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OBSTRUCTED LABOR Obstructed labor: A. May be due to mechanical or functional factors. B. Is not related to malpresentations. C. Rarely causes fetal asphyxia. D. Is commonly associated with formation of caput. E. Is responsible for the formation of a contraction ring. Etiological factors of obstructed labor include: A. Contracted pelvis. B. Hypotonic inertia. C. Contraction ring. D. Persistent occipito-posterior. E. Hydrocephalus. Etiological factors of obstructed labor include: A. Direct mento-posterior. B. Shoulder dystocia. C. Direct occipito-posterior. D. Macrosomia. E. Hypertonic inertia. Clinical picture of obstructed labor: A. Is also known as impending rupture of the uterus. B. Prolonged rupture of membranes is common. C. Blood pressure usually rises with prolongation of the second stage. D. The fetal heart sounds are always inaudible. E. The cause of obstruction can usually be determined by PV. Clinical picture of obstructed labor: A. A history of previous attempts at vaginal delivery is commonly obtained. B. Signs of dehydration are rarely seen. C. Fetal parts are difficult to palpate. D. A pathological retraction ring may be seen. E. Cervical caput is commonly felt. Pathological retraction ring: A. Occurs during a prolonged second stage. B. The mother is not necessarily distressed. C. Always lies between the upper and lower segments. D. Rises up. E. Can not be seen abdominally. Pathological retraction ring: A. The uterus is tonically retracted. B. The mother is distressed. C. The fetus is distressed or dead. D. Relieved only when the fetus is born. E. Can usually be felt vaginally. Complications of obstructed labor include: A. Intra-amniotic infection. B. Puerperal sepsis. C. Rupture of the uterus. D. Malpresentations. E. Acute puerperal inversion of the uterus. Complications of obstructed labor include: A. Atonic post partum hemorrhage. B. Traumatic post partum hemorrhage. C. Oligohydramnios. D. Intra-uterine asphyxia. E. Asphyxia neonatorum. Management of obstructed labor: A. Forceps or ventouse delivery may save the patient a cesarean section in some cases. B. Craniotomy may save the patient a cesarean section if the fetus is dead. C. Cesarean section carries a considerable risk of extension of the uterine incision. D. Extraction of the fetus during cesarean section is commonly difficult. E. Exploration of the birth canal under anesthesia is essential after any vaginal manipulation. Pathological retraction ring: 1- It is a complication of obstructed labor. 2- It is also called Bandl ring. 3- It can be felt and seen abdominally. 4- It occurs in the middle of the upper uterine segment. 5- It has a fixed position and does not rise up with labor progression. Say true or false: a. Forceps delivery may lead to perineal, cervical lacerations or rupture uterus. b. Vulval hematoma may extend to the broad ligament. c. Cervical laceration may lead to broad ligament hematoma. d. Rupture scar of LSCS is usualy incomplete. e. Annular detachment of the cervix may lead to severe post-partum hemorrhage. f. Cervical lacerations mostly affect the lateral angle of the cervix. g. Cervical laceration may in the form of button hole of the cervix. h. Ureteric injury is common with cervical lacerations. i. Hysterectomy is the only line of treatment of rupture uterus. j. Vaginal laceration may occur as an extention from perineal or cervical lacerations. k. Concealed accidental hemorrage and perforating mole may be a cause of rupture uterus during pregnancy. l. Placenta previa increases the risk of rupture uterus. m. Vulval varcosities increases the risk of vulval hematoma. n. Fetal distress is an early sign of rupture uterus. o. Tenderness over the scar may a sign of threatened rupture uterus. p. Hysterectomy done for cases of rupture uterus is usualy panhysterectomy. q. In cases of rupture uterus shock is usuall propotinate to the amount of vaginal bleeding. r. Vaginal pack for 24 hours is essential after treatig vaginal or cervical lacerations. (1)Obstructed labour is defined as:- A) Protracted active phase. B) Prolonged latent phase. C) Arrested labour due to the presence of mechanical obstruction. D) All of the above. (2)The salient feature of obstructed labour is :- A) Tardy cervical dilation. B) Ruptured membranes with liquor drainage. C) Presence of rising retraction ring. D) Patient's exhaustion & dehydration. (3)Facing obstruction, the uterus develops over activity with the possibility of rupture uterus in: A) Primigravida. B) Multigravida. (4)After development of manifestations of obstruction, if labor pains cease & the presenting part recedes upwards. The case is: A) Impending rupture of uterus. B) Rupture of uterus. (5)In case of obstructed labor, caput succedaneum show the following EXCEPT: A) It is a good prognostic sign. B) It over-rides & hides the suture. C) It gives a false impression of progressive head descent. D) It gives a false impression of a head on the perineum. (6)In obstructed labor, differential diagnosis includes(Mark the wrong statement). A) Full bladder. B) Fundal mayoma. C) Constriction ring. D) All of the above. E) None of the above.