Quiz: How to minimize vaginal birth complications

This month's quiz goes over the steps ob/gyns can take to lessen the likelihood of vaginal birth complications that were discussed in the article, "How to minimize vaginal birth complications" by Bob Kronemeyer (September 2018).

1. Incidence of shoulder dystocia during vaginal birth is:

a. between 0.2 and 3%
b. between 4% and 5%
c. between 7% and 10%
d. over 12%

Please click here for answer, discussion, and next question.

Answer: A. Between 0.2 and 3%

Shoulder dystocia occurs when the fetal head delivers but the shoulders do not deliver with normal maneuvers.

2. Which of the following postpartum complications may occur in women who have experienced a shoulder dystocia?

a. pelvic floor prolapse
b. third- and fourth-degree lacerations
c. postpartum preeclampsia
d. all of the above

Please click here for answer, discussion, and next question.

Answer: B. Third- and fourth-degree lacerations

Postpartum hemorrhage can also occur. 

3. According to experts quoted in this article, if a first twin is breech, delivery should be:

a. vaginal for both twins
b. cesarean for both twins
c. vaginal or cesarean for both twins

Please click here for answer, discussion, and next question.

Answer: B. Cesarean for both twins

In contrast, if the first twin is head down, a vaginal delivery is planned for both twins unless there is a good reason not to do so. 

4. Delivery of a second twin can be complicated by which of the following?

a. ruptured membranes
b. a prolapsed umbilical cord
c. vasa previa
d. all of the above

Please click here for answer, discussion, and next question.

Answer: D. All of the above

Having a plan in place for delivery of a second twin is critical, as well as adequate medical team members available to perform an emergency cesarean if necessary. 

5. Good candidates for vaginal breech delivery are:

a. mothers who are at least 36 to 37 weeks’ pregnant
b. mothers with a growth-restricted or preterm baby
c. mothers with baby in abnormal descent
d. all of the above

Please click here for answer, discussion, and next question.

Answer: A. Mothers who are at least 36 to 37 weeks' pregnant

Other features of good candidates for breech delivery include those with a baby in frank or complete breech, spontaneous labor progressing, normal descent, adequate pelvis, and fetal weight between 2,500 and 4,000 g.

6. Risks of breech birth include which of the following?

a. fetal head entrapment with neurologic injury and/or death
b. bone fractures or dislocation
c. maternal injury of the pelvic floor
d. all of the above

Please click here for answer, discussion, and next question.

Answer: D. All of the above

Lacerations into the bowel/bladder with risk of incontinence are also a risk.

7. An episiotomy should be performed for a breech birth, especially with a first-time birth.

a. True
b. False

Please click here for answer, discussion, and next question.

Answer: B. False

An intact perineum can actually often help the baby flex its own head.