Labor and Delivery Practice Questions

Q: Which of the following is NOT used in the treatment for postpartum hemorrhage?

Ritodrine. **Explanation:** Postpartum Hemorrhage (PPH) is primarily caused by **uterine atony** (failure of the uterus to contract after delivery). Management requires **uterotonic agents**—drugs that increase uterine contractions to compress intramyometrial blood vessels. **Why Ritodrine is the correct answer:** Ritodrine is a **Beta-2 agonist**. Its mechanism of action is to relax the uterine smooth muscle (**tocolysis**). It is used to arrest preterm labor, not to treat hemorrhage. Administering a tocolytic during PPH would worsen uterine atony and increase bleeding, making it contraindicated. **Analysis of Incorrect Options (Uterotonics used in PPH):** * **Oxytocin:** The first-line agent for both prophylaxis and treatment of PPH. It acts on G-protein coupled receptors to trigger rhythmic upper segment contractions. * **Carboprost (15-methyl PGF2α):** A potent prostaglandin used when oxytocin fails. It is administered intramuscularly but is contraindicated in patients with **asthma** due to its bronchoconstrictive effects. * **Ergometrine:** An ergot alkaloid that causes tetanic uterine contractions. It is highly effective but contraindicated in patients with **hypertension or pre-eclampsia** as it causes peripheral vasoconstriction. **NEET-PG High-Yield Pearls:** * **Definition of PPH:** Blood loss >500 ml (Vaginal) or >1000 ml (C-section). * **Active Management of Third Stage of Labor (AMTSL):** Reduces PPH risk by 60%; Oxytocin (10 IU IM) is the drug of choice. * **Misoprostol (PGE1):** Often used in resource-limited settings (600–800 mcg sublingual/rectal). * **Surgical Management:** If medical management fails, proceed to uterine artery embolization, B-Lynch sutures, or internal iliac artery ligation.

Q: What is the recommended treatment for placenta accreta?

Hysterectomy. **Explanation:** **Placenta Accreta** is a life-threatening obstetric complication where the chorionic villi adhere directly to the myometrium due to a partial or total absence of the decidua basalis. **Why Hysterectomy is the Correct Answer:** The gold standard and recommended management for placenta accreta is a **planned cesarean hysterectomy**. Attempting to detach the placenta often leads to massive, uncontrollable postpartum hemorrhage (PPH) because the placenta cannot separate naturally from the uterine wall. To minimize blood loss and maternal morbidity, the uterus is removed with the placenta left *in situ* after the delivery of the fetus. **Analysis of Incorrect Options:** * **A. Manual separation:** This is strictly **contraindicated**. Forcing separation leads to profuse hemorrhage, disseminated intravascular coagulation (DIC), and maternal mortality. * **C. Leave it alone:** While "expectant management" (leaving the placenta to resorb) is an option for women strongly desiring future fertility, it is not the *recommended* primary treatment due to high risks of delayed hemorrhage and severe infection/sepsis. * **D. Hysterectomy and removal of placenta:** This is incorrect because the placenta should **not** be removed prior to or during the hysterectomy. Attempting to remove it first triggers the very bleeding the surgery aims to avoid. **High-Yield Clinical Pearls for NEET-PG:** * **Risk Factors:** Most common risk factors are a **previous Cesarean section** and **Placenta Previa**. * **Spectrum:** Accreta (adheres to myometrium), Increta (invades myometrium), Percreta (penetrates through serosa/into bladder). * **Diagnosis:** Antenatal diagnosis is primarily via **Ultrasound/Doppler** (look for "Swiss cheese" appearance/placental lacunae and loss of retroplacental hypoechoic zone). * **Management:** If diagnosed antenatally, the surgery is ideally scheduled at **34 0/7–35 6/7 weeks** of gestation.

Q: True labor pains is represented by:

Show. **Explanation:** The diagnosis of **True Labor** is based on the presence of regular, rhythmic uterine contractions that increase in frequency and intensity, leading to progressive cervical effacement and dilatation. **Why "Show" is correct:** "Show" refers to the expulsion of the cervical mucus plug mixed with a small amount of blood (from the rupture of small capillaries as the cervix dilates). It is a classic clinical sign of true labor, indicating that cervical changes are actively occurring. While not every patient experiences a visible show, its presence is a strong diagnostic indicator of true labor. **Analysis of Incorrect Options:** * **A. Pain and discomfort in the abdomen:** In true labor, pain typically starts in the **back** and radiates to the front of the abdomen. Pain confined only to the lower abdomen or groin is more characteristic of false labor. * **C. Relieved by enema and administration of sedative:** This is a hallmark of **False Labor**. True labor pains are not relieved by sedatives, enemas, or walking; in fact, they often intensify with activity. * **D. Dull in nature:** True labor pains are described as **colicky and rhythmic**, not dull. They have a distinct pattern of contraction and relaxation. **NEET-PG High-Yield Pearls:** * **The Definitive Sign:** The single most important feature of true labor is **progressive cervical dilatation and effacement**. * **False Labor (Braxton Hicks):** Characterized by irregular contractions, no cervical changes, and relief with sedation/rest. * **Formation of Bag of Waters:** In true labor, the membranes become detached from the lower uterine segment, leading to the formation of the "bag of waters" due to cervical dilatation.

Q: A 25-year-old female presents to the casualty with a history of amenorrhea for two and a half months and abdominal pain and bleeding per vaginum for one day. On examination, vital parameters and other systems are normal. On speculum examination, bleeding is found to come from the Os. On bimanual examination, the uterus is of 10 weeks size, soft, and the Os admits one finger. What is the most likely diagnosis?

Inevitable abortion. **Explanation:** The clinical presentation of amenorrhea, vaginal bleeding, and abdominal pain in the first trimester suggests a spontaneous abortion. The definitive diagnostic feature in this case is the **dilated internal cervical os** (admits one finger) in the presence of vaginal bleeding. 1. **Inevitable Abortion (Correct):** This is defined as a clinical state where the pregnancy is complicated by vaginal bleeding and abdominal pain, and the **internal os is open**, making the continuation of pregnancy impossible. The uterine size usually corresponds to the period of amenorrhea (10 weeks in this case). 2. **Threatened Abortion (Incorrect):** While bleeding and pain are present, the hallmark of threatened abortion is a **closed internal os**. The pregnancy is potentially viable. 3. **Missed Abortion (Incorrect):** This refers to the retention of a dead fetus in utero for several weeks. Typically, the **internal os is closed**, and the uterine size is **smaller** than the period of amenorrhea. 4. **Incomplete Abortion (Incorrect):** In this condition, some products of conception have been expelled while some remain. The **os is open**, but the uterine size is typically **smaller** than the period of amenorrhea due to partial evacuation. **High-Yield Clinical Pearls for NEET-PG:** * **Os Status is Key:** If the Os is **Closed**, it is either Threatened, Missed, or Complete abortion. If the Os is **Open**, it is either Inevitable or Incomplete abortion. * **Management of Inevitable Abortion:** If 12 weeks, uterine contraction is induced via Oxytocin or Prostaglandins. * **Uterine Size:** In Inevitable abortion, Uterine Size = Period of Amenorrhea. In Incomplete/Missed abortion, Uterine Size < Period of Amenorrhea.

Q: What is the ideal management for a 37-week pregnant elderly primigravida with placenta previa and active bleeding?

Cesarean section. **Explanation:** The correct management is **Cesarean section** because the patient is at term (37 weeks) and presenting with active bleeding due to placenta previa. In placenta previa, the placenta is implanted over the internal os; as the cervix dilates, the placental attachments are sheared, leading to life-threatening maternal hemorrhage and fetal distress. 1. **Why Cesarean Section is Correct:** At 37 weeks, the fetus is mature. Since the placenta obstructs the birth canal, vaginal delivery is contraindicated as it would cause massive bleeding. Immediate delivery via Cesarean section is the definitive treatment to save both mother and child when there is active bleeding at term. 2. **Why other options are incorrect:** * **Labor induction/Vaginal delivery:** These are contraindicated in placenta previa (especially if the edge is <2cm from the os) because the presenting part cannot engage, and cervical dilation will cause catastrophic hemorrhage. * **Expectant management (MacAfee regime):** This is only indicated if the pregnancy is <37 weeks, the bleeding is slight/stopped, and both mother and fetus are stable. Since this patient is 37 weeks (term) and has active bleeding, expectant management is no longer appropriate. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Diagnosis:** Transvaginal Ultrasound (TVS) is the most accurate and safe method to localize the placenta. * **Contraindication:** Never perform a per-vaginal (PV) examination in a case of antepartum hemorrhage until placenta previa is ruled out, as it can provoke torrential bleeding (the "Stallworthy's sign" may be seen on abdominal exam). * **Elderly Primigravida:** This factor increases the risk of complications, further favoring a controlled surgical delivery.

Q: What is the designated fetal station when the lowermost portion of the presenting fetal part is at the level of the ischial spines?

0. ### Explanation **Correct Option: C (0)** **Underlying Medical Concept:** Fetal station is a clinical measurement used to describe the descent of the presenting part (usually the fetal head) through the birth canal in relation to the maternal **ischial spines**. The ischial spines serve as the fixed anatomical landmark for **Station 0** because they represent the narrowest diameter of the pelvic mid-cavity. When the leading bony part of the fetus reaches this level, the biparietal diameter has typically entered the pelvic inlet, signifying that the head is **engaged**. **Analysis of Incorrect Options:** * **Option A (-2) and B (-1):** These represent stations **above** the ischial spines. Negative numbers indicate the distance in centimeters (e.g., -2 is 2 cm above the spines). These are seen during the early stages of labor before engagement is complete. * **Option D (+1):** Positive numbers represent stations **below** the ischial spines. A +1 station means the presenting part is 1 cm below the level of the spines, moving toward the pelvic outlet. **Clinical Pearls for NEET-PG:** * **Engagement:** Defined as the passage of the widest transverse diameter (biparietal diameter) through the pelvic inlet. Clinically, this corresponds to Station 0. * **DeLee vs. Modified System:** While the traditional DeLee system divided the pelvis into 1/5ths, the modern **ACOG classification** uses centimeters (-5 to +5). * **Caput Succedaneum:** Be cautious during vaginal exams; significant scalp edema (caput) can give a false impression of a lower station than the actual bony vault. * **Ischial Spines:** These are also the landmark for performing a **Pudendal Nerve Block** during the second stage of labor.

Question 1

What is the common cause of death in inversion of the uterus?

Accepted Answer

Hemorrhage

Answer

Neurogenic shock

Answer

Pulmonary embolism

Answer

Infection

Question 2

A 30-year-old gravida 3 presents to the Gynaecology OPD with a 6-month history of amenorrhea, vaginal bleeding for 1 day, and significant pallor. Her ultrasound findings indicate a 28-week intrauterine fetal death with placental abruption. What is the best line of management?

Accepted Answer

Artificial rupture of membranes with Syntocinon drip and arrange for blood transfusion

Answer

Immediate cesarean section

Answer

Artificial rupture of membranes with oxytocin drip

Answer

Wait for spontaneous onset of labor

Question 3

Which of the following is NOT used in the treatment for postpartum hemorrhage?

Accepted Answer

Ritodrine

Answer

Oxytocin

Answer

Carboprost

Answer

Ergometrine

Question 4

What is the recommended treatment for placenta accreta?

Accepted Answer

Hysterectomy

Answer

Manual separation

Answer

Leave it alone

Answer

Hysterectomy and removal of placenta

Question 5

True labor pains is represented by:

Accepted Answer

Show

Answer

Pain and discomfort in the abdomen

Answer

Relieved by enema and administration of sedative

Answer

Dull in nature

Question 6

Regarding insulin management during labor, all are true except?

Accepted Answer

Blood glucose level during labor should be maintained above 140 mg/dL.

Answer

Usual dose of intermediate-acting insulin is given at bedtime.

Answer

Morning dose of insulin is withheld.

Answer

Once labor begins, normal saline infusion is changed to 5% dextrose.

Question 7

A 25-year-old female presents to the casualty with a history of amenorrhea for two and a half months and abdominal pain and bleeding per vaginum for one day. On examination, vital parameters and other systems are normal. On speculum examination, bleeding is found to come from the Os. On bimanual examination, the uterus is of 10 weeks size, soft, and the Os admits one finger. What is the most likely diagnosis?

Accepted Answer

Inevitable abortion

Answer

Threatened abortion

Answer

Missed abortion

Answer

Incomplete abortion

Question 8

What is the ideal management for a 37-week pregnant elderly primigravida with placenta previa and active bleeding?

Accepted Answer

Cesarean section

Answer

Labor induction

Answer

Vaginal delivery

Answer

Expectant management

Question 9

What is the designated fetal station when the lowermost portion of the presenting fetal part is at the level of the ischial spines?

Accepted Answer

0

Answer

-2

Answer

-1

Answer

+1

Question 10

All of the following are true about the delivery of the placenta in the third stage of labor, EXCEPT?

Accepted Answer

Separation of the placenta always manifests as revealed bleeding per vaginam, and is the most specific sign.

Answer

Lengthening of the umbilical cord is a sign of placental separation.

Answer

The fundus of the uterus must be palpated after placental delivery to rule out atonicity.

Answer

Placenta accreta may be a cause for retained placenta.

Labor and Delivery — MCQs

Labor and Delivery — MCQs

On this page

Practice by Chapter

Want unlimited practice?