Normal Labor - William Obstetric 24th Study Guide

22–1.

The relation of the fetal long axis to that of the mother is termed which of the following?

a.

Fetal lie

b.

Fetal angle

c.

Fetal position

d.

Fetal polarity

22–2.

Which of the following is not a predisposing factor for transverse fetal lie?

a.

Multiparity

b.

Oligohydramnios

c.

Placenta previa

d.

Uterine anomalies

22–3.

Which of the following fetal presentations is the least common?

a.

Breech

b.

Cephalic

c.

Compound

d.

Transverse lie

22–4.

What percentage of fetuses are breech at 28 weeks’ gestation?

a.

b.

10%

c.

25%

d.

50%

22–5.

When the anterior fontanel is the presenting part, which term is used?

a.

Brow

b.

Face

c.

Vertex

d.

Sinciput

22–6.

This drawing shows a fetal head in which position?

Reproduced with permission from Cunningham FG, Leveno KJ, Bloom SL, et al (eds): Normal labor. In Williams Obstetrics, 24th ed. New York, McGraw-Hill, 2014, Figure 22-3A.

a.

Left occiput anterior (LOA)

b.

Left occiput posterior (LOP)

c.

Right occiput anterior (ROA)

d.

Right occiput posterior (ROP)

N orma l La bor CH A P T E R 2 2

145 22–7.

The face presentation in this drawing is described as which of the following?

Reproduced with permission from Cunningham FG, Leveno KJ, Bloom SL, et al (eds): Normal labor. In Williams Obstetrics, 24th ed. New York, McGraw-Hill, 2014, Figure 22-5A.

a.

Left mento-anterior

b.

Left mento-posterior

c.

Right mento-anterior

d.

Right mento-posterior

22–8.

The fetus in this drawing is breech. His position is best described as which of the following?

Reproduced with permission from Cunningham FG, Leveno KJ, Bloom SL, et al (eds): Breech delivery. In Williams Obstetrics, 24th ed. New York, McGraw-Hill, 2014, Figure 28-2.

a.

Left sacrum anterior

b.

Left sacrum posterior

c.

Right sacrum anterior

La bor SE C T I O N 7

146 22–9.

The fetus in this drawing has a transverse lie. The position is best described as which of the following?

Reproduced with permission from Cunningham FG, Leveno KJ, Bloom SL, et al (eds): Normal labor. In Williams Obstetrics, 24th ed. New York, McGraw-Hill, 2014, Figure 22-7.

a.

Left acromidorsoanterior (LADA)

b.

Left acromidorsoposterior (LADP)

c.

Right acromidorsoanterior (RADA)

d.

Right acromidorsoposterior (RADP)

22–10.

In shoulder presentations, the portion of the fetus chosen for orientation with the maternal pelvis is which of the following?

a.

Head

b.

Breech

c.

Scapula

d.

Umbilicus

22–11.

Which of the following could inhibit performance of Leopold maneuvers?

a.

Oligohydramnios

b.

Maternal obesity

c.

Posterior placenta

d.

Supine maternal positioning

22–12.

Which of the following is the correct order for the cardinal movements of labor?

a.

Descent, engagement, internal fixation, flexion, extension, external rotation, expulsion

b.

Descent, flexion, engagement, external fixation, extension, internal rotation, expulsion

c.

Engagement, descent, flexion, internal rotation, extension, external rotation, and expulsion

d.

Engagement, flexion, descent, internal rotation, straightening, extension, and expulsion

22–13.

Regarding engagement of the fetal head, which of the following statements is true?

a.

It does not occur until labor commences.

b.

Engagement prior to the onset of labor does not affect vaginal delivery rates.

c.

It is the mechanism by which the biparietal diameter passes through the pelvic outlet.

d.

A normal-sized head usually engages with its sagittal suture directed anteroposteriorly.

22–14.

On palpation of the fetal head during vaginal examination, you note that the sagittal suture is transverse and close to the pubic symphysis. The posterior ear can be easily palpated. Which of the following best describes this orientation?

a.

Anterior asynclitism

b.

Posterior asynclitism

c.

Mento-anterior position

d.

Mento-posterior position

22–15.

Of the cardinal movements of labor, internal rotation achieves what goal?

a.

Flexes the fetal neck

b.

Brings the occiput to an anterior position

c.

Brings the anterior fontanel through the pelvic inlet

d.

None of the above

22–16.

In what percentage of labors does the fetus enter the pelvis in an occiput posterior position?

a.

0.5%

b.

c.

20%

d.

33%

22–17.

Which of the following is not a risk factor for incomplete rotation of the posterior occiput?

a.

Macrosomia

b.

Poor contractions

c.

Lack of analgesia

d.

Inadequate head flexion

N orma l La bor CH A P T E R 2 2

147 22–18.

This photograph demonstrates which of the following?

a.

Hydrocephalus

b.

Plagiocephaly

c.

Craniosynostosis

d.

Caput and molding

22–19.

Which of the following statements regarding the preparatory division of labor is true?

a.

The cervix dilates very little.

b.

Connective tissue components of the cervix change considerably.

c.

Sedation and conduction analgesia are capable of arresting this labor division.

d.

All of the above

22–20.

When does the latent phase of labor end for most women?

a.

1–2 cm

b.

2–3 cm

c.

3–5 cm

d.

7–8 cm

22–21.

A 20-year-old G1P0 at 39 weeks’ gestation presents complaining of strong contractions. Her cervix is dilated 1 cm. She is given sedation, and 4 hours later, her contractions have stopped. Her cervix is still 1 cm dilated. Which of the following is the most likely diagnosis?

a.

False labor

b.

Prolonged latent phase of labor

c.

Arrest of the latent phase of labor

d.

Arrest of the active phase of labor

22–22.

According to Friedman, the minimum normal rate of active-phase labor in a multipara is which of the following?

a.

1 cm/hr

b.

1.2 cm/hr

c.

1.5 cm/hr

d.

3.4 cm/hr

22–23.

Which stage of labor begins with complete cervical dilatation and ends with delivery of the fetus?

a.

First stage

b.

Second stage

c.

Third stage

d.

Fourth stage

22–24.

A 24-year-old G1P0 at 27 weeks’ gestation presents in active preterm labor to a hospital without

delivery services or a neonatal intensive care unit. The physician in the emergency department

evaluates the patient. He determines that her cervix is approximately 4 cm dilated and membranes are intact. He would like to transfer her to you because you are at the nearest hospital with obstetric and neonatal services qualified to handle this patient’s complications. According to the Emergency Medical Treatment and Labor Act (EMTALA), which of the following is true?

a.

A woman complaining of contractions is not considered an emergency.

b.

A screening examination is not required because it will unreasonably slow the transfer of the

patient.

c.

The patient cannot be transferred because a

woman in true labor is considered “unstable” for interhospital transfer.

d.

This patient can be transferred if the physician certifies that the benefits of treatment at your facility outweigh the transfer risks.

22–25.

When evaluating a pregnant woman for rupture of membranes, which of the following has been associated with a false-positive nitrazine test result?

a.

Blood

b.

Semen

c.

Bacterial vaginosis

La bor SE C T I O N 7

148 22–26.

When performing a bimanual examination on a pregnant woman, the position of the cervix is determined by the relationship of the cervical os to which of the following?

a.

Rectum

b.

Uterus

c.

Fetal head

d.

Pubic symphysis

22–27.

Station describes the relationship between which of the following?

a.

The biparietal diameter and the pelvic outlet

b.

The biparietal diameter and the ischial spines

c.

The lowermost portion of the presenting fetal part and the pelvic inlet

d.

The lowermost portion of the presenting fetal part and the ischial spines

22–28.

A 20-year-old G2P1 presents in active labor at term. The patient requires augmentation with oxytocin during her labor course. She has a forceps-assisted vaginal delivery and sustains a second-degree

laceration. Which of the following is not a risk factor for urinary retention in this patient?

a.

Multiparity

b.

Perineal laceration

c.

Oxytocin-augmented labor

d.

Operative vaginal delivery

22–29.

What is the median duration of second-stage labor in nulliparas without conduction analgesia?

a.

20 minutes

b.

40 minutes

c.

50 minutes

d.

90 minutes

22–30.

What is the median duration of the second-stage labor in multiparas without conduction analgesia?

a.

20 minutes

b.

40 minutes

c.

50 minutes

d.

90 minutes

22–31.

A 25-year-old G1P0 at 39 weeks’ gestation presents in active labor. Her cervix is dilated 4 cm and is completely effaced, and the presenting fetal part has reached 0 station. Membranes are intact. With examination 2 hours later, you note that the cervix is still 4 cm dilated. At this point, which of the following is the best management?

a.

Cesarean delivery

b.

Rupture of membranes

c.

Insertion of a bladder catheter to assist fetal head descent

d.

Rupture of membranes, placement of internal monitors, and oxytocin augmentation

22–32.

A 19-year-old G1P0 at term presents in active labor. Her cervix is 5 cm dilated, and fluid is leaking from spontaneously ruptured membranes. You examine her 2 hours later, and the cervix is still 5 cm dilated. At this point, which of the following is the best

management?

a.

Cesarean delivery

b.

Placement of internal monitors and reassessment in 2 hours

c.

Placement of internal monitors, oxytocin augmentation, and reassessment in 2 hours

d.

Placement of internal monitors, oxytocin

augmentation, antibiotics for prolonged rupture of membranes, and reassessment in 2 hours