Undergraduate course lectures in Obstetrics&Gynecology .Faculty of medicine,Zagazig University Prepared by DR Manal Behery

2.  Part 2: ABNORMAL LABOUR

3. A-Hydroceplus
B- Occipto –anterior
C-Face presenation
D- Occipto –Posterior
E-Ovarian mass
F- Shoulder dystocia
Answer B

4.  Difficult labor, but refers to abnormally slow
progress of labor

6.  Things are moving slower than expected
 No change occurs

8.  Nulliparous: dilation <1.2cm/hr, descent
<1.0cm/hr
 Multiparous: dilation <1.5cm/hr, descent
<2.0cm/hr

9.  -Nulliparous: NOdilation >2hr, no descent >1hr
 -Multiparous: NO dilation >2hr, no descent >1hr

10.  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

11.  A-Chorioamnionitis
 B-Uterine rupture
 C-Reassuring FHR trace
 D-Pelvic floor injury
ANSWER C

12.  A-Power: uterine contractions
 B-Passenger: the baby
 C-Passage: the patient's pelvis, pelvic floor

13.  During first stage of labor, you are
concerned with the power of the uterine
contractions
 During the second stage of labor, you are
concerned with the power of the patient's
pushing efforts

14.  -External tocodynamometry or an
intrauterine pressure catheter (IUPC)
 For IUPC, patient must be ruptured and
increased the risk of infection

15.  Strong enough to cause cervical change
 Optimal frequency is a minimum of three
contractions in a 10 min period (ideal is every
2 min)
 Greater than or equal to 200 Montevideo units

16.  -If contraction pattern is irregular or less
than 3 in 10 minutes or if MVU's are less
than 200, use Pitocin to increase intensity
and frequency of contractions.

17. 1) Allow patient to rest through a few contractions
to catch her breath.
2) Try different positions for more effective
pushing
3) If everything fails, operative vaginal delivery or
Cesarean section
•

18.  Lie
 Presentation
 Size
 Anomalies

19. -Fetal lie: non-longitudinal presentation-
transverse, oblique or shoulder
-Fetal presentation: breech, face (1 in 600),
or brow (1 in 3000), compound presentation
(1 in 700)-hand or arm prolapses along fetal
head
Asynclitism-lateral deflection of the head to a
more anterior or posterior position in pelvis
•

20.  frank breech: legs are piked
-complete breech: indian style or curled legs
-footling breech: one leg down, monitor for if
umbilical cord falls through pelvis

21.  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

22. 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

23. A- multiparity
B-placenta previa
C- presenting part engagement
D- CPD
Ans: A

24. 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

25. A-induction of labor
B- internal rotation to make mentum ant position
C- observation to allow spontaneous rotation
D- C/S
Ans:C

26. 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

27.  -Macrosomia is defined as an infant
weighing greater than 4,000-4,500 g
 Risk factors include maternal obesity,
diabetes, multiparity, excessive maternal
weight gain, prolonged gestation and a
history of a macrosomic infant
•

28.  -Hydrocephalus
 large fetal abdomen from tumor
 Ascites
 distended bladder
 Conjoined twins

29. • -not much we can do about fetal weight or
anomalies
-external cephalic version prior to labor can
be performed to convert breech or transverse
to vertex
-rotation of fetal head to direct OA
presentation manually or with forceps
•

30.  -The size of the maternal pelvis is
inadequate to the size of the presenting
part of the fetus

31.  -manual evaluation of the diameters of the
pelvis


32. • 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
•

33.  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)

34.  -normal female type male type
- inlet triangular or heart-shaped

35.  -Ape-like type
-Anteroposterior
diameters long,
 Transverse short,
 Sacrum long and narrow,
 Subpubic angle narrow


36.  All anteroposterior diameters are short,
 Transverse are long, subpubic angle is wide

37. 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

38.  -Rotate fetal head if necessary
 Change positions
 Operative delivery

39.  -If placenta not delivered w/in 30 min:
manual sweep should be performed


40.  -Fetal head delivers but the shoulder is
impacted behind the pubic symphysis
 Risk factors: fetal macrosomia, diabetes,
operative delivery

41. • 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

43. 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

45. 1. get help
2. be sure bladder is drained
3. cut episiotomy if needed for more room
4. suprapubic pressure
5. McRobert's Maneuver:sharply flex
maternal thigh
6. woods screw maneuver:turn shoulders to a
more direct AP position
7. delivery of the posterior arm
8. fracture clavicle or humerus
9. zavanelli maneuver: flex and reinsert fetal
head and do C-section

46. A-Maternal heart disease, pulmonary
compromise
B- prolonged first stage of labor,
C-maternal exhaustion
D- non-reassuring fetal heart rate pattern
ANSWER B
•

47. • 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

48. • -maternal complications
*perineal trauma
*hematoma
*pelvic floor injury
-fetal complications
*facial nerve injury
*skull fracture
*intracranial hemorrhage
*corneal abrasion if misplaced
•

49. EPISIOTOMY – midline vs mediolateral
PERINEAL TEAR – first to fourth degree

50. 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
•

51. Fourth-degree
Perineal tear

52. A- immediately
B-3 months later
C- 6 months later
D- 9 months later
Ans:A

53. Which of the following is appropriate device
A- LOW FORCEPS
B-MID FORCEPS
C- SOFT CUP VACCUM
D- PIPER FORCEPS
ANSWER A

54. -less maternal trauma
-neonatal risks
*intracranial hemorrhage
*subgaleal hematoma
*scalp laceration
*hyperbilirubinemia
*retinal hemorrhage
*cephalohematoma
•

55. • -Caput succedaneum: subcutaneous bleeding
and swelling
-Cephalohematoma: bleeding beneath the
periosteum and therefore does not cross
suture lines unless there is a skull fracture
•

56. This patient has a bishop score of
A- 4
B-5
C-6
D-8
ANSWER B

58. 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

59. 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
•

60. THANK YOU