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Dr.Niraj Mahajan
Dr.Niraj Mahajan
Dr.Niraj Mahajan



By AdminPosted On 05-Oct-2016

1. APGAR Score

Findings at 5 minutes of life: pulse 130 bpm, cyanotic hands and feet, good muscle tone, and a strong cry and grimace. What should be the APGAR score?

a) 6

b) 7

c) 8

d) 9

e) 10

Correct Answer: c) 8. 1 for grimace and 1 for blue extremities.

2. Foetal scalp blood pH is abnormal when

a) pH less than 7.25

b) pH less than 7.3

c) pH less than 7.35

d) pH less than 7.4

e) pH less than 7.5

Correct Answer: a) pH less than or = 7.25. Two constituents that are commonly tested byFetal scalp blood testing are pH and lactate, both being indicators of acid base homeostasis. A low pH and high level of lactate indicate that there is acidosis, which in turn is associated with hypoxia. pH and lactate have the same sensitivity in indicating hypoxia during labour.

3. Neonatal Resuscitation

A term infant is placed under a radiant warmer, the skin is dried, and the oropharynx and nose are suctioned. After tactile stimulation, there is minimal respiratory effort, dusky color, and a heart rate of 86 beats/min. Bag/mask ventilation is performed for 30 seconds with 100% oxygen at a rate of 40 to 60 breaths/min. The heart rate increases to 100 beats/min. Of the following, the NEXT best step is to:

a) Administer sodium bicarbonate

b) Continue bag/mask ventilation at a rate of 20 to 40 breaths/min

c) Continue ventilation and begin chest compressions

d) Observe for spontaneous respiration and discontinues ventilation

e) Perform endotracheal intubation

Correct Answer: d) Observe for spontaneous respiration and discontinues ventilation

4. Which of the following statements is "True" of the Apgar score?

a) APGAR stands for Airway, Pulse, Gasp, Alertness, Reflexes

b) Umbilical cord gases are not as reliable as Apgar scores when it comes to assessing the severity of asphyxia.

c) The Apgar score has excellent consistency when administered by different operators.

d) An Apgar score of <7 at 1 minute means the baby requires immediate advanced resuscitation.

e) An Apgar score of <5 at 10 minutes is associated with a poor outcome.

Correct Answer: e) Apgar score of <5 at 10 minutes is one of several criteria for considering therapeutic hypothermia if a baby has HIE, as the outcome may otherwise be poor. The Apgar score is named after Virginia Apgar, an American anaesthetist. Paired umbilical cord gases are the gold standard for assessing the severity of a perinatal insult. The Apgar score is a quick and easy standardized assessment, but different operators will often score the same baby quite differently due to misinterpretation of the score. It is also difficult to score once the baby is receiving resuscitation. Most babies with an Apgar of <7 at 1 minute will recover quickly without extensive resuscitation, provided they have an open airway.

5. Fetal Blood Oxygen

Which of the following statements is FALSE regarding normal birth?

a) As the uterus contracts, blood flow through the uterine artery is interrupted.

b) Fetal blood oxygen levels can be 4–6 kPa (30–45 mmHg) without causing brain damage.

c) The fetal brain can use alternative fuels such as ketones if the supply of glucose is interrupted.

d) The umbilical arterial pH is the same or higher than the venous pH.

e) Most babies are cyanosed at birth

Correct Answer: d) The umbilical artery caries used blood away from the fetus and so the pH can never be higher than in the vein. Hyperstimulation of the uterus with oxytocin can be dangerous to the fetus as blood flow through the uterine artery is interrupted. 4–6 kPa is a normal level for fetal oxygen concentration. Fetal haemoglobin concentration is higher and the fetal haemoglobin dissociation curve is different from that of the adult, allowing the fetus to cope with lower pO2 than the adult. The fresh blood is delivered almost directly to the fetal brain. The brain can use alternative metabolites such as ketones. Most babies are cyanosed at birth and it can take up to 10 minutes before oxygen saturations are greater than 90%.

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Dr. Niraj Mahajan

MD- Gynecologist, Laparoscopic Surgeon, Uro-gynecologist , Infertility specialist & Cosmetic Gynecologist.

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