Obstetrics - 2M Flashcards by Arianne DG

Which of the following describes Pinards

maneuver?

Two fingers of the provider are placed beneath
and then parallel to the femur and knees must be
flexed to bring the foot within reach.

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Which of the following studies stated that there is
no excessive morbidity in term breech singletons
delivered vaginally provided strict fetal biometric
and maternal pelvimetry parameters are applied?

Lille Breech Study Group

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Regarding breech delivery, which of the following

has Level II-1, Grade A recommendation?

The absence of adequate progress in labor during
the first stage of labor in a patient who is
undergoing a planned vaginal delivery is an
indication for CS.

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What is the best indicator of pelvic adequacy for

vaginal breech delivery?

Phase of maximum slope reaching second stage
of labor after 2 hours accompanied by regular
contractions in a multigravida

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A 28 yo G5P4 at 38wks AOG came in due to labor
pains. On pelvic examination, you noted that the
foot is already visible at the introitus. The cervix
was seemingly fully dilated and fully effaced.
What is the next most appropriate in the
management?

Immediate CS

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A 27 yo G2P1 (1001) at 32 wks AOG has been at
the labor room for 2 wks for the management of
preterm premature rupture of membranes
(PPROM). Her most recent ultrasound showed
an appropriately grown fetus in a footling breech
presentation showing oligohydramnios. The OB
resident refers back the patient because there are
recurrent fetal heart rate decelerations as low as
70bpm on her NST. If you’re the attending
consultant, what is the initial verbal order you give
to the resident when you go to see the patient?

Immediately do internal examination

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(A 27 yo G2P1 (1001) at 32 wks AOG has been at
the labor room for 2 wks for the management of
preterm premature rupture of membranes
(PPROM). Her most recent ultrasound showed
an appropriately grown fetus in a footling breech
presentation showing oligohydramnios. The OB
resident refers back the patient because there are
recurrent fetal heart rate decelerations as low as
70bpm on her NST.)

Same patient as #6. On examination, the 2 feet
and loop of umbilical cord was noted at the
vaginal introitus. Patient was brought to the OR.
At the OR, FHR was noted to be recovered after
resuscitation. A repeat examination revealed that
the scapula of the fetus are passed to what
seems to be completely dilated cervix and the
fetal buttocks are at the introitus. Which of the
following is true regarding vaginal breech in this
setting?

There is an increased risk of head entrapment

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Same patient. How will you best manage the
most common complication?

Do incision at the 2 o’clock and 10 o’clock
position, possibly 6 o’clock position of the cervix
(Duhrssen incision)

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Same patient. If the procedure that you
performed is not successful, which of the
following may aid in the fetal delivery?

Assisted vaginal delivery using Piper’s forceps

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A primigravida patient who underwent CS
because of primi breech at 39 wks AOG followed
up at the clinic for postpartum care. You
explained to her that during the surgery, the
uterus was normal and no anomalies were
identified. She asked you what are the chances
that she will have a breech presentation in her
future pregnancies. How will you answer this
patient?

With one previous breech presentation at term,
the chances that she will have another breech
presentation is 10%.

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Application of forceps is appropriate in which of

the following situations?

Mentum anterior, station +3, cervix completely

dilated and membranes ruptures

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Anticipating success, an obstetrician has made a
concerted attempt to deliver a patient using
forceps. The attempt fails. How is the procedure
termed?

Failed forceps

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A 35 yo G7P6 38 wks pregnant, presents in
advance labor with a frank breech presenting at
the perineum. The vaginal breech delivers
without difficulty until the head becomes
entrapped in the incompletely dilated cervix. To 2
release the head, which of the following should
be done?

Duhrssen incision

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A 28 yo G4P3 at 39 wks came in due to labor
pains. IE was done revealing 5 cm dilated, fully
effaced, +BOW, station -1, cephalic. Labor
progressed up to full cervical dilation. However,
during the 2nd stage of labor, there was
prolongation and you noted that the sagittal
sutures are being palpated. Further descent of
the fetal head at station +2, you palpated the
ears. How is the situation resolved after
placement of forceps?

Pulling and pushing each branch along the long

axis

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What is the most favorable clinical scenario for a

successful vaginal delivery after a CS birth?

Previous vaginal delivery

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28 yo G1P0 at 38wks AOG came in due to labor
pains. IE upon admission was 4cm. Labor
progressed until she was at 2nd stage of labor.
After 2 hrs without epidural anesthesia, you noted
that the occiput is at the sacrum, station -3. Which
of the following actions is necessary to rotate a
fetus from this position to appropriate position?

Flexion of the fetal head

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(28 yo G1P0 at 38wks AOG came in due to labor
pains. IE upon admission was 4cm. Labor
progressed until she was at 2nd stage of labor.
After 2 hrs without epidural anesthesia, you noted
that the occiput is at the sacrum, station -3.)

Same patient. In this setting, when the occiput is
at the sacrum, correctly placed blades are
equidistant at what landmarks?

Midline of the face and the brow

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Same patient. Which of the following pelvic types
is generally associated if the position of the fetal
head persists?

Anthropoid

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Same patient. Estimated fetal weight is 3400g.
Considering the presentation of this patient,
which of the following would be associated with
failure of operative delivery?

The occiput posterior position

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A 31 yo primigravid undergoing induction of labor
reaches 2nd stage of labor after 36 hrs. Before
beginning to push, she says that she’s too tired
and desires an operative vaginal delivery. You
decided to do a vacuum extraction. Which of the
following is a prerequisite for vacuum extraction
but not for forceps assisted vaginal delivery?

Minimum of 34 wks

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A patient presents approximately 10 yrs
postmenopause with complaints of a vulvar mass
which on examination turned out to be a
prolapsed uterus. She is a G10P10 and all her
children were home delivered. Which of the
following pelvic muscles were most likely
compromised during the vaginal delivery?

Levator ani muscles

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A 36 yo G3P2 3 mos pregnant develops bleeding,
abdominal cramps, and passes tissues per
vagina. After 2 hrs, she bled profusely hence was
brought to the ER. On admission, the cervix
admits one finger, and tissues were felt within the
os. What is the indicated procedure?

Curettage

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A 20 yo primigravid whose LMP was 10 wks ago
presented with scanty vaginal bleeding. TVS
showed the uterus to be 15 wks size with various
sized cystic structures inside the endometrial
cavity. No fetus seen. The cervix was long and
closed. The hCG titer is 10,000IU. What is the
initial step in the indicated procedure?

Slow dilatation of the cervix

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A postpartum woman who underwent a
prolonged labor and uneventful vaginal delivery
under epidural anesthesia complained of severe
hypogastric pain 5 hrs postpartum. On
examination, the hypogastrium was distended.
Which of the following is the most probable
diagnosis?

Urinary retention

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A 24 yo G3P2 diagnosed to have missed abortion was undergoing curettage. And just as the operator was finishing with the procedure, there was sudden profuse bleeding from the uterus. Which of the following might be the cause of the bleeding?

Laceration of the uterine artery

A 31 yo G1P1 consulted due to vaginal bleeding 3 wks postpartum. She claimed that her delivery was uncomplicated. Which of the following is considered the first line treatment in a vaginal bleeding 3 wks postpartum?

Antibiotics

(A 31 yo G1P1 consulted due to vaginal bleeding 3 wks postpartum. She claimed that her delivery was uncomplicated.) Same patient. You started your first line treatment, but still the patient had vaginal 3 bleeding. What will be the next efficacious treatment for this patient?

Curettage

A 32 yo G3P3 3003 who came in because of breast tenderness. She delivered via CS 2 wks ago. She is breastfeeding. She presented with 2 days fever, chills, and breast pain. She cannot breastfeed on the affected side. On examination, the breast is warm, red, and tender. Your considerations were mastitis vs abscess. What is the best management of this patient after seeing the ultrasound result? (Doc says the ultrasound shows abscess)

Give antibiotics, drain abscess, do culture, pumping or breastfeeding continued for both breasts

A patient had CS for obstructed labor. Postop, she had spiking temperature despite antibiotics. The diagnosis of postpartum pelvic thrombophlebitis was made and suddenly, she complained of chestpain and dyspnea. Which of the following will be the most likely diagnosis?

Pulmonary embolism

18 yo primigravida delivered a 4000g infant vaginally. Her prenatal course was complicated by anemia, poor weight gain and maternal obesity. Her labor was protracted including a 3 hr second stage. A low forceps delivery was done with episiotomy that extended to a 3rd degree perineal tear. Which of the following is the greatest predisposing cause of puerperal infection in this patient?

Poor nutrition

Images were not shown, doc only described the pictures. Picture A - Normal waveform. Picture B - Decrease in diastole. What can you say about the umbilical artery?

SD ratio is greater in B than A

28 yo primigravid diagnosed with GDM at 24 wks. She was managed with diet and is controlled. However, at 32 wks, the fundal height was smaller than AOG. Impression was IUGR. Doppler velocimetry was requested revealing these findings (images not shown). Low diastole. What can you say about the doppler waveform?

There is increased impedance to flow with | abnormally elevated SD ratio

28 yo primigravid diagnosed with GDM at 24 wks. She was managed with diet and is controlled. However, at 32 wks, the fundal height was smaller than AOG. Impression was IUGR. Doppler velocimetry was requested revealing these findings (images not shown). Same patient. What is the implication of the result of the doppler velocimetry to the fetus?

30% placental occlusion and MR of 5.6%

28 yo primigravid diagnosed with GDM at 24 wks. She was managed with diet and is controlled. However, at 32 wks, the fundal height was smaller than AOG. Impression was IUGR. Doppler velocimetry was requested revealing these findings (images not shown). Same patient as in 33. Doppler velocimetry showed same results. On checking the MCA, it has low pulsatility index and resistance index. What does this imply?

Brain sparing indicative of acute hypoxia.

28 yo primigravid diagnosed with GDM at 24 wks. She was managed with diet and is controlled. However, at 32 wks, the fundal height was smaller than AOG. Impression was IUGR. Doppler velocimetry was requested revealing these findings (images not shown). Same patient. Your decision regarding time of delivery would be guided by which of the following?

Ctg and amniotic fluid volume

Which of the following Doppler results warrants an urgent C section for it may lead to fetal distress?

Normal umbilical artery pulsatility index+ | decreased MCA pulsatility index.

A 38 year old G4P3 (3003) came in due to labor pain. Fundic height is 35cm. Patient is diagnosed with GDM. IE was 6cm. Labor progress was until the second stage of labor. Upon delivery, there was a recoil of the fetal head at the perinium. Shoulder dystocia was diagnosed. Which maneuver will you use for anterior disimpaction of the shoulder?

Shoulder is pushed to the chest.

(A 38 year old G4P3 (3003) came in due to labor pain. Fundic height is 35cm. Patient is diagnosed with GDM. IE was 6cm. Labor progress was until the second stage of labor. Upon delivery, there was a recoil of the fetal head at the perinium. Shoulder dystocia was diagnosed.) ``` Same patient (37) which is the vaginal approach for anterior shoulder disimpaction? ```

Rubin’s

What fetal heart abnormality shows cerebral | palsy and indicates prompt intervention?

No specific fetal heart rate pattern

A 47 year old G1P1, had spontaneous vaginal delivery at 28 weeks, but developed intracranial hemorrhage. What is the most common etiology?

Hypoxia ischemia

21 year old regularly menstruating female experiences amenorrhea for 5.5 weeks. He B HcG test was positive, had tender breasts, and nausea. Picture presented of a transvaginal ultrasound ( one gestational sac, one yolk sac). 4 Pregnancy uterine, 5 weeks AOG by mean sac diameter. After 2 weeks, another scan was done. ( 1 gestational sac, 1 yolk sac, 2 embryos). What type of twinning is this?

Mono mono

(21 year old regularly menstruating female experiences amenorrhea for 5.5 weeks. He B HcG test was positive, had tender breasts, and nausea. Picture presented of a transvaginal ultrasound ( one gestational sac, one yolk sac). 4 Pregnancy uterine, 5 weeks AOG by mean sac diameter. After 2 weeks, another scan was done. ( 1 gestational sac, 1 yolk sac, 2 embryos) Same patient, this twinning results from division at?

8-12 days after fertilization

Early delivery

27 year old G2P1 (1001) with abdominal enlargement sought consult. LMP was last November 2020. First pregnancy was term, with no complications. Fundal height is 28cm, two fetal heart tones. This was her first prenatal checkup. You requested an US, which revealed IU pregnancy 24 weeks AOG.. Twin A, cephalic presentation, male, seen on maternal right, inferiorly located, amt placenta grade 2 estimated weight 2.5 kg. Twin B, breech, male, left side, superiorly located, placenta grade 2 weight: 2.1kg. There is an intervening membrane measuring 2 cm. What is the type of twinning?

Di, di

Vaginal delivery for first twin, a complete breech | extraction for second.

None

A 35 year old, has a missed period for 6 weeks. B HcG positive, has symptoms like nausea, breast tenderness. Her US findings showed 1 gestational sac, 2 embryos, 2 yolk sac. What type of twinning it is?

Monochorionic, diamnionic

Twin to twin transfusion syndrome

A 35 year old, has a missed period for 6 weeks. B HcG positive, has symptoms like nausea, breast tenderness. Her US findings showed 1 gestational sac, 2 embryos, 2 yolk sac Same patient, repeated US at 28 weeks, showed the following findings, intrauterine twin pregnancy. Twin A: 26 weeks, 4 days by fetal biometry, cephalic, maternal right side, more superiorly located, approx weight is 1200g, single vertical pocket of amniotic fluid is 1.8 cm. Twin B, 29 weeks 5 days live, breech, maternal left, more inferiorly located estimated fetal weight is 1900g, single vertical pocket is 8.3 cm. Thin intervening membrane seen. Same patient, after 2 weeks, repeat US, twin A: 27 weeks 2 days, live, cephalic, wt: 1320g, single vertical pocket is 1.7cm . Twin B 31 weeks, breech, wt: 2300g, single vertical pocket is 9cm with ascites and hydrothorax. What is the diagnosis of in the photo presented, you can see reversal of end diastolic flow?

TTS stage 4

Admit, close fetal surveillance and give | corticosteroids and MgSO4

This medical complication can cause preterm | birth

Preeclampsia

Which of the following is true *preterm/postterm topic

Short stature maybe a factor in preterm birth

This is the most imp factor for women who maybe | at risk of preterm birth

Prior preterm birth

Which is true regarding US evaluation of cervical | length

Cervical length is measured at 16-24 weeks

Which of the following is false in the management | of bacterial vaginosis

Bac vaginosis is an infection caused by | Gardnerella

27 year old, 33 weeks AOG, complains of watery discharge from the vagina 3 days ago. Vital signs are normal. FHT 140 bpm, FH of 31cm. Cephalic, uterine contraction every 4-5 minutes, speculum exam: amniotic fluid pooling, IE: 2cm dilated, 50% effaced, st-2. What is the management?

Tocolytic, betamethasone, antibiotics, mgso4

32 year old, 31-32 AOG, complains of watery discharge from vagina 3 days ago, normal vital signs. FHT is 170bpm, LMP breech. IE: 2 cm, 50% effaced. - membranes Management?

Antibiotics and do C section

Which of the following recommendations are appropriate for women with ruptured membranes at 34 weeks and below

If maternal and fetal status are reassuring, | transfer them to ante partum unit

Which of the following are not feared constituents of nearing post partum or post partum women?

Fetal hypoglycaemia

Which is the most appropriate management at 41 weeks of gestation with IE: 2cm dilated, 50% effaced, st -3, medium consistency and posterior?

Insert laminaria tent

Chronic hypertension

32 year old female comes at the Opd for consult. Amenorrheic for 8 weeks, positive B HcG, second pregnancy. First pregnancy was delivered at 35 weeks in oct 2019, by emergent C section due to blood pressure of 180/100, severe headache, blurring of vision. Her BP is still intermittently high even after delivery, failed to follow up. At the clinic, bp is 100/70, rr: 21, temp: 36. Same patient, at 31 weeks now, complains of headache. No other complains. For vitals, her bp is 200/110, pulse rate is 90bpm, FHT is 30cm, no uterine contractions. Cervix closed, uterus enlarged to AOG. Albumin+2, -ve sugar in the urine. What is the diagnosis?

Preeclampsia superimposed on chronic | hypertension.

Control bp, give corticosteroid, seizure | prophylaxis

32 year old female comes at the Opd for consult. Amenorrheic for 8 weeks, positive B HcG, second pregnancy. First pregnancy was delivered at 35 weeks in oct 2019, by emergent C section due to blood pressure of 180/100, severe headache, blurring of vision. Her BP is still intermittently high even after delivery, failed to follow up. At the clinic, bp is 100/70, rr: 21, temp: 36. Same patient, bp comes down to 150-160/ 100- 110. Eventually the patient develops difficulty in breathing with mid facial bipedal edema. Bp becomes 170/100, pulse rate of 120 bpm. Auscultation of chest reveals *****(not clear)What is the possible complication?

Pulmonary congestion. But always consider | COVID

A 31 year old G3P2, (2002) pregnant for 33 weeks, has vaginal spotting and headache. Diagnosed with hypertension starting 20 weeks, maintained at methyldopa 250mg BID. Bp is 160/100, FH 30cm. FHT 130bpm. Cervix is smooth, no bleeding, IE not done. Hb is 120, wbc is 8.2, platelet of 80,000 proteinuria +1, no sugar, pus cells 0-2, LDH 960/L, SGPT 200unit/L, creatinine 1mg/dl. TransAbdominal US revealed a live intrauterine pregnancy at 33 weeks, placenta anterograde, high lying, adequate amniotic fluid. What is your adequate impression?

HELLP syndrome

Seizure prophylactic, give steroids, deliver after | completion of steroids

10meqs/L

A 25 year old G1P0, pregnant at 6 weeks comes to the clinic for prenatal care. She is non-diabetic and non-hypertensive and given folic acid. You requested for laboratory work ups, after 2 weeks the patient came back with normal lab results. TVS revealed an intrauterine pregnancy 7 weeks of gestation, patient was advised to continue the folic acid. However at 21 weeks the BP was 150/90, you start her on Methyldopa 200mg/tab BID, her BP is maintained on normal levels until on her 29th week, she started having bipedal edema with elevations 160-170/100-110 with proteinuria of +3. What is your diagnosis?

D. Preeclampsia with severe features

A. Admit the patient for BP control, seizure prophylaxis, corticosteroids for fetal lung maturity

A primigravid at 34 weeks was admitted because of persistently elevated 160/110 BP despite medications, she was diagnosed with IUGR. Doppler ultrasound revealed decreased end diastolic flow, 24 hour album revealed 5000mg. What is the indication for delivery?

A. BP of 160/110mmHg

Which of the following legal theories describe the failure of a physician to disclose a risk of procedure

C. Informed consent

Which legal document sets out the patient’s wishes regarding her future health status including end of life issues

Advance directive

When we give importance to the role women should play in decision making in respect to their health care, we are invoking their right to?

C. Autonomy

Because of the intimate personal nature of obstetrics and gynecologic care, there is a special need to protect the patients?

Confidentiality

Which of the following ethical principles identifies familial, social, institutional, financial and legal settings within which a particular case takes place insofar as they influence medical decisions.

C. Principle of Justice and Fairness

A 23 year old primigravid at 38 weeks wants to undergo elective cesarean delivery per request because of fear of labor pains and complications of pelvic organ prolapse. What is the number 1 ethical principle applied in this case?

B. Principle of Beneficence

A G3P2 2002, 30 year old, with 2 previous CS wants a tubal ligation to be done along with her 3rd CS. She said that her husband does not want to give his consent because he wants to have 4 children.

A. The physician should support the patient’s | right to decide about future reproduction.

A G1P0 35 year old, desires to deliver a fatally malformed fetus by CS because she believes this procedure will increase newborn’s chance of surviving. However in the physician’s best judgment, the theoretical benefit to a non viable infant may not justify the risk of the surgical delivery to the woman. Which of the following ethical principles may run in conflict with the OB’s obligation to respect the patient’s autonomy

B. Beneficence

In giving COVID 19 vaccination, what is the | number 1 ethical principle that must be implied?

C. Autonomy

What ethical principle is being applied in a female patient diagnosed with ectopic pregnancy, live fetus who presented with hemodynamically status and will undergo methotrexate management that will kill the live fetus immediately?

C. Double effect

As an adaptation to pregnancy, preload rises at | what age of gestation?

B. 10-20 weeks

. Which of the following statements does not describe the adaptation of the cardiovascular system in pregnancy?

A. Increase heart rate = decrease CO

Cardiac output may increase as early as what | age of gestation?

A. 5 weeks

Which is responsible for the limited physical | activities for patients in 28-32 weeks AOG

B. Increase intravascular volume

Which of the following cardiovascular conditions of pregnancy is each therapeutic measure trying to address the likelihood of complication of gravidocardiac?

D. Postpartum intravascular fluid immobilization

Which of the following cardiovascular conditions of pregnancy is each therapeutic measure trying to decrease the likelihood of complication of gravidocardiac?

C. Hypercoagulability

Which of the following cardiovascular conditions of pregnancy is each therapeutic measure trying to address in order to decrease likelihood of complications of gravidocardiac, the epidural anesthesia during labor?

E. Marked increase of peripartal cardiac output.

Which of the statements may predict cardiac | complications in pregnancy?

A. Left-sided obstruction

89. Which of the following is true regarding | intrapartum heart failure?

A. Fluid overload is treated with diuresis

90. Aortic stenosis is caused by

B. Congenital bicuspid valve

In making incision, when it is imperative to incise higher on the uterus to avoid laceration of the uterine vessels or unintended entry into the vagina

A. Completed dilated cervix

In making a higher incision to avoid laceration of the uterine vessels which of the following is being used as a guide in the procedure

B. The vesico-uterine serosal reflection

A primi patient on her 28 weeks gestation goes into labor with passage of watery vaginal discharge, and suddenly develops signs of chorioamnionitis. Upon internal examination, the cervix has poor bishop score, you plan to do CS section so what is the best uterine incision for the patient?

C. Vertical incision on the upper segment of the | uterus or Classical CS

94. 24 year old G2P1(1001) at 37 weeks LMP, supported by a 9-week ultrasound, states that her mother is in town in the next 4 days and will be available to assist in taking care of her baby. She requested for CS, although controversial, CS delivery on maternal request should only be considered as option when which of the following criteria have been met?

A. Pregnancy reached at least 39 weeks

95. 24 year old G2P1(1001) at 37 weeks LMP, supported by a 9-week ultrasound, states that her mother is in town in the next 4 days and will be available to assist in taking care of her baby. She requested for CS, although controversial, CS delivery on maternal request. Which of the following is the best response to the patient’s request of doing CS at 37 weeks?

C. CS at 37 weeks increases neonatal | complications compared to 39 weeks

96. Which of the following abdominal incision involves the separation of rectus muscles to the symphysis pubis and separated from the pyramidalis

C. Cherney incision

A single layer closure of uterus with 2 layer closure of abdomen is done in what type of abdominal incision?

B. Misgav Ladach procedure

Which vessel should be anticipated halfway between the skin and fascia several centimeters from the midline during the pfannenstiel incision?

B. Superficial epigastric arteries

The separation of the bladder from the lower uterine segment should not exceed in what distance?

C. 5cm

Which of the abdominal incisions has increased risk of interrupting the perforating capillaries causing superficial hematoma?

C. Transverse incision