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Category: Obstetrics & Gynecology--->Normal and Abnormal Labor and Delivery
Page: 5

Question 21# Print Question

A 19-year-old P0 at 41 weeks presents in spontaneous labor. Her membranes rupture spontaneously after she is admitted to labor and delivery, demonstrating meconium-stained amniotic fluid.

What is the best management strategy for this patient and fetus at the time of delivery?

A. No special measures need to be taken, and this infant can be managed per the normal routine
B. The obstetrician should suction the oropharynx and nasopharynx on the perineum after delivery of the head but before the delivery of the shoulders (intrapartum suctioning)
C. A pediatrician should be called to the delivery in order to perform intubation of the neonate
D. A pediatrician should be called to perform routine tracheal suctioning
E. A pediatrician should be called, and if the newborn is depressed, they should intubate the trachea and suction meconium or other aspirated material from beneath the glottis


Question 22# Print Question

A 38-year-old G3P2 at 40 weeks’ gestation presents to labor and delivery with gross rupture of membranes occurring 1 hour prior to arrival. The patient is having contraction every 3 to 4 minutes on the external tocometer, and each contraction lasts 60 seconds. The FHR tracing is 120 beats per minute with accelerations and no decelerations. The patient has a history of rapid vaginal deliveries, and her largest baby was 3200 g. On cervical examination she is 5-cm dilated and completely effaced, with the vertex at -2 station. The estimated fetal weight is 3300 g. The patient is in a lot of pain and requesting medication.

Which of the following is the most appropriate method of pain control for this patient?

A. Intramuscular meperidine
B. Pudendal block
C. Perineal block
D. Epidural analgesia
E. General anesthesia


Question 23# Print Question

A 35-year-old G2P1 at 39 weeks’ gestation presents to labor and delivery in active labor. Her cervix is 5-cm dilated and 80% effaced, and the vertex is at 0 station. The tocometer shows that she is having contractions every 3 minutes. The fetal heart tracing shows a baseline rate of 140 beats per minute, moderate variability, with accelerations and no decelerations.

This FHR tracing may best be interpreted as which of the following?

A. Category I
B. Category II
C. Category III
D. Category IV
E. Category V


Question 24# Print Question

A 35-year-old G2P1 at 39 weeks’ gestation presents to labor and delivery in active labor. Her cervix is 5-cm dilated and 80% effaced, and the vertex is at 0 station. The tocometer shows that she is having contractions every 3 minutes. The fetal heart tracing shows a baseline rate of 140 beats per minute, moderate variability, with accelerations and no decelerations.

One hour after she is admitted, her membranes rupture spontaneously. Shortly thereafter, she develops recurrent variable decelerations.

What is the best next step in management?

A. Continue to monitor, as variable decelerations do not require intervention
B. Initiate an amnioinfusion
C. Since she is remote from delivery, perform a cesarean
D. Administer oxygen by nasal cannula
E. Administer terbutaline


Question 25# Print Question

A 29-year-old G2P1 at 40 weeks is in active labor. Her cervix is 5-cm dilated, completely effaced, and the vertex is at 0 station. She is on oxytocin to augment her labor, and she has just received an epidural for pain management. The nurse calls you to the room because the FHR has been in the 70s for the past 3 minutes. The contraction pattern is noted to be every 3 minutes, each lasting 60 seconds, with return to normal tone in between contractions. The patient’s vital signs are: blood pressure 90/40 mm Hg, pulse 105 beats per minute, respiratory rate 18 breaths per minute, and temperature 36.1°C (97.6°F). On repeat cervical examination, the vertex is well applied to the cervix and the patient remains 5-cm dilated and at 0 station, and no vaginal bleeding is noted.

Which of the following is the most likely cause for the deceleration?

A. Cord prolapse
B. Epidural analgesia
C. Pitocin
D. Placental abruption
E. Tachysystole




Category: Obstetrics & Gynecology--->Normal and Abnormal Labor and Delivery
Page: 5 of 7