Labor Complications — MCQs

A 30-year-old woman, gravida 2 para 1, at 39 weeks gestation presents to the hospital with painful contractions and a rupture of membranes. She reports that the contractions started a couple hours ago and are now occurring every 4 minutes. She is accompanied by her husband who states, “her water broke an hour ago before we left for the hospital." The patient denies vaginal bleeding, and fetal movements are normal. The patient has attended all her pre-natal visits without pregnancy complications. She has no chronic medical conditions and takes only pre-natal vitamins. Her blood pressure is 110/75 mm Hg and pulse is 82/min. A fetal heart rate tracing shows a pulse of 140/min with moderate variability and no decelerations. Cervical examination reveals a cervix that is 7 cm dilated and 100% effaced with the fetal head at -1 station. The patient forgoes epidural anesthesia. During which of the following scenarios should a cesarean delivery be considered for this patient?

A 70-year-old woman, gravida 5, para 5, comes to the physician for the evaluation of sensation of vaginal fullness for the last six months. During this period, she has had lower back and pelvic pain that is worse with prolonged standing or walking. The patient underwent a hysterectomy at the age of 35 years because of severe dysmenorrhea. She has type 2 diabetes mellitus and hypercholesterolemia. Medications include metformin and atorvastatin. Vital signs are within normal limits. Pelvic examination elicits a feeling of pressure on the perineum. Pelvic floor muscle and anal sphincter tone are decreased. Pelvic examination shows protrusion of posterior vaginal wall with Valsalva maneuver and vaginal discharge. Which of the following is the most likely diagnosis?

A clinical diagnosis of abruptio placentae is suspected. Which of the following is the most appropriate next step in the management of this patient?

A 37-year-old woman, gravida 2, para 1, at 35 weeks' gestation is brought to the emergency department for the evaluation of continuous, dark, vaginal bleeding and abdominal pain for one hour. Her first child was delivered by lower segment transverse cesarean section because of a nonreassuring fetal heart rate. The patient has a history of hypertension and has been noncompliant with her hypertensive regimen. Her medications include methyldopa, folic acid, and a multivitamin. Her pulse is 90/min, respirations are 16/min, and blood pressure is 145/90 mm Hg. The abdomen is tender, and hypertonic contractions can be felt. There is blood on the vulva, the introitus, and on the medial aspect of both thighs. The fetus is in a breech presentation. The fetal heart rate is 180/min with recurrent decelerations. Which of the following is the cause of fetal compromise?

A 24-year-old woman, gravida 1, para 0, at 39 weeks' gestation, is admitted to the hospital in active labor. She currently has contractions occurring every 3–5 minutes. For the past 3 days, she has had burning pain in the vulvar area associated with intense itching. Her pregnancy has been uneventful. She has a history of genital herpes at the age of 16, which was treated with acyclovir. Her vital signs are within normal limits. Genital examination shows grouped vesicles on an erythematous base over the vulvar region. Pelvic examination shows rupture of membranes and that the cervix is 3 cm dilated. Which of the following is the most appropriate next step in management?

A 27-year-old nulligravid woman comes to the physician for evaluation of fertility. She has been unable to conceive for one year despite regular intercourse with her husband 1–2 times per week. Recent analysis of her husband's semen showed a normal sperm count. Two years ago, she had an episode of a febrile illness with lower abdominal pain, which resolved without treatment. Menarche was at age 12 and menses occur at regular 28-day intervals and last 4 to 5 days. Before her marriage, she was sexually active with 4 male partners and used a combined oral contraceptive pill with estrogen and progesterone consistently, as well as barrier protection inconsistently. One year ago, she stopped using the oral contraceptive pill in order to be able to conceive. She is 165 cm (5 ft 5 in) tall and weighs 84 kg (185 lb); BMI is 30.8 kg/m2. Physical examination shows no abnormalities. Which of the following is the most likely cause of this patient's infertility?

Four hours after undergoing an abdominal hysterectomy, a 43-year-old woman is evaluated in the post-anesthesia care unit because she has only had a urine output of 5 mL of blue-tinged urine since surgery. The operation went smoothly and ureter patency was checked via retrograde injection of methylene blue dye mixed with saline through the Foley catheter. She received 2.4 L of crystalloid fluids intraoperatively and urine output was 1.2 L. She had a history of fibroids with painful and heavy menses. She is otherwise healthy. She underwent 2 cesarean sections 8 and 5 years ago, respectively. Her temperature is 37.4°C (99.3°F), pulse is 75/min, respirations are 16/min, and blood pressure is 122/76 mm Hg. She appears comfortable. Cardiopulmonary examination shows no abnormalities. There is a midline surgical incision with clean and dry dressings. Her abdomen is soft and mildly distended in the lower quadrants. Her bladder is slightly palpable. Extremities are warm and well perfused, and capillary refill is brisk. Laboratory studies show: Leukocyte count 8,300/mm3 Hemoglobin 10.3 g/dL Hematocrit 31% Platelet count 250,000/mm3 Serum _Na+ 140 mEq/L _K+ 4.2 mEq/L _HCO3+ 26 mEq/L _Urea nitrogen 26 mg/dL _Creatinine 1.0 mg/dL Urine _Blood 1+ _WBC none _Protein negative _RBC none _RBC casts none A bladder scan shows 250 mL of retained urine. Which of the following is the next best step in the evaluation of this patient?

A 17-year-old female presents to your office expressing concern that despite experiencing monthly pelvic pain for the past few years, she has not yet started her menstrual cycle. She is not taking oral contraceptive therapy and has never been sexually active. On physical exam the patient is of normal stature with appropriate breast development and growth of pubic and underarm hair. The patient declined a vaginal exam. Karyotype analysis reveals she has 46 XX. Pregnancy test is negative, thyroid stimulating hormone, prolactin, luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels are normal. The uterus is normal on ultrasound. What is the likely cause of this patient's primary amenorrhea?

A 22-year-old woman, gravida 2, para 1, at 41 weeks' gestation is admitted to the hospital in active labor. Pregnancy has been uncomplicated. At the beginning of the second stage of labor, the cervix is 100% effaced and 10 cm dilated; the vertex is at -1 station. The fetal heart rate is reactive with no decelerations. As she pushes, it is noted that the fetal heart rate decreases, as seen on cardiotocography (CTG). Which of the following is the most likely cause of this finding?

A 29-year-old nulligravid woman comes to the physician for evaluation of infertility. She has been unable to conceive for 14 months. One year ago, she stopped taking the oral contraceptive pill, which she had been taking since she was 17. Her husband's semen analysis was normal. Four years ago, she had an episode of a pelvic tenderness and vaginal discharge that resolved without treatment. Menses occur at regular 28-day intervals. Before her marriage, she was sexually active with 5 male partners and used condoms inconsistently. She is 169 cm (5 ft 6 in) tall and weighs 86 kg (190 lb); BMI is 31.6 kg/m2. Physical examination shows no abnormalities. Which of the following is the most likely cause of this patient's infertility?