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Obstetrics quiz

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Question 1
At 12 weeks gestation where would you expect to feel the uterine fundus?
A
Halfway between umbilicus and xiphisternum
B
Symphysis pubis
C
Xiphisternum
D
Umbilicus
Question 2
At 28 weeks gestation where would you expect to feel the uterine fundus?
A
Umbilicus
B
Halfway between xiphisternum and umbilicus
C
Xiphisternum
D
Symphysis pubis
Question 3
What does symmetrical intrauterine growth restriction (both the head circumference and abdominal circumference are lower than normal) suggest?
A
Chromosomal disorder
B
Placental insufficiency
Question 3 Explanation: 
Symmetrical IUGR usually suggests a baby has a chromosomal disorder. This is because in a healthy baby the head circumference should remain normal, even if there is significant placental insufficiency, as the body makes sure the brain receives the necessary fuel at the expense of the rest of the body. That's why in placental insufficiency the abdominal circumference is reduced but the head circumference is normal (asymmetrical IUGR).
Question 4
Which 2 of the following does a "membrane sweep" involve?
A
Rupture of membranes
B
Release of prostaglandins
C
Significant bleeding
D
Use of finger to separate the amniotic membrane from the cervix.
Question 4 Explanation: 
A midwife usually performs an internal examination on the mother and uses their finger to separate the amniotic membranes from the walls of the cervix. This causes release of prostaglandins which can kickstart the labour process.
Question 5
Which of the following methods is the correct way to calculate the estimated date of delivery (EDD)?
A
First day of LMP + 9 months
B
Last day of LMP + 8 months and 1 week
C
First day of LMP + 9 months and 1 week
D
First day of last menstrual period (LMP) + 8 months and 1 week
Question 5 Explanation: 
The correct way to calculate the EDD is to add 9 months and 1 week onto the first day of the last normal menstrual period. This method may not be reliable if a woman is unsure about when her last menstrual period was. As a result ultrasound is used to more accurately date pregnancies.
Question 6
Which of the following are risk factors for pre-eclampsia?
A
Maternal age > 40
B
Change of partner
C
Family history of pre-eclampsia in mother or sisters
D
First pregnancy
E
Obesity (BMI >35)
Question 7
Which of the following are causes of postpartum haemorrhage?
A
Vaginal or vulval lacerations
B
Uterine atony
C
Retained Placenta
D
Coagulapathy
Question 7 Explanation: 
All of the above are potential causes of PPH with uterine atony been the most common. Coagulopathy is a rare cause, accounting around 1% of PPH.
Question 8
At what stage of gestation would you expect a nulliparous women to begin to feel foetal movements?
A
14-16 weeks
B
10-12 weeks
C
22-24 weeks
D
18-20 weeks
Question 8 Explanation: 
Most women will become aware of foetal movements around 18-20 weeks. However if a women has had previous pregnancies they often notice movements earlier (around 15-18 weeks).
Question 9
What is the most common cause of postpartum haemorrhage?
A
Uterine atony
B
Uterine rupture
C
Vulval or vaginal lacerations
D
Retained placenta
Question 9 Explanation: 
The most common cause of PPH is uterine atony, however retained placenta and vaginal lacerations also account for a significant proportion of PPH. Uterine atony describes a state in which the uterus can no longer effectively contract. Because the uterus cannot contract the blood vessels which were supplying the placenta are not compressed and can therefore bleed profusely. A uterus can become atonic for a number of reasons such as prolonged labour, large baby, multiple pregnancy and retained placenta.
Question 10
Which of the following statements describe the first stage of labour correctly?
A
Starts when regular painful contractions begin and ends when the cervix is fully effaced and dilated to 5 cm.
B
Onset of painful contractions to full effacement of the cervix. The membranes are still intact.
C
Starts when the effaced cervix is 3cm dilated and ends when the cervix is fully dilated at 10cm.
Question 11
At 22 weeks gestation where would you expect to find the uterine fundus?
A
Halfway between umbilicus and xiphisternum
B
Umbilicus
C
Xiphisternum
D
Symphysis pubis
Question 12
What is the definition of postpartum haemorrhage (PPH)?
A
Loss of >200ml of blood from the vagina during delivery
B
Loss of >200ml of blood from the vagina within 24 hours of delivery
C
Loss of >500ml of blood from the vagina within 24 hours of delivery
D
Loss of >500ml of blood from the vagina during delivery
Question 12 Explanation: 
Primary postpartum haemorrhage is defined as a loss of blood >500ml from the vagina within 24 hours of delivery. If the blood loss is between 500-1000ml it is defined as a minor PPH. If the blood loss is more than 1000ml it is defined as a major PPH.
Question 13
Which period of gestation does the 3rd trimester represent?
A
30-41 weeks
B
29-40 weeks
C
27-39 weeks
D
28-40 weeks
Question 13 Explanation: 
The third trimester starts at 29 weeks and ends at 40 weeks.
Question 14
Which of the following need to be present for a women to be diagnosed with pre-eclampsia?
A
Visual disturbance
B
Haematuria
C
Hypertension
D
Proteinurea
E
Hypotension
Question 14 Explanation: 
Pre-eclampsia is defined as the presence of both hypertension and proteinuria during pregnancy.
Question 15
At 36 weeks gestation where would you expect to find the uterine fundus?
A
Umbilicus
B
Halfway between umbilicus and xiphisternum
C
Xiphisternum
D
Symphysis pubis
Question 16
Which of the following statements describes the third stage of labour correctly?
A
The third stage begins once the baby is born and ends 24 hours after the time the baby was born.
B
The third stage begins once the baby and placenta have been expelled from the uterus and ends when the uterus contracts down to its normal size.
C
The third stage begins once the baby is born and ends once the placenta and membranes have been expelled from the uterus.
Question 17
Which of the following are complications of induction?
A
Prolapsed cord
B
Uterine hyper-stimulation
C
Caesarian section
D
IUGR
E
Uterine rupture
Question 17 Explanation: 
Induction of labour increases the risk of a number of complications. The uterus can become over stimulated causing prolonged contractions which can starve the baby of oxygen. It can also cause contractions to be so powerful they cause rupture of the uterus. Finally if a women is induced to early it can result in prolonged labour.
Question 18
Which of the following is a prostaglandin commonly used in induction of labour?
A
Atenolol
B
Misoprostol
C
Labetalol
Question 18 Explanation: 
Misoprostol is inserted vaginally and causes effacement of the cervix in addition to uterine contraction.
Question 19
What does asymmetrical intrauterine growth restriction (normal head circumference with reduced abdominal circumference) suggest?
A
Chromosomal disorder
B
Placental insufficiency
Question 19 Explanation: 
If the placenta is not supplying adequate blood to the fetus the body directs prioritises brain development at the expense of the body. As a result the abdominal circumference decreases whilst the head circumference remains normal.
Question 20
Which 2 of the following are drugs which can be used to induce labour?
A
Syntocinon
B
Nitrogen oxide
C
Misoprostol
D
Labetalol
Question 20 Explanation: 
Syntocinon is a synthetic form of oxytocin. Oxytocin causes uterine contractions and cervical dilatation. Misoprostol is a prostaglandin which causes thinning of the cervix and uterine contraction.
Question 21
Which of the following is thought to be a cause of hyperemesis gravidarum?
A
Underlying infection
B
Psychological issues
C
High levels of circulating HCG
D
Over eating
Question 21 Explanation: 
Hyperemesis gravidarum is a severe form of morning sickness in which women suffer with excessive nausea and vomiting which prevents them taking in adequate amounts of food and water. It is thought to be caused by high levels of circulating HCG. This is supported by the fact that it's more common in multiple pregnancies and also tends to only affect women during the first 12 weeks of pregnancy.
Question 22
Which period of gestation does the 1st trimester represent?
A
1-11 weeks
B
1-12 weeks
C
1-13 weeks
D
1-10 weeks
Question 22 Explanation: 
The first trimester refers to the first 12 weeks of pregnancy.
Question 23
Which of the following statements describes the second stage of labour correctly?
A
The second stage begins at full dilation of the cervix and ends once the baby and placenta have been expelled from uterus.
B
The second stage begins at full dilatation of the cervix and ends when the baby is born.
C
The second stage begins when the cervix is 7 cm dilated and ends when the cervix reaches full dilatation.
Question 24

By James Heilman, MD

Which sign is present on this pregnant abdomen?

A
Stria albicans
B
Linea nigra
C
Striae gravidarum
Question 24 Explanation: 
Linea nigra can be seen on this image. This occurs in around 3/4 of pregnancies. It's described as a vertical line of increased pigmentation running down the centre of the pregnant abdomen. The increased pigmentation occurs over the linea alba which is stretched during pregnancy to accommodate the developing foetus.
Question 25
Which period of gestation does the 2nd trimester represent?
A
13-28 weeks
B
14-29 weeks
C
10-20 weeks
D
15-30 weeks
Question 25 Explanation: 
The second trimester begins at 13 weeks and ends at 28 weeks.
Question 26
Which of the following are recognised causes of intrauterine growth restriction (IUGR)?
A
Diabetes
B
Smoking
C
Pre-eclampsia
D
Alcohol
E
Hypertension
F
Hypercholesterolaemia
Question 26 Explanation: 
IUGR can occur for a large number of reasons . Smoking accounts for around 30-40% of IUGR cases.
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