UPSC-CMS 2025 - Obstetrics and Gynecology Practice Questions

Q: According to WHO Intrapartum Care Guidelines 2018, which of the following are correct about birthing position? I. For a woman without epidural analgesia, adoption of birthing position is individual woman's choice. II. For a woman without epidural analgesia, upright birthing position may be adopted. III. For a woman with epidural analgesia, lithotomy and supine position only are recommended. Select the answer using the code given below :

I and II only. ***I and II only*** - According to the **WHO Intrapartum Care Guidelines 2018**, for women **without epidural analgesia**, the adoption of **birthing position** should be the **individual woman's choice** (Statement I is correct). - **Upright positions** (including sitting, standing, kneeling, squatting, or hands-and-knees) are specifically **encouraged** for women without epidural as they may reduce duration of second stage of labor and instrumental delivery rates (Statement II is correct). - The WHO guidelines emphasize **woman-centered care** and respect for maternal preferences regarding birthing positions. *I, II and III* - This option is **incorrect** because Statement III is false. - The WHO 2018 guidelines do **NOT** restrict women with epidural analgesia to only lithotomy and supine positions. - Even with epidural, women should be **encouraged to adopt positions of their choice**, including lateral and supported upright positions when feasible. *II and III only* - This option is **incorrect** as it omits Statement I, which correctly reflects the WHO principle of **individual woman's choice** for birthing position. - Statement III is also **false** - women with epidural are not limited to only lithotomy and supine positions according to WHO guidelines. *I and III only* - This option is **incorrect** because Statement III is false. - WHO guidelines advocate for **flexible positioning** even with epidural analgesia, not restriction to lithotomy and supine positions only. - The guidelines support exploring various positions based on maternal comfort, clinical circumstances, and healthcare provider support.

Q: Twin pregnancy should have ultrasound at 10-13 weeks to confirm which of the following? I. Number of foetus II. Viability of foetus III. Chorionicity of twins IV. Malformation in either foetus Select the correct answer using the code given below :

I, II and III only. ***I, II and III only*** - A **first-trimester ultrasound** (10-13 weeks) in a twin pregnancy is essential for confirming the **number of fetuses**, assessing their **viability** (cardiac activity), and most importantly determining the **chorionicity of twins**. - **Chorionicity determination** is crucial at this stage as it guides the entire pregnancy management - monochorionic twins require more intensive surveillance due to higher risks. - While nuchal translucency screening for chromosomal abnormalities is performed at 11-13+6 weeks, **systematic structural malformation screening is NOT the primary objective** of the first-trimester scan and is typically performed at **18-22 weeks**. *I and III only* - While confirming the **number of fetuses** and **chorionicity** is essential, this option incorrectly omits the assessment of **fetal viability**. - Confirming cardiac activity and viability of both fetuses is a fundamental component of the first-trimester ultrasound examination. *II and IV only* - This option fails to include the most critical aspects of first-trimester twin ultrasound: confirming the **number of fetuses** and determining **chorionicity**. - Additionally, **malformation screening** is NOT a primary objective at 10-13 weeks; detailed anomaly scanning is performed in the second trimester (18-22 weeks). *I, II, III and IV* - While this option correctly includes fetal number, viability, and chorionicity determination, it incorrectly adds **malformation screening** as a primary objective. - **Structural anomaly scanning** is performed during the **mid-trimester ultrasound (18-22 weeks)**, not at 10-13 weeks, when organ development is more complete and detailed anatomical survey is possible.

Q: Which of the following are contraindications to External Cephalic Version (ECV) in breech? I. Pregnancy less than 36 weeks II. Multiple pregnancy III. Previous cesarean delivery IV. Rhesus isoimmunization Select the correct answer using the code given below :

II, III and IV. ***II, III and IV*** - **Multiple pregnancy** is an absolute contraindication to ECV due to significantly increased risks of cord entanglement, placental abruption, premature rupture of membranes, and the complexity of managing two or more fetuses during the procedure. - **Previous cesarean delivery** is generally considered a relative contraindication due to the theoretical increased risk of uterine rupture during ECV, though some centers perform ECV in carefully selected cases with prior cesarean section. - **Rhesus isoimmunization** is a contraindication because ECV carries the risk of fetomaternal hemorrhage, which can worsen existing isoimmunization and increase maternal antibody production, potentially compromising fetal wellbeing. *I, II and III* - While **multiple pregnancy** and **previous cesarean delivery** are valid contraindications, **pregnancy less than 36 weeks** is not a true contraindication to ECV. - The standard timing for ECV is at or after 37 weeks of gestation, but being less than 36 weeks represents inappropriate timing rather than a contraindication. If there were a compelling reason for ECV before 36 weeks, the early gestational age itself would not prohibit the procedure. *I, III and IV* - **Previous cesarean delivery** and **Rhesus isoimmunization** are correct contraindications. - However, **pregnancy less than 36 weeks** is not a standard contraindication - it simply represents a gestational age before the recommended timing for the procedure (≥37 weeks). *I, II and IV* - **Multiple pregnancy** and **Rhesus isoimmunization** are valid contraindications. - **Pregnancy less than 36 weeks** is not a contraindication but rather reflects suboptimal timing, as ECV is typically performed at 37+ weeks when the likelihood of spontaneous version has decreased and the fetus is term.

Q: Which of the following maternal complications can be seen in hyperemesis gravidarum? I. Wernicke's encephalopathy II. Hepatic failure III. Hypoprothrombinemia IV. Convulsions Select the correct answer using the code given below :

I, III and IV only. ***Correct Option: I, III and IV only*** - **Hyperemesis gravidarum** can lead to severe metabolic derangements and nutrient deficiencies, resulting in multiple maternal complications. - **Wernicke's encephalopathy** occurs due to **thiamine (vitamin B1) deficiency** from prolonged vomiting and malnutrition, presenting with confusion, ataxia, and ophthalmoplegia. - **Hypoprothrombinemia** develops due to **vitamin K deficiency**, which can lead to coagulopathy and bleeding complications. - **Convulsions** can occur secondary to severe **electrolyte imbalances** (particularly hyponatremia, hypocalcemia) or metabolic derangements. *Incorrect Option: I, II, III and IV* - This option incorrectly includes **hepatic failure** as a complication of hyperemesis gravidarum. - While **mild transient elevation of liver enzymes** (transaminitis) can occur in hyperemesis gravidarum, **true hepatic failure does NOT occur**. - Hepatic failure in pregnancy is associated with other distinct conditions like **acute fatty liver of pregnancy (AFLP)** or **HELLP syndrome**, not hyperemesis gravidarum. *Incorrect Option: I, II and IV only* - This option incorrectly includes **hepatic failure**, which is not a recognized complication of hyperemesis gravidarum. - It also incorrectly excludes **hypoprothrombinemia**, which can occur due to vitamin K deficiency in severe cases. *Incorrect Option: II and III only* - This option is incorrect as it includes **hepatic failure** (which does not occur in hyperemesis gravidarum). - It also incorrectly excludes **Wernicke's encephalopathy** and **convulsions**, which are well-recognized severe complications of hyperemesis gravidarum.

Q: The commonest ovarian tumour seen during pregnancy is:

Benign cystic teratoma. ***Benign cystic teratoma*** - **Benign cystic teratomas (dermoid cysts)** are the most common ovarian tumors found during pregnancy, often identified incidentally on ultrasound. - They are typically asymptomatic but can lead to complications like **torsion** due to their weight and composition. *Endometrioma* - Endometriomas are **cysts formed from endometrial tissue** outside the uterus, and while not uncommon, they are not the leading type of ovarian tumor discovered during pregnancy. - While endometriomas can be seen in pregnancy, their incidence is lower than that of dermoid cysts, and they might even decrease in size during pregnancy due to hormonal changes. *Mucinous cystadenoma* - Mucinous cystadenomas are **benign epithelial ovarian tumors** and can be quite large, but they are less frequently encountered in pregnancy compared to benign cystic teratomas. - These tumors are characterized by their **mucus-filled** nature and are less common causes of adnexal masses in pregnant women. *Adenocarcinoma ovary* - **Ovarian adenocarcinoma** is a malignant tumor and, while serious, is rare in pregnancy, especially compared to benign ovarian masses. - The discovery of a malignant ovarian mass during pregnancy requires careful management due to potential risks to both the mother and the fetus.

Q: Which of the following statements are correct regarding shoulder dystocia? I. It can be predicted during early labour. II. Fetal macrosomia is a risk factor. III. Turtle neck sign is present. IV. Episiotomy should always be given. Select the answer using the code given below :

II and III. ***II and III*** - **Fetal macrosomia** (birth weight >4000g or >4500g) is a well-established risk factor for shoulder dystocia, as larger fetal size increases the likelihood of shoulder impaction behind the maternal pubic symphysis. - The **"turtle sign"** (or "turtle neck sign") is a pathognomonic sign of shoulder dystocia, where the fetal head retracts against the perineum after delivery because the anterior shoulder is impacted behind the pubic symphysis. *I and III* - Shoulder dystocia is generally **unpredictable** in early labor. While risk factors (maternal diabetes, fetal macrosomia, maternal obesity) identify high-risk pregnancies, most cases occur without warning and cannot be reliably predicted during early labor. Up to 50% of shoulder dystocia cases occur in pregnancies without identifiable risk factors. *II and IV* - While episiotomy may be performed to facilitate maneuvers by providing more working space, it is **not always indicated** and does not directly relieve the bony obstruction. The primary issue in shoulder dystocia is impaction of the anterior shoulder behind the pubic symphysis (bony obstruction), not soft tissue restriction. Episiotomy should be selective, not routine. *I and II* - As stated, shoulder dystocia cannot be reliably predicted during early labor, despite the presence of risk factors. Clinical judgment and preparedness are more important than prediction. - Fetal macrosomia remains a significant risk factor, though many macrosomic babies deliver without shoulder dystocia and many cases occur with normal-weight infants.

Q: Which of the following factors favour posterior position of the vertex? I. Anthropoid pelvis II. Low inclination pelvis III. Attachment of placenta on the anterior wall IV. Primary brachycephaly Select the correct answer using the code given below :

I, III and IV. ***I, III and IV*** - An **anthropoid pelvis** has a long anteroposterior diameter and a narrow transverse diameter, making it more likely for the fetal head to engage in an anteroposterior position, which can lead to a posterior vertex. - **Placenta attached to the anterior wall** can create less space posteriorly, potentially pushing the fetal back towards the posterior aspect of the uterus, thereby promoting an occiput posterior position. - **Primary brachycephaly** (a fetal head that is wider than it is long) may find it difficult to rotate in the pelvis, increasing the likelihood of remaining in an occiput posterior position due to less favorable biomechanics for rotation. *II, III and IV* - A **low inclination pelvis** typically refers to a gynecoid pelvis with a flattened sacrum, which tends to promote rotation to an anterior position, not a posterior one. - Therefore, option II is incorrect as it favors anterior rotation. *I, II and IV* - This option incorrectly includes **low inclination pelvis** as a factor favoring posterior position. - A low inclination pelvis, particularly if it's a gynecoid type, is generally associated with more favorable conditions for fetal rotation to an anterior position. *I, II and III* - This option also incorrectly includes **low inclination pelvis** as a factor contributing to posterior vertex presentation. - The biomechanics of a low inclination pelvis do not typically predispose to a posterior vertex engagement or presentation.

Question 1

According to WHO Intrapartum Care Guidelines 2018, which one of the following is correct about duration of first stage labour?

Accepted Answer

Duration of latent phase of primigravida has not been established

Answer

Duration of active stage of primigravida should not exceed 8 hours

Answer

Duration of active stage of multigravida should not exceed 6 hours

Answer

Duration of active stage of primigravida should not exceed 18 hours

Question 2

According to WHO Intrapartum Care Guidelines 2018, which of the following are correct about birthing position?
I. For a woman without epidural analgesia, adoption of birthing position is individual woman's choice.
II. For a woman without epidural analgesia, upright birthing position may be adopted.
III. For a woman with epidural analgesia, lithotomy and supine position only are recommended.

Select the answer using the code given below :

Accepted Answer

I and II only

Answer

I, II and III

Answer

II and III only

Answer

I and III only

Question 3

Twin pregnancy should have ultrasound at 10-13 weeks to confirm which of the following?
I. Number of foetus
II. Viability of foetus
III. Chorionicity of twins
IV. Malformation in either foetus

Select the correct answer using the code given below :

Accepted Answer

I, II and III only

Answer

I and III only

Answer

II and IV only

Answer

I, II, III and IV

Question 4

Chadwick's sign describes :

Accepted Answer

the dusky hue of the vestibule and anterior vaginal wall visible at about 8th week of pregnancy

Answer

regular and rhythmic uterine contraction which can be elicited during bimanual examination at 4-8 weeks of pregnancy

Answer

softening of cervix at 6th week of pregnancy

Answer

the abdominal and vaginal fingers apposed below the body of the uterus during bimanual examination

Question 5

Which of the following are contraindications to External Cephalic Version (ECV) in breech?
I. Pregnancy less than 36 weeks
II. Multiple pregnancy
III. Previous cesarean delivery
IV. Rhesus isoimmunization

Select the correct answer using the code given below :

Accepted Answer

II, III and IV

Answer

I, II and III

Answer

I, III and IV

Answer

I, II and IV

Question 6

Which of the following maternal complications can be seen in hyperemesis gravidarum?
I. Wernicke's encephalopathy
II. Hepatic failure
III. Hypoprothrombinemia
IV. Convulsions

Select the correct answer using the code given below :

Accepted Answer

I, III and IV only

Answer

I, II, III and IV

Answer

I, II and IV only

Answer

II and III only

Question 7

The commonest ovarian tumour seen during pregnancy is:

Accepted Answer

Benign cystic teratoma

Answer

Endometrioma

Answer

Mucinous cystadenoma

Answer

Adenocarcinoma ovary

Question 8

Which of the following statements are correct regarding shoulder dystocia?
I. It can be predicted during early labour.
II. Fetal macrosomia is a risk factor.
III. Turtle neck sign is present.
IV. Episiotomy should always be given.

Select the answer using the code given below :

Accepted Answer

II and III

Answer

I and III

Answer

II and IV

Answer

I and II

Question 9

Which of the following factors favour posterior position of the vertex?
I. Anthropoid pelvis
II. Low inclination pelvis
III. Attachment of placenta on the anterior wall
IV. Primary brachycephaly

Select the correct answer using the code given below :

Accepted Answer

I, III and IV

Answer

II, III and IV

Answer

I, II and IV

Answer

I, II and III

UPSC-CMS 2025 — Obstetrics and Gynecology