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

Question 31#Print Question

A 20-year-old G1 at 41 weeks has been pushing for 2½ hours. The fetal head is at the introitus and beginning to crown. It is necessary to cut an episiotomy. The tear extends through the sphincter of the rectum, but the rectal mucosa is intact.

How should you classify this type of episiotomy?

a. First-degree
b. Second-degree
c. Third-degree
d. Fourth-degree
e. Mediolateral episiotomy


Question 32#Print Question

A 16-year-old G1P0 at 38 weeks’ gestation presents to labor and delivery for the second time during the same weekend that you are on call. She initially presented at 2:00 pm Saturday afternoon complaining of regular uterine contractions. Her cervix was 1-cm dilated, 50% effaced with the vertex at −1 station, and she was sent home after walking for 2 hours in the hospital without any cervical change. It is now Sunday night at 8:00 pm, and the patient returns to labor and delivery with increasing pain. She is exhausted because she did not sleep the night before because her contractions kept waking her up. The patient is placed on the external fetal monitor. Her contractions are occurring every 2 to 3 minutes. You reexamine the patient and determine that her cervix is unchanged.

Which of the following is the best next step in the management of this patient?

a. Perform artificial rupture of membranes to initiate labor
b. Administer an epidural
c. Administer Pitocin to augment labor
d. Achieve cervical ripening with prostaglandin gel
e. Administer 10 mg intramuscular morphine


Question 33#Print Question

A 25-year-old G1P0 patient at 37 weeks presents to labor and delivery reporting gross rupture of membranes and painful uterine contractions. The tocometer shows contractions every 2 to 3 minutes, and the fetal heart tracing is category I. On cervical examination, she is 4-cm dilated and completely effaced with the presenting part at -3 station. The presenting part is soft and felt to be the fetal buttock. A bedside ultrasound reveals a breech presentation with both hips flexed and knees extended. The estimated weight of the fetus is approximately 6 lb.

Which of the following is the best method to achieve delivery?

a. Deliver the fetus vaginally by breech extraction
b. Deliver the baby vaginally after external cephalic version
c. Perform an emergent cesarean delivery
d. Perform an internal podalic version
e. Perform a forceps-assisted vaginal breech delivery


Question 34#Print Question

A 25-year-old G1P0 patient at 37 weeks presents to labor and delivery reporting gross rupture of membranes and painful uterine contractions. The tocometer shows contractions every 2 to 3 minutes, and the fetal heart tracing is category I. On cervical examination, she is 4-cm dilated and completely effaced with the presenting part at -3 station. The presenting part is soft and felt to be the fetal buttock. A bedside ultrasound reveals a breech presentation with both hips flexed and knees extended. The estimated weight of the fetus is approximately 6 lb.

What type of breech presentation is described?

a. Frank
b. Incomplete, single footling
c. Complete
d. Double footling




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