TWIN/MULTIFETAL PREGNANCY
Q. Which of these options is the first step in the management:
a. Abduct mothers thigh and apply suprapubic pressure.
b. Apply fundal pressure.
c. Flex mothers thigh against her abdomen.
d. Push infants head back into the uterus and do cesarean section.
e. Do a symphiosotomy.
55. A 28 year old G1P0 woman at 31 weeks gestation presents with 4hours history of abdominal cramping and contraction. She is feeling contractions at regular intervals of 10 mins and are increasing is intensity.
She has had a small amount of vaginal discharge but is unsure whether her water bag has broken or not.
She has had no vagina bleeding
Her temp is 36.80 C (98.30F), BP-137/84mm of Hg, pulse 87/min and R/R=12/min
On examination:
• Uterus is soft
• Fundal ht ~ 32weeks
• Contractions present 20-30secs/8mins
• Cephalic presentation
• FHS + Regular
Which of the following is the next best step in management:
a. Cervical culture for group B streptococci
b. Digital cervical examination and assessment of dilation and effacement.
c. Quantification of strength and timing of contraction with external tocometer.
d. Speculum examination to rule out leaking and usually assess cervical dilatation and effacement.
e. USG examination of the fetus.
56. A primigravida at 37th weeks of gestation with loss of engagement, 1 cm effacement of cervix and 10 uterne contractions per hour. She is hemodynamically stable and not in distress. What is the management.
(AI 2011) a. Sedate the patient and wait
b. LSCS c. Amniotomy
d. Induction with membrane rupture
57. A 30 year old primigravida at 39 weeks has been completely dilated and pushing for 3 hrs. She has taken epidural analgesia.She is exhausted and her temp is 37.8^c. FHS is 170/min with decreased variability.
Patients membranes are ruptured for over 24 hrs. P/V shows cervix is fully dilated and fetal head is visible in between contractions and fetal bones are at +3 station.What is the most appropriate management:
a. do LSCS
b. encourage the patient to push after a short period of rest.
c. attempt forceps delivery d. apply fundal pressure
58. A 32 year old G2P1 at 38 weeks of gestation presents to the labour room with regular intense painful uterine contractions for the past one hour.She belives her water bag has broken and has H/O previous LSCS for fetal distress.
• O/E – P/R = 95/min
• B/P = 135/8 o mmof hg
• R/R – 15/min
• P/A – fetus lie-long,presentation cephalic
• Tocometer detcts contractions every 8 mins
• Fetal heart rate tracing show baseline FHS 140/min,beat to beat variability is present, occasional heart rate acceleration of 160/min for 15–20 secs. There are also decelarations to 115–120/min with the onset of contractions.
What is the most appropriate next step in management?
a. Augment contractions wid oxytocin b. Monitor and follow labor on partogram c. Obtain immediate consent for LSCS d. Send the patient for BPS
e. Perform urgent aminoinfusion
59. A healthy 30 yr old G1P0 at 41 weeks presents to labor and delivery at 11 pm because the baby’s movements were less for the past 24 hrs.
the pregnancy period was without any complication. Her baseline BP was normal. FHR is 180 bpm with absent variability. Uterine contractions are every 3 min accompanied by FHR deceleration. Physical exam indicates cervix is long/ closed/-2. What is the appropriate plan of mgmt.
a. Emergency CS
b. IV MgSO4 and induce labor with with pitocin
c. Overnight cervix ripening with PGE2 and induction with Pitocin in morning
d. Admission and CS after 12 hrs of NPO e. Induce labor with misoprostil
60. A healthy 23 yr old G1P0 has an uncomplicated pregnancy to date. She is dissapointed because she is 41 weeks gestational age by good dates and a 1st trimester USG and wants to have her baby. Pt reports good fetal movements, baby’s kick count is abt. 8–10 times/hr.
On exam cervix is firm, posterior, 50% effaced and 1 cm dilated and vertex is at -1 stn. What will be the next advice for the pt.
a. Admission and immidiate CS b. Admission and Pitocin induction
c. Schedule a CS in one week if she has not undergone spontaneous labor in the mean time
d. She should continue to monitor kick count and return to you after a week to reassess the situation
61. A 24 yr old primi female at term, has been dilated to 9 cms for 3 hrs.The fetal vertex is at Rt occipito posterior position and at +1 station.There have been mild decelerations for the last 10 mins.Twenty mins back fetal scalp Ph was 7.27 and now it is 7.20. Next line of management is:
a. wait and watch
b. repeat scalp ph after 15 mins c. midforceps rotation
d. LSCS
62. A 27-year-old G2P1 woman at 40 weeks’ gestation presents in labor. She has a history of an uncomplicated spontaneous vaginal delivery of a healthy child weighing 3.9 kg (8.6 lb). On examination her blood pressure is 123/89 mm Hg, pulse is 87/min, and temperature is 36.7°C (98°F). The fetal heart rate ranges from 140 to 150/min with good beat-to-beat variability. Tocometry detects regular contractions occurring every 8-10 minutes. The cervix is dilated at 4 cm and the vertex is at the -3 position. Immediately after artificial rupture of membranes, fetal bradycardia of 65-75/min is noted for 2 minutes without recovery.
Which of the following is the next best step in mgt:
a. incr rate of oxytocin infusion b. Perform sterile vaginal examination c. perform immediate LSCS
d. Perform mc roberts manouvre e. stimulate fetal scalp
63. Treatment of cord prolapse is based on all of the following factors except:
a. Fetal viabilty
b. Fetal maturity c. Fetal weight d. Cervical dilatation
64. A 37-year-old G2P1 woman at 38 weeks’ gestation, with regular prenatal care, presents to the labor and delivery floor after several hours of increasingly frequent and strong contractions with ruptured amniotic membranes. On examination her cervix is soft, anterior, and completely effaced and dilated. Labor continues for another 3 hours, at which time the fetus has still not been delivered. The fetal mean heart rate is 146/min, with variable accelerations and no appreciable decelerations.
Evaluation of the fetus and maternal pelvis indicate that anatomic factors are adequate for vaginal delivery.
Which of the following is an indication for forceps delivery:
a. Fetal distress during active stage of labor.
b. Labor complicated by shoulder dystocia.
c. Prolonged active stage of labor due to inadequate uterine contraction strength.
d. Prolonged latent stage of labor due to inadequate uterine contraction strength.
e. Prolonged second stage of labor due to adequate uterine contraction strength.
65. In the criteria for outlet forceps application all are correct except:
a. Fetus should be vertex prestation or face presentation with mentoanterior
b. The saggital plane should be less than 15 degree from anterioposterior plane
c. There should be no caput saccedenum
d. It should be at station zero (AIIMS Nov 2011) 66. Long axis of the forceps lie along which fetal diameter:
a. Mentovertical
b. Suboccipitobregmatic c. Occipitofrontal d. Occipitomental
67. A forceps rotation of 30o from left occipito anterior with extraction of fetus from +2 station is described as which type of forceps application:
a. High forceps b. Mid cavity forceps c. Low forceps d. Outlet forceps
68. An abnormal attitude is illustrated by:
a. Breech presentation b. Face presentation c. Transverse position d. Occiput posterior e. Occiput anterior
69. A 30 yr old G1P1001 patient comes to see you in office at 37 weeks gestational age for her routine OB visit. Her 1st pregnancy resulted in a vaginal delivery of a 9-lb, 8-oz baby boy after 30 min of pushing.
On doing Leopold maneuvers during this office visit, you determine that the fetus is breech. Vaginal exam demonstrate that the cervix is 50% effaced and 1–2 cm dilated. The presenting breech is high out of pelvis. The estimated fetal wt. is about 7 lb. you send the pt. for a USG, which confirms a fetus with a frank breech prestation. There is a normal amount of amniotic fluid present, and the head is well flexed.
As the patient’s obstetrician, you offer all the following possible mgmt plans except:
a. Allow the pt to undergo a vaginal breech delivery whenever she goes into labor
b. Send the pt to labor and delivery immidiately for an emergent CS c. Schedule a CS at or after 39 weeks gestation age
d. Schedule an ext cephalic version in next few days PUERPERIUM
70. Kegels exercise shd begin: (AIPG2012) Version 1:
a. immediately after delivery b. 24 hrs after delivery c. 3 weeks after delivery d. 6 weeks after delivery
Version 2:
a. Immediately after delivery b. 3 weeks after delivery c. Only after LSCS
d. During third trimester of pregnancy
71. A 24-year-old P2+0 woman presents to the emergency department complaining of pain in her right breast. The patient is postpartum day 10 from an uncomplicated spontaneous vaginal delivery at 42 weeks.
She reports no difficulty breast-feeding for the first several days postpartum, but states that for the past week her daughter has had difficulty latching on. Three days ago her right nipple became dry and cracked, and since yesterday it has become increasingly swollen and painful. Her temperature is 38.3°C (101°F). Her right nipple and areola are warm, swollen, red, and tender. There is no fluctuance or induration, and no pus can be expressed from the nipple.
a. Continue breast feeding from both the breasts b. Breastfeed from unaffected breast only
c. Immediately start antibiotics and breastfeed only when antibiotics are discontinued.
d. Pump and discard breastmilk till infection is over and then continue breatfedding
e. Stop breastfeeding immediately.
72. A 27-year-old woman presents to her obstetrician with the complaint of pain and swelling in her left breast. She reports a fever of around 38.3°C (101°F) for the past 2 days. She recently gave birth to a healthy baby girl and has been breastfeeding every 3-4 hours. Examination reveals focal tenderness just medial to the nipple with surrounding warmth and erythema. Her WBC count is 12,000/mm³
Which of the following is the best treatment:
a. Amoxicillin b. Diclocloxacillin c. Penicillin v d. Erythromycin e. Levofloxacilin
73. Sarita, a 30 year old woman develops a deep vein thrombosis in her left calf on fourth post operative day following cesarean section done for fetal distress. The patient is started on heparin and is scheduled to begin a 6 weeks course of warfarin therapy.
The patient is a devoted mother who wants to breast feed her baby.