The physician performs an episiotomy on. The cut is made directly toward, but not into, the rectal muscle. This episiotomy is called:

lateral

Mediolateral

midline

Posterior

Answer and Explanation

The Correct Answer is C

A. lateral: A lateral episiotomy is made horizontally from the vaginal opening toward the side of the perineum. This technique is rarely used in modern obstetrics because it provides poor anatomical results and carries a higher risk of injury to the Bartholin glands. It is not the standard vertical or diagonal approach.

B. Mediolateral: This incision starts at the midline of the posterior fourchette and is directed at a 45° angle toward the ischial tuberosity. While it avoids the rectum, it involves more muscle tissue and results in greater blood loss and postpartum pain. It is not directed straight toward the rectal muscle.

C. midline: A midline or median episiotomy is an incision made directly in the center of the perineal body toward the anal sphincter. It follows the natural fibrous midline, resulting in less bleeding and easier surgical repair. However, it carries a higher risk of extension into the rectal mucosa.

D. Posterior: This term is a general anatomical descriptor rather than a specific type of episiotomy. All standard episiotomies are performed on the posterior vaginal wall to enlarge the outlet for delivery. The nomenclature of the procedure is based on the specific direction and angle of the surgical cut.

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Correct Answer is A

Explanation

A. at the beginning of the second stage: This stage is defined by complete cervical dilation of 10 centimeters and 100% effacement. Pushing at this point utilizes the Ferguson reflex to facilitate fetal descent through the birth canal. It ensures the cervix is no longer an obstruction.

B. at the end of the active phase: This phase concludes when dilation reaches approximately 8 centimeters. Pushing before full dilation can cause cervical edema, maternal exhaustion, and potential cervical lacerations. The birth canal is not yet physiologically prepared for the forceful expulsion of the fetus.

C. during the latter part of the second stage: While pushing is necessary here, it must be initiated as soon as the stage starts to ensure progress. Waiting until the head is crowning or the stage is nearly over prolongs labor. Early coordination of contractions and pushing is optimal.

D. during transition: This represents the final part of the first stage of labor. Although the urge to push is intense, the cervix is not yet fully dilated. Premature pushing during transition increases the risk of maternal soft tissue trauma and fetal distress.

A. stop premature labor contractions B. control active vaginal bleeding C. prevent dilation of the cervix D. prevent spontaneous rupture of membranes

Correct Answer is C

Explanation

A. stop premature labor contractions: Cerclage is a surgical procedure involving the placement of a non-absorbable suture around the cervical os. It provides mechanical support to a weakened cervix but does not possess tocolytic properties. Pharmacological agents are required to inhibit active uterine myometrial activity.

B. control active vaginal bleeding: This procedure is contraindicated in the presence of active hemorrhage or placental abruption. Placing a stitch in a bleeding cervix could mask a serious underlying pathology or exacerbate maternal trauma. It is an elective or emergent structural intervention, not a hemostatic one.

C. prevent dilation of the cervix: Cerclage is specifically indicated for cervical insufficiency to provide structural reinforcement during the second trimester. It prevents the passive, painless dilation and effacement that lead to mid-trimester pregnancy loss. This maintains the pregnancy by keeping the internal os closed.

D. prevent spontaneous rupture of membranes: While a cerclage helps maintain cervical length, it cannot biologically prevent the biochemical processes that lead to membrane rupture. In fact, bulging membranes are a risk factor that complicates the procedure. The primary goal is cervical stability rather than membrane protection.

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The physician performs an episiotomy on. The cut is made directly toward, but not into, the rectal muscle. This episiotomy is called:

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Naxlex Comprehensive Predictor Exams

The nurse instructs the laboring client to begin pushing with her contractions

Correct Answer is A

Explanation

The nurse explains to a client that the purpose of a cerclage is to

Correct Answer is C

Explanation

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