Vaginal Delivery

Prepared by: Casey Rae Yano, Senior Clerk

1. What term collectively refers to third- and fourth-degree perineal lacerations involving the
anal sphincter and perineal body?
a. Caput succedaneum
*b. Obstetric anal sphincter injuries (OASIS)
c. Episiotomy complications
d. Perineal trauma

2. In a large randomized study, what benefits were mainly observed in nulliparas who
performed daily antepartum perineal massage?
a. Reduced OASIS rates
*b. Lower rates of episiotomy and first-degree laceration
c. Decreased caput formation
d. Prevention of fetal malpositioning

3. What is the purpose of the Epi-No intravaginal pump balloon in perineal management?
a. To expedite labor
b. To induce uterine contractions
*c. To stretch the perineum antepartum
d. To control postpartum bleeding

4. How is gentle axial traction applied during childbirth?

a) Applying pressure on the abdomen
*b) Grasping the head and neck sides
c) Pulling the legs gently
d) Lateral neck extension

5. Why is it crucial to avoid abrupt lateral extension of the neck during delivery?
a) To speed up the process
*b) To prevent brachial plexus injury
c) To facilitate external rotation
d) To ensure proper positioning

6. Describes the Modified Ritgen maneuver

a) Applying pressure on the abdomen
b) Lateral neck extension
*c) Upward pressure on the fetal chin
d) Pulling the legs gently

7. In cases of prolonged delay during childbirth, what actions may be taken to facilitate the
birth process?

Prepared By: Yano, Casey Rae

UCSM Senior Clerk
 a) Delay further and monitor
b) Apply forceful lateral extension
c) Administer medication
*d) Moderate outward traction on the head

8. Why has immediate nasopharyngeal bulb suctioning become less routine in newborn
care?
a) To speed up the process
*b) To prevent neonatal bradycardia
c) To reduce the risk of infection
d) To facilitate external rotation

9. Under what circumstances is suctioning recommended for neonates, particularly in the

presence of meconium-stained fluid?
a) Routine practice for all newborns
b) When the newborn is vigorous
c) Only if the baby is crying loudly
*d) When there is an obstruction to spontaneous breathing

10. Why is delayed cord clamping recommended for vigorous term neonates?
a. To prevent neonatal jaundice
b. To expedite maternal resuscitation
*c. To transfer blood to the newborn
d. To lower anemia rates

11. What potential harm is associated with greater hemoglobin concentration due to delayed
cord clamping?
a. Increased risk of hypotension
*b. Elevated risks for hyperbilirubinemia
c. Improved neonatal phototherapy rates
d. Reduced Apgar scores

12. In which populations may delayed cord clamping be particularly valuable?

a. Populations with high Apgar scores
b. Populations with low iron deficiency
*c. Populations where iron deficiency is prevalent
d. Populations with elevated hemoglobin concentrations

13. What is the primary benefit of manual rotation of the occiput during childbirth?
a. Increased rates of cesarean delivery
b. Reduced rates of blood loss
*c. Lower rates of OASIS (obstetric anal sphincter injuries)
d. Elevated rates of persistent occiput posterior position

Prepared By: Yano, Casey Rae

UCSM Senior Clerk
14. A primiparous woman is concerned about the risk of perineal trauma. She inquires about
the Epi-No intravaginal pump balloon. What information would you provide regarding the
Epi-No device?
a. Epi-No has been proven effective in preventing episiotomy and perineal trauma.
*b. Randomized trials have not shown the Epi-No device to prevent episiotomy, perineal
trauma, or levator injury.
c. Epi-No is recommended for all pregnant women as a standard practice.
d. The Epi-No device is primarily used for pain relief during labor.

15. A woman is considering antepartum perineal massage as part of her birth preparation.
What counseling points would you provide to her regarding the potential benefits and
limitations of antepartum perineal massage?
*a. Antepartum perineal massage may reduce the need for episiotomy and decrease the
risk of first-degree lacerations but may not consistently prevent obstetric anal sphincter
injuries (OASIS).
b. Antepartum perineal massage guarantees the prevention of all perineal trauma.
c. Antepartum perineal massage is only effective if started after 38 weeks of gestation.
d. Antepartum perineal massage has no impact on the rates of episiotomy or perineal
lacerations.

16. What predisposing risks are associated with persistent occiput posterior position during
labor?
a. Epidural analgesia and nulliparity
b. Reduced fetal weight and pelvic shapes
c. Prior delivery with occiput anterior position
*d. Epidural analgesia, nulliparity, greater fetal weight, and prior delivery with occiput
posterior positioning

17. How is shoulder dystocia diagnosed according to the American College of Obstetricians
and Gynecologists (ACOG)?
a. Mean head-to-body delivery time >60 seconds
*b. Maneuvers required to free the shoulder
c. Clinical perception of normal traction ineffectiveness
d. Maternal obesity and diabetes

18. What are the main maternal risks associated with shoulder dystocia?
a. Brachial plexus injury
b. Neonatal asphyxia
c. Increased rates of hyperbilirubinemia
*d. Serious perineal tears and postpartum hemorrhage

19. What maternal characteristics are associated with an increased risk of shoulder
dystocia?
a. Short stature and low BMI

Prepared By: Yano, Casey Rae

UCSM Senior Clerk
 b. Multiparity and postterm pregnancy
*c. Maternal obesity and diabetes
d. Nulliparity and prior cesarean delivery

20. What technique involves cutting the intervening symphyseal cartilage and ligamentous
support to widen the pelvic outlet?
a. McRoberts maneuver
b. All-fours maneuver
c. Woods maneuver
*d. Symphysiotomy

21. How many types of female genital mutilation (FGM) are classified by the World Health
Organization (WHO)?
a. Three
b. Five
*c. Four
d. Six

22. What long-term risks are associated with female genital mutilation (FGM)?
a. Increased fertility rates
*b. Propensity for urogenital infection, chronic vulvar pain, and dyspareunia
c. Improved psychological well-being
d. Decreased risk of perineal lacerations during childbirth
23. What is the term for the surgical release of scar tissue in the vulva to reopen the vaginal
opening in female genital mutilation (FGM)?
a. Anterior episiotomy
*b. Defibulation
c. Episiorrhaphy
d. Urethrotomy

24. What is the recommended approach for preventing obstetrical complications in women
with female genital mutilation (FGM)?
*a. Deinfibulation
b. Cesarean delivery for all cases
c. Intrapartum incision of the clitoris
d. Vaginal reconstruction surgery

25. What are the goals during the third stage of labor?
a. Rupture of membranes
b. Fetal head engagement
*c. Delivering an intact placenta and avoiding uterine inversion or postpartum
hemorrhage
d. Assessing cervical dilation

Prepared By: Yano, Casey Rae

UCSM Senior Clerk
26. What is the usual practice immediately after newborn birth if the uterus remains firm and
bleeding is minimal?
a. Uterine massage
b. Downward fundal pressure
*c. Watchful waiting until the placenta separates
d. Immediate administration of oxytocin

27. Why must umbilical cord traction not be used to pull the placenta from the uterus?
a. Preventing uterine inversion
b. Enhancing placental separation
c. Facilitating placental delivery
*d. Avoiding complications such as uterine inversion

28. What signs indicate placental separation?

*a. Sudden gush of blood into the vagina, a globular and firmer fundus, outward
movement of the umbilical cord, and elevation of the uterus into the abdomen
b. Decrease in maternal blood pressure
c. Absence of uterine contractions
d. Retention of the placenta in the cervix

29. When can the mother bear down to expel the placenta into the vagina?
a. Immediately after fetal birth
*b. Once the placenta has detached from the uterine wall
c. Before placental separation
d. During the second stage of labor

30. How is the detached placenta propelled into the vagina?

*a. Pressure on the fundus and simultaneous pressure between the symphysis pubis
and the uterine fundus
b. Umbilical cord traction
c. Uterine massage
d. External cephalic version

31. What should be done if placental membranes begin to tear during delivery?
a. Ignore the tears as they are inconsequential
b. Apply increased traction on the umbilical cord
*c. Grasp with a clamp and remove by gentle teasing
d. Administer uterotonic medications

32. 36. What is included in active management of the third stage of labor?
a. Delayed cord clamping and spontaneous placental delivery
b. Gravity-assisted placental delivery
*c. Earlier cord clamping, controlled cord traction, and immediate prophylactic
administration of a uterotonic agent

Prepared By: Yano, Casey Rae

UCSM Senior Clerk
 d. Manual removal of the placenta only

33. Which agent is recommended by the WHO as a first-line choice for postpartum
hemorrhage prevention?
*a. Oxytocin
b. Misoprostol
c. Ergonovine
d. Methylergonovine

34. How is oxytocin usually administered to prevent postpartum hemorrhage?

a. Bolus injection
*b. Continuous intravenous infusion or intramuscular injection
c. Oral administration
d. Subcutaneous injection

35. What is the recommended dose of oxytocin per liter of crystalloid solution for intravenous
infusion?
a. 10 units
*b. 20 units
c. 30 units
d. 40 units

36. Which uterotonic agent is contraindicated in hypertensive women due to its side effects?
a. Oxytocin
b. Misoprostol
c. Ergonovine
*d. Methylergonovine

37. Which uterotonic agent is a long-acting oxytocin analogue?

a. Misoprostol
b. Ergonovine
c. Oxytocin
*d. Carbetocin
38. What is the mean half-life of synthetic oxytocin?
a. 1–2 minutes
b. 2–3 minutes
*c. 3–5 minutes
d. 5–10 minutes

39. 43.How is synthetic oxytocin usually administered to prevent hemodynamic changes?

a. Bolus injection
*b. Continuous intravenous infusion or intramuscular injection
c. Oral administration
d. Subcutaneous injection

Prepared By: Yano, Casey Rae

UCSM Senior Clerk
40. In resource-poor settings lacking oxytocin, what is a suitable dose of misoprostol for
hemorrhage prophylaxis?
a. 200 μg
b. 400 μg
*c. 600 μg
d. 800 μg

41. What side effects are associated with misoprostol use for hemorrhage prophylaxis?
a. Fever and hypertension
*b. Fever and diarrhea
c. Hypotension and nausea
d. Bradycardia and constipation

42. What is the primary aim of skin-to-skin contact between the mother and newborn?
a. Facilitate immediate breastfeeding
b. Ensure the baby's warmth
*c. Connect the mother and newborn dyad early
d. Prevent perineal tears

43. What precautions should be taken during skin-to-skin contact to ensure safety?
a. Use a tight swaddle to secure the newborn
b. Cover the newborn's head and face completely
*c. Continually monitor for physiologic stability, unobstructed breathing, and safe
positioning
d. Keep the room temperature cool to prevent overheating

44. What are the risk factors for obstetric anal sphincter injuries (OASIS)?
a. Primiparity and cesarean delivery
*b. Nulliparity, midline episiotomy, persistent OP position, increasing fetal birthweight,
and operative vaginal delivery
c. Multiparity and breech presentation
d. Post-term gestation and epidural analgesia

45. What long-term complication is associated with obstetric anal sphincter injuries
(OASIS)?
a. Uterine prolapse
b. Ovarian cysts
*c. Anal incontinence
d. Vaginal stenosis

46. How is intrapartum endoanal ultrasound used in the management of perineal

lacerations?
a. Routine screening for all pregnant women

Prepared By: Yano, Casey Rae

UCSM Senior Clerk
 b. Diagnosis of fetal position during labor
*c. Unmask clinically occult tears and ensure appropriate repair
d. Evaluation of uterine contractions

47. What potential indication justifies the use of episiotomy?

a. High fetal weight alone
*b. Fetal jeopardy and situations where failure to perform an episiotomy may result in
significant perineal rupture
c. Operative vaginal delivery only
d. Primiparity and prolonged labor

48. Which type of episiotomy has a greater likelihood of associated obstetric anal sphincter
injuries (OASIS)?
a. Mediolateral episiotomy
*b. Midline episiotomy
c. Lateral episiotomy
d. Selective episiotomy

49. When is episiotomy typically performed during delivery?

a. Early in the first stage of labor
*b. When the head is visible during a contraction
c. After delivery of the shoulders
d. Postpartum during repair

50. What is the angle of a mediolateral episiotomy incision?

a. 30 degrees
*b. 45 degrees
c. 60 degrees
d. 75 degrees

Prepared By: Yano, Casey Rae

UCSM Senior Clerk