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| Question | Answer |
|---|---|
| What is an abnormal lie of the fetus? | It is when the long axis of the fetus is not lying along the long axis of the mother’s uterus. |
| What are the 3 types of abnormal lie? | Transverse Oblique Unstable (Longitudinal lie may either be cephalic or breech and is considered normal.) |
| What is malposition in terms of fetal positioning? | It is when the fetus is lying longitudinally and the vertex is presenting, but not in the Occiput Anterior (OA) position. |
| what are the two Occiput under MALPOSITION? | Occiput Posterior (OP) Occiput Transverse (OT) |
| What is Occiput Posterior (OP)? | A malposition of vertex presentation. Arrested labor may occur when the head does not rotate and/or descend. Delivery may be complicated by perineal tears or extension of an episiotomy. |
| What is Occiput Transverse (OT)? | It is the incomplete rotation of Occiput Posterior to Occiput Anterior, resulting in a horizontal or transverse position of the fetal head. |
| What 5 factors favor malposition? | 1. Pendulous abdomen – in multiparae 2. Anthropoid pelvic brim – favors direct OP/OA 3. Android pelvic brim 4. Flat sacrum – transverse position 5. Placenta on the anterior uterine wall |
| What is the usual course of labor in malposition cases? | Labor is usually normal, except for a prolonged second stage lasting more than 2 hours. |
| What are the abdominal examination findings in malposition? | a) Lower part of the abdomen is flattened b) Difficult to palpate the fetal back c) Fetal small parts are palpable anteriorly d) Fetal heart tone may be heard in the flanks |
| What are the vaginal examination findings in malposition? | a) Posterior fontanel towards sacral-iliac joint (hard to feel) b) Anterior fontanel easily felt if head is deflexed c) Marked molding and extensive caput, making station and position hard to assess |
| What is the management for malposition during labor? | Spontaneous rotation to occiput anterior occurs in 90% of cases, especially with good uterine contractions, a spacious pelvis, and an average-sized fetus. If arrest of labor occurs in the second stage: Emergency cesarean section. |
| What is malpresentation? | It is when the fetus is lying longitudinally, but presents in any manner other than vertex. |
| 5 pparts of the body where Malpresentation occur | • Breech • Brow • Face • Shoulder • Compound |
| It’s a type of vertex malpresentation and is the most uncommon of all presentations. Babies born vaginally from brow presentation experience extreme facial edema. | Brow Presentation |
| How is Brow Presentation assessed on abdominal examination? | More than half of the fetal head is above the symphysis pubis, and the occiput is palpable at a higher level than the sinciput. |
| How is Brow Presentation assessed on vaginal examination? | It can be delivered only by cesarean section (CS). |
| It occurs when the fetal head is hyper-extended and the face becomes the presenting part. The chin (mentum) is the denominator. | Face Presentation |
| What is the mechanism of labor in Face Presentation? | Descent Internal Rotation Flexion Extension External Rotation Expulsion |
| What are the maternal causes of Face Presentation? | Lax uterus due to multiparity Contracted pelvis / cephalopelvic disproportion (CPD) Placenta previa Multiple pregnancy Occiput posterior position |
| What are the fetal causes of Face Presentation? | Large fetus Congenital malformation (e.g. anencephaly) Multiple cord coils Musculoskeletal abnormality (spasm/shortening of neck extensors) Tumors around the neck (e.g. congenital goiter) |
| a. Absence of engagement b. On internal examination, fingers feel the mouth, nose, malar bones, and orbital ridges c. Ultrasound (UTZ) confirms the diagnosis are sign and symtomps of? | Face Presentation |
| What is the management for Face Presentation when the chin is in the anterior position (LMA or RMA)? | If uterine contractions are strong, the head is small, shoulders have entered the pelvis, and there’s no pelvic contraction, vaginal delivery is possible but longer than usual. Forceps may be used to hasten the second stage. |
| What is the management for Face Presentation when the chin is in the posterior position (LMP or RMP)? | Vaginal delivery is usually impossible and dangerous as it can lead to transverse arrest — cesarean section (CS) is recommended. |
| It occurs when the larger diameter of the fetal head presents, causing slower labor progress and descent of the fetal head. | Sincipital Presentation |
| How does Sincipital Presentation affect labor? | It slows labor progress and the descent of the fetal head due to the larger presenting diameter. |
| What are the different presenting part diameters in various fetal presentations? (in cm) (underSincipal Presentation Suboccipitobregmatic (Flexed vertex)-__cm | 9.5 cm |
| What are the different presenting part diameters in various fetal presentations? (in cm) (underSincipal Presentation) Suboccipitofrontal (Partially deflexed vertex)__cm | 10.5 cm |
| What are the different presenting part diameters in various fetal presentations? (in cm) (underSincipal Presentation) Occipitofrontal (Deflexed vertex)__cm | 11.5 cm |
| What are the different presenting part diameters in various fetal presentations? (in cm) (underSincipal Presentation) Mentovertical (Brow)__cm | 13 cm |
| What are the different presenting part diameters in various fetal presentations? (in cm) (underSincipal Presentation) Submentobregmatic (Face)__cm | 9.5 cm |
| 4 types of .MALPRESENTATION | Vertex Malpresentation Breech Presentation Shoulder Presentation Compound Presentation |
| 3 types of Vertex Malpresentationn (under malpresentation) | Brow Presentation Face Presentation Sincipal Presentation |
| Most common cause of fetal malpresentation. | Breech Presentation |
| 4 Types of Breech Presentation | Frank Breech Complete Breech Footling Breech Kneeling Breech |
| the buttocks come first, with the hips flexed and the knees extended. what type of Breech Presentation is it? | Frank Breech |
| the buttocks come first, with both the hips and knees flexed. what type of Breech Presentation is it? | Complete Breech |
| when one or both feet come first. It’s rare in term pregnancies but common in premature births. what type of Breech Presentation is it? | Footling Breech |
| when one or both legs are extended at the hips and flexed at the knees. This presentation is extremely rare. what type of Breech Presentation is it? | Kneeling Breech |
| Leopold’s Maneuver no. 1 – head is felt on the fundus. what examination is this? (under Assessment in Breech Presentation) | Abdominal Examination |
| Leopold’s Maneuver no. 2 – FHT on upper quadrant of the abdomen. what examination is this? (under Assessment in Breech Presentation) | Auscultation |
| Buttocks and/or feet are felt; thick dark meconium is normal. what examination is this? (under Assessment in Breech Presentation) | Vaginal Examination |
| What are the maternal causes (etiology) of breech presentation? | Polyhydramnios Oligohydramnios Uterine abnormalities Pelvic tumor Uterine surgery Contracted pelvis Previous breech delivery |
| What are the fetal causes (etiology) of breech presentation? | Prematurity Multiple pregnancy Fetal anomalies such as: • Hydrocephalus • Anencephaly |
| What is the placental cause (etiology) of breech presentation? | Placenta previa |
| Which of the following is a common complication of breech presentation due to poor fitting of the presenting part into the pelvic brim? A. Meconium aspiration B. Cord prolapse C. Shoulder dystocia D. Uterine rupture | B. Cord prolapse |
| Which of the following birth injuries can occur in breech presentation? A. Skull fracture B. Intracranial hemorrhage C. Abdominal organ rupture D. All of the above | D. All of the above |
| What causes dysfunctional and prolonged labor in breech presentation? A. Strong uterine contractions B. Rigid cervix C. Soft buttocks failing to aid cervical dilatation D. Small fetal head | C. Soft buttocks failing to aid cervical dilatation |
| Why is meconium aspiration a risk in breech presentation? A. Premature rupture of membranes B. Pressure on abdomen and buttocks forces meconium into amniotic fluid before birth C. Uterine infection D. Tight nuchal cord | B. Pressure on abdomen and buttocks forces meconium into amniotic fluid before birth |
| What is intrauterine anoxia? A. Excess amniotic fluid B. Fetal oxygen deprivation inside the uterus C. Premature delivery D. Cord prolapse | B. Fetal oxygen deprivation inside the uterus |
| The most serious complication of breech presentation is: A. Meconium aspiration B. Cord prolapse C. Fetal death D. Prolonged labor | C. Fetal death |
| How is breech presentation confirmed? A. Leopold’s maneuvers only B. X-ray pelvimetry C. Ultrasound at or after 36 weeks D. Internal examination | C. Ultrasound at or after 36 weeks |
| When is an External Cephalic Version (ECV) attempted? A. At or after 34 weeks B. At or after 37 weeks, if vaginal delivery is possible and no contraindications exist C. Only during labor D. After membrane rupture | B. At or after 37 weeks, if vaginal delivery is possible and no contraindications exist |
| Which of the following is a contraindication for ECV? A. Breech presentation B. Fetal abnormality C. Cephalic presentation D. Adequate amniotic fluid | B. Fetal abnormality |
| What are the risks associated with ECV? A. Placental abruption B. PROM (Premature Rupture of Membranes) C. Cord accident D. All of the above | D. All of the above |
| Vaginal breech delivery may be attempted if: A. Fetal weight is more than 3,500 grams B. There’s no pelvic contraction and labor progresses spontaneously C. No experienced personnel is available D. There’s cephalopelvic disproportion | B. There’s no pelvic contraction and labor progresses spontaneously |
| What is the key principle for the safe conduct of vaginal breech delivery? A. Immediate extraction of the fetus B. Masterly Inactivity (Hands-Off) approach C. Continuous pulling of the fetus D. Routine cesarean section in all breech cases | B. Masterly Inactivity (Hands-Off) approach |
| Which is NOT correct in the safe conduct of vaginal breech delivery? A. Never pull from below B. Keep fetal back posterior C. Forceps ready for the head D. Anesthetist and pediatrician present | B. Keep fetal back posterior |
| born without traction or manipulation from OB (under General Techniques of Vaginal Breech Delivery) | Spontaneous Breech Delivery |
| born up to the umbilicus; rest of the body is extracted (under General Techniques of Vaginal Breech Delivery) | Partial Breech Extraction |
| entire body is extracted by OB (under General Techniques of Vaginal Breech Delivery) | Total Breech Extraction |
| what are the 3 General Techniques of Vaginal Breech Delivery | Spontaneous Breech Delivery – born without traction or manipulation from OB Partial Breech Extraction – born up to the umbilicus; rest of the body is extracted Total Breech Extraction – entire body is extracted by OB |
| What is the primary purpose of Pinard’s Maneuver in breech delivery? A. To rotate the shoulders B. To flex the knee in breech with an extended leg C. To deliver the head D. To assist with trunk extension | B. To flex the knee in breech with an extended leg |
| The Loveset Maneuver is used to correct: A. Upward displacement of the arms during breech delivery B. Flexion of the knee C. Head deflection during delivery D. Shoulder rotation during breech delivery | A. Upward displacement of the arms during breech delivery |
| In which maneuver is traction applied to the jaw and shoulders to extract the head after the infant's body has been delivered? A. Mauriceau-Smellie-Veit Maneuver B. Prague Maneuver C. Bracht Maneuver D. Pinard’s Maneuver | A. Mauriceau-Smellie-Veit Maneuver |
| Prague Maneuver is used when: A. The breech baby has a deflexed head B. The fetus's back fails to rotate to the anterior C. The fetus's arms need to be rotated D. The head is fully delivered | B. The fetus's back fails to rotate to the anterior |
| What is the Bracht Maneuver used for during breech delivery? A. To extend the fetus’s trunk and legs to assist in head delivery B. To rotate the arms C. To flex the knee of an extended leg D. To correct a failed shoulder rotation | A. To extend the fetus’s trunk and legs to assist in head deliver |
| When is Abdominal Rescue indicated during breech delivery? A. Extended arms in breech presentation B. Deflexed and entrapped head C. Stuck shoulders D. Failure of leg extensio | B. Deflexed and entrapped head |
| Cleidotomy is typically performed in cases of: A. Shoulder dystocia during vaginal breech delivery B. Breech delivery with an extended leg C. Fetal head extension D. Failure of the fetus’s back to rotate | A. Shoulder dystocia during vaginal breech delivery |
| Enumerate the maneuvers used in breech delivery | Pinard’s Maneuver Loveset Maneuver Mauriceau-Smellie-Veit Maneuver Prague Maneuver Bracht Maneuver Abdominal Rescue Cleidotomy |
| Enumerate the maneuvers used in breech delivery and their primary purpose: | Pinard’s – Flexes knee. Loveset – Fixes arm displacement. Mauriceau-Smellie-Veit – Extracts head. Prague – Fixes back rotation. Bracht – Extends body. Abdominal Rescue – Replaces fetus. Cleidotomy – Cuts shoulde |
| Which of the following are 2 aspects in the management of BP A. Continuous assessment of POL (contractions, effacement, dilation, station, presentation) B. Ultrasound to detect anomalies like hydrocephaly, microcephaly, and anencephaly C.assess HR | A. Continuous assessment of POL (contractions, effacement, dilation, station, presentation) B. Ultrasound to detect anomalies like hydrocephaly, microcephaly, and anencephaly |
| what are the 4 management used in Breech Presentation | Confirmation by ultrasound External Cephalic Version (ECV) Vaginal Breech Delivery Cesarean Section (CS) |
| Occurs when fetus assumes a transverse or oblique lie | Shoulder Presentation |
| The fetus does not engage in this presentation so there is a great danger of cord prolapsed after membranes have ruptured what kind of malpresentation is this? | Shoulder Presentation |
| Which of the following is NOT a cause of shoulder presentation? A. Lax uterine and abdominal muscles due to multiparity B. Contracted pelvis C. Normal fetal lie and well-engaged vertex D. Placenta previa | C. Normal fetal lie and well-engaged vertex |
| Causes of shoulder presentation include: A. Lax uterine/abdominal muscles, contracted pelvis, uterine abnormalities, preterm fetus, hydrocephalus, placenta previa, multiple pregnancy B. Fully engaged cephalic, adequate pelvis, toned uterus | A. Lax uterine/abdominal muscles, contracted pelvis, uterine abnormalities, preterm fetus, hydrocephalus, placenta previa, multiple pregnancy |
| Signs & symptoms of shoulder presentation: A. Uterus more horizontal than vertical & on Leopold’s head & buttocks occupy the sides of the uterus B. Fetal head engaged, vertical uterus C. Head in fundus, breech at pelvi D. FHT in lower abdomen | A. Uterus more horizontal than vertical & on Leopold’s head & buttocks occupy the sides of the uterus |
| management for shoulder presentation? A. External version can be performed before labor begins to rotate fetus, and if version fails, the preferred method is Cesarean section B. Immediate forceps delivery C. Labor induction with oxytocin | A. External version can be performed before labor begins to rotate fetus, and if version fails, the preferred method is Cesarean section |
| A fetal presentation in which an extremity presents alongside the part of the fetus closest to the birth canal. The majority of compound presentations consist of a fetal hand or arm presenting with the vertex. | Compound Presentation |
| Which of the following describes the correct management of compound presentation? A. Observe if the arm retracts; if not, gently push it upward while applying fundal pressure to move the head down. B. Immediate cesarean section. C. Vacuum extraction. | A. Observe if the arm retracts; if not, gently push it upward while applying fundal pressure to move the head down. |
| (under summary) what is the management for Face? | Vaginal delivery (chin anterior), CS (chin posterior) |
| (under summary) what is the management for Breech | Vaginal delivery +- ECV / CS |
| (under summary) what is the management for Brow? | Cesarean Section (CS) |
| (under summary) what is the management for Shoulder ? | Cesarean Section (CS) |
| (under summary) what is the management for Compound ? | Replacement of prolapsed arm →vaginal delivery / Cesarean Section |
| Refers to the presence of signs in a pregnant woman before or during childbirth that suggest that the fetus may not be well. | FETAL DISTRESS |
| Which of the following is a sign of fetal distress related to maternal perception? A. Increased fetal movement felt by the mother B. Decreased movement felt by the mother C. Clear amniotic fluid D. Normal fetal heart rate | B. Decreased movement felt by the mother |
| Which of the following is a sign of fetal distress related to the amniotic fluid? A. Clear amniotic fluid B. Green meconium-stained amniotic fluid C. Yellowish amniotic fluid D. Odorless amniotic fluid | B. Green meconium-stained amniotic fluid |
| Which of the following is a non-reassuring pattern seen on cardiotocography indicating fetal distress? A. Increased fetal heart rate variability B. Late decelerations C. Decreased fetal movement D. Consistent heart rate after contraction | B. Late decelerations |
| Which of the following fetal heart rate patterns are associated with fetal distress? A. Increased variability in fetal heart rate B. Tachycardia and bradycardia, especially during and after contractions C. Stable heart rate without any changes | B. Tachycardia and bradycardia, especially during and after contractions |
| What would decreased variability in the fetal heart rate most likely indicate? A. Healthy fetus B. Fetal distress C. Normal labor D. Good maternal condition | B. Fetal distress |
| Causes of Fetal Distress (1-5) (total of 10) | 1. Breathing problems 2. Abnormal position and presentation of the fetus 3. Multiple births 4. Shoulder dystocia 5. Umbilical cord prolapse |
| Causes of Fetal Distress (6-10) (total of 10) | 6. Nuchal cord 7. Placental abruption 8. Premature closure of the fetal ductus arteriosus 9. Uterine rupture 10. Intrahepatic cholestasis of pregnancy, a liver disorder during pregnancy |
| What current recommendations say about the treatment of "fetal distress"? A. Look for specific signs, assess them, and implement intrauterine resuscitation. B. Always perform a cesarean section. C. Wait for the situation to resolve. | A. Look for specific signs, assess them, and implement intrauterine resuscitation. |
| How did diagnosis of "fetal distress" traditionally affect treatment? A. Led to rapid delivery by instrumental delivery or cesarean if vaginal delivery was not advised. B. Led to observation and monitoring. C. Led to antibiotic treatment. | A. Led to rapid delivery by instrumental delivery or cesarean if vaginal delivery was not advised. |
| Occurs when the cord passes out the uterus ahead of the presenting part. Occurs after membranes have ruptured when the fetus is not yet engaged or does not completely cover the pelvic inlet. (identification) | PROLAPSE UMBILICAL CORD |
| What occurs in a prolapsed umbilical cord when the presenting part descends in the birth canal? A. Fetal movement increases B. The umbilical cord is compressed C. There is no effect on the fetal heart rate D. The cervix opens more quickly | B. The umbilical cord is compressed (Always lead to cord compression as the presenting part descends in the birth canal.) |
| enumeration 6 Causes of PROLAPSE UMBILICAL CORD | 1. Polyhydramnios 2. Long cord 3. Malposition and malpresentation (shoulder and foot) 4. Prematurity 5. Placenta previa 6. Premature rupture of membranes |
| Abnormal fetal lie tends to result in space below the fetus in the maternal pelvis, which can then be occupied by the cord. what risk factor is it? (under PROLAPSE UMBILICAL CORD Spontaneous Factors) ( | Fetal Malpresentation |
| or an abnormally high amount of amniotic fluid what risk factor is it? (under PROLAPSE UMBILICAL CORD Spontaneous Factors) | Polyhydramnios, |
| likely related to increased chance of malpresentation and relative polyhydramnios what risk factor is it? (under PROLAPSE UMBILICAL CORD Spontaneous Factors) | Prematurity |
| usually described as <2500g at birth, though some studies will use <1500g. Cause is likely similar to those for prematurity what risk factor is it? (under PROLAPSE UMBILICAL CORD Spontaneous Factors) | Low Birth Weight |
| or being pregnant with more than one fetus at a given time: more likely to occur in the fetus that is not born first. what risk factor is it? (under PROLAPSE UMBILICAL CORD Spontaneous Factors) | Multiple Gestation |
| about half of prolapses occur within 5 minutes of membrane rupture, two-thirds within 1 hour, 95 % within 24 hours. what risk factor is it? (under PROLAPSE UMBILICAL CORD Spontaneous Factors) | Spontaneous Rupture of Membranes |
| • Artificial rupture of membranes • Placement of internal monitors (for example, internal scalp electrode or intrauterine pressure catheter) • Manual rotation of fetal head are the treatment for? | PROLAPSE UMBILICAL CORD |
| Which of the following is indicated when the cord protrudes from the vagina during labor? A. Sign of Prolapsed Umbilical Cord B. Cause of Fetal Distress C. Associated Factor D. Management Step | A. Sign of Prolapsed Umbilical Cord |
| What does it indicate when the umbilical cord is palpable in the vaginal canal or cervix during an internal examination (IE)? | A. Sign of Prolapsed Umbilical Cord |
| What does fetal distress with variable decelerations in the fetal heart tracing (FHT) pattern usually indicate? A. Cause of Low Birth Weight B. Multiple Gestation C. Artificial Rupture of Membranes D. Sign of Prolapsed Umbilical Cord | D. Sign of Prolapsed Umbilical Cord |
| 1. Cord protrudes from the vagina. 2. Cord is palpable in vaginal canal /cervix during IE 3. Fetal distress, especially variable deceleration in FHT pattern are the sign and symtomps of? | Prolapsed Umbilical Cord |
| This is the most common type of cord prolapse A. Overt Umbilical Prolapse B. Occult Umbilical Prolapse C. Funic (Cord) Presentation | a.Overt Umbilical Cord Prolapse |
| Descent of the umbilical cord past the presenting fetal part. - Cord is through the cervix and into or beyond the vagina. - Requires rupture of membranes. A. Overt Umbilical Prolapse B. Occult Umbilical Prolapse C. Funic (Cord) Presentation | A. Overt Umbilical Prolapse |
| Which type of umbilical prolapse occurs when the umbilical cord descends alongside the presenting fetal part, but has not advanced past the presenting part and can occur with either intact or ruptured membranes? | Occult Umbilical Prolapse |
| Which type of umbilical prolapse involves the cord between the presenting part and membranes, without passing the cervix, and with intact membranes? A. Overt Prolapse B. Occult Prolapse C. Funic Presentation | C. Funic Presentation |
| Enumerate the three types of umbilical cord prolapse: | Overt Umbilical Cord Prolapse Occult Umbilical Prolapse Funic (Cord) Presentation |
| 1. What is the first step in managing umbilical cord prolapse after membranes have ruptured? A. Always assess FHT (Fetal Heart Tones). B. Apply pressure on the umbilical cord. C. Replace the cord back into the vagina. | A. Always assess FHT (Fetal Heart Tones). |
| Which position should the client be placed in to reduce pressure on the umbilical cord? A. Lying flat on the back. B. Knee-chest or Trendelenburg position. C. Supine with hips elevated. D. Sitting upright in a chair | B. Knee-chest or Trendelenburg position. |
| What should be done if the umbilical cord is exposed to air? A. Leave the cord exposed for monitoring. B. Cover the cord with a sterile saline-moistened compress to prevent drying. C. Apply pressure on the cord to prevent it from drying. | B. Cover the cord with a sterile saline-moistened compress to prevent drying. |
| What should never be done when managing an umbilical cord prolapse? A. Apply oxygen therapy to the mother. B. Replace the cord back into the vagina. C. Perform an emergency cesarean section. D. Place the mother in a knee-chest position. | B. Replace the cord back into the vagina. |
| Which of the following is an essential step in managing umbilical cord prolapse? A. Apply oxygen therapy to the mother. B. Perform immediate cesarean section. C. Allow the cord to dry and monitor. | A. Apply oxygen therapy to the mother. |
| When is vaginal delivery appropriate in cases of umbilical cord prolapse? A. Only if the cervix is fully dilated and there is no fetal distress. B. If the mother is under anesthesia. C. When the fetal heart rate is low. | A. Only if the cervix is fully dilated and there is no fetal distress. |
| In what situation is a cesarean section indicated for managing umbilical cord prolapse? A. When the cervix is fully dilated and the fetal heart rate is reassuring B. When the cervix is not fully dilated and there is fetal distress | B. When the cervix is not fully dilated and there is fetal distress. |
| What are the 6 steps in managing umbilical cord prolapse after membranes have ruptured? | Prevention Reduce pressure on the cord If cord is exposed to air, cover with saline moistened sterile compress Never replace cord back into the vagina O2 therapy . Deliver baby ASAP |
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