Labor and Delivery — MCQs

Labor and Delivery Indian Medical PG Practice Questions and MCQs

Question 1121: What is the minimum parity for a woman to be classified as a grand multipara?

A. Para 3
B. Para 4
C. Para 5 (Correct Answer)
D. Para 6

Explanation: ***Para 5 (5 or more deliveries)*** - A woman is classified as a **grand multipara** when she has had **five or more previous deliveries** at ≥20 weeks of gestation. - The term specifically refers to **parity** (number of deliveries), not gravidity (number of pregnancies). - This classification helps identify pregnancies at potentially higher risk for certain complications including postpartum hemorrhage, abnormal placentation, and uterine rupture. *Para 3* - A woman with three previous deliveries is typically referred to as a **multipara**, not a grand multipara. - The term "grand multipara" specifically denotes a higher parity threshold. *Para 4* - A woman with four previous deliveries is still considered a **multipara** and does not meet the criteria for grand multiparity. - The threshold for grand multiparity is strictly defined as five or more deliveries at ≥20 weeks gestation. *Para 6* - While six deliveries certainly qualifies a woman as a grand multipara, it is not the **minimum number** for the classification. - The definition starts at five previous deliveries, making para 5 the minimum threshold.

Question 1122: Total uterine activity during normal labor is measured as 190-300 units over a 10-minute period. Which unit is being referred to here?

A. Montevideo units (Correct Answer)
B. mm of Hg
C. cm of water
D. Joules /kg

Explanation: ***Montevideo units*** - Montevideo units (MVUs) are a measure of **uterine contraction intensity** over a 10-minute period, multiplied by the number of contractions. - A value between **190-300 MVUs** is generally considered adequate for effective labor progression. *mm of Hg* - **mmHg (millimeters of mercury)** is typically used to measure **blood pressure** and other physiological pressures. - While uterine contraction strength can be measured in mmHg directly, the combined measure over time is expressed as MVUs. *cm of water* - **cm of water** is a unit of pressure primarily used in measuring **cerebrospinal fluid pressure** or central venous pressure. - It is not the standard unit for quantifying uterine contraction strength in the context of normal labor. *Joules /kg* - **Joules per kilogram (J/kg)** is a unit of **specific energy** or specific enthalpy. - It describes the energy content per unit mass and is not relevant to measuring uterine contraction pressure.

Question 1123: What is considered an abnormal fetal scalp blood pH level that necessitates urgent intervention?

A. pH 7.4
B. pH 7.3
C. pH 7.35
D. pH 7.15 (Correct Answer)

Explanation: ***pH 7.15*** - A fetal scalp blood pH of **7.15** (representing pH <7.20) indicates **significant fetal acidosis** and requires **urgent intervention**, such as expedited delivery. - The critical threshold is **pH <7.20**; values below this suggest **fetal compromise** with high risk of adverse neonatal outcomes, necessitating immediate action. - pH values **<7.15** are considered **severe acidosis** requiring emergency delivery. *pH 7.4* - A pH of 7.4 is considered a **normal** and healthy fetal scalp blood pH (normal range: 7.25-7.35). - This indicates **no acidosis or compromise**, with the fetus being well-oxygenated. *pH 7.3* - A pH of 7.3 is within the **normal range** (7.25-7.35) for fetal scalp blood. - This represents **adequate fetal oxygenation** with no intervention required. *pH 7.35* - A pH of 7.35 is at the **upper end of the normal physiological range** for fetal scalp blood. - This level indicates **excellent fetal oxygenation** and acid-base balance with no interventions required.

Question 1124: The definite sign of placental separation in stage 3 of parturition is

A. Lengthening of cord (Correct Answer)
B. Uterine contraction
C. Increase of BP
D. Descent of placenta into vagina

Explanation: ***Lengthening of cord*** - As the placenta detaches from the uterine wall and descends, the **umbilical cord will appear to lengthen** at the vulva, indicating that it has partially or fully entered the lower uterine segment or vagina. - This lengthening is a direct physical sign that the placenta has separated and is moving out of the uterus, making it a **definitive sign** of placental separation. *Uterine contraction* - **Uterine contractions** are necessary for placental separation, as they reduce the size of the placental bed, causing it to detach. - However, contractions alone do not definitively prove separation; the placenta may still be attached even with strong contractions. *Increase of BP* - An **increase in blood pressure (BP)** is not a direct or reliable sign of placental separation. - Blood pressure changes during labor and the third stage can be influenced by various factors, including pain, anxiety, and medication, making it an unreliable indicator. *Descent of placenta into vagina* - While the **descent of the placenta into the vagina** is a sign that separation has occurred, it is a later event. - The crucial "definite sign" of *separation* itself is often observed earlier via the lengthening of the cord and a gush of blood, indicating that detachment has occurred within the uterus.

Question 1125: True labor pain includes all of the following except.

A. Painful uterine contraction
B. Cervical dilation
C. Show (mucus plug discharge)
D. Formation of the bag of waters (Correct Answer)

Explanation: ***Formation of the bag of waters*** - The **bag of waters** (amniotic sac) forms during pregnancy, not during labor itself. Its formation is not a component or feature of true labor. - While **rupture of membranes** may occur during labor, the formation of the bag of waters happens well before labor begins. - This is the correct answer as it is NOT included in true labor pain characteristics. *Painful uterine contractions* - **Painful, regular uterine contractions** are the hallmark of true labor, distinguishing it from false labor (Braxton Hicks contractions). - These contractions progressively increase in frequency, intensity, and duration, and are not relieved by rest or position changes. *Cervical dilation* - **Cervical dilation** (and effacement) is the most critical diagnostic criterion for true labor, representing progressive physiological changes. - True labor always leads to measurable cervical changes, unlike false labor. *Show (mucus plug discharge)* - The **"show"** refers to the passage of blood-tinged mucus from the cervical canal as it begins to dilate and efface. - This is a classic sign of true labor onset and represents the dislodgement of the mucus plug that sealed the cervical canal during pregnancy.

Question 1126: A 25-year-old, 2nd gravida arrives in the labor room at full dilation. Which of the following practices is contraindicated at this stage of labor?

A. Cord blood to be saved in 2 tubes - plain & EDTA
B. Early clamping of cord
C. Liberal prophylactic use of ergometrine (Correct Answer)
D. Avoidance of manual removal of placenta

Explanation: ***Liberal prophylactic use of ergometrine*** - **Ergometrine is CONTRAINDICATED at full dilation** (second stage of labor) because it causes **strong, sustained tetanic uterine contractions**. - If given before delivery of the baby, these tetanic contractions can: - **Trap the fetus** inside the uterus - Compromise **uteroplacental blood flow** leading to fetal hypoxia - Increase risk of **uterine rupture** - Impede normal progress of labor - Ergometrine is reserved for **third stage management** (after delivery of baby) for prevention of postpartum hemorrhage, NOT for use during active labor at full dilation. - **Oxytocin** is preferred over ergometrine even in third stage due to better safety profile. *Cord blood to be saved in 2 tubes - plain & EDTA* - Collecting **cord blood** for banking or analysis is not contraindicated at full dilation. - This is routinely done at the time of delivery using appropriate collection tubes (plain for serum studies, EDTA for cell counts). - This practice does not interfere with labor management. *Early clamping of cord* - While **delayed cord clamping** (30-60 seconds) is now preferred for improved neonatal outcomes (better iron stores, higher hemoglobin levels), early clamping is **not contraindicated**. - Early clamping may still be indicated in specific situations such as need for immediate neonatal resuscitation, placental abruption, or maternal instability. - The timing of cord clamping is decided at delivery, not at full dilation. *Avoidance of manual removal of placenta* - **Manual removal of placenta** is reserved for retained placenta (failure to deliver within 30 minutes after baby) that doesn't respond to conservative management. - Avoiding unnecessary manual removal reduces risk of infection, hemorrhage, and uterine trauma. - This is appropriate management, not a contraindicated practice at full dilation.

Question 1127: On transvaginal sonography, which of the following shapes of the cervix indicates preterm labor?

A. T
B. Y
C. U (Correct Answer)
D. O

Explanation: ***U*** - A **U-shaped cervix** on transvaginal sonography indicates **significant cervical funneling** and effacement, which is the classic finding strongly predictive of **impending preterm labor**. - This shape represents advanced cervical dilation from the internal os, indicating the cervix is actively shortening and opening, signifying high risk for preterm delivery. *T* - A **T-shaped cervix** typically represents a **normal, closed cervix**, with the internal os remaining intact and funneling absent or minimal. - This shape suggests a **low risk of preterm labor**, as the cervix maintains its structural integrity. *Y* - A **Y-shaped cervix** indicates **mild cervical funneling**, where the internal os has started to open but is not yet significantly dilated. - While it may suggest a **higher risk** of preterm labor than a T-shaped cervix, it is less indicative of imminent preterm labor than a U-shaped cervix. *O* - An **O-shaped cervix** refers to a **completely dilated cervix**, indicating active labor is already established. - This shape signifies that both the internal and external os are widely open, representing an advanced stage of cervical dilation beyond the predictive phase.

Question 1128: What is the expected rate of cervical dilatation per hour during active labor in a primigravida?

A. 1.0 cm (Correct Answer)
B. 1.5 cm
C. 2 cm
D. 1-7 cm per hour

Explanation: ***1.0 cm*** - Historically, the **minimum expected rate** of cervical dilatation during the active phase of labor for a primigravida has been accepted as **1.0 cm per hour**. - This rate is often used to define **protraction disorders** in labor, when dilatation falls below this threshold. *1.5 cm* - This rate is typically associated with the expected cervical dilatation in **multiparous women** during active labor, who often progress faster than primigravidae. - While some primigravidae may dilate at this rate, it is not the traditionally accepted **minimum expected rate** for the entire group. *1-7 cm per hour* - This range is too broad and does not represent a specific, expected minimum rate, but rather a **wide spectrum of possible dilatation speeds**. - While actual dilatation can vary significantly, the question asks for the **expected rate**, which implies a more defined minimum or average. *2 cm* - A dilatation rate of 2 cm per hour is considered **very rapid** and, while beneficial, is not the minimum expected or average rate for a primigravida in active labor. - Such a fast rate would indicate excellent labor progression, rather than the baseline expectation.

Question 1129: When a fetus is in an attitude of flexion, which presentation is most likely?

A. Brow
B. Cephalic (Correct Answer)
C. Face
D. Transverse

Explanation: ***Cephalic*** - An **attitude of flexion** is the normal fetal attitude where the head is flexed onto the chest, with the chin tucked, and the limbs are flexed towards the body. This attitude is characteristic of a **cephalic presentation**. - In a cephalic presentation, the **head is the presenting part** to the maternal pelvis, aligning with the fetus being in a flexed attitude. *Brow* - In a brow presentation, the fetal head is **partially extended**, with the brow being the presenting part. This is an abnormal attitude, not one of complete flexion. - This presentation often leads to **labor dystocia** due to the larger presenting diameter of the head. *Face* - A face presentation involves **complete extension** of the fetal head, with the occiput touching the fetal back. The face is the presenting part. - This is an abnormal variation of cephalic presentation and is incompatible with a flexed attitude. *Transverse* - A transverse lie means the fetus is positioned horizontally across the uterus, with the **shoulder being the presenting part**. - This presentation concerns the fetal lie, not the attitude of flexion or extension of the head relative to the body.

Question 1130: What is Vagitus uterinus?

A. An infection of vagina
B. An infection of uterus
C. A cry of unborn baby from uterus (Correct Answer)
D. Infection of both vagina and uterus

Explanation: ***A cry of unborn baby from uterus*** - **Vagitus uterinus** refers to the **crying out** or **vocalization of a fetus** while still inside the uterus. - This rare phenomenon occurs when air somehow enters the uterus, allowing the fetal vocal cords to vibrate and produce a sound. *An infection of vagina* - This describes **vaginitis**, which is an inflammation of the vagina caused by infection (e.g., bacterial vaginosis, candidiasis) or other factors. - It does not involve any sound or crying from the fetus. *An infection of uterus* - This condition is known as **endometritis** (infection of the uterine lining) or **chorioamnionitis** (infection of the amniotic fluid and membranes during pregnancy). - These are inflammatory conditions of the uterus and do not involve fetal vocalization. *Infection of both vagina and uterus* - While possible to have both conditions concurrently, this description points towards a combination of **vaginitis** and **endometritis** or **chorioamnionitis**. - It has no relation to the fetal crying within the uterus.

Practice by Chapter

Physiology of Labor

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Stages of Labor and Normal Progression

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Fetal Monitoring Techniques

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Pain Management in Labor

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Induction and Augmentation of Labor

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Operative Delivery (Forceps and Vacuum)

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Cesarean Section: Indications and Techniques

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Dystocia and Abnormal Labor Patterns

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Obstetric Emergencies

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Postpartum Hemorrhage Management

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