Labor Complications — MCQs

A 24-year-old woman, G1P0, presents to her OB/GYN for her annual examination with complaints of painful cramps, abdominal pressure, and bloating with her cycle. She reports that she has not menstruated since her missed abortion requiring dilatation and curettage (D&C) seven months ago. She is sexually active with her husband and is not using any form of contraception. Her BMI is 29. At the clinic, her vitals are as follows: temperature, 98.9°F; pulse, 80/min; and blood pressure, 120/70 mm Hg. The physical examination is unremarkable. Thyroid-stimulating hormone, follicle-stimulating hormone, and prolactin concentrations are all within normal limits. The patient tests negative for qualitative serum beta‐hCG. A progestin challenge test reveals no withdrawal bleeding. What is the most likely diagnosis?

A 30-year-old G3P0 woman who is 28 weeks pregnant presents for a prenatal care visit. She reports occasionally feeling her baby move but has not kept count over the past couple weeks. She denies any bleeding, loss of fluid, or contractions. Her previous pregnancies resulted in spontaneous abortions at 12 and 14 weeks. She works as a business executive, has been in excellent health, and has had no surgeries. She states that she hired a nutritionist and pregnancy coach to ensure good prospects for this pregnancy. On physical exam, fetal heart tones are not detected. Abdominal ultrasound shows a 24-week fetal demise. The patient requests an autopsy on the fetus and wishes for the fetus to pass "as naturally as possible." What is the best next step in management?

A 28-year-old primigravid woman at 36 weeks' gestation comes to the emergency department because of worsening pelvic pain for 2 hours. Three days ago, she had a burning sensation with urination that resolved spontaneously. She has nausea and has vomited fluid twice on her way to the hospital. She appears ill. Her temperature is 39.7°C (103.5°F), pulse is 125/min, respirations are 33/min, and blood pressure is 130/70 mm Hg. Abdominal examination shows diffuse tenderness. No contractions are felt. Speculum examination shows pooling of nonbloody, malodorous fluid in the vaginal vault. The cervix is not effaced or dilated. Laboratory studies show a hemoglobin concentration of 14 g/dL, a leukocyte count of 16,000/mm3, and a platelet count of 250,000/mm3. Fetal heart rate is 148/min and reactive with no decelerations. Which of the following is the most appropriate next step in management?

A 38-year-old woman, gravida 4, para 3, at 20 weeks' gestation comes to the physician for a prenatal care visit. She used fertility enhancing treatment for her current pregnancy. Her other children were born before 37 weeks' gestation. She is 170 cm (5 ft 7 in) tall and weighs 82 kg (180 lb); BMI is 28.4 kg/m2. Her vital signs are within normal limits. The abdomen is nontender, and no contractions are felt. Ultrasonography shows a cervical length of 22 mm and a fetal heart rate of 140/min. Which of the following is the most likely diagnosis?

A 42-year-old, G3P2012 woman comes to the clinic complaining of painful menstruation for the past 4 months. She is also using more tampons compared to prior periods. She is concerned as her close friend was just diagnosed with endometrial cancer. Prior to these symptoms, her menstrual cycle was regular (every 28 days) and without pain. She denies abnormal uterine bleeding, abnormal discharge, past sexually transmitted diseases, or spotting. A bimanual pelvic examination is unremarkable except for a mobile, diffusely enlarged, globular uterus. What is the most likely explanation for this patient’s symptoms?

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?

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?

A 26-year-old primigravid woman at 39 weeks' gestation is admitted to the hospital in active labor. Pregnancy was complicated by mild oligohydramnios detected a week ago, which was managed with hydration. Her pulse is 92/min, respirations are 18/min, and blood pressure is 134/76 mm Hg. Pelvic examination shows 100% cervical effacement and 10 cm cervical dilation; the vertex is at 0 station. Cardiotocography is shown. Which of the following is the most appropriate next step in management?

A 42-year-old woman, gravida 5, para 5, comes to the physician because of a 6-month history of occasional involuntary urine loss that is exacerbated by coughing, sneezing, and laughing. She has no urgency or dysuria. Physical examination shows normal appearing external genitalia, vagina, and cervix. There is a loss of urine with the Valsalva maneuver. The physician recommends doing Kegel exercises. Which of the following muscles is strengthened by these exercises?

A 57-year-old woman comes to the physician because of several years of recurrent pelvic pain and constipation. She has increased fecal urgency and a sensation of incomplete evacuation following defecation. She has had no problems associated with urination. Her last menstrual period was 6 years ago. She has had three uncomplicated vaginal deliveries. Physical examination shows normal external genitalia. Speculum examination of the vagina and the cervix shows bulging of the posterior vaginal wall during Valsalva maneuver. Weakness of which of the following structures is the most likely cause of this patient's symptoms?