UPSC-CMS 2024 — Obstetrics and Gynecology
27 Previous Year Questions with Answers & Explanations
Consider the following statements regarding oligohydramnios: 1. It is defined on USG when maximum vertical pocket of liquor is less than 3 cm. 2. It is defined on USG when AFI is less than 5 cm. 3. It is associated with increased risk of cord compression during labor. 4. It is commonly seen in post-term pregnancies. Select the correct answer using the code given below.
Which of the following are correct about endocrine changes in normal pregnancy? 1. Increase in levels of maternal serum iodine 2. Increase in serum levels of Corticotropin-Releasing Hormone (CRH) 3. Increase in serum levels of aldosterone Select the answer using the code given below.
Which of the following features are correct regarding onset of true labour? 1. Regular uterine contractions 2. Progressive cervical dilation and effacement 3. Presence of show 4. Labour and delivery are synonymous Select the answer using the code given below.
According to the WHO Intrapartum Care Guidelines, 2018, the active phase of labour starts from what dilation of cervix?
The diameter of engagement of foetal skull in marked deflexion is
Which of the following are correct regarding pathological findings of placenta accreta? 1. Absence of decidua basalis 2. Absence of Nitabuch's fibrinoid layer 3. Loss of normal hypoechoic retroplacental myometrial zone in ultrasonography Select the answer using the code given below.
Which of the following statements are correct regarding peripartum cardiomyopathy? 1. It is usually seen in multiparous women. 2. Echocardiography shows ejection fraction less than 45%. 3. ACE inhibitors are contraindicated. 4. History of prior heart disease is mostly present. Select the answer using the code given below.
A 28-year-old female G2P1L1 with history of previous cesarean presents to the gynaecology emergency in labour. On examination, she is hypotensive, foetal heart sounds are absent and foetal parts are easily palpable. What is her diagnosis?
A 24-year-old primigravida comes to ANC clinic at 8 months amenorrhoea. Her BP is found to be 160/100 mm Hg. Lab findings reveal thrombocytopenia, increased SGOT/SGPT and LDH. What is her diagnosis?
A patient, who is 2 months pregnant, reports to a hospital with complaints of increased vaginal bleeding and pain in lower abdomen. Internal examination reveals dilated internal os of cervix and products of conception are felt through it. What is her likely clinical diagnosis?
UPSC-CMS 2024 - Obstetrics and Gynecology UPSC-CMS Practice Questions and MCQs
Question 1: Consider the following statements regarding oligohydramnios: 1. It is defined on USG when maximum vertical pocket of liquor is less than 3 cm. 2. It is defined on USG when AFI is less than 5 cm. 3. It is associated with increased risk of cord compression during labor. 4. It is commonly seen in post-term pregnancies. Select the correct answer using the code given below.
- A. 1 and 2 only
- B. 1, 2 and 4
- C. 1, 3 and 4
- D. 2, 3 and 4 (Correct Answer)
Explanation: ***2, 3 and 4*** - This option correctly identifies the accurate definitions and associations of **oligohydramnios**. - Statement 2 correctly defines oligohydramnios as **AFI < 5 cm** using the Amniotic Fluid Index method. - Statement 3 is correct: oligohydramnios is associated with increased risk of **cord compression** during labor due to reduced cushioning effect of amniotic fluid. - Statement 4 is correct: oligohydramnios is commonly seen in **post-term pregnancies** (> 42 weeks) due to placental insufficiency and reduced fetal urine production. *1 and 2 only* - Statement 1 is **incorrect**: oligohydramnios is defined as maximum vertical pocket (MVP) **< 2 cm**, not < 3 cm. - This option excludes the important clinical associations of cord compression and post-term pregnancy. *1, 2 and 4* - Statement 1 is **incorrect**: the correct cutoff for MVP is **< 2 cm**, not < 3 cm. - This option misses the crucial risk of **cord compression** during labor. *1, 3 and 4* - Statement 1 is **incorrect**: oligohydramnios by MVP method is defined as **< 2 cm**, not < 3 cm. - This option misses the alternative and commonly used definition via **AFI < 5 cm**.
Question 2: Which of the following are correct about endocrine changes in normal pregnancy? 1. Increase in levels of maternal serum iodine 2. Increase in serum levels of Corticotropin-Releasing Hormone (CRH) 3. Increase in serum levels of aldosterone Select the answer using the code given below.
- A. 1 and 2 only
- B. 1 and 3 only
- C. 2 and 3 only (Correct Answer)
- D. 1, 2 and 3
Explanation: ***2 and 3 only*** - **Corticotropin-releasing hormone (CRH)** levels increase dramatically during pregnancy, produced by the **placenta**, influencing the timing of labor and fetal development. - **Aldosterone** levels significantly increase during pregnancy to help maintain **fluid balance** and counteract the natriuretic effects of increased progesterone and vasodilation. *1 and 2 only* - While CRH levels do increase, **maternal serum iodine levels do not increase**; rather, there is an increased demand for iodine and a decrease in serum iodine concentration due to increased renal clearance and transfer to the fetus. - This option incorrectly states an increase in maternal serum iodine. *1 and 3 only* - Although aldosterone levels increase, **maternal serum iodine levels do not increase** during normal pregnancy. - This option incorrectly implies an increase in serum iodine while correctly identifying an increase in aldosterone. *1, 2 and 3* - This option is incorrect because **maternal serum iodine levels do not increase** in normal pregnancy; instead, there is often a relative iodine deficiency due to increased demand and excretion. - Only CRH and aldosterone levels increase among the choices provided.
Question 3: Which of the following features are correct regarding onset of true labour? 1. Regular uterine contractions 2. Progressive cervical dilation and effacement 3. Presence of show 4. Labour and delivery are synonymous Select the answer using the code given below.
- A. 2, 3 and 4
- B. 1, 2 and 3 (Correct Answer)
- C. 1, 3 and 4
- D. 1, 2 and 4
Explanation: ***Correct: 1, 2 and 3*** - **Regular uterine contractions** (statement 1) are a hallmark of true labor, occurring at regular intervals with increasing frequency, duration, and intensity. - **Progressive cervical dilation and effacement** (statement 2) is the definitive diagnostic criterion for true labor, distinguishing it from false labor (Braxton Hicks contractions). - **Presence of 'show'** (statement 3) - the expulsion of the cervical mucus plug mixed with blood - is a common and reliable indicator of true labor onset. - Statement 4 is **incorrect**: labor and delivery are **not synonymous**. **Labor** is the entire process of childbirth (contractions, cervical changes, descent of fetus), while **delivery** refers specifically to the expulsion of the baby. *Incorrect: 2, 3 and 4* - Incorrectly includes statement 4, which falsely claims labor and delivery are synonymous. - Omits statement 1 (regular uterine contractions), which is a fundamental feature of true labor. *Incorrect: 1, 3 and 4* - Incorrectly includes statement 4 about labor and delivery being synonymous. - Critically omits statement 2 (progressive cervical dilation and effacement), which is the most important diagnostic criterion for true labor. *Incorrect: 1, 2 and 4* - Incorrectly includes statement 4, which is false. - Omits statement 3 (presence of show), which is a valid indicator of true labor onset.
Question 4: According to the WHO Intrapartum Care Guidelines, 2018, the active phase of labour starts from what dilation of cervix?
- A. 4 cm
- B. 3 cm
- C. 6 cm
- D. 5 cm (Correct Answer)
Explanation: ***5 cm*** - According to the **WHO Intrapartum Care Guidelines, 2018**, the active first stage of labor is defined as starting when the cervix is dilated to **5 cm**. - The WHO guidelines state: "The active first stage is the period of time from 5 cm of cervical dilatation until full cervical dilatation." - This updated definition aims to reduce unnecessary interventions, as cervical dilation before 5 cm (latent phase) can be slow and variable, which is part of normal labor progression. *6 cm* - **6 cm cervical dilation** is beyond the threshold defined by WHO 2018 guidelines for the start of active phase. - While some clinicians may use 6 cm as a benchmark in practice, the **official WHO 2018 guideline** specifically designates **5 cm** as the starting point. *4 cm* - Historically, **4 cm cervical dilation** was considered the start of the active phase in older definitions (Friedman curve). - This earlier benchmark led to premature diagnosis of "failure to progress" and increased interventions. - The **WHO 2018 guidelines** revised this upward to **5 cm** to reflect a more expectant management approach for slow but normal labor progression. *3 cm* - A **cervical dilation of 3 cm** is typically within the latent phase of labor, where cervical changes are usually slower and less predictable. - Defining the active phase at this early stage would significantly increase the possibility of diagnosing **abnormal labor patterns** prematurely and lead to unnecessary interventions.
Question 5: The diameter of engagement of foetal skull in marked deflexion is
- A. suboccipitofrontal diameter
- B. occipitofrontal diameter (Correct Answer)
- C. suboccipitobregmatic diameter
- D. mentovertebral diameter
Explanation: ***occipitofrontal diameter*** - In cases of **marked deflexion** (also called **persistent occipitoposterior** or **military attitude** in some contexts), the fetal head presents with extension, causing the **occipitofrontal diameter** to engage. - This diameter extends from the **occipital protuberance to the root of the nose (glabella)**, measuring approximately **11.5 cm**. - This represents a **moderately extended** attitude of the fetal head, making vaginal delivery more challenging than with flexion. *suboccipitofrontal diameter* - This diameter measures about **10.0 cm** and engages with **partial deflexion**. - It extends from the **subocciput to the glabella** (center of forehead). - This is an intermediate position between full flexion and marked deflexion. *suboccipitobregmatic diameter* - This is the diameter of engagement in a **well-flexed head** (normal vertex presentation), measuring approximately **9.5 cm**. - It extends from the **subocciput to the bregma** (anterior fontanelle). - This is the **ideal diameter** for vaginal birth as it presents the smallest diameter. *mentovertical diameter* - This diameter is relevant in **brow presentation** (maximum deflexion/extension), measuring about **13-13.5 cm**. - It extends from the **chin (mentum) to the vertex**. - Brow presentation is **highly unfavorable** for vaginal delivery due to this very large engaging diameter and typically requires cesarean section.
Question 6: Which of the following are correct regarding pathological findings of placenta accreta? 1. Absence of decidua basalis 2. Absence of Nitabuch's fibrinoid layer 3. Loss of normal hypoechoic retroplacental myometrial zone in ultrasonography Select the answer using the code given below.
- A. 1 and 3 only
- B. 1, 2 and 3 (Correct Answer)
- C. 1 and 2 only
- D. 2 and 3 only
Explanation: **Correct: 1, 2 and 3** - **Placenta accreta** is pathologically defined by the **direct adherence of villi to the myometrium** due to a deficient or absent decidua. - The absence of both the **decidua basalis** and the **Nitabuch's fibrinoid layer** allows for the abnormal trophoblast invasion and adherence to the myometrium. - On ultrasound, this condition is characterized by the **loss of the normal hypoechoic retroplacental myometrial zone**, which indicates the absence of a clear boundary between the placenta and the uterine wall. - All three findings (statements 1, 2, and 3) are correct pathological and diagnostic features of placenta accreta. *Incorrect: 1 and 3 only* - This option is incomplete as it omits the crucial role of the **Nitabuch's fibrinoid layer** absence in the pathology of placenta accreta. - The Nitabuch's layer normally acts as a protective barrier against deep placental invasion, and its absence is a key pathological feature. *Incorrect: 1 and 2 only* - While both the absence of decidua basalis and Nitabuch's fibrinoid layer are definitive pathological findings, this option fails to include the important **ultrasonographic feature** that aids in antenatal diagnosis. - The **loss of the retroplacental hypoechoic zone** is a critical diagnostic sign in clinical practice. *Incorrect: 2 and 3 only* - This option is incorrect because it overlooks the primary pathological feature of placenta accreta, which is the **absence of the decidua basalis**. - The decidua basalis normally forms the maternal component of the placenta, and its absence is fundamental to the abnormal adherence.
Question 7: Which of the following statements are correct regarding peripartum cardiomyopathy? 1. It is usually seen in multiparous women. 2. Echocardiography shows ejection fraction less than 45%. 3. ACE inhibitors are contraindicated. 4. History of prior heart disease is mostly present. Select the answer using the code given below.
- A. 1, 2 and 3
- B. 1, 3 and 4
- C. 1 and 2 only (Correct Answer)
- D. 3 and 4 only
Explanation: ***1 and 2 only*** - **Peripartum cardiomyopathy** (PPCM) is more common in **multiparous women**, particularly those with a history of preeclampsia, hypertension, or multiple pregnancies. - The diagnostic criteria for PPCM include the development of **heart failure** in the last month of pregnancy or within five months postpartum, with an **ejection fraction (EF) less than 45%** (often <40%) and no other identifiable cause. *1, 2 and 3* - While statements 1 and 2 are correct, **ACE inhibitors** are generally **contraindicated during pregnancy** due to teratogenic effects, but **can be used postpartum** for PPCM treatment, especially if not breastfeeding. - The contraindication during pregnancy does not universally apply to the entire peripartum period or postpartum management. *1, 3 and 4* - Statements 1 and 3 are incorrect in parts; while multiparity is a risk factor, statement 3 regarding ACE inhibitors is nuanced as they can be used postpartum. - PPCM is diagnosed in the absence of **prior heart disease**, meaning it is a *new onset* cardiomyopathy; therefore, statement 4 is incorrect. *3 and 4 only* - Both statements 3 and 4 are incorrect because ACE inhibitors can be used postpartum, and PPCM is characterized by the absence of prior heart disease. - The diagnostic criteria for PPCM specifically exclude cases where pre-existing heart disease can explain the heart failure.
Question 8: A 28-year-old female G2P1L1 with history of previous cesarean presents to the gynaecology emergency in labour. On examination, she is hypotensive, foetal heart sounds are absent and foetal parts are easily palpable. What is her diagnosis?
- A. Hydatidiform mole
- B. Oligohydramnios
- C. Abruptio placentae
- D. Uterine rupture (Correct Answer)
Explanation: ***Uterine rupture*** - The patient's presentation with **hypotension**, **absent fetal heart sounds**, and **easily palpable fetal parts** following a previous cesarean section strongly suggests uterine rupture. - A **previous cesarean section** is a significant risk factor for uterine rupture, as the scar tissue can be weakened and tear during labor. *Hydatidiform mole* - This condition involves abnormal growth of placental tissue, often presenting with a **grape-like appearance** and **high hCG levels**. - It does not typically cause acute maternal hypotension or easily palpable fetal parts in the context of labor. *Oligohydramnios* - Characterized by **low amniotic fluid volume**, which can lead to complications such as **fetal compression** or developmental issues. - It does not directly cause maternal hypotension, absent fetal heart sounds, or the sensation of easily palpable fetal parts during active labor. *Abruptio placentae* - Involves the **premature separation of the placenta** from the uterine wall, leading to vaginal bleeding, abdominal pain, and fetal distress. - While it can cause fetal compromise and maternal hypotension, the finding of **easily palpable fetal parts** is more indicative of a disrupted uterus rather than just placental separation.
Question 9: A 24-year-old primigravida comes to ANC clinic at 8 months amenorrhoea. Her BP is found to be 160/100 mm Hg. Lab findings reveal thrombocytopenia, increased SGOT/SGPT and LDH. What is her diagnosis?
- A. Eclampsia
- B. Hepatitis B
- C. HELLP syndrome (Correct Answer)
- D. Obstetric cholestasis
Explanation: ***HELLP syndrome*** - **HELLP syndrome** is characterized by **hemolysis**, **elevated liver enzymes** (SGOT/SGPT, LDH), and **low platelet count (thrombocytopenia)**, all of which are present in this patient with severe hypertension. - It is a severe form of **preeclampsia** and requires prompt recognition and management due to high maternal and fetal morbidity and mortality. *Eclampsia* - Eclampsia involves the occurrence of **new-onset grand mal seizures** in a woman with preeclampsia, which is not mentioned in the patient's presentation. - While preeclampsia (high BP) is present, the defining feature of eclampsia (seizures) is absent. *Hepatitis B* - **Hepatitis B** infection can cause elevated liver enzymes, but it typically presents with symptoms such as **abdominal pain, nausea, jaundice**, and may not involve hypertension or thrombocytopenia. - The combination of severe hypertension and thrombocytopenia makes hepatitis B an unlikely primary diagnosis in this context. *Obstetric cholestasis* - **Obstetric cholestasis** is characterized by **pruritus (itching)**, especially on the palms and soles, and elevated bile acids, often with only mildly elevated liver enzymes. - It does not typically cause **severe hypertension** or **thrombocytopenia**.
Question 10: A patient, who is 2 months pregnant, reports to a hospital with complaints of increased vaginal bleeding and pain in lower abdomen. Internal examination reveals dilated internal os of cervix and products of conception are felt through it. What is her likely clinical diagnosis?
- A. Inevitable abortion (Correct Answer)
- B. Threatened abortion
- C. Incomplete abortion
- D. Septic abortion
Explanation: ***Inevitable abortion*** - This diagnosis is characterized by **vaginal bleeding**, **lower abdominal pain**, and a **dilated cervix** with **products of conception palpable through the cervical os**. - The dilation of the internal os and products protruding through it indicate that the abortion process **cannot be halted** and will inevitably proceed to completion, distinguishing it from a threatened abortion. - In inevitable abortion, the products may be felt through the dilated os but have not yet been fully expelled from the uterus. *Threatened abortion* - While there is vaginal bleeding and a viable intrauterine pregnancy, the **cervix remains closed**, and there is no expulsion of fetal tissue. - The symptoms are milder, and with appropriate management, the pregnancy can often continue successfully. *Incomplete abortion* - This involves the **partial expulsion of the products of conception**, meaning some tissue has already passed out of the uterus, but some remains inside. - The key difference is that in incomplete abortion, **part of the products have been expelled**, with retained tissue remaining in the uterus, often requiring intervention (such as surgical evacuation) to remove the retained tissue. - The patient would typically report passage of tissue. *Septic abortion* - This is a serious complication involving an **infection of the uterus** during an abortion, presenting with **fever, chills, foul-smelling or purulent vaginal discharge**, in addition to bleeding and pain. - The clinical picture provided (bleeding, pain, dilated os, palpable products of conception) does not include signs of infection such as fever or other systemic symptoms of sepsis.