Stages of labor Practice Questions

Question 1

A 39-year-old woman, gravida 5, para 4, at 41 weeks' gestation is brought to the hospital because of regular uterine contractions that started 2 hours ago. Pregnancy has been complicated by iron deficiency anemia treated with iron supplements. Pelvic examination shows the cervix is 90% effaced and 7-cm dilated; the vertex is at -1 station. Fetal heart tracing is shown. The patient is repositioned, O2 therapy is initiated, and amnioinfusion is done. A repeat assessment after 20 minutes shows a similar cervical status, and no changes in the fetal heart tracing, and less than 5 contractions in a period of 10 minutes.What is the most appropriate next step in management?

Accepted Answer

Emergent cesarean delivery

Answer

Monitor without intervention

Answer

Begin active pushing

Answer

Retry maternal repositioning

Answer

Administer tocolytics

Question 2

Two days after vaginal delivery of a healthy newborn at term, a 32-year-old woman, gravida 2, para 2, is unable to breastfeed. Her labor was complicated by antepartum hemorrhage and she received two units of packed red blood cells. Her pulse is 99/min and blood pressure is 90/55 mm Hg. Further evaluation of this patient is most likely to show which of the following sets of serum findings?
 $$$ ACTH %%% Aldosterone %%% Cortisol $$$

Accepted Answer

↓ normal ↓

Answer

↑ ↓ ↓

Answer

↓ ↑ ↓

Answer

↑ normal ↑

Answer

↓ normal ↑

Question 3

A 29-year-old G1P0 female at 32 weeks gestation presents to the emergency department with vaginal bleeding. She has had minimal prenatal care to-date with only an initial visit with an obstetrician after a positive home pregnancy test. She describes minimal spotting that she noticed earlier today that has progressed to larger amounts of blood; she estimates 30 mL of blood loss. She denies any cramping, pain, or contractions, and she reports feeling continued movements of the baby. Ultrasound and fetal heart rate monitoring confirm the presence of a healthy fetus without any evidence of current or impending complications. The consulted obstetrician orders blood testing for Rh-status of both the mother as well as the father, who brought the patient to the hospital. Which of the following represents the best management strategy for this situation?

Accepted Answer

If mother is Rh-negative and father is Rh-positive then administer RhoGAM

Answer

After 28 weeks gestation, administration of RhoGAM will have no benefit

Answer

If mother is Rh-positive and father is Rh-negative then administer RhoGAM

Answer

If mother is Rh-negative and father is Rh-negative then administer RhoGAM

Answer

If mother is Rh-negative and father is Rh-positive, RhoGAM administration is not needed

Question 4

A 28-year-old primigravid woman at 36 weeks' gestation comes to the emergency department for 2 hours of contractions. Her pregnancy has been uncomplicated. The contractions occur once every 20–30 minutes, last less than 30 seconds, and have been consistent in intensity and duration since onset. During that time there has been an increase in fetal movements. Her temperature is 37.1°C (98.8°F), pulse is 98/min, and blood pressure is 104/76 mm Hg. Pelvic examination shows clear cervical mucus and a firm uterus consistent in size with a 36-week gestation. The cervix is 0% effaced and undilated; the vertex is at -3 station. The fetal heart rate is reassuring. After an hour of monitoring in the emergency department, the character of the contractions and pelvic examination findings remain unchanged. Which of the following is the most appropriate next step?

Accepted Answer

Reassurance and discharge

Answer

Admit for continuous monitoring

Answer

Administer tocolytics

Answer

Perform cesarean delivery

Answer

Offer local or regional anesthesia

Question 5

A 22-year-old primigravid woman at 41 weeks' gestation is admitted to the hospital in active labor. Pregnancy has been uncomplicated. She has asthma treated with theophylline and inhaled corticosteroids. She has had 2 surgeries in the past to repair multiple lower limb and pelvis fractures that were the result of a car accident. She is otherwise healthy. Her temperature is 37.2°C (99°F) and blood pressure is 108/70 mm Hg. Examination shows the cervix is 100% effaced and 10 cm dilated; the vertex is at -4 station, with the occiput in the anterior position. Uterine activity is measured at 275 MVUs. Maternal pushing occurs during the contractions. Fetal heart tracing is 166/min and reactive with no decelerations. Epidural anesthesia is initiated for pain relief. After 4 hours of pushing, the vertex is found to be at -4 station, with increasing strength and rate of uterine contractions; fetal heart tracing shows late decelerations. Which of the following is the most likely cause of this patient's prolonged labor?

Accepted Answer

Cephalopelvic disproportion

Answer

Deep transverse arrest

Answer

Insufficient uterine contraction

Answer

Epidural anesthesia

Answer

Inefficient maternal pushing

Question 6

Five minutes after initiating a change of position and oxygen inhalation, the oxytocin infusion is discontinued. A repeat CTG that is done 10 minutes later shows recurrent variable decelerations and a total of 3 uterine contractions in 10 minutes. Which of the following is the most appropriate next step in management?

Accepted Answer

Amnioinfusion

Answer

Restart oxytocin infusion

Answer

Emergent Cesarean section

Answer

Administer terbutaline

Answer

Monitor without intervention

Question 7

A 30-year-old woman, gravida 2, para 1, at 38 weeks' gestation comes to the hospital for regular, painful contractions that have been increasing in frequency. Her pregnancy has been complicated by gestational diabetes treated with insulin. Pelvic examination shows the cervix is 50% effaced and 4 cm dilated; the vertex is at -1 station. Ultrasonography shows no abnormalities. A tocometer and Doppler fetal heart monitor are placed on the patient's abdomen. The fetal heart rate monitoring strip shows a baseline heart rate of 145/min with a variability of ≥ 15/min. Within a 20-minute recording, there are 7 uterine contractions, 4 accelerations, and 3 decelerations that have a nadir occurring within half a minute. The decelerations occur at differing intervals relative to the contractions. Which of the following is the most appropriate next step in the management of this patient?

Accepted Answer

Routine monitoring

Answer

Vibroacoustic stimulation

Answer

Administer tocolytics

Answer

Emergent cesarean delivery

Answer

Placement of fetal scalp electrode

Question 8

Thirty minutes after vaginal delivery of a 2780-g (6-lb 2-oz) newborn at term, a 25-year-old woman, gravida 1, para 1, has heavy vaginal bleeding. Her pregnancy was complicated by pre-eclampsia. Her pulse is 111/min and blood pressure is 95/65 mm Hg. Physical examination shows a fundal height 2 inches below the xiphoid process of the sternum. A drug with which of the following mechanisms of action is most appropriate for this patient?

Accepted Answer

Activation of phospholipase C

Answer

Depolarization of the motor end plate

Answer

Increased synthesis of cyclic AMP

Answer

Inhibition of norepinephrine reuptake

Answer

Binding to prostaglandin I2 receptors

Question 9

A 28-year-old woman, gravida 2, para 1, at 14 weeks' gestation, comes to the physician with a 3-day history of abnormal vaginal discharge. She has not had fever, chills, or abdominal pain. One week ago, her 2-year-old daughter had a urinary tract infection that quickly resolved after antibiotic therapy. The patient reports that she is sexually active with one male partner and they do not use condoms. Vital signs are within normal limits. Pelvic examination shows an inflamed and friable cervix. There is mucopurulent, foul-smelling discharge from the cervical os. There is no uterine or cervical motion tenderness. Vaginal pH measurement shows a pH of 3.5. Which of the following is the most appropriate initial step in management?

Accepted Answer

Nucleic acid amplification test

Answer

Wet mount preparation

Answer

Amine test

Answer

Urine analysis and culture

Answer

Potassium hydroxide preparation

Question 10

A 31-year-old G6P6 woman with a history of fibroids gives birth to twins via vaginal delivery. Her pregnancy was uneventful, and she reported having good prenatal care. Both placentas are delivered immediately after the birth. The patient continues to bleed significantly over the next 20 minutes. Her temperature is 97.0°F (36.1°C), blood pressure is 124/84 mmHg, pulse is 95/min, respirations are 16/min, and oxygen saturation is 98% on room air. Continued vaginal bleeding is noted. Which of the following is the most appropriate initial step in management?

Accepted Answer

Bimanual massage

Answer

Oxytocin

Answer

Blood product transfusion

Answer

Uterine artery embolization

Answer

Hysterectomy

Stages of labor

Study Resources

Lessons

Questions

Flashcards

Lessons

Physiology of parturition

First stage of labor

Second stage of labor

Third stage of labor

Fourth stage of labor

Cardinal movements of labor

Labor curve and Friedman curve

Induction of labor indications and methods

Augmentation of labor

Cervical ripening methods

Fetal heart rate monitoring

Pain management in labor

Operative vaginal delivery

Practice Questions

Flashcards

About Stages of labor for USMLE

Lessons in Stages of labor

Master Stages of labor