Cord Prolapse

1. Cord Prolapse occurs more with the following conditions. SELECT ALL THAT
APPLY

A. Premature rupture of membranes

B. Fetal presentation other than cephalic

C. Placenta previa

D. A small fetus

E. CPD preventing firm engagement

ANSWER: A, B, C, D and E

RATIONALE: Cord prolapse tends to occur most often with: Premature rupture of
membranes, Fetal presentation other than cephalic, Placenta previa, Intrauterine tumors
preventing the presenting part from engaging, A small fetus, CPD preventing firm
engagement, Polyhydramnios and Multiple gestation.

2. Dayanara, a pregnant client is admitted to the Emergency Room Department and

was transfer to your area. She told you that her membranes ruptured on the way to
the hospital and there is something on her vagina that feels like rope. Upon initial
assessment it is umbilical cord prolapse. Which of the following is the nurse’s initial
action when umbilical cord prolapse occurs?

A. Begin monitoring maternal vital signs and FHR

B. Place the client in a knee-chest position in bed

C. Notify the physician and prepare the client for delivery

D. Apply a sterile warm saline dressing to the exposed cord

ANSWER: B

RATIONALE: Because of the space between the presenting part and the cervix, prolapse of
the umbilical cord is common. Placing the patient on a knee-chest position will lessen the
cord compression.

3. When assessing Dayanara, the nurse will check the progress of her labor. The
nurse should position her: SELECT ALL THAT APPLY

A. Dorsal Recumbent

B. Sim’s Position
C. Knee-chest Position

D. Modified Sim’s Position

ANSWER: A, B and C

RATIONALE: The aforementioned positions are made best so as to expose the gynecologic
area to be examined.

4. When assessing Dayanara, the nurse finds a prolapsed cord. The nurse should:

A. Attempt to replace the cord

B. Place the client on her left side

C. Elevate the client’s hips

D. Cover the cord with a dry, sterile gauze

ANSWER: C

RATIONALE: The client with a prolapsed cord should be treated by elevating the hips first
before covering the cord with a moist, sterile saline gauze.

5. You are caring for Dayanara who was diagnosed with cord prolapse and was
ordered by the Obstetrician to do Knee-Chest position. She asked you why she needs
to be positioned that way, you answered:

A. Knee-chest position is use to check for the progress of labor.

B. You will be in this position because this is the only way your baby will not move.

C. Knee-chest position uses gravity to shift the fetus out of the pelvis and will lessen cord
compression.

D. The obstetrician had ordered wrong position.

ANSWER: C

RATIONALE: Knee-chest position uses gravity to shift the fetus out of the pelvis and will
lessen cord compression.

6. You are on duty in CEMonc Facility while assessing a pregnant client you found out
the presentation is breech and with prolapse cord. What will you do?

A. Remove my gloves and report it to the Obstetrician.

B. Stay with the patient and ask assistance with her husband to refer the client to the
Obstetrician.

C. Prepare for emergency cesarean section.

D. Position the client on a modified sim’s position then refer to the Obstetrician.

ANSWER: D

RATIONALE: Knee-chest position and Modified Sim’s Position uses gravity to shift the fetus
out of the pelvis and will lessen cord compression.

7. Karen a pregnant woman's amniotic membranes rupture. Prolapsed umbilical cord

is suspected. What intervention would be the less priority?

a. Placing the woman in the knee-chest position

b. Covering the cord in sterile gauze soaked in saline

c. Preparing the woman for a cesarean birth

d. Starting oxygen by face mask

ANSWER: D

RATIONALE: The woman should be assisted into a position (e.g., modified Sims position or
the knee-chest position in which gravity keeps the pressure of the presenting part off the
cord.

8. TRUE or FALSE: Elevating the presenting part by filling the urinary bladder by
inserting a catheter and instruct the client not to bear down.

A. True

B. False

ANSWER: A

RATIONALE: Elevating the presenting part by filling the urinary bladder by inserting a
catheter and instruct the client not to bear down. If the decision-to-delivery interval is likely to
be prolonged, particularly if it involves ambulance transfer, elevation through bladder filling
may be more practical.

9. What is the rationale of Elevating the presenting part by filling the urinary bladder
by inserting a catheter and instruct the client not to bear down. SELECT ALL THAT
APPLY

A. If the decision-to-delivery interval is likely to be prolonged, particularly if it involves

ambulance transfer, elevation through bladder filling may be more practical.

B. Bladder filling can be achieved quickly by inserting the cut end of an intravenous giving
set into a Foley’s catheter.

C. Elevation of the presenting part is thought to relieve pressure on the umbilical cord and
prevent mechanical vascular occlusion.
D. Manual elevation is performed by inserting a gloved hand or two fingers in the vagina and
pushing the presenting part upwards.

ANSWER: A, B and C

RATIONALE: Elevation of the presenting part is thought to relieve pressure on the umbilical
cord and prevent mechanical vascular occlusion.

10. TRUE or FALSE: Elevating the presenting part by inserting your fingers into the
vagina and push the head of the fetus upward.

A. True

B. False

ANSWER: A

RATIONALE: Elevation of the presenting part is thought to relieve pressure on the umbilical
cord and prevent mechanical vascular occlusion. Manual elevation is performed by inserting
a gloved hand or two fingers in the vagina and pushing the presenting part upwards.

FORCEP AND VACUUM DELIVERY

1. Although no longer used routinely, forceps may be necessary with any of the following
conditions: SELECT ALL THAT APPLY

A. A woman is unable to push with contractions in the pelvic division of labor such as might
happen with a woman who received regional anesthesia or who has a spinal cord injury.

B. Cessation of descent in the second stage of labor occurs.

C. A fetus is in an abnormal position.

D. A fetus is in distress from a complication such as a prolapsed cord.

ANSWER: A, B, C and D

RATIONALE: Forceps assisted delivery may be used with these conditions mentioned in the
choices. The health care provider needs to be cautious when using these instruments.

2. All but one is true regarding Fenestrated Blades.

A. It has an opening within or a depression along the blade surface

B. It reduces the degree of head slippage during forceps rotation.

C. It can increase friction between the blade and vaginal wall.

D. the forceps blade is smooth on the outer maternal side but indented on the inner fetal
surface.

ANSWER: B

RATIONALE: Fenestrated Blades reduces the degree of head slippage during forceps
rotation

3. All but one is true regarding Pseudofenestrated Blades.

A. It has an opening within or a depression along the blade surface

B. It reduces the degree of head slippage during forceps rotation.

C. It can increase friction between the blade and vaginal wall.

D. the forceps blade is smooth on the outer maternal side but indented on the inner fetal
surface.

ANSWER: D

RATIONALE: Pseudofenestrated blades is smooth on the outer maternal side but indented
on the inner fetal surface.

4. All but one is true regarding Fenestrated or Pseudofenestrated Blades.

A. It has an opening within or a depression along the blade surface

B. It reduces the degree of head slippage during forceps rotation.

C. It can increase friction between the blade and vaginal wall.

D. the forceps blade is smooth on the outer maternal side but indented on the inner fetal
surface.

ANSWER: A

RATIONALE: Fenestrated or Pseudofenestrated Blades has an opening within or a

depression along the blade surface

5. The following are favourable position and presentation for Forceps Assisted Delivery,
EXCEPT:
A. Occipito-anterior

B. Occipito-posterior

C. Shoulder presentation

D. Face presentation

E. After-coming head in breech

ANSWER: C

RATIONALE: Shoulder presentation is unfavourable position for forceps assisted delivery.

The management for Shoulder presentation should be Cesarean Section.

6. The following are prerequisite for Forceps Application, SELECT ALL THAT APPLY:

A. Contraction of the uterus should be present

B. Fully dilated cervix

C. Engaged head

D. Ruptured membranes

ANSWER: A, B, C and D

RATIONALE: The choices above are all part of prerequisites for Forceps application.

7. The following are fetal complications of Forceps Application, EXCEPT:

A. Injury to facial nerves requires observation.

B. Lacerations of the face and scalp may occur.

C. Fractures of the face and skull require observation.

D. Uterine rupture

ANSWER: D

RATIONALE: Uterine rupture is a part of the maternal complications of Forceps Application.

8. A type of Forceps Application wherein the forceps is applied on the sides of the fetal head
in the mento-vertical diameter so the injury of the fetal face, eyes and facial nerves are
avoided.
A. Pelvic Application

B. Cephalic Application

C. Cephalo-Pelvic Application

D. Footling-Breech Application

ANSWER: B

RATIONALE: Cephalic Application is applied on the sides of the fetal head in the
mento-vertical diameter so the injury of the fetal face, eyes and facial nerves are avoided.

9. A type of Forceps Application wherein the forceps is applied along the maternal pelvic wall
irrespective to the position of the head. It is easier for application but carries a great risk of
fetal injuries.

A. Pelvic Application

B. Cephalic Application

C. Cephalo-Pelvic Application

D. Footling-Breech Application

ANSWER: A

RATIONALE: Pelvic application is applied along the maternal pelvic wall irrespective to the
position of the head. It is easier for application but carries a great risk of fetal injuries.

10. A type of Forceps Application wherein it is the ideal application and possible when the
occiput is directly anterior or posterior or in direct mento-anterior position.

A. Pelvic Application

B. Cephalic Application

C. Cephalo-Pelvic Application

D. Footling-Breech Application

ANSWER: C

RATIONALE: Cephalo-pelvic application is the ideal application and possible when the
occiput is directly anterior or posterior or in direct mento-anterior position.
11. The following are indications of Vacuum Assisted Delivery, EXCEPT:

A. Drug induced analgesia

B. Relative Cephalopelvic disproportion

C. Malposition

D. Premature fetus

E. Malpresentation

ANSWER: D

RATIONALE: Premature fetus is a part of contraindication for Vacuum Assisted Delivery

because before 34 weeks of gestation is due to perceived increased risk of birth injuries.

12. The following are advantages of Vacuum Assisted Delivery, EXCEPT:

A. Regional Anesthesia is not required so it is preferred in cardiac and pulmonary patient.

B. Less genital tract lacerations

C. Should be applied only at full cervical dilatation

D. Can be applied before full cervical dilatation

ANSWER: C

RATIONALE: Vacuum Assisted Delivery can be applied before full cervical dilatation on
Forceps assisted delivery it should be applied only when the client is on full cervical
dilatation.

13. The following are disadvantages of Vacuum Assisted Delivery, EXCEPT:

A. The ventouse is not occupying a space beside the head as forceps

B. It causes a marked caput on the newborn head that may be noticeable as long as 7 days
after birth.

C. Vacuum extraction should not be used as a method of birth if fetal scalp blood sampling
was used because the suction pressure can cause severe bleeding at the sampling site.

D. Vacuum extraction is not advantageous for preterm infants because of the softness of the
preterm skull.

ANSWER: A
RATIONALE: The ventouse is not occupying a space beside the head as forceps is part of
advantages of Vacuum Assisted Delivery.

14. The following are maternal complications of Vacuum Assisted Delivery, EXCEPT:

A. Perineal, vaginal, labial, periurethral and cervical lacerations.

B. Cervical incompetence and future prolapse if used with incompletely dilated cervix.

C. Tears of the genital tract may occur.

D. Injury of sixth and seventh cranial nerves

ANSWER: D

RATIONALE: Injury of the sixth and seventh cranial nerves are part of fetal complications of
Vacuum Assisted Delivery.

15. Application of the cup over the sagittal suture ____ in front of the posterior fontanelle.

A. 4 cm

B. 3 cm

C. 5 cm

D. 1 cm

ANSWER: B

RATIONALE: Proper application of the cup results in flexion of the fetal head when traction is
applied. It is situated 3 cm in front of the posterior fontanelle.

16. Gentle traction should be applied at _____ angles to the plane of the cup.

A. Left

B. Right

C. Transverse

D. Side

ANSWER: B

RATIONALE: Gentle traction should be applied at the RIGHT angles to the plane of the cup
this is to ensure that no maternal tissue is between the fetal head and the vacuum cup.
17. Traction is usually applied at settings between __________.

A. 700 to 800 mmHg

B. 200 to 300 mmHg

C. 500 and 600 mmHg

D. 300 to 400 mmHg

ANSWER: C

RATIONALE: Traction is usually applied at settings between 500 to 600 mmHg. The vacuum
pressure may or may not be released between contractions, to resting pressure settings of
between 100 and 200 mm Hg (0.1– 0.3 kg/cm2), depending on the type of vacuum used.

18. The following are indication of a Vacuum Failure, EXCEPT:

A. Ensure adequate assistance is present if such complications should occur.

B. Consider the fetal status before making your attempt to deliver the baby and the time
necessary to initiate a cesarean section if the procedure fails.

C. The vacuum procedure has failed when descent or delivery has not been accomplished.

D. The procedure should be abandoned at this point, and an alternate method of delivery
should be selected.

E. It is imperative that some descent is observed with each pull.

ANSWER: E

RATIONALE: Choice E is not part of the indication for a vacuum failure but a warning to stop
Vacuum Assisted Delivery

19. Assuming fetopelvic disproportion and malpresentation have been ruled out, vacuum
extraction delivery may be appropriate when:

A. Shoulder dystocia occurs

B. Fetal head is rotated 45° from the midline

C. Need to speed delivery for a small preterm baby

D. Failure to descend
ANSWER: B

RATIONALE: Fetal head is rotated 45 degrees from the midline is appropriate because there
is a possibility that vacuum assisted delivery will be successful.

20. The following are signs that Vacuum Assisted Delivery should be stop, EXCEPT:

A. The vacuum procedure has failed when descent or delivery has not been accomplished

B. 3 pulls over 3 contractions, no progress abandon procedure

C. After 20 minutes of application with no progress

D. The incidence of scalp trauma is increased when the cup application is greater than 10
minutes compared to less than 10 minutes.

ANSWER: A

RATIONALE: The vacuum procedure has failed when descent or delivery has not been
accomplished is a part of Vacuum Assisted failure.

Shoulder Dystocia

1. This maneuver straightens sacrum and decreases angle of incline symphysis pubis and
dislodges the impacted shoulder. Shoulder dystocia is often resolved by this maneuver
alone.

A. Corkscrew

B. Zavanelli

C. McRoberts

D. Rubin

ANSWER: C

RATIONALE: When shoulder dystocia is suspected, the McRoberts maneuver should be

attempted first because it is a simple, logical, and effective technique.

2. Shoulder dystocia is an obstetrical emergency, therefore:

A. The fetus must be delivered immediately

B. The obstetrician must begin a cesarean section immediately

C. Deliberate, logical, and coordinated steps are important

D. Taking additional time to deliver the infant is detrimental

ANSWER: C
RATIONALE: Although, shoulder dystocia is considered an obstetrical emergency, this is
NOT the time for hasty maneuvers. Deliberate, logical, and coordinated steps should be
taken to ensure the safe delivery of the infant. Taking several minutes to deliver the infant
rarely results in significant morbidity, especially with normal fetal oxygenation

3. What type of pressure should be avoided during a shoulder dystocia delivery?

A. Fundal

B. Suprapubic

C. Symphysis pubis

D. Sacral promontory

ANSWER: A

RATIONALE: Application of pressure over the fundus of the uterus is never appropriate and
only serves to worsen the impaction, potentially injuring the fetus and/or mother

4. Suprapubic pressure should be applied for no longer than:

A. 10 seconds

B. 30 seconds

C. 1 minute

D. 2 minutes

ANSWER: B

RATIONALE: Suprapubic pressure can be applied above the symphysis pubis, over the
fetus’ anterior shoulder, to assist the infant in adducting the arms closer to the body and
releasing the impacted shoulder. This pressure should not be applied for more than 30
seconds. If this procedure fails after 30 seconds, the next procedure should be immediately
attempted.

5. The main purpose of Rubin’s maneuver is to:

A. Deliver the posterior arm

B. Loosen the fetal shoulders to facilitate descent

C. Rotate the shoulders into the oblique diameter of the pelvis

D. Deliver the anterior arm

ANSWER: C
RATIONALE: Rubin maneuver. In this maneuver, one hand supports the infant’s head, while
the other hand is inserted in the birth canal posteriorly or anteriorly, on the dorsal aspect of
the fetal shoulder. The shoulder is then rotated inward (adduction) so that the shoulders
come to lie in the oblique diameter of the pelvis. By applying pressure to the dorsal aspect of
the shoulder, the rotation itself adducts the fetal shoulders, thereby reducing their
bisacromial diameter

6. This maneuver is done by applying suprapubic pressure applied with the heel of clasped
hands from the posterior aspect of the anterior shoulder to dislodge it:

A. Rubin’s Maneuver

B. Woodscrew Maneuver

C. Mazzanti Maneuver

D. Gaskin Maneuver

ANSWER: C

RATIONALE: Mazzanti Maneuver is done by applying pressure on the suprapubic region is

done to dislodge anterior shoulder and simultaneously instructing the client to bear down

7. This maneuver is done by applying pressure to the anterior aspect of the posterior
shoulder, and an attempt is made to rotate the posterior shoulder to the anterior position.

A. Rubin’s Maneuver

B. Woodscrew Maneuver

C. Mazzanti Maneuver

D. Gaskin Maneuver

ANSWER: B

RATIONALE: Woodscrew maneuver is done by inserting two fingers on anterior aspect of

posterior shoulder while pressure is applied to the anterior aspect of the posterior shoulder,
and an attempt is made to rotate the posterior shoulder to the anterior position

8. This maneuver is done by assisting the client to roll onto hands and knees and applying
downward traction to deliver posterior shoulder and may be repeated if needed until the
shoulder is delivered.

A. Rubin’s Maneuver

B. Woodscrew Maneuver

C. Mazzanti Maneuver

D. Gaskin Maneuver
ANSWER: D

RATIONALE: Gaskin maneuver is done by assisting the client to roll onto hands and knees
and I will apply downward traction (pull downward) to deliver the posterior shoulder that can
be repeated until the shoulder of the fetus is delivered.

9. This maneuver attempts to position the shoulders to utilize the smallest possible diameter
of the fetus through the largest diameter of the woman.

A. Rubin’s Maneuver

B. Woodscrew Maneuver

C. Mazzanti Maneuver

D. Gaskin Maneuver

ANSWER: A

RATIONALE: Rubin Maneuver/Reverse Woodscrew Maneuver is done with inserting my

fingers behind the posterior aspect of the anterior shoulder and rotate the shoulder toward
fetal chest

10. This maneuver involves reversing the cardinal movements of labor. The head is rotated
to occiput anterior, flex, push up, rotate to transverse, disengage, and perform a cesarean
section.

A. Woodscrew Maneuver

B. Zavanelli Maneuver

C. McRoberts Maneuver

D. Rubin’s Maneuver

ANSWER: B

RATIONALE: The Zavanelli maneuver is an obstetric maneuver that involves pushing back
the delivered fetal head into the birth canal in anticipation of performing a cesarean section
in cases of shoulder dystocia.