Labor and Delivery — MCQs

Labor and Delivery Indian Medical PG Practice Questions and MCQs

Question 1131: Which delivery method is associated with the least risk of HIV transmission during childbirth?

A. Forceps delivery
B. ARM
C. Vacuum delivery
D. Cesarean section (Correct Answer)

Explanation: ***Cesarean section*** - **Elective Cesarean section** (scheduled at 38 weeks) reduces the risk of **mother-to-child HIV transmission** when maternal **viral load is >1000 copies/mL** or unknown near delivery. - It avoids exposure to maternal blood and genital secretions during passage through the birth canal. - With effective **antiretroviral therapy (ART)** and viral suppression (<50 copies/mL), vaginal delivery is safe and C-section offers **no additional benefit**. - Among delivery methods compared without considering viral suppression, C-section has the **lowest transmission risk**. *Forceps delivery* - **Forceps delivery** increases risk of fetal trauma and scalp lacerations, potentially increasing exposure to maternal blood. - May cause **vaginal lacerations** in the mother, increasing blood exposure. - Should be avoided when possible in HIV-positive mothers, especially with detectable viral loads. *ARM (Artificial Rupture of Membranes)* - **ARM** prolongs duration of ruptured membranes, increasing fetal exposure time to potentially infected genital tract secretions. - Removes the protective barrier of intact membranes. - While not a delivery method per se, prolonged rupture of membranes (>4 hours) is associated with **increased transmission risk**. *Vacuum delivery* - **Vacuum delivery** can cause scalp abrasions, cephalohematomas, or subgaleal hemorrhage, creating portals for viral entry. - Increases trauma to both fetal scalp and maternal birth canal. - Should be avoided in HIV-positive mothers when other options are available.

Question 1132: Which of the following is the shortest diameter of the fetal head?

A. Biparietal diameter
B. Suboccipitofrontal diameter
C. Occipitofrontal diameter
D. Bitemporal diameter (Correct Answer)

Explanation: ***Bitemporal diameter*** - The **bitemporal diameter** measures the distance between the two temporal bones and is typically **8.0 cm**, making it the **shortest diameter** of the fetal head. - This is a transverse measurement and is important in assessing cephalopelvic disproportion. *Biparietal diameter* - The **biparietal diameter** measures between the two parietal eminences and is typically about **9.5 cm**. - It is the most commonly measured diameter during ultrasound for assessing **fetal growth** and **gestational age**. - This is the presenting diameter in **well-flexed vertex presentation** (suboccipitobregmatic plane). *Suboccipitofrontal diameter* - The **suboccipitofrontal diameter** measures from the subocciput (below the occipital protuberance) to the center of the anterior fontanelle and is approximately **10.0 cm**. - This diameter presents in **deflexed vertex presentation** or **military attitude** where the head is in a neutral position (neither flexed nor extended). *Occipitofrontal diameter* - The **occipitofrontal diameter** measures from the occipital prominence to the glabella (root of the nose) and is about **11.5 cm**. - This is the presenting diameter in **persistent occipitoposterior position** with deflexion or in early stages before full flexion occurs.

Question 1133: In the pelvic inlet, which is the shortest anteroposterior diameter?

A. Obstetric conjugate (Correct Answer)
B. Anatomical conjugate
C. Bispinous diameter
D. True conjugate

Explanation: ***Obstetric conjugate*** - The obstetric conjugate extends from the **posterior surface** of the **symphysis pubis** to the middle of the **sacral promontory**. - It is the **shortest anteroposterior diameter** of the pelvic inlet, measuring approximately **10.5-11 cm**. - This is the most clinically important measurement as it represents the actual available space for the fetal head during delivery. - It is shorter than the anatomical conjugate by approximately 1-1.5 cm (the thickness of the symphysis pubis). *Anatomical conjugate* - This diameter measures from the **superior border** of the **symphysis pubis** to the **sacral promontory**. - It measures approximately **11.5 cm**, making it slightly longer than the obstetric conjugate. - It doesn't account for the inward projection of the posterior surface of the symphysis pubis into the pelvic cavity. *Bispinous diameter* - The bispinous diameter is a **transverse diameter** (not anteroposterior), measuring the distance between the **ischial spines**. - This measurement belongs to the **midpelvis** (pelvic cavity), not the pelvic inlet. - Since the question asks specifically for an **anteroposterior diameter** of the pelvic inlet, this option is categorically incorrect. *True conjugate* - The true conjugate is synonymous with the **anatomical conjugate**, measuring from the **superior border** of the **symphysis pubis** to the **sacral promontory**. - It is not the shortest anteroposterior diameter; the obstetric conjugate is functionally shorter due to measurement from the posterior (rather than superior) surface of the symphysis pubis.

Question 1134: Which of the following is the ideal method of removal of the placenta after delivery in routine delivery cases?

A. Manual removal of placenta after delivery of baby
B. Immediate & firm traction of cord after delivery of baby
C. Crede's method (Fundal pressure squeezing uterus to help placental separation and delivery)
D. Spontaneous separation of placenta or by controlled cord traction (Correct Answer)

Explanation: ***Spontaneous separation of placenta or by controlled cord traction*** - This method, often part of **active management of the third stage of labor**, combines **controlled cord traction** with uterine massage and oxytocin administration. It aims to reduce the risk of **postpartum hemorrhage**. - **Controlled cord traction** should only be applied after signs of placental separation are evident to avoid uterine inversion. *Manual removal of placenta after delivery of baby* - This is a more invasive procedure, usually reserved for cases of **retained placenta** where spontaneous separation or controlled cord traction has failed. - It carries a higher risk of complications such as **infection** and uterine trauma. *Immediate & firm traction of cord after delivery of baby* - **Immediate and firm traction** can lead to complications such as **cord avulsion**, **uterine inversion**, and **hemorrhage** if the placenta has not separated. - Traction should only be applied under gentle and sustained manner and after clear signs of placental separation. *Crede's method (Fundal pressure squeezing uterus to help placental separation and delivery)* - **Crede's method** involves vigorous fundal pressure to express the placenta, which is now largely discouraged due to the risk of **uterine inversion**, trauma, and pain. - Modern obstetrical practice favors less aggressive and safer methods for placental expulsion.

Question 1135: A pregnant woman comes at 40 weeks' gestation, with a fundal height measuring 34 cm. USG shows a maximum vertical pocket of liquor less than 2 cm and an AFI of 3 cm. Which of the following statements is false regarding the management of this case scenario?

A. Do induction if vaginal delivery is not contraindicated
B. During labour, cord compression is common in these patients
C. Strict intrapartum fetal surveillance
D. If cervix is unripe, immediate LSCS should be considered (Correct Answer)

Explanation: ***If cervix is unripe, immediate LSCS should be considered.*** - This statement is **false**. In cases of **oligohydramnios** at term, particularly with a favorable cervix, **labor induction** is generally preferred over immediate C-section. - An unripe cervix does not automatically necessitate an immediate C-section; rather, cervical ripening agents (e.g., prostaglandins) can be used to prepare the cervix for induction. *Do induction if vaginal delivery is not contraindicated* - This is a **correct management strategy** for oligohydramnios at term, provided there are no contraindications to vaginal birth (e.g., placenta previa, severe fetal distress pre-labor). - **Induction** allows for controlled labor and delivery with close fetal monitoring. *During labour, cord compression is common in these patients* - This statement is **true**. **Oligohydramnios** (AFI ≤ 5 cm or maximum vertical pocket < 2 cm) significantly increases the risk of **umbilical cord compression** during labor. - Reduced amniotic fluid means less cushioning protection for the umbilical cord, leading to potential variable decelerations and fetal compromise. *Strict intrapartum fetal surveillance* - This statement is **true** and crucial for managing oligohydramnios during labor. Given the increased risk of **fetal compromise** (e.g., from cord compression), continuous electronic fetal monitoring is essential. - This allows for early detection of **fetal distress** and timely intervention, if necessary.

Question 1136: Which type of pelvis is most suitable for childbirth in females?

A. Gynaecoid (Correct Answer)
B. Android
C. Anthropoid
D. Platypelloid

Explanation: ***Gynaecoid*** - The **gynaecoid pelvis** is considered the classic female pelvis, with an **adequate, rounded inlet** and spacious dimensions that are optimal for vaginal delivery. - It has a wide and deep sacral curve, a wide subpubic angle, and parallel side walls, all facilitating the passage of the fetal head. *Android* - The **android pelvis** is typically male-like, characterized by a **heart-shaped or wedge-shaped inlet** and a narrow subpubic angle. - This shape makes it more difficult for the fetal head to engage and descend, often leading to prolonged labor or necessitating a cesarean section. *Anthropoid* - The **anthropoid pelvis** has an **oval-shaped inlet** that is wider in the anterior-posterior diameter and narrower in the transverse diameter. - While possible for delivery, the narrow transverse diameter can sometimes lead to difficulty with engagement or require a persistent occiput posterior presentation. *Platypelloid* - The **platypelloid pelvis** is characterized by a **flat, transverse oval inlet** and a short anterior-posterior diameter. - This shape is the least common and presents significant challenges for vaginal delivery, as the fetal head may not be able to engage due to the narrow anterior-posterior diameter.

Question 1137: In which of these scenarios is a medial episiotomy preferred over a medio-lateral episiotomy during delivery? (Select one option)

A. Before application of forceps in an operative vaginal delivery
B. Prolonged second stage of labor with fetal distress requiring immediate delivery
C. Uncomplicated delivery in a multiparous woman with adequate perineal length and low risk of complications (Correct Answer)
D. Nullipara with a thick perineum and high risk of severe perineal tears

Explanation: ***Uncomplicated delivery in a multiparous woman with adequate perineal length and low risk of complications*** - A **medial episiotomy** is generally preferred in situations with **low risk of severe perineal tears** due to its easier repair and less pain post-delivery. - In a multiparous woman with **adequate perineal length**, the risk of **anal sphincter involvement** is lower, making a medial episiotomy a safer choice. *Before application of forceps in an operative vaginal delivery* - This scenario often has a **higher risk of severe perineal tears**, which makes a **mediolateral episiotomy** more appropriate to prevent **anal sphincter damage**. - **Forceps delivery** significantly increases the likelihood of 3rd and 4th-degree tears, which medial episiotomy offers less protection against. *Prolonged second stage of labor with fetal distress requiring immediate delivery* - In situations of **fetal distress**, a **mediolateral episiotomy** is preferred due to its ability to provide **rapid and wider access** to facilitate a faster delivery. - The primary concern here is the **expedited delivery** of the fetus, and a mediolateral approach generally offers more space while decreasing the risk of **anal sphincter injury** compared to a medial one. *Nullipara with a thick perineum and high risk of severe perineal tears* - A **mediolateral episiotomy** is indicated in this situation to reduce the risk of **severe perineal trauma**, including **third and fourth-degree tears**. - **Nulliparity** and a **thick perineum** are risk factors for extensive perineal damage, making the protective nature of a mediolateral cut more favorable.

Question 1138: Which of the following is not a prerequisite for the internal rotation of the fetal head during labor?

A. Efficient uterine contraction
B. Favourable shape of the pelvis
C. Well flexed head
D. Inadequate tone of the abdominal muscles (Correct Answer)

Explanation: ***Inadequate tone of the abdominal muscles*** - While **abdominal muscle tone** can influence the efficiency of maternal pushing efforts in the second stage of labor, it is **not a prerequisite** for the internal rotation of the fetal head. - Internal rotation is primarily a passive process driven by the interaction between the fetal head and the **pelvic floor muscles** and **pelvic architecture**. *Well flexed head* - A **well-flexed head** presents the smallest diameters (e.g., **suboccipitobregmatic diameter**) to the pelvis, allowing for easier passage and rotation. - Less optimal flexion (deflexion) can lead to larger presenting diameters and hinder internal rotation, often resulting in **asynclitism** or **malpositions**. *Efficient uterine contraction* - **Efficient uterine contractions** are crucial for exerting downward pressure on the fetus, which drives the fetal head into the pelvis and facilitates its descent and rotation. - **Inadequate contractions** can lead to **protracted labor** and failure of descent and rotation. *Favourable shape of the pelvis* - A **gynacoid pelvis**, with its rounded inlet and well-curved sacrum, provides the optimal dimensions and shape for the fetal head to engage and rotate. - A **contracted pelvis** or an **android/anthropoid pelvis** can impede rotation and lead to malpositions due to their less favorable shape and dimensions.

Question 1139: Which maneuver is not performed for shoulder dystocia?

A. Wood's maneuver
B. Zavanelli maneuver
C. McRoberts maneuver
D. Mauriceau-Smellie-Veit technique (Correct Answer)

Explanation: ***Mauriceau-Smellie-Veit technique*** - This technique is a maneuver used in the delivery of the **aftercoming head** in a **breech presentation**, not for shoulder dystocia. - It involves **flexing the fetal head** upon the chest to facilitate delivery, often requiring an assistant to apply pressure above the symphysis. *McRoberts maneuver* - The **McRoberts maneuver** is a common and effective initial intervention for shoulder dystocia, involving hyperflexion of the mother's hips towards her abdomen [1]. - This action changes the **pelvic tilt**, rotating the symphysis pubis superiorly to free the impacted shoulder [1]. *Wood's maneuver* - **Wood's maneuver** is a technique used to resolve shoulder dystocia, where the posterior shoulder is rotated to a more oblique diameter within the maternal pelvis [1]. - This involves applying pressure to the posterior aspect of the fetal clavicle to spin the shoulder. *Zavanelli maneuver* - The **Zavanelli maneuver** is a rare and extreme intervention for severe shoulder dystocia, involving the **replacement of the fetal head back into the uterus** for subsequent cesarean delivery. - It involves head flexion, reverse rotation, and pushing the head back into the vagina to allow for a laparotomy.

Question 1140: What marks the beginning of the second stage of labor?

A. Complete cervical dilation (Correct Answer)
B. Beginning of fetal descent
C. Expulsion of placenta
D. Internal rotation during labor

Explanation: ***Complete cervical dilation*** - The **second stage of labor** officially begins once the cervix is **fully dilated to 10 centimeters**, allowing for the passage of the fetal head. - This stage is characterized by the mother's active pushing efforts and culminates in the birth of the baby. *Beginning of fetal descent* - While fetal descent occurs during labor, it is an ongoing process that starts before **complete cervical dilation**. - Significant fetal descent is a feature of the second stage, but not its defining start point. *Expulsion of placenta* - The expulsion of the placenta marks the **third stage of labor**, which follows the birth of the baby. - This event signals the completion of the birthing process, not the beginning of the second stage. *Internal rotation during labor* - **Internal rotation** is a mechanism of labor that occurs as the fetal head descends through the pelvis, typically during the first and early second stages. - It is a fetal movement for optimal fit within the maternal pelvis, rather than a marker for the onset of a specific labor stage.

Practice by Chapter

Physiology of Labor

Practice Questions

Stages of Labor and Normal Progression

Practice Questions

Fetal Monitoring Techniques

Practice Questions

Pain Management in Labor

Practice Questions

Induction and Augmentation of Labor

Practice Questions

Operative Delivery (Forceps and Vacuum)

Practice Questions

Cesarean Section: Indications and Techniques

Practice Questions

Dystocia and Abnormal Labor Patterns

Practice Questions

Obstetric Emergencies

Practice Questions

Postpartum Hemorrhage Management

Practice Questions

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