[OB] Evals 2 Past-E

The correct answer is: A. Seek hospital admission right away Term - 37 weeks to 42 weeks Constant watery discharge is a sign of True Labor w/ pic OB evals 2 batch 2020 #36

A 21 year-old G1P0 is on her 37-38 weeks AOG complains of constant watery vaginal discharge upon waking up. What is the best advice? Select one: a. Seek hospital admission right away b. Ask for history of fever c. Consult at the doctor's clinic on the same day d. Observe closely for occurrence of uterine contractions

The correct answer is: C. Contracted Remember the Clinical Pelvimetry Table w/ table OB evals 2 batch 2020 #16 All of the described pelvimetry are under contracted.

A 23 year old primigravid in labor, at 38 weeks age of gestation is examined at the emergency room. Clinical pelvimetry includes: flat sacral curvature, convergent sidewalls, prominent ischial spines and narrow sacrosciatic notch. What is the interpretation of pelvimetry? Select one: a. Adequate b. Doubtful c. Contracted

The correct answer is: B. Ultrasound examination Letter A = Leopold maneuvers 2 and 3 will not definitely verify the presentation, just give the clinician a clue to the probable presentation. It will be impossible or difficult to perform if the patient is obese, there is excess amniotic fluid (polyhydramnios) and if the placenta is implanted anteriorly Letter C = Doesn't give information on the presentation Letter D = Doesn't give information on the presentation B is the best answer

A 23 year old primigravida consulted for first prenatal check-up. AOG is 34 weeks. Fetal heart tone = 150 bpm. Leopold maneuver One = round ballotable mass. Internal examination shows closed and uneffaced cervix. What examination can definitely verify the presentation? Select one: a. Leopold maneuvers 2 and 3 b. Ultrasound examination c. Abdominal percussion d. Fetal monitor (CTG)

The correct answer is: C. Vulvo-vaginal hematoma vaginal hematoma is a collection of blood that pools in the soft tissues of the vagina or vulva, which is the outer part of the vagina. It happens when nearby blood vessels break, usually due to an injury. Larger hematomas may cause: Pain and swelling. You may be able to feel or see a mass covered by purple- or blue-colored​ skin, similar to a bruise

A 23 year-old, G1P1 (1-0-0-1) delivered to a live baby boy, 3.8 kg by vaginal spontaneous delivery with median episiotomy and repair after 20 hours of labor under epidural anesthesia. Estimated blood loss was 400 ml. Four hours post-partum, patient complains of severe perineal pain with inability to void. On PE, BP is 100/60 mmHg, PR- 92/min, RR- 18 cycles/min, afebrile with pale palpebral conjunctivae. The uterus is contracted and there is a bluish discoloration on the episiotomy wound. What is the most likely diagnosis? Select one: a. Uterine rupture b. Uterine atony c. Vulvo-vaginal hematoma d. Vaginal tract lacerations

The correct answer is: C. 8 Rate of dilation: ● Primigravid: 1.2 cm/hr ● Multigravid: 1.5 cm/hr The patient is multigravid. Therefore, 5 cm + (1.5 cm/hr x 2 hrs) = 8

A G2P1 (1-0-0-1) was admitted at 5 cm cervical dilatation. With adequate uterine contractions, what is the expected cervical dilatation in centimeters, after two hours? Select one: a. 7 b. 7.5 c. 8 d. 8.5

The correct answer is: B. Mentum anterior Face Presentation ● Attitude: neck is sharply extended, the occiput and back come in contact ● Presenting fixed reference point: Mentum ● Presenting AP diameter: Submento- or Trachelobregmatic- 9.5 cm ● IE: soft-like breech ● Vaginal delivery may result in Cervical Spinal Cord injury ● Abdominal exam: groove felt between Occiput and fetal back ● Vaginal exam: Distinct facial features and Sinciput and occiput not palpable ● Etiology: Any factor that favors extension or prevents flexion (e.g. Anencephaly) ● Chin/mentum anterior​: expect vaginal delivery ● CS if obstructed labor (dystocia) ● Chin/mentum posterior: Vaginal deliver possible only if internally rotate anteriorly ○ Cause of obstructed labor: fetal brow (bregma) pressed against maternal symphysis pubis ○ Short neck cannot span the curvature of sacrum

A fetus in face presentation will most likely deliver vaginally if fetus assumes which position? Select one: a. Mentum posterior b. Mentum anterior c. Right mentum transverse d. Left mentum transverse

The correct answer is: D. No intervention, body is delivered spontaneously w/ pic OB evals 2 batch 2020 #75

After delivery of the fetal shoulders, how should the delivery of the rest of the body facilitated? Select one: a. Instruct mother to bear down with full strength b. An assistant to apply gentle fundal pressure c. Apply gentle traction on the fetal axilla d. No intervention, body is delivered spontaneously

The correct answer is: B. No The patient is in the 1st phase of labor (2nd phase starts when cervical dilatation reaches 10cm). During the 1st phase, uterine contractions should occur every 10 minutes​, then gradually decrease in interval. In phase 2, contractions occur every 1 minute or less.

Are the uterine contractions adequate at this stage of the patient's labor? Select one: a. Yes b. No

The correct answer is: D. Face w/ pic OB evals 2 batch 2020 #1

Determine the type of fetal presentation in the picture shown below. w/ pic OB evals 2 batch 2020 #1 Select one: a. Brow b. Sinciput c. Occiput d. Face

The correct answer is B. Frank breech w/ pic OB evals 2 batch 2020 #3

Determine the type of presentation: w/ pic OB evals 2 batch 2020 #7 Select one: a. Footling b. Frank breech c. Incomplete d. Complete breech

The correct answer is: A. Pelvic Inflammatory Disease

Due to the cervical changes during pregnancy, which of the following diseases is the pregnant patient most likely NOT have? Select one: a. Pelvic Inflammatory Disease b. Hepatitis B infection c. Urinary Tract Infection d. Cervico-vaginitis

The correct answer is: C. Diagonal Diagonal Conjugate is the distance that extends from the lowermost portion of symphysis pubis to the sacral promontory. It is the only choice that can be directly measured.

During a clinical pelvimetry examination of a parturient, the sacral promontory was reached at 14 cm. What is this diameter being measured? Select one: a. True b. Anatomic c. Diagonal d. Obstetric

The correct answer is: D. Progression of cervical dilatation and descent

During a labor watch, what are the objective clinical findings to determine the adequacy of uterine contractions, and if the fetus can pass thru the birth canal? Select one: a. Biparietal diameter is not more than 9.5 cm and the position remains in LOA b. Contraction frequency and duration c. Adequate inlet, midpelvis and outlet d. Progression of cervical dilatation and descent

The correct answer is: C. 12. - OB conjugate = Diagonal Conjugate minus 1.5-2.0 cm. - Diagonal conjugate = from the inferior border of the symphysis pubis to the sacral promontory.

During a pelvic examination of a parturient, the distance from the sacral promontory to the lower border of the symphysis pubis is 14 cm. What is the distance of Obstetric Conjugate? Select one: a. 10 b. 11 c. 12 d. 13

The correct answer is: A. Contractions are rhythmic and regular The fetal monitor tracing showed no irregularities of sudden increase in the peak of the wave and length of each wave, hence, with rhythm and regular.

Given a fetal monitor tracing below, which of the following characteristic of uterine contractions during labor is depicted? w/ pic OB evals 2 batch 2020 #19 Select one: a. Contractions are rhythmic and regular b. Contractions originating from the uterine cornu c. Lower uterine segment with least intensity d. Fundal dominance with greatest intensity

The correct answer is: B. Deceleration phase Friedman's curve The Active phase is divided into: Acceleration phase-within 4-6 cm Phase of maximum slope-which is 6-8 cm Deceleration phase/fetal descent - from 8-10 cm Descent expected to take place at around deceleration phase when the cervix is at 8cm. There is active descent.

Fetal head descent starts at what phase/stage of active labor? Select one: a. Acceleration phase b. Deceleration phase c. Second stage of labor d. Phase of maximum slope

The correct answer is: C. Tachysystole w/ table OB evals 2 batch 2020 #18 Based on the monitoring, the patient had 7 contractions in ten minutes. Therefore, she is tachysystole. This is interpreting the frequency. Hyperstimulation was "abandoned" according to the trans. Interpreting the intensity or uterine power, the patient has a uterine power of 550 Montevideo units (80+80+90+70+70+80+80). Greater than or equal to 200 MvU is adequate uterine contractions. However, frequency is the one being asked.

Given the following 10 minute-period tracing below during external fetal monitoring, interpret the FREQUENCY of contractions. w/ pic OB evals 2 batch 2020 #18 Select one: a. Adequate contractions b. More than adequate c. Tachysystole d. Hyperstimulation

The correct answer is: B. Perform amniotomy. - This is the only option that will allow active progression of labor. - Bowel enema will not help with the progress of labor. - The cervix cannot be manually dilated. - The contraction is already every 4 minutes. It is no longer advised for the patient to walk around.

If active management of labor will be applied, what should be done next? Select one: a. Do bowel enema b. Perform amniotomy c. Manually dilate the cervix d. Encourage patient to walk around

The correct answer is: D. 4 w/ pic OB evals 2 batch 2020 #68

If the labor pattern has reached the Alert Line, in the WHO Partograph, how many hours is allowed before a definitive action (crossing the Action Line) is allowed? Select one: a. 1 b. 2 c. 3 d. 4

The correct answer is: B. Decidua From Williams Obstetrics, 24th edition, Chapter 21: Physiology of labor, p.427 "During labor, PROSTAGLANDIN PRODUCTION within the myometrium and DECIDUA is an efficient mechanism of activating contractions. For example, PROSTAGLANDIN SYNTHESIS is HIGH and UNCHANGING in the DECIDUA​ during Phase 2 and 3 or parturition."

Which of the following is the major source of prostaglandin synthesis? Select one: a. Myometrium b. Decidua c. Fetal membranes d. Placenta

The correct answer is: A. When did regular uterine contractions start? True labor includes Regular ​uterine ​contractions with intervals gradually shortening and intensity increasing

Which of the following questions is the most relevant to ask in determining if a patient is in true labor? Select one: a. When did regular uterine contractions start? b. Was there passage of clear watery fluid? c. Was there passage of mucoid bloody discharge? d. When is your Last Menstrual Period?

The correct answer is: B. The fetal biparietal diameter has passed through the pelvic inlet. w/ pic OB evals 2 batch 2020 #41

Which of the following statements is the definition of engagement of the fetal head? Select one: a. The fetal head does not move on Leopold's Maneuver 3. b. The fetal biparietal diameter has passed through the pelvic inlet. c. The most dependent portion of the fetal head is the station 0. d. The fetal head is visible through the introitus during a contraction.

The correct answer is: B. Latent The onset of latent labor, as defined 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. Prolonged latent phase is defined as latent phase exceeding 20 hours in the nullipara and 14 hours in the multipara. Factors that affected latent phase duration include excessive sedation​ or epidural analgesia

Which phase of labor can be prolonged by heavy sedation? Select one: a. Acceleration b. Latent c. Deceleration d. Maximum slope

The correct answer is: B. 2 Phase 1- Uterine quiescence and cervical softening ● From the time of implantation up to late 3rd trimester Phase 2 - Preparation for labor ● Uterine preparedness ● Cervical Softening Phase 3- Labor ● Clinical phases of labor Phase 4- Puerperium ● Period immediately after delivery of placenta and mother has regained pre-pregnancy state ● Influenced by the length of breastfeeding

Which phase of parturition deals with marked changes in the cervical tissue matrix? Select one: a. 1 b. 2 c. 3 d. 4

The correct answer is: B. 1 Phase 1- Uterine quiescence and cervical softening ● From the time of implantation up to late 3rd trimester

Which phase of parturition is characterized by uterine quiescence? Select one: a. 0 b. 1 c. 2 d. 3

The correct answer is: B. Discontinue oxytocin drip The goal of augmentation is to effect uterine activity sufficient to produce cervical change and fetal descent, while avoiding development of a non- reassuring fetal status. Augmentation with Oxytocin should be discontinued if: ● Contractions persists with a frequency greater than five in a 10-minute period or seven in a 15- minute period ● With a persistent non-reassuring fetal heart rate pattern, normal fetal heart is 120-160 beats per minute. The baby is tachycardic.

While monitoring a parturient on oxytocin drip, Fetal Heart Tones was noted to be 175 beats/minute. What should be the immediate management? Select one: a. Do emergency cesarean section b. Discontinue oxytocin drip c. Place patient in left lateral decubitus position d. Oxygen inhalation

The correct answer is: C. Distended bladder URINARY BLADDER FUNCTION ● Palpate suprapubic area ○ If full (hinders descent fetal head), encourage patient to void ○ Catheterize if unable to void ● Avoid bladder distention ○ Hinder the descent of the presenting part ○ Lead to bladder hypotonia and infection ● Common complications in post partum is inability to void due to insensitivity of the bladder caused by labor or anesthetics or when bed ridden-early ambulation

While monitoring a patient in labor for eight hours, the clinical clerk noticed a midline, fixed, cystic, suprapubic enlargement, non-tender 8 cm in diameter. No other significant findings noted. What is the most likely cause of this suprapubic enlargement? Select one: a. Palpable fetal head b. Ovarian cyst c. Distended bladder d. Myoma uteri

The correct answer is: B. 0 We measure Station 0 as bony part of the head and not the edema of head. Sometimes in prolong labor the part of the scalp that has become entrapped in the opening of cervix becomes edematous and sometimes elongate. 2 cm caput succedaneum is not a bony part.. Caput Succedaneum is edema of the scalp area overlying the skull. Don't count it as natural station.

The fetus of a parturient at full cervical dilatation for the past two hours, developed a 2cm caput succedaneum. The most dependent portion of which is felt 2 cm below the ischial spines. What is the station of the fetal head? Select one: a. -2 b. 0 c. +2 d. Cannot be assessed due to caput

The correct answer is: B. Deceleration Phase Pelvic division includes deceleration phase and 2nd stage of labor. At this division, accomodation of fetal head through maternal pelvis happens thus reflecting adequacy of the pelvis.

In Friedman's Labor Curve, which phase reflects adequacy of the pelvis? Select one: a. Acceleration Phase b. Deceleration Phase c. Phase of Maximum Slope d. Latent Phase

The correct answer is: C. Acromion w/ table OB evals 2 batch 2020 #2

In determining fetal position, what is the arbitrary chosen point in the image shown? w/ pic OB evals 2 batch 2020 #2 Select one: a. Sinciput b. Mentum c. Acromion d. Occiput

The correct answer is: D. Posterior asynclitism Asynclitism ​- deflection of sagittal suture anteriorly (towards pubic symphysis) or posteriorly (towards the sacral promontory) ● Sagittal suture is nearer the pubic symphysis -you can palpate posterior parietal bone this is called "Posterior Asynclitism" ● when the sagittal suture is near near the sacrum - anterior parietal bone can be appreciated) this is called "Anterior Asynclitism" w/ pic OB evals 2 batch 2020 #42

On fetal head descent, the sagittal suture is deflected towards the symphysis pubis. What is this called? Select one: a. Lateral asynclitism b. Anterior asynclitism c. Synclitism d. Posterior asynclitism

The correct answer is: C. 75 Effacement is expressed in terms of length of the cervical canal compared with that of uneffaced cervix. It is the obliteration, thinning of canal, expressed in percentage. Fully effaced is when the canal is completely obliterated, paper thin = 100% When the length of the cervical canal is 3-4 cm= uneffaced When the length of the cervical canal is 2 cm = 50% effaced Therefore if the length of the endocervical canal is 1 cm = 75% effaced (mid between 100% and 50%)

On internal examination of a patient in labor, the endocevical canal is 1 cm in length from a prelabor length of 4 cm. What is the effacement of the cervix in percentage? Select one: a. 25 b. 50 c. 75 d. 100

The correct answer is: C. Lesser Greater fontanelle ● Anterior​ fontanelle ● Larger, diamond​ or star-shaped ● Bounded by the frontal and parietal lobe ● Junction of the sagittal, coronal, and frontal sutures ● Future site of bregma Lesser fontanelle ● Posterior​ fontanelle ● Bounded by the parietal and occipital bone ● Junction of the lambdoid and sagittal suture ● Future site of lambda

What fontanelle is formed by the junction of occipital and parietal bones? Select one: a. Greater b. Casserian c. Lesser

The correct answer is: A. Prevention of fetal anemia Delayed cord clamping until umbilical cord stops pulsating (2-3 minutes) ● Additional 80 mL of blood = 50 mg of iron ● Prevents Iron deficiency anemia ● Increased risk of Hyperbilirubinemia ● 1 minute delay - increase Hg concentration of 2.2 gm/dL Hypothermia is avoided through IMMEDIATE DRYING and UNINTERRUPTED SKIN-TO-SKIN CONTACT by the mother and baby

What is achieved with delayed cord clamping? Select one: a. Prevention of fetal anemia b. Avoidance of hypothermia c. Fetal-maternal bonding d. Prevention of postpartum hemorrhage

The correct answer is: A. The fetal occiput is brought under the symphysis pubis INTERNAL ROTATION ● Rotation of the fetal head occiput (small fontanel) approaches the symphysis pubis. It now rotates from the occiput transverse to become occiput anterior. ○ Essential for delivery to happen unless the baby is small. ● Complete as it reaches the pelvic floor, it rotates so that the sagittal suture is in the anteroposterior diameter of the outlet. ○ This means that the shoulders will pass through the widest part of the pelvic inlet, which is from right to left. ● Remember: ○ At the pelvic inlet, the diameter of the pelvis is widest from right to left.

What is achieved with internal rotation? Select one: a. The fetal occiput is brought under the symphysis pubis b. The shoulders are along the AP diameter of the mother c. Delivery of the rest of the body follows d. The fetal chin is just above the mother's anus

The correct answer is: B. Delivery of the placenta First Stage ​- progressive cervical effacement and dilatation ● The first stage begins when widely spaced uterine contractions ​of sufficient frequency, intensity, and duration are attained to bring about cervical thinning, termed effacement. This labor stage ends when the cervix is fully dilated​—about 10 cm—to allow passage of the fetal head. The first stage of labor, therefore, is the stage of cervical effacement and dilatation Second Stage ​- from full cervical dilation until fetal expulsion ● The second stage begins when cervical dilatation is complete, and ends with delivery. Thus, the second stage of labor is the stage of fetal expulsion Third Stage ​- delivery of the fetus to placental separation and delivery ● The third stage begins immediately after delivery of the fetus and ends with the delivery of the placenta. Thus, the third stage of labor is the stage of placental separation and expulsion

What is achieved with the completion of Phase 3 of Parturition? Select one: a. Full cervical dilatation b. Delivery of the placenta c. Uterine involution d. Delivery of the fetus

The correct answer is: D. Good rate of cervical dilatation The other choices are part of the labor process but it cannot indicate the progression descent of the child. The best indicator of the efficiency of the progress of labor is still cervical dilatation.

What is the best gauge of the efficiency of the progress of labor? Select one: a. Spontaneous rupture of the bow b. Increasing amount of show c. Mounting intensity of pain d. Good rate of cervical dilatation

The correct answer is: D. Cervical stromal invasion of inflammatory cells Phase 2 of parturition (preparation for labor: myometrial changes, cervical ripening: inflammatory changes). Inflammatory changes include stromal invasion of inflammatory cells as cervical chemoattractants attract inflammatory cells and these cells release proteases that aid in degradation of collagen and other components. Hence, more inflammatory cells is found during labor and puerperium. Vaginal infection activates inflammatory cells resulting to the early ripening of the cervix, causing preterm delivery.

What is the cause of preterm labor in a patient with Bacterial Vaginosis? Select one: a. Deceased expression of proteoglycans b. Presence of large molecular weight hyaluronan c. Structure of fibrils become less compact d. Cervical stromal invasion of inflammatory cells

The correct answer is: A. Increased cervical gland secretion w/ pic OB evals 2 batch 2020 #26

What is the cause of the increased watery vaginal discharge commonly experienced during pregnancy? Select one: a. Increased cervical gland secretion b. Increased vaginal secretion c. Urinary incontinence d. Minimal escape of amniotic fluid

The correct answer is: B. Second w/ pic OB evals 2 batch 2020 #80 First degree of laceration involves up to the vaginal mucosa whereas second, third, and fourth is up to the muscles of the perineal body, anal sphincter, and rectal mucosa, respectively.

What is the degree of perineal laceration when lacerations involve the muscles of the perineal body? Select one: a. First b. Second c. Third d. Fourth

The correct answer is: A. Return of adequate utero-placental perfusion. Increase in intensity and duration (Under Uterine Labor Contractions) ● From mild to moderate to strong contractions ● From 30 secs to up to 90 seconds ● Periods of relaxation between contractions are essential to prevent utero-placenetal insufficiency (which may cause fetal hypoxemia) ● Adequate blood flowing to the utero-placental circulation is permitted during uterine relaxation and baby can recover from the transient decrease in blood flow ● Normal baby should be able to handle decrease blood flow and stress of the contraction, there should be no effect on the heart rate ● If there is fetal distress, then C section is advised ● Persistent/ tetanic contraction can be fetal and may result to abruptio-placenta ● Abruptio-placenta is the early separation of placenta and fetus. The presence of blood within would stimulate further contraction, not giving enough relaxation for the fetal circulation.

What is the physiologic reason for periods of relaxation in between uterine contractions? Select one: a. Return of adequate utero-placental perfusion b. Maternal recovery from too much pain c. Allows uterine muscle recovery from hypoxia d. Avoids endless compression of the fetus

The correct answer is: D. Oxytocin receptors are increased during late pregnancy. w/ pic OB evals 2 batch 2020 #28 Because in early stage of pregnancy or the Quiescent Stage, it promotes progesterone which increases oxytocin receptor degradation.

What is the reason why the uterus is more sensitive to oxytocin infusion during late pregnancy than in early pregnancy? Select one: a. Increase in intracellular calcium levels occur during late pregnancy. b. A more mature fetus is required for oxytocin to take effect. c. Rigid cervix during early pregnancy negates oxytocin effectivity. d. Oxytocin receptors are increased during late pregnancy.

The correct answer is: A. Abruptio placenta Amniotomy - Hastens Labor; Artificial rupture of fetal membranes by use of an amniotome or special gloves; Done in between uterine contractions when the uterus is relaxed - May rupture bag of water during a contraction (because if you do it during contraction, (inc. intrauterine pressure) there would be sudden decrease in pressure causing premature separation of the placenta​) - If there is fetal distress, then C section is advised. Persistent/ tetanic contraction can be fetal and may result to abruptio-placenta. - Abruptio-placenta is the early separation of placenta and fetus. The presence of blood within would stimulate further contraction, not giving enough relaxation for the fetal circulation. - Indications of Amniotomy: Protracted labor, Assess character of amniotic fluid (clear or meconium stained), and Membrane rupture with the intention of accelerating labor

What is the risk of doing amniotomy in a patient in active phase of labor? Select one: a. Abruptio placenta b. Trauma to the cervix c. Fetal tachycardia d. Slow progress of labor

The correct answer is: D. Umbilical cord prolapse Clinical significance of detecting rupture of membrane include the risk of umbilical cord prolapse (probability of which is very high). If the membrane ruptures, a loop of umbilical cord be insinuate and be ahead of the head → compression of the cord during delivery → distress in fetal circulation --> obstetrical emergency w/ pic OB evals 2 batch 2020 #63

What is the risk of rupture of the fetal membranes in early labor? Select one: a. Fetal distress b. Placenta previa c. Abruptio placenta d. Umbilical cord prolapse

The correct answer is: C. Cervix fully dilated First Stage ​- progressive cervical effacement and dilatation ● The first stage begins when widely spaced uterine contractions ​of sufficient frequency, intensity, and duration are attained to bring about cervical thinning, termed effacement. This labor stage ends when the cervix is fully dilated​—about 10 cm—to allow passage of the fetal head. The first stage of labor, therefore, is the stage of cervical effacement and dilatation Second Stage ​- from full cervical dilation until fetal expulsion ● The second stage begins when cervical dilatation is complete, and ends with delivery. Thus, the second stage of labor is the stage of fetal expulsion Third Stage ​- delivery of the fetus to placental separation and delivery ● The third stage begins immediately after delivery of the fetus and ends with the delivery of the placenta. Thus, the third stage of labor is the stage of placental separation and expulsion

What marks the end of Stage 1 of labor? Select one: a. Cervix fully effaced b. Fetal head at station 0 c. Cervix fully dilated d. Rupture of BOW

The correct answer is: B. Preterm labor and delivery Phase 2 of Parturition (Preparation for Labor) consists of (1) myometrial, (2) cervical, and (3) inflammatory changes. During this phase, there is increased responsiveness of the myometrium to uterotonins or agents that stimulate uterine contractions​. On the other hand, cervical ripening occurs as a result of the change in cervical fibril organization and structure. In addition, in cases of vaginal infections, inflammatory cells are activated resulting to the early ripening of the cervix causing preterm delivery.

What may occur if the changes during Phase 2 of parturition is exaggerated? Select one: a. Fetal distress b. Preterm labor and delivery c. Cervical lacerations d. Abnormal labor pattern

The correct answer is: B. Upward gliding of sacroiliac joint w/ pic OB evals 2 batch 2020 #10

What mechanism happens when a patient is placed on Mc Roberts' position to increase the outlet diameter? Select one: a. Widening of bituberous diameter b. Upward gliding of sacroiliac joint c. Relaxation of symphysis pubis d. Increase in Obstetric conjugate

The correct answer is: A. Check for presence of nuchal cord NUCHAL CORD ● Determine if umbilical cord is encircled in the fetal neck after delivery of the head ● If cord is loose, slip over the head or insinuate your hand under the cord and slip over the anterior shoulder as you deliver the shoulders and the rest of the body ● If cord is tight, cut loop between 2 clamps

What must be done prior to the delivery of the fetal shoulders? Select one: a. Check for presence of nuchal cord b. Rotate the baby along the AP diameter c. Empty the urinary bladder d. Perform liberal episiotomy

The correct answer is: C. 3 Phase 3 of Parturition ​is synonymous with active labor​, which consists of three clinical stages of labor. - First ​Stage - progressive cervical effacement and dilatation; clinical onset of true labor - Second ​Stage - from full cervical dilation until fetal expulsion; fetal head descent - Third ​Stage - delivery of the fetus to placental separation and delivery w/ pic OB evals 2 batch 2020 #33

What phase of parturition corresponds to the clinical stages of labor? Select one: a. 1 b. 2 c. 3 d. 4

The correct answer is: C. Downward then upwards Anterior shoulder should be delivered first followed by the posterior shoulder. Done so by pushing downward​ then pull upward. w/ pic OB evals 2 batch 2020 #74

What should be the direction of the birth attendant's pull when delivering the fetal shoulders? Select one: a. Upwards then straight b. Upwards then downwards c. Downward then upwards d. Downward then straight

The correct answer is: A. Wipe the baby dry with a clean cloth w/ pic OB evals 2 batch 2020 #72

What should be the first thing to be done after the baby has been delivered? Select one: a. Wipe the baby dry with a clean cloth b. Cut the umbilical cord immediately c. Clear the nasopharynx with a bulb syringe d. Lower the baby below the perineum for a few minutes

The correct answer is: B. Ripening Changes that happen during phase 2 of Parturition: 1. Myometrial changes - more responsive to uterotonins • Uterotonins - agents that stimulate uterine contractions 2. Cervical changes - cervical ripening

What significant cervical change happens during phase 2 of parturition? Select one: a. Dilatation b. Ripening c. Effacement d. Softening

The correct answer is: C. After disappearance of cord pulsations Delayed cord clamping prevents anemia hence, the need to wait for the pulsation to stop (1-3 minutes). Clamp the cord 4-5 cm from the umbilicus of the newborn and another clamp 2-3cm away from the first clamp and cut in between

When is the time to do cord clamping? Select one: a. Anytime after the first cry of the baby b. Immediately after delivery of the baby c. After disappearance of cord pulsations d. Five minutes after the delivery

The correct answer is: D. Fetal head encircles the vulvar ring Episiotomy​ / Perineotomy​- incision of the pudenda PURPOSE ● Substitution of a straight surgical incision which is easier to repair than a ragged laceration ● Post-op pain is less and healing improved ● Prevents pelvic laceration, cystocoele, rectocoele and urinary incontinence INDICATIONS ● Shoulder dystocia ● Breech delivery ● Forceps or vacuum extraction delivery ● Occiput posterior position ● Instances when failure to perform an episiotomy will result in perineal rupture *The final rule is that there is no substitute for surgical judgment and common sense.

When should episiotomy be performed? Select one: a. Fecal material is coming out from anus b. Bearing down efforts are too strong c. Fetal head is at station +5 d. Fetal head encircles the vulvar ring

The correct answer is: C. Cervical mucus plug In the first stage labor and the clinical onset of true labor, maybe heralded by the extrusion of mucus plug with a little blood before the delivery.

Where does the mucoid bloody discharge come from just before labor ensues? Select one: a. Vaginal glands discharge b. Edge of the placenta c. Cervical mucus plug d. Decidual mucoid secretions

The correct answer is: C. Formation of the lower uterine segment Phase 2: Preparation for labor A. Myometrial changes a. Changes in expression of key proteins that control contraction b. Formation of lower uterine segment i. 32 weeks AOG ii. Arising from the uterine isthmus iii. WIll now have a delineation between Upper Uterine Segment and Lower Uterine Segment iv. 'Lightening' has occured w/ pic OB evals 2 batch 2020 #29 B. Cervical ripening

Which among the following precedes the phenomenon of 'lightening'? Select one: a. Pressure of the fundus on the fetal breech b. Soft and yielding cervix c. Formation of the lower uterine segment d. Lengthening of the fetal axis

The correct answer is: A. Laterally by the ilialpectineal lines Boundaries: ● Posteriorly: promontory and alae of the sacrum ● Laterally: linea terminalis ● Anteriorly: pubic rami and symphysis pubis Iliopectineal line is the border of the iliopubic eminence. It can be defined as a compound structure of the arcuate line (from the ilium) and pectineal line (from the pubis). With the sacral promontory, it makes up the Linea terminalis. w/ pic OB evals 2 batch 2020 #9

Which among the following statements defines the boundary of the inlet? Select one: a. Laterally by the ilialpectineal lines b. Posteriorly by the inferior borders of the promontory of sacrum c. Posteriorly by the anterior superior margin of the pubic symphysis d. Laterally bounded by the ala

The correct answer is: C. Cervical dilatation occurs w/ table OB evals 2 batch 2020 #52

Which of the following characterizes true labor? Select one: a. Intensity of contractions remains the same b. Pain is relieved by sedation c. Cervical dilatation occurs d. Discomfort comes from the lower abdomen

The correct answer is: D. Bacterial vaginosis DIAGNOSIS OF A RUPTURED MEMBRANE: Nitrazine paper test ● pH of vaginal fluid - 4.5 to 5.5 ● pH of amniotic fluid - 7 to 7.5 ● (+) test: pH 6.5 ● False positive: if there is blood, semen, Bacterial Vaginosis (presence of anaerobic organisms in the vagina) ● False negative: scant fluid Table 2. Nitrazine Test Color Interpretation w/ table OB evals 2 batch 2020 #52 Remember Olive Green​ is acidic bec. Olives are sour. Blue Green is basic. Take Note of the 2 colors. pH6.5 is the indicator of base.

Which of the following conditions can give a false positive Nitrazine paper test? Select one: a. Gonococcal infection b. Moniliasis c. Chlamydia infection d. Bacterial vaginosis

The correct answer is: D. Regular hardening of the uterine fundus ● Periodic (=intermittent, infrequent) pain at LUS indicates irregular contractions → false labor ● Regular hardening of the uterine fundus indicates an increase in intensity of uterine contractions → best indication of labor

Which of the following conditions signifies onset of true labor? Select one: a. Periodic pain at the lower uterine segment b. Passage of mucoid bloody discharge c. Continuous flow of fluid from the vagina d. Regular hardening of the uterine fundus

The correct answer is: A w/ table OB evals 2 batch 2020 #3 Flexion = vertex Military aka sinciput Brow = partial extension Face = complete extension w/ pic OB evals 2 batch 2020 #3

Which of the following fetal head presentation has the greatest presenting circumference? Select one: w/ pic OB evals 2 batch 2020 #3

The correct answer is: A. The inlet allows passage of the head. - The bispinous diameter is narrowest segment of the passage. If the most dependent portion of the head is past this area then it means it will allow its passage.

Which of the following is deduced if the most dependent part of the fetal head is at the level of ischial spines? Select one: a. The inlet allows passage of the head b. The midpelvis is adequate c. The head is confined at the linea terminalis d. The outlet is doubtful

The correct answer is: A. The fetal membranes have been ruptured. DIAGNOSIS OF A RUPTURED MEMBRANE: Nitrazine paper test ● pH of vaginal fluid - 4.5 to 5.5 ● pH of amniotic fluid - 7 to 7.5 ● (+) test: pH 6.5 ● False positive: if there is blood, semen, Bacterial Vaginosis (presence of anaerobic organisms in the vagina) ● False negative: scant fluid Table 2. Nitrazine Test Color Interpretation w/ table OB evals 2 batch 2020 #52 Remember Olive Green​ is acidic bec. Olives are sour. Blue Green is basic. Take Note of the 2 colors. pH6.5 is the indicator of base.

The Nitrazine paper turned to blue on testing the vaginal discharge. What can be concluded? Select one: a. The fetal membranes have been ruptured. b. The fetal membranes are intact. c. There specimen is contaminated with urine. d. No conclusions can be derived.

The correct answer is: D. Collagen STRUCTURAL CHANGES WITH CERVICAL SOFTENING • Collagen-main structural protein of the cervix • Softening of the cervix brought about by: o Increased vascularity o Stromal hypertrophy o Glandular hypertrophy and hyperplasia o Compositional or structural changes of the extracellular matrix • Collagen undergoes conformational changes • Reduction in cross links between newly synthesized collagen monomers leads to unstable collagen fibril formation • Reduced expression and activity of the cross-link forming enzymes

Which of the following is the major component of the cervix responsible for maintenance of pregnancy? Select one: a. Striated muscles b. Cartilage c. Smooth muscles d. Collagen

The correct answer is: C. Large fetal size 4th degree laceration ● Stool softener necessary ● Avoid enema ● Prophylactic antibiotics ● Pain after episiotomy and repair maybe due to a large vulvar, paravaginal or ischiorectal hematoma ​or perineal cellulitis ● Examine carefully if pain is severe or persistent in the absence of complications oral analgesics is given LACERATIONS OF THE VAGINA & PERINEUM ● When episiotomy is not done ● Passage of large babies

A 23 year-old, G1P1 (1-0-0-1) delivered to a live baby boy, 3.8 kg by vaginal spontaneous delivery with median episiotomy and repair after 20 hours of labor under epidural anesthesia. Estimated blood loss was 400 ml. Four hours post-partum, patient complains of severe perineal pain with inability to void. On PE, BP is 100/60 mmHg, PR- 92/min, RR- 18 cycles/min, afebrile with pale palpebral conjunctivae. The uterus is contracted and there is a bluish discoloration on the episiotomy wound. Which of the following factors predisposed this patient in developing such complication? Select one: a. Epidural anesthesia b. Primiparity c. Large fetal size d. Labor of 20 hours

The correct answer is: C. Phase of maximum slope FRIEDMAN'S Curve. LATENT state should be until 4cm, ACTIVE stage will be divided into 3 phases. Every 2 hours, there is a change in phases in: ACTIVE STAGE. Sudden acceleration phase- 4cm to 6cm; Phase of maximum Slope phase- 6cm to 8cm; Deceleration phase/fetal descent- 8cm to 10cm. 2nd stage of labor starts once it reaches the 10cm mark. The important is the FETAL DESCENT. It can start at around 8

A 24 y/o G1P0 is in active labor for ten hours. Internal examination showed a 6 cm cervical dilatation, intact BOW, the fetal head at 2 cm above the symphysis pubis. Contractions come every 4 minutes, mild to moderate in intensity, 30 seconds in duration. In what phase of labor is the patient into? Select one: a. Pelvic phase b. Acceleration phase c. Phase of maximum slope d. Deceleration phase

The correct answer is: A. -2 Midpelvis marks the zero. Above midpelvis = negative Below midpelvis = positive w/ pic OB evals 2 batch 2020 #60

A 24 y/o G1P0 is in active labor for ten hours. Internal examination showed a 6 cm cervical dilatation, intact BOW, the fetal head at 2 cm above the symphysis pubis. Contractions come every 4 minutes, mild to moderate in intensity, 30 seconds in duration. What is the station of the fetal head? Select one: a. -2 b. -1 c. +1 d. +2

The correct answer is: C. Start oxytocin IV infusion Start oxytocin IV infusion since the patient is already in labor and based on the case it is a true labor, oxytocin can help proceed the process and help in delivering the baby. Oxytocin is needed for more efficient contractions.

A 27 y/o G1P0 is in active labor with cervical dilatation of 7 cm, cephalic presentation, station -1 with ruptured BOWs. Uterine contractions occur every 5 minutes, 30 seconds duration, mild in intensity. What is the next best step in the management of her labor? Select one: a. No intervention needed at this time b. Instruct mother to bear down during each contraction c. Start oxytocin IV infusion d. Ask mother to assume a left lateral decubitus position

The correct answer is: a. Inlet Pelvic inlet - During labor, fetal head engagement is defined by the fetal head's biparietal diameter (BPD) passing through this plane ● See clinical pelvimetry on number 16. To compare the findings, the patient's pelvis is contracted and, therefore, is not adequate. ● (I think another possible answer for this question is inadequate midpelvis. However, it's not in the choices but midplane​ instead. Outlet: To assess, place a closed fist in front of the vulva of the patient in dorsolithotomy position, if kasya yung kamay in that introitus, it's probably adequate. Midpelvis: Pelvic sidewalls are convergent: convergent- if you draw an imaginary line in the pelvic sidewall and they meet on the lower extremity; parallel- never meet. Normal is nearly parallel.

A 34 year old primigravid in labor, at 38 weeks age of gestation has the following pelvimetry findings: Diagonal conjugate = 11 cm; wide sacrosciatic notch; easily reached sacral promontory; parallel sidewalls; closed fist fits over the bituberous diameter. Which plane is NOT adequate? Select one: a. Inlet b. Line terminalis c. Midplane d. Outlet

The correct answer is: B. Institute medication to control BP Part of the vital signs assessment hence, if the patient presents with HPN, manage that first among the other choices listed. Doing an Internal Exam to a patient with HPN is a contraindication (never do an IE with a HPN patient → can lead to seizure) (HPN in pregnancy is very common in the PH)

A 38 y/o G4P3 (2-1-0-3) is on her 38-39 weeks AOG came to the ER for labor pains. BP is 170/100 mmHg. The rest of the PE are unremarkable. What is the immediate next best step in the management? Select one: a. Do a speculum exam to check on the BOW b. Institute medication to control BP c. Request for fetal well-being studies d. Do an Internal Exam to determine the cervical dilatation

The correct answer is: C. Lie, presentation, position Important relationships of the fetus with respect to the birth canal ● Fetal lie ● Presentation ● Attitude ● Position Based on the case: Lie​ - Longitudinal lie because the occiput is at the level of the ischial spine Presentation​ - Cephalic vertex presentation Position​ - Left occiput anterior ● Fetal lie - relationship of the long axis of the fetus to that of the mother: Longitudinal, Transverse, Oblique ● Presentation ○ Fetal Body Part: Within the birth canal or in closest proximity to it ○ Felt through the Cervix on IE ○ The presenting fetal body part determines the presentation ○ May be: Cephalic, Breech, Shoulder, or Compound presentation ● Position ○ relationship of an arbitrary chosen point of the presenting part to one of the four quadrants of the maternal birth canal w/ table OB evals 2 batch 2020 #8 ● Attitude ○ Fetal attitude or posture or habitus ○ In the latter month of pregnancy, the fetus assumes a posture ● Station ○ Level of the presenting part in the birth canal in relation to the ischial spines ○ In Centimeters above spine (-) stations or below spine (+) stations w/ pic OB evals 2 batch 2020 #8 Reference: Trans on Power, Passenger, Passage Page 4 (Lie and Presentation) & Page 8 (Position)

During an internal examination, the physician noted an 8 cm dilated cervix, left occiput anterior with occiput at the level of ischial spine and clear amniotic fluid. Based on these findings, which of the following data are established? Select one: a. Lie, presentation b. Station, presentation, attitude c. Lie, presentation, position d. Station, presentation, attitude, station

The correct answer is: D. Flexion Engagement Entering of the widest diameter, (biparietal diameter - measuring ear tip to ear tip across the top of the baby's head), of the fetal presenting part through the plane of the pelvis/pelvic inlet. Asynclitism - deflection of sagittal suture anteriorly (towards pubic symphysis) or posteriorly (towards the sacral promontory) Descent Movement of the head into the pelvis. When the occiput is at the level of the ischial spines, it can be assumed that the widest diameter of the baby's head is engaged - descent occurs after this happens. Flexion Fetal chin flexes to the chest. The longer occipitofrontal which is 12.5 cm becomes shorter (suboccipitobregmatic) that is only 9.5 cm Internal Rotation Rotation of the fetal head occiput (small fontanel) approaches the symphysis pubis. It now rotates from the occiput transverse to become occiput anterior. Extension This is the point when the birth canal curves upward. Head, face and chin curve up due to anterior resistance in pubic symphysis (there is now extension of the head). External rotation (a.k.a. Restitution) Brings rotation of the body During this phase the Shoulder (Acromial diameter) is along the Anteroposterior diameter that is necessary for the shoulders to fit under the pubic arch. Expulsion Anterior shoulder delivers first, followed by the posterior shoulder

Which cardinal movement converts the occipitofrontal diameter to suboccipito-bregmatic diameter? Select one: a. Engagement b. Internal rotation c. Descent d. Flexion

The correct answer is: A. External rotation External rotation ● (a.k.a. Restitution) ● Brings rotation of the body ● During this phase the Shoulder (Acromial diameter) is along the Anteroposterior diameter that is necessary for the shoulders to fit under the pubic arch. ● When the head is delivered in the ideal position, (either left occiput transverse or right occiput transverse), the baby's shoulders are positioned anterior-posterior which is the widest diameter of the pelvic outlet.

Which cardinal movement is essential prior to delivery of the shoulders? Select one: a. External rotation b. Expulsion c. Extension d. Internal rotation

The correct answer is: A. Extension Extension ● This is the point when the birth canal curves upward. ● Head, face and chin curve up due to anterior resistance in pubic symphysis (there is now extension of the head). ● If it remained flex there will be increase pressure towards the perineal floor. ● therefore, this prevents injury of the perineal floor and facilitates delivery of the head. ● There will be progressive distention of the perineum and vaginal opening. ● First you can see the occiput, followed by bregma, forehead, nose, mouth and chin - now baby's head is delivered.

Which cardinal movement leads to delivery of the fetal head? Select one: a. Extension b. External rotation c. Internal rotation d. Expulsion

The correct answer is: B. Contractions every 2 to 3 minutes Uterine contraction: ● Early First Stage (latent) ○ Every 3 to 5 mins contraction, 30 secs, mild ● Late First Stage ○ Every 2-3 mins, 40-60 secs, moderate ● Second Stage ○ Every 1 to 2 mins, 60 - 90 secs, strong Increasing baseline tone→may decrease blood flow during contraction Increasing intervals→not really. Actually, the interval decreases as the labor progresses Generations of at least 120 Montevideo units during active labor→Mean or median spontaneous uterine contraction pattern resulting in a progression to a vaginal delivery was between 140 and 150 Montevideo units

Which characteristic of uterine contractions is effective in causing progression of labor and successful vaginal delivery? Select one: a. Increasing baseline tone b. Contractions every 2 to 3 minutes c. Increasing intervals d. Generations of at least 120 Montevideo units during active labor

The correct answer is: A. Anteroposterior w/ pic OB evals 2 batch 2020 #11 For clinical purpose, the obstetrical conjugate is estimated indirectly​ by subtracting 1.5 to 2.0 cm from the diagonal conjugate

Which diameter of the pelvic inlet can be assessed by internal examination? Select one: a. Anteroposterior b. Transverse c. Superoinferior d. Oblique

The correct answer is: D. Endocervical epithelium and cervical stroma PHASE 2: PREPARATION FOR CHANGES Cervical Ripening ● More remodeling of the cervix ● Results in cervical yielding and dilatation, due to connective tissue changes. ● Transition from softening to ripening begins weeks or days before onset of contractions ● Sometime mothers takes too long to proceed in labor, because her cervix is unripe, even if there is good contraction 1. Endocervical epithelial: ● Endocervical canal lined with mucus-secreting columnar and stratified squamous cells. ● During pregnancy, proliferation of endocervical epithelial cells and glands ● Expulsion of mucus plug ○ color dark red, sign of contraction and cervix ripening ○ guard against microbial invasion ● Cervical epithelia may aid cervical ripening by regulating tissue hydration and maintenance of barrier function 2. Cervical tissue components: ● 10-15 % smooth muscle ● 80-85 % extracellular connective tissue ○ collagen ○ glycosaminoglycans ○ proteoglycans

Which of the following is/are involved during cervical ripening? Select one: a. Cervical stroma b. Endocervical epithelium c. Internal cervical os d. Endocervical epithelium and cervical stroma

The correct answer is: D. False labor The Latent phase is prolonged when the cervical dilatation remains less than 4cm after 8hours. Labor as evidenced by uterine contractions should result in effacement of the cervix, opening, dilatation and eventually delivery of the baby. The main goal of uterine contractions is to deliver the baby but before that the cervix needs to open up first. False labor will not result in cervical dilatation enough to deliver the baby. It may open but only 1-3cm but not full dilatation.

Which of the following may lead to prolonged Latent Phase of labor? Select one: a. Breech presentation b. Persistent occiput posterior position c. Intact fetal membranes d. False labor

The correct answer is: A. Increased frequency and intensity during the end of the third trimester UTERINE CONTRACTIONS DURING PHASE 1 OF PARTURITION • Some myometrial contractions may occur but do not normally cause cervical dilatation. • Unpredictable • Low intensity • Brief duration • Discomfort chiefly in lower abdomen and groin. • Braxton-Hicks contractions o near the end of pregnancy o more common in multiparous women o do NOT cause cervical dilatation o false labor - Braxton Hicks contractions can begin as early as the second trimester. However, they are most commonly experienced in the third trimester - American pregnancy.org website

Which of the following phrases is TRUE regarding uterine contractions during Phase 1 of parturition​? Select one: a. Increased frequency and intensity during the end of the third trimester b. No uterine contractions occur at all to maintain the pregnancy c. Are necessary to facilitate uterine preparedness and cause minor cervical dilatation. d. Cause discomfort in the uterine fundus and lower back

The correct answer is: A. Leopold's maneuver Leopold's maneuver - Divided into four techniques, Fundal Grip, Umbilical Grip, Pawlik's Grip and Pelvic Grip, verifies the position of the fetus, the presenting part, and fetal engagement Determining the adequacy of the pelvis is done by measurement of different pelvic planes and diameters such as the Pelvic Inlet, Midpelvis and Pelvic Outlet. Pelvic Inlet True/Anatomic Conjugate ● Extends from the uppermost margins of symphysis pubis to sacral promontory. ● 11.0 centimeters. ● Has no obstetric significance. Obstetrical Conjugate ● Shortest distance between symphysis pubis and sacral promontory. ● 10.0 centimeters ● Cannot be measured directly with examining finger. ● One through which the fetus must pass. Diagonal Conjugate ● Extends from the lowermost margins of symphysis pubis to sacral promontory. ● 12.0 centimeters Midpelvis Interspinous Diameter ● The midpelvis and ischial spine serve to mark zero station ● 10.0 to 10.5 centimeter ● Usually the smallest pelvic diameter Pelvic Outlet ● Unless there is significant bony disease, the pelvic outlet seldom obstructs vaginal delivery. Speculum Examination ​is done to check for cervical dilatation, effacement, position and consistency. Measurement of Fundic height ​is done by measuring from the superior border of the symphysis pubis upwards to the fundus of the uterus. It is done to determine the estimated AOG of the fetus up to 36 weeks. At 20-34 weeks AOG there is 1:1 correspondence in height in cm (e.g. at 20 weeks AOG, fundic height is 20cm)

Which of the following procedures will determine the fetal presentation? Select one: a. Leopold's maneuver b. Determining adequacy of the pelvis c. Speculum examination d. Measurement of fundic height