A-between 37 and 42 weeks from the last

menstrual period
B- Before 37 weeks gestation
C-After 42 weeks gestation
D- After 24 weeks gestation

ANSWER A
 Gravidity
› #of current and completed
pregnancies of any kind
 Parity
› # of completed pregnancies ≥ 20
weeks
› not delivered infants (e.g. twins)
 Nullipara
 Primipara
 Multipara
 Grand Multipara
T= Term deliveries ≥ 37 wks
P= Preterm deliveries < 37 wks
A= Abortions (< 20 wks)
L= Living children
› 3rd Pregnancy
› 1 Term delivery
› 0 Preterm deliveries
› 1 Abortion
› 1 Living child
› 5th Pregnancy
› 2 Term deliveries
› 1 Preterm delivery
› 1 Abortion
› 0 Living children
› 2nd Pregnancy
› 0 Term deliveries
› 2 Preterm deliveries
› 0 Abortions
› 3 Living children
A. – longitudinal axis of the fetus in relation to
the oblique axis of the maternal uterus
B. longitudinal axis of the fetus in relation to the
transverse axis of the maternal uterus
C. longitudinal axis of the fetus in relation to the
long axis of the maternal uterus
D. longitudinal axis of the fetus in relation to the
long axis of the maternal pelvis
ANSWER C
 Logitudinal transverse oblique
A. Relates to right or left side of maternal pelvis
B. presenting or is the closest in proximity to
the birthing canal
C. Ralated to long axis of mother
D. First enter the pelvic cavity
E. First felt by vaginal examination

ANSWER B
 The part of the fetus that is presenting or is the
closest in proximity to the birthing canal

 Vertex Breech
A. position is either cephalic or breech
B. attitude is either flexion ,OR deflexion
C. position is the relationship of a landmark on
the presenting part to the right or left side of
the pelvis
D. Position is either oblique lognitudinal or
treasverse
E .Attuide is landmark on presenting part that
determine position
ANSWER C
 ROA OA LOA

ROT LOT
ROP LOP
OP

•LOT: 40%
•ROT: 20%
•OP: 20%
?????
Left Occiput
Anterior
?????
 Right
Occiput
Posterior
?????
Left Occiput
Transverse
 The relationship of the fetal
presenting part to the level of the
ischial spines
A. Passage of bloody show
B. Occurance of uterine contraction
C. Excessive fetal movement
D. Cervical dilation and effacement
E. Gush of vaginal fluid
ANSWER D
 cervical change
 Effacemant :is shortening of the cervical canal
(from a length of 3 cm to a circular aperture.
› Progressive dilation and effacement
of cervix
› Descent of fetus
› Expulsion of fetus and placenta
A-Occur at regular intervals

B-Intervals get gradually smaller

C-Intensity increases

D-Pain felt in the back and abdomen

E-Pain stop with sedation

F-Cervix dilate
ANSWER E
A-Occur At Irregular Intervals
B-Intensity doesn't change
C-Pain primarily in lower abdomen
D-Pain usually relieved with sedation
E-Cervix dilate
ANSWER E
A-Relaxion after uterine contraction
B-Intensity of uterine contraction in upper and
lower segment
C-The myometrium of the upper uterine become
shorter after contraction
D- the pacemaker in the right cornu of the uterus
ANSWER C
A. 5-1-1: contractions approximately every 5
minutes lasting for 1 min for 1 hour
B. Sudden gush of fluid from the vagina or a
constant leakage/wetness
C. Vaginal bleeding(bloody show)

D.Decrease in fetal movement

(kick counts should be 10 kicks
in 2 hours)
E All of the above
ANSWER E
A. Dilation ,presention and effacment
B. Effacement ,station and position
C. Dilation ,effacment ,and station
D. Station ,dilation and descent
E. Presentation ,station ,and dilation
ANSWER C
 -3: 3 cm above the ischial spines
0: at the ischial spines, engaged
+3: 3 cm below the ischial spines
A. First stage of labor ends with delivery of fetus
B. Second stage of labor is divded into latent and
active phase
C. Third stage of labor lasts one hours
D.Third stage of labor begins immediately
after delivery of the infant and ends with
placental delivery
ANSWER D
A. Relfied by maternal position on left side
B. Compression of fetal head mediated by vagus
C. Caused by umbilical cord compression
D. Is not worrisome if non recurrent
E. Is mostly due to placental insufficancy
ANSWER E
A. Variability is the result of push pull of
sympathetic and para sympathetic
B. Acceleration is > 2 elevation of baslind FHR
above 25 pbm in 30 min period
C. Acceleration with absent variability is
reassuring trace
D. Moderate variability and lasck of accleration
is worrisome
ANSWER A
A. 50% or more of contraction
B. All of contraction
C. 25% or more of contraction
D. One out of tree contraction
ANSWER A
 A-engagement
B-flexion
C-descent
D-internal rotation
E-extension
F-Backword rotation
 ANSWER F
A-Gush of blood
B-Lengthening of umbilical cord
C-Rebound of the uterus
D-All of the above
ANSWER D
A-IV oxytocin after
delivery of ant shoulder.

B-Controlled cord traction

C- Suprapubic massage
D-Uterine massage

ANSWER C
A- Dilation and intensity of contraction
B-Dilation and effecmant
C-Dilation and descent
D,Frequancy of contraction and descent
E- All of the above

ANSWER C
 Part 2: ABNORMAL LABOUR
A-Hydroceplus
B- Occipto –anterior
C-Face presenation
D- Occipto –Posterior
E-Ovarian mass
F- Shoulder dystocia

Answer B
 A-1 hr if multi,2hrs if nulli ,add 1hrs if
epidural

 B-2 hrs if mulli,3 hrs if nulli ,add 1hrs if

epidural

 C-1.5 hr if multi ,2.5 hrs, add 1 hr if epidural

ANSWER A
 32 yo G1P0 36 weeks presented with
contractions. Looks uncomfortable, and is
contracting every 3 minutes but cervix is 2 cm
and 50% effaced. Was seen the previous day with
similar complaints and findings.

 Diagnosis:
› Prolonged latent phase

 Management:
› “Therapeutic Rest”
 24 yo P1001 39 weeks presented in labor.
Contracting every 3 minutes but looks
comfortable. Progressed from 4 to 6 centimeters
in 6 hours. Membranes intact. Estimated fetal
weight – 3000 grams. Pelvis adequate on
examination. Vertex presentation.

 Diagnosis:
Protracted active phase likely secondary to inadequate
labor (insufficient power)
 Management:
 Amniotomy, Oxytocin augmentation +/- IUPC
 32 yo P0000 Class C diabetic at 40 weeks
undergoing labor induction. Contracting every 2-
3 minutes. 7 cm dilation x 4 hours. Confirmed
adequate labor with intrauterine pressure
catheter. Membranes ruptured, Estimated fetal
weight – 4200 grams. Pelvis adequate on
examination. Vertex presentation.
 Diagnosis:
› Arrest of dilatation likely secondary to cephalopelvic
disproportion/fetal macrosomia (Passenger too big for
pelvis)
 Management:
 Cesarean Delivery
 28 yo P0101 at 42 weeks presented in labor. History
of previous MVA with pelvic fracture. Contracting
every 2-3 minutes. 6 cm dilation x 4 hours.
Confirmed adequate labor with intrauterine
pressure catheter. Membranes ruptured, Estimated
fetal weight – 3200 grams. Constricted pelvic inlet
with non-engaged fetal head. Vertex presentation.
 Diagnosis:
› Arrest of dilatation likely secondary to cephalopelvic
disproportion/abnormal pelvis (Pelvis too small for pelvis)
 Management:
 Cesarean Delivery
 A-Chorioamnionitis

 B-Uterine rupture

 C-Reassuring FHR trace

 D-Pelvic floor injury

ANSWER C
 A- Pinard manouverto deliver leg,rotate sacrum
anterior,wrap trunk in tawel,deliver arm when scapula
visible,downward pr on maxilla to deliver the head

 B- Pinard manouverto deliver leg,rotate sacrum

anterior,wrap trunk in tawel,deliver arm when scapula
visible,downward pr on mandible to deliver the head

 C- Pinard manouverto deliver leg,rotate sacrum

posterior,wrap trunk in tawel,deliver arm when scapula
visible,downward pr on mandible to deliver the head

 ANSWER B
A-ant hip has a more rapid decent than post hip
B- ant hip is beneath the symphysis pubis and
intertrochanteric diameter rotates around a 45
degree axis
C- if post hip is beneath the symphysis pubis it has
to go through 225 degree axis rotation
D-for sacrum ant or post position, the axis of
rotation is around 45 degrees
Ans: C
A- multiparity
B-placenta previa
C- presenting part engagement
D- CPD

Ans: A
A- This is a rare presentation above inlet
B-brow presentation most of the time changes to face
presentation
C- decent mechanism is completely different from
vertex presentation
D-delivery is possible if mentum appears beneath the
symphysis.
Ans:C
A-induction of labor
B- internal rotation to make mentum ant position
C- observation to allow spontaneous rotation
D- C/S

Ans:C
A-Forceps can be applied
B-manual rotation of the head can be done
C- manual rotation of the head can’t be done
D-there is no place for observation

Ans:D
• A-Ability to touch sacral promontory with index finger
•
B-Significant divergence of the pelvic side wall
•
C-Forward inclination of a straight sacrum
•
D-Sharp ischial spines with a narrow interspinous
• diameter
E -Narrow suprapubic arch
ANSWER B
•
 Obstetric: shortest anteroposterior diameter
of pelvis

 Diagonal: distance from the lower margin of

the symphysis to the promontory of the sacrum
and subtracting 1.5cm (you want diagonal
conjugate to be greater than 11.5cm)
 -normal female type male type
- inlet triangular or heart-shaped
 -Ape-like type
-Anteroposterior
diameters long,
 Transverse short,
 Sacrum long and narrow,
 Subpubic angle narrow

 All anteroposterior diameters are short,
 Transverse are long, subpubic angle is wide
A-Prolonged latent phase: question if false labor,
treat with observation and sedation if needed

B-Protraction disorder of active phase: augment

with amniotomy or oxytocin
C-Arrest disorder with adequate contractions: C-
section
D- All of the above
Answer D
• A-McRobert's Maneuver:sharply flex
maternal thigh
• B-Cut episiotomy if needed for more room
C. Fundal pressure
D-woods screw maneuver
E. Delivery of the posterior arm
ANSWER C
A-rotation of post. shoulder to deliver ant.
shoulder
B- abduction of shoulders
C- flex of mother’s knees and suprapubic
pressure
D- rotation and extraction of ant. shoulder
Ans:B
Woods screw=A
McRoberts m.=C
Zavanelli m.= repositioning of fetal head back
into the uterus and C/S
A-Maternal heart disease, pulmonary
compromise
B- prolonged first stage of labor,
C-maternal exhaustion
D- non-reassuring fetal heart rate pattern
ANSWER B

•
• A-inability to definitely determine position of
fetal vertex
B-fetus with presentation other than vertex or
face with chin anterior
C-fetus not engaged or above +2 station
D-CPD: inadequate pelvis, estimated fetal weight
>4000g
E-membranes ruptured or cervix fully dilated

F-fetus <34 weeks for vacuum delivery

• ANSWER C
A-1st degree: involve the forchette, perineal
skin and vaginal mucous membrane

B-2nd degree: the fascia and muscles of the

perineal body
C-3rd degree: involve the anal CANAL
D-4th degree: extends through the rectal
mucosa to expose the lumen of the rectum
• ANSWER C
•
Fourth-degree
Perineal tear
A- immediately
B-3 months later
C- 6 months later
D- 9 months later

Ans:A
Which of the following is appropriate device
A- LOW FORCEPS
B-MID FORCEPS
C- SOFT CUP VACCUM
D- PIPER FORCEPS
ANSWER A
This patient has a bishop score of
A- 4
B-5
C-6
D-8
ANSWER B
The most like explanation of deccleration is
A- Maternal position on left lateral side
B- Uterine hyperstimulation from cervical
ripening agent
C- Compression of the fetal head mediated by
vagus
D- Umbilical cord compression
ANSWER B
A- prior C-section or uterine scar
B- Face mento anterior
C- labor dystocia
D- Breech presentation<35 WKS
E- fetal distress
F- persistent mento posterior

• ANSWER B
•
THANK YOU