1. MERCADO, EUNICE F. Preconceptional counseling should be sought by those:

a. with pregestational diabetes mellitusb. contemplated to undergo assisted reproductive technologyc. working as xerox operatord. all of the abovee. A and B

Answer: D.Rationale: Preconceptional counseling should address ALL RISK factors pertinent to both mother and fetus. General questions to be answered include how pregnancy will affect maternal health, and how a high-risk condition will affect the fetus. Almost any medical, obstetrical, or genetic condition warrants some consideration prior to pregnancy.

Reference: Williams Obstetrics 22nd Edition p.114

2. Mendoza, Rigel Faye R.Preterm pregnancy is best defined as:

A. Live birth less than 37 weeks age of gestationB. Live birth more than 20 weeks but less than 37 weeks AOGC. Delivery more than 20 weeks but less than 37 weeks AOGD. Delivery after 20 weeks AOG but before the expected date of confinement (EDC)E. Delivery after 20 weeks but before 42 weeks AOG

Answer: B. Live Birth more than 20 weeks but less than 37 weeks AOGRationale: Preterm Pregnancy is a viable pregnancy (greater than 20 weeks AOG). Preterm pregnancy runs from >20 weeks to <37 weeks.

Reference: Textbook of Obstetrics 3rd edition, Sumpaico, Andres, Capito, Carnero, Diamante, Gamilla, Page 258, Chapter 16.

3. MASTRILI, JESSICA MARIE T.A patient who is very much desirous on getting pregnant came because of amenorrhea for 3 months and frequent urination. She has regular menstrual period since menarche. She claimed to feel brisk fetal movement starting yesterday. On physical examination, the uterine fundus is palpated midway between symphisis pubis and umbilicus. You requested for a pregnancy test. The best evidence that this patient is pregnant is:

a. amenorrhea on a background of regular menstrual cycleb. enlarged uterusc. brisk fetal movement felt by the patientd. positive pregnancy test

ANSWER: BRATIONALE: Amenorrhea is not a reliable indication of pregnancy because there is a variation in the length of the menstrual cycle among women. A positive pregnancy test may be a false positive test. In general, after a first successful pregnancy, a woman may first perceive fetal movements between 16 and 18 weeks (assuming her LNMP is correct, she would only be 12 months pregnant). By 12 weeks into the pregnancy, the body of the uterus is almost globular with an average diameter of 8cm, evidently showing it is enlarged.

Reference: Williams 23rd Ed., p.192

4. Tanhui, KristelA 35 year old PARTURIENT was seen with the following obstetrical history: G1 – May, 2000, delivered a live baby boy at 36 weeks AOG by vaginal butdied at 5 years of ageG2 – June, 2002, spontaneous abortion at 8 weeks AOGG3 – July, 2003, delivered live twins by VSD at 37 weeks, both presently aliveG4 – August, 2004, H-mole, suction curettage done at 12 weeks AOGG5 – September, 2006, ectopic pregnancy at 6 weeks AOG

G6 – October, 2008, delivered alive at 34 weeks AOG by CS for placenta previa, neonatal deathThe patient is a:

a. G6 P3 (1-2-3-1)b. G6 P3 (1-2-3-2)c. G7 P3 (1-2-3-2)d. G7 P4 (1-2-3-2)e. G7 P4 (2-2-3-1)

Answer: c. G7 P3 (1-2-3-2)Rationale: To solve for the answer we draw up the following table.G P T P A L

1 1 1

1 1

1 1 1 2

1 1

1 1

1 1 1

1

Total

7 3 1 2 3 2Source: Williams p. 194

5. Reyes, KatrinaA pregnant patient came for prenatal check-up but is not certain of her last normal menstrual period. Her menstrual period became irregular after giving birth to her third child. Asked about her quickening, she is very certain it was 2 weeks ago. She is approximately____ weeks pregnant.

a) 14-16b) 16-18c) 18-20d) 20-22e) Cannot be determined

Answer: C. Rationale: 18-20 weeks- Maternal perception of fetal movement may depend on factors such as parity and habitus. In general, after a first successful pregnancy, a woman may first perceive fetal movements between 16 and 18 weeks. (Meaning, a multiparous woman experiences quickening sometime between 16-18 weeks, adding 2 weeks [the day she came for the consult]= 18-20 weeks pregnant).

Reference: Cunningham, F. et al, Williams Obstetrics, 23rd edition, McGraw-Hills Company, Inc, 2010, Chapter 8. Prenatal Care

6. REYES, RACHEL ANN Q.The primary reason for doing internal examination on the first prenatal check up on patient seen early in pregnancy is to determine the:

a) presence of uterine and adnexal massesb) fetal presenting partc) bony structure of the pelvis (pelvic contraction)d) cervical dilatation and effacemente) all of the above

Answer: ARationale: During the first prenatal checkup of a pregnant woman, a thorough physical examination should be done. Under this is the pelvic exam which involves digital internal examination and visualization of cervix through speculum. According to Williams, “Digital pelvic examination is completed by palpation, with special attention

given to the consistency, length, and dilatation (only) of the cervix; to uterine size and any adnexal masses; to the fetal presentation ‘later’ in pregnancy; to the bony architecture (not structure; just like structural vs. architectural engineering; two different things; and there are no pelvic contractions yet in early pregnancy)of the pelvis; and to any anomalies of the vagina and perineum.”

Reference: Cunningham, Gary F., et al. Williams Obstetrics 22nd Edition Ebook, 2005. Page 122

7. RADIN, C PHILIP TEOMAR, II, A.On regular prenatal check-up, vaginal examination is done weekly:

A. on the first trimesterB. on the second trimesterC. late in pregnancyD. if there is vaginal bleedingE. if there is leaking amniotic fluid

Answer: CRationale: Because according to Sumpaico’s Textbook of Obstetrics, vaginal examination is done subsequently only if indicated during the first visit. However, at term, (late in pregnancy) it should be done weekly to determine the consistency, effacement and dilatation of the cervix; the presenting part, and clinical mensuration of the pelvis. It should not be done if there is history of vaginal bleeding.

Reference: Sumpaico W., et. al., Textbook of Obstetrics (Physiologic and Pathologic Obstetrics) 3rd edition, 2008. Page 265

08. ALPHA RANA M. HAYES (evals 2) Considerable weight loss of the newborn happens after delivery. Therefore, the newborn must be weighed during the first ___ hour/s of life.

a. 1 c. 12b. 6 d. 24

Answer: BRationale: It is expected that all newborns will lose some weight in the first week of life. A 5% weight loss is considered normal for a formula fed newborn. A 7%-10% loss is considered normal for the breastfed baby. Most babies should be back at birth weight by days10-14 of life. If a baby loses a significant amount of weight, is sick or premature, it may take up to 3 weeks to get back to birth weight. The reason for the weight loss is because of loss of fluid during birth. Weight measurement can be done six hours after delivery because the first few hours are dedicated for APGAR scoring by the physician (which usually lasts for only 5-10 mins.), establishing the newborn’s airway, identifying the infant after delivery, and establishing initial skin-to-skin contact to initiate breastfeeding by the mother. Weight measurement of the infant is usually done prior to admission to the nursery room after all the initial tests has been done.

References: Sumpaico, Walfrido et. al (2008) Textbook of Obstetrics: Physiologic and Pathologic Obstetrics. 3rd Edition. Chapter 43. Quezon City: Association of Writers of the Philippine Textbooks of Obstetrics and Gynecology, Inc.

http://www.americanpregnancy.org/firstyearoflife/newbornweightgain.htmhttp://www.brooksidepress.org/Products/Obstetric_and_Newborn_Care_II/lesson_8_Section_1.htm

9. NALDO, JACOB TIMOTHY C.The recommended weight that a pregnant woman should gain during pregnancy is based on her:

a. Pre-pregnancy weightb. Pre-pregnancy body mass c. Weight on her first prenatal check upd. Appetitee. Previous birth weights of her children

Answer: BRationale: It was recommended that weight gain during pregnancy be limited to less than 20 lb or 9.1 kg to prevent gestational hypertension and fetal macrosomia in the first half of the 20th century. By the 1970's, the

amount increased to 25 lb o 11.4 kg to prevent preterm birth and fetal-growth retardation. In 1990, the Institute of Medicine recommended a weight gain of 25 to 35 lb or 11.5 to 16 kg based if the woman is having a normal pregnancy and on her pre-pregnancy Body Mass Index (BMI). The American Academy of Pediatrics and the American College of Obstetrics and Gynecologists (2007) have endorsed these guidelines.

Reference: Williams EDITION 23, PAGE # 200

10. SAMPELO, MA. CARMELA. AThe main factor affecting accrued weight being retained over time by a woman after giving birth is her:

A. prepregnancy BMIB. prenatal weight gainC. parityD. AgeE. Birth weights of her babies

Answer: D. AgeRationale: Just because in Weight Retention after Pregnancy the main factor affecting weight gain over time is age. Also , there is no relationship between prepregnancy BMI(letter A) or prenatal weight gain(letter B) and weight retention. Parity(letter C) is affected to a lesser extent but not as much as age. Birth weights of her babies(letter D) has no effect as well.

Reference: Williams 23th edition, page 202

11. Ridao, Hanna Clare P.All are supplied by a well-balanced diet EXCEPT:

A. IronB. Vitamin AC. Vitamin BD. Vitamin CE. Vitamin E

Answer: A. IronRationale: "Of the approximately 300mg of iron transferred to the fetus and placenta and the 500mg incorporated into the expanding maternal hemoglobin mass, nearly all is used after mid pregnancy. During that time, iron requirements imposed by pregnancy and maternal excretion total approximately 7mg per day. Few women have sufficient iron stores or dietary iron intake to supply this amount. Thus, the American Academy of Pediatrics and the American College of Obstericians and Gynecologists endorse the recommendation by the National Academy of Sciences that at least 27mg of ferrous iron supplement be given daily to pregnant women. This amount is contained in most prenatal vitamins."

Reference: Williams 23rd Edition pages 202-203

12. VILLARUEL, ANDREA R.The type of exercise that a pregnant can have depends on her:

a. Healthb. Level of activity before pregnancyc. Parityd. All of the abovee. A and B

Answer: ERationale: Exercise depends on a pregnant woman’s health because the effects of physical exertion can be diverse. How well a pregnant woman can cope with this type of stress is determined by her general physical state. According to Williams, it is generally advised, that pregnant women refrain from activities that are too physically demanding or exercise that will lead them to a point of exhaustion. With that said, it must be inferred that the type of exercise a pregnant woman can tolerate will vary from person to person. If she has preexisting conditions such as hypertension or asthma, the consequences of exercising to this woman will be different as to someone who is physically healthy and is accustomed or well adapted to that level of activity even before getting pregnant.

However, there are no concrete evidences that exercising during pregnancy will result to deleterious effects. It’s just that subjecting a pregnant woman’s vulnerable body to some amount of physical activity may lead to instances of loss of balance, joint problems and the like.

Reference: Williams Obstetrics, 23rd Edition, Chapter 7, page 182

13. MENDOZA, CHRISTIAN JULIUS P.Sexual intercourse during pregnancy is:

a) Contraindicated all throughout pregnancyb) Permitted as long as there is no concomitant obstetrical nor medical complication

c) Permitted only after the 37th week of pregnancyd) Not advised among primigravidase) Advised in all patients nearing posterm

Answer: BRationale: Sexual intercourse is not contraindicated throughout pregnancy, eliminating choice A. Therefore it also

follows that it is not permitted only after the 37th week of pregnancy (choice C). According to Williams, it is generally accepted in healthy women, but should be avoided whenever abortion or preterm labor threatens.

Source: Williams Obstetrics, 23rd ed. Page 8; Chapter 1 (Overview)

14: ABIGAIL A. NAVOREvals 2: Smoking during pregnancy can cause the following, EXCEPT:

a) Low birth weight infantsb) Premature laborc) Postdatismd) Premature rupture of membranese) A and B

Answer: C Rationalization: Cigarette smoking: numerous adverse outcomes have been linked to smoking during pregnancy. Potential teratogenic effects (chapter 14, pp329): reduction in fetal growth doubles the risks of low birth weight and increases the rate of fetal-growth restriction; there is twofold risk of placental abruption and premature membrane rupture compared with non smokers, risks for spontaneous abortion, fetal death and fetal digital anomalies are also increased ( chapter 8, pp 195)

Reference: Willias, chapter 14, pp329, chapter 8, pp 195

15. Morcilla, HannaTravel by air does not directly jeopardize pregnancy but may cause:

a) Changes in sleep patternsb) Risk of not having immediate competent obstetric care in case of emergencyc) Increased venous stasis due to prolonged sittingd) All of the abovee) A and B

Answer: ERationale: Travelling may change the sleeping pattern of the pregnant woman when travelling to a place with a different time zone. There may be difficulty in adjusting to the new time zone. Another reason is that the patient may have difficulty in sleeping while on the plane due to discomfort in the assumed seating position. The risk of not having immediate competent obstetric care in case of emergency is simply because there might be no health professional on board that could help her in case of emergency. There really isn’t much risk of developing venous stasis unless the flight is very long.

Reference

16. TECSON, KRISTOFFER S.The death of the mother is a_________death:

a) direct obstetricb) indirect obstetricc) non-obstetric

Answer: BRationale: Indirect Obstetric Death results from previous existing disease or other health conditions that developed during pregnancy and which were not due to direct obstetric cause, but which was aggravated by physiologic effects of pregnancy.

Reference Textbook of OBSTETRICS Sumpaico 3rd edition page 8

17. Sigua, RoxanneExcessive vomiting during pregnancy causing electrolyte imbalance is called:a. Pseudocyesisb. Hyperemesis gravidarumc. Ptyalismd. Picae. None of the above

Answer: b. Hyperemesis gravidarumRationalization: In some women, vomiting may be so severe that dehydration, electrolyte and acid-base disturbances and starvation ketosis become serious problems. This is termed hyperemesis gravidarum.

Reference: Chapter 8 page 210, William's Obstetrics 23rd edition

18. RIVERA, ANGELA MAE M.A pregnant patient on her 32 wks age of gestation complained of sharp groin pain, more on the right side. She is best managed by:

a. activity modificationb. analgesiac. abdominal massaged. all of the abovee. A and B

ANSWER: ARATIONALE: Groin pain during pregnancy is caused by tension exerted by the round ligament. The round ligament supports the uterus, and it stretches during pregnancy. It contracts and relaxes just like muscles but much more slowly so any pressure exerted that forces it to quickly contract may cause pain.It can be managed by rest or slowly changing your position.

Reference: http://www.americanpregnancy.org/pregnancyhealth/roundligament.htm

19. OZAETA, KATHLEEN JOYCEConstipation is a common problem during pregnancy brought about by:

a. progesterone induced suppression of bowel motilityb. compression of the intestines by the enlarging uterusc. intake of iron suplement d. all of the abovee. A and B

Answer: DRationale: Hormonal influences (e.g. progesterone) exerted by pregnancy on the intestinal tract as well as the mechanical pressure execrted by the enlarging abdomen to the reectosigmoid area contributes to constipation.Sometimes iron tablets may contribute to constipation.

Reference: Textbook of Obstetrics (Physiologic and Pathologic Obstetrics) 3rd Edition by Walfrido W. Sumpaico, MD Page

237http://www.americanpregnancy.org/pregnancyhealth/constipation.html

20. PACIFICO, MA. PRISCILLA ELENA B.The backache and pain at the buttocks down to the thighs during pregnancy is due to:

a. Motion of symphysis pubis d. All of the aboveb. Motion of the lumbosacral joints e. A and Bc. Relaxation of pelvic ligaments

Answer: DRationale: During pregnancy, the hormones cause the dense ligaments to soften, which leads to joint laxity so as to allow for expansion during delivery. This leads to an increase in the mobility of the sacroiliac, sacrococcygeal and pubic joints and thus, contributes to the lower back pain experienced during pregnancy.

Furthermore, on page 273 of Sumpaico, it states that: "pregnant patients may develop backache and pain which are often referred to the region of buttocks and down to the thighs... In some women, motion of the symphysis pubis and lumbosacral joints and general relaxation of pelvic ligaments may be demonstrated."

Reference: Sumpaico (Textbook of Obstetrics), 3rd Edition, pages 240-241, 273

21. MAGTIBAY, ARIANNE ASHLEYThe exposure to teratogen during this period coincides with the “all-or-none” period. This is during the period:

a) Pre-implantationb) Embryonic c) Fetald) All of the above

Answer: ARationale: “The pre-implantation period is 2 weeks from fertilization to implantation and has traditionally been called the “all-or-none period”.

Reference: Williams OB 23rd Edition, page 313, under EVALUATION OF POTENTIAL TERATOGENS,

22. MAGNO, WARLYN GRACE L. The period when an insult is introduced to pregnancy will produce an irreparable damage.

A. pre-implantationB. embryonicC. fetalD. anytime during gestation

Answer: B.Rationale: A congenital malformation is an anatomical or structural abnormality present at birth. Congenital malformations may be caused by genetic factors or environmental insults or a combination of the two that occur during prenatal development. Most common congenital malformations demonstrate multifactorial inheritance with a threshold effect and are determined by a combination of genetic and environmental factors. Exposure must occur during a critical developmental period. Syndromes resulting from teratogen exposure are named according to the time of exposure. The preimplantation period is the 2 weeks from fertilization to implantation and has traditionally been called the "all or none" period. The zygote undergoes cleavage, and an insult damaging a large number of cells usually causes death of the embryo. If only a few cells are injured, compensation is usually possible with continued normal development (Clayton-Smith and Donnai, 1996). The embryonic period is from the second through the eighth week. It encompasses organogenesis and is thus the most crucial with regard to structural malformations. During this fetal period, where maturation and functional development continue after 8 weeks, certain organs remain vulnerable.

Reference: Williams Obstetrics 23rd.CHM: Teratology and Medications that Affect the Fetus: IntroductionTeratogens and Their Effects: http://www.columbia.edu/itc/hs/medical/humandev/2004/Chpt23-Teratogens.pdf

23. Parao, Angelo E. An example of a drug that inhibits post-translation carboxylation proteins :

A. Angiotensin converting enzymesB. StreptomycinC. WarfarinD. Chloramphenicol

Answer : C. WARFARINRationale: Warfarin and most of the anticoagulants cause inhibition of post-translational carboxylation of proteins. ACE inhibitors cause disruption of the RAAS system causing renal anomalies. Streptomycin is ototoxic to the fetus while Chloramphenicol causes Gray Baby Sydrome because it readily crosses the blood-brain barrier

Source : Williams Obstetrics, 22nd edition, pages 349, 352, 358

24. Nano, Marjorie Ann J.At what period of fetal development (in weeks) is the heart vulnerable to the effect of a teratogen?

a) pre- implantation to 2nd c) 7th-10thb) 3rd- 6th d) 11th- 14th

Answer: BRationale: The embryonic period is from 2nd through the eighth week. In this period, organogenesis occur thus the most crucial period with regard to structural malformations. The formation of the heart is from the 3rd weeks up to the 8th weeks but the major malformation occurs mostly on the 3rd-6th weeks. During pre-implantation to 2nd weeks, this is the period of all or none. meaning when there is an insult depending on the number of damaged cells, it will cause either death of the embryo or will continue normal development.

Reference: Cunningham, G.F, et al. (2005) William Obstetrics; Prenatal care. 23rd edition. [chapter 14 pp 312-314].USA. McGraw-hill Companies, Inc.

25. SALVACION, CARL LOUIE G. If there is marked folic acid deficiency during this period of pregnancy (weeks), the fetal brain will be greatly affected:

a. preimplantation to 2nd week c. 17th to 20th

b. 3rd to 6th d. 21st to 24th

Answer: ARationale: A recent study by Hernandez-Diaz and colleagues (2000), including 5832 infants with birth defects and 8387 control infants, showed that fetuses who were exposed during embryogenesis to antiseizure medications known to act as folic acid antagonists had a two- to threefold increased risk for oral clefts, cardiac defects, and urinary tract defects. Although periconceptional folate supplementation lowers the malformation rate, women with epilepsy should be given the fewest number of drugs possible during pregnancy as well as folic acid supplementation (Lewis and co-workers, 1998; Zhu and Zhou, 1989).

Reference: WILLIAMS OBSTETRICS - 22nd Ed. (2005) E-BOOKRationale: When a woman realizes her pregnancy, the pregnancy is actually 5-6 weeks old. In fact, fetal neural tube defects (NTD) can be formed when the pregnancy was 2-4 weeks. That is why, ideally needs folic acid has been fulfilled since before the pregnancy.

Reference: http://www.bukisa.com/articles/289930_importance-of-folic-acid#ixzz1nCJPo8Mu

26. Pamplona, Hayzelle P.There will be musculinisation of the female external genitalia if the mother is given progestational drugs during this period of pregnancy (weeks)

a) preimplantation to 2nd weekb)3rd to 5th

c) 6th to 8th d)9th week till term

Answer: CRationalization : From the figure below, we'll see that embryogenesis of the external genitalia occurs begins at 7th week AOG, which falls under the period of embroyogenesis. Maturation and differentiation will occur in the 9th week AOG.

Reference: Williams 23rd ed., page 313-314

27. SANDING, ELRIZA MYRHEL S.The effect of retinoids particularly isotretinoin is most evident at the face. The most common form of fetal deformity caused by this drug if given during pregnancy is:

a) Microcephalyb) Microtiac) Nasal hypoplasiad) Cleft palate

Answer: B. MicrotiaRationale: The craniofacial malformation most strongly associated with isotretinoin is microtia or anotia, bilateral but often assymetrical. Other defects include cleft palate and maldevelopment of the facial bones and cranium.

Reference: Williams 23rd edition, page 324

28. Xandra Regina MartinezFor epidemiological findings to be consistent there must be at least how many high quality studies that will manifest that the defect is produced by a particular agent?

a) 2b) 3c) 4d) 5

Answer: A

Rationale: In order to evaluate a potential teratogen, epidemiological findings must be consistent. The initial evaluation of teratogen exposure is usually retrospective and may be hampered by recall bias, inadequate reporting, and incomplete assessment of the exposed population. The investigation is often confounded by a variety of dosages, concomitant drug therapy, and maternal disease(s). Familial and environmental factors can also influence development of birth defects. Thus, an important criterion for proving teratogenicity is that two or more high-quality epidemiological studies should report similar findings. These studies should control for confounding factors, exclude positive and negative biases, include a sufficient number of cases, and be conducted prospectively.

Reference: Williams Obstetrics, 23rd Edition. Chapter 14 – Teratology and Medications that affect the fetus: Introduction. Pages 313-314.

29. VERGARA, RENN MIGUEL R.Threshold dose is described as the dosage that:

a) will produce the effects below the levels of controlsb) can initiate the effects with the maximum amount of its dosec) may produce 50 percent of defects in the entire group of subjectsd) can produce the defects by using the half strength of its dose

Answer: ARationale: According to an online article by Diav-Citrin, et al titled “Human Teratogens: A Clinical Evaluation,” threshold dose is defined as the dosage below which the incidence of adverse effects is not statistically greater than that of controls. For supplementation, according to an online dictionary, threshold dose is defined as the lowest amount or exposure level of a toxic substance at which a specified and measureable effect manifests. Furthermore, in Williams, it was discussed that a toxic drug must cross the placenta in sufficient quantity to directly influence fetal development or alter maternal or placental metabolism to exert an indirect fetal effect.

Reference: Human Teratogens: A Clinical Evaluation by Orna Diav-Citrin, MD, and Gideon Koren, MD retrieved from http://www.nvp-volumes.org/p2_4.htm

Williams Obstetrics 23 rd edition, page 313 Online Medical Dictionary http://medical-dictionary.thefreedictionary.com/threshold+dose

30. PANGHULAN, ALDEE RAY L.The primary organ responsible for the metabolism of drugs taken during pregnancy:

a. liverb. kidneyc. skind. lungs

Answer: A. LIVER RATIONALE: During the lecture of Dr. Salvador on “Drugs, Medicine and Immunization in Pregnancy”, (and as heard from the voice recorded copy of his lecture) he mentioned that during pregnancy two step processes were involved during pregnancy. One is METABOLISM which occurs mainly in the liver and another is EXCRETION which occurs in renal and hepatobiliary. The book Williams Obstetrics barely mentioned about the specific drug metabolism but focused on teratology.

Reference was mentioned in the rationale.

31. MAGDAONG, MELAYNE JEWEL R.The following drugs may produce nasal hypoplasia:

a. Tetracyclinesb. Aminoglycosidesc. Anticonvulsantsd. Sulphonamides

Answer: CRationalization: Tetracyclines, cause yellowish discoloration of deciduous teeth or deposited in fetal long bones.

Aminoglycosides, could cause nephrotoxic and ototoxic. Sulphonamides, it displace bilirubin from protein binding sites causing hyperbiliribinemia. Anticonvulnats, i. e Phenobarbital, cause impaired folic acid metabolism, neural tube defects, oral clefts, cardiac anomalies & urinary tract malformations. Fetal Hydantoin Syndrome: upper (upturned nose, mild facial hypoplasia & long upper lip thin vermillion border).

Reference: Williams. 23rd edition. Pages 318-320

32. Mostajo, Joven Amor, Jr. T.The group of drugs that is noted to cause oligohydramnios and intrauterine growth restriction.

a. Aminoglycosides c. ACE inhibitorsb. Anticoagulants d. NSAIDs

ANSWER: (C)Rationale: ACE inhibitors are fetotoxic, and more recently they have also been associated with embryotoxicity. The most frequently associated agent is enalapril, although captopril and lisinopril have also been implicated. These drugs disrupt the fetal renin-angiotensin system, which is essential for normal renal development (Guron and Friberg, 2000). In addition, they may provoke prolonged fetal hypotension and hypoperfusion, thus initiating a sequence of events leading to renal ischemia, renal tubular dysgenesis, and anuria (Pryde and colleagues, 1993; Schubiger and associates, 1988). The resulting OLIGOHYDRAMNIOS may prevent normal lung development and lead to limb contractures. Reduced perfusion also causes growth restriction, relative limb shortening, and maldevelopment of the calvarium (Barr and Cohen, 1991). Because these changes occur after organogenesis, and thus during the fetal period, they are termed ACE inhibitor fetopathy (see Evaluation of Potential Teratogens).

REFERENCE: Williams obstetrics 23rd edition, Chapter 14. Teratology and Medications That Affect the Fetus.

33. ROBENNE MAREE A. TANThe agent promotes closure of ductus arteriosus when given during the last trimester of pregnancy.

A. AlcoholB. NSAID'sC. AnticonvulsantsD. Angiotensin receptor blocker

Answer: BRationale: Indomethacin (NSAID's) result in constriction of the fetal ductus arteriosus and subsequently pulmonary hypertension in neonates.Alcohol is the most potent teratogens known.Anticonvulsants may cause the malformations of all types are more prevalent with high serum anticonvulsant concentrations.Angiotensin receptor blocker is a hypertensive agents have been associated with many reports of fetal damage.

Reference: Williams obstetrics 22nd edition, Section III, chapter 14 teratology, drugs, and other medications -- pp. 341

34. PACCAL, PATRICK JULIUS G.This group of drugs is noted for ototoxicity even among adults

a. aminoglycosidesb. anticoagulantsc. angiotensin receptor blockersd. chlorampenicol

Answer: ARationale: Maternal administration of aminoglycosides can result in toxic fetal blood levels, but this can be avoided by using lower divided doses. Nephrotoxicity and ototoxicity have been reported in preterm newborns and ADULTS treated with gentamicin or streptomycin.

Reference: William’s Obstetrics 23rd Edition p278 and p320

35. RAMOS, GENIE ANNEThis drug produces the so called Gray baby syndrome reaction?

a) Isotretinoinb) Methotrexatec) Chloramphenicold) Sulfonamide

ANSWER: C RATIONALE: Chloramphenicol readily crosses the placenta and results in significant fetal blood levels. The incidence of congenital anomalies does not appear to be increased in exposed fetuses. When given to the preterm neonate, the gray baby syndrome may develop. This is manifested by cyanosis, vascular collapse, and death. It seems unlikely that fetal serum levels obtained from maternal administration would cause this syndrom.

Reference: William Obstetrics and Gynecology 23rd, Page 320

36. YU, PHILIP ANDREW S.Phase 1 of parturition has the following functions EXCEPT:

a) Maintains uterine muscle tranquilityb) Initiates changes in vascularity and sizec) Promotes uterine excitabilityd) Maintains structural cervical integrity

Answer: C. Promotes uterine excitabilityRationale: The shift from uterine tranquility to uterine excitability is the function of phase 2. It results from alterations in the expression of key proteins responsible for contractions. These include oxytocin receptors, prostaglandin F receptors and connexin 43. Together these lead to increased uterine irritability and responsiveness to uterotonins.

Reference: Williams 23rd edition, page 138

37. Rellora, Lauren Victoria R.The extracellular connective tissues involve in cervical changes during parturition include the following EXCEPT:

a) Collagenb) Proteoglycansc) Claudinsd) Elastin

ANSWER: CRationale: The cervical tissue is composed of only 10-15% of smooth muscle, the remaining is made up of type I, III, and IV collagen, glycosaminoglycans (GAGs), proteoglycans, and elastin. Collagen solubility and changes in proteoglycan have been noted during cervical ripening. One example of GAGs is Hyaluronan. When it is increased, there is decreased duration of labor and incidence of ceasarean delivery.

References: Cunningham, F., et.al. (2010). Parturition. Williams Obstetrics (23rd ed., p.140). United Sates of America: The McGraw-Hill Companies, Inc.

38. NAZARENO, CHRISTINEThe substance that promotes myometrial relaxation during phase 1 of parturition are:

a. Prostacyclinb. Relaxinc. 15-hydroxy prostaglandin dehydrogenased. All of the above

Answer: DRationale: Myometrial quiescence of parturition phase 1 is induced by multiple independent and cooperative biomolecular processes – all manners of molecular systems like neural, endocrine (17B-Estradiol, Progesterone, CRH, hCG, Relaxin), paracrine (CRH, Relaxin, 15-hydroxy prostaglandin dehydrogenase), and autocrine (PGE2 and PGI2) are called on to implement and coordinate a state of relative uterine unresponsiveness.

•Both PGE2 and PGI2 (Prostacyclin) can maintain uterine quiescence by increasing cAMP signaling.

•Relaxin mediates lengthening of the pubic ligament, cervical softening, vaginal relaxation,, and inhibition of myometrial contractions and therefore may promote myometrial relaxation•15-hydroxy prostaglandin dehydrogenase (PGDH) degrades uterotonins such as prostaglandins to inactivate prostaglandins to their 15-keto metabolites

Reference: Williams 23rd EDITION; p. 152-154

39. PATAUNIA, JOSAN JAN R.The role/s of progesterone in phase 1 parturition is/are:

e. Decreases the expression of contraction-associated proteins (CAPs)f. Inhibits the expression of connexion 43, a gap junction proteing. Sustains the cervical competencyh. All of the above

Answer: DRationale:

It is said that if progesterone is withdrawn, pregnancy will directly proceeds from Phase 1 parturition to Phase 2 parturition, thus promoting some or all key features of parturition such as cervical ripening, increased cervical distensibility and increased uterine sensitivity to uterotonins. This is because progesterone functions to increase uterine quiescence by decreasing expression of contraction-associated proteins (CAPs), inhibiting expression of gap junctional protein connexion 43, and prevents or delays labor or sustaining cervical competency.

Referrence:Williams Obstetrics 23rd Edition pages 151-152.

40. LAMEDA, RANDALL M.To prepare the cervix for phase 2 parturition, these changes in the cervical structure must have occured, EXCEPT:

a. collagen dispersionb. collagen degradationc. loss of tissue integrityd. enhancement of tissue compliance

Answer: a. collagen dispersionRationale: "The first change relates to the state of the bundles of collagen fibers that act during most of gestation to provide rigid support. Late in gestation there is an INCREASE IN COLLAGEN BREAKDOWN and a REARRANGMENT OF THE COLLAGEN FIBER BUNDLES this process causes a DECREASE IN THE NUMBER AND SIZE OF COLLAGEN BUNDLES within the cervix leading to cervical softening." This just means that collagen is broken down or in other words degraded to decrease its number to soften the cervix to help in proper parturition. The cervix losses tissue integrity and enhances tissue compliance which is the softening of the cervix.

Reference: Williams 22nd Edition, Page Number 153, Chapter6: Parturation

41. Crisanto MacaraegWhat is the reliable basis of using menstrual age for determining age if pregnancy?

a. most women have regular cyclesb. it is more accurate than ovulatory periodc. it is used in Naegele's ruled. the last menstrual period is easy to recall

Answer: D. Rationale: A lot of women have irregular cycles (choice A) and it would be wrong to estimate age of gestation [AOG] by assuming all patients are regulars. The ovulatory period is probably the actual age of the fetus (choice B), thus being 2weeks earlier than menstrual age. Naegele's rule does not include menstrual age as a variable (choice C). It is used to estimate the due date of the pregnancy. Menstrual age is used because women tend to remember their menstruations,some even up to date, making it easy to ask for.

Reference: William's, 23rd ed. Pages 199 & 78

42. Villarin, Lilia G.Which of the substance/s is/are increased during phase 3 of parturition to favor labor?

a) Oxytocin receptorsb) Fetal Corticotropin Releasing Hormonec) Prostaglandinsd) All of the Above

Answer: D = All of the above.Rationalization: Coinciding with the increase in contractile responsiveness of the uterus to oxytocin, the elevation in the number of oxytocin receptors (50 fold or more increase) occur during late pregnancy, beginning at phase 2 of parturition. Oxytocin is the first uterotonin implicated during the initiation of parturition. Moreover, though it does not seem to cause parturition, oxytocin is perhaps one of the substances that ensure labor effectiveness. To prevent post-partum hemorrhage, phase 3 also demands persistent uterine contractions and retractions—oxytocin likely causes and sustains the former (1). Furthermore, oxytocin recepetors in the myoepithelium of mammary ducts increase in late pregnancy and during puerperium, they act on the cells of the breast duct to effect milk let-down, a component of phase 3 of parturition (2).The levels of Fetal (Placental) Corticotropin Releasing Hormone are also increased during the phase 3 of parturition. Maternal CRH has its own CRH binding protein, and once they are bound, the ACTH stimulating activity of the placental CRH is inactivated. This causes the low CRH levels during most of the pregnancy. However, during late pregnancy, the levels of the said binding protein decline, causing the striking increase of CRH (1). A positive feedback can be observed in relation to this hormone. Placental CRH enhance fetal cortisol, which then causes the placenta to produce more CRH (2).

Though prostaglandin (PG) influence in the phase 2 of parturition has been well documented and studied, its contribution in phase 3 is just as clear. Within the decidua and myometrium, the production of prostaglandins has been an effective mechanism of activating contractions. The synthesis of PG mostly happens in the decidua during phase 2 and phase 3. Fetal membranes and placenta also produce PG, and as the fetus grows, the levels of PG in the amniotic fluid concomitantly elevates as well (1).

Reference:

•Cunningham, F., et.al. (2010). Parturition. Williams Obstetrics (23rd

ed., pp. 157-160). United States of America: The McGraw-Hill Companies, Inc.

•Sumpaico, W., et. al. (2002). Parturition: Biomolecular and physiologic processes. Textbook of Obstetrics (3rd

ed., pp.373-374). Philippines: Association of Writers of the Philippine Textbooks of Obstetrics and Gynecology, Inc.

43. Montecalvo, Victor III The following conditions belong to phase 3 of parturition except: a. stage of placental separation b. fetal expulsionc. presence of cervical changes in dilatation and effacementd. uterine involution

Answer: DRationale: Because choices letter a, b, and c belong to phase 3 of parturition except for letter d which belong to phase 4 of parturition.

Reference: ebook Williams obstetrics 22 edition, http://wiki.answers.com/Q/What_are_the_phases_of_parturition

44. MICLAT, FRANCES LEAH D.The substance/s that may induce myometrial contraction and thus induce labor is/are:

a.cAMPb. RU486c. cGMPd. all of the above

Answer: BRationale: Three medications for early medical abortion have been widely studied and used: the antiprogestin mifepristone, the antimetabolite methotrexate, and the prostaglandin misoprostol. These agents cause abortion by increasing uterine contractility either by reversing the progesterone-induced inhibition of contractions – mifepristone and methotrexate or by stimulating the myometrium directly – misoprostol. In addition, mifepristone causes cervical collagen degradation, possibly because of increased expression of matrix metalloproteinase-2.

Reference: Williams 23rd Edition , Pages 232

45. VERGARA, MELODY JOYCE S.The newer understanding regarding the role of estrogen in pregnancy is/are:

a) Hasten the degradation of progesteroneb) Indirectly induces progesterone responsivenessc) Potentiating further the local effects of estrogen in myometriumd) Has no effect on phase 1 of parturition

ANSWER: BRATIONALIZATION: The exact role of estrogen in regulating human uterine activity and cervical competency is even less well understood. That said, it appears that estrogen can act to promote progesterone responsiveness, and in doing so, promote uterine quiescence.

REFERENCE: Williams Obstetrics 23rd Edition, Chapter 06

46. Krizia Aira J. OclaritOxytocin levels are increased during Phase ____ and 3 of Partuition:

a) 1b) 2c) 4

Answer: C. 4Rationalization: Role of Oxytocin in Phases 3 and 4 of Parturition: Because of successful labor induction with oxytocin, it was logically suspected in parturition initiation. First, in addition to its effectiveness in inducing labor at term, oxytocin is a potent uterotonin and occurs naturally in humans. Subsequent observations provide additional support for this theory:

•The number of oxytocin receptors strikingly increases in myometrial and decidual tissues near the end of gestation •Oxytocin acts on decidual tissue to promote prostaglandin release •Oxytocin is synthesized directly in decidual and extraembryonic fetal tissues and in the placenta (Chibbar and associates, 1993; Zingg and colleagues, 1995).

Although little evidence suggests a role for oxytocin in phase 2 of parturition, abundant data support its important role during second-stage labor and the puerperium—phase 4 of parturition. Specifically, there are increased maternal serum oxytocin levels: (1) during second-stage labor—the end of phase 3 of parturition, (2) in the early postpartum period, and (3) during breast feeding—phase 4 of parturition (Nissen and co-workers, 1995). Immediately after delivery of the fetus, placenta, and membranes—completion of parturition phase 3—firm and persistent uterine contraction and retraction are essential to prevent postpartum hemorrhage. Oxytocin likely causes persistent contractions.

Reference: Chapter 6 of William Obstetrics 23rd edition (Ebook)

47. Sabrina Florence DL. O'NeillThe action/s of relaxin during partition is/are:

A.) Mediates lengthening of the public ligamentB.) Induces myometrium contractionsC.) Promotes cervical ripeningD.) all of the above

Answer: ARationale: Verbatim from the book: "Relaxin mediates lengthening of the pubic ligament, cervical softening, vaginal relaxation and inhibition of myometrium contractions." One must remember that it is RELAXin so it's action would be towards the "relaxation" process. On the other hand, actions of the calcium concentration, CRH's Gq-alpha protein pathway and endothelin would promote myometrium contractions while the change in proteoglycan composition/ direct application of prostaglandins would promote cervical ripening.

Reference: Chapter 4, Fetal Growth and Development, Williams 23rd Edition EBook for the IPad

48. Rosales, Carol Zaidel M.During pregnancy, prodstaglandin acts as _______ to the uterus

a. Uterotonins (ANSWER)b. anti-inflammatoryc. muscle relaxantd. all of the above

Answer: ARationalization: Uterotonin theories of the initiation of Parturition: In part because of Progesterone withdrawal does not precede the initiation of parturition in human pregnancy, Many researchers began to investigate the possibility that an increase in the formation of uterotonin is the most likely cause of the initiation of parturition. It was also written in the book that many uterotonins are responsible in the second phase of parturition. Many of the uterotonins that are known to cause myometrial contractions of the smooth muscle are as follows: oxytocin, prostaglandins, serotonin, histamine, platelet activating factor, Angiotensin II and others.

Many investigators have fostered that prostaglandins have a great effect in Phase 2 of parturition particularly PGF2A and PGE2.

Reference: Williams Obstetrics 21st Edition: F. Gary Cunningham (Editor), Norman F. Gant MD, Kenneth J., Md Leveno, Larry C., Iii, Md Gilstrap, John C., Md Hauth, Katharine D., Md Wenstrom, John C. Hauth, J. Whitridge Obstetrics Williams (Editor), Steven L. Clark, Katharine D. Wenstrom, by Mcgraw-Hill Professional (April 27, 2001). From Section 4:Normal Labor and Delivery, Chapter 11: Parturition (page 171 of 1132)

49. RECIERDO, FRANCINE MARIE REGAYAThe fetal signal/s that initial labor is/are:

a) fetal growthb) production of corticotropin releasing hormonec) presence of fetal lung surfactantd) all of the above

Answer: D.Rationale: Fetal growth: There is now considerable evidence that fetal growth is an important component in uterine activation in phase 1 of parturition. In association with fetal growth, significant increases in myometrial tensile stress and amniotic fuid pressure follow (Fisk and co-workers, 1992). With uterine activation, stretch is required for induction of specific contraction-associated proteins (CAPs). Stretch increases expression of the gap junction protein-connexin 43, as well as oxytocin receptors. Others have hypothesized that stretch plays an integrated role with fetal-maternal endocrine cascades of uterine contraction (Lyall and co-workers, 2002; Ou and colleagues, 1997, 1998).

Cell signaling systems used by stretch to regulate the myometrial cell continue to be defined. This process-mechanotransduction-may include activation of cell-surfacereceptors or ion channels, transmission of signals through extracellular matrix, or release of autocrine molecules that act directly on the extracellular matrix protein, fibronectin, and its cell surface receptor, alpha 5 integrin receptor, are induced in the rodent in response to stretch (Shynlova and colleagues, 2007). This interaction, may aid force transduction during labor contraction by anchoring hypertrophied myocytes to the uterine extracellular matrix.

Production of Corticotrophin Releasing Hormone:A CRH hormone identical to maternal and fetal hypothalamic CRH is synthesized by the placenta in

relatively large amounts (Grino and associates, 1987; Saijonmaa and colleagues, 1988). One important difference is that, unlike hypothalamic CRH, which is under glucocorticoid negative feedback, cortisol has been shown to

stimulate placental CRH production (Jones and co-workers, 1989). This ability makes it possible to create a fee-forward endocrine cascade that does not end until separation of the fetus from the placenta at delivery.

Presence of Fetal Lung Surfactant:Surfactant Protein A (SP-A) produced by the fetal lung is required for lung maturation. Its levels are

increased in amniotic fluid at term in women and mice. Recent studies in the mouse suggest that the increasing SP-A concentrations in amniotic fluid activate fluid macrophages to migrate into the myometrium and induce a transcription factor-nuclear factor-kB (Condon and co-workers, 2004). This factor activates inflammatory response genes in the myometrium, which in turn promote uterine contractility. This model supports the supposition that fetal signals paly a role in parturition initiation. The exact mechanisms by which SP-A activates myometrial contractility in women, however, remains, to be clarified as studies in women suggest that fetal macrophages in the amniotic cavity do not enter the myometrium during the labor (Kim and colleagues, 2006; Leong and associates, 2008). Pulmonary surfactant and components of surfactant such as platelet activating factor, when secreted into human amniotic fluid, have been reported to stimulate prostaglandin synthesis (PGE2) and uterine contractility. This supports a function of SP-A in human parturition (Lopez and co-workers, 1988; Toyoshima and associates, 1995).

Reference: Williams 23rd edition, pages 156-158

50. Sierra, Rei Fabbie F.Aside from oxytocin, what is/are the other uterotonins that my induce labor?

a. Platelet activating factor c. Serotoninb. Histamine d. all of the above

Answer: D. all of the aboveRationale: uterotonins that are candidates for labor induction includes oxytocin, prostaglandin, serotonin, histamine, platelet activating factor, angiotensin II and many others.

Reference: page 158, William’s Obstetrics 23rd edition

51. MARAVILLA, RACHELLE DIANE B.In order to cause increase in the cervical dilatation, the uterine contractions should emanate and be greatest in the ___________ of the uterus.

a) fundal areab) lower segmentc) cervical segmentd) corporeal segment

Answer: ARationale: The normal contractile waves of labor starts at the “pacemakers” located near the uterine end of one of the fallopian tubes. From the pacemaker, the contractions will spread throughout the uterus at a rate of 2cm/sec and will eventually depolarize the whole uterus. Such depolarization will proceed downward towards the cervix. From the said pacemakers, the intensity of the contractions will be greatest in the fundal area. As the aforementioned depolarization proceeds towards the cervix, the intensity of contractions will decrease beginning in the lower uterus.

Reference: Williams 23rd EDITION, PAGE 439

52. ASUNCION, JESSICA B.As labor progresses the upper uterine segment becomes progressively: A. Thinner and Shorter B. Thinner and longer C. Thicker and shorter D. Thicker and longer

Answer: C

Rationale: The myometrium is relaxed to its original length after contractions. Instead it becomes relatively fixed at a shorter length. Because of the successive shortening of the muscular fibers, the upper active segment becomes progressively thickened throughout the first and second stage labor.

Reference: Williams EDITION 23, PAGE # 142

53. VILLAMER, AILYN O.The main force necessary to expel the baby out of the vaginal canal after full cervical dilatation is the _______________ pressure.

a) Intra-abdominal c.) Intracervicalb) Intra-uterine d.) Intra-vaginal

Answer: A. INTRA-ABDOMINALRationale: After the cervix is dilated fully, the most important force in fetal expulsion is that produced by maternal intra-abdominal pressure. Contraction of the abdominal muscles simultaneously with forced respiratory efforts with the glottis closed is referred to as pushing. The nature of the force is similar to that with defecation, but the intensity usually is much greater. The importance of intra-abdominal pressure is attested to by prolonged descent during labor in paraplegic women.

Reference: Williams Obstetrics 23rd edition, page 143

54. RIVERA, JAN ERIC A. A woman in labor is seen at the emergency room. The minimum frequency of uterine contraction which will confirm the diagnosis that she is in labor and make you recommend that she is admitted is at least _____ in ten minutes**.

a) one c) threeb) two d) four

Answer: b. twoRationale: Pates and colleagues (2007) studied the commonly used recommendations given to pregnant women that, in the absence of ruptured membranes or bleeding, uterine contractions 5 minutes apart for 1 hour—that is, greater than or equal to 12 contractions in 1 hour—may signify labor onset. Among 768 women studied at Parkland Hospital, active labor defined as cervical dilatation 4 cm was diagnosed within 24 hours in three fourths of women with 12 or more contractions per hour.**Therefore, if 60 minutes: 12 contractions then 10 minutes: 2 contractions

Reference: Williams Obstetrics, 23e Chapter 17. Normal Labor and Delivery (e-book ginamit ko, din aka indicate yung page number.)

55. Soler, FidelA primigravida was admitted due to labor pains with the following Leopold’s maneuver findings:LM1=large, nodular massLM2=smooth, board like mass along right maternal sideLM3=hard, round ballotable massThe fetal presentation is:

a) Cephalic c) Faceb) Breech d) Shoulder

Answer: A. cephalicRationale:Abdominal Palpation Leopold’s Maneuver•The first maneuver permits identification of which fetal pole, cephalic or podalic, occupies the uterine fundus. The breech gives sensation of large nodular mass whereas the head feels hard and round and is more mobile and ballotable.•Performed after determination of fetal lie, the second maneuver is accomplished as the palms are placed on either sides of the maternal abdomen and gentle but deep pressure is exerted. On one side, a hard, resistant structure is felt, the back. On the other, numerous small, irregular, mobile parts are felt, fetal extremities. By noting whether the back is directed anteriorly, transversely or posteriorly, the orientation of the fetus can be determined.

•The third maneuver is performed by grasping with the thumb and fingers of one hand the lower portion of the maternal abdomen just above the symphysis pubis. If the presenting part is not engaged, a movable mass is felt, usually the head. The differentiation between the head and breech is made is in the first maneuver. If the presenting part is deeply engaged, however, the findings from this maneuver are simply indicative that the lower fetal pole is in the pelvis and the details are then defined by the fourth maneuver.•To perform the fourth maneuver the examiner faces the mothers feet and with the tips of the first three fingers of each hand, inserts deep pressure in the direction of the axis of the pelvic inlet. In many instances, when the head has descended into the pelvis, the anterior shoulder may be differentiated readily by the third maneuver.

References: Williams Obstetrics Pg. 377

56. Matias, Jobell D.A primigravida was admitted due to labor pains with the following Leopold’s maneuver findings:

LM 1- large, nodular massLM 2- smooth board-like mass along right maternal sideLM 3- hard, round, ballotable mass

On IE you appreciated a soft mass through the cervix which is 5 cms. Fetal heart tones are best appreciated in the ________________ quadrant.

a) Left upper c) Right upperb) Left lower d) Right lower

Answer: d. Right LowerRationale: The presentation of the fetus is definitely cephalic presentation (vertex) because in the palpation of LM 1, the buttocks of the fetus is large and nodular. LM 2 maneuver identifies which side of the mother lies the fetal back which in this case is the right side of the mother. LM 3 maneuver differentiates between head and breech and if the head is engaged or not. In this case, the head is palpated because the palpated part is hard, round and ballotable. LM 2 also points to where the fetal heart sound is best heard. It is best to auscultate the fetal back in vertex presentation and fetal thorax in face presentation. In this case, the presentation of the fetus is vertex so it is best to auscultate in the lower portion of the mother’s abdomen and and on the right side because it is where fetal back lies.

Reference: Williams Obstetrics, 23rd edition, pages 96 and 377.

57. SALVADOR, ZAFRIL JOSE S.R.A primigravida was admitted due to labor pains with the following Leopold’s maneuver findings:

LM1 – large, nodular massLM2 – smooth, board-like mass along right maternal sideLM3 – hard, round, ballotable mass

What s the fetal lie?a) Longitudinalb) Obliquec) Sagitald) Transverse

ANSWER: A – LONGITUDINAL RATIONALE: the long axis of the fetus is parallel of that of the mother.

REFERENCE: Wiliiam’s 22nd edition. Page 410-415.

58. Mendoza, JaimeFetal attitude refers to the relationship between the fetal head and body. Which of the following fetal attitude is correctly defined?

a. Occiput- head completely flexed c. Face- head partly extendedb. Sinciput- head partly flexed d. Brow- head completely extended

Answer: A or BRationale: Occiput presentation refers to when the head is flexed sharply making the chin in contact with the thorax. Sinciput presentation presents with the bregma thus positioning the partly flexed, while the brow

presentation makes the head partly extended. In rare cases, the occiput and the back come in contact, making the face foremost in the birth canal, making it completely extended thus the face presentation.

Source: Williams 22nd ed.

59. PARAS, ROBERT JULIUS Fetal attitude determines the presenting diameter that will enter the maternal pelvis. If on internal examination the fetal head is assessed to be in complete flexion, the presenting diameter is:

a. suboccipitobregmaticb. submentobregmaticc. occipitofrontald. occipitomental

Answer: ARationale: Note that with complete flexion, the chin is on the chest. The suboccipitobregmatic diameter, the shortest anteroposterior diameter of the fetal head, is passing through the pelvic inlet” (Williams, 2009). “When the head is fully flexed or in complete flexion, the chin lies in front of the chest and the presenting anteroposterior diameter is the suboccipitobregmatic” (Sumpaico 2008).

Reference: Williams, 2009 23rd Edition p.385 & Sumpaico, 2008. 3rd Edition p.391

60. Ramos, Iziah Rainier D.S.Fetal presenting diameter most compatible with spontaneous vaginal delivery:

a) Suboccipitobregmatic b) Submentobregmaticc) Occipitofrontald) Occipitomental

Answer: ARationale: Since the suboccipitobregmatic diameter is usually 9.5 cm, it is the most compatible diameter for the pelvic outlet which usually measures 9.5- 11.5 cm antero-posterior and 11 cm transverse.

Reference: William’s Obstetric 22/e page 233 (e-book)

61. OLIVEROS, MARK JOSEPH N.A primigravida was admitted due to labor pains. On IE you assess the fetus to be in cephalic presentation. What is the fetal position if the fixed reference point (FRP) is pointing to the mother’s right side and closer to her sacrum?

a) Right FRP anterior c) Left FRP anteriorb) Right FRP posterior d) Left FRP posterior

Answer: BRationale: In cephalic presentation, the occipital fontanel is the presenting part, and this presentation is referred to as a vertex or occiput presentation (where Fixed Reference Point is derived). Therefore, the fetal position is Right FRP posterior since FRP is the occiput part of the baby’s head is pointing to the mother’s right side and closer to her sacrum

Reference: Section IV. Labor and Delivery, Chapter 17. Normal Labor and Delivery, Williams Obstetrics 22nd edition Ebook

62. Marasigan, Al JosefEtiology of deflection in attitudes in cephalic presentation include fetal:

a) Neck anomaliesb) Head anomaliesc) Macrosomiad) All of the above

ANSWER: ARATIONALE: Neck anomalies like tumors, bone malformations will result into a decrease in the ability of the fetus to fully flex the neck, thus causing deflection in attitude.

REFERENCE: Williams Obstetrics 22ND EDDITION ebook> Section IV. Labor and Delivery > Chapter 17. Normal Labor and Delivery

63. Reyes,Kevin MatthewFetal presentation is determined by the fetal part which:

A. Descends in the maternal pelvisB. is palpated on leopold's maneuver 3C. Is appreciated as occupying the cervical opening on internal examinationD. All of the above

Answer: DRationale: fetal presentation. The presenting part is that portion of the fetal body that is either formost within the birth canal or in closest proximity to it. It can be felt through the cervix on vaginal examination. Accordingly, in longitudinal lies, the presenting part is either the fetal head or breech, creating caphalic and breech presentations, respectively.Third maneuver: if the presenting part is not engaged, a moveable mass will be felt usually the head.

Referrence: williams 22nd edition page 410 -412

64. Soler, AlexanderThe most common fetal presentation:

a) breech c) faceb) cephalic d) shoulder

Answer: b. cephalicRationale: The presenting part is that portion of the body of the fetus that is either foremost within the birth canal or in closest proximity to it. The presenting part determines the presentation.Frequency of various presentation•vertex 96% c. face 0.3%•breech 3.5% d. shoulder 0.4%There are several explanations why the term fetus usually presents by the vertex. The most logical is because the uterus is piriform shaped. Although the fetal head at term is slightly larger than the breech, the entire podalic pole of the fetus-that is the breech and its entire flexed extremities- is bulkier and is more movable than the cephalic pole. The cephalic pole is comprised of the fetal head only.

Reference: Williams 21st ed., pages 294-296

65. SAULOG, ROLDANOn internal examination, you are able to palpate the posterior fontanel in full at a lower level compared to the posterior fontanel, What is the most probable presentation?

a) browb) facec) occiputd) sinciput

ANSWER: CRationale: The occipital fontanel/posterior fontanel is the presenting part, and this presentation is referred to as the vertex or occiput presentation. when the neck of the fetus is sharply extended such as the occiput and the back are in contact, and the face is foremost in the birth canal it is referred to as face presentation. when the head is partially flexed and the anterior fontanel or bregma is presenting it is referred to as sinciput presentation. If the head is partially extended it is referred to as brow presentation. sinciput and brow presentation almost always converts to occiput presentation by neck flexion or extension, failure to do so can lead to dystocia.

Reference: Williams 23rd edition, pages 374-375

66. TALATALA, KITH ELGIN N.Which plane of the pelvis determines its shape?

a) inletb) midplanec) outletd) sagital

Answer: (A) INLETRationale: Caldwell and Moloy developed classification of the pelvis based on its shape. Familiarity on this helps clinician understand better the mechanisms of labor. The Caldwell-Moloy Classification is based on measurement of the greatest transverse diameter of the INLET and its division into anterior or posterior segments. The shapes of these are used to classify pelvis as gynecoid, anthropoid, android and platypeloid.Reference: page 32, paragraphs 1 and 2. Williams Obstetrics: 23rd Edition.

67. MENDOZA, ROI JOSEPH Which pelvic shape is favourable for normal delivery?

a. android c. gynecoidb. anthropoid d. platypeloid

Answer: C- GynecoidRationale: using the Caldwell Moloy classification, Gynecoid has the greatest transverse diameter of the inlet making it the best morphologic type of all 4 basic pelvic bone structures for normal vaginal delivery

Reference: Williams22nd page 49

68. MANUEL, MARVILLO M.Pelvic plane described by the following boundaries - sacral promontory, linea terminalis, symphysis pubis:

a) inlet c) midletb) midplane d) outlet

ANSWER: ARationale: The superior strait or pelvic inlet is bounded posteriorly by the promontory and alae of the sacrum, laterally by the linea terminalis, and anteriorly by the horizontal pubic rami and the symphysis pubis. The inlet of the female pelvis – compared with the male pelvis – typically is more nearly round than ovoid. Caldwell (1934) identified radiograhically a nearly round or gynecoid pelvic inlet in a approximately half of white women.

Reference: Williams Obstetrics 23rd Ed.Page number: 31

69. SILVALLANA, RICHELLE A.Clinical finding that assess the inlet:

a) Distance from symphysis pubis to sacral promontoryb) Vergence of pelvic sidewallsc) Prominence of ischial spinesd) Sacral concavity

Answer: ARationale: Pelvic inlet, also called superior strait, as defined is bounded posteriorly by the promontory and the alae of the sacrum, laterally by the linea terminalis, and anteriorly by the horizontal pubic rami and the symphysis pubis.

Reference: Williams 23rd edition, page 31

70. Sorilla, Mae Angeli G.Distance from the lower border of the symphysis pubis and the sacral promontory.

a. true conjugateb. false conjugatec. obstetric conjugated. diagonal conjugate

ANSWER: D

Rationale: The true conjugate is measured from the upper border of the symphysis pubis and the sacral promontory. The obstetrical conjugate is estimated indirectly by subtracting 1.5 to 2 cm from the diagonal conjugate. The diagonal conjugate is clinically estimated by measuring the distance from the sacral promontory to the lower margin of the symphysis pubis.

Reference: Williams 22nd edition E-book, Williams Obstetrics > Section II. Anatomy and Physiology > Chapter 2. Maternal Anatomy

71. Manalang, CapellaThe cardinal movements of labor occur continuously takes place until the completion of the second stage of labor?

a) preparatory b) dilatationalc) pelvic

Answer: CRationale: Downward movement of the biparietal diameter of the fetal head to within the pelvic diameter of the fetal head to within the pelvic inlet, full descent occurs and the fetal head extrudes beyond and touches the posterior vaginal wall

Reference: Demelin L (1927) La Contraction Uterine et les Discinesies Correlative. Paris: Dupon

72. Patdu, Jacky A.Which of the following cardinal movements of labor continuously takes place until the completion of the second stage.

a. Descentb. Flexionc. Internal rotationd. Extension

Answer: ARationale: In primiparous woman, engagement must be completed first before descent can occur. In multiparous woman, descent usually begins with engagement. Descent must then be said to be continuous until the end of labor because it is the descending action of the baby through the pelvic inlet. The completion of the second stage is defined as the expulsion of the baby. Descent is not complete until this stage because the baby is continuously descending towards being expulsed.

References: William Edition 23, page 378-380, 389

77. PAO, CHRISTEL V.In occiput anterior presentation, which among the fetal part appears first during extension?

a) browb) nosec) mouth d) chin

Answer: ARationale: With progressive distension of the perineum and vaginal opening, an increasingly larger portion of the occiput gradually appears. The head is born as the occiput, bregma, forehead, nose, mouth, and finally the chin pass successively over the anterior margin of the perineum. Hence, among the choices above, the brow will appear first before the succeeding parts.

Reference: Williams Obstetrics, 23rd edition, Chapter 23

74. Yaun, Pilipina Karla Mutya V. Expulsion is concerned with the delivery of what fetal part?

a) headb) shoulderc) thorax

d) abdomenAnswer: b. shoulder

Rationale: Expulsion occurs almost immediately after external rotation, the anterior shoulder appears under the symphysis pubis, and the perineum soon becomes distended by the posterior shoulder. After delivery of the shoulder, the rest of the body quickly passes. The shoulder, since it the widest among the fetal parts that has to pass through, it is the most difficult part to be expelled. After expulsion of the shoulder, we can ensure that the rest of the body will quickly pass since they have smaller breadth.

Source: William’s Obstetrics, 23rd edition: Normal Labor and Delivery, pages 59-61 and 380

75. MELISSA KATE D. MENDOZAAs the fetal head engages, the sagittal suture commonly lies:

a) Midway between the symphysis pubis and promontoryb) Nearer the symphysis pubisc) Nearer the promontoryd) Along the oblique diameter

Answer: A. Midway between the symphysis pubis and promontoryRationale: Asynclitism- Although the fetal head tends to accommodate to the transverse axis of the pelvic inlet, the sagittal suture, while remaining parallel to that axis, may not lie exactly midway between the symphysis and the sacral promontory. The sagittal suture frequently is deflected either posteriorly toward the promontory or anteriorly toward the symphysis. Such lateral deflection to a more anterior or posterior position in the pelvis is called asynclitism. If the sagittal suture approaches the sacral promontory, more of the anterior parietal bone presents itself to the examining fingers, and the condition is called anterior asynclitism. If, however, the sagittal suture lies close to the symphysis, more of the posterior parietal bone will present, and the condition is called posterior asynclitism. With extreme posterior asynclitism, the posterior ear may be easily palpated. Moderate degrees of asynclitism are the rule in normal labor. However, if severe, the condition is a common reason for cephalopelvic disproportion even with an otherwise normal-sized pelvis. Successive shifting from posterior to anterior asynclitism aids descent.

Reference: William’s Obstetrics, 23 rd Edition, page 379

76. RAGASA, JOHN R.In determining the station of the fetal head, which of the following fetal and maternal landmark relationship is

correct?a) biparietal diameter – ischial spinesb) biparietal diameter – pelvic inletc) presenting part – ischial spinesd) presenting part – pelvic inlet

Answer: CRationale: The station of the presenting fetal part in the birth canal is describe in relationsip to the ischial spines, ahich are halfway between the pelvic inlet and the pelvic outlet. When the lowermost portion of the presenting fetal part is at the level of the spines, it is designated as being at 0 station. Each fifth represents a centimeter above or below the spines. (-) if towards the spines and (+) if it passes the spines.

Reference: Williams Obstetrics 23rd Edition, p. 392.

77. MATABUENA, MAIKA ALMINA F. Which among the following cardinal movements of labor requires the resistance of the pelvic

a. descentb. internal rotationc. extensiond. expulsion

Answer: C

Rationale: Because one of the two forces come into play during extension is the force supplied by the resistant pelvic floor that acts anteriorly, while the other one is the force exerted by the uterus which acts more posteriorly.

Reference: Williams Obstetrics, 22nd ed.(2005) page 233

78. Rojas, Bianca B.Which of the following cardinal movements may take place even before the onset of labor in a primipara?

a. engagementb. descentc. flexiond. internal rotaion

Answer: ENGAGEMENT. Rationale: The mechanism by which the biparietal diameter, the greatest transverse diameter of the fetal head in occiput presentations, passes through the pelvic inlet is designated engagement. The fetal head may engage during the last few weeks of pregnancy or not until after the commencement of labor. In many multiparous and some nulliparous women, the fetal head is freely movable above the pelvic inlet at the onset of labor. In nulliparas, engagement may take place before the onset of labor, and further descent may not follow until the onset of the second stage. In multiparous women, descent usually begins with engagement.

Reference: Williams, 22ndedition, SECTION IV - LABOR AND DELIVERY, Chapter 17 Normal Labor and Delivery, page 413

79. Sadang Ronaldo B.Restitution occurs during what cardinal movement of Labor

a) Extentionb) descentc) internal rotationd) EXTERNAL ROTATION

ANSWER: DRATIONALE: External rotation OR restitution refers to return of the fetal head to the correct anatomic position in reference to the fetal torso. When the fetal head

is free of resistance, it untwists about 45o left or right returning to its anatomic position

Reference: Sumpaico, 3rd edition, page 400

80. ORPILLA, MARK JASON G.Engagement is determined by what Leopolds Maneuver?

a) Ib) IIc) IIId) IV

Answer: D. IVRationale: THIRD MANEUVER. Using the thumb and fingers of one hand, the lower portion of the maternal abdomen is grasped just above the symphysis pubis. If the presenting part is not engaged, a movable mass will be felt, usually the head. The differentiation between head and breech is made as in the first maneuver. If the presenting part is deeply engaged, however, the findings from this maneuver are simply indicative that the lower fetal pole is in the pelvis, and details are then defined by the last (fourth) maneuver.FOURTH MANEUVER. The examiner faces the mother's feet and, with the tips of the first three fingers of each hand, exerts deep pressure in the direction of the axis of the pelvic inlet. In many instances, when the head has descended into the pelvis, the anterior shoulder may be differentiated readily by the third maneuver.

Reference: Williams 22nd Edition Page 231 via Ebook

81. NABONG, MARCO PAULO C.

The purpose of external rotation is to bring the _________ diameter of the fetus along the anteroposterior diameter of the pelvic outlet.

a. bisacromialb. bitemporalc. biparietald. mentooccipital

Answer: ARationale: External Rotation. The delivered head next undergoes restitution. Restitution of the head to the oblique position is followed by a completion of external rotation to the transverse position, a movement that corresponds to rotation of the fetal body, serving to bring its bisacromial diameter into relation with the anteroposterior diameter of the pelvic outlet.

Reference: Williams Obstetrics 22nd edition. Chapter 17 Normal Labor and Delivery. pp417

82. Maebritt Wincent M. TibubosWhen the cervix becomes fully dilated with the presenting part in LOT, station +2, what cardinal movement should take place next?

a) Flexionb) Internal rotationc) Extensiond) External rotation

Answer: The most probable answer is letter C. extension.Rationalization: The end of internal rotation occurs when the sharply flexed head reaches the pelvic floor which is most likely in station +1 or +2. Therefore, the next cardinal movement is extension.

Reference: Chapter 17. Normal Labor and Delivery. Section 4 page 380 William’s Obstetrics 23rd Edition.

83. Desiree Joy Anne M. TimtimanA parturient arrives at the emergency room with a bulging perineum and anterior fontanel palpable over the posterior rim of the vaginal opening. What cardinal movement of the labor is taking place?

a) Internal rotationb) Extensionc) restitutiond) expulsion

Answer: b. extension. Rationale: Since in restitution and extension the fetus head is already out of the vagina then it is impossible to palpate for the anterior fontanel inside the vaginal opening. As define by Williams, internal rotation ends when the head reaches the pelvic floor and extension begins when the head reaches the vulva until the face of the fetus is seen. Hence the extension is most probably the cardinal movement taking place in this patient.

Reference: Chapter 17. Normal Labor and Delivery section 4 page 380 William’s Obstetrics 23rd Edition.

84. Villoso, Aaron Christian Earl I. The straightening and extension of the fetal body during a uterine contraction promotes which mechanism of labor?

a. flexion c. descent b. internal rotation d. Extension – caused by force exerted by the uterus, which acts more posteriorly, and the second, supplied by the resistant pelvic floor and the symphysis, which acts more anteriorly. The resultant vector is in the direction of the vulvar opening, thereby causing head extension

Answer: C. DESCENTRationale: Descent is brought about by one or more of four forces: (1) pressure of the amnionic fluid, (2) direct pressure of the fundus upon the breech with contractions, (3) bearing-down efforts of maternal abdominal muscles, and (4) extension and straightening of the fetal body.

Reference: Williams Obstetrics 23rd edition, page 380

85. TEE, JAN RAEMONThe sagittal suture is noted to be deflected towards the symphysis pubis. What bone is palpable during vaginal examination?

A. posterior parietalB. anterior parietalC. frontalD. Occipital

ANSWER: ARATIONALE: "the sagittal suture lies close to the symphysis, more of the posterior parietal bone will present, and the condition is called posterior asynclitism"

REFERENCE: William's 23rd edition, Chapter 17: Normal Labor and Delivery

86. YUSINGBO, Iami Rio Patricia A.During the second stage of labor, the presenting part is noted to be directly behind the symphysis pubis. What cardinal movement has taken place?

a. Flexionb. Internal Rotationc. Descentd. Extension

ANSWER: B. Internal RotationRationale: This movement consists of a turning of the head in such a manner that the occiput gradually moves toward the symphysis pubis anteriorly from its original position or less commonly, posteriorly toward the hollow of the sacrum. Internal rotation is essential for the completion of labor, except when the fetus is unusually small.Flexion - As soon as the descending head meets resistance, whether from the cervix, walls of the pelvis, or pelvic floor, then flexion of the head normally results. In this movement, the chin is brought into more intimate contact with the fetal thorax, and the appreciably shorter suboccipitobregmatic diameter is substituted for the longer occipitofrontal diameter. The suboccipitobregmatic diameter, the shortest anteroposterior diameter of the fetal head, is passing through the pelvic inlet in this cardinal movement.Descent - This movement is the first requisite for birth of the newborn. In nulliparas, engagement may take place before the onset of labor, and further descent may not follow until the onset of the second stage. In multiparous women, descent usually begins with engagement. Descent is brought about by one or more of four forces: (1) pressure of the amnionic fluid, (2) direct pressure of the fundus upon the breech with contractions, (3) bearing-down efforts of maternal abdominal muscles, and (4) extension and straightening of the fetal body.Extension - After internal rotation, the sharply flexed head reaches the vulva and undergoes extension. If the sharply flexed head, on reaching the pelvic floor, did not extend but was driven farther downward, it would impinge on the posterior portion of the perineum and would eventually be forced through the tissues of the perineum. When the head presses upon the pelvic floor, however, two forces come into play. The first force, exerted by the uterus, acts more posteriorly, and the second, supplied by the resistant pelvic floor and the symphysis, acts more anteriorly. The resultant vector is in the direction of the vulvar opening, thereby causing head extension. This brings the base of the occiput into direct contact with the inferior margin of the symphysis pubis.

Reference: William’s Obstetrics. 23rd edition e-book. Chapter 17 - Normal Labor & Delivery. (No page number indicated in the ebook)

87. ROMERO, KRISTINE JOY V.A Primigravid is admitted on her 8th hour of her labor with the following findings on vaginal examination: cervix is 4-5cms dilated both fontanels are palpated easily, station 0.Which of the cardinal movements of labor has taken place?

a) Engagementb) Descentc) Flexiond) Internal Rotation

Answer: ARationale: Because at Station 0 it means that the presenting part of the fetus is now in a level of below the pelvic inlet which means the pelvis inlet is adequate for the fetal head.

Reference: Williams Obstetrics 22nd edition Section II Chapter 2

88. Pena, Abigail R.What is the significance of the findings on the station of the presenting part?

a. fetal head is smallb. pelvic inlet is adequatec. vaginal delivery is highly anticipatedd. fetal membranes are likely to rupture early

Answer: BRationale: The mechanism by which the biparietal diameter- greatest transverse diameter in an occiput presentation passess through the pelvic inlet is designated engagement. In Station 0, fetal head is at the level of the ischial spine, therefore the head is engaged and pelvic inlet is adequate.

Reference: Williams Obstetrics, 23rd edition page: 378

89. ORAA, MIKHAIL JOREX B.

On the 12th

hour of labor, the cervix is dilated to 8-9 cms. The triangular fontanel is palpated easily but not the diamond shaped fontanel. What cardinal movement of labor has taken place? a. Descent b. Flexion c. Internal Rotation d. ExtensionAnswer: B

Rationale: Flexion. In this movement, the chin is brought into more intimate contact with the fetal thorax, and the appreciably shorter suboccipitobregmatic diameter is substituted for the longer occipitofrontal diameter.Triangular fontanel is synonymous to the posterior fontanel w/c is the presenting part after flexion has taken place in an occiput posterior position.

Reference: Williams Obstetrics 22nd

edition. Chapter 17 Normal Labor and Delivery. page 417

90. OLIVA, MARK MOSES D.One hour after the cervix becomes fully dilated, the presenting part remains in LOT. What cardinal movement of labor failed to take place?

a. descent c. internal rotationb. flexion d. extension

Answer: C. internal rotationRationale: In phase 3 of parturition where the cervix is fully dilated, of about 10 cm allows the passage of presenting fetal part and it marks the first stage of labor, the stage of cervical effacement and dilatation. In internal rotation which is essential in completion of labor, the fetus starts to descend in LOT, in some instances when the fetus is unusually small, the presenting part fails to express from Left Occiput Transverse(LOT) to Occiput Anterior(OA) thus Internal rotation doesn’t take place and the presenting fetal part remains in Left Occiput Transverse(LOT).

Reference: Williams Obstetrics, Twenty-Third Edition (ebook), Chapter 6 and Chapter 17 http://www.brooksidepress.org/Products/Obstetric_and_Newborn_Care_1/lesson_10_Section_1A.htm

91. OMAPAS, SHEILAAnimal studies have shown an adverse effect and there are no adequate and well controlled studies done on pregnant women.

a. Category A

b. Category Bc. Category Cd. Category De. Category X

Answer: CRationale: Explained almost verbatim in Williams

Reference: Williams, 23rd edition, page 315, table 14-3.

92. Montillano, Ana Cristina N.Adequate and well controlled studies have not shown an increased risk of abnormalities

Answer: Category ARationale: According to the guidelines released by the US Food and Drug Administration, Category A drugs have not shown to increase the risk of abnormalities in all the trimesters of pregnancy.

Source: William’s Obstetrics 23rd edition page 315

93. MACATANGAY, MIKHAILJON SAMUEL C.Studies that are adequate well controlled and observational in pregnant women or animals have shown fetal abnormalities

a) Category Ab) Category Bc) Category Cd) Category De) Category X

Answer: ERationale: CATEGORY X - this medication is contraindicated who are or may become pregnant. It may cause fetal harm. If is drug is used during pregnancy or if a woman becomes pregnant while taking this medication, she should be appraised of potential hazard to the fetus. There are few medication in this medication in this category that have never been shown to cause fetal harm but should be avoided nonetheless such as the rubella vaccine.

Reference: Williams 23rd Edition page 315 Table 14-3

94. Siocon, Mariel L.No adequate and well controlled studies have been conducted in pregnant women and animals.

a. Category Ab. Category Bc. Category Cd. Category De. Category X

Answer: C Rationale: Food and Drug Administration Categories for Drugs and Medications

Category A: Studies in pregnant women have not shown an increased risk for fetal abnormalities if administered during.Category B: Animal reproduction studies have been performed and have revealed no evidence of impaired fertility or harm to the fetus.Animal studies have shown an adverse effect, but adequate and well-controlled studies in pregnant women have failed to demonstrate a risk to the fetus during the first trimester of pregnancy, and there is no evidence of a risk in later trimesters.Category C: Animal reproduction studies have shown that this medication is teratogenic (or embryocidal or has other adverse effect), and there are no adequate and well-controlled studies in pregnant womenThere are no animal reproduction studies and no adequate and well-controlled studies in humans.

Category D: This medication can cause fetal harm when administered to a pregnant woman. If this drug is used during pregnancy or if a woman becomes pregnant while taking this medication, she should be apprised of the potential hazard to the fetus.This category also contains medications used to treat potentially life-threatening medical conditions.Category X: This medication is contraindicated in women who are or may become pregnant. It may cause fetal harm.

Reference: Page 315, table 14-3, Williams Obstetrics 23rd edition.

95. MACALINTAL, KATRINA CYRIL M.Animal studies have shown an adverse effect, but adequate and controlled studies on pregnant women have not shown risk to the fetus.

A. Category AB. Category BC. Category CD. Category DE. Category X

Answer: BRationale:Table 14-3. Food and Drug Administration Categories for Drugs and MedicationsCategory A: Studies in pregnant women have not shown an increased risk for fetal abnormalities if administered during the first (second, third, or all) trimester(s) of pregnancy, and the possibility of fetal harm appears remote.Fewer than 1 percent of all medications are in this category. Examples include levothyroxine, potassium supplementation, and prenatal vitamins, when taken at recommended doses.Category B: Animal reproduction studies have been performed and have revealed no evidence of impaired fertility or harm to the fetus. Prescribing information should specify kind of animal and how dose compares with human dose.orAnimal studies have shown an adverse effect, but adequate and well-controlled studies in pregnant women have failed to demonstrate a risk to the fetus during the first trimester of pregnancy, and there is no evidence of a risk in later trimesters.Examples include many antibiotics, such as penicillins, macrolides, and most cephalosporins.Category C: Animal reproduction studies have shown that this medication is teratogenic (or embryocidal or has other adverse effect), and there are no adequate and well-controlled studies in pregnant women. Prescribing information should specify kind of animal and how dose compares with human dose.orThere are no animal reproduction studies and no adequate and well-controlled studies in humans.Approximately two thirds of all medications are in this category. It contains medications commonly used to treat potentially life-threatening medical conditions, such as albuterol for asthma, zidovudine and lamivudine for human immunodeficiency viral infection, and many antihypertensives, including -blockers and calcium-channel blockers.Category D: This medication can cause fetal harm when administered to a pregnant woman. If this drug is used during pregnancy or if a woman becomes pregnant while taking this medication, she should be apprised of the potential hazard to the fetus.This category also contains medications used to treat potentially life-threatening medical conditions, for example: systemic corticosteroids, azathioprine, phenytoin, carbamazepine, valproic acid, and lithium.Category X: This medication is contraindicated in women who are or may become pregnant. It may cause fetal harm. If this drug is used during pregnancy or if a woman becomes pregnant while taking this medication, she should be apprised of the potential hazard to the fetus.There are a few medications in this category that have never been shown to cause fetal harm but should be avoided nonetheless such as the rubella vaccine.

Reference: Williams Obstetrics, 23rd edition, Table 14-3

96. PURIFICACION, ARMIN JR. ON.R had missed her period for the first time and she decided to seek consult with an OB-Gyn where an internal

examination revealed a soft and closed cervixA. Phase 1 (ANSWER)B. Phase 2C. Phase 3D. Phase 4

ANSWER: ARATIONALE: Phase 1 of Parturition is exemplified by Uterine Quiescene and Cervical Softening. According to William's, "Thus, the first stage of this remodeling—termed softening—is characterized by an increase in tissue compliance, yet the cervix remains firm and unyielding. Hegar (1895) first described palpable softening of the lower uterine segment at 4 to 6 weeks' gestation, and this sign was once used to diagnose pregnancy."Thus the cervix becomes softer than in the non-pregnant state, "In nonpregnant women, the cervix is closed and firm, and its consistency is similar to nasal cartilage.", however remains closed as the cervix is not yet ready to dilate.

Reference: E-Book Version of Williams 23rd Edition Copyright © The McGraw-Hill Companies. All rights reserved. Williams Obstetrics, 23e > Chapter 6. Parturition >

97. Reyes, Christian Lawrence L.A.B. experienced labor pains of eight hours duration. She consulted at the ER and examination revealed a five cm cervical dilatation fully effaced, cephalic presentation and intact membranes.

i. Phase I - period of uterine quiescence and cervical softeningj. Phase 2 – uterine awekening and activation, cervical ripeningk. Phase 3 – progressive dilation and effacement of the cervix to delivery of the fetusl. Phase 4 - involution and repair of the uterus

Answer: CRationale: Reference:

98. Noche, Rizza Joyce C. What is the significance of the findings on the station of the presenting part?

a) The fetal head is smallb) The pelvic inlet is adequatec) Vaginal delivery is highly anticipatedd) Fetal membranes are likely to rupture early

Answer: b. the pelvic inlet is adequate. Rationale: The level or station is the relationship of the fetal presenting part to the ischial spines, halfway between the pelvic inlet and outlet. When the lowermost portion of the presenting part is at the level of the ischial spines, it is designated as 0. If presenting part is at station 0 or below, it is most often considered as engaged because the biparietal plane has passed through the pelvic inlet. The significance of the findings is the Bishop scoring. Assessed and tabulated are the 5 characteristics namely: Cervical dilatation, Effacement, Consistency, Position & Fetal station, used to predict labor induction outcome. American College of Obstetrics and Gynecology classification of stations dividing the pelvis above and below the spines into fifths with intervals of approximately 1 cm. From the pelvic inlet toward the ischial spines, designated as -5 to -1 then below the spines, +1 to +5, corresponding to its visibility at the introitus. (Williams, p.392)

*Bishop Scoring System for Assessment of Inducibility (Williams, p. 502)Score Dilatation Effacement Station Cervical

consistencyCervical position

0 Closed 0 – 30 % - 3 Firm Posterior1 1 to 2 cm 40 – 50 % - 2 Medium Midposition2 3 to 4 cm 60 – 70 % - 1 Soft Anterior3 ≥ 5 cm ≥ 80 % + 1, + 2 --- ---

Reference: (Williams, p.392)

99. ROY, JAMES MAXIMILLIAN VD.W. is currently breastfeeding and is seeking opinion regarding family planning.

a. Phase 1b. Phase 2c. Phase 3d. Phase 4

Answer: DRationale: Phase 4 of parturition includes the parturient’s recovery, uterine involution, cervical repair and breastfeeding which occurs after the delivery of conceptus and before the restoration of the woman’s fertility.

Reference: Williams 23rd

Edition (E-Book), Chapter 6, Phases of Parturition, Figure 6-1

100. VILLASENOR, MARICE VL.L. is at the Labor Room she has reached full cervical dilatation and the nurse is preparing her for vaginal delivery

a. Phase 1b. Phase 2c. Phase 3d. Phase 4

Answer: CRationale: Phase 3 is summarized in 3 clinical stages. The first stage begins when widely spaced uterine contractions of sufficient frequency, intensity, and duration are attained to bring about cervical thinning, termed effacement. This labor stage ends when the cervix is fully dilated—about 10 cm—to allow passage of the fetal head. The first stage of labor, therefore, is the stage of cervical effacement and dilatationThe second stage begins when cervical dilatation is complete, and ends with delivery. Thus, the second stage of labor is the stage of fetal expulsionThe third stage begins immediately after delivery of the fetus and ends with the delivery of the placenta. Thus, the third stage of labor is the stage of placental separation and expulsion.

Reference: Williams 23rd

Edition (E-Book), Chapter 6, Phases of Parturition, Figure 6-1