TESTS FOR CONCLUSION LESSON

for students of the ІV course

Modul 1. Physiology of pregnancy, labor and the puerperium

1. During immediate postpartum period the mother is monitored for:

А. Blood loss.
В. Signs of infection.
С. Abnormal blood pressure
D. Contraction of the uterus.
Е. Ability to void.
F. All above mentioned.

2. The external os of cervix closes such that a finger cannot be easily introduced:
А. By the end of the first week.
В. Till 3-4 days.
С. By the end of the second week.
D. Till 2-3 days.
Е. By the end of the third week.

3. Volume of physiological blood loss during delivery is:

A. 200 - 300 ml.
B. 300 - 400 ml.
C. 1% of body weight.
D. 0.5% of body weight.
E. 100 - 150 ml.

4. The first few days after delivery the lochia names:

A. Lochia serosa.
B. Lochia alba.
C. Lochia rubra.
D. Lochia mucosa.

5. The second stage of labor is:

A. The stage of separation and expulsion of the placenta..
B. The stage of cervical effacement and dilatation..
C. The stage of expulsion of the fetus.
D. Prodromal labor.
E. The stage of rupture of membranes.

6. Volume of physiological blood loss during delivery is:

A. 200 - 300 ml.
B. 0.5% of body weight.
C. 1% of body weight.
D. 300 - 400 ml.
E. 100 - 150 ml.

7. The signs of placental separation are positive. When it should be delivered?

A. Immediately.
B. For 30 minutes.
C. After 1 hour.
D. After 2 hours.
E. After 5 - 10 minutes.
8. The evaluation of Solovyov's index helps to determine:
A. Obstetric conjugate.
B. Anatomical conjugate.
C. Distantia cristarum.
D. Diagonal conjugate.
E. External conjugate.

9. There are sizes of the plane of pelvic inlet, except:

A. Anterposterior diameter - 11 cm
B. Transverse diameter - 13 cm
C. Left oblique diameter - 12 cm
D. Right oblique diameter - 12 cm
E. Anterposterior diameter - 10 cm

10. By pelviometry it was determined that conjugate diagonalis is 12 cm. High of pubis simphysis is 4 cm.
Calculate the size of conjugata vera.
А. 10 сm.
В. 11 сm.
С. 10,5 сm.
D. 20 сm
Е. 12,5 сm.

11. Conjugata vera is the size between:

А. Lower part of pubis and promontorium.
В. The most projected point on the internal surface of symphysis and promontorium.
С. Upper part of the symphysis and promontorium.
D. Lower part of pubis and coccygeal bone.
Е. Midpoint of pubis and promontorium.

12. Fetal heart rate is:

A. 110-170 beats per minute.
B. 100-170 beats per minute.
C. 110-150 beats per minute.
D. 120-140 beats per minute.
E. 120-160 beats per minute.

13. With the third Leopold's method in the uterus define:

A. The variety of the fetus.
B. Fetal position.
C. The lie of the fetus.
D. Presenting part of fetus and its relation to the plane of the entrance to the small pelvis.
E. The height of uterine fundus standing.

14. Corpus luteum can undergo absorption or regression:

А. at the 1st month of pregnancy.
В. at the 3-4th months of pregnancy.
С. at the 2nd month of pregnancy
D. at the 8-9th months of pregnancy.
Е. Corpus luteum insists till the end of pregnancy.

15. What glands are the glands of mixed secretion?:

А. Pituitary gland.
В. Gastric glands.
С. Pancreatic gland.
D. Thyroid gland.
Е. Supradrenal glands.
16. The neonate heart rates normally is:
A. 120-160 bpm.
B. 140-170 bpm.
C. 120-100 bpm.
D. 110-170 bpm.
E. 100-180 bpm

17. A baby is called “a newborn” in a period:

A. First 2 weeks.
B. First 4 weeks.
C. First 1 week.
D. First 14 days.
E. First 6 weeks.

18. The following methods are provided for prevention of complications in breech delivery in the II
period of labor except:
А. Operation of extraction fetus on pelvic side.
В. Injections of spasmolitics.
С. Episiotomy.
D. Intravenous injection of oxytocin.
Е. Classic manual aid.

19. Classic manual aid by breech presentation has the following moments, except:
А. Removal of fetal posterior arm.
В. Delivery of fetal head.
С. Supporting of fetal legs in vagina.
D. Rotation of fetus on 180°.
Е. Removal of another arm of fetus.

20. Generally contracted pelvis has:

А. Right form.
В. Thin bones.
С. Even contractions of all distances.
D. Acute angle of pubic.
Е. All above mentioned.

21. Leading point on fetal head by flat rachitic pelvis is:

А. Occipital fontanel.
В. Frontal fontanel.
С. Agreed anterior fontanel.
D. Bridge of nose.
Е. Forehead.

22. Additional screens are offered to high-risk patients are all the following, except:
А. Amniocentesis.
В. Chorionic villous sampling.
С. General blood test.
D. Fetal blood sampling.
Е. Fetal echocardiogram.

23. The most common complications of multiple pregnancy include the following, except:
А. Miscarriage.
В. Preterm labor and birth.
С. Pregnancy-induced hypertension.
D. Postterm pregnancy.
Е. Birth defects.
24. There are the following signs of postterm newborn except:
А. Decrease of skin turgor.
В. Dry skin and maceration.
С. Rudimentary tooth.
D. Dense skull bones.
Е. Narrow sutures and fontanels.

25. Contraindications for amniocentesis:

А. Titer of antibodies is or more than 1:64.
В. In anamnesis – infants with hemolytic diseases were born.
С. Previous mortinatus newborns.
D. Threatened of premature labor.
Е. Increases of titer of antibodies in 4 times in 2 weeks.

26. Immunological reactions of pregnancy are based on determination in urine or blood:

А. Estriol.
В. Folliclestimulative hormone.
С. Beta-chorionic gonadotropin.
D. Placental lactogen.
Е. Progesterone.

27. Presumptive signs of pregnancy are (some answers are correct):

A – slight fatigue;
B – vomiting;
C – nausea;
D – appetite changes;
E – enlargement of uterus;
F – disturbances of taste and sense of smell;
G – cessation of menses;
H – sleepiness.

28. Risk factors of ABO-isoimmunization are:

А. Hemotherapy in anamnesis.
В. Vaccination.
С. Injections of curative serums.
D. Contacts of mother and bacteria with antigen factors A and B.
Е. All above mentioned.

29. What is necessary dose of anti-Rh-immunoglobulin in the presence of Rh-isoimmunization till the
term of 13 weeks of pregnancy:
А. 75 mcg.
В. 125 mcg.
С. 50 mcg.
D. 300 mcg.
Е. 110 mcg.

30. The following moments are important for diagnostic of fetal distress during pregnancy except:
А. Changes of fetal heart beating.
В. Changes of fetal movements.
С. Presence of meconium in amniotic fluid.
D. Estimation of fetal state by Doppler, biophysical profile.
Е. Estimation acidic-alkaline metabolism in presenting part of fetus.
31. There are the following risk factors of chronic placental insufficiency except:
А. Hypertension in mother.
В. Smoking and drinking of mother.
С. Chronic specific and nonspecific infections.
D. Recurrent pregnancy loss.
Е. Eclampsia.

32. A 19-year-old primigravida patient presents for an initial prenatal visit at 7 weeks' gestation. She is
concerned because she used both cocaine and heroin in the month before she discovered she was pregnant.
In a long discussion with her about the risks of substance abuse during pregnancy, you tell her that use of
which of the following has the highest correlation with congenital abnormalities?
A. Alcohol.
B. Caffeine.
C. Cocaine.
D. Opiates.
E. Smoking tobacco.

33. Second-trimester ultrasound screening is recommended?

А. In 11-13 weeks of pregnancy.
В. In 18-21 weeks of pregnancy.
С. In 15-16 weeks of pregnancy.
D. In 16-18 weeks of pregnancy.
Е. At any time.

34. Which is necessary to do if a pregnant woman doesn’t visit a doctor in a female dispensary?
A. To wait a patient (pregnant woman).
B. A midwife must visit a patient at home within the next few days.
C. A midwife must visit a patient at home within the next few weeks.
D. To invite a patient to female dispensary by post.

35. What indices are not normal during pregnancy?

A. Hemoglobin – 115 g/l.
B. Fibrinogen – 4,9 g/l.
C. Proteins – 62 g/l.
D. Thrombocytes – 150 thousands/l
E. ESR – 40 mm/hour

36. Menstruation doesn’t depend on:

А. Hypothalamus releasing hormones.
В. Endometrium reaction on sex hormones.
С. Gonadotropins.
D. Permeability of uterine tubes.
Е. Level of steroid ovarian hormones.

37. What glands are the glands of mixed secretion?:

А. Pituitary gland.
В. Gastric glands.
С. Pancreatic gland.
D. Thyroid gland.
Е. Supradrenal glands.
38. A pregnant woman, 35 years old, of 32 weeks of gestation was recommended to weight one time per
week. What weight is normal to be increased for this week of pregnancy?
А. 300 g
В. 500 g
C. 700 g
D. 200 g
Е. 100 g

39. The following physiological changes occur during pregnancy, except:

А. Lower back pain.
В. Palmar erythema.
С. Spider angiomata.
D. Generalised edema.
Е. Hyperpigmentationic gland.

40. In what week of pregnancy the level of chorionic gonadotropin in blood is the highest?
А. 5-6 weeks.
В. 8-10 weeks.
С. 14-16 weeks.
D. 35-37 weeks.
Е. The level of chorionic gonadotropin is constant during the whole pregnancy.

41. Perinatal period of human’s life is:

А. From 22 weeks of pregnancy till 7 days of life after birth.
В. From 28 weeks of pregnancy till the beginning of labor.
С. From birth till 7 days of life after birth.
D. From beginning of labor till the birth of baby.
Е. From 28 weeks of pregnancy till the beginning of labor.

42. The normal neonate breathe is:

A. 60-80 breaths per minute.
B. 40-60 breaths per minute.
C. 16-20 breaths per minute.
D. 20-40 breaths per minute.
E. 18-30 breaths per minute

43. The edge of the liver is normally palpable:

А. Below and often as far as 3 cm inferior to the right costal margin
В. The lower end of the right costal margin.
С. Below and often as far as 1 cm inferior to the right costal margin.
D. At the level of the maternal umbilicus.
Е. All above mentioned.

44. What is normal Apgar score of newborn:

А. 3-4 balls.
В. 6-7 balls.
С. 4-6 balls.
D. 8-10 balls.
Е. 4-5 balls.

45. Body length of a mature infant is:

A. 47 cm and more.
B. 48 cm and more.
C. 45 cm and more.
D. 50 cm and more.
E. 46 cm and more
46. Signs of a mature fetus are the following, except:
А. Body weight is more than 2500 g
В. Height is more than 47 cm
С. Nails cover the ends of phalanges of fingers.
D. The subcutaneous tissue is moderately edematous.
Е. An umbilicus is located in the middle between symphysis pubis and xyphoid process

47. Physical findings of the skin and subcutaneous tissue of newborn infant are the following, except:
А. Physiologic jaundice.
В. Peripheral cyanosis.
С. General cyanosis.
D. Moderate edema of the subcutaneous tissue.
Е. Vernix caseosa.

48. There are following reasons of breech presentation except:

А. Insufficiency of miometrium.
В. Macrosomia.
С. Polyhydramnion.
D. Abnormalities of pelvic.
Е. Multiply pregnancy.

49. Fetal heat beating is more clear to auscultate by breech presentation in point:
А. Above umbilicus.
В. Lower umbilicus.
С. At the level of umbilicus.
D. Lateral posterior fontanel.

50. Fetal position and variety by breech presentation are determined by Leopold maneuvers by:
А. Fetal back.
В. Fetal anterior buttock.
С. Fetal posterior buttock.
D. Fetal head.
Е. Fetal sacrum bone.

51. The following complications are the most often in delivery by breech presentation, except:
А. Premature amnion rupture.
В. Falling small parts of fetus out.
С. Abnormalities of uterine activity.
D. Falling fetal hands back.
Е. Hypertension of mother in labor.

52. What does descend in first in small pelvis during labor by breech presentation:
А. Anterior buttock.
В. Posterior buttock.
С. Coccygeal bone.
D. Sacrum bone.
Е. Head.

53. At what presentanion often occurs early or premature rupture of membranes:

A. Incomplete breech.
B. Complete breech.
C. Foot presentation.
D. Oblique.
E. All the answers are correct.
54. Contraindications to perform external rotation of fetal head is at:
A. Normal sizes pelvis.
B. Weightof baby less than 3700.
C. Polyhydramnios or oligohydramnios.
D. Normal uterine tone.
E. Normal amniotic wather.

55. Distance of conjugate true by II degree of contracted pelvis is:

А. 6,5 cm and less
В. 7,5 – 6,5 cm
С. 9 – 8 сm
D. 10 - 9,1 сm
Е. 10-11 сm

56. Peculiarities of biomechanism by simple flat pelvis:

А. Deflexion of head in pelvic inlet.
В. Sagittal suture of the fetal head arresting in the transverse diameter of the plane of pelvic inlet.
С. Asynclitism.
D. Low transverse location of saggital suture.
Е. All above mentioned.

57. What kind of pelvis does have the following diameters (25-28-31-18):
A. Simple flat pelvis.
B. Flat rachitic pelvis.
С. Generally contracted pelvis.
D. Generally contracted flat pelvis.
Е. Non above mentioned.

58. What kind of pelvis does have the following diameters (27-27-30-18):
A. Simple flat pelvis.
B. Obliquely dislocated pelvis.
С. Flat rachitic pelvis.
D. Generally contracted pelvis.
Е. Generally contracted flat pelvis.

59. Movement of fetal head in the I plane of pelvis by simple flat pelvis:
А. Extension.
В. Flexion.
С. Descending.
D. Considerable fetal head extension.
Е. Considerable fetal head flexion.

60. Anatomically contracted pelvis has conjugate true less than:

A. 14 сm
B. 13 сm
C. 11 сm
D. 10 сm
E. 8 сm.

61. What pregnant women are not in specific high-risk groups for development of fetus abnormalities?
А. Age 35 or older.
В. Women who have babies with a birth defect or genetic problems.
С. Prior gestational diabetic, pregestational diabetic
D. Women who have family histories to genetic disorders.
Е. Age 18 or younger.
62. Amniotic fluid index in polyhydramnios is:
А. 10-15.
В. 20-25.
С. 2-5.
D. 15-20.
Е. 5-10.

63. Etiology factors of oligohydramnios are all the following, except:

А. Placental insufficiency.
В. Trauma.
С. Severe preeclampsia.
D. Postterm pregnancy.
Е. Urinary tract malformations.

64. Methods of examination of polyhydramnios are all the following, except:

А. The uterus is tense.
В. The fundal level is higher than gestational age.
С. The symptoms of fluctuation.
D. The fetal parts are felt easily.
Е. Malpresentation and nonegagement are common.
F. Auscultation with difficulty.

65. Symptoms of polyhydramnios are all the following, except:

А. Abdominal discomfort.
В. Abdominal pain.
С. Dyspnoea.
D. Pregnancy induced hypertension.
Е. Edema and varicosities of the lower limbs.

66. Sometimes one or both testes of baby remain in the pelvic cavity and do not descend after delivery.
This is called:
А. Cryptorchism.
В. Congenital inguinal hernia
С. Hypospadias.
D. Urachal fistula
Е. Pelvic kidney
67. What indices are important for estimation of cardiotocography?
А. Basal heart rate.
В. Presence and rate of accelerations.
С. Presence of decelerations.
D. Amplitude of instantaneous oscillations .
Е. All above mentioned.

68. The main reason of acute placental insufficiency is:

А. Threatened of premature labor.
В. Rupture of placenta.
С. Genital infantilism.
D. Professional unhealthy conditions of work.
Е. Amnion rupture.

69. How many times is it necessary to check fetal heart beating in the II period of labor?
А. Every 5 minutes.
В. Every 10 minutes.
С. Every 30 minutes.
D. After every uterine contraction.
Е. Only at the beginning of the II period of labor.
70. The following methods are used for diagnostic of fetal distress during labor except:
А. Auscultation of fetal heart.
В. Actography.
С. Cardiotocography.
D. Presence of meconium in amniotic fluid after amnion rupture.
Е. Estimation acidic-alkaline metabolism in presenting part of fetus.

71. Indications for hospitalization in obstetrical department:

А. Pathological state of biophysical profile ( 6 and less).
В. Equivocal scale of biophysical profile (7-8) in a day.
С. Delayed diastolic blood flow in umbilical arteries.
D. Critical changes of blood flow in umbilical arteries (zero or reversed).
Е. All above mentioned.

72. Taking umbilical blood through abdomen is called:

А. Amniocentesis.
В. Cordocentesis.
С. Paracentesis.
D. Amnioscopy.
Е. Hysteroscopy.

73. Prevention during pregnancy when the Rh-isoimmunization is absent:

А. Intramuscular injection of 1 dose (300 mcg) anti-Rh-immunoglobulin.
В. Intramuscular injection of 3 doses anti-Rh-immunoglobulin.
С. Intramuscular injection of 1 dose (500 mcg) anti-Rh-immunoglobulin.
D. Intramuscular injection of 2 doses anti-Rh-immunoglobulin.
Е. Prevention is not necessary.

74. Diagnostic of fetal hemolytic disease includes:

А. Ultrasound examination.
В. Cardiotocography.
С. Transabdominal amniocentesis.
D. Cordocentesis.
Е. All above mentioned.

75. Prevention of Rh-immunization by anti-Rh-immunoglobulin when of Rh-minus woman born Rh-

positive baby is provided in the term:
А. Not later than 12 hours after delivery.
В. Not later than 24 hours after delivery.
С.Right away after delivery.
D. Not later than 72 hours after delivery.
Е. During a month after delivery.

76. There are the following risk factors of hemolytic disease development except:
А. Abortions.
В. Transfusion of Rh-positive blood in anamnesis.
С. Providing of specific profile of Rh-incompatibility after previous pregnancy.
D. Rh-incompatibility during previous pregnancy.
Е. Previous mortinatus newborns.

77. All below mentioned increases the risk of isoimmunization except:

А. Rupture of placenta.
В. Perform of amnioscopy.
С. Viral infections.
D. Initial spontaneous abortion, reptoplacental hematoma.
Е. Operations during previous pregnancy.
78. Positive signs of pregnancy are the following except:
A - cessation of menses;
B – palpation of fetal parts;
C – auscultation of fetal heart beating;
D – perception of active fetal movements by the examiner.

79. By bimanual examination a doctor determines softening of isthmus of uterus, fingers of external and
internal hand can meet easy. Cervix is recognizes as firm organ than uterus. This is sign:
А. Heanter’s.
В. Horvits-Hegar’s.
С. Piskachek's.
D. Snegirov's.
Е. Hubarev’s and Haus’.

80. During taking history it was determined that a pregnant woman had the last menses at the 15th of May.
Calculate the data of labor.

81. The relationship of fetal axis to the vertical axis of the uterus is:
A. The position of the fetus.
B. The lie of the fetus.
C. Type of variety of the fetus.
D. Relation to the plane of the entrance to the small pelvis.
E. Presenting part of fetus.

82. In pregnancy in vagina are the following physiological changes:

A. Sharply increased blood supply to the vaginal walls.
B. Softness of vaginal walls.
C. Hypertrophy and hyperplasia of muscle fibers of the vagina.
D. Reaction of vaginal content becomes alkaline.
E. All listed correctly.

83. Internal obstetric examination provides information on:

A. Status of the cervix.
B. Status of muscles of pelvic floor.
C. The presence of pelvic deformities.
D. The presenting part.
E. All answers are correct.

84. Connective tissue of triangle form with three sutures is palpated on the presenting part of the head. What
fontanel is this?
А. Frontal fontanel.
В. Occipital fontanel.
С. Lateral anterior fontanel.
D. Lateral posterior fontanel.
85. Sutures on fetal head:
А. _________________________
В. _________________________
С. _________________________
D. _________________________

86. Determine the number of pelvis's planes of pregnant:

A. 2.
B. 3.
C. 5.
D. 4.
E. 6.
87. There are the following external sizes of the pelvis, except:
A. Distantia spinarum.
B. Conjugata diagonalis.
C. Distantia cristarum.
D. Distantia trochanterica.
E. Conjugata exerna.

88. The leading line of the pelvis (pelvic axis) - is:

A. The distance from the lower margin of the symphysis to the promontorium.
B. The distance between the acetabular fossa and the upper margin of the symphysis.
C. Line, which connects the midpoints of all anterposterior diameters of the pelvis's planes.
D. The distance between the most projecting points of the iliac crests.
E. The angle between the branches of the pubic bone.

89. What are the signs of the first stage of labor:

A. The appearance of regular contractions.
B. Availability of "ripe" cervix.
C. History of a gush or leaking of fluid from the vagina.
D. The fetal head engages into the pelvis
E. All of the above.

90. The indications for the urgency vaginal examination are all these clinical situation, except:
A. Discharge of amniotic fluid.
B. Appearance bleeding from the genital tract.
C. Changes in fetal heart.
D. Chronic placental insufficiency.
E. Cord prolapse.

91. The first step for the birth of the infant is descent. Descent is occur due to forces:
A. Pressure of the amniotic fluid,
B. Direct pressure of the fundus upon the breech,
C. Contraction of the abdominal muscles,
D. Extension and straightening of the fetal body.
E. All of the answers are wright.

92. The cardinal movements of a labor in occiput anterior presentation are all, except:
A. Flexion.
B. Internal rotation of the fetal head.
C. Additional flexion.
D. Extension of the fetal head.
E. Internal rotation of the fetal head and external rotation of the fetal body.

93. Membranes rupture prior to the onset of labor is named:

A. Premature.
B. Early.
C. Late.
D. Timely.
E. All of the answers are wrong.

94. During the each day of puerperium the fundus goes down on:
A. 3 cm.
B. 2 cm.
C. 1 cm.
D. 4 cm.
E. 1,5 cm.
95. Uterine discharge after delivery consists of:
A. Erythrocytes.
B. Shreds of deciduas.
C. Epithelial cells.
D. Bacteria.
E. All of the answers are correct.

96. Colostrum contains all the following, except:

A. More protein.
B. More globulin.
C. Less fat.
D. More sugar.
E. Immunoglobulin A.

97. Immediately postpartum, the uterine fundus is palpable:

А. At the level of the maternal umbilicus.
В. Just above the symphysis pubis.
С. Half way between the symphysis and the umbilicus.
D. Half way between the umbilicus and the lower end of the sternum.
Е. The lower end of the sternum.

98. Lanugo of premature infants may be particularly noticeable, except:

А. On the back.
В. Shoulders.
С. The whole body.
D. Forehead.
Е. Face.

99. The respiratory rate of newborn infant just after delivery is:
A. 60-80 breaths per minute.
B. 40-50 breaths per minute.
C. 16-20 breaths per minute.
D. 20-40 breaths per minute.
E. 18-30 breaths per minute

100. At what time of the recommended special remedial gymnastics:

A. From 32 to 37 weeks.
B. From 28 to 35 weeks.
C. From 37 to 40 weeks.
D. With 28 weeks until delivery.
E. At any time is not recommended.

101. Diameter of fetal head which is descended in plane of pelvic inlet by simple flat pelvis:
А. Diameter suboccipitobregmaticus
В. Diameter suboccipitofrontalis.
С. Diameter mentooccipitalis.
D. Diameter frontooccipitalis.
Е. Diameter sublinguobregmaticus.

102. Degree of contracted pelvis is determined by:

A. Dist. Spinarum.
B. Conjugate true.
C. Solovjov' index.
D. Horizontal diagonal of Michael's' rhomb.
E. Pubic angle.
103. There are the following indices of biophysical profile of fetus except:
А. Fetal reflexes.
В. Presence of fetal movements.
С. Rate of respiration movements of fetus.
D. Muscle’s tonus of fetus.
Е. Nonstress test.
F. Amount of amniotic fluid.

104. Clinical forms of hemolytic disease of infants:

А. Jaundice, edematic, mixed.
В. Intestinal, jaundice, mixed, anemic.
С. Jaundice, anemic, edematic, mixed.
D. Anemic, edematic, degenerative, mixed.
Е. None of mentioned.

105. Solovjovs' index is:

А. 9-10 сm.
В. 11-12 сm.
С. 14-15 сm.
D. 16-17 сm.
Е. 12-13 сm.

106. The signs of the second stage of labor:

A. Regular contractions.
B. Discharge of amniotic fluid.
C. Full dilatation of the cervix.
D. Signs of placental separation are positive..
E. The fetal head engages into the pelvis.

107. The uterus rises up and to the right in the abdomen because the placenta passes down into the lower
uterine segment. What it is the sign of the separation of the placenta?
A. Shreder`s sign
B. Chukalov`s sign
C. Alfeld`s sign
D. Dovzhenko`s sign.
E. Rohovin`s sign.

108. The following hormones stimulate lactogenesis, except:

A. Prolactin.
B. Estrogen.
C. Progesterone.
D. Placental lactogen.
E. Oxytocin.

109. The puerperium is defined as:

А. The first 6 weeks after delivery.
В. The first 4 weeks after delivery.
С. The first 2 weeks after delivery.
D. The first 8 weeks after delivery.
Е. The first 5 weeks after delivery.
110. The leading point by anterior occipital presentation is:
А. Middle of frontal fontanel.
В. Anterior angle of frontal fontanel.
С. Occipital fontanel.
D. Parietal tuber.
Е. Anterior level of frontal hair.
Task. A primigravidae woman 39 weeks of gestation was hospitalized. She complained on rupture of
amnion. Uterine activity was absent. After examination it was determined: abdomen had sharp form,
longitudinal lie of fetus, head presented over the pelvic inlet, abdomen circumference - 100 cm, height of
uterine fundus – 39 cm, d. spinarum – 26 cm, d. cristarum – 26 cm, d. trochanterica – 31 cm, c. externa –
17 cm, upper angle of Michael's' rhomb was obtuse. Bimanual examination: cervix was mature, c.
diagonalis – 10 cm, c. vera – 8 cm, nontrue promontorium was reached, coccyx was removed back.
Diagnose? Management of labor.

Task. A multigravidae woman 37 weeks of gestation was hospitalized with active uterine contractions.
The first baby was born with weight 2500g. After examination it was determined: growth 156 cm,
abdomen was loosed-hanging, longitudinal lie of fetus, head presented and fixed in the pelvic inlet,
abdomen circumference - 84 cm, height of uterine fundus – 32 cm, d. spinarum – 24 cm, d. cristarum – 26
cm, d. trochanterica – 29 cm, c. externa – 18,5 cm, Solovjov' index – 14 cm. Bimanual examination:
cervix dilated on 8 cm, head was in the I plane of pelvis, saggital suture was in right oblique diameter,
posterior fontanel was localized forward left, c. diagonalis – 11,5 см.
Diagnose? Management of labor.

Task. A primigravidae woman 37 weeks of gestation was hospitalized in the I period of labor.
Pelviometry: d. spinarum – 24 сm, d. cristarum – 27 сm, d. trochanterica – 30 сm, c. externa – 20 сm,
Solovjov' index – 15 cm; abdomen circumference - 90 cm, height of uterine fundus – 35 cm. Bimanual
examination: cervix dilated on 6 cm, amnion was palpated, head was in the I plane of pelvis, forehead
with frontal suture were presented, bridge of nose and orbital ridges were palpated forward, anterior angle
of frontal fontanel was palpated back.
Diagnose? Management of labor.

Task. A primigravidae woman 38 weeks of gestation was hospitalized. She did not feel movements of
fetus during a day, uterine activity was absent. After examination it was determined: longitudinal lie of
fetus, head presented over the pelvic inlet, abdomen circumference - 95 cm, height of uterine fundus – 36
cm, d. spinarum – 26 cm, d. cristarum – 26 cm, d. trochanterica – 31 cm, c. externa – 17 cm, upper angle
of Michael's' rhomb was obtuse. Heart rate of fetus was not hearing during auscultation. Bimanual
examination: cervix was mature, c. diagonalis – 10 cm, c. vera – 8 cm, head was in the I plane of pelvis,
coccyx was removed back.
Diagnose? Management of labor.

Task. A multigravidae woman, 26 years old, with term of gestation 39 weeks was hospitalized with
excessive uterine activity. After examination it was determined: longitudinal lie of fetus, head presented
and fixed in the pelvic inlet, heart beating of fetus was clear, rhythmic, 140 per minute, abdomen
circumference - 104 cm, height of uterine fundus – 39 cm, d. spinarum – 25 cm, d. cristarum – 25 cm, d.
trochanterica – 31 cm, c. externa – 21 cm, Solovjov' index – 15 cm, Vasten's and Zangemeister signs are
positive. Bimanual examination: cervix became effaced, was oedematic, complete dilatation, amnion was
absent, head was on the I plane of pelvis, saggital suture was in transverse diameter near promontorium.
Diagnose? Management of labor.

Task. A primigravidae woman with term pregnancy was hospitalized with premature rupture of amnion.
After examination it was determined: abdomen had sharp form, longitudinal lie of fetus, head presented
over the pelvic inlet, fetal heart rate was clear, rhythmic, 140 per minute, abdomen circumference - 100
cm, height of uterine fundus – 37 cm, d. spinarum – 26 cm, d. cristarum – 29 cm, d. trochanterica – 31 cm,
c. externa – 18 cm, Solovjov' index – 16. Bimanual examination: cervix was not mature, c. diagonalis – 10
cm, anteroposterior diameter of pelvic outlet – 7 cm.
Diagnose? Management of labor.

Task. A woman in labor was hospitalized to the Obstetric Hospital with the signs of acute respiratory
infection.
In what kind of obstetric department is she ought to be hospitalized?
Task. A primigravidae woman, 28 years old, 37 weeks of gestation was hospitalized. She complained on
regular uterine activity, rupture of amnion. After examination it was determined: transverse lie of fetus,
head was located in right, fetal heart rate was clear, rhythmic, 140 per minute, abdomen circumference -
110 cm, height of uterine fundus – 34 cm, d. spinarum – 23 cm, d. cristarum – 29 cm, d. trochanterica – 29
cm, c. externa – 18 cm, Solovjov' index – 14 cm. Bimanual examination: cervix became effaced and
dilated on 2 cm, amnion was absent, no presentative part, c. diagonalis – 11 cm.
Diagnose? Management of labor.

Task. A woman on the third day after delivery had increased of temperature till 38° C, she complained on
the low abdominal pain, purulent vaginal discharges with bed smell. There was diagnosed endometritis.
What is doctor’s management?

Task. A multigravidae woman 37 weeks of gestation was hospitalized in the I period of labor. D. spinarum
– 26 сm, d. cristarum – 26 сm, d. trochanterica – 31 сm, c. externa – 17 сm, upper angle of Michael's'
rhomb was obtuse. Bimanual examination: cervix became effaced and dilated on 8 cm, amnion was
absent, head was in the I plane of pelvis, nose, mouth, chin near the promontorium were palpated, c.
diagonalis – 10 сm, c. vera – 8 сm, nontrue promontorium was reached, coccyx was removed back.
Diagnose? Management of labor.

Task. A primigravidae woman, 28 years old, 34-35 weeks of gestation was hospitalized with active
uterine contractions. After examination it was determined: longitudinal lie of fetus, head presented and
fixed in the pelvic inlet, fetal heart rate was clear, rhythmic, 146 per minute, abdomen circumference - 82
cm, height of uterine fundus – 30 cm, d. spinarum – 23 cm, d. cristarum – 26 cm, d. trochanterica – 29 cm,
c. externa – 18 cm, Solovjov' index – 14 cm. Bimanual examination: cervix became effaced and dilated on
6cm, amnion was palpated, head was in the I plane of pelvis, c. diagonalis – 11 сm.
Diagnose? Management of labor.

Task. A primigravidae woman 39 weeks of gestation was hospitalized. She complained on rupture of
amnion. Uterine activity was absent. After examination it was determined: oblique lie of fetus, head was
localized in low left, fetal heart rate was clear, rhythmic, 144 per minute, abdomen circumference - 104
cm, height of uterine fundus – 35 cm, d. spinarum – 26 cm, d. cristarum – 29cm, d. trochanterica – 31 cm,
c. externa – 18 cm, Solovjov' index – 14 cm. Bimanual examination: cervix became effaced till 1 cm, was
closed, during palpation of fornix there was no presentative part, head was palpated left, c. diagonalis –
10,5 см.
Diagnose? Management of labor.

Task. A woman in labor was hospitalized to the Obstetric Hospital. In anamnesis – 8 years ago she had
viral hepatitis, child’s diseases – measles, scarlatina, parotiditis. 3 month ago she had acute respiratory
infection.
What is doctor’s management during hospitalization?

Task. A 30-year-old gravida 1 para 0 at 40 weeks' gestation complains of strong uterine contractions. She
is nonexaminated. The patient`s condition is normal. BP is 120/80 mm Hg. The fetal lie is longitudinal, the
head is in the pelvic cavity. Fetal heart rate is 120-130 bpm. At vaginal examination the cervix is fully
dilated, the head is in midpelvis. What is the most likely diagnosis?

Task. A 35-year-old G 2 P 1 woman at 41 weeks gestation has been pushing for 3h without progress.
Throughout this time, her vaginal examination has remained completely dilated, completely effaced, and 0
station, with the head persistently in the occiput posterior position. The pelvic sizes are: d. spinarum – 23
cm, d. cristarum – 26 cm, d. trochanterica – 29 cm, c. exerna – 18 cm. What is the situation?

Task. A 23-year-old G1 P0 at 37 weeks' gestation presents with a vaginal gush of fluid. On sterile
speculum examination, the patient has a pool of clear fluid in the vagina that is nitrazine and fern positive.
She is contracting every 3 to 4 minutes, and her cervix on visualization appears to be dilated 2 to 3 cm.
What is the situation? What is the best course of action?