Induction and Augmentation of Labor - William Obstetric 24th Study Guide

26–1.

Compared with the induction of labor, the augmentation of labor differs in what regard?

a.

The fetal membranes are intact.

b.

Oxytocin is titrated to effect.

c.

Contractions are pharmacologically stimulated.

d.

Previously commenced labor fails to effect cervical change.

26–2.

All EXCEPT which of the following are contraindications to labor induction?

a.

Twin gestation

b.

Breech presentation

c.

Fetal-growth restriction

d.

Prior vertical hysterotomy cesarean delivery

26–3.

The risk for cesarean delivery is increased in women undergoing induction of labor in which of the

following situations?

a.

Low Bishop score

b.

Engaged fetal head

c.

Multiparous parturient

d.

All of the above

26–4.

Women whose labors are managed with amniotomy are at increased risk for which complication?

a.

Uterine atony

b.

Chorioamnionitis

c.

Cervical lacerations

d.

All of the above

26–5.

A 30-year-old G2P1 at 37 weeks’ gestation with one prior cesarean delivery presents with contractions and premature rupture of the fetal membranes.

Her cervix is 3 cm dilated. She requests a trial of labor and is deemed an appropriate candidate. An oxytocin infusion is initiated, and 2 hours later, you are called to the room to evaluate the fetal heart rate tracing, which is shown below. According to a large study conducted by the Maternal-Fetal Medicine Units Network, the use of oxytocin increases the risk for uterine rupture by what magnitude in women with a prior cesarean delivery?

a.

Threefold

b.

Sixfold

c.

Tenfold

d.

No change from background risk in women undergoing trial of labor after cesarean

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174 26–11.

A 22-year-old primigravida is diagnosed with severe preeclampsia at 39 weeks’ gestation. A magnesium sulfate infusion is initiated for seizure prophylaxis, and plans are made for induction of labor. Her cervix is 3 cm dilated, 50-percent effaced, slightly soft, and located anteriorly. The fetal head is at –1 station. What is her Bishop score?

a.

b.

c.

d.

26–12.

Of the five elements that comprise the Bishop

scoring system, only three are significantly associated with predicting successful vaginal delivery. This

simplified Bishop scoring system includes all EXCEPT which of the following?

a.

Fetal station

b.

Cervical dilation

c.

Cervical effacement

d.

Cervical consistency

26–13.

Intracervical administration of dinoprostone

(Prepidil) for the purpose of cervical ripening may be repeated every 6 hours with a maximum of how many doses?

a.

b.

c.

d.

26–14.

When administering dinoprostone using the device shown here, which of the following should be avoided?

a.

Subsequent use of oxytocin

b.

Use of lubricants during insertion

c.

Removal of the device with labor onset

d.

Recumbent positioning for the first 2 hours after insertion

26–6.

The patient presented in Question 26–5 is taken emergently for cesarean delivery due to uterine rupture. If misoprostol had been considered as an induction agent rather than oxytocin, what is the safest prostaglandin route and dose to use in a patient with a uterine cesarean scar?

a.

Oral administration only

b.

Low-dose preparation only

c.

Vaginal administration only

d.

They should be avoided completely.

26–7.

Labor induction or augmentation increases the likelihood of which of the following peripartum complications?

a.

Hysterectomy

b.

Uterine atony

c.

Postpartum hemorrhage

d.

All of the above

26–8.

Which of the following women would be most likely to have a successful induction of labor?

a.

G2P1 with a body mass index of 34 and a neonatal birthweight of 3250 g

b.

G1P0 with a body mass index of 25 and a neonatal birthweight of 3800 g

c.

G2P1 with a body mass index of 27 and a neonatal birthweight of 3150 g

d.

G1P0 with a body mass index of 31 and a neonatal birthweight of 2900 g

26–9.

Which of the following administration routes is acceptable for preinduction cervical ripening with prostaglandin E₂ (dinoprostone)?

a.

Intravenous

b.

Intravaginal

c.

Intramuscular

d.

All of the above

26–10.

Use of cervical ripening agents is associated with which of the following outcomes?

a.

Labor initiation

b.

Decreased cesarean delivery rate

c.

Decreased maternal morbidity rate

d.

All of the above

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175 26–15.

Based on the available literature, the use of

dinoprostone appears to have what effect on the cesarean delivery rate?

a.

Unchanged

b.

Decreased

c.

Increased for fetal distress

d.

Increased for labor dystocia

26–16.

A 16-year-old primigravida is admitted to the hospital for preterm, premature rupture of the fetal membranes at 32 weeks’ gestation. Two days later, she complains of contractions and vaginal bleeding, and the following fetal heart rate tracing is noted to be associated with frequent uterine

contractions. According to the definitions established by the American College of Obstetricians and

Gynecologists, what is the appropriate term for this condition?

Reproduced with permission from Cunningham FG, Leveno KJ, Bloom SL, et al (eds):

Intrapartum assessment. In Williams Obstetrics, 24th ed. New York, McGraw-Hill, 2014, Figure 24-24.

a.

Uterine hypertonus

b.

Uterine tachysystole

c.

Uterine hyperstimulation

d.

Uterine hypercontractility

26–17.

A 25-year-old G2P1 at 41 weeks’ gestation presents for preinduction cervical ripening, and a 10-mg dinoprostone insert (Cervidil) is placed in the posterior vaginal fornix. Thirty minutes later, she is noted to have 6 contractions every 10 minutes.

What is the most appropriate next step in management?

a.

Remove the insert

b.

Irrigate the vagina

c.

Administer supplemental oxygen

d.

Increase intravenous fluid administration rate

26–18.

Misoprostol (prostaglandin E₁) is approved by the U.S. Food and Drug Administration for what indication?

a.

Labor induction

b.

Cervical ripening

c.

Cholelithiasis pain

d.

Peptic ulcer prevention

26–19.

When administered vaginally for labor induction, what is the recommended dose of misoprostol (prostaglandin E₁)?

a.

25 µg

b.

25 mg

c.

100 µg

d.

100 mg

26–20.

Which of the following observations prompted investigators to search for clinical agents that stimulate nitric oxide (NO) production?

a.

NO is a mediator of cervical ripening.

b.

NO metabolite levels are increased in early labor.

c.

NO production prior to labor is low in postterm pregnancies.

d.

All of the above

26–21.

For cervical ripening, the addition of nitric oxide donors to prostaglandins has been demonstrated to have which of the following outcomes compared with prostaglandins alone?

a.

Shortened time to vaginal delivery

b.

Enhanced cervical ripening in term pregnancies

c.

Enhanced cervical ripening in preterm pregnancies

d.

None of the above

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176 26–22.

When using a transcervical catheter to mechanically promote cervical ripening, concurrent extraamnionic saline infusion through the catheter reduces what complication compared with catheter placement without infusion?

a.

Tachysystole

b.

Uterine rupture

c.

Chorioamnionitis

d.

Placental abruption

26–23.

Compared with prostaglandins for cervical ripening, transcervical catheters have what benefit?

a.

Lower cesarean delivery rate

b.

Lower rates of supplemental oxytocin use

c.

Fewer cases of cardiotocographic changes

d.

All of the above

26–24.

For cervical ripening, use of the mechanical dilating device shown here has which of the following

benefits compared with prostaglandins?

Reproduced with permission from Cunningham FG, Leveno KJ, Bloom SL, et al (eds):

Abortion. In Williams Obstetrics, 24th ed. New York, McGraw-Hill, 2014, Figure 18-8B.

a.

Low cost

b.

Patient comfort

c.

Lower chorioamnionitis rate

d.

Shorter induction-to-delivery intervals

26–25.

All EXCEPT which of the following statements regarding oxytocin are accurate?

a.

It was the first polypeptide hormone synthesized.

b.

It may be used for labor induction or augmentation.

c.

It can be administered by intravenous or intravaginal routes.

d.

It is one of the most frequently used medications in the United States.

26–26.

In general, oxytocin infusions should be

discontinued if the number of contractions per 10 minutes consistently exceeds what value?

a.

b.

c.

d.

26–27.

What is the mean half-life of oxytocin?

a.

1 minute

b.

5 minutes

c.

10 minutes

d.

20 minutes

26–28.

Potential benefits of a high-dose oxytocin regimen (4.5 to 6 mU/mL) compared with a low-dose

regimen (0.5–1.5 mU/mL) include which of the following?

a.

Fewer failed inductions

b.

Decreased admission-to-delivery intervals

c.

Lower rates of intrapartum chorioamnionitis

d.

All of the above

26–29.

At what oxytocin infusion dose does free-water clearance begin to decrease markedly?

a.

10 mIU/mL

b.

20 mIU/mL

c.

36 mIU/mL

d.

48 mIU/mL

26–30.

On average, epidural analgesia prolongs the active phase of labor how many minutes?

a.

60 minutes

b.

90 minutes

c.

120 minutes

d.

180 minutes

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177 26–31.

Which of the following can follow amniotomy?

a.

Cord prolapse

b.

Placental abruption

c.

Variable fetal heart rate decelerations

d.

All of the above

26–32.

Membrane stripping has been associated with which of the following untoward outcomes?

a.

Chorioamnionitis

b.

Precipitous labor

c.

Patient discomfort

d.

Premature rupture of the fetal membranes

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178

CHAPTER 26 ANSw ER KEy

Q uestion

number Letter

a nswer Pa ge

cited Hea der cited

In document William Obstetric 24th Study Guide (Page 186-191)