Normal Birth Management

1) Normal birth is defined by WHO as:

a) Spontaneous birth of infant in the vertex position between 37 and 42 completed weeks of
pregnancy;
b) Spontaneous birth of infant in the breech position between 37 and 42 completed weeks of
pregnancy;
c) Spontaneous birth of infant in the breech position between 37 and 40 completed weeks of
pregnancy;
d) Spontaneous birth of infant in the vertex position between 35 and 42 completed weeks of
pregnancy.
2) Laboring woman should be admitted to the hospital when she has – mark the wrong answer:
a) Regular contractions that require the woman’s focus and attention;
b) Significant effacement of the cervix (≥80 percent);
c) 4 to 5 cm dilation of the cervix;
d) No cervical change or contractions at the end of two hours observation.
3) What should we find out by initial examination of laboring woman – mark the wrong
answer:
a) Whether fetal membranes are intact or ruptured;
b) Whether uterine bleeding is present and excessive;
c) Cervical dilation and effacement;
d) Assessment of uterine fibroids by ultrasound.
4) What should we find out by initial examination of laboring woman – mark the wrong
answer:
a) Fetal station;
b) Fetal lie, presentation, position;
c) Estimating fetal weight by ultrasound;
d) Fetal heart-rate.
5) Fetal lie can be – mark the wrong answer:
a) Longitudinal;
b) Perpendicular;
c) Transverse;
d) Oblique;
6) Should we perform laboratory assessment of hemoglobin/hematocrit upon admission of
a laboring woman?
a) There is no evidence that this practice is necessary in uncomplicated pregnancies.
Relying on a normal hemoglobin result obtained at 26 to 28 weeks appears to be a
safe and acceptable approach;
 b) Yes, in every case;
c) We can rely on laboratory test results obtained at the first prenatal visit;
d) No, never.
7) Should we perform Rhesus (Rh) typing with a negative antibody screen upon admission
of a laboring woman? - mark the wrong answer:
a) Yes, in every case;
b) Rhesus (Rh) typing with a negative antibody screen at the first prenatal visit is
adequate for women at low risk of postpartum hemorrhage;
c) A reasonable approach is to type and crossmatch women at high risk of needing a
transfusion;
d) A reasonable approach is to type and screen women at moderate risk of needing a
transfusion.

8) Group B streptococcus screening is performed at :

a) 28-30 weeks of pregnancy;

b) 35-37 weeks of pregnancy;

c) 18-22 weeks of pregnancy;

d) at the first prenatal visit.

9) Mark the wrong statement - in labor:

a) Avoid routine enemas and perineal shaving.

b) A urinary catheter is unnecessary unless the woman is unable to void;

c) Bladder distention does not affect labor progress.

d) We should restrict fluids and oral intake to prevent the risk of aspiration pneumonitis
10) Maternal activity and position in labor - mark the wrong answer:
a) Maternal preferences can guide maternal activity;
b) Walking during the first stage does not enhance or impair active labor and has no harmful
effects;
c) Laboring women should assume positions that are comfortable, unless specific positions are
needed because of maternal-fetal status and need for close monitoring;
d) The only position for laboring woman is lithotomy.
11) Amniotomy should be avoided (if possible) to minimize exposing the fetus to ascending
infection in women with – mark the wrong answer:

a) hepatitis B;

b) hepatitis C;
c) HIV infection;

d) Positive GBS carrier.

12) Fetal heart rate monitoring should be performed – mark the wrong answer:

a) In low-risk pregnancies every 30 minutes in the first stage of labor and every 15 minutes in
the second stage;
b) For higher-risk pregnancies - every 15 minutes in the first stage and every five minutes in the
second stage;
c) Continuously in women with pregnancies at increased risk of fetal compromise during labor
(eg, suspected fetal growth restriction, preeclampsia, abruptio placenta, type 1 diabetes;
d) In low-risk pregnancies every 1 hour in the first stage of labor and every 30 minutes in the
second stage.

13) Vaginal examination of the cervix, fetal position, and fetal descent is performed – mark the
wrong answer:
a) On admission;
b) At four-hour intervals in the first stage;
c) At one-hour intervals in the first stage;
d) At two-hour intervals in the second stage.

14) The number of vaginal examinations is kept to a minimum – mark the wrong answer:
a) For patient comfort;
b) To minimize iatrogenically exposing the fetus to vaginal flora;
c) Because we can’t assess whether labor is progressing normally by vaginal examination.

15) Why should we avoid the supine position of laboring woman?

a) Should be avoided because of aortocaval compression;
b) Should be avoided because of faster descent of fetal head in his position;
c) Should be avoided because of carotid arteries’ compression;
d) Should be avoided because of higher risk of perineal lacerations.

16) Mark the wrong answer:

a) Routine use of episiotomy is not beneficial and should be avoided;
b) Episiotomy is reserved for deliveries with a high risk of severe perineal laceration;
c) Episiotomy is reserved for deliveries with significant soft tissue dystocia, or need to facilitate
delivery of a possibly compromised fetus;
d) We are recommended to use episiotomy routinely.

17) Oropharyngeal care of the newborn - mark the wrong answer:

a) The mouth is suctioned first and then the nares to decrease the risk for aspiration
(newborns are obligate nose breathers);
 b) Suctioning of the posterior pharynx should be avoided, as it can stimulate a vagal
response, resulting in apnea and/or bradycardia;
c) We are recommended to perform routine nasopharyngeal suctioning of meconium-
stained newborns, because this approach decreases meconium aspiration syndrome and
improves perinatal outcome;
d) Suctioning immediately after birth is appropriate for newborns with obvious
obstruction to spontaneous breathing due to secretions or who are likely to require
positive-pressure ventilation.

18) Delaying umbilical cord clamping after birth in vigorous term infants – mark the
wrong answer:
a) Delaying cord clamping should not interfere with timely care of the newborn;
b) We should delay cord clamping even if we compromise the safety of the mother or
newborn;
c) In term infants, the main advantage of delayed cord clamping is higher infant iron
stores at six months of age;
d) Minimum delay - of at least one minute in term births.

19) Disadvantages of delayed cord clamping – mark the wrong answer:

a) An increase in hyperbilirubinemia in the immediate newborn period resulting in more
phototherapy;
b) An increased risk of polycythemia in growth-restricted neonates;
c) Delaying cord clamping also reduces the volume of umbilical cord blood available for
harvesting stem cells;
d) In term infants delayed cord clamping is higher infant iron stores at six months of age.

20) Delaying cord clamping for at least 30 seconds in vigorous preterm infants – mark
the wrong answer:
a) Reduces neonatal hospital mortality by approximately 30 percent;
b) Reduces the proportion of infants having blood transfusion by 10 percent;
c) Increases peak serum bilirubin by 4 micromol/L without increasing morbidity;
d) Reduces the incidence of intubation for resuscitation, mechanical ventilation, severe
intraventricular hemorrhage, brain injury, chronic lung disease, ductus arteriosus,
necrotizing enterocolitis, late onset sepsis or severe retinopathy of prematurity.

21) Signs of placental separation – mark the wrong answer:

a) A gush of blood;
b) Lengthening of the umbilical cord;
c) Anterior-cephalad movement of the uterine fundus;
d) Shortening of the umbilical cord.

22) Active management and delivery of the placenta – mark the wrong answer:
a) Active management generally consists of prophylactic administration of an uterotonic
agent before delivery of the placenta;
b) Active management generally consists of controlled traction of the umbilical cord
after cord clamping and transection;
c) There are no significant harms from the maneuver if performed gently without
excessive traction, which can result in cord avulsion or uterine inversion;
d) Active management increases the risk of severe postpartum blood loss and blood
transfusion compared with expectant management.

23) Active management of delivering the placenta includes – mark the wrong answer:
a) Controlled cord traction to facilitate separation and delivery of the placenta;
b) Slowly rotating the placenta in circles as it is delivered;
c) Grasping the membranes with a clamp to prevent them from tearing and possibly
being retained in the uterine cavity;
d) Manual removal of the placenta routinely.

24) The major risk factors for third and fourth degree perineal lacerations are – mark the
wrong answer:
a) Nulliparity,
b) Operative vaginal delivery,
c) Midline episiotomy and delivery of a macrosomic newborn;
d) When newborn weight is less than 2500gr.

25) Excessive vaginal bleeding after delivery - mark the wrong answer:
a) May be related to uterine atony / trauma;
b) May be related to coagulopathy;
c) May be related to placental abnormalities or uterine inversion;
d) Blood loss <500 mL.