UPSC-CMS 2013 Practice Questions

Q: Use of ventose is preferred over forceps in the delivery of :

occipito posterior position. ***occipito posterior position*** - In **occipito posterior positions**, the ventouse appliance can be used to achieve **rotation of the fetal head** to an occipito-anterior position, making delivery easier and less traumatic than forceps. - The suction cup applies traction to the fetal head, which can facilitate rotation, especially when the fetal head is still high or partially engaged. *face presentation* - **Ventouse is contraindicated** in face presentations because it can cause severe trauma to the fetal face, which is delicate and not designed for suction application. - The use of forceps in face presentation is also generally avoided due to the risk of facial nerve palsy or other trauma unless a mentum-anterior position is achieved. *aftercoming head in breech* - Forceps, specifically **Piper's forceps**, are typically preferred for the delivery of the **aftercoming head in a breech presentation** to provide controlled traction and minimize pressure on the fetal neck and cerebellum. - The ventouse is **not suitable** for the aftercoming head due to its inability to provide firm, controlled traction on the fetal head in this orientation, which can lead to cervical spine injury or detachment of the cup. *foetal distress* - In cases of **severe fetal distress** requiring immediate delivery, **forceps delivery** is often preferred over ventouse, especially if the head is low, due to the ability to achieve **faster delivery**. - While both can expedite delivery, the ventouse may take longer to apply effective traction due to the time required to build suction, making forceps a faster choice when every second counts for fetal well-being.

Q: Normal pH of foetal scalp blood is :

7.30. ***7.30*** - A **normal foetal scalp pH** is generally considered to be above 7.25, with an ideal range being closer to **7.30-7.35**. - A pH of **7.30** indicates adequate oxygenation and acid-base balance, suggesting the foetus is not experiencing significant hypoxia or acidosis. *7.20* - A pH of **7.20** is typically considered a **borderline acidic** value in foetal scalp blood. - While not immediately critical, it often warrants close monitoring or further assessment of foetal well-being, as it may indicate mild **acidosis**. *7.0* - A pH of **7.0** in foetal scalp blood is a significantly **acidotic** value. - This level suggests considerable **foetal distress and hypoxemia**, often necessitating urgent intervention like expedited delivery. *7.10* - A pH of **7.10** is indicative of definite **foetal acidosis**. - This level is a strong indicator of **foetal compromise** and would typically prompt immediate action to resolve the underlying issue or deliver the baby.

Q: Face to pubis delivery is common in which type of pelvis ?

Anthropoid. ***Anthropoid*** - The **anthropoid pelvis** has an oval inlet with a long anteroposterior (AP) diameter, which favors **persistent occiput posterior (OP) positions**. - In OP position, the fetal occiput faces the maternal sacrum, and the fetal face faces the maternal pubis, resulting in **"face to pubis" delivery**. - This pelvic shape aligns the fetal head to enter and descend in the AP diameter, increasing the likelihood of the occiput remaining posterior throughout labor, leading to delivery in the OP position. *Android* - An **android pelvis** is heart-shaped and narrow, often associated with complications like **failure to progress** and fetal head arrest, but not specifically face to pubis deliveries. - Its narrow forepelvis makes internal rotation difficult, often leading to **transverse arrest** of the fetal head rather than persistent OP position. *Gynaecoid* - The **gynaecoid pelvis** is the ideal and most common female pelvic type, characterized by a rounded inlet and adequate diameters, typically allowing for delivery in the favorable **occiput anterior (OA) position**. - It facilitates **spontaneous internal rotation** to OA position, making face to pubis (OP) delivery uncommon. *Platypelloid* - A **platypelloid pelvis** has a flattened inlet with a short anteroposterior and a wide transverse diameter, often leading to **transverse arrest** of the fetal head. - This shape is unfavorable for vaginal delivery in general and does not specifically predispose to face to pubis presentations.

Q: The following are the signs of placental separation except :

The fundal height decreases. ***The fundal height decreases*** - Following placental separation, the uterus often rises in the abdomen due to the pooling of blood behind the placenta, causing the **fundal height to appear to increase**, not decrease. - A decrease in fundal height is not a recognized sign of placental separation. *The uterus becomes hard and globular* - As the placenta separates, the uterus naturally contracts firmly to prevent postpartum hemorrhage, thus becoming **hard and globular** to the touch. - This **sustained contraction** is a key clinical sign indicating effective uterine retrieval and placental detachment. *Permanent lengthening of the cord* - Once the placenta detaches from the uterine wall and descends into the lower uterine segment or vagina, the **umbilical cord will appear to lengthen** permanently outside the vulva. - This external lengthening signifies that the placenta has moved from its intrauterine position. *Fresh bleeding occurs* - Fresh bleeding is expected after placental separation because the detachment process exposes maternal blood vessels, leading to **external blood loss**. - This **active bleeding** is a normal physiological sign indicating the placenta is no longer attached to the uterine wall.

Q: The following conditions are associated with molar pregnancy except:

Gestational diabetes. **Gestational diabetes** - Gestational diabetes is not directly associated with a **molar pregnancy**. Its pathogenesis is related to **insulin resistance** and pancreatic beta-cell dysfunction during pregnancy. - While both conditions can occur during pregnancy, there is no increased risk of gestational diabetes in the presence of a molar pregnancy. *Thyrotoxicosis* - **Molar pregnancies** produce very high levels of **human chorionic gonadotropin (hCG)**, which has a structural similarity to thyroid-stimulating hormone (TSH). - This high hCG can stimulate the thyroid gland, leading to **hyperthyroidism** or thyrotoxicosis in some patients. *Hyperemesis gravidarum* - The extremely high levels of **hCG** produced in a **molar pregnancy** are strongly linked to the severity of nausea and vomiting experienced during pregnancy. - This often manifests as **hyperemesis gravidarum**, which is more common and severe in molar pregnancies due to the exaggerated hormonal response. *Pregnancy induced hypertension* - Patients with **molar pregnancies** are at an increased risk of developing **pregnancy-induced hypertension (PIH)**, often presenting earlier in gestation than typical pre-eclampsia. - The precise mechanism is thought to involve the abnormal placental development and exaggerated maternal inflammatory response associated with molar tissue.

Q: What is the commonest cause of retention of urine at 12-14 weeks of pregnancy ?

Retroverted gravid uterus. ***Retroverted gravid uterus*** - A **retroverted uterus** can become "trapped" in the pelvis as it enlarges during pregnancy, causing the **cervix to push against the urethra, leading to outflow obstruction**. - This typically occurs between **12-14 weeks of gestation** before the uterus ascents out of the pelvis. *Diminished bladder tone* - While bladder tone can be affected in pregnancy, it's not the primary or most common cause of **acute urinary retention** at this specific gestational age. - **Decreased bladder sensation** and volume capacity changes are more gradual and less likely to cause acute retention until later stages. *Prolapse of uterus* - **Uterine prolapse** is more common in **multiparous women** and tends to cause symptoms like pressure, discomfort, and potentially urinary incontinence, rather than acute retention, particularly in early pregnancy. - A prolapsed uterus is usually located **lower in the pelvic cavity**, which would not typically obstruct the urethra in the manner of a retroverted uterus. *Impacted pelvic tumour* - An **impacted pelvic tumour** could cause urinary retention, but it is a **less common cause** than a retroverted gravid uterus in the context of a healthy 12-14 week pregnancy. - This would be a more serious and typically pre-existing condition, often with other associated symptoms, and not a physiological consequence of pregnancy.

Q: Which of the following is a uterine compression suture during management of atonic postpartum haemorrhage?

B-Lynch suture. **B-Lynch suture** - The **B-Lynch suture** is a specific type of surgical technique involving the placement of sutures across the uterine fundus and lower uterine segment to compress the uterus. - This compression helps to reduce blood loss by mechanically occluding the endometrial vessels, making it highly effective in managing **atonic postpartum hemorrhage**. *Sturmdorf suture* - The Sturmdorf suture is primarily used in **cervical cone biopsy** or **trachelectomy** to close the cervical stump. - It involves everting and suturing the cervical mucosa to provide hemostasis and promote healing of the cervix, not for uterine compression. *Fothergill's suture* - Fothergill's operation (Manchester operation) is used for **pelvic organ prolapse**, particularly uterine prolapse. - It typically involves shortening the cardinal ligaments and repairing the perineum, but does not involve uterine compression for hemorrhage. *Moscowitz suture* - The Moscowitz suture is used for **obliteration of the cul-de-sac (pouch of Douglas)** to prevent **enterocele** formation during pelvic floor repair. - This technique involves plicating the peritoneum over the pouch of Douglas, and is not a uterine compression suture for atonic hemorrhage.

Q: The hormone Relaxin of pregnancy is secreted by:

Ovary. ***Ovary*** - During early pregnancy, **relaxin** is primarily produced by the **corpus luteum** in the ovary. - Subsequently, towards late pregnancy, the **decidua** and **placenta** also contribute to relaxin production. *Pituitary gland* - The **pituitary gland** produces hormones such as **FSH**, **LH**, **prolactin**, and **oxytocin**, but not relaxin. - These hormones play roles in **menstrual cycle regulation**, **lactation**, and **uterine contractions**. *Vagina* - The **vagina** is a muscular canal that serves as the birth canal; it does not produce hormones. - Its primary functions are in **sexual intercourse** and **childbirth**. *Fallopian tube* - The **fallopian tubes** are responsible for transporting eggs from the ovaries to the uterus and are sites of fertilization. - They do not have a role in the production of **pregnancy hormones** like relaxin.

Q: Which of the following anti-hypertensive drugs is/are best avoided during pregnancy ?

Angiotensin converting enzyme inhibitors. ***Angiotensin converting enzyme inhibitors*** - **ACE inhibitors** are contraindicated in pregnancy due to their association with **fetal renal abnormalities**, **oligohydramnios**, and **fetal death**. - They can cause severe **birth defects** and are categorized as pregnancy category D drugs, meaning there is positive evidence of human fetal risk. *Nifedipine* - **Nifedipine**, a dihydropyridine calcium channel blocker, is considered a **safe** and effective antihypertensive in pregnancy. - It is frequently used for managing **hypertension** and **preterm labor** in pregnant women. *Methyldopa* - **Methyldopa** is often considered the **first-line drug** for chronic hypertension in pregnancy due to its established safety profile for both mother and fetus. - It has a long history of use and is one of the most studied antihypertensives in pregnancy. *Labetalol* - **Labetalol**, a combined alpha and beta-blocker, is also considered a **safe** and effective option for managing hypertension in pregnancy. - It is often used for **gestational hypertension** and **preeclampsia** and has a good fetal safety record.

Q: Complications of heparin therapy in pregnancy include all except :

Teratogenicity. ***Teratogenicity*** - **Heparin** does not cross the placenta due to its large molecular weight, making it a safe anticoagulant choice during pregnancy regarding fetal malformations. - Therefore, it is **not associated with teratogenicity**, unlike some other anticoagulants like warfarin. *Thrombocytopaenia* - **Heparin-induced thrombocytopenia (HIT)** is a known complication, where antibodies against heparin-platelet factor 4 complexes lead to platelet activation and consumption. - While typically Type II HIT is more severe, a mild, transient drop in platelet count (Type I) can also occur. *Osteoporosis* - **Long-term heparin therapy**, particularly unfractionated heparin, is associated with an increased risk of bone demineralization and **osteoporosis** due to its direct effect on osteoblasts and osteoclasts. - This complication is less common with low molecular weight heparin (LMWH) but still a potential concern. *Bleeding* - As an anticoagulant, **heparin's primary mechanism of action** involves inhibiting coagulation factors, which inherently increases the risk of **bleeding**. - The risk of bleeding can range from minor ecchymoses to life-threatening hemorrhages depending on the dose and individual patient factors.

Question 1

Use of ventose is preferred over forceps in the delivery of :

Accepted Answer

occipito posterior position

Answer

face presentation

Answer

aftercoming head in breech

Answer

foetal distress

Question 2

Normal pH of foetal scalp blood is :

Accepted Answer

7.30

Answer

7.20

Answer

7.0

Answer

7.10

Question 3

Face to pubis delivery is common in which type of pelvis ?

Accepted Answer

Anthropoid

Answer

Android

Answer

Gynaecoid

Answer

Platypelloid

Question 4

The following are the signs of placental separation except :

Accepted Answer

The fundal height decreases

Answer

The uterus becomes hard and globular

Answer

Permanent lengthening of the cord

Answer

Fresh bleeding occurs

Question 5

The following conditions are associated with molar pregnancy except:

Accepted Answer

Gestational diabetes

Answer

Thyrotoxicosis

Answer

Hyperemesis gravidarum

Answer

Pregnancy induced hypertension

Question 6

What is the commonest cause of retention of urine at 12-14 weeks of pregnancy ?

Accepted Answer

Retroverted gravid uterus

Answer

Diminished bladder tone

Answer

Prolapse of uterus

Answer

Impacted pelvic tumour

Question 7

Which of the following is a uterine compression suture during management of atonic postpartum haemorrhage?

Accepted Answer

B-Lynch suture

Answer

Sturmdorf suture

Answer

Fothergill's suture

Answer

Moscowitz suture

Question 8

The hormone Relaxin of pregnancy is secreted by:

Accepted Answer

Ovary

Answer

Pituitary gland

Answer

Vagina

Answer

Fallopian tube

Question 9

Which of the following anti-hypertensive drugs is/are best avoided during pregnancy ?

Accepted Answer

Angiotensin converting enzyme inhibitors

Answer

Nifedipine

Answer

Methyldopa

Answer

Labetalol

Question 10

Complications of heparin therapy in pregnancy include all except :

Accepted Answer

Teratogenicity

Answer

Thrombocytopaenia

Answer

Osteoporosis

Answer

Bleeding

UPSC-CMS 2013

Obstetrics and Gynecology

Pharmacology