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

Gravidity› #of current and completed

pregnancies of any kind Parity

› # of completed pregnancies ≥ 20 weeks

› not delivered infants (e.g. twins)

Nullipara

Primipara

Multipara

Grand Multipara

T = Term deliveries ≥ 37 wksP = Preterm deliveries < 37 wksA = Abortions (< 20 wks)L = Living children

› 3rd Pregnancy

› 1 Term delivery

› 0 Preterm deliveries

› 1 Abortion

› 1 Living child

› 5th Pregnancy

› 2 Term deliveries

› 1 Preterm delivery

› 1 Abortion

› 0 Living children

› 2nd Pregnancy

› 0 Term deliveries

› 2 Preterm deliveries

› 0 Abortions

› 3 Living children

A. – longitudinal axis of the fetus in relation to the oblique axis of the maternal uterus

B. longitudinal axis of the fetus in relation to the transverse axis of the maternal uterus

C. longitudinal axis of the fetus in relation to the long axis of the maternal uterus

D. longitudinal axis of the fetus in relation to the long axis of the maternal pelvis

ANSWER C

Logitudinal transverse oblique

A. Relates to right or left side of maternal pelvis

B. presenting or is the closest in proximity to the birthing canal

C. Ralated to long axis of mother

D. First enter the pelvic cavity

E. First felt by vaginal examination

ANSWER B

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

Vertex Breech

A. position is either cephalic or breech

B. attitude is either flexion ,OR deflexion

C. position is the relationship of a landmark on the presenting part to the right or left side of the pelvis

D. Position is either oblique lognitudinal or treasverse

E .Attuide is landmark on presenting part that determine position

ANSWER C

OP

LOT

OA

ROT

LOPROP

LOAROA

•LOT: 40%•ROT: 20%•OP: 20%

?????

Left OcciputAnterior

?????

Right Occiput

Posterior

?????

Left OcciputTransver

se

The relationship of the fetal presenting part to the level of the

ischial spines

A. Passage of bloody show

B. Occurance of uterine contraction

C. Excessive fetal movement

D. Cervical dilation and effacement

E. Gush of vaginal fluid ANSWER D

cervical change Effacemant :is shortening of the cervical canal

(from a length of 3 cm to a circular aperture.

› Progressive dilation and effacement

of cervix› Descent of fetus› Expulsion of fetus and placenta

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

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

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

A. 5-1-1: contractions approximately every 5 minutes lasting for 1 min for 1 hour

B. Sudden gush of fluid from the vagina or a constant leakage/wetness

C. 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

A. Dilation ,presention and effacment

B. Effacement ,station and position

C. Dilation ,effacment ,and station

D. Station ,dilation and descent

E. Presentation ,station ,and dilation

ANSWER C

-3: 3 cm above the ischial spines0: at the ischial spines, engaged+3: 3 cm below the ischial spines

A. First stage of labor ends with delivery of fetus

B. Second stage of labor is divded into latent and active phase

C. 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

A. Relfied by maternal position on left side

B. Compression of fetal head mediated by vagus

C. Caused by umbilical cord compression

D. Is not worrisome if non recurrent

E. Is mostly due to placental insufficancy

ANSWER E

A. Variability is the result of push pull of sympathetic and para sympathetic

B. Acceleration is > 2 elevation of baslind FHR above 25 pbm in 30 min period

C. Acceleration with absent variability is reassuring trace

D. Moderate variability and lasck of accleration is worrisome

ANSWER A

A. 50% or more of contraction

B. All of contraction

C. 25% or more of contraction

D. One out of tree contractionANSWER A

A-engagementB-flexionC-descentD-internal rotationE-extensionF-Backword rotation

ANSWER F

A-Gush of blood

B-Lengthening of umbilical cord

C-Rebound of the uterus

D-All of the above

ANSWER D

A-IV oxytocin after

delivery of ant shoulder.

B-Controlled cord traction

C- Suprapubic massage

D-Uterine massage

ANSWER C

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

Part 2: ABNORMAL LABOUR

A-Hydroceplus

B- Occipto –anterior

C-Face presenation

D- Occipto –Posterior

E-Ovarian mass

F- Shoulder dystocia

Answer B

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

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”

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

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

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

A-Chorioamnionitis

B-Uterine rupture

C-Reassuring FHR trace

D-Pelvic floor injury

ANSWER C

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

A-ant hip has a more rapid decent than post hipB- 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

A- multiparity

B-placenta previa

C- presenting part engagement

D- CPD

Ans: A

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.

Ans:C

A-induction of labor

B- internal rotation to make mentum ant position

C- observation to allow spontaneous rotation

D- C/S

Ans:C

A-Forceps can be applied

B-manual rotation of the head can be done

C- manual rotation of the head can’t be done

D-there is no place for observation

Ans:D

• 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• diameter

E -Narrow suprapubic archANSWER B

•

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)

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

-Ape-like type-Anteroposterior

diameters long, Transverse short, Sacrum long and narrow, Subpubic angle narrow

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

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

•

• A-McRobert's Maneuver:sharply flex maternal thigh

• B-Cut episiotomy if needed for more roomC. Fundal pressure D-woods screw maneuverE. Delivery of the posterior arm

ANSWER C

A-rotation of post. shoulder to deliver ant. shoulder

B- abduction of shouldersC- flex of mother’s knees and suprapubic

pressureD- rotation and extraction of ant. shoulderAns:BWoods screw=AMcRoberts m.=CZavanelli m.= repositioning of fetal head back

into the uterus and C/S

A-Maternal heart disease, pulmonary compromise

B- prolonged first stage of labor,

C-maternal exhaustion

D- non-reassuring fetal heart rate pattern

ANSWER B

•

• 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 >4000gE-membranes ruptured or cervix fully dilated

F-fetus <34 weeks for vacuum delivery• ANSWER C

•

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 CANALD-4th degree: extends through the rectal

mucosa to expose the lumen of the rectum• ANSWER C

•

Fourth-degree Fourth-degree Perineal tearPerineal tear

A- immediately

B-3 months later

C- 6 months later

D- 9 months later

Ans:A

Which of the following is appropriate deviceA- LOW FORCEPS

B-MID FORCEPS

C- SOFT CUP VACCUM

D- PIPER FORCEPS

ANSWER A

This patient has a bishop score of A- 4

B-5

C-6

D-8

ANSWER B

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

A- prior C-section or uterine scar

B- Face mento anterior

C- labor dystocia

D- Breech presentation<35 WKS

E- fetal distress

F- persistent mento posterior

• ANSWER B•

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