Labor and Delivery Practice Questions

Q: Which of the following is NOT a tocolytic agent?

Dinoprostone. **Explanation:** The core concept tested here is the pharmacological management of uterine activity. **Tocolytics** are drugs used to inhibit uterine contractions to delay preterm labor, whereas **Uterotonics** are drugs used to stimulate contractions. **Why Dinoprostone is the correct answer:** **Dinoprostone (Prostaglandin E2)** is a potent **uterotonic** agent. Its primary clinical uses are for cervical ripening and the induction of labor. It acts by increasing intracellular calcium in the myometrium, leading to contractions. Therefore, it is the opposite of a tocolytic. **Analysis of Incorrect Options (Tocolytic Agents):** * **Nifedipine:** A Calcium Channel Blocker (CCB). It is currently the **first-line tocolytic** in many guidelines due to its high efficacy and favorable side-effect profile. It works by preventing calcium entry into myometrial cells. * **MgSO4 (Magnesium Sulfate):** While primarily used for neuroprotection in preterm birth and seizure prophylaxis in eclampsia, it acts as a tocolytic by competing with calcium at the motor endplate. * **Terbutaline:** A Beta-2 adrenergic agonist. It increases cAMP levels, which leads to myometrial relaxation. It is often used for "acute tocolysis" to manage uterine hyperstimulation. **High-Yield Clinical Pearls for NEET-PG:** * **Drug of choice for Tocolysis:** Nifedipine (CCB). * **Specific Tocolytic:** Atosiban (Oxytocin receptor antagonist) is highly specific with the fewest side effects but is expensive. * **Indomethacin (NSAID):** Used as a tocolytic before 32 weeks; contraindicated after 32 weeks due to the risk of premature closure of the *ductus arteriosus*. * **Absolute Contraindication for Tocolysis:** Chorioamnionitis, lethal fetal anomaly, or severe abruption.

Q: What is the most common presentation of a breech presentation?

Left sacroposterior. In breech presentation, the **sacrum** is the denominator. The position is determined by the relationship of the fetal sacrum to the maternal pelvis. ### **Explanation of the Correct Answer** **B. Left Sacroposterior (LSP)** is the most common position in breech presentation. The underlying medical concept relates to the shape of the maternal pelvis and the adaptation of the fetus. In a normal gynecoid pelvis, the left oblique diameter is slightly more spacious due to the presence of the sigmoid colon on the left side of the pelvic brim. This anatomical configuration encourages the fetal sacrum to orient itself toward the **left posterior** segment of the maternal pelvis. ### **Analysis of Incorrect Options** * **D. Left Sacroanterior (LSA):** While LSA is the second most common position, it is less frequent than LSP. (Note: In cephalic presentations, the "Anterior" positions like LOA/ROA are more common, but breech follows a different mechanical preference). * **A & C. Right Sacroanterior/Posterior:** Right-sided positions are less common because the right oblique diameter of the pelvis is often more encroached upon by the bulk of the liver and the specific curvature of the lower spine, making the left side the path of least resistance for the fetal back. ### **High-Yield Clinical Pearls for NEET-PG** * **Denominator:** The Sacrum. * **Most Common Variety of Breech:** Frank breech (extended breech), especially in primigravidae. * **Incidence:** Breech occurs in approximately 3–4% of term pregnancies. * **Diagnosis:** Confirmed by Leopold’s maneuvers (hard, round head at the fundus) and Vaginal Examination (feeling the ischial tuberosities and anus). * **Management:** External Cephalic Version (ECV) is typically offered at 36 weeks in primigravidae and 37 weeks in multigravidae.

Q: What is the average duration of the third stage of labor?

15 minutes. **Explanation:** The **third stage of labor** begins immediately after the delivery of the fetus and ends with the complete expulsion of the placenta and membranes. **Why 15 minutes is correct:** In modern obstetric practice, the average duration of the third stage is approximately **15 minutes**. While the physiological process can take longer, the widespread use of **Active Management of Third Stage of Labor (AMTSL)**—which includes the administration of uterotonics (Oxytocin), controlled cord traction (CCT), and uterine massage—has significantly reduced the average duration to this timeframe. **Analysis of Incorrect Options:** * **5 minutes (Option D):** While the placenta can occasionally separate very rapidly, 5 minutes is shorter than the average duration for most women. * **45 minutes (Option A) & 60 minutes (Option C):** These durations are considered pathologically prolonged. In clinical practice, the third stage is defined as **prolonged** if it exceeds **30 minutes** with AMTSL or **60 minutes** with expectant management. Prolonged third stage significantly increases the risk of Postpartum Hemorrhage (PPH). **NEET-PG High-Yield Pearls:** * **Definition of Retained Placenta:** If the placenta is not delivered within 30 minutes (with AMTSL), it is termed a retained placenta, necessitating manual removal. * **Signs of Placental Separation:** 1. **Schultze mechanism:** Central separation (most common, 80%). 2. **Matthews Duncan mechanism:** Peripheral separation (20%). * **Clinical Signs of Separation:** Sudden gush of blood, lengthening of the umbilical cord, and the uterus becoming firm, globular, and rising in the abdomen (Calkin’s sign). * **Drug of Choice for AMTSL:** Injection Oxytocin (10 IU IM or 5 IU slow IV).

Q: What is the ideal management of a 37-week uncomplicated breech pregnancy?

External cephalic version and trial of vaginal delivery. ### Explanation **1. Why Option C is Correct:** The management of a breech presentation at term (37 weeks or beyond) focuses on reducing the risks associated with breech vaginal delivery while avoiding unnecessary surgery. **External Cephalic Version (ECV)** is the preferred initial management for an uncomplicated breech pregnancy at 37 weeks. If successful, it converts the fetus to a cephalic presentation, allowing for a **Trial of Labor After Version (TOLAV)**. ECV has a success rate of approximately 50-60% and significantly reduces the rate of Cesarean Sections (CS). **2. Why Other Options are Incorrect:** * **Option A (Spontaneous Vaginal Delivery):** While possible, a planned vaginal breech delivery is associated with higher perinatal morbidity and mortality compared to cephalic delivery or planned CS (as per the *Term Breech Trial*). It is generally reserved for specific criteria (e.g., frank breech, flexed head) or emergency situations. * **Option B (Elective Cesarean Section):** While many clinicians opt for CS for breech, it is not the "ideal" first step for an *uncomplicated* case at 37 weeks. ECV should be offered first to provide the patient the opportunity for a safer vaginal delivery. **3. Clinical Pearls for NEET-PG:** * **Timing of ECV:** Performed at **37 weeks** in nulliparous women (to allow for spontaneous version before 37 weeks and ensure fetal maturity if labor is induced by the procedure). * **Prerequisites for ECV:** Reactive NST, adequate liquor (AFI >5), and no contraindications (e.g., placenta previa, prior classical CS, or oligohydramnios). * **Tocolysis:** Beta-mimetics (like Ritodrine or Terbutaline) are often used to relax the uterus during ECV to increase success rates. * **Most common type of breech:** Frank breech (extended legs). * **Safety:** The most common complication of ECV is transient fetal bradycardia.

Q: What does the presence of fibronectin in a fetus indicate?

Preterm labor. **Explanation:** **Fetal Fibronectin (fFN)** is a high-molecular-weight glycoprotein that acts as a "biological glue," anchoring the fetal membranes (chorioamnion) to the maternal decidua. 1. **Why Preterm Labor is Correct:** Under normal physiological conditions, fFN is present in cervicovaginal secretions before 20 weeks and again near term (after 37 weeks) as the body prepares for labor. However, its presence between **22 and 34 weeks** indicates a disruption of the choriodecidual interface. This leakage into the vagina serves as a potent biochemical marker for **Preterm Labor (PTL)**. Its clinical strength lies in its **High Negative Predictive Value (95-99%)**: if fFN is absent, there is a <1% chance the patient will deliver within the next 7–14 days. 2. **Why Other Options are Incorrect:** * **Post-dated pregnancy:** fFN is naturally present at term and post-term due to the physiological breakdown of the choriodecidual interface; it is not a diagnostic marker for post-maturity. * **Pre-eclampsia:** This is a multi-system hypertensive disorder related to placental implantation and endothelial dysfunction. It is diagnosed via blood pressure and proteinuria, not fFN. **Clinical Pearls for NEET-PG:** * **Prerequisites for fFN Test:** The test must be performed before a digital vaginal exam or transvaginal ultrasound. * **False Positives:** Recent sexual intercourse (semen), vaginal bleeding, or use of lubricants/antiseptics within the last 24 hours can cause false-positive results. * **Cut-off Value:** A concentration of **>50 ng/mL** is considered a positive result.

Question 1

Which of the following is NOT a tocolytic agent?

Accepted Answer

Dinoprostone

Answer

Nifedipine

Answer

MgSO4

Answer

Terbutaline

Question 2

What is the most common presentation of a breech presentation?

Accepted Answer

Left sacroposterior

Answer

Right sacroanterior

Answer

Right sacroposterior

Answer

Left sacroanterior

Question 3

A 30-year-old lady presented with strong labor pains for the last 3 hours and no progress, found to have pelvic deformities leading to cephalopelvic disproportion. The baby was delivered by cesarean section. The woman is likely to have suffered from the deficiency of which vitamin?

Accepted Answer

Vitamin D

Answer

Vitamin B

Answer

Vitamin C

Answer

Vitamin A

Question 4

Which of the following interventions is NOT recommended in the active management of the third stage of labor?

Accepted Answer

Immediate clamping, cutting, and ligation of the cord

Answer

Administration of uterotonic within 1 minute of delivery

Answer

Gentle massage of the uterus

Answer

Controlled cord traction

Question 5

What is the average duration of the third stage of labor?

Accepted Answer

15 minutes

Answer

45 minutes

Answer

60 minutes

Answer

5 minutes

Question 6

What is the ideal management of a 37-week uncomplicated breech pregnancy?

Accepted Answer

External cephalic version and trial of vaginal delivery

Answer

Spontaneous vaginal delivery

Answer

Elective cesarean section

Answer

None of the above

Question 7

What does the presence of fibronectin in a fetus indicate?

Accepted Answer

Preterm labor

Answer

Post-dated pregnancy

Answer

Pre-eclampsia

Answer

None of the above

Question 8

Delayed labour occurs in which of the following conditions?

Accepted Answer

Early use of epidural anesthesia with analgesia, Early use of analgesia, Preeclampsia, Use of sedative early in course of labour

Answer

Early use of epidural anesthesia with analgesia, Early use of analgesia, Unripened cervix, Preeclampsia

Answer

Early use of epidural anesthesia with analgesia, Unripened cervix, Preeclampsia, Use of sedative early in course of labour

Question 9

Which of the following is NOT a feature of uterine contraction in spastic lower segment?

Accepted Answer

Presence of fundal dominance

Answer

There may be reversed polarity

Answer

Inadequate relaxation in between contractions

Answer

Basal tonus is usually raised above the critical level of 20 mm Hg

Question 10

In modern-day obstetrics, what is the most common cause of uterine rupture?

Accepted Answer

Previous lower segment caesarean section scar rupture

Answer

Prolonged labor

Answer

Forceps delivery

Answer

Internal podalic version

Labor and Delivery — MCQs

Labor and Delivery — MCQs

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