Operational Obstetrics &
Gynecology Correspondence Course
Naval School of Health Sciences
Portsmouth, Virginia
Nonresident Training Course
No. 13109-A
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Assignment 5
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Medical Support of Women in Field Environments
Appendix A
OPNAVINST 6000.1A
Management of Pregnant Servicewomen
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When you are ready to begin answering the test questions, print an Answer Sheet by clicking here.
After you have completed all six assignments and tests, mail them to the Naval School of Health Sciences.
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When you have completed this assignment, you will be ready for the 6th and final assignment.
Test Questions
Learning Objective: Understand the medical basis for normal labor and delivery.
5-1. Labor consists of regular, frequent uterine contractions which lead to progressive cervical dilatation and effacement.
1. True
2. False
5-2. The diagnosis of labor is always obvious.
1. True.
2. False
In answering questions 5-3 through 5-7, select from column B the phase of labor which most closely matches the description in column A. Some responses may be used once, more than once, or not at all.
| A. Description | B. Phase of Labor |
| 5-3. May have regular contractions | 1. Latent Phase |
| 5-4. Contractions may be painful | 2. Active phase |
| 5-5. Cervix dilated 7 cm. | 3. Both |
| 5-6. The woman can talk and laugh through the contractions. | 4. Neither |
| 5-7. Rapid change in cervical dilatation. |
5-8. For a woman having her first baby, labor usually lasts about:
1. 12-14 minutes.
2. 12-14 hours.
3. 12-14 days.
4. 12-14 weeks.
In answering questions 5-9 through 5-12, select from column B the station which most closely matches the description in column A. Some responses may be used once, more than once, or not at all.
The leading edge of the fetal presenting part has descended through the birth canal to:
| A. Description | B. Station |
| 5-9. 1 cm above the ischial spines. | 1. -1 Station |
| 5-10. Exactly at the ischial spines. | 2. 0 Station |
| 5-11. 1 cm below the ischial spines. | 3. +1 Station |
| 5-12. Completely engaged. |
5-13. During delivery, what comes next after Engagement, Descent, and Flexion?
1. Internal Rotation.
2. Extension.
3. External Rotation.
4. Expulsion.
5-14. For women having their first baby, the 2nd stage of labor usually lasts:
1. 1-2 seconds.
2. 1-2 minutes.
3. 1-2 hours.
4. 1-2 days.
5-15. Which of the following signs is not NOT an indication of placental separation?
1. Cessation of contractions.
2. A sudden gush of blood.
3. Lengthening of the visible portion of the umbilical cord.
4. The uterus, which is usually soft and flat immediately after delivery, becomes round and firm.
5-16. Most labors and deliveries are safe, spontaneous processes, requiring little or no intervention, and result in a healthy mother and healthy baby.
1. True
2. False
5-17. All of the following are part of an initial evaluation of a woman in labor, EXCEPT:
1. Evaluation of the current health status of the mother.
2. Identification of risk factors.
3. Establish names for the baby.
4. Determine the labor status of the mother.
In answering questions 5-18 through 5-27, select from column B the risk category which most closely matches the pregnancy complication in column A. Some responses may be used once, more than once, or not at all.
| A. Pregnancy Complication | B. Risk Level |
| 5-18. Maternal age 15. | 1. Low Risk |
| 5-19. Maternal age 25. | 2. Moderate Risk |
| 5-20. Cigarette smoking. | 3. Higher risk |
| 5-21. Prior perinatal death.. | |
| 5-22. 38-week labor. | |
| 5-23. 32-week labor. | |
| 5-24. Herpes. | |
| 5-25. Breech presentation | |
| 5-26. Bleeding at 30 weeks | |
| 5-27. 1 previous induced abortion. |
5-28. The normal fetal heart rate at term ranges between:
1. 90-110 BPM
2. Up to 100 BPM
3. 110-200 BPM
4. 120-160 BPM
5-29. Confirmation of rupture of membranes can be by any of the following, EXCEPT:
1. A history of a sudden gush of fluid.
2. Pooling of clear, Nitrazine positive fluid in the vagina.
3. Ferning of dried fluid.
4. Continuing, steady leakage of large amounts of fluid from the vagina.
5-30. During early labor, maternal vital signs should be re-checked about every...
1. Day
2. 40 minutes
3. 4 hours
4. 8 hours
5-31. Causes of fetal tachycardia include all of the following, EXCEPT:
1. Maternal fever
2. Intrauterine infection (chorio-amnionitis)
3. Fetal hypoxia
4. Increased fetal vagal tone
5-32. Narcotics are not used during labor because they are too dangerous.
1. True
2. False
5-35. Preparation of the vulva with antiseptic solution, shaving of pubic hairs and evacuating the bowels with an enema is not generally necessary, but might be a good idea in selected operational settings where contamination may be significant.
1. True.
2. False
5-36. HM3 Chessie Nimitz sees you during Sick Call, complaining of frequent, intense, abdominal pain that waxes and wanes every 5 minutes. She has an abdominal mass that extends from the pubic bone up to the ribs that palpably hardens and rises out of the abdomen during each "pain." She denies any possibility that she might be pregnant but does not recall when her last period began. You should:
1. Order a urine culture.
2. Prepare for obstetrical delivery.
3. See if she might feel better if she would just have a little something to eat.
4. Recommend bed rest for a few days.
5-37. 10 minutes later, HM3 Nimitz says she feels like she needs to move her bowels. You should:
1. Let her go to the bathroom in Enlisted Berthing, two decks below the Medical Department.
2. Let her go to the bathroom, but only within the Medical Department.
3. Let her go to the bathroom, but only within the Medical Department AND only with a buddy.
4. Check her cervix first, to make sure that her urge to move her bowels isn't the baby descending through the birth canal.
5-38. HM3 Nimitz delivers her baby uneventfully, and seems to be recovering normally. 3 days after delivery, while you are still underway toward the nearest port, she tells you she is continuing to bleed heavily, "like a normal menstrual flow." You tell her:
1. This is normal following delivery.
2. This is a sign of infection.
3. This is a sign of pre-eclampsia.
4. This may indicate she is pregnant again.
Learning Objective: Understand common labor and delivery problems.
5-39. Which of the following is useful in treating preterm labor?
1. Magnesium sulfate.
2. Methotrexate.
3. 4 low dose birth control pills, followed 12 hours later by 4 more pills.
4. Valium.
5-40. Preterm labor is:
1. Associated with intrauterine infection in about 10% of cases.
2. Any labor occurring prior to the due date.
3. Always treated with drugs to stop the labor.
4. Associated with risk of immaturity of the fetal respiratory tree.
5-41. With premature rupture of membranes,
1. No treatment may be needed if at full term initially.
2. Labor induction may be undertaken if remote from term.
3. Waiting for further fetal maturity may be undertaken if remote from term.
4. All of the above.
In answering questions 5-42 through 5-51, select from column B the type of delivery which most closely matches the labor complication in column A. Some responses may be used once, more than once, or not at all.
| A. Labor Complication | B. Type of Delivery |
| 5-42. Fetal transverse lie. | 1. Usually a normal vaginal delivery |
| 5-43. Prolapsed umbilical cord. | 2. Usually a cesarean section |
| 5-44. Fetal compound presentation. | 3. Might be either a cesarean section or vaginal delivery, depending on some other things. |
| 5-45. Deep transverse arrest. | |
| 5-46. Occiput posterior presentation. | |
| 5-47. Arrest of active labor. | |
| 5-48. Footling breech presentation. | |
| 5-49. Umbilical cord wrapped around the fetal neck, once, loosely. | |
| 5-50. Complete placenta previa. | |
| 5-51. Steady progress in the active phase of labor. |
5-52. Shoulder dystocia may require special obstetrical maneuvers to avoid injury to the baby.
1. True
2. False
5-53. Maneuvers commonly used to disimpact the anterior shoulder during a shoulder dystocia include all of the following EXCEPT:
1. Flexing the mother's legs tightly against her abdomen.
2. Excessive downward traction on the fetal head.
3. Suprapubic pressure
4. Delivery of the posterior arm.
5-54. Following delivery of the first twin, there is a period of time during which contractions slow or stop.
1. True.
2. False.
5-55. Immediate delivery is the best solution to the problem of prolapsed umbilical cord.
1. True
2. False
5-56. Your ship, a frigate, is engaged in the evacuation of 10 American civilians from an American Embassy which is taking fire during a local insurrection. Among the civilians is Katie Beach, a 32 year old dependent wife of the Military Attache. Katie is pregnant with her second baby, thinks she is about 36 weeks pregnant, but is uncertain, and is having regular uterine contractions every 5 minutes. She doesn't think that she's in labor as she's had several episodes like this in the last few weeks. You have called for further MEDEVAC to the amphibious battle group, but they are en route to your area and will not be within helicopter range for another 10 hours. You should:
1. Prepare for cesarean section.
2. Ask her to return during normal sick call hours
3. Have her lie down in the medical department and start an IV.
4. Ask the Executive Officer if he knows of any good OB-GYN doctors on board the ship.
5-57. 30 minutes later, Mrs. Beach experiences a sudden gush of clear liquid from the vagina. She continues to leak large amounts of fluid. You place a strip of Nitrazine paper against the fluid and the paper turns a deep blue color. She complains of more frequent, very painful contractions and rectal pressure. She asks to use the bathroom because she feels like she is about to have a bowel movement. You should:
1. Do a pelvic examination to see if delivery is imminent.
2. Let her use the head but caution her not to take too much time.
3. Reassure her that this is a normal sensation during pregnancy.
4. All of the above
5-58. 10 minutes later, Mrs. Beach delivers her baby. You clamp and cut the umbilical cord, dry the baby and wrap it in a pillowcase. The baby is crying vigorously. 5 minutes later, the placenta is spontaneously expelled. You inspect it and it appears complete.
Then you notice that Mrs. Beach is continuing to bleed briskly. You should:
1. Massage the uterus, trying to get it to firmly contract.
2. Put 20 units of oxytocin in her IV bag and increase the IV flow rate so that it is wide open.
3. Notify the Executive Officer of the events of the last few minutes and ask for radio contact with the Fleet Surgical Team embarked aboard the amphibious battle so they can provide advice for further treatment.
4. All of the above.
5-59. Despite your best efforts, Mrs. Beach continues to bleed. You estimate visually that she has lost somewhere between 1 and 3 liters of blood. Her pulse is 130 BPM, her BP is 100/40, she is breathing rapidly, looks pale, complains of dizziness and shortness of breath. She has received a total of 3 liters of crystalloid IV fluid. She appears agitated and confused. In addition to continuing vigorous uterine massage, administration of oxygen, and raising her legs, you should:
1. Ask the amphibious battle group to begin thawing a unit of frozen blood.
2. Give Lasix because she is probably fluid overloaded.
3. Give up and turn your attention to the next patient.
4. Immediately (within the next 10 minutes) transfuse her with about one unit of fresh, whole, O negative blood from a volunteer donor, and get a second donor ready to transfuse.
5-60. Your treatment has been successful and Mrs. Beach is feeling much better. Her vital signs are normal, and her bleeding is minimal. The uterus is firmly contracted. The baby is crying and hungry. She would like to breast-feed the baby. Your decision is:
1. Go ahead and let her breast-feed the baby.
2. Deny permission, because breast-feeding of babies is not allowed aboard U.S. Warships.
3. Deny permission, because it would be too dangerous for the baby, considering how much oxytocin the mother has received.
4. Deny permission because the baby doesn't have enough experience with breast-feeding to be able to do it well when it's only a few hours old.
5-61. While writing your report on the delivery of Mrs. Beach, you receive a call that another helicopter is inbound to your ship from the Embassy. They are carrying a wounded Marine guard who sustained a gunshot wound to the left upper thigh and who is bleeding profusely. A Hospital Corpsman is in the helicopter with the Marine and is applying direct pressure to the leg to try to stop the bleeding. The Skipper wants you on the Helo deck ASAP. You should:
1. Grab the supplies you think you might need and go immediately to the helo deck.
2. Advise the Captain of your circumstances and await further direction.
3. Stay in the Medical Department because you should never leave a woman who has just delivered, particularly if she's just had a postpartum hemorrhage.
4. Ask Mrs. Beach for her advice on how to handle this troublesome dilemma.
Learning Objective: Understand basic, immediate care of the newborn.
5-62. Newborn babies should be dried only with warm, soft towels.
1. True
2. False
5-63. Babies can lose a tremendous amount of heat very quickly, particularly if they are wet.
1. True
2. False
5-64. Babies should be kept on their backs or tilted to the side, but not on their stomachs.
1. True
2. False
5-65. A newborn (5 minutes old), has pink skin color of its' chest, belly, and face, but it's arms, hands, legs and feet are blue. This is:
1. Normal
2. Abnormal, but usually does not result in brain damage.
3. Abnormal and usually results in brain damage.
4. Normal as far as the brain is concerned, but permanent and considered a birth defect.
5-66. Your supply ship, following a successful resupply mission to the carrier battle group, is returning to home port. The ship is being maneuvered toward the pier, which is only about 100 yards off the port beam. You would like to be up on the weather deck, watching the docking procedures, but you are busy in the Medical Department evaluating a twisted ankle. Out of the gray speaker overhead, you hear a voice saying, "Doc, Report to Enlisted Berthing!" "DOC, STAT TO ENLISTED BERTHING." You should:
1. Finish with your first patient.
2. Go up on the weather deck as you had originally planned.
3. Write to Mrs. Beach, asking her for her advise with this troublesome dilemma.
4. Grab your Unit 1 Bag and go directly to Enlisted Berthing.
5-67. On arrival at Enlisted Berthing, you are met by Chief Fletcher who says, "Doc, come quick...its' EN1 Halsey." You find EN1 Halsey is in her bunk (the bottom bunk of a 3-tiered bank). She has just delivered a baby. She is awake and alert, but trembling. The baby, who appears not quite full-term in size, is still connected to the umbilical cord. The baby is completely blue, not breathing, and is limp. You should first:
1. Quickly dry the baby using the bed linens in Berthing, clear the airway with your finger, and immediately begin mouth-to-mouth resuscitation, ventilating the baby with short "puffs" of air. You pay particular attention to the angle of the head, not hyperextending the head backwards, nor flexing the head against the chest.
2. Take the mother's blood pressure.
3. Take the baby's blood pressure.
4. Take Chief Fletcher's blood pressure.
5-68. Your efforts are successful. The baby sputters, coughs, takes several deep breaths, turns centrally pink, and lets out a long, piercing, reassuring wail. You should then:
1. Clamp and cut the umbilical cord; then wrap the baby in a dry blanket taken from the middle bunk.
2. Turn to Chief Fletcher and ask, "Chief, what the heck is going on?"
3. Turn to EN1 Halsey and ask "Halsey, what the heck is going on?"
4. Put on hearing protection gear (either plugs or muffs) in accordance with OPNAVINST 6000.1A. Make sure Chief Fletcher, EN1 Halsey, and EN1 Halsey's baby are all wearing their hearing protection, too.