Obstetrics and Gynecology
10 questionsLabour is called normal if it fulfills the following criteria EXCEPT:
Which one of the following methods is NOT used for cervical cancer screening?
Consider the following regarding the use of Magnesium Sulphate: 1. Used as tocolytic 2. As neuroprotective agent 3. Used in management of postpartum eclampsia Which of the statements given above are correct?
Which one of the following is NOT a common cause of recurrent abortions?
Contraindications to Uterine Cerclage for Incompetent os are all EXCEPT:
The most common cause of early spontaneous abortion is:
Cause of Fetal growth restriction may be: 1. Chromosomal abnormality 2. Congenital abnormality 3. Abnormal cord insertion Which of the statements given above is/are correct?
Which one of the following regarding fetal growth restriction is NOT true?
Which one of the following statements regarding contraception is NOT true?
A 26 year old P2L2 has just had delivery. What are the contraceptive choices she has at present? 1. Post placental insertion of IUCD 2. Post partum ligation 3. Oral contraceptive pill 4. Lap ligation Select the correct answer using the code given below:
UPSC-CMS 2019 - Obstetrics and Gynecology UPSC-CMS Practice Questions and MCQs
Question 61: Labour is called normal if it fulfills the following criteria EXCEPT:
- A. Spontaneous onset at term
- B. Vertex presentation
- C. Vaginal delivery with episiotomy
- D. Vaginal breech delivery (Correct Answer)
Explanation: ***Vaginal breech delivery*** - A **breech presentation** (where the baby's buttocks or feet are descended first) is **definitively NOT considered normal labor**. - Normal labor requires **cephalic (vertex) presentation** as a fundamental criterion. - While vaginal breech delivery may be attempted in select cases, it carries **significantly higher risks** and is classified as **abnormal presentation**, making this the correct answer to the EXCEPT question. *Spontaneous onset at term* - **Spontaneous onset** (not induced) occurring **at term** (37-42 weeks of gestation) is a **core characteristic of normal labor**. - This ensures physiologic readiness and fetal maturity. *Vertex presentation* - **Vertex (cephalic) presentation** with the occiput as the presenting part is the **defining requirement** for normal labor. - This is the optimal presentation allowing the smallest diameter to navigate the birth canal. *Vaginal delivery with episiotomy* - Traditionally, vaginal delivery with episiotomy has been included in definitions of normal labor, though episiotomy itself is a surgical intervention. - **Note**: Modern obstetric guidelines (WHO, NICE) emphasize that **routine episiotomy should be avoided** and normal birth should be spontaneous without operative interventions. However, for examination purposes and based on traditional definitions used in this PYQ, vaginal delivery (even with episiotomy) is distinguished from operative delivery (forceps/vacuum) or cesarean section. - The key distinction: **breech presentation** itself (regardless of delivery mode) makes labor abnormal, whereas episiotomy is a **procedural intervention** during an otherwise potentially normal labor.
Question 62: Which one of the following methods is NOT used for cervical cancer screening?
- A. VILI
- B. VIA
- C. Cervical biopsy (Correct Answer)
- D. Pap smear
Explanation: ***Cervical biopsy*** - A **cervical biopsy** is a diagnostic procedure performed after an abnormal screening result to confirm the presence of **precancerous** or **cancerous** cells. - It involves removing a tissue sample for histological examination and is not a primary screening method. *VILI* - **Visual Inspection with Lugol's Iodine** (**VILI**) is a method used for cervical cancer screening, particularly in low-resource settings. - It involves applying **Lugol's iodine** to the cervix, where normal glycogen-rich cells stain brown, while abnormal, glycogen-deficient cells remain unstained (yellow). *VIA* - **Visual Inspection with Acetic Acid** (**VIA**) is a cost-effective screening method for cervical cancer, especially in settings where cytology is not readily available. - After applying **acetic acid** to the cervix, abnormal areas with high nuclear-to-cytoplasmic ratio and increased protein content rapidly coagulate the mucus and turn white. *Pap smear* - A **Pap smear** (Papanicolaou test) is a widely used and validated screening test for cervical cancer. - It involves collecting cells from the cervix to detect **dysplastic** or **premalignant changes** and is effective in reducing cervical cancer incidence and mortality.
Question 63: Consider the following regarding the use of Magnesium Sulphate: 1. Used as tocolytic 2. As neuroprotective agent 3. Used in management of postpartum eclampsia Which of the statements given above are correct?
- A. 1 and 3 only
- B. 2 and 3 only
- C. 1 and 2 only
- D. 1, 2 and 3 (Correct Answer)
Explanation: ***1, 2 and 3*** - **Magnesium sulfate** is a well-established **tocolytic agent**, used to delay preterm labor by relaxing the uterine smooth muscle. - It is also utilized for its **neuroprotective effects** in preterm infants, reducing the risk of cerebral palsy and other neurological sequelae when administered to mothers at risk of preterm birth. - Furthermore, magnesium sulfate is the **drug of choice** for the prevention and management of **eclampsia and pre-eclampsia**, which can occur both during pregnancy and in the postpartum period. *1 and 3 only* - This option correctly identifies the use of **magnesium sulfate** as a **tocolytic** and for **postpartum eclampsia**, but incorrectly omits its significant role as a **neuroprotective agent**. - The neuroprotective effect, particularly in reducing the risk of cerebral palsy in preterm infants, is a crucial indication for magnesium sulfate use. *2 and 3 only* - This option correctly recognizes **magnesium sulfate's** application as a **neuroprotective agent** and in **postpartum eclampsia**, but overlooks its primary role as a **tocolytic** for preterm labor. - Its ability to relax uterine contractions makes it a vital medication in managing threatened preterm delivery. *1 and 2 only* - This option accurately states the use of **magnesium sulfate** as a **tocolytic** and a **neuroprotective agent**, but fails to include its critical role in the management of **postpartum eclampsia**. - Eclampsia, defined by seizures in a pre-eclamptic patient, is effectively prevented and treated with magnesium sulfate.
Question 64: Which one of the following is NOT a common cause of recurrent abortions?
- A. Antiphospholipid syndrome
- B. Chromosomal abnormality
- C. TORCH group of infections
- D. Maternal diabetes (Correct Answer)
Explanation: ***Maternal diabetes*** - While uncontrolled diabetes can increase the risk of **miscarriage** and **birth defects** in general, it is typically not considered a common or direct cause of *recurrent abortions* (defined as three or more consecutive pregnancy losses). - Its effects are often seen in isolated miscarriages or specific fetal anomalies rather than a pattern of repeated losses. *Antiphospholipid syndrome* - This is a well-established cause of recurrent abortions due to the formation of **thrombi** in the placental circulation, leading to impaired blood flow and fetal demise. - It involves the presence of **antiphospholipid antibodies** that interfere with normal pregnancy progression. *Chromosomal abnormality* - Both parental and embryonic chromosomal abnormalities are a very common cause of recurrent pregnancy loss, particularly in the **first trimester**. - These abnormalities often result in non-viable embryos, leading to spontaneous abortion. *TORCH group of infections* - Infections like **Toxoplasmosis, Other (syphilis, parvovirus), Rubella, Cytomegalovirus (CMV), and Herpes simplex virus (HSV)** can cause significant fetal damage and pregnancy loss. - While they can lead to miscarriage, they are generally associated with sporadic miscarriages or specific fetal syndromes rather than recurring abortions in consecutive pregnancies.
Question 65: Contraindications to Uterine Cerclage for Incompetent os are all EXCEPT:
- A. Previous history suggestive of abortion due to incompetent os (Correct Answer)
- B. Bulging membrane
- C. History of vaginal bleeding
- D. Ruptured membrane
Explanation: ***Previous history suggestive of abortion due to incompetent os*** - A **history of recurrent second-trimester abortions or deliveries** attributed to **cervical insufficiency** is an **indication** for a cerclage, not a contraindication. - Cerclage aims to reinforce a weakened cervix, preventing premature dilation and expulsion of the fetus in future pregnancies. *Bulging membrane* - A **bulging membrane** (prolapse of the amniotic sac into the vagina) indicates significant cervical dilation and puts the membranes at high risk of **rupture during the cerclage procedure**. - Performing a cerclage in this situation can precipitate **preterm labor, infection**, or membrane rupture. *History of vaginal bleeding* - **Vaginal bleeding** suggests potential complications such as **placental abruption** or ongoing **preterm labor**, making cerclage contraindicated. - A cerclage should not be performed if there is an active process threatening the pregnancy, as it would not resolve the underlying issue and could worsen outcomes. *Ruptured membrane* - **Ruptured membranes** mean the amniotic sac has broken, and the primary concern becomes infection and delivery, not cervical reinforcement. - Performing a cerclage with ruptured membranes is contraindicated due to the high risk of **chorioamnionitis** and would not salvage the pregnancy.
Question 66: The most common cause of early spontaneous abortion is:
- A. Teratogens
- B. Endocrine disorder
- C. Infection
- D. Chromosomal abnormality (Correct Answer)
Explanation: ***Chromosomal abnormality*** - **Chromosomal abnormalities**, such as aneuploidy (e.g., trisomy, monosomy), are responsible for approximately 50-70% of all **early spontaneous abortions**. - These abnormalities often result in **non-viable embryos** or fetuses, leading to pregnancy loss before 12-20 weeks of gestation. *Teratogens* - **Teratogens** are agents that can cause birth defects, but they are a less common cause of **early spontaneous abortion** compared to chromosomal abnormalities. - While they can lead to fetal demise, their primary impact is often on **fetal development** rather than embryonic non-viability. *Endocrine disorder* - **Endocrine disorders** like uncontrolled diabetes or thyroid disease can increase the risk of spontaneous abortion, but they are not the **most common cause**. - These factors tend to contribute to a smaller percentage of **early pregnancy losses** compared to genetic errors. *Infection* - Certain **infections** (e.g., TORCH infections, bacterial vaginosis) can cause spontaneous abortion, especially if systemic or severe. - However, similar to endocrine disorders, infections are a less frequent cause of **early spontaneous abortion** than chromosomal abnormalities.
Question 67: Cause of Fetal growth restriction may be: 1. Chromosomal abnormality 2. Congenital abnormality 3. Abnormal cord insertion Which of the statements given above is/are correct?
- A. 1 and 3 only
- B. 1 and 2 only
- C. 1, 2 and 3 (Correct Answer)
- D. 2 and 3 only
Explanation: ***Correct: 1, 2 and 3*** All three statements represent established causes of **Fetal Growth Restriction (FGR)**: - **Chromosomal abnormalities** (trisomy 13, 18, 21, Turner syndrome) cause **intrinsic poor growth potential** of the fetus by disrupting normal cellular development and metabolism, directly leading to FGR. - **Congenital abnormalities** (cardiac defects, renal malformations, CNS anomalies) impair fetal development and nutrient utilization through structural and functional deficits, resulting in FGR. - **Abnormal cord insertion** (velamentous or marginal cord insertion) compromises the efficiency of **nutrient and oxygen transfer** from the placenta to the fetus by reducing vascular support, thus causing placental insufficiency and FGR. *Incorrect: 1 and 3 only* This incorrectly excludes **congenital abnormalities**, which are a well-established independent cause of FGR. Structural malformations directly impair fetal growth through metabolic and functional deficits. *Incorrect: 1 and 2 only* This incorrectly excludes **abnormal cord insertion**, which directly impacts placental function and nutrient supply—a key pathway for uteroplacental insufficiency leading to FGR. *Incorrect: 2 and 3 only* This incorrectly excludes **chromosomal abnormalities**, which are a major genetic cause of intrinsic FGR. Chromosomal defects (e.g., trisomies) are fundamental causes of impaired fetal growth potential.
Question 68: Which one of the following regarding fetal growth restriction is NOT true?
- A. Delivery always at 34 weeks (Correct Answer)
- B. Biophysical profile is done
- C. Umbilical artery Doppler studies are done
- D. Daily fetal movement count is advised
Explanation: ***Delivery always at 34 weeks*** - The timing of delivery in **fetal growth restriction (FGR)** is highly **individualized** and depends on several factors, including the severity of FGR, gestational age, and results of fetal surveillance tests like Doppler studies and biophysical profiles. It is not an absolute rule to deliver all FGR fetuses at 34 weeks. - Early delivery, especially before term, carries risks of **prematurity**, and the decision is made when the risks of continuing the pregnancy outweigh the risks of early delivery. *Biophysical profile is done* - The **biophysical profile (BPP)** is a common method of fetal surveillance used in pregnancies complicated by FGR to assess fetal well-being, including **fetal movements, tone, breathing, amniotic fluid volume,** and **non-stress test results**. - It helps in making decisions about the timing of delivery and ongoing management. *Umbilical artery Doppler studies are done* - **Umbilical artery Doppler studies** are crucial for monitoring FGR, as they assess placental function and fetal compromise by measuring blood flow in the umbilical artery. - Abnormal Doppler findings, such as **absent** or **reversed end-diastolic flow**, indicate increased placental resistance and are important in guiding management and determining the optimal timing of delivery. *Daily fetal movement count is advised* - **Daily fetal movement counting**, or "kick counts," is an important and simple method of fetal surveillance that women can perform at home to monitor fetal well-being. - A significant decrease in fetal movements can signal **fetal compromise** and warrants further evaluation.
Question 69: Which one of the following statements regarding contraception is NOT true?
- A. Copper T can be inserted just after delivery
- B. Implanon is a hormonal contraceptive
- C. Copper T can be used as post coital contraception
- D. Vaginal ring is a barrier method (Correct Answer)
Explanation: ***Vaginal ring is a barrier method*** - The **vaginal ring** (e.g., NuvaRing) is a **hormonal contraceptive** that releases estrogen and progestin, not a barrier method. - Its mechanism of action involves **inhibiting ovulation** and altering cervical mucus, unlike barrier methods that physically block sperm. *Copper T can be inserted just after delivery* - The **Copper T (IUD)** can be safely inserted immediately after delivery, ideally within **48 hours**, as a **postpartum IUD insertion**. - This timing is often preferred as the cervix is still dilated, and the woman is already in a healthcare setting. *Implanon is a hormonal contraceptive* - **Implanon** (now Nexplanon) is indeed a **hormonal contraceptive**, containing etonogestrel, a progestin. - It is an implantable rod that provides **long-acting reversible contraception (LARC)** for up to three years. *Copper T can be used as post coital contraception* - The **Copper T IUD** is highly effective as **emergency contraception** when inserted within **5 days** of unprotected intercourse. - It works by preventing fertilization or implantation, making it more effective than emergency contraceptive pills.
Question 70: A 26 year old P2L2 has just had delivery. What are the contraceptive choices she has at present? 1. Post placental insertion of IUCD 2. Post partum ligation 3. Oral contraceptive pill 4. Lap ligation Select the correct answer using the code given below:
- A. 1 and 2 only (Correct Answer)
- B. 2 only
- C. 1, 2 and 4
- D. 1 and 3
Explanation: **1 and 2 only** - **Post-placental insertion of an IUCD** (Intrauterine Contraceptive Device) is a safe and effective immediate contraception option after delivery, as the cervix is still dilated, facilitating insertion. - **Postpartum ligation** (tubal ligation) is a common and highly effective permanent contraception method that can be performed shortly after delivery, often before discharge from the hospital. *2 only* - This option is incomplete as **post-placental IUCD insertion** is also a viable and often preferred immediate post-delivery contraceptive choice. - Limiting options to only postpartum ligation overlooks another readily available and effective method. *1, 2 and 4* - This option includes **lap ligation**, which typically refers to a laparoscopic procedure and is usually not performed immediately postpartum due to the enlarged uterus and increased vascularity, making it less ideal than ligation performed via mini-laparotomy shortly after delivery. - While laparoscopic approaches are possible later, **postpartum mini-laparotomy ligation** (which '2' likely refers to in this context) is the more immediate and common surgical approach. *1 and 3* - This option includes **oral contraceptive pills**, which are generally not recommended for immediate use in the postpartum period, especially for breastfeeding mothers, due to the potential impact on lactation and an increased risk of thromboembolism in the initial weeks after delivery. - **Progestin-only pills** can be considered later in the postpartum period, but combined oral contraceptives are typically delayed.