••• Chapter 6^ Operative Obstetrics Pearls^67
❍ True or False: The FDA-approved combination of mifepristone and misoprotol has an efficacy
of approximately 92% in women with pregnancies up to 49 days of gestation.
True.
❍ The majority of midtrimester abortions are performed in the United States by what technique?
Dilation and evacuation.
❍ What is the safest method for termination of pregnancy in terms of mortality and morbidity between
13 and 16 weeks’ gestation?
Dilation and evacuation.
❍ Of the procedures curettage, D&E, instillation procedures, and hysterotomy, what procedure is associated
with the highest case fatality rate?
Hysterotomy.
❍ At what gestational age, should elective repeat cesarean delivery be performed?
American college of obstetrics and gynecology(ACOG) recommends elective delivery at or beyond 39 weeks
with the following criteria met: (1) normal menstrual cycles; (2) no recent oral contraceptive use; (3) one of the
following: fetal heart tones auscultated by 10 menstrual weeks, positive pregnancy test by 4 menstrual weeks, and
ultrasound confirming menstrual dates prior to 20 weeks’ gestation.
❍ What is the most frequent indication for primary cesarean delivery in the United States?
Labor dystocia.
❍ What are the three common uterine incisions utilized to perform a cesarean delivery?
Low transverse, low vertical, and classical.
❍ What is the most common abdominal operation performed in the United States?
Cesarean delivery.
❍ List the ACOG practice bulletin indications for operative vaginal (there are four indications).
- Prolonged second stage for a nulliparous woman: Lack of continuing progress for 3 hours with regional
anesthesia, or 2 hours without regional anesthesia. - Prolonged second state for a multiparous woman: Lack of continuing progress for 2 hours with regional
anesthesia, or 1 hour without regional anesthesia. - Suspicion of immediate or potential fetal compromise.
- Shortening of the second stage for maternal benefit.
❍ True or False: In 1988, ACOG redefined the classification of station and types of forceps deliveries. The
revised classification uses the level of the leading bony point of the fetal head in centimeters at or below
the level of the maternal ischial spines to define station (0–5 cm), instead of the previously used method
of describing the birth canal in terms of thirds (0–3+).
True