Soal-soal

TOPIK
1.Embriotomi
1. Yang bukan merupakan syarat embriotomi ? B
a. Janin sudah mati
b. Canjugata vera lebih dari 7,5 cm
c. Pembukaan servik >7 cm
d. Jalan lahir normal
2. Yang bukan jenis tindakan embriotomi? A
a. Evoserasi
b. Pungsi
c. Dekapitasi
d. Kraniotomi
3. Indikasi kleidotomi ?
a. Distosia bahu
b. Letak lintang dosro inferior
c. hidrosepalus
d. letak lintang
4. alat yang tidak digunakan untuk kraniotomi? D
a. Perforator simpson
b. Cunam boer
c. Acunam mouzeaux
d. Gergaji gigli
5. Fungsi gergaji gigli ? A
a. Untuk memotong leher janin
b. Untuk memotong calvicula
c. Memotong kranium
d. Momotong femur

6. Tindakan untuk memperkecil tindakan kepala janin dangan cara membei

lubangdan mengeluarkan isi tengkorak, sehingga jani dapat dilahirkan
pervaginam ? A
a. kraniotomi
b. dekapitasi
c. kleidotomi
d. eviserasi

7. Alat yang digunakan pada kraniotomi adalah? D

a. pisau bedah
b. perforator simpson
c. kranioblast
d. semua benar
2. Persiapan SC
1. Reasons for increasing use of caesarean delivery include which of the following ? C
a. An incresing percentage of birth to multiparas
b. Declining average maternal age
c. Widespread use of electronic fetal
d. Higher rates of labor induction in womwn with preaeclampsia
2. Elective caesarean deliveries are increasingly being performed for what indication? D
a. Prevention of pelvic floor injury
b. Medically indicated preterm birth
C. Maternal request
d. All of above
3. Compared with vaginal delivery, the maternal risks of caecarean delivery include
which of the following? A
a) Increased morbidity and mortality rates
b) Increased morbidity but equipment mortality rates
c) Increased morbidity but decreased mortality rates
d) Equivalent morbidity snd mortality rates
4. what benevit does pfannenstiel incision offer over a midline incision ? D
a) Improved cosmetic result
b) Less postoperative pain
c) Decreased rates of incisional hernia
d) All of above
5. the highest succes rate for a trial of labor occurs in patient with which of the following
indication for the previous caesarean delivery ? C
a) Dytocia
b) Fetal distress
c) Breech presentation
d) History of myomectomy
6. what is the most concerning complication related to multiple repeat caecarean
deliveries?B
a) Bladder injury
b) Placenta acreta
c) Recurreb=nt wound infection
d) Abdominal hernia development
7. as the number of prior caesarean delivery increase, which of the following is true?B
a) The risk of uterine rupture remains unchanged
b) The riskof uterine rupture is two- to threefold higher in some report
c) ACOG recommeds encouraging attempts at vaginal birth to decrease
operative complications
d) Non of the above
3. Penyulit Persalinan dab kelainan letak
Soal 1-4
A 38-year-old G3P2A0 womwan presents T 40 weeks days with contractions to labor and
delivery triage. Contractions started 1 hour ago and are very painfull. The patients denies
leacking fluid but dis notice blood and muccus on her underwear. The baby has not been
particulary active since contractions started. Her pracnancy has been complicated by A2GDM.
Fasting blood glucose are usually between 80/90 mg/dL with 1-hour postprandial valueas between
120 and 140 mg/dL. Her prepregnancy weight was 130 lb and she is 5 ft 5 in (BMI21.6) She has gained
30 lb this pregnancy (BMI 26.6). Hemoglobin A1C is 6.0%. Fetal Ultrasound at 20 weeks
demonstrated normal fetal anatomy. Repeat ultrasound for growth at 38 weeks demonstrated fetus
with weight in the 90th percentile and an EFW of 4.350 g. Her last pregnancy was complicated by
A1GDM and she delivered a 4.200 g infant without complications. Initial cervical examination reveals
dilation of 6 cm, 50% effacement, and -1 station. Two hours leter the nurse calls you to the room
after the patient water breaks. Examination show complete dilation and effacement, and fetus at +1
station. The patient has a strong urge to push and begins pushing. The delivery is complicated by a
second=degree perineal laceration and a postpartum hemorrhage of 600 mL. Fetal weight is 4,560 g
and the Apgar scores are 6,8.

1. What neonatal risks are most commonly present in macrosomic fetuses? A

1. Jaundice
2. Hypoglycemia
3. Hyperglycemia
4. Birth trauma
5. Asthma
6. Hypocalcemia
a. 1, 2, 4, 6
b. 1, 3, 4, 5
c. 3, 4, 5
d. 1, 3, 5, 6
e. 2, 4, 5, 6

2. Which of the following is most likely the cause of fetal macrosomia in this case? B
a. Maternal weight gain in pregnancy
b. Gestational diabetes
c. Poor glycemic control
d. Advanced maternal age
e. Postern pregnancy
 3. The patient returns to your clinic for her 6-week postpartum visit. You ask her about
contraception, and she states that she would like to have one more child in the near future.
She is breastfeeding and it is going well. What do you also recommend as part of her
postpartum care in this setting? E
a. Immediate weight loss to 20% under prepregnancy weight
b. RPR
c. Continue insulin regimen postpartum
d. Start metformin
e. Perform a 2-hour glucose tolerance test

4. The patient return 2 year later to your office. She is now 8 weeks 3 day pregnant by certain
LMP. She weighs 160 lb (BMI 26.6). She has been very nauseatedthis pregnancy and is eating
frequent small snack. She has not been physician since hier last postparumvisit with you
during her last pregnancy. What test in particular do you recommend performing, in addition
to, routine prenatal laboratory studies? D
a. Preclamsia panel (creatininie, AST, BUN, platelets, usric acid)
b. 24-hour urine protein collection
c. Referral for eye examination to evaluate for retinophaty
d. Glucose tolerance test
e. Hemoglobin A1C

Soal 5-7

A 35-year old woman with a history of primary infertility presents with her partner for initial prenatal
visit. They had been attempting pregnancy for the past 3 years and have now conceived through IVF.
She had one embryo transferred 7 weeks ago. The patients medical history is significant for
rheumatoid, arthritis and polycystics ovarian syndrome. She is overweight. In interview in their family
history, she tells you that her grandmother was a twin and there is no family history of congenital
abnormalities or known genetics disorder in their family. Today she report nausea and vomiting,
which is worse in the morning. She has not has any vaginal bleeding or cramping. You perform a
transvaginal ultrasound and notice not one, but two embryos. There is appears to be a thin dividing
membrane between the two. Heart rate for each embryo is around 150 bpm

5. At what stage of division in the embryonic disc does monochrorionic-diamniotic twinning

occur? B
a. Before differentiation of the trophoblast
b. After trophoblast differentiation and before amnion formation
c. After amnion formation
d. Not until day 15 of development

6. During your visit with the couple, you explain that you will be monitoring fetal growth of their
twin closely because they are at risk for SGA and twin to twin transfusion syndrome. You also
explain that multiple gestation are at risk for preterm labor, preterm birth, placental
abnormalities, cesarean section due to malpresentation, preeclamsia, and gestational
diabetes. In twin-to-twin transfusion syndrome, the recipient twin may suffer from which of
the following complications ? A
a. Fetal hydrops
 b. Anemia
c. Growth restriction
d. Oligohydramnios
e. Hypovolemia
7. The couple return for routine prenatal care at 30 weeks. The patient has been feeling well.
She report mild low back pain and fatigue. The babies are very active. The last ultrasound
showed only 12% discordance in fetal weights, with a baby A estimated to be 200 g larger
than baby B. Baby A is currently cephalic and baby B is frank breech. The couple would like
trial oflabor. You begin counseling them on risks and benefits of vaginal birth twins, including
breech extraction, and cesarean section. In which of the following pairs would trial of labor
not be recommended? B
a. Twin A 2,800 g cephalic; twin B 2,650 g cephalic
b. Twin A 2,850 g cephalic; twin B 3,375 g breech
c. Twin A 3,150 g cephalic; twin B 3,010 g frank breech
d. Twin A 3,440 g cephalic; twin B 3,220 g footling breech
e. Twin A 1,645 g cephalic; twin B 1,550 g cephalic

8. Pada persalinan dengan manual aid ( partial breech extraction), dikenal beberapa teksnik.
Teknik yang menggunakan prinsip melahirkan lengan belakang lebih dahlu, lalu dilanjutkan
dengan melahirkan lengan deoan yang berada di bawah simfisis, aitu tehnik...
a. Mueller
b. Deventer
c. Lovset
d. Bickenbach
e. Mauriceau

5. Vakum Ekstraksi
1. With vaccum extraction, a metal cup compared with a soft cup is associated with
significantly higher rates of which of the following? D
a. Cephalohematoa
b. Birth canal trauma
c. Low appgar score
d. None of the above
2. In general, vaccum extraction would be contraindicated in all except which if he
following clinical settings? C
e. 30. Weeks fetus
f. Fetal thrombocytopenia
g. Occiput transverse presentation
 h. Inability to access fetal head potition
3. With vaccum extraction, correct cup placeent is described by which of the
following ? A
i. Centered across the sagital suture
j. Placed over the posterior fontanel
k. IfROA, the cup is placed of the left fetal parietal bone
l. Traction axis is aligned with the suboccipitobregnatic diameter
4. A 24 years old G2P1 A0 women at 39 weeks and3 days is seen in the clinics she has
been experiencing more frequent contractions and thinks she might be in labor. Her
last pregnancy ended with a caesarean delivery after a stage 1 arrest. There was not
evidence of cephalopelvic disproportion. Earlier in a course of her current pregnancy
she had desired scheduled repeat caesarean, but now that she might be in labor she
would like to try and delivery vaginally.
You decide to attempted vaccuum extraction. Which of the following is the common
complication of vaccuum extraction?
m. Fetal facial nerve palsy
n. Maternal perineal laceration
o. Cephalohematoma
p. Fetal skull fracture
q. Prolonged state three

6. Forcep Ekstraksi
1. Which of the following describes forceps thet are appliled to the fetal head
with the scalp visble at the introitus without manual separation of the labia?
D
a. Midforceps
b. Low forceps
c. Inlet forceps
d. Outlet forceps

2.Which of the following is true of high foceps delivery? C

a) Indicated for fetal distress
b) Forceps applied at +1 station
c) No rule in moderd obstetric
d) Forceps apllied whwn head is aengaged
3.Compared with forceps delivery, vaccum extraction is associated with lower rates
of which of the following ? C
 a) Neontal jaundice
b) Cephalhematoma
c) Third-degree laceration
d) Neonatal retinal hemorrhage
4.When correctly appliled to a fetus in an occiput anterior potition, forceps align
along which fetal head diameter? C
a. Bitemporal
r. Occipitofrontal
s. Occipitomental
t. Suboccipitobregmatic
5.Maternal morbidity with forceps delivery is most clesely predicated by which of
the following? A
u. Fetal station
v. Maternal parity
w. Degree of fetal distress
x. Degree of fetal head molding
6.During forceps delivery of a fetus with a face presentation, blade should be swept
upward whan which of the following? A
y. Chin
z. Brow
aa. Upper lip
bb. Base of the nose
7.Forceps delivery, campare with a spontaneus vaginal delivery, is accosiated with
higher short-term rates of which f the following maternal complications? D
cc. Episiotomy
dd. Anal inconinence
ee. Urinary incontinace
ff. Al of the above