous correction
Traverse lie can be described as existant when the long axis of the fetus lies perpendicular to the maternal spine or centralized uterine axis. Spontaneous correction of traverse lie often occurs during the pregnancy (and is a favorable outcome since it decreases the likelihood of the patient needing a cesarean section). On the other hand, ketoacidosis and bleeding are harmful to the mother and fetus.

Question 8

A 25 years old female reports significant bleeding from her genital tract after the 28th week of her pregnancy. Of the following possibilities, which is most likely to be the probable cause? (Choose all that apply)

Accepted Answer

Carcinoma of the cervix and D. Local trauma
This may be a case of antepartum hemorrhage. Causes of antepartum hemorrhage include:
1) Placenta previa
2) Abruptio placentae
3) Cervical polyps
4) Carcinoma of the cervix
5) Local trauma
6. Vaginal varicosities (varicose veins of the vagina)

Question 9

Antepartum hemorrhage (APH) can be dangerous to the mother. What percentage of pregnant females develop APH?

Accepted Answer

3 - 4%
Antepartum hemorrhage is bleeding from (or into) the genital tract after the 28th week of pregnancy, but before the birth of the baby. The incidence is approximately 3%. Causes of antepartum hemorrhage include the following: 1) placenta previa, 2) abruptio placenta, 3) cervical polyps, 4) carcinoma of the cervix, and 5) vaginal vericosities (vericose veins).

Question 10

A 20 years old female reported of bleeding in her third trimester of pregnancy. Which of the following are a probable cause? (Choose all that apply)

Accepted Answer

All of the above
Causes of bleeding in the third trimester of pregnancy include:
1) Abruptio placenta
2) Placenta praevia
3) Vasa praevia
4) Circumvallate placenta
5) Uterine rupture
6) Abnormal clotting mechanism
7) Cervical erosion, polyp, carcinoma etc.

Question 11

A pregnant woman's placenta is implanted partially in her lower uterine segment. What is this called?

Accepted Answer

Placenta previa
When the placenta is implanted partially or completely in the lower uterine segment, it is called placenta previa. About one third cases of antepartum hemmorhage are due to placenta praevia. In pregnant women with placenta previa, there is more likelihood of breech and transverse lie. This is because the placenta occupies the lower segment, so the fetus may be unable to move into delivery position. Multiparity is one of the predisposing factors of placenta previa.

Question 12

In this pregnant woman, the major part of the placenta is attached to the upper segment. Only the lower margin encroaches onto the lower segment, but not upto the os. What kind of placenta previa it this?

Accepted Answer

Type 1
Type 1 (or low lying placenta previa) presents as the major part of the placenta attached to the upper segment, with only the lower margin encroaching onto the lower segment-but not upto the os. On the other hand, Type 2 (or posterior placenta previa) is the most dangerous of all types of placenta previa. Type 2 is characterized as the placenta reaching the margin of the internal os, but not covering it.

Question 13

When the placenta is implanted partially (or completely) in the lower uterine segment, it is called placenta previa. Which kind of placenta previa is the most dangerous type?

Accepted Answer

Type 2
Type 1 (or low lying placenta previa) presents as the major part of the placenta attached to the upper segment, with only the lower margin encroaching onto the lower segment-but not upto the os. On the other hand, Type 2 (or posterior placenta previa) is the most dangerous of all types of placenta previa. Type 2 is characterized as the placenta reaching the margin of the internal os, but not covering it.

Question 14

A 30 years old pregnant woman reports a history of amenorrhea for 37 weeks with "blood loss per vaginam" (P/V) bleeding for the past 8 hours. How will you manage her?

Accepted Answer

All of the above
This is a case of placenta previa. Recommended management includes the following:
1) Bed rest with bathroom privileges
2) Iron, folic acid, and zinc supplement
3) Nothing by mouth
4)Wide bore I.V. cannula
5) Intravenous infusion
6) Blood transfusion
7) Catheterization
8) Monitoring

Question 15

When the placenta is implanted partially or completely in the lower uterine segment, it is called placenta previa. Which one of the following is a complication of placenta previa?

Accepted Answer

All of the above
Potential complications of placenta previa include:
1) Malpresentation
2) Premature labor
3) Antipartum hemmorhage (APH)
4) Cord prolapse
5) Slow dilation of the cervix
6) Intrapartum hemorrhage
7) Postpartum hemorrhage
8) Embolism
9) Subinvolution

Question 16

A second gravida presents at 34 weeks of pregnancy with painless P/V bleeding. Which one of the following can be a fetal complication? (Choose all that apply)

Accepted Answer

Asphyxia and D. Birth injury
This is a case of placenta previain a pregnant woman (second gravida) with 34 weeks pregnancy. The fetal complications of placenta previa include:
1) Low birth rate
2) Asphyxia
3) Birth injury
4) Congenital malformation
5) Death
Embolism and cord prolapse are maternal compilations related to placenta previa.

Question 17

There are some differences between placenta previa and abruptio placenta. Which one of the following statement is true?

Accepted Answer

In placenta previa, features of preeclampsia are not of primary relevance
Placenta previa presents as the placenta implanted partially or completely in the uterine lower segment. About one third of cases of APH are due to placenta praevia; there is also a greater chance of breech and transverse lie. In placenta previa, blood color of blood is bright red. In abruptio placenta, USG shows placenta in the upper segment.

Question 18

The injury can be described as laceration of remnants of the hymen, the fourchette, the lower part of the vagina, and the perineal skin (but with the perineal body intact). What is this injury called?

Accepted Answer

First degree perineal tear
First degree perineal tear involves the laceration of remnants of the hymen, the fourchette, the lower part of the vagina, and the perineal skin (but with the perineal body intact). In second degree perineal tears, there is tearing of the perineal body (excluding the anal sphincter). In third degree perineal tears, there is tearing of the anal sphincter.

Question 19

The injury can be described as laceration of remnants of the hymen, the fourchette, the lower part of the vagina, and the perineal skin (and involving the perineum and posterior vaginal wall-with tear of the perineal body including the anal sphincter). What is this injury called?

Accepted Answer

Third degree perineal tear
Third degree perineal tear is more severe than either second degree or first degree perineal tear. In first degree perineal tear, there is laceration of remnants of the hymen, the fourchette, the lower part of the vagina, and the perineal skin (but the perineal body remains intact). In second degree perineal tears, there is tearing of the perineal body (excluding the anal sphincter). In third degree perineal tears, there is tearing of the anal sphincter.

Question 20

A 26 years old female is suffering from a minor degree of cervical tear during her first delivery. Which of the following can be a possible complication?

Accepted Answer

All of the above
A minor degree of cervical tear is frequent during first delivery, and requires no special treatment. However, depending on severity of the tear, complications of cervical tear can include:
1) Postpartum hemmorhage (PPH)
2) Broad ligament hematoma
3) Thrombophlebitis
4) Pelvic cellulitis

Quiz 2: Labor Birthand Immediate Postpartum