Labor and Delivery Practice Questions

Q: Female in labor shows abrupt fetal bradycardia after spontaneous rupture of membrane. Cervix is 6cm dilated. 5/5 of the head is palpable. Diagnosis?

Cord prolapse. ***Cord prolapse*** - Sudden fetal bradycardia following rupture of membranes with a high, unengaged fetal head (5/5 palpable) is the classic presentation of **umbilical cord prolapse**, which causes acute cord compression and fetal hypoxia. - This is an **obstetric emergency** requiring immediate delivery, typically via **emergency cesarean section**, to alleviate the cord compression. *Abruption* - While **placental abruption** causes fetal compromise, the classic presentation includes **vaginal bleeding** and a firm, tender uterus, rather than the isolated fetal bradycardia seen here. - Abruption typically occurs over time or following trauma/hypertension, whereas the bradycardia here is temporally linked specifically to the rupture of membranes. *Uterine prolapse* - **Uterine prolapse** is unlikely during labor as the uterus is held in place by the cervix and supporting ligaments, and it does not present with acute fetal bradycardia. - It would present as a mass protruding through the introitus, which is not described in this acute clinical scenario of fetal distress. *Vasa previa* - **Vasa previa** is a condition where fetal vessels traverse the membranes near the cervix, which rupture upon membrane tear, leading to **painless vaginal bleeding** and rapid fetal exsanguination. - While it causes fetal bradycardia, it is classically associated with vaginal bleeding immediately following rupture of membranes, not noted in this case describing a high unengaged head.

Q: The maneuver shown in the image is done for which of the following conditions?

Second twin transverse lie. ***Second twin transverse lie*** - This maneuver, known as **internal podalic version** (IPV), is specifically indicated for the **second twin** when it is in a **transverse or oblique lie** after the delivery of the first twin. - It involves grasping the fetus's **feet** to convert the lie into a **breech presentation** to facilitate delivery safely. *Face presentation* - Face presentation is generally managed by observing labor progress as many convert spontaneously to occiput anterior; it is not resolved by **internal podalic version**. - Forceful manipulation in the presence of a **face presentation** is contraindicated due to risks of cervical spine injury and facial trauma. *Shoulder presentation* - While a transverse lie (shoulder presentation) in a singleton pregnancy might seem similar, **internal podalic version** is generally **contraindicated** in singleton pregnancies due to the high risk of **uterine rupture**. - Management of a singleton transverse lie is almost universally a **cesarean section** rather than manual manipulation. *Breech* - A breech presentation is already a longitudinal lie and does not require conversion via a version maneuver. - The maneuver shown is specifically used to **change** a presentation from transverse to breech, not to correct an existing breech presentation.

Q: Identify CTG..

Late deceleration. ***Late deceleration*** - These are characterized by a gradual decrease in fetal heart rate starting **after the onset of the contraction**, with the nadir occurring **after the peak of the contraction**. - They indicate **uteroplacental insufficiency** and suggest fetal hypoxia, requiring careful clinical evaluation. *Early deceleration* - These mirror the contraction shape, starting and ending with it, caused by **fetal head compression**. - They are typically **benign** and do not require intervention as they are a normal vagal response. *Variable deceleration* - These are abrupt decreases in heart rate unrelated to the timing of contractions, often looking like a 'V' or 'U' shape. - They are typically caused by **umbilical cord compression** and are usually benign unless recurrent or severe. *Prolonged deceleration* - These involve a decrease in heart rate of at least 15 beats per minute lasting **longer than 2 minutes** but less than 10 minutes. - They often indicate a **significant interruption** in oxygen supply to the fetus, such as cord prolapse or maternal hypotension.

Q: A woman in labor, P/V findings -sagittal suture obliquely placed, posterior fontanelle at 4 o’ clock position & the anterior fontanelle easily palpable. What is the most likely fetal presentation?

Occipitoposterior presentation. ***Occipitoposterior presentation*** - In this scenario, the sagittal suture is oblique, and the posterior fontanelle is at the 4 o'clock position; since the posterior fontanelle is palpable and associated with a low-lying occiput relative to the pelvis, the occiput is posterior. - The palpable anterior fontanelle suggests that the sinciput (forehead) is also relatively prominent or accessible, common in **occipitoposterior positions**, where the fetal head is usually deflexed. *Cephalic presentation* - While this is technically a type of cephalic presentation (head-first), it is a non-specific term that encompasses vertex (flexed), sinciput (deflexed), and brow presentations. - Specificity is required for labor management, making the more precise anatomical diagnosis of **occipitoposterior** the correct clinical answer. *Breech presentation* - A breech presentation would imply that the **sacrum** is the presenting part, and the posterior fontanelle would not be the primary landmark palpated. - Clinical assessment of the presenting part (breech) would reveal the **buttocks**, anus, or genitalia rather than the vertex fontanelles. *Brow presentation* - In a brow presentation, the **anterior fontanelle** and the orbital ridges (supra-orbital ridges) are the primary landmarks, not the posterior fontanelle. - The **mentum (chin)** is often more difficult to palpate, and the head is in a state of partial extension, which is distinct from the vertex presentation described.

Q: A patient is unable to pass urine four hours after an instrumental vaginal delivery. Examination reveals a bluish cystic swelling in the vaginal wall. What is the most likely diagnosis?

Vaginal hematoma. ***Vaginal hematoma*** - A **bluish cystic swelling** in the vaginal wall appearing shortly after an instrumental delivery is pathognomonic for a vaginal hematoma caused by hemorrhage into the paravaginal tissues. - Urinary retention occurs due to **mass effect** and compression of the urethra or bladder, preventing normal voiding. *Perineal tear* - A perineal tear involves **laceration of the skin** and subcutaneous tissue, typically presenting with visible tissue disruption rather than a discrete cystic swelling. - While it may cause pain, it does not typically present as a distinct **bluish cystic mass** or specifically cause the described obstructive urinary symptoms. *Bartholin's cyst* - A Bartholin's cyst results from an obstruction of the Bartholin gland duct, presenting as a **fluctuant swelling** at the four or eight o'clock position of the vaginal introitus. - These are usually not associated with acute postpartum trauma or instrumental delivery and are typically **not bluish** in color unless complicated by an abscess. *Cystocoele* - A cystocoele is a **prolapse of the bladder** into the anterior vaginal wall, typically presenting as a soft bulge that may increase with straining. - It would appear as a **skin-colored or mucosa-colored protrusion** rather than a bluish cystic mass and is usually chronic rather than an acute post-procedural complication.

Question 1

Female in labor shows abrupt fetal bradycardia after spontaneous rupture of membrane. Cervix is 6cm dilated. 5/5 of the head is palpable. Diagnosis?

Accepted Answer

Cord prolapse

Answer

Abruption

Answer

Uterine prolapse

Answer

Vasa previa

Question 2

The maneuver shown in the image is done for which of the following conditions?

Accepted Answer

Second twin transverse lie

Answer

Face presentation

Answer

Shoulder presentation

Answer

Breech

Question 3

Identify CTG..

Accepted Answer

Late deceleration

Answer

Early deceleration

Answer

Variable deceleration

Answer

Prolonged deceleration

Question 4

A woman in labor, P/V findings -sagittal suture obliquely placed, posterior fontanelle at 4 o’ clock position & the anterior fontanelle easily palpable. What is the most likely fetal presentation?

Accepted Answer

Occipitoposterior presentation

Answer

Cephalic presentation

Answer

Breech presentation

Answer

Brow presentation

Question 5

A patient is unable to pass urine four hours after an instrumental vaginal delivery. Examination
reveals a bluish cystic swelling in the vaginal wall. What is the most likely diagnosis?

Accepted Answer

Vaginal hematoma

Answer

Perineal tear

Answer

Bartholin's cyst

Answer

Cystocoele

Labor and Delivery — MCQs

Labor and Delivery — MCQs

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