NEET-PG 2012 Obstetrics and Gynecology MCQs — Questions 61–63 (Page 7 of 7)

Q: Least common presentation of twins?

Both transverse. ***Correct: Both transverse*** - A **transverse lie** means both fetuses are positioned horizontally across the uterus - This is the **rarest twin presentation**, occurring in approximately **0.5% of twin pregnancies** - The limited uterine space and natural tendency of fetuses to settle into longitudinal positions makes this presentation exceptionally uncommon - **Management**: Requires cesarean delivery due to impossibility of vaginal birth with both twins transverse *Incorrect: Both breech* - **Breech presentation** (feet or buttocks first) is more common in twin pregnancies than in singletons - Occurs in approximately **5-10% of twin pregnancies** - While complicated, both twins being breech is **significantly more common** than both transverse *Incorrect: First vertex and 2nd transverse* - The **first twin being cephalic (vertex)** is the most favorable and common position - The **second twin presenting transversely** can occur after delivery of the first twin when increased intrauterine space allows position change - This combination is **more common than both transverse** but requires careful management of the second twin *Incorrect: Both vertex* - **Vertex presentation for both twins** (both head-down) is the **most common presentation**, occurring in **40-45% of twin pregnancies** - This is the **optimal presentation for vaginal delivery** - Offers the best outcomes with lowest intervention rates

Q: Which of the following cannot be treated by laparoscopy?

Genital prolapse. ***Genital prolapse*** - **Genital prolapse** typically requires **vaginal surgical approaches** such as **anterior/posterior colporrhaphy** and **vaginal hysterectomy** for comprehensive repair of multiple compartment defects. - While **laparoscopic sacrocolpopexy** exists for vault prolapse, it does not address all compartments of complete prolapse and requires advanced laparoscopic expertise compared to established vaginal techniques. *Sterilization* - **Laparoscopic tubal sterilization** is one of the most commonly performed laparoscopic procedures worldwide. - Methods include **Filshie clips**, **Falope rings**, or **electrocautery** to occlude fallopian tubes with minimal morbidity. *Non descent of uterus* - Can be effectively managed with **laparoscopic-assisted vaginal hysterectomy (LAVH)** or **total laparoscopic hysterectomy (TLH)**. - Laparoscopy facilitates **uterine vessel ligation** and dissection of attachments with excellent visualization and minimal invasiveness. *Ectopic pregnancy* - **Laparoscopic surgery** is the **gold standard** for treating ectopic pregnancy when hemodynamically stable. - Procedures include **laparoscopic salpingectomy** or **salpingostomy** with advantages of reduced recovery time and minimal scarring.

Q: Classical cesarean section is specifically indicated in which of the following conditions?

Cervical cancer involving lower uterine segment. ***Cervical cancer involving lower uterine segment*** - A classical cesarean section, involving a **vertical incision into the upper uterine segment**, allows for delivery of the fetus without disturbing the cancerous cervix and lower uterine segment. - This approach minimizes the risk of **tumor dissemination** and excessive bleeding, which would be high with a low transverse incision. *Transverse lie with back down* - A **low transverse cesarean section** is generally preferred for a transverse lie presentation as it aligns better with the uterine architecture and is associated with fewer future uterine rupture risks. - A classical incision is typically reserved for extreme cases of transverse lie (e.g., morbidly obese patient making access difficult or fetal anomaly) or when the **lower uterine segment is not adequately formed**. *Placenta previa with anterior placenta accreta* - This condition typically necessitates a **low transverse cesarean section**, often combined with a **hysterectomy**, due to the abnormal placental adherence to the anterior lower uterine segment. - A classical incision would likely lead to **significant hemorrhage** and may not effectively manage the adherent placenta. *Previous two cesarean sections* - While a previous cesarean section increases the risk of uterine rupture in subsequent pregnancies, it does not automatically indicate a classical cesarean section for the third delivery. - A repeat **low transverse cesarean section** is usually performed as it carries a lower risk of rupture in future pregnancies compared to a classical incision scar.

Q61

Least common presentation of twins?

Q62

Which of the following cannot be treated by laparoscopy?

Q63

Classical cesarean section is specifically indicated in which of the following conditions?

NEET-PG 2012 — Obstetrics and Gynecology