Delivery

Question 1

Easy surgical repair
Rare faulty healing
Minimal postoperative pain
Excellent anatomical result
Less blood loss
Rare dyspareunia
Common extensions

Answer 1

Midline episiotomy

Question 2

More difficult surgical repair
More common faulty healing
Common postoperative pain
Occasionally faulty anatomical results
More blood loss
Occasional dyspareunia
Uncommon extensions

Answer 2

Mediolateral episiotomy

Question 3

Lowest risk of maternal and fetal comorbidity

Inc risk for pelvic floor disorder

Answer 3

SVD

Question 4

50 minutes in nullipara
20 minutes in mutlipara

Healthy neonate with minimal trauma to the mother is the culmination

Answer 4

Second stage of labor

Question 5

Done when HEAD distends vulva and expulsive efforts are inadequate

Forward pressure on fetal chin in front of maternal coccyx by one hand

Other hand exerts pressure superiorly against the occipit

Promotes controlled delivery of the head
Promotes neck extension so that the smallest diameter of the head passes through the introitus

Answer 5

Modified Ritgen Maneuver

Question 6

Attendant does not touch perineum during delivery of the head

Compared with traditional perineal support, does not appear to offer greater third degree laceration protection

Answer 6

Hands-poised method

Question 7

Done after fetus had undergone restitution and external rotation to transverse position and shoulders appear at the vulva

Hooking fingers in the axillae is avoided

Answer 7

Shoulder delivery

Question 8

Anterior fetal shoulder becomes wedged behind symphysis pubis and fail to deliver using normally exerted downward traction and maternal pushing

Answer 8

Shoulder dystocia

Question 9

Removing legs from stirrup and flexing the thighs up unto the abdomen also providinf suprapubic pressure

Answer 9

McRoberts maneuver

Question 10

Hand is placed behind posterior shoulder and shoulder rotated 180 degrees until anterior shoulder is released

Answer 10

Woods corckscrew maneuver

Question 11

Cephalic replacement into the pelvis followed by CS

Terbutaline 0.25 mg is given SQ to induce uterine relaxation

Answer 11

Zavanelli maneuver

Question 12

Shoulder-to-shoulder diameter is aligned vertically then accessible shoulder is pushed toward anterior chest of wall of the fetus

Answer 12

Rubin maneuver

Question 13

Third stage of labor

Answer 13

Placental delivery

Uterotonic administration

Question 14

Signs of placental separation

Answer 14

Globular and firmer uterus
Sudden gush of blood into the vagina
Uterus rises in abdomen
The umbilical cord protruding further out the vagina

Question 15

Downward pressure above symphysis pubis while pushing uterus cephalad when with delayed placental separation

Answer 15

Kristeller’s maneuver

Question 16

First 1 hr after delivery
Repair of lacerations
WOF postpartum hemorrhage

Answer 16

Fourth stage of labor

Question 17

Superficial tear involving skin and mucous membrane, fourchette and periurethral skin

Answer 17

First degree

Question 18

Tears extend into fascia and muscles
Bulbocavernosus and superficial transverse perineal

Forms irregular triangle due to extension upward and one or both sides

Answer 18

Second degree

Question 19

Extends into or through external anal sphincter

Answer 19

Third degree

Question 20

Extension into anorectal muscle with disruption of both external and internal anal sphincter

Answer 20

Fourth degree

Question 21

More hemorrhage
Cuts through blood vessels

Less severe extension to anorectal area as sole advantage

Answer 21

Mediolateral ep

Question 22

Two most important discriminators of risk for both mother and infant using forceps delivery

Answer 22

station
rotation

Outlet - scap visible
Low - + 2 head station
Mid - 0 + 2 head station
High - no place in modern OB

Question 23

A persistent occiput posterior
Transverse position of fetus

use

Answer 23

Forceps

Question 24

Indications for forceps delivery

Answer 24

Maternal heart disease
Pulmo compromise
Intrapartum infection 
Neurologic conditions
Maternal exhaustion
Non-reassuring fetal heart rate pattern
Premature placental separation and prolonged second stage of labor (most common) prolonged by regional anesthesia

Question 25

Forceps with fenestrated blades Best used for delivery of molded head Curved blade fits the pelvis Common in nulliparous

Answer 25

Simpson of Elliot forceps

Question 26

Also used for molded head but ideal for head rotation because of no pelvic curvature No fenestration in central opening

Answer 26

Kielland forcep

Question 27

Best used for rounded head because of its thin, smooth blades

Answer 27

Tucker-Mclane forceps

Question 28

Maternal morbidity from forceps delivery

Answer 28

Postpartum urinary retention Bladder dysfunction Urinary fecal and flatus incontinence

Question 29

Fetal morbidity following forceps delivery

Answer 29

Facial nerve palsy Skull fracture Intracranial hemorrhage

Question 30

Same indications as forceps but cannot be used for face presentation or fetal coagulopathy (use forceps) Rigid or soft cup places 3cm in front of posterior fontannel centering sagittal sutures Vacuum generated from machine slowly up to 600mmHg creating chignon or artificial caput on feral head

Answer 30

Vacuum extraction Abandon when no descent of head despite adequate traction or if cup dislodges 3x

Question 31

Vacuum extraction complications mostly fetal

Answer 31

``` Scalp laceration Bruising Subgaleal hematoma Cephalhematoma ICH ```

Question 32

Most common breech presentation in delivery

Answer 32

Frank breech (buttocks)

Question 33

Breech predisposing factors

Answer 33

``` Oligohydramnios/Polyhydramnios High parity Multiple fetus Preterm fetus - most common Fetal malformation - 17% preterm and 9% term Uterine anomalies or fibroids Placenta previa Fundal placement implantation Pelvic tumors High parity with uterine relaxation Prior breech delivery ```

Question 34

Lower extremities are flexed at hips Knees extended Pike position feet lie beside the head 50-70%

Answer 34

Frank breech

Question 35

One or both knees flexed Flexed at hips against the abdomen with one or both knees flexed Buddah position Cannonball position 5-10%

Answer 35

Complete breech

Question 36

One or both hips extended and one or both feet or knees lies below the breech such that foot or knee is lowermost in the birth cana Footling 10-30%

Answer 36

Incomplete breech Single footling - one leg extended and the other flexed Double - both legs extended below level of buttocks, possible risk of umbilical cord accident

Question 37

Breech may be delivered vaginally

Answer 37

Frank | Complete

Question 38

More common in breech presentation

Answer 38

Umbilical cord prolapse

Question 39

CS indications

Answer 39

``` Large fetus >4000 g Any degree of pelvic contraction (platypelloid, android) Hyperextended head (stargazer fetus) Uncontrolled pre-eclampsia Uterine dysfunction Incomplete or footling breech PPROM Severe FGR Previois perinatal death from birth trauma ```

Question 40

Spontaneous delivery up to umbilicus and rest of the fetal body is delivered with assisted maneuvers and traction Most commonly employed Avoids prolonged cord compression

Answer 40

Partial breech extraction

Question 41

Done in footling breech

Answer 41

Total breech delivery

Question 42

Delivery of the aftercoming head with fetal head being delivered, flexion of the head is maintained by suprapubic pressure provided by an assistant Pressure on maxilla is applied simultaneously by the operator as upward and outward traction Breech

Answer 42

Mauriceau Maneuver

Question 43

Used for persistent backdown fetuses | 2 fingers grasping the fetal shoulders from below while the feet are drawn upward up towards the maternal abdomen

Answer 43

Modified Prague Maneuver

Question 44

Use of forceps when Mauriceau and Prage fails

Answer 44

Piper of Laufe forceps

Question 45

Decomposes breech

Answer 45

Pinard’s maneuver

Question 46

Performed when there is entrapment of aftercoming head and gentle traction on the fetal body does not help occiput slip out 2 oclock 10 oclock 6 oclock incisions

Answer 46

Duhrssen incision