National Institue of Child Health and
Human Development (NICHD, 2008)
Katagori I
1. Merupakan kondisi normal dalam pemantauan DJJ
2. Menggambarkan status asam bassa janin saat pemantauan dalam keadaan normal 3. Dapat dipantau pada pemeriksaan rutin asuhan antenatal
4. Tidak memerlukan tatalaksana khusus
Katagori II
1. Gambaran/prediksi adanya abnormalitas asam basa janin 2. Memerlukan evaluasi lebih lanjut
3. Memerlukan re-evaluasi dan mencari faktor – faktor yang berkaitan dengan keadaan klinis 4. Diperlukan uji diagnostik, utk memastikan status kesejahteraan janin
5. Melakukan resusitasi intrauterine
Katagori III
1. Berkaitan dengan abnormalitas status asam basa pada saat pemantauan janin tsb dilakukan 2. Kategori III memerlukan evaluasi yang baik (akurat)
3. Pada kondisi ini, tindakan yang dilakukan tidak terbatas hanya untuk memberikan oksigenasi bagi ibu, merubah posisi ibu, menghentikan stimulasi persalinan, atasi hipotensi maternal 4. Pertimbangkan kondisi klinis, bila kategori III tidak dapat diatasi pertimbangkan terminasi
kehamilan
1. What is a goal of antepartum fetal surveillance?
a. Predict timing of fetal death
b. Avoid unnecessary intervention
c. Improve positive predictive value of maternal kick counts
d. None of the above
2. Concerning antepartum testing, positive predictive values for true-positive abnormal test results
approximate which of the following?
a. 5–10%
b. 10–40%
c. 40–60%
d. 60–80%
3. Which of the following statements concerning fetal movements is true?
a. Fetuses spend most of their time in behavioral states 2F and 3F after 36 weeks.
b. The average number of fetal
movements increases weekly until 40 weeks’ gestation.
c. General body movements become organized between 20 and 30 weeks’
gestation.
d. Beyond 6 weeks’ gestation, fetal movements are never absent for periods exceeding 13 minutes
4. Which of the following findings have been attributed to studies in fetal
movement?
a. Women are more likely to perceive fetal movements lasting more than 20 seconds.
b. Informal maternal perceptions of fetal movement are as valuable as formally recorded fetal movement.
c. Growth restricted fetuses were
identified before birth more often when fetal movement count was used.
d. All of the above
Manakah dari temuan berikut yang dikaitkan dengan penelitian tentang gerakan janin?
A. Wanita lebih mungkin untuk merasakan gerakan janin yang berlangsung lebih dari 20 detik.
B. Persepsi ibu informal tentang gerakan janin sama berharganya dengan gerakan janin yang direkam secara formal.
C. Janin dengan pertumbuhan terbatas diidentifikasi sebelum kelahiran lebih sering ketika jumlah gerakan janin digunakan.
D. Semua yang di atas
5. Which of the following is true regarding fetal movements?
a. The lowest number of weekly fetal movements occurs at term.
b. The number of weekly fetal movements peaks at 32 weeks’
gestation.
c. In a normal pregnancy there should be 10 counts in a 12-hour period.
d. Declining amnionic fluid volume and space account for decreased fetal
movements at 30 weeks’ gestation.
6. Which of the following statements are true concerning contraction stress tests?
a. Identifies uteroplacental insufficiency.
b. Average time to completion is 75 minutes.
c. Equivocal-suspicious tests should be repeated in 24 hours.
d. Variable decelerations are normal and do not require assessment.
7. A 36-year-old multiparous patient is undergoing a contraction stress test (CST). The nurse in the testing center calls and tells you the CST has adequate contractions, and late decelerations
with every third contraction. How would this CST be interpreted?
a. Positive CST b. Negative CST
c. Equivocal-suspicious CST d. None of the above
8. Which of the following statements are true concerning nonstress tests?
a. They assess fetal condition rather than uteroplacental function.
b. It has a similar ability to predict fetal wellbeing as a contraction stress test.
c. The time to perform a nonstress test is much shorter than a contraction
stress test.
d. All of the above
9. Which of the following statements regarding a nonstress test is not true?
a. They do not predict acute asphyxial events.
b. Vibroacoustic stimulation of the fetus is not allowed.
c. More than 20 minutes may be
needed to account for fetal sleep cycles.
d. One acceleration is just as reliable as two in predicting healthy fetal status.
10. The components of a biophysical profile include all except which of the following?
a. Fetal tone
b. Fetal breathing
c. Contraction stress test
d. Amnionic fluid volume measurement
11. In a woman without history of prior cesarean delivery, at what
gestational age is removal of a prophylactic
transvaginal cerclage most reasonable?
a. 34 weeks’ gestation b. 37 weeks’ gestation c. 39 weeks’ gestation
d. Defer until the onset of labor
12. Which of the following is an
indication for transabdominal cerclage?
a. Twin gestation
b. History of cervical insufficiency
c. History of failed transvaginal cerclage d. Prior preterm birth at 26 weeks’
gestation
13. When counseling a patient regarding prophylactic cerclage placement, which of the following is a known risk?
a. Bleeding b. Infection
c. Membrane rupture d. All of the above
14. A 22-year-old primigravida is
scheduled to undergo suction dilation and curettage for a missed abortion at 8
weeks’ gestation. Prior to the procedure the decision is made to place hygroscopic dilators. A single Dilapan-S dilator is
placed in the cervix, and a moist gauze is placed subsequently in the vaginal vault.
How long will it take the dilator to reach its maximum diameter?
a. 1–2 hours b. 2–4 hours c. 4–6 hours d. 6–12 hours
15. A 32-year-old multigravida is
diagnosed with an embryonic demise at 7 weeks’ gestation. When counseling
her regarding options other than
expectant management, you explain that as compared to suction curettage, which has an efficacy rate of 96–100%, medical abortion is associated with
what risk of failure?
a. 2–17%
b. 4–9%
c. 5–26%
d. 10–20%
16. The patient in Question 15 elects to undergo dilation and curettage.
Misoprostol is chosen for cervical
ripening prior to the procedure. Which route of administration is thought to be least effective?
a. Oral
b. Vaginal c. Sublingual
d. All are equivalent
17. Which regimen is recommended by the American College of Obstetricians and Gynecologists for prophylaxis for postabortive infection?
a. Ancef 2 g IV at time of the procedure b. Clindamycin 900 mg IV at the time of the procedure
c. Doxycycline 100 mg BID × 14 days after the procedure
d. 100 mg doxycycline 1 hour prior and 200 mg doxycycline after the procedure
18. Which of the following is a relative contraindication to outpatient medical termination of pregnancy?
a. IUD in situ
b. Use of anticoagulation
c. Severe renal, liver, or cardiovascular disease
d. All of the above
19. A 22-year-old woman presents for elective termination of pregnancy at 7 weeks’ gestation. After
counseling she is prescribed mifepristone and misoprostol to complete outpatient medical abortion. She completes the dose of mifepristone in the office, but then calls back stating she has decided not to proceed with termination of pregnancy. You inform her of the risks of mifepristone exposure in pregnancy which include which of the following?
a. 28% risk of preterm birth
b. 5% risk of fetal malformations c. 10–46% risk of pregnancy loss d. None of the above
20. A 24-year-old woman with missed abortion at 6 weeks’ gestation elects for outpatient medical treatment. You
prescribe 800 µg of misoprostol to be taken up to 3 times 3 hours apart. What of the following are side effects of
misoprostol?
21. Of vulvar cancers, approximately what percentage is positive or human papillomavirus (HPV)?
a. 5 percent b. 30 percent c. 60 percent d. 90 percent
22. A 39-year-old woman is referred or a painful 3-cm vulvar mass. Biopsy o the mass reveals invasive squamous cell
carcinoma. Which of the following tests should be performed prior to definitive surgery?
a. Vulvoscopy
b. Cervical cytology
c. Human immunodeficiency virus (HIV) assay
d. All of the above
23. A 68-year-old woman presents or her annual well woman examination and complains vulvar pruritus. A
thickened, white plaque is noted on her vulvar skin. What is the most
appropriate next step?
a. Biopsy the lesion in the office b. Prescribe clobetasol cream and reevaluate in 3 months
c. Prescribe estrogen cream and reevaluate in 3 months
d. Perform a wide local excision in the operating room
24. With squamous cell carcinoma of the vulva, what is the risk of lymph node metastasis with 2-mm depth of invasion?
a. 0.03 percent b. 0.9 percent c. 9 percent d. 33 percent
25. What is the most important
prognostic factor in vulvar cancer?
a. Grade
b. Tumor size
c. Depth of invasion
d. Lymph node metastasis .
KEPALA “ FLOATING “
ENGAGEMEN - FLEKSI - DESENSUS
DESENSUS
PUTAR PAKSI DALAM
ROTASI SEMPURNA AWAL EKSTENSI
EKSTENSI LENGKAP
RESITUSI - PPL
PERSALINAN BAHU DEPAN
PERSALINAN BAHU BELAKANG
DIMULAI pada saat pembukaan serviks telah lengkap.
BERAKHIR pada saat bayi telah lahir lengkap.
His menjadi lebih kuat, lebih sering, lebih lama, sangat kuat.
Selaput ketuban mungkin juga baru pecah spontan pada awal kala 2.
Peristiwa penting pada persalinan kala 2
1. Bagian terbawah janin (pada persalinan normal : kepala) turun sampai dasar panggul.
2. Ibu timbul perasaan / refleks ingin mengejan yang makin berat.
3. Perineum meregang dan anus membuka (hemoroid fisiologik) 4. Kepala dilahirkan lebih dulu, dengan suboksiput di bawah
simfisis (simfisis pubis sebagai sumbu putar / hipomoklion), selanjutnya dilahirkan badan dan anggota badan.
5. Kemungkinan diperlukan pemotongan jaringan perineum untuk memperbesar jalan lahir (episiotomi).
Lama kala 2 pada primigravida + 1.5 jam, multipara + 0.5 jam.
KEPALA
“FLOATING”
SEBELUM ENGAGEMEN