A 29-year-old female with 3 months amenorrhoea presents to gynaecology OPD with complaints of something coming out of her vagina. On clinical evaluation she was found to have single live pregnancy with second degree uterine prolapse. Which one of the following is the best management plan for her ?
During delivery of HIV infected women, which of the following are recommended ? 1. Zidovudine (ZDV) is given at the onset of labour. 2. Elective caesarean delivery reduces the risk of vertical transmission. 3. Amniotomy and oxytocin augmentation should be done. 4. Antiretroviral therapy should be given to all neonates. Select the correct answer using the code given below :
Which of the following can be a complication in the baby due to post maturity of pregnancy ?
Intrahepatic cholestasis of pregnancy presents with which of the following features ? 1. Pruritus after 28 weeks gestation, especially in palms and soles 2. Serum bilirubin levels > 5 mg% 3. Raised levels of serum bile acids 4. Features subside within two weeks postpartum Select the correct answer using the code given below :
Which of the following are correct regarding 'Chhaya' contraceptive ? 1. It has potent anti-estrogenic and weak estrogenic property. 2. Failure rate is 1 - 4 per HWY (Hundred Women Years) of use. 3. It inhibits ovulation. 4. It creates asynchrony between zygote and endometrium. Select the correct answer using the code given below :
Which of the following are examples of LARC (Long Acting Reversible Contraceptives) ? 1. Copper-T 380A 2. Implants 3. LNG-IUS Select the correct answer using the code given below :
How many times in a year does withdrawal bleeding occur in extended continuous regimens of combined oral contraceptive pills?
Bilateral total salpingectomy is a recommended surgical procedure to reduce the risk of :
Tongue bite occurs in eclampsia at :
Indication for removal of IUDs include which of the following ? 1. Perforation of uterus 2. Pregnancy with device in situ 3. One year after menopause 4. Persistent migraine Select the correct answer using the code given below :
UPSC-CMS 2023 - Obstetrics and Gynecology UPSC-CMS Practice Questions and MCQs
Question 51: A 29-year-old female with 3 months amenorrhoea presents to gynaecology OPD with complaints of something coming out of her vagina. On clinical evaluation she was found to have single live pregnancy with second degree uterine prolapse. Which one of the following is the best management plan for her ?
- A. Reassurance
- B. Cerclage operation
- C. Cervical amputation
- D. Pessary treatment (Correct Answer)
Explanation: ***Pessary treatment*** - **Symptomatic uterine prolapse during pregnancy** (patient complaining of "something coming out") requires **active management**, not just reassurance. - **Pessary insertion** is the **first-line treatment** for symptomatic uterine prolapse in pregnancy, providing mechanical support and immediate symptom relief. - **Ring pessary or Hodge pessary** can be safely used to support the prolapsed uterus until natural ascension occurs in the second trimester. - Combined with **bed rest** and **knee-chest position**, pessaries effectively manage symptoms while allowing pregnancy to continue. - The pessary can typically be removed after **16-20 weeks** when the gravid uterus naturally rises out of the pelvis. *Reassurance* - While it's true that the growing uterus will naturally ascend in the second trimester (reducing the prolapse), **reassurance alone is inadequate** for a patient with **active symptoms**. - Reassurance would be appropriate for **asymptomatic** or **mild prolapse**, but this patient has second-degree prolapse with troublesome symptoms requiring intervention. - Leaving symptomatic prolapse untreated risks complications like **cervical edema, ulceration, infection**, and increased patient distress. *Cerclage operation* - **Cervical cerclage** addresses **cervical insufficiency** to prevent preterm birth, not uterine prolapse. - It does not provide mechanical support for a prolapsed uterus and is not indicated in this clinical scenario. *Cervical amputation* - **Cervical amputation (trachelectomy)** is a radical procedure for **cervical cancer** or severe cervical pathology. - It would be **contraindicated in ongoing pregnancy** and carries significant risks of pregnancy loss. - Completely inappropriate for managing uterine prolapse.
Question 52: During delivery of HIV infected women, which of the following are recommended ? 1. Zidovudine (ZDV) is given at the onset of labour. 2. Elective caesarean delivery reduces the risk of vertical transmission. 3. Amniotomy and oxytocin augmentation should be done. 4. Antiretroviral therapy should be given to all neonates. Select the correct answer using the code given below :
- A. 1 and 2 only (Correct Answer)
- B. 2, 3 and 4
- C. 1, 2 and 4
- D. 1, 2 and 3
Explanation: ***1 and 2 only*** - **Zidovudine (ZDV)** is administered intravenously to the mother at the onset of labor and during delivery as part of the **PMTCT (Prevention of Mother-to-Child Transmission)** protocol. It reduces viral load and provides pre-exposure prophylaxis to the fetus, significantly decreasing the risk of **vertical HIV transmission**. - **Elective cesarean section** is recommended for HIV-infected women with **viral loads >1,000 copies/mL** or unknown viral loads near term (performed at 38 weeks). This reduces neonatal exposure to maternal blood and genital tract secretions during vaginal delivery, thereby **reducing perinatal HIV transmission risk by approximately 50%** compared to vaginal delivery in women not on effective antiretroviral therapy. - Statement 3 is **incorrect**: **Amniotomy (artificial rupture of membranes) and oxytocin augmentation are contraindicated** in HIV-infected women as these procedures increase fetal exposure to maternal blood and bodily fluids, thereby **increasing the risk of vertical transmission**. Guidelines recommend avoiding invasive obstetric procedures. - Statement 4 is **incorrect**: While **antiretroviral prophylaxis** (typically zidovudine syrup) is given to all neonates born to HIV-infected mothers for 4-6 weeks, **full antiretroviral therapy (ART)** is only initiated if the infant tests positive for HIV. The statement incorrectly uses "therapy" instead of "prophylaxis." *1, 2 and 3* - This option incorrectly includes statement 3. **Amniotomy and oxytocin augmentation should be avoided**, not recommended, in HIV-infected women as they increase the risk of vertical transmission through increased fetal exposure to maternal blood. *2, 3 and 4* - Statement 3 is **incorrect** as amniotomy and oxytocin augmentation are **contraindicated** in HIV management during labor. - Statement 4 is **incorrect** as all neonates receive **prophylaxis**, not full antiretroviral **therapy**. *1, 2 and 4* - While statements 1 and 2 are correct, statement 4 is **incorrect** because neonates receive **antiretroviral prophylaxis** (not therapy). Full **ART** is reserved for confirmed HIV-positive infants.
Question 53: Which of the following can be a complication in the baby due to post maturity of pregnancy ?
- A. Meconium aspiration (Correct Answer)
- B. Hypoglycemia
- C. Intraventricular hemorrhage
- D. Polycythemia
Explanation: ***Meconium aspiration*** - **Post-term pregnancies** (>42 weeks) are associated with **oligohydramnios** and **placental insufficiency**, leading to fetal distress - Fetal distress causes passage of **meconium** into amniotic fluid, which can be aspirated during gasping movements - **Meconium aspiration syndrome** is one of the **most characteristic complications** of post-maturity - This is the **most recognized** complication among the options listed *Hypoglycemia* - Post-term infants **ARE actually at risk** for hypoglycemia - Mechanism: **Placental insufficiency** leads to depleted fetal **glycogen stores** and subcutaneous fat - However, this is **less specific** to post-term pregnancy compared to meconium aspiration, as it occurs in multiple conditions - While medically correct, meconium aspiration is the more characteristic complication *Intraventricular hemorrhage* - This is primarily a complication of **prematurity**, especially in very low birth weight infants - Caused by fragility of the **germinal matrix** in preterm brains - **Not associated with post-term pregnancy** *Polycythemia* - Post-term infants **can develop polycythemia** (hematocrit >65%) - Mechanism: Chronic **placental insufficiency** → fetal hypoxia → increased **erythropoietin production** - While this is a recognized complication, **meconium aspiration** remains the **most classic and frequently tested** complication of post-maturity
Question 54: Intrahepatic cholestasis of pregnancy presents with which of the following features ? 1. Pruritus after 28 weeks gestation, especially in palms and soles 2. Serum bilirubin levels > 5 mg% 3. Raised levels of serum bile acids 4. Features subside within two weeks postpartum Select the correct answer using the code given below :
- A. 1, 2 and 3
- B. 1, 3 and 4 (Correct Answer)
- C. 1, 2 and 4
- D. 2, 3 and 4
Explanation: ***1, 3 and 4*** - **Intrahepatic cholestasis of pregnancy (ICP)** is characterized by **pruritus** without skin lesions, which typically begins in the **late second or third trimester (after 28 weeks gestation)**. The itching is often most severe on the **palms and soles**. - A hallmark of ICP is **elevated serum bile acid levels** (typically >10 μmol/L). The condition and its symptoms **subside rapidly** after delivery, usually **within 1-2 weeks postpartum**, as hormonal influences resolve. *1, 2 and 3* - This option incorrectly includes the feature of **serum bilirubin levels > 5 mg%**. While bilirubin levels can be mildly elevated in ICP, they typically remain below this threshold, and values **above 5 mg%** would suggest a more severe or alternative cause of **liver dysfunction**. - The other features (**pruritus after 28 weeks, raised serum bile acids**) are indeed characteristic of ICP. *1, 2 and 4* - This option also incorrectly includes **serum bilirubin levels > 5 mg%**, which is uncharacteristic for ICP and would warrant further investigation for other liver pathologies. - The presence of pruritus and the resolution postpartum are correct features. *2, 3 and 4* - This option incorrectly includes **serum bilirubin levels > 5 mg%** and does not include **pruritus as a primary symptom**, which is the most common presenting complaint of ICP. - While raised bile acids and postpartum resolution are correct, the absence of pruritus as a core feature and the high bilirubin level make this option incorrect.
Question 55: Which of the following are correct regarding 'Chhaya' contraceptive ? 1. It has potent anti-estrogenic and weak estrogenic property. 2. Failure rate is 1 - 4 per HWY (Hundred Women Years) of use. 3. It inhibits ovulation. 4. It creates asynchrony between zygote and endometrium. Select the correct answer using the code given below :
- A. 1, 3 and 4
- B. 1, 2 and 3
- C. 2, 3 and 4
- D. 1, 2 and 4 (Correct Answer)
Explanation: ***1, 2 and 4*** - **Chhaya (Centchroman)** is a **non-steroidal oral contraceptive** that acts primarily through its **anti-estrogenic effects** on the endometrium, while also possessing weak estrogenic properties. - Its mechanism of action leads to **asynchrony between the zygote and endometrium**, preventing implantation, and it has a reported **failure rate of 1-4 per 100 women-years**. *1, 3 and 4* - This option incorrectly includes the statement that Chhaya **inhibits ovulation**. Chhaya is a **non-hormonal contraceptive** and does not primarily prevent ovulation; rather, it makes the uterus unreceptive to implantation. - Its main contraceptive effect is through altering the endometrium, which does not typically include an anovulatory mechanism. *2, 3 and 4* - This option is incorrect because Chhaya **does not inhibit ovulation**. This mechanism is typically associated with hormonal contraceptives, which suppress the hypothalamic-pituitary-ovarian axis. - The primary action of Chhaya is on the endometrium, making it unsuitable for implantation, not preventing the release of an egg. *1, 2 and 3* - This option is incorrect because Chhaya **does not inhibit ovulation**. While it has potent anti-estrogenic and weak estrogenic properties (1) and a failure rate of 1-4 per HWY (2), it does not act by preventing egg release (3). - Its contraceptive efficacy is mainly due to its impact on the endometrial lining and ovum transport.
Question 56: Which of the following are examples of LARC (Long Acting Reversible Contraceptives) ? 1. Copper-T 380A 2. Implants 3. LNG-IUS Select the correct answer using the code given below :
- A. 1, 2 and 3 (Correct Answer)
- B. 1 and 3 only
- C. 1 and 2 only
- D. 2 and 3 only
Explanation: ***1, 2 and 3*** - **Long-acting reversible contraceptives (LARCs)** include all methods that are effective for an extended period, do not require daily attention, and are reversible. The **Copper-T 380A intra-uterine device (IUD)**, **subdermal implants**, and the **levonorgestrel-releasing intra-uterine system (LNG-IUS)** all fit this description. - These methods are highly effective due to minimal user error and provide contraception for several years, making them ideal for long-term birth control. *1 and 3 only* - This option incorrectly excludes **implants**, which are a well-established and highly effective form of LARC, offering contraception for up to three years. - While Copper-T 380A and LNG-IUS are indeed LARCs, the exclusion of implants makes this option incomplete. *1 and 2 only* - This option incorrectly excludes the **levonorgestrel-releasing intra-uterine system (LNG-IUS)**, which is an increasingly popular and effective LARC, providing contraception for up to five years. - The LNG-IUS is a hormonal LARC often used for both contraception and managing heavy menstrual bleeding. *2 and 3 only* - This option incorrectly excludes the **Copper-T 380A IUD**, which is a non-hormonal LARC. - The Copper-T 380A is one of the most widely used LARCs globally, offering highly effective contraception for up to ten years.
Question 57: How many times in a year does withdrawal bleeding occur in extended continuous regimens of combined oral contraceptive pills?
- A. 6
- B. 3
- C. 5
- D. 4 (Correct Answer)
Explanation: **4** - **Extended continuous regimens** of combined oral contraceptive pills typically involve taking active pills for 84 days, followed by a 7-day placebo or hormone-free interval. - This regimen results in **four withdrawal bleeds per year**, as opposed to thirteen for conventional cyclic regimens. *6* - This frequency of withdrawal bleeding would be more common with regimens that have shorter active pill cycles, such as 21 days active with 7 days off, but not with typical extended continuous use. - While some custom regimens might approach this frequency, it is not the standard for "extended continuous" which aims to reduce bleeding frequency. *3* - A frequency of three withdrawal bleeds per year would imply a longer continuous active pill phase than the typical 84 days, such as 112 days on active pills followed by a 7-day break. - While such regimens exist, they are less commonly described as the standard "extended continuous" which typically refers to the 84/7 day cycle. *5* - Five withdrawal bleeds per year is not a standard frequency for either conventional cyclic or typical extended continuous oral contraceptive regimens. - It would require an unusual cycle length for active pills and break days that does not correspond to common prescribing patterns.
Question 58: Bilateral total salpingectomy is a recommended surgical procedure to reduce the risk of :
- A. Uterine cancer
- B. Epithelial ovarian cancer (Correct Answer)
- C. Fallopian tube cancer
- D. Peritoneal cancer
Explanation: ***Epithelial ovarian cancer*** - Many high-grade serous ovarian cancers, the most common and aggressive type, are now believed to originate in the **distal fallopian tube** (specifically the fimbriae). - Removing the fallopian tubes significantly reduces the risk of these cancers, especially in women at **high genetic risk** (e.g., BRCA1/2 mutations) or undergoing hysterectomy for benign indications. *Uterine cancer* - Uterine cancer primarily affects the **endometrium** (lining of the uterus) or the **myometrium** (muscle wall). - Bilateral salpingectomy, which involves removing the fallopian tubes, does not directly influence the risk of uterine cancer. *Fallopian tube cancer* - While bilateral salpingectomy removes the fallopian tubes, the primary goal for risk reduction associated with these tubes is for **epithelial ovarian cancer**, not primary fallopian tube cancer itself. - Primary fallopian tube cancer is extremely rare, and often shares similar histopathological features and biological behavior with high-grade serous ovarian cancer. *Peritoneal cancer* - Peritoneal cancer can arise from the lining of the abdominal cavity, often with a similar histology to **serous ovarian cancer**. - While there might be some overlap in the pathogenesis, the strongest evidence for risk reduction with salpingectomy specifically targets the origin of **epithelial ovarian cancer** from the fallopian tube, rather than direct primary peritoneal cancer risk.
Question 59: Tongue bite occurs in eclampsia at :
- A. Tonic stage (Correct Answer)
- B. Coma stage
- C. Clonic stage
- D. Postictal stage
Explanation: ***Tonic stage*** - During the **tonic stage** of an eclamptic seizure, there is a sudden, sustained contraction of all muscles, including the **masseter muscles** (jaw muscles). - This forceful, sustained jaw clenching causes the teeth to clench tightly, leading to involuntary **biting of the tongue**. - The tonic phase lasts 10-20 seconds and is the first phase of the eclamptic seizure, characterized by rigid muscle contraction. *Coma stage* - The coma stage occurs after the seizure activity has ceased, and the patient is unconscious. - While aspiration or other complications can occur during this stage, **tongue biting** specifically happens during the active tonic phase of the seizure, not afterward. *Clonic stage* - The clonic stage follows the tonic stage and is characterized by rhythmic, jerking movements of the limbs and body. - Although there is muscle activity, the severe, **sustained jaw clenching** that causes tongue bite is specific to the tonic phase. - In the clonic phase, the jaw may rhythmically open and close, but the initial tongue bite has already occurred. *Postictal stage* - The postictal stage is the period of recovery immediately following a seizure. - The patient may be confused, drowsy, or unresponsive, but the active seizure movements, including **tongue biting**, have already occurred in the tonic phase.
Question 60: Indication for removal of IUDs include which of the following ? 1. Perforation of uterus 2. Pregnancy with device in situ 3. One year after menopause 4. Persistent migraine Select the correct answer using the code given below :
- A. 2, 3 and 4
- B. 1, 2 and 4 (Correct Answer)
- C. 1, 2 and 3
- D. 1 and 3 only
Explanation: ***Correct Answer: 1, 2 and 4*** **Statement 1 - Perforation of uterus:** ✅ **Valid indication** - Uterine perforation is a serious complication where the IUD punctures the uterine wall - This is an **absolute indication** for immediate removal to prevent further damage, infection, or injury to adjacent organs - Requires prompt surgical intervention **Statement 2 - Pregnancy with device in situ:** ✅ **Valid indication** - IUD should be removed if the strings are visible and removal is feasible - Removal reduces risks of **spontaneous abortion** (50% vs 25%), **septic abortion**, **preterm labor**, and **chorioamnionitis** - If strings are not visible, removal attempts may cause more harm than leaving it in place **Statement 4 - Persistent migraine:** ✅ **Valid indication (especially for hormonal IUDs)** - Relevant primarily for **levonorgestrel-releasing IUDs** (LNG-IUS) - Some women experience exacerbated or new-onset migraines due to hormonal fluctuations - Persistent or worsening migraines, especially **migraines with aura**, may warrant IUD removal - Less relevant for copper IUDs which have no hormonal effects *Statement 3 - One year after menopause:* ❌ **NOT an absolute indication** - While general guidelines suggest removal 1 year after menopause (if inserted after age 40), this is **NOT mandatory** - **Copper IUDs** can remain in place until age 55 if inserted after age 40, providing continued contraception - **LNG-IUS** may be retained for **endometrial protection** in women receiving estrogen replacement therapy - Removal is only necessary if the device is past its effective lifespan or causing symptoms - The decision should be individualized based on patient circumstances