1. To*prevent*aspiration*during*anesthesia,*what* 3.

A*parturient*who*is*fully*dilated*with*head*at*
maneuver*is*applied?* station*+4*feels*9/10*pain*at*the*vaginal*are.*No*
a. SELLICK’S*** qualified*anesthetist*is*present.*Best*thing*to*
b. McRoberts* do?*
c. Thom’s* a. Observe*
d. Ritgen’s* b. Spinal*block*
c. PUDENDAL*BLOCK**
Immediately*after*a*patient*is*rendered*unconscious,* d. Saddle*block*
a* muscle* relaxant* is* given* to* aid* intubation.* Sellick*
* PUDENDAL* BLOCK* –* Every* obstetrician* should* be*
maneuver—is* applied* by* a* trained* assistant* to*
proficient* in* local% and% pudendal% analgesia* that*
occlude* the* esophagus* from* the* onset* of* induction* * may* be* administered* in* appropriately* selected*
until*intubation*is*completed.*ERT*
circumstances.*In*general,*however,*it*is*preferable*
*
McRoberts* cause* straightening* of* the* sacrum* for* an* anesthesiologist* or* anesthetist* to* provide*
relative* * pain* relief* so* that* the* obstetrician* can* focus*
to* the* lumbar* vertebrae,* rotation* of* the* symphysis* attention*on*the*laboring*woman*and*her*fetus.*
pubis* *
toward* the* maternal* head,* and* a* decrease* in* the*
angle*of*pelvic*inclination* *
*
Ritgen*maneuver,*gloved*fingers*beneath* 4. To*mitigate*risk*in*case*of*aspiration,*which*
a* draped* towel* exert* forward* pressure* on* the* fetal* should*be*given*shortly*before*anesthesia*
chin*through* induction?*
the*perineum*just*in*front*of*the*coccyx* a. ANTACIDS**
*
b. Antibiotics*
*
c. Analgesic*
* d. Antipyretics*

2. A*parturient*is*more*than*5*cms*dilated*and* *
ANTACIDS*`*Administered*shortly*before*induction*
feels*pain*at*the*infraumbilical*area*8/10*in*
*
of*anesthesia;*Sodium*citrate*with*citric*acid*
severity,*Best*management?*
*
(Bacitra)*30mL%given%45%minutes*before*surgery*
a. Paracervical*block*
b. EPIDURAL*BLOCK* *
c. Spinal*block*
d. Pudendal*block* 5. A*parturient*is*given*combined*spinal*and*
epidural*anesthesia.*Seconds*later*she*had*
* seizures.*What*is*the*most*likely*reason*for*this?*
EPIDURAL*BLOCK*`*considering*the*pt*is*already*on* a. SPINAL*ANESTHESIA***
*
active*labor** b. Epidural*anesthesia*
* c. Both*
Rapid*onset*of*pain*relief* d. None*of*the*above*
* *Decrease*in*shivering*
Less*dense*motor*blockade* *
* * Leakage* of* cerebrospinal* fluid* (CSF)* from* the*
*
meningeal* puncture* site* can* lead* to* CSF*
* and* the* pain* is* in* the* INFRAUMBILICAL* area* ``EB*
T10`S5* * hypotension,* the* diminished* CSF* volume* creates*
* traction* on* pain`sensitive* central* nervous* system*
* structures.**
 6. The*following*patients*require*prompt* 8. Non*pharmacological*method*of*pain*control*
anesthesia*consultation* that*helps*increase*beta*endorphins*in*the*
a. Primigravid*who*is*markedly*obese* peripheral*blood*
b. Multigravid*with*a*history*of*spinal*cord* a. Lamaze**
injury* b. CLINICAL*HYPNOSIS**
c. Primigravid*with*severe*preeclampsia* c. Acupuncture*
d. ALL*OF*THE*ABOVE* d. Deep*breathing*

* Maternal*Factors*That*May*Prompt* * LAMAZE* `* relaxed* breathing* and* their* labor*

Anesthetic*Consultation*
* ! Morbid*obesity* * partners* psychological* support* techniques.* The*
! Severe*edema*or*anatomical*abnormalities* presence* of* a* supportive* spouse* or* other* family*
* of*the*face,neck,*or*spine,*including*trauma* * member.*
or*surgery*
*
! Abnormal*dentition,*small*mandible,*or* * CLINICAL* HYPNOSIS* `* power* of* the* mind* to* heal*
difficulty*openingthe*mouth*
* the* body;* increases* of* beta* endorphins* in* the*
! Extremely*short*stature,*short*neck,*or*neck* *
* peripheral*blood*
arthritis*
*
! Goiter* *
*
! Serious*maternal*medical*problems,*such*as*
* 9. Which*of*the*ff*should*be*done*to*decrease*
cardiac,pulmonary,*or*neurological*disease*
*
! Bleeding*disorders* morbidity*from*obstetric*anesthesia?*
*
! Severe*preeclampsia* a. Fasting*for*atleast*8*hours*
! Prior*anesthetic*complications*
* b. Giving*anti*emetic*
! Obstetrical*complications*likely*to*lead*to*
* c. Pre*anesthetic*fluid*hydration*
operativedelivery—examples*include*
* d. ALL*OF*THE*ABOVE*
placenta*previa,*pretermbreech*
*
presentation,*or*higher`order*multifetal* *
*
gestation* Massive* gastric* acidic* inhalation* may* cause*
* * pulmonary* insufficiency* from* aspiration*
7. Which*of*the*ff*is*TRUE*of*intravenous* pneumonitis.* Such* pneumonitis* has* in* the* past*
sedatives?* * been*the*most*common*cause*of*anesthetic*deaths*
a. Cause*of*prolongation*of*labor* in* obstetrics* and* therefore* deserves* special*
*
b. Safer*than*regional*anesthesia* attention.*To*minimize*this*risk,*antacids*should*be*
c. Equally*efficacious*with*regional*analgesia* * given*routinely.*
in*providing**
pain*relief* * Recommendations* are* that* modest* amounts* of*
clear* liquids* such* as* water,* clear* tea,* black* coffee,*
d. READILY*CROSS*THE*PLACENTA*
Inhalational% agents*and* most* intravenous* agents* * carbonated*beverages,*and*pulp`free*fruit*juices*be*
allowed* in* uncomplicated* laboring* women.*
* freely* cross* the* placenta;* however,* inhalational*
agents*cause*little*fetal*depression*.* * Obvious*solid*foods*should*be*avoided.**
* * *
Intravenous% agents*readily* cross* the* placenta* and* * A*fasting* period*of*6*to*8*hours,* depending*on*the*
* can*be*detected*in*the*fetal*circulation.** type* of* food* ingested,* is* recommended* for*
* uncomplicated* parturients* undergoing* elective*
*
* Muscle% Relaxants%are*highly*ionized*which*impedes* cesarean*deliveryor*puerperal*tubal*ligation.*
*
placental* transfer,* resulting* in* minimal* effects* on*
* the*fetus.*
*
*
* Local% anesthetics*are* weakly* basic* drugs* that* are*
*
principally* bound* to* 1`acid* glycoprotein.* Highly*
*
protein`bound* agents* diffuse* poorly* across* the* *
*

10. This*is*a*universal*neonatal*complication*of*
narcotic*sedatives*
a. Hypoglycaemia*
b. RESPIRATORY*DEPRESSION*
c. Shivering*
d. Hypotension*

*
My one & only tip for BONY PELVIS is to recall your anatomy. ! I know kinda hard to adapt kasi
wala namang cadaver na lalaki sa gross lab lol.
For easy points: memorize NORMAL values ng conjugates & diameters. Definitions na rin ng TC,
OC, DC, etc. -MERB 2A

11. The bones that make up the female bony pelvis are joined to the sacrum by the:
A. Symphysis pubis
B. Sacroiliac synchondrosis
C. Sacroccygeal joints
D. Pubic joints

Picture: (need I say more, LOL)

12. What anatomical structure separates the true pelvis from the false pelvis?
A. Linea terminalis
B. Interischial diameter
C. Intertuberous diameter
D. Greater transverse diameter of the inlet
13. If the pelvic cavity is obliquely truncated like a bent cylinder, which statement is correct?
A. The length of the posterior wall is shorter than the anterior wall
B. The length of the anterior wall is shorter than the posterior wall
C. Anterior and posterior wall are of the same length

Diretsong nakuha sa trans (Physio OB 2015-2016) : if the cavity is OBLIQUELY TRUNCATED,

bent cylinder with anterior wall measuring 5cm and posterior wall is about 10cm. (Nasa ppt din yan
slide number 4)
Picture plzzzz:

14. The AP diameter of the pelvic inlet is BEST indicated by this measurement:
A. Diagonal conjugate
B. True conjugate
C. Obstetric conjugate
D. Shape of the pelvic inlet

OC is the midposition of the symphysis pubis to promontory of the sacrum. It measures 10cm or
more. And is the SHORTEST AP diameter of the inlet, so it being the shortest, this is the 'minimum'
diameter that needs to be passed through by the fetal head. Thus, being the best indicator of the
AP diameter of the pelvic inlet. :)

15. Clinically, to measure the obstetric conjugate, you have to deduct from the diagonal conjugate
this measurement:
A. 1-1.2cm
B. 1.5-2cm
C. 2.2-2.5 cm
D. 2.6-3cm

OC is estimated by SUBTRACTING 1.5 to 2 cm from the diagonal conjugate.

16. A primigravida in early labor for a full term fetus in cephalic presentation had a measurement of
11cm from the midposition of the symphysis pubis to the promontory of the sacrum. Is her pelvic
inlet adequate?
A. Yes
B. No

Always remember the definitions ng mga conjugates, like this one, hindi sinabi directly na
OBSTETRICAL CONJUGATE lang pala yung midposition of symphysis pubis to sacral
promontory. Do not take a leap of faith and just choose yes or no. Pag-isipan! "

Diagnonal conjugate: lower margin of the symphysis pubis to sacral promontory

True conjugate: superior portion of the symphysis pubis to sacral promontory
Do you remember? Normal value for OC is 10 cm or more. Thus, 11 cm OC for this primigravida is
ADEQUATE.

17. A primigravida in her second stage of labor had an occiput transverse presentation station +1
for 3 hours. On examination, she has prominent ischial spines, convergent side walls, and straight
sacrum. Where is the cephalopelvic disproportion?
A. Pelvic inlet
B. Pelvic midplane
C. Pelvic outlet
D. No cephalopelvic disproportion

Remember the Caldwell and Moloy Classification?

Midpelvis (plane of least pelvic dimensions) includes the sacrum, sacrosciatic notch, and side
walls.
I guess it helps to know the boundaries ng inlet, outlet, and midpelvis so you can 'imagine'
anatomically.

18. On clinical pelvimetry, the distance between the 2 ischial tuberosities was 11cm and the
posterior sagittal of the outlet was 8 cm. is the pelvic outlet adequate?
A. Yes
B. No

Normal value for IT is 11cm and PSO's NV is 7.5cm. So....ADEQUATE yung sa patient, may 0.5cm
pa nga syang buffer sa PSO eh.
19. What represents the shortest diameter of the pelvic cavity?
A. Obstetric conjugate (NV is 10 cm or more)
B. True conjugate (NV 11cm)
C. Interspinous diameter
D. Intertuberous diameter (NV is 11cm)

Interspinous diameter (IS) is between 2 ischial spines. Measures 10cm (compare the values I
placed above)
Supporting detail, Proof from the ppt (naka-orange pa): smallest meaning SHORTEST.

20. Which of the following pelvic diameter measurements is NORMAL?

A. Greatest transverse diameter of the inlet 12cm (NV is 13.5cm)
B. Anteroposterior diameter of the midplane 11cm
C. Interspinous diameter 10cm
D. Posterior sagittal diameter of the outlet 4.5cm (NV is greater than or equal to 7.5cm)

Yup! Normal ang IS diba? See previous question for NV.

21. What type of pelvis is oval anteroposteriorly has increased anterior and posterior segments,
straight or divergent sidewalls, long and curved pubic arch and slightly narrow subpubic angle?
A. Gynecoid
B. Anthropoid
C. Android
D. Platypeloid

Just recall Caldwell and Moloy above. Minsan wala kang ibang choice kung di i-memorize...by
heart. Haha!

22. Clinical pelvimetry of a px in labor revealed that the sacral promontory could not be reached at
11.5cm, sidewalls straight, ischial spines not prominent, sacrum well curved, sacrosciatic notch
wide and shallow and subpubic angle 85%. What is your assessment of the pelvis?
A. Clinically adequate
B. Contracted

When I answered this during the exam, first clue ko na yung SACRAL PROMONTORY COULD
NOT BE REACHED AT 11.5cm, therefore DC is >11.5cm, it is justifiable to assume that the pelvic
inlet is ADEQUATE.

Hey, ang minemeasure ng mga obstetricians ay DC bec DC is the LOWER margin of the
symphysis pubis to the sacral promontory.
You cannot lay a finger on the OC (MIDposition of SP to sacral promontory) nor TC (SUPERIOR
portion of SP to sacral promontory), hehe.
TC: subtract 1.2cm from DC to get TC.
OC: subtract 1.5-cm from DC.
(Well, I could not forget this bec pinag-recite ako sa class, from that day forward, I could not forget
it parang first heartbreak. Hehehehe)

Ischial spines not prominent- adequate! (What caldwell and moloy classif?!)
Sacrum well curved- #berigudmamser (seems to me na gynecoid si mudra---check table!)
Sacrosciatic notch wide and shallow- #berigudmamser pa rin (diba parang gynecoid?)
Subpubic angle 85%- adequate (confirmed GYNECOID si mama!)

So if gynecoid si mama, berigud talaga! Hehehe

23. Internal examination of a nulliparous woman in active labor revealed the most dependent
portion of the head to be at station 0. What does this mean?
A. The head is engaged
B. The inlet is adequate
C. The midplane is contracted
D. A&B

Without a doubt, once the head reaches STATION 0 , to be specific the head's biparietal diameter
(or the widest transverse diameter of fetal's head) , it is safe to assume that fetal head is
ENGAGED, therefore inlet is ADEQUATE. Engagement is the decent of the biparietal plane of the
fetal head to a level BELOW that of a pelvic inlet. The widest part must be engaged to a level
below pelvic inlet para masabing engaged.

24. A parturient consulted because of watery vaginal discharge of 5 hours. FHTs 140s with irregular
uterine contractions appreciated, mild in character. IE: cervix 1cm dilated, beginning effacement,
ruptured bug of waters, cephalic fetal head is floating. What plane of the pelvis is most likely
contracted?
A. Inlet
B. Midplane
C. Outlet

MY clue (sorry this part ain't so definite bec I just eliminated choices): On IE cervix is 1cm dilated
(this gives me a clue na wala pa for sure sa outlet) & cephalic fetal head is floating. Well, fetal head
cannot 'float' per se sa midplane bec plane of least pelvic dimension, baka engaged (see num 23
for definition of engaged) Lalo namang hindi pa sya aabot sa outlet bec wala pa nga sa midplane
eh.
FHT 140s with irregular uterine contractions, mild in character---another clue!
Beginning effacement or simply put as thinning of cervix---yup, a clue!

In a NORMAL PELVIS, the last 3 sacral vertebrae can be felt without indenting the perineum
In a CONTRACTED PELVIS, the entire anterior surface is palpable.

25. Thom's rule for the outlet states that the outlet is adequate if the sum of the intertuberous
diameter and the posterior sagittal diameter of the outlet (PSO) is this value, provided that the IT is
at least 8cm.
A. >12cm
B. >13cm
C. >14cm
D. >15cm

IT is intertuberous diameter which is defined as 2 ischial tuberosities (11cm)

PSO is the tip of the sacrum and the line created by the intertuberous diameter (7.5cm)
Thom's rule is transverse diameter + PSO (clinical x-ray), if >15cm then bony outlet is adequate.
RATIO: 26-40 | Physio OB Finals 1st sem 2015 Ratio

IDENTIFY THE PHASE OF PARTURITION IN THE FOLLOWING:

A. Stimulation (Phase 2)
B. Quiescence (Phase 1)
C. Involution (Phase 4)
D. Activation (Phase 3)

26. A 33 y/o G1P1 is currently breastfeeding her one day old infant in the hospital’s breastfeeding room.
C. Involution (Phase 4)
one day - post partum
Immediately and for about an hour or so after delivery
Uterine involution and cervical repair, both remodeling processes that restore these organs to
the nonpregnant state
27. A 22y/o G2P1 (1001) consulting the OPD at 18 weeks gestation for congenital anomaly scan by UTZ.
B. Quiescence (Phase 1)
Myometrial unresponsiveness of phase 1 continues until near the end of pregnancy.
28. A 27 y/o G1P0 37 weeks gestation mentions during her prenatal visit that she felt the baby “dropped”
and descended, causing pressure in her inguinal area.
A. Stimulation (Phase 2)
Uterine awakening or activation
Changes during the last 6 – 8 weeks of labor
The abdomen commonly undergoes a shape change, sometimes described by women as “the
baby dropped.”
29. A 39y/o G4P3 (3003) 38 weeks gestation is currently fully dilated cervix is actively pushing during
contraction.
D. Activation (Phase 3) Patient is already at 2nd stage of labor.

TIPS:
Know the events for every phase.
Look for key words.

Mandapat, 2A
Identify the stage/phase of labor of the following:

A. First stage, latent phase

B. First stage, active phase
C. First stage, deceleration phase
D. Second stage
E. Third stage

30. A 32 y/o G3P2 (2002) who was delivered a live term infant, and is currently showing signs of placental
separation.
Answer: E. THIRD STAGE OF LABOR: DELIVERY OF PLACENTA AND MEMBRANES - Begins immediately
after fetal delivery and involves separation and expulsion of the placenta and membranes

A 19 y/o G1P0 39 weeks, cervix 2cm dilated, 70% effaced,cephalic, station (-1), intact bag of water;
uterine contractions every 10-12 minutes, mild to moderate.
Answer: A. First stage, latent phase
31. A 29 y/o G2P1 (1001) 38 weeks, cervix fully dilated and effaced, station +2, uterine contraction every
2-3 minutes, 50 secs duration, strong.
Answer: D. Second Stage - starts from fully dilated cervix to expulsion of baby
32. A 23 y/o G3P2 (2002) 37 weeks, cervix 6 cm dilated, 90% effaced, cephalic station (-1 statin)
raptured bag of water; uterine contraction every 5-6 minutes, moderate.
Answer: B. First stage, active phase

RATIO for 31 & 33

In the latent phase, the contractions become more frequent, stronger, and gain regularity, and most of
the change of the cervix involves thinning, or effacement. The latent phase is the most variable from
woman to woman, and from labor to labor. It may take a few days, or be as short as a few hours. We
typically expect the latent phase to be 10 to 12 hours for a woman who has had children. For first
pregnancies, it may last closer to 20 hours. For many women, the latent phase of labor can be confused

Mandapat, 2A
with Braxton Hicks contractions. Membranes may spontaneously rupture in the early- to mid-portion of
the first stage of labor. If they rupture, the labor process usually speeds up.
The next portion of the first stage of labor is the active phase, which is the phase of the most
rapid cervical dilatation. For most women this is from 3 to 4 centimeters of dilatation until 8 to 9
centimeters of dilatation. The active phase is the most predictable, lasting an average of five hours in
first-time mothers and two hours in mothers who have birthed before.
Finally, there is the deceleration phase, during which the cervical dilation continues, but at a
slower pace, until full dilation. In some women the deceleration phase is not really noticeable,
blending into the active phase. This is also a phase of more rapid descent, when the baby is passing
lower into the pelvis and deeper into the birth canal. The deceleration phase is also called transition,
and, in mothers with no anesthesia, it’s often punctuated by vomiting and uncontrollable shaking.
These symptoms can be frightening to watch, but they’re a part of normal birth, and they signal that
the first state is almost completed.
Reference: http://pennmedicine.adam.com/content.aspx?productId=14&pid=14&gid=000126
TIPS
Know the events for every stage.
Look for keywords.

Identify the stage/phase of labor in Friedman’s curve:

A. First stage, latent phase

B. First stage, active phase
C. First stage, deceleration phase
D. First stage, maximum slope of dilation
E. Second stage

37. A 36. B 35. D 34. E

Mandapat, 2A
38. Which of the following is/are TRUE of Braxton Hicks Contractions?
A. Earliest Sign of labor
B. Pathologic if seen in phase 1 of parturition
C. Benign myometrial contractions
D. All of the above
E. A and B only
RATIO: BRAXTON HICKS CONTRACTIONS OR FALSE LABOR
Some low-intensity myometrial contractions
Felt during the quiescent phase
Do not normally cause cervical dilatation
More common toward the end of pregnancy, especially in multiparous Women
This is physiologic during Phase 1
Not an earliest sign of labor.

39. Mrs Chloe came back with her UTZ result as follows: single live intrauterine pregnancy, 24 weeks
AOG, appropriate for gestational age. Good somatic activity. Adequate amniotic fluid. No adnexal mass.
Cervix 1cm long. Which of the following is the BEST advice for her?
A. Her pregnancy is okay. Come back for next check up after 4 weeks.
B. She is at risk for preterm labor.
C. She is in preterm labor.
D. She has an incompetent cervix
RATIO: Patient is only at her 24th weeks AOG, but her cervix is already at 1cm long which is already 50%
effaced. Normally cervix should be 2cm long until labor arise. Therefore the patient is at RISK of preterm
labor. She is not in preterm labor because there’s no any signs of labor yet. If you have an incompetent
cervix, you might not experience any signs or symptoms as your cervix begins to open during early
pregnancy. Mild discomfort or spotting over the course of several days or weeks is possible, however,
starting between 14 and 20 weeks of pregnancy. Be on the lookout for:
A sensation of pelvic pressure
A backache
Mild abdominal cramps
A change in vaginal discharge
Light vaginal bleeding

40. Cervical ripening is mainly due to:

A. Increase in muscle tissue
B. Alteration of proteoglycans and glycosaminoglycans
C. Elongation of fibroblast
D. All of the above
E. A and C only
RATIO: Glycosaminoglycans (HYALURONAN) hyaluronan synthase isoenzymes - Expression of these
enzymes is increased in the cervix during ripening; Proteoglycans Changes in the amount of core protein
or in the number, length, or degree of sulfation of GAG chains can influence proteoglycan function.

PS: For corrections and questions feel free to PM me. Good Luck and God Bless Doctors! :)

Mandapat, 2A
41. What is second stage of labor?
A. Regular uterine contractions to 4 cms cervical dilatation
B. 4 cms dilatation to full cervical dilatation
C. Full cervical dilatation to delivery of the foetus
D. Full cervical dilatation to delivery of placenta

Answer:
C. Full cervical dilatation to delivery of the fetus

First stage of labor: Regular uterine contractions—> Full cervical dilatation and effacement
Second stage of labor: Full cervical dilatation (10 cm)—> Delivery of fetus
Third stage of labor: Delivery of fetus—> Delivery of the placenta

Wrong answers:

A Regular uterine contractions to 4 cms cervical dilatation 1st phase (latent), 1st stage

B 4 cms dilatation to full cervical dilatation 1st phase (active), 1st stage

D Full cervical dilatation to delivery of placenta 2nd stage to 3rd stage

42. Which of the following statements is TRUE of Ferguson reflex?

A. Mechanical stretching of the cervix enhances uterine activity
B. Stripping increased oxytocin receptors
C. Stripping of fetal membranes releases prostaglandin metabolites
D. All of the above
E. A and C only

Answer:
A. Mechanical stretching of the cervix enhances uterine activity
Ferguson Reflex (William’s): Mechanical stretching of the cervix enhances uterine activity in several
species, including humans. Exact mechanism is not clear, release of oxytocin has been suggested but
not proven. Manipulation of the cervix and “stripping” the fetal membranes is associated with an
increase in blood levels of prostaglandin F2a metabolites.

*Based on the answer key the answer is A, but based on William’s its A and C. I’m not sure if this was
corrected.
43. Which of the following describes the Duncan mechanism of placental separation
A. Retroplacental hematoma forms and pushes the center
B. Blood collects between the membranes and the uterine wall and escapes from the vagina
C. Glistening amnion, covering the placental surface, presents at the vulva
D. Retroplacental hematoma follows the placenta

Answer:
B. Blood collects between the membranes and the uterine wall and escapes from the vagina

From William’s:
Duncan mechanism of separation of placenta:
- placenta separates first at the periphery
- blood collects between the membranes and the uterine wall and escapes from the vagina
- Placenta descends sideways
- Maternal surface appears first

Schultze mechanism:
- retroplacental hematoma either follows the placenta or is found within the inverted sac formed by
the membranes
- Blood from placental site pours into the membrane sac and does not escape externally until
extrusion of placenta

Wrong answers:

A Retroplacental hematoma forms and pushes Duncan separates from the periphery first
the center
C Glistening amnion, covering the placental The placenta descends sideways in Duncan
surface, presents at the vulva mechanism

D Retroplacental hematoma follows the Schultze mechanism

placenta

44. How is postpartum hemorrhage prevented in the phase 4 of parturition?

A. Maintain myometrium in a stage of rigid and persistent contraction and retraction
B. Promote closure of the cervical opening to prevent blood loss
C. Manual extraction of the placenta
D. All of the above
E. A and C only

Answer: A. Maintain myometrium in a stage of rigid and persistent contraction and retraction
- Physiological or expectant management involves waiting for placental separation signs and
allowing the placenta to deliver either spontaneously or aided by nipple stimulation or gravity
(World Health Organization, 2012). In contrast, active management of third-stage labor consists of
early cord clamp- ing, controlled cord traction during placental delivery, and immediate
administration of prophylactic uterotonics. The goal of this triad is to limit postpartum hemorrhage
45. Phase 4 Parturition lasts for:
A. An hour after delivery of the baby
B. An hour after the delivery of the placenta
C. 2 weeks after labor and delivery
D. 4-6 weeks after labor and delivery

Answer: D. 4-6 weeks after labor and delivery

Phase 4 (William’s): puerperium- time following delivery during which pregnancy-induced maternal
anatomical and physiological changes return to the non pregnant state. Considered to be between 4-6
weeks

46. Which group of agents is theorised to initiate phase 3 of parturition?

A. Uterotonics
B. Sex steroids
C. Betemimetics
D. Calcium channel blockers

Answer: A. Uterotonics
Phase 3: Uterine stimulation
- synonymous with uterine contractions that bring about progressive cervical dilatation and delivery.
Current data favour the uterotonin theory of labor initiation.
- Uterotonins that are candidates for labor induction include oxytocin, prostaglandins, serotonin,
histamine, PAF, angiotensin II, and many others. All have been shown to stimulate smooth muscle
contraction through G-protein coupling.

47. Which of the following is a primary regulator of oxytocin receptor expression?

A. Calcium
B. Progesterone
C. Prostaglandin dehydrogenase
D. Corticotropin- releasing hormone

Answer: B. Progesterone
- Still controversial whether oxytocin role in early phases of uterine activation, or if sole function is in
expulsive phase
- Progesterone and estradiol primary regulators of expression

48. Which of the following is the main contributor to CRH levels in pregnancy?
A. Placenta
B. Fetal adrenal
C. Fetal hypothalamus
D. Maternal hypothalamus

Answer: A. Placenta
- CRH is synthesised in the placenta and hypothalamus
- CRH plasma levels increase dramatically during the final 6-8 weeks of normal pregnancy and have
been implicated in the mechanisms controlling the timing of human parturition
49. On ultrasound, the baby was noted to have an absent frontal calvarium. Which of the following
abnormalities of parturition has been associated with this finding?
A. Preterm labor
B. Prolonged gestation
C. Uterine tachysystole
D. All of the above

Answer: B. Prolonged gestation

Association between fetal anencephaly and prolonged human gestation was observed.
Anencephalic fetus that was prolonged to 374 days—53 weeks.
He concluded that the association between anencephaly and prolonged gestation was attributable to
anomalous fetal brain-pituitary-adrenal function. The adrenal glands of the anencephalic fetus are very
small and, at term, may be only 5 to 10 percent as large as those of a normal fetus.

50. Which of the following tissues contributes to the increasing levels of prostaglandins during phase 3
parturition?
A. Amnion
B. Decidua
C. Chorion
D. All of the above

Answer: D. All of the above

51. A G1P0 term complains of hypogastric pain and bloody show. The cervix is 5 cms dilated. Which of
the following are plausible causes of the complaint of the patient?
A. Myometrial hypoxia
B. Uterine peritoneum stretching
C. Compressed vein ganglia in cervix
D. A and B only
E. B and C only

Answer: D: A and B only

Uterine labor contractions posible causes:
1. hypoxia of the contracted myometrium— such as that with angina pectoris
2. compression of nerve ganglia in the cervix and lower uterus by contracted interlocking muscle
bundles
3. Cervical stretching during dilatation
4. Stretching of the peritoneum overlong the fundus

52. Which of the following is/are true about the longitudinal lie?
A. It is present in about 50% of labor at term
B. It is unstable and can convert to transverse or oblique lie
C. The long axis of the foetus lies parallel to that of the mother.
D. All of the above

Answer: C. The long axis of the fetus lies parallel to that of the
mother
A longitudinal lie is present in more than 99% of labor at term.
 Wrong answers:

A It is present in about 50% of labor at term It is 99% of labor at term

B It is unstable and can convert to transverse Oblique lie is unstable and becomes longitudinal
or oblique lie or transverse during labor

53. A 20-year old primigravida on her 38th week of gestation is in labor, with a 7 cm dilated, almost
fully effaced cervix, ruptured bag of waters, cephalic, with the anterior fontanel lowermost in the birth
canal. What is this type of presentation?
A. face
B. sinciput
C. brow
D. vertex

Answer: B. Sinciput- Fetal head may assume a position between the extremes (face and vertex),
partially flexed in some cases, with the anterior (large) fontanel aka bregma

Wrong answers:

A face Fetal neck may be sharply extended so that the occiput and back may come in contact

C brow Partially extended

D vertex Aka occiput, posterior fontanel (lambdoid) is the presenting part

54. Predisposing factors to transverse lie include the following, EXCEPT:

A. Nulliparity
B. Placenta previa
C. Hydramnios
D. Uterine anomalies
Answer: A. nulliparity
Predisposing factors for transverse fetal position include multiparty, placenta prevue, hydramnios, and
uterine anomalies

55. How is the third Leopold’s manoeuvre performed?

A. The tips of the fingers of both hands are placed on each side of the lower maternal abdomen and
deep pressure is exerted
B. By grasping with thumb and fingers of one hand the lower portion of the maternal abdomen
C. With the tips of the first three fingers of each hand, deep pressure is made in the direction of the
axis of the pelvic inlet
D. All of the above

Answer: B. By grasping with thumb and fingers of one hand the lower portion of the maternal
abdomen

First maneuver permits identification of which fetal pole—that is, cephalic or podalic—occupies the
uterine fundus. The breech gives the sensation of a large, nodular mass, whereas the head feels hard
and round and is more mobile and ballottable.

Second maneuver is accomplished as the palms are placed on either side of the maternal abdomen,
and gentle but deep pressure is exerted. On one side, a hard, resistant structure is felt—the back. On
the other, numerous small, irregular, mobile parts are felt—the fetal extremities. By noting whether the
back is directed anteriorly, transversely, or posteriorly, fetal orientation can be determined.

The third maneuver is performed by grasping with

the thumb and fingers of one hand the lower portion
of the maternal abdomen just above the symphysis
pubis. If the presenting part is not engaged, a
movable mass will be felt, usually the head. The
differentiation between head and breech is made as
in the first maneuver. If the presenting part is deeply
engaged, however, the findings from this maneuver
are simply indicative that the lower fetal pole is in the
pelvis, and details are then defined by the fourth
maneuver.

Fourth maneuver, the examiner faces the mother’s

feet and, with the tips of the first three fingers of
each hand, exerts deep pressure in the direction of
the axis of the pelvic inlet. In many instances, when
the head has descended into the pelvis, the anterior
shoulder may be differentiated readily by the third
maneuver.
56.$With$full$flexion,$what$fetal$head$diameter$navigates$the$planes$of$the$pelvis?$
$ A.$occipitofrontal$
$ B.$suboccipitobregmatic$
$ C.$mentooccipital$
$ D.$biparietal$
$
• On$full$flexion,$the$chin$is$brought$into$more$intimate$contact$with$the$fetal$
thorax.$At$this$point,$the$most$important$diameter$is$suboccipitobregmatic,$
the$diameter$of$the$fetal$head$from$the$lowest$posterior$point$of$the$occipital$
bone$to$the$center$of$the$anterior$fontanelle.$
$
57.$A$26$year$old$primigravida$in$labor$was$admitted$with$a$5$cm$dilated,$80%$
effaced$cervix,$BOW$(+),$cephalic,$station$(K)1.$After$5$hours$the$cervix$became$10$
cm$dilated$and$the$bag$of$waters$(BOW)$ruptured$spontaneously,$with$the$head$now$
at$station$0.$Three$hours$later,$the$head$was$still$at$station$0.$Which$part$of$labor$
here$was$prolonged?$
$ A.$the$latent$phase$
$ B.$the$phase$of$maximum$slope$
$ C.$the$decceleration$phase$
$ D.$the$second$stage$of$labor$
$
• 1st$stage$of$labor$–$regular$contractions$up$to$cervix$10$cm$dilated$(DONE)$
2nd$stage$of$labor–$cervix$10$cm$dilated$up$to$delivery$of$baby$
(HALTED/PROLONGED)$
$
58.$What$is$the$clinical$significance$of$the$phase$of$maximum$slope$of$the$first$stage$
of$labor?$
$ A.$predictive$of$the$outcome$of$labor$
$ B.$denotes$the$overall$efficiency$of$the$uterine$expulsive$forces$
C.$reflective$of$fetopelvic$relationship$
D.$All$of$the$above$
$
• A$–$refers$to$acceleration$phase$
B$–$refers$to$phase$of$maximum$slope$
C$–$refers$to$decceleration$phase$
$
59.$Which$of$the$cardinal$movements$of$labor$is$responsible$for$the$smaller$
presenting$diameter$of$the$fetal$head?$
$ A.$engagement$
$ B.$descent$
$ C.$flexion$–$9.5$cm,$suboccipitobregmatic$
$ D.$internal$rotation$
$
60.$When$engagement$has$occurred,$which$of$the$following$has$been$accomplished?$
$ A.$The$biparietal$plane$has$passed$the$inlet$
$ B.$The$most$dependent$portion$of$the$fetal$head$is$at$the$level$of$the$inlet$
$ C.$The$fetal$head$is$just$entering$the$true$pelvis$
$ D.$The$cephalic$prominence$cannot$be$determined$on$L4$maneuver$
$
• Fetal$engagement$refers$to$the$passing$of$the$greatest$transverse$dameter$of$
the$fetal$head,$biparietal$diameter,$throught$the$pelvic$inlet.$$
$
61.$Which$of$the$following$will$signify$internal$rotation?$
$ A.$Extension$of$the$head$on$passing$the$pelvic$curvature$
$ B.$Changing$from$left$occiput$transverse$to$direct$occiput$anterior$
$ C.$Passing$from$Station$K1$to$+2$
$ D.$Tilting$of$the$sagittal$suture$towards$the$sacrum$
$
• Internal$rotation$meaning$paloob.$So$kung$ano$yung$nasa$bandang$outer$part$
will$displace$internally.$Left$occiput$trasverse$refers$to$a$position$where$in$
baby’s$occiput$is$located$on$the$left$side$of$the$pelvis.$When$there$is$internal$
rotation,$occiput$will$be$displaced$internally,$meaning$it$will$displace$
towards$the$center$and$anteriorly,$thus$direct$occiput$anterior.$
$
62.$After$external$rotation,$what$is$the$next$step$to$deliver$the$anterior$shoulder?$
$ A.$Pull$the$baby$up$
$ B.$Pull$the$baby$sideways$
$ C.$Pull$the$baby$down$
$ D.$Pull$the$baby$up$diagonally$
$
• Gentle$downward$traction$to$effect$descent$of$the$anterior$shoulder.$
$
63.$When$the$sagittal$suture$is$closer$to$the$symphysis$pubis,$what$is$the$condition?$
$ A.$Anterior$asynclitism$
$ B.$Posterior$asynclitism$
$ C.$No$asynclitism$
$
• Anterior$–$sAcral$
Posterior$–$symPhysis$
Remember$nalang$:)))$
$
64.$In$cases$of$extreme$asynclitism,$what$is$the$likely$management?$
$ A.$Expectant$
$ B.$Assisted$vaginal$delivery$
$ C.$Not$significant.$Ignore$
$ D.$Cesarean$section$K$to$avoid$creating$more$pain$to$the$mother$and$further$
harm$to$the$fetus$
$
65.$What$is$the$portion$of$the$head$develops$caput$succedaneum?$
$ A.$Area$adjacent$to$the$ischial$spines$
$ B.$Area$beneath$the$symphysis$pubis$
$ C.$Area$above$the$cervical$os$
$ D.$Are$adjacent$to$the$sacral$promontory$
$
• Caput$succedaneum$is$a$neonatal$condition$involving$fluid$collection$caused$
bu$the$pressure$of$the$presenting$part$of$the$scalp$against$the$dilating$cervix$
(cervical$os)$during$delivery.$This$is$thought$to$be$the$tourniquet$effect$of$the$
cervix.$
$
66.$This$type$of$episiotomy$is$associated$with$higher$rates$of$anal$sphincter$injury$
$ A.$Median$
$ B.$Mediolateral$
$ C.$Both$
$
• This$is$based$on$anatomical$position.$Median$episiotomy$will$more$likely$
injure$anal$sphincter$because$the$laceration$is$along$the$centerline,$while$
mediolateral$is$more$of$a$diagonal$laceration.$
$
67.$One$hand$over$the$posterior$perineum$over$the$fetal$chin$to$extend$the$fetal$
head$and$another$hand$over$the$occiput$with$pressure$downward$to$flex$the$head$is:$
$ A.$Modified$Ritgen’s$
$ B.$Vacuum$extraction$–$uses$an$instrument$to$assist$delivery$
$C.$Modified$Crede’s$–$technique$to$assist$expulsion$of$placenta,$where$in$the$
uterus$is$pushed$toward$the$birth$canal$by$pressure$exerted$by$the$thumb$of$
one$hand$on$the$posterior$surface$of$the$abdomen$and$the$other$hand$on$the$
anterior$surface.$ $
D.$Brandt$Andrews$–$one$hand$grasps$the$umbilical$cord$while$the$other$is$
placed$on$the$mother's$abdomen$with$the$fingers$over$the$anterior$surface$of$
the$uterus.$While$the$hand$on$the$abdomen$is$pressed$backward$and$slightly$
upward,$the$other$applies$gentle$traction$on$the$cord.$
$
68.$Intravenous$fluids$are$given$to$a$woman$in$labor$to:$
$ A.$Prevent$dehydration$
$ B.$Provides$glucose$and$water$
$ C.$Provides$a$line$to$intravenous$medications$
$ D.$All$of$the$above$
$
69.$Auscultation$of$the$FHT$done$___________$a$uterine$contraction$
$ A.$At$the$onset$of$
$ B.$During$the$peak$of$
$ C.$After$
$
• This$is$a$contraction$stress$test$by$which$physician$lets$uterus$to$contract$to$
stimulate$fetal$heart$rate,$thus$auscultations$will$be$made$after$contractions$
(stimuli).$
$
70.$When$the$fetal$head$is$encircled$by$the$vulvar$ring,$this$is$called:$
$ A.$Ritgen’s$–$maneuver$to$assist$delivery$of$the$fetal$head$
$B.$Crowning$–$fetal$head$has$negotiated$with$the$pelvic$outlet$this,$thus$can$
be$seen$sticking$out$from$the$vaginal$orifice$
$C.$Engagement$K$passing$of$biparietal$diameter$throught$the$pelvic$inlet$
71. The earliest sign of placental separation is:
a. Lengthening of the cord
b. Gush of blood from the vagina
c. Calkin’s sign
d. Uterus rises in the abdomen
Rationale:
All of these are signs of placental separation but Calkin’s sign is the EARLIEST to appear among the 4.
Calkin’s sign pertains to the uterus becoming globular and, as a rule, firmer

72. Profuse bleeding after placental delivery may be due to:

a. Uterine atony
b. Lacerations at the cervix and vagina
c. Retained secundins
d. All of the above
Rationale:
The hour immediately after delivery of the placenta or the 4th stage of labor is critical. Uterine atony,
birth canal lacerations, retained placental fragments, membranes & umbilical cord, expansion of
hematoma are most likely to cause postpartum hemorrhage. Therefore mgt are as follows:
• examination for completeness of placenta, membranes & umbilical cord
• uterine tone & perineum should be frequently evaluated
• maternal BP & pulse be recorded immediately after delivery & every 15 mins for the 1st 2 hours.

73. Prolonged second stage of labor in nulliparas occurs when the:

a. It exceeds 3 hours with epidural anesthesia
b. If it is more than 2 hours without anesthesia
c. Both
d. Neither
Rationale:
2nd stage may be prolonged due to :
1. large fetus
2. with conduction analgesia
3. intense sedation.
A prolonged second stage or arrest occurs when it exceeds more than 2hours both for nulliparas &
multiparas.

74. Lacerations extending to the rectal mucosa is:

a. 1st degree
b. 2nd degree
c. 3rd degree
d. 4th degree
Rationale: 4th degree laceration is a combination of 1st, 2nd & 3rd degree plus the extension through the
rectal mucosa to expose the lumen of the rectum
DEGREE OF LACERATION INVOLVEMENT
1st degree Involve the fourchette, perineal skin and vaginal
mucous membrane
2nd degree 1st degree + fascia & perineal body
3rd degree 1st & 2nd degree + anal sphincter
4th degree 1st ,2nd & 3rd degree + rectal mucosa exposing its
lumen

75. After the delivery of fetus, the umbilical cord is clamped and cut. The next step to do while holding
the clamped cord is:
a. Perform vigorous traction of the cord to pull the placenta
b. Pressure is applied to the body of the uterine cephalad
c. Uterus is pushed downward with the abdominal hand
Rationale: Uterus is lifted cephalad with the abdominal hand. NO traction of the cord. NO vigorous
massage or Oxytocin infusion, to avoid uterine inversion.

76. How is oxytocin administered in the active management of the 3rd stage of labor?
a. May be given IM injection in a dose of 10 USP units
b. May be given IV as a large bolus
 c. If an IV infusion is in place, standard practice has been in to add 30 units of oxytocin per liter of
infusate
d. Intramuscular injection of 30 USP units
Rationale:
• These hemodynamic changes could be dangerous for women hypovolemic from hemorrhage
or those with cardiac disease. Thus, oxytocin SHOULD NOT be given intravenously as a large
bolus. Rather, it SHOULD be given as a dilute solution by continuous intravenous infusion or as
an intramuscular injection in a dose of 10 USP units
• The considerable antidiuretic action of oxytocin can cause water intoxication. With high-dose
oxytocin, it is possible to produce water intoxication if the oxytocin is administered in a large
volume of electrolyte-free aqueous dextrose solution; AVOID HIGH DOSES.

77. Upon inspection of the perineum after delivery of the infant and placenta, a laceration was noted
from the skin and vaginal mucosa and perineal muscle with involvement of the anal sphincter. This is
what type of laceration?
a. 1st degree
b. 2nd degree
c. 3rd degree
d. 4th degree
Rationale:
DEGREE OF LACERATION INVOLVEMENT
1st degree Involve the fourchette, perineal skin and vaginal
mucous membrane
2nd degree 1st degree + fascia & perineal body
3 degree
rd 1st & 2nd degree + anal sphincter
4th degree 1st ,2nd & 3rd degree + rectal mucosa exposing its
lumen

78. Faulty healing and postoperative pain are common in

a. Median episiotomy
b. Mediolateral episiotomy
Rationale:
Characteristic Median Mediolateral
Surgical repair Easy More difficult
Faulty healing Rare More common
Postoperative pain Minimal Common
Anatomical results Excellent Occasionally faulty
Blood loss Less More
Dyspareunia Rare Occasional
Extensions Common Uncommon

79. A 32 year old G2P1 (1001) term, cephalic is admitted at the delivery room at 4 cm. 60% effaced,
station -2, with intact bag of waters. The following is/are components of active management of labor
for this patient:
a. Pelvic examination is done every 2 hours
b. Amniotomy is performed if cervical dilatation is not progressing 1cm/hour
c. Oxytocin infusion is given if there is inadequate uterine contractions
d. All of the above

Rationale: The mother is still in the 1st stage of labor; Active phase which is exemplified by its cervical
dilatation of 4cm. (ALWAYS take note of the cervical dilatation to determine specific stage & specific
phases) Therefore, management for 1st stage includes all those 3 in the choices and the ff:

Temperature, vital signs, and BP
at least every 4 hours
FHR checked immediately and
during the next uterine
Oxytocin prophylactically and
at times therapeutically when
uterine atony persists › With
longer labors, administration of
glucose, sodium, and water at a
rate of 60- 120 mL/hr to prevent
dehydration and acidosis
Assume position most
comfortable which is lateral
Bladder distention should be
avoided because it can lead to
obstructed labor and
subsequent bladder hypotonia
and infection
Analgesia is initiated on the
basis of the woman’s discomfort
contraction to detect an occult
umbilical cord compression
Food withheld during active
labor and delivery
recumbency when in be
Amniotomy- presumed labor 1.
Rapid Labor
2. Early detection of meconium
staining
3. Opportunity to apply
electrode and insert pressure
catheter into uterine cavity
& Cervical dilatation of at least 2
cm
Subsequent vaginal
examinations will vary during
the 1st stage
BUT WHEN membranes rupture –
examination repeated
expeditiously if fetal head was
not definitely engaged at the
previous vaginal examination

80. This refers to the time following delivery during which maternal changes return to nonpregnant state:
a. Puerperium
b. Postpartum
c. Peripartum
d. 5th stage of labor
Rationale:
Puerperium
• time following delivery during which pregnancy-induced maternal anatomical and
physiological changes return to the nonpregnant state
• considered to be between 4 and 6 weeks
• appreciable changes, some of which may be either bothersome or worrisome for the new
mother

81. Postpartum diuresis occurs at ______ day:

a. 1st and 2nd
b. 2nd and 5th
c. 3rd and 6th
d. 4th and 7th

Rationale:
Urinary tract changes
Diuresis that occurs postpartum (2nd-5th day) is a physiological reversal of increase in extracellular
water in normal pregnancy
Puerperal bladder has an increased capacity and a relative insensitivity to intravesical fluid pressure
due to paralyzing effect of analgesics, especially epidural and spinal blocks are contributory
Overdistention, incomplete emptying, and excessive residual urine are common

82. The uterus returns to pregravid size by:

a. 3 weeks after delivery
b. 5 weeks after delivery
c. 8 weeks after delivery
d. 10 weeks after delivery

Rationale:
1st week after delivery Uterus size dissipates rapidly
8 weeks after delivery Uterus and endometrium return to pregravid size
Up to 2 months Demonstrable uterine contents are seen

83. A primipara delivered 2 weeks ago is complaining of intermittent crampy hypogastric pain. What is
NOT considered in the immediate management?
a. Initiate empiric antimicrobial therapy for endometritis
b. Reassure the patient that the uterus tends to remain tonically contracted following delivery but
usually becomes mild by the 3rd day.
c. Offer analgesic therapy

Rationale: Histologic endometritis is a part of NORMAL reparative process therefore, ANTIMICROBIAL

THERAPY NEED NOT TO BE INITIATED.
84. A puepara on her 2nd week postpartum is complaining of white-yellow vaginal discharge. What is
your impression?
a. Lochia Rubra
b. Lochia Serosa
c. Lochia Alba

Rationale: Puerpara is on her 14th day with white-yellow vaginal discharge therefore, impression is lochia
alba which starts after about 10 days.

LOCHIA RUBRA 1-3 days RED

LOCHIA SEROSA After 3 or 4days or 4th-9th PROGRESSIVELY
day PALE/PINKISH
LOCHIA ALBA 10 days to 6weeks WHITE-YELLOWISH/WHITE
postpartum

85. Which of the following is NOT found in lochial discharge?

a. Erythrocytes
b. Placental fragments
c. Shredded deciduas
d. Bacteria
Rationale:
Lochia
-sloughing of decidual tissue results in a vaginal discharge of variable quantity
Consists of:
o Erythrocytes
o Shredded decidua
o Epithelial cells
o Bacteria
86.Which of the following becomes the source of new endometrium during the puerperium?
A. DECIDUA BASALIS
B. Decidua functionalis
C. Decidua spongiosa
D. Decidua compacta
Rationale:
The basal layer adjacent to the myometrium remains intact and is the source of new
endometrium.
The superficial layer becomes necrotic and is sloughed in the lochia.

87. A woman on her 3rd postpartum week comes complaining of persistent vaginal bleeding of
minimal amount. On bimanual examination, the fundus is softish and noted halfway between the
umbilicus and symphysis. Ultrasound showed thickened heterogenous endometrium. Which is
the MOST likely cause of this condition?
A.Chlamydial infection
B. RETAINED PLACENTAL FRAGMENTS
C. Incompletely remodeled uteroplacental arteries
Rationale:
Few women with delayed hemorrhage are found to have retained placental fragments.

88. Which of the following is TRUE of placental site involution?

A. IT IS AN EXFOLIATION PROCESS
B. It involves development of endometrial tissue from the glands and stroma left in the
zona functionalis.
C. It involves downgrowth of endometrium from the margins of the placental site.
Rationale:
Placental site involution is an exfoliative process, which is prompted in great part by
undermining of the implantation site by new endometrial proliferation.
Exfoliation consists of both extension and “downgrowth” of endometrium from the margins
of the placental site, as well as development of endometrial tissue from the glands and stroma
left deep in the deciduas basalis after placental separartion.

89. According to the Ameican College of Obstetricians and Gynecologists, secondary

postpartum hemorrhage is defined as:
A. bleeding 6 hours to 12 hours after delivery
B. BLEEDING 24 HOURS TO 12 WEEKS AFTER DELIVERY
C. develops 14 weeks after the delivery
D. develops 16 weeks after the delivery
Rationale:
The Ameican College of Obstetricians and Gynecologists defines secondary postpartum
hemorrhage as bleeding 24 hours to 12 weeks after delivery. Clinically worrisome uterine
hemorrhage develops within 1 to 2 weeks perhaps 1 percent of women.
90. A woman delivered 10 days ago came back complaining of moderate vaginal bleeding. On
PE: stable vital signs; IE: cervix firm closed, corpus slightly enlarged, no adnexal mass nor
tenderness. Ultrasound revealed thin endometrium. What is the BEST management in this
patient?
A. Give antibiotics
B. Perform suction curettage
C. Perform Curettage
D. UTEROTONICS: METHYLERGONOVINE

91. A woman delivered 2 weeks ago consulted complaining of moderate vaginal bleeding. On
PE: stable vital signs; IE: cervix is 1 cm open, corpus enlarged to 2 months size, no adnexal
mass nor tenderness. Ultrasound revealed thickened endometrium probably retained placental
tissues. What is the BEST management in this patient?
A.Give antibiotics
B. Perform suction curettage
C. PERFORM CURETTAGE
D. Uterotonics: oxytocin

Rationale for 90 and 91:

stable patient, if sonographic exam shows an empty cavity, the oxytocin,
methylergonovine or prostaglandin analogue is given.
With uterine infection- antimicrobials
Large clots seen in uterine cavity with sonography- gentle suction curettage
Curettage is carried out ony if appreciable bleeding persists or recurs after medical
management

92. What are the obstetrical factors that can cause urinary incontinence?
A. LENGTH OF 2ND STAGE OF LABOR
B. INFANT HEAD CIRCUMFERENCE
C. BIRTHWEIGHT
D. ALL OF THE ABOVE
Rationale:
Urinary incontinence is correlated with obstetrical factors such as length of second-stage
labor, infant head circumference, birthweight, and episiotomy.

93. Blood volume will return to nonpreganant level at __ week/s after delivery
A. 1
B. 2
C. 3
D. 4
Rationale:
The blood volume has returned nearly to its nonpregnant level at 1 week after delivery.
94. Which of the following hematological changes in the puerperium is abnormal?
A. WBC count sometimes reaches 30,000/ul
B. relative lymphopenia
C. absolute eosinophilis
D. THROMBOCYTOPENIA
Rationale:
Marked leukocytosis and thrombocytosis may occur during and after labor. The white
blood cell count sometimes reaches 30, 000/ul, with the increase predominantly due to
granulocytes. There is relative lymphopenia and an absolute eosinopenia.
Hemoglobin concentration and hematocrit fluctuate moderately during the first few
postpartum days.

95. TRUE about weight loss in the puerperium:

A. loss of 2 to 3 kg due to uterine evacuation and blood loss
B. LOSS OF 5 TO 6 KG DUE TO UTERINE EVACATION AND BLOOD LOSS
C. loss of about 4 to 5 kg through dieresis
D. loss of about 5 to 6 kg through diueresis
Rationale:
Loss of about 5 to 6 kg weight loss due to uterine evacuation and normal blood loss.
Postpartum diueresis results in relatively rapid weight loss of 2 to 3 kg.

96. Marked separation of rectus abdominis is called:

A. DIASTASIS RECTI
B. Linea nigra
C. striae gravidarum
Rationale:
Diastasis recti- markes separation of the rectus abdominis muscles
Striae gravidarum- silvery abdominal striae
Linea nigra- dark brown-black pigmentation on the midline anterior abdominal wall

97. Compared with mature milk, colostrums is richer with this/these component/s, which protects
the newborn against enteric pathogens.
A. Minerals and amino acid
B. Essential fatty acids
C. IMMUNOGLOBULIN A
D. all of the above
Rationale:
Compared with mature milk, colostrum is rich in immunological components and contains
more minerals and amino acids.
The colostrums content of immunoglobulin A offers the newborn protection against
enteric pathogems.
98. Which hormone stimulates the milk ejection or let down?
A. Prolactin
B. OXYTOCIN
C. Dopamine
D. Cortisol
Rationale:
Milk ejection or letting down is a reflex initiated especially by suckling which stimulates
the posterior pituitary to liberate oxytocin.
Oxytocin- stimulates contraction of myoepithelial cells in the alveoli and small milk ducts
Prolactin- stimulates milk production

99. Who among the following is allowed to breastfeed?

A. G2P2 marijuana user
B. G1P1 with HIV infection
C. G4P4 with active untreated TB
D. G1P1 HEPATITIS B REACTIVE
Rationale:
Contraindications to breastfeeding:
- women who take street drugs or do not control their alcohol use
- infant with galactosemia
- have HIV infection
- have ACTIVE, UNTREATED TB
- take certain medications
- UNDERGOING TREATMENT for breast cancer
- although hepatitis B is excreted in milk, breastfeeding is NOT
CONTRAINDICATED if HEPA B IMMUNOGLOBULIN is given to infants of
seropositive mothers
- women with active herpes simplex virus may suckle if there are no breast lesions and if
particular care is directed to hand washing before nursing

100. A 25 y/o G1P1, on her 2nd postpartum day, is very anxious because she’s still not lactating.
She complained that her breasts are engorged and tender. Her last attempt to nurse her baby is
right after delivery. What is the BEST advice to give her?
A. ENCOURAGE HER TO REGULARLY BREASTFEED AND/OR PUMP BREASTS
B. REASSURE HER THAT SOME WOMEN MAY NOT LACTATE IMMEDIATELY
C. Prescribe her with formula or infant milk
D. All of the above
E. A AND B ONLY
Rationale:
Human milk is ideal food for neonates. It provides species- and age-specific nutrients for the
infant.

SOURCE: Williams and Lecture’s PPT

101.$Women$who$do$not$breastfeed$may$expect$their$menstruation$___$after$delivery:$

$ a.$6>8$weeks$

$ b.$10>12$weeks$

$ c.$6>8$months$

$ d.$10>12$months$

Women&not&breast&feeding&have&return&of&menses&usually&within&6&to&8&weeks.&At&times,&however,&it&is&
difficult& clinically& to& assign& a& specific& date& to& the& first& menstrual& period& after& delivery.& A& minority& of&
women&bleed&small&to&moderate&amounts&intermittently,&starting&soon&after&delivery.&Ovulation&occurs&
at&a&mean&of&7&weeks,&but&ranges&from&5&to&11&weeks&(Perez,&1972).&
&
102.$ A$ G3P3$ delivered$ 2$ months$ ago$ consulted$ for$ family$ planning.$ She$ has$ been$ exclusively$
breastfeeding$for$2$months.$What$contraception$can$be$given$to$her$at$this$time?$

$ a.$Progestin>only$contraceptives$

$ b.$Combined$oral$contraceptive$pills$

$ c.$Calendar$method$

For& the& breastIfeeding& woman,& progestinIonly& contraceptives—& miniIpills,& depot&

medroxyprogesterone,&or&progestin&implants—do&not&affect&the&quality&or&quantity&of&milk.&These&may&
be& initiated& any& time& during& the& puerperium.& EstrogenIprogestin& contraceptives& likely& reduce& the&
quantity& of& breast& milk,& but& under& the& proper& circumstances,& they& too& can& be& used& by& breastIfeeding&
women.&However,&these&are&withheld&until&
after&the&first&4&weeks&because&of&their&higher&thromboembolic&risk&in&puerperal&patients.&
&
103.$Postpartum$blues$is$likely$the$result$of$several$factor/s:$

$ a.$Emotional$letdown$following$excitement$and$fears$during$pregnancy$

$ b.$Fatigue$from$loss$of$sleep$during$labor$and$postpartum$

$ c.$Anxiety$over$ability$to$provide$appropriate$care$for$new$baby$

$ d.$All$of$the$above$

Postpartum*blues,*this&likely&is&the&consequence&of&several&factors&that*include&emotional&letdown&that&
follows&the&excitement&and*fears&experienced&during&pregnancy&and&delivery,&discomforts*of&the&early&
puerperium,&fatigue&from&sleep&deprivation,&anxiety*over&the&ability&to&provide&appropriate&infant&care,&
and&body*image&concerns.&
*
$

$
104.$Advantages$of$EARLY$ambulation$include/s:$

$ a.$Less$bladder$complications$

$ b.$Improved$bowel$function$

$ c.$Increased$thromboembolic$events$

$ d.$All$of$the$Above$

$ e.$A$and$B$only$

Women&are&out&of&bed&within&a&few&hours&after&delivery.&An&attendant&should&be&present&for&at&least&the&
first&time,&in&case&the&woman&becomes&syncopal.&The&many&confirmed&advantages&of&early&ambulation&
include&fewer&bladder&complications,&less&frequent&constipation,&and&reduced&rates&of&puerperal&venous&
thromboembolism.&
&
105.$ $ A$ G1P1,$ who$ recently$ underwent$ Cesarean$ section$ is$ on$ her$ 3rd$ unremarkable$ post>op$ day.$
According$to$the$American$College$of$Obstetricians$and$Gynecologists,$when$is$the$BEST$TIME$to$
discharge$her$from$the$hospital?$

$ a.$12$hours$

$ b.$24$hours$

$ c.$48$hours$

$ d.$96$hours$

Currently,&the&norms&are&hospital&stays&up&to&48&hours&following&uncomplicated&vaginal&delivery&and&up&
to& 96& hours& following& uncomplicated& cesarean& delivery& (American& Academy& of& Pediatrics& and& the&
American&College&of&Obstetricians&and&Gynecologists,&2012).&Earlier&hospital&discharge&is&acceptable&for&
appropriately&selected&women&if&they&desire&it.&
!

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