FORMATIVE ASSESSMENT 1 - OB

• Which of the following is the positive sign of pregnancy?

o Fetal heart tone
• Which is the shortest distance between the sacral promontory and symphysis pubis?
o Obstetric conjugate
• What is the primary functional change in the cardiovascular system in pregnancy?
o Increase cardiac output
• During labor when does active descent of the presenting part usually occur?
o Deceleration phase
• How many centimeters cervical dilatations represents the beginning of the active phase of
labor?
o 6 centimeters
• Which of the respiratory functions is unchanged during pregnancy?
o Respiratory rate
• What is the diagnostic criterion for anemia of pregnancy?
o Less than 110 g/L
• Which of the following characteristics of uterine contractions will lead to true labor?
o Uterine contractions that lead to cervical change
• What does the term engagement refer to?
o When the biparietal diameter of the fetal head passes through the pelvic inlet
• A 30-year-old G2P0 is in active labor. She is shouting on top of her voice and has the urge to
bear down. Upon examining the patient, you noticed that the head is visible at the introitus.
What is the fetal station?
o +5
• What is the normal duration of pregnancy calculated from the first day of the last menstrual
period?
o 280 days
• Microscopically, this is an arborization of ice-like crystals as a result of amniotic fluid leakage?
o Ferning
• 75 gms OGTT is screening for gestational diabetes done at what age of gestation?
o 24-28 weeks of gestation
• AB, 22-year-old, G3P1 (1011), Pregnancy uterine 28 6/7 weeks AOG by LMP. During her prenatal
visit, she voiced out a concern that her office mate was diagnosed with chicken pox and would
like to be vaccinated. How should you advise her?
o Varicella vaccination is contraindicated in pregnancy
• What do you call a woman who has never completed a pregnancy beyond 20 weeks of
gestation?
o Nullipara
• At what period of pregnancy when a physiologic decrease in blood pressure is noted?
o Mid pregnancy
• In pregnancy, it is when the vaginal mucosa becomes dark bluish, purplish-red and congested.
o Chadwick’s sign
• Which is a TRUE statement with regards to obesity in pregnancy?
o The recommended pregnancy weight gain for singleton pregnancy in obese women is
about 11-20 lbs.
• Age of gestation when fetal movement is appreciated by a primigravid?
o 18-20 weeks
• In a healthy pregnant woman, sexual intercourse is not usually harmful. However, when should
coitus be avoided?
o Presence of placenta previa
• What type of placental expulsion of placental delivery when the placenta leaves the endometrial
cavity before the retroplacental hematoma?
o Schultze
• Which of the following factor is LEAST associated with increased risk of pregnancy loss?
o Previous cesarean section
• With regards to fetal position, if the occiput is located halfway between the sacral promontory
and the symphysis, the position is termed either:
o Left or right occiput transverse (LOT or ROT)
• Which of the following women could be classified as a nulligravida?
o A 30-year-old who has never been pregnant before
• This describes the descent of the fetal biparietal diameter in relation to a line drawn between
maternal ischial spines:
o Station
• Effacement of the cervix refers to which of the following findings?
o Shortening of the cervix
• The following describes the cardinal movements of labor and delivery:
o Engagement, descent, flexion, internal rotation, extension, external rotation, expulsion
• The clinical stages of labor, first, second, and third stages, make up which phase of parturition?
o Phase 3
• What is the most important force in fetal expulsion at the end of first stage of labor?
o Uterine contractions
• In Leopold’s, what maneuver determines the degree of fetal descent?
o 4th maneuver
• At how many weeks will an embryo with cardiac motion typically detected on ultrasonography?
o 6 weeks
• The mechanism by which the biparietal diameter passes through the pelvic inlet
o Engagement
• Fetal movements are typically first perceived by the mother at approximately what gestational
age?
o 16 weeks
• In labor, what anatomic landmark is used to assess the station of the presenting part?
o Ischial spine
• Most fetuses initiate the cardinal movements in what fetal position?
o Occiput transverse position
• What phase of labor is characterized by rapid cervical dilation?
o Phase of maximum slope
• This condition occurs when the head is not in the same longitudinal axis as the fetal vertebral
column
o Asynclitism
• Which of the following is NOT a consequence of vascular changes in women during pregnancy?
o Angioma
• What is the beginning of the second stage of labor?
o Begins with complete cervical dilation
• At the moment of engagement and descent of the vertex into the pelvis, the fetus will be in a
transverse position. What brings about the internal rotation of the presenting part to rotate
towards the symphysis pubis?
o Resistance of the pubococcygeus and iliococcygeus muscles
• Which of the following findings is NOT a classic sign that indicate that the placenta has
separated from the uterus?
o The uterus contracts and relaxes upon palpation
• What hormone is detected in maternal blood and urine which serves as the basis for endocrine
assay of pregnancy?
o HCG
• On abdominal palpation of the cephalic prominence of the fetal head is in line with the small
parts. What is the presentation?
o Vertex presentation
• FM 25-year-old G1p0 on her 12 weeks gestation, came into the clinic with an HbA1c result of
4.5%. What is the patient’s classification with regards to her blood glucose level?
o Normal level
• Which of the following statements is TRUE regarding physiologic changes in the gastrointestinal
tract during pregnancy?
o Gallbladder contractility is increased
• The abrupt cessation o menstruation in a healthy reproductive-aged woman is known as:
o Amenorrhea
• In regularly menstruating woman, amenorrhea is not a reliable pregnancy indicator until how
many days or more after expected menses have passed?
o 7 days
• High doses of which of the following vitamins is associated with an increased risk of birth defects
and should not be used in pregnancy?
o Vitamin A
• When the fetus lies with the long axis transversely, what is the presenting part?
o Shoulder
• Which of the following physical findings on cardiovascular examination is considered
pathologic?
o Diastolic murmur
• At 32-year-old G1P0, who at 32 weeks gestation is noted to have cervical dilatation in the
absence of uterine contractions. What does this condition suggest?
o Cervical insufficiency
• A 38-year-old woman came in for a check-up. LMP: September 12, 2021. She had 4 prior
pregnancies. First pregnancy resulted in a delivery of a term male neonate. Her second
pregnancy was spontaneously terminated at 17 weeks AOG. She underwent pelvic laparotomy
for ectopic pregnancy during her third pregnancy at 12 weeks of AOG. Her fourth pregnancy
resulted in a delivery of a live female neonate at 38 weeks AOG. What is this patient’s OB score?
o G5P2 (2022)
• A 24-year-old G2P0 (0010) at 38 weeks AOG came in for consult due to strong, painful uterine
contractions. Cervical examination revealed 1 cm cervical dilation, slightly effaced. The patient
was given sedation and 4 hours later the contractions were noted to have stopped.
Reassessment of the cervix still revealed 1 cm cervical dilatation. What is the most likely
diagnosis?
o False labor
• What vitamin has been recommended for supplementation for the prevention of neural tube
defects?
o Folic acid
• What is the first sonographic evidence of pregnancy?
o Double decidual sign
• Which of the following is the probable sign of pregnancy?
o (+) pregnancy test
• A 20-year-old G1P0 was admitted because of spontaneous rupture of membranes and
eventually delivered a 500 g that succumbed. The fetus is
o Abortus
• Prenatal consult should be initiated early to
o To define the health status of the mother and fetus
• What is the most common type of anemia in pregnancy?
o Iron deficiency anemia
• At what age is a woman labeled as elderly gravida?
o 35-year-old
• Plasma volume increase in pregnancy reaches its peak at about how many weeks age of
gestation?
o 32-34 weeks
• Adding 7 days to the first day of the last menstrual period and counting back 3 months to
estimate the day of delivery is
o Naegele’s rule
• Blood levels of the pregnancy hormone human chorionic gonadotropic (HCG) can be detected as
early as
o 48 hours of implantation
• Although it is within normal limits, which of the following blood components tend to fall
progressively in a normal pregnancy?
o Platelets
• A 16-year-old G1P0 is admitted at 34 weeks gestation in which induction of labor was done
because of hypertension. The neonate was successfully delivered vaginally. Based on the
gestational age. How would classify the neonate?
o Late preterm
• AB, 22 years old, has her first pregnancy, twins, live, preterm birth, second pregnancy, abortion,
third pregnancy, H. mole, fourth pregnancy, current pregnancy at 32 weeks. What is the
gravidity and parity?
o G4P2 (0222)
• What is defined as the relation of the various parts of the fetus to each other?
o Attitude
• In performing the Leopold’s Maneuver, to diagnosis presentation which procedure allows the
identification of the fetal parts in the upper pole (fundus) of the uterus.
o First maneuver
• What is the single primary metabolic substrate for placental metabolism?
o Glucose
• Fundal height measurements in centimeters correlate closely with the gestational age between
how many weeks?
o 18 – 32 weeks
• Of the four phases of parturition, phase 2 is characterized by which of the following?
o Uterine activation, cervical ripening
• Which vaccine has not been associated with adverse fetal outcomes and thus not
contraindicated in pregnancy?
o Rabies vaccine
• AB, 22-year-old, G1P0, 9-week AOG, complaining of nausea and vomiting. Symptomatic relief
can be provided by?
o Orange juice
• What is the classic action of B-hCG?
o Maintenance of the corpus luteum (CL)
• When does the fall in hemoglobin levels typically by 1 – 2 g/dl occur physiologically?
o Late second trimester
• Hemoglobin A1C determination will give you an assessment for what possible risk in pregnancy?
o Risk for fetal anomalies
• What is recommended elemental iron supplemented per day to a pregnant woman?
o 30 to 60 mg
• What is the normal length of the cervix, the basis of its condition will determine effacement?
o 3 to 4 cm
• When combined with doxylamine, which has been found to be helpful in cases of nausea and
vomiting in pregnancy?
o Vitamin B6
• Which phase of parturition corresponds to the clinical stages of labor?
o Phase 3
FORMATIVE ASSESSMENT 2 – OB
• Immediately after delivery, the neonate is whimpering and grimaces when touched. His fingers
and toes are bluish and his HR is 130 bpm. Active movement with flexed arms and legs and good
cry.
o Apgar of 8
• Which interischial tuberous diameter measurement serves as the threshold to define pelvic
outlet contraction?
o 8 cm
• A system used for assessment of cervical inducibility
o Bishop scoring
• In the recommended universal newborn screening, which of the following condition is due to
amino acid metabolism disorder?
• Which of the following is true about newborn assessment?
o This includes the APGAR and Ballard score.
• Which of the following is not an element of the APGAR score?
o Cry
• A 25-year-old primigravida gestational hypertension has new-onset vaginal bleeding that is
accompanied by fetal decelerations. She undergoes an emergency cesarean delivery and the
placental findings below are noted. According to the American College of Obstetricians and
Gynecologist and the American Academy of Pediatrics, which of the following would support the
diagnosis of hypoxia – induced metabolic acidemia?
o Neonatal seizure in the first 24 hours of life
• Metabolic acidemia at birth is mostly closely linked to long-term neurological outcome in which
of the following circumstance?
o When the birthweight is < 1000 g
• These are situations requiring immediate intervention in newborn care, EXCEPT:
o Term infant
• What is the correct ratio of chest compressions to breaths per minute in resuscitating a term
neonate?
o 90 compressions: 30 breaths
• According to the ACOG, which of the following is not an indication for cord blood gas
determination?
o Vaginal breech before delivery
• Which of the following conditions may influence the APGAR score?
o All of the above
• Meconium stooling in the delivery room suggest which of the following?
o Gastrointestinal tract patency
• It is indicated if the heart rate remains < or = to 60 bpm after adequate ventilation and chest
compressions:
o Epinephrine
• What is not included in the essential newborn care?
o None of the above
• This is used for assessment of gestational age of the neonate:
o Ballard score
• In the APGAR score, what score is considered to be moderately depressed?
o 4–6
• Despite ventilatory support and chest compressions, the neonatal heart rate is 45 bpm. What is
the appropriate management?
o Administer endotracheal epinephrine.
• A multiparous patient with rapid labor has moderate staining of her amniotic fluid with
meconium. She received a single 50-mg dose of meperidine intravenously for pain relief.
Following variable decelerations at 90 beats per minute with pushing, she delivers the neonate.
What is the first step in newborn resuscitation?
o Warm, dry and stimulate the newborn
• When is APGAR scoring done?
o 1 and 5 minutes after birth
• What is the reason that Vitamin K is administered to newborns within one hour after birth?
o To prevent vitamin K dependent hemorrhagic disease of the newborn
• Which of the following scenarios is an indication for endotracheal intubation?
o Heart rate <100 bpm for >60 seconds
• What are small elevations that are scattered through the areola which are hypertrophic
sebaceous gland?
o Glands of Montgomery
• What hormone is ejected during milk ejection?
o Oxytocin
• Which is not a benefit of breastfeeding?
o None of the above
• What is the treatment to relieve the pain of breast engorgement?
o Analgesic
• These are factors that influence drug excretion, EXCEPT:
o Shorter half-life
• These are absolutely contraindicated drugs with breastfeeding except:
o None of the above
• Colostrum secretion persists for how long?
o Both A and B
• To minimize neonatal drug exposure from maternal medications, which drug quality is preferred
during selection?
o Poor lipid solubiity
• All the following therapies are absolutely contraindicated during breast feeding, EXCEPT:
o SSRI
• Contraindications to breastfeeding include maternal infection caused by which of the following
viruses?
o HIV
• In a woman who chooses not to breastfeed, treatment of bilateral breast engorgement that is
associated with fever in the first few postpartum days is managed best with which of the
following?
 o Antipyretic analgesia and breast binding
• Benefits of breastfeeding include lower rates of all EXCEPT which of the following?
o Puerperal mastitis
• All of the following measures are included in the WHO steps to successful breastfeeding,
EXCEPT:
o Discouraged breastfeeding on demand by infants
• Which gland secretes oxytocin?
o Posterior pituitary gland
• What is the treatment for breast abscess?
o Surgical drainage and aspiration
• This allows prolactin to act unopposed in its stimulation of alpha-lactalbumin production:
o Progesterone withdrawal
• This is provoked by an infant cry and can be inhibited by maternal fright or stress:
o Both A and B
• Colostrum is gradually converted from transitional to mature milk in how many weeks?
o 4 – 6 weeks
• Advantages of breastfeeding, EXCEPT:
o All of the above
• This factor interferes with cellular metabolism and potentially cause immune suppression or
neutropenia, affect growth, and increase the risk of childhood cancer.
o Use of cytotoxic drugs
• When performing a bimanual examination on a pregnant woman, the position of the cervix is
determined by the relationship of the cervical os to which of the following?
o Fetal head
• Station describes the relationship between which of the following?
o The biparietal diameter and ischial spines.
• A 25-year-old G1P0 at 39 weeks gestation presents in active labor, cervix 4 cm dilated,
completely effaced, station 0, membranes intact. Two hours later, the cervix is still 4 cm dilated.
At this point, which of the following is the best management?
o Rupture membranes
• A 19-year-old G1P) at term presents in active labor. Her cervix is 5 cm dilated, and fluid is leaking
from spontaneously ruptured membranes. You examine her 2 hours later, and the cervix is still 5
cm dilated. At this point, which of the following is the best management?
o Placement of internal monitors and reassessment in 2 hours
• According to Friedman, the minimum normal rate of active-phase labor in a multipara is which
of the following?
o 1.5 cm/hr

• Which stage of labor begins with complete cervical dilation and ends with delivery of the fetus?
o Second stage
• A 20-year-old G1P0 at 39 weeks’ gestation presents complaining of strong contractions. Her
cervix is dilated 1 cm. She is given sedation and 4 hours later, her contractions have stopped.
Her cervix is 1 cm dilated. Which of the following is the most likely diagnosis?
o False labor
• In shoulder presentation, the portion of the fetus chosen for orientation with the maternal
pelvis is which of the following?
o Scapula
• When the anterior fontanel is the presenting part, which term is used?
o Sinciput
• Regarding engagement of the fetal head, which of the following statement is true?
o Engagement prior to the onset of labor does not affect vaginal delivery rates.
• Which of the following statements regarding the preparatory division of labor is true?
o All of the above
• When evaluating a pregnant woman for rupture of membranes, which of the following has been
associated with a false-positive nitrazine test result?
o All of the above
• Which of the following may be responsible for dystocia in labor?
o All of the above
• Which of the following is not a risk factor for incomplete rotation of the posterior occiput?
o Lack of analgesia
• On palpation of the fetal head during vaginal examination, you note that the sagittal suture is
transverse and close to the pubic symphysis. The posterior ear can be easily palpated. Which of
the following best describes this orientation?
o Posterior asynclitism
• What manuever is pelvic grip?
o Leopold’s manuever 4
• Of the cardinal movements of labor, internal rotations achieve what goal?
o Brings the occiput to an anterior position
• By definition, the puerperium last what time interval following delivery?
o 6 weeks
• What time interval following delivery is required for the typical uterus to complete involution?
o 4 weeks
• Which of the following is true regarding the physiological change of the cervix during
postpartum period?
o The cervix undergoes considerable remodeling
• Lochia, in its various forms, typically resolves after how many weeks postpartum?
o 5 weeks

• Compared with colostrum, mature milk typically has greater amounts of which of the following
per volume weight?
o Fat
• It is defined as bleeding 24 hours to 12 weeks after delivery
o Secondary postpartum hemorrhage
• Which of the following is not associated with postpartum urinary retention?
o Chorioamnionitis
• Which of the following is true regarding hematological and coagulation changes during the
puerperium?
o The white blood cell count sometimes reaches 30,000/L with the increase
predominantly due to granulocytes
• Immediate postpartum care includes which of the following except:
o None of the above
• Because of deep-vein thrombosis risks, combination hormonal contraception should not be
initiated sooner than how many weeks postpartum?
o 4 weeks
• This blocks pituitary secretion of FSH and LH and thereby inhibits ovulation:
o Combined COC
• The mother’s chance of pregnancy in lactation amenorrhea method is increased if:
o All of the above
• In a woman who chooses not to breastfeed, treatment of bilateral breast engorgement that is
associated with ever in the first few postpartum days is managed best with which of the
following?
o Antipyretic analgesia and breast binding
• Your patient had a vaginal delivery yesterday complicated by a first degree perineal laceration a
term a 12-hour labor. She is asymptomatic, a febrile, and has normal vital signs. Her uterus is
firm and nontender. Her remaining physical examination is remarkable. She has voided several
times and total urine output or the past 12 hour is 1400 mL. Which of the following is the best
management step?
o Continue routine postpartum care
• Benefits of breastfeeding include lower rates of all EXCEPT which of the following?
o Puerperal mastitis
• Your patient who is breastfeeding presents 8 weeks postpartum with complaints of breast pain
and associated mass that has enlarged during last 2 weeks. A significantly tender, fluctuant, non-
erythematous mass is present. Management of this patient should primarily include which of
the following?
o Therapeutic needle aspiration
• Secondary postpartum hemorrhage is defined as bleeding from 24 hours to 12 weeks
postpartum. It may be caused by all except which of the following?
o Placental abruption
• Correct statements regarding contraception in breastfeeding women in general include which of
the following?
o Progestin-only birth control pills do not affect the quantity of breast milk.
• Following spontaneous vaginal delivery, the patient complaints of right leg weakness, and is
unable to flex the right hip and extend the leg. A common risk factor for this complication
includes which of the following?
o Prolonged second-stage labor
• What is the treatment for breast infection like mastitis and breast abscess?
o Both A and B.
• What is the fixed point of reference in a vertex presentation?
o Posterior fontanel
• What is the Bishop score of the patient when internal examination reveals cervix= 2cm, 50%
effaced, cephalic, station -2, intact BOW with posterior and firm cervix?
o 3
• Immediately after a term neonate is delivered, at least by how many breaths does the
newborn's breathing becomes similar to that of an adult?
o 5 breaths
• What stage of labor incorporate many of the cardinal movements necessary for the fetus to
negotiate the birth canal?
o 2nd stage of labor
• Which of the following structures of the fetal head is the fixed point of reference in a vertex
presentation?
o Posterior fontanel
• M.S. 29-year-old G1P0, full term admitted in labor. On clinical pelvimetry, the diagonal
conjugate is >11.5 cm: sacrum is curved: prominent ischial spines, wide subpubic arch. Which of
the following findings is suggestive a contracted pelvis?
o Prominent ischial spines