Labor and Delivery Practice Questions

Q: Bandl's ring is associated with which of the following?

Cephalopelvic disproportion. **Explanation:** **Bandl’s Ring** (Pathological Retraction Ring) is a hallmark sign of **obstructed labor**. It occurs when there is a physical barrier to the descent of the fetus, most commonly due to **Cephalopelvic Disproportion (CPD)** or malpresentation. 1. **Why A is correct:** In obstructed labor, the upper uterine segment contracts and thickens vigorously to overcome the obstruction, while the lower uterine segment becomes progressively thinner and distended. The junction between these two segments becomes visible and palpable as a horizontal ridge known as Bandl’s ring. If the obstruction (CPD) is not relieved, this leads to imminent uterine rupture. 2. **Why B is incorrect:** While fetal death can occur as a *consequence* of prolonged obstructed labor, it is not the cause of Bandl’s ring. 3. **Why C is incorrect:** Uterine inertia refers to weak or absent contractions. Bandl’s ring requires *hyperactive* contractions of the upper segment; in inertia, the uterus is too weak to form a retraction ring. 4. **Why D is incorrect:** Placenta previa is a cause of antepartum hemorrhage. While it may necessitate a C-section, it does not typically present with the hyper-contractile state seen in obstructed labor unless labor is allowed to progress against an obstruction. **High-Yield Clinical Pearls for NEET-PG:** * **Location:** Bandl’s ring is situated at the junction of the upper and lower uterine segments. * **Clinical Sign:** It is a late sign of obstructed labor and a warning of **impending uterine rupture**. * **Management:** Immediate delivery, usually via **Emergency Cesarean Section**. * **Distinction:** Do not confuse it with a **Constriction Ring**, which is a localized spasm of the uterine muscle that can occur at any level and is not associated with uterine rupture.

Q: In which type of abortion does the gestational age correspond to the uterine size?

Threatened. In clinical practice, comparing uterine size to the period of amenorrhea (POA) is a high-yield diagnostic tool for differentiating types of abortion. ### **Why Threatened Abortion is Correct** In **Threatened Abortion**, the pregnancy is still viable. The fetus is alive, the cervical os remains closed, and the products of conception (POC) are entirely intact within the uterine cavity. Because no tissue has been expelled and the gestational sac continues to develop, the **uterine size corresponds to the gestational age.** ### **Why Other Options are Incorrect** * **Inevitable Abortion:** While the POC are still inside, there is often associated cervical dilation and significant hemorrhage. In some cases, the uterus may feel slightly smaller due to the rupture of membranes or beginning of expulsion, though it is primarily distinguished from threatened abortion by the *open* cervical os. * **Complete Abortion:** All products of conception have been expelled. Consequently, the uterus is empty and contracted, making the **uterine size significantly smaller** than the period of amenorrhea. * **Missed Abortion (often confused with 'Mixed'):** The fetus has died but is retained. Over time, the amniotic fluid is absorbed and the placenta atrophies, leading to a **uterine size smaller** than the gestational age. ### **High-Yield Clinical Pearls for NEET-PG** * **Uterine Size POA:** Molar pregnancy, Multiple pregnancy, Polyhydramnios, or incorrect dates. * **Cervical Os:** It is **closed** in Threatened and Missed abortions; it is **open** in Inevitable and Incomplete abortions. * **Management:** Threatened abortion is managed conservatively with bed rest and follow-up; Inevitable abortion requires suction evacuation.

Q: True about intrauterine fetal death (IUD)?

Overlapping of skull bones. **Explanation:** Intrauterine Fetal Death (IUFD) is characterized by specific radiological signs that occur due to the cessation of circulation and subsequent degenerative changes in the fetus. **1. Why Option C is Correct:** **Spalding’s Sign** refers to the **overlapping of fetal skull bones**. It occurs due to the liquefaction of the brain matter and loss of intracranial pressure following fetal death. This sign typically appears 4–7 days after death. It is a classic radiological marker for IUFD, provided the mother is not in labor (as molding during labor can also cause overlapping). **2. Analysis of Incorrect Options:** * **Option A (Gas bubbles in great vessels):** This is known as **Robert’s Sign**. While it is a sign of IUFD, it is caused by the liberation of gas (CO2) from blood decomposition. However, it is an early sign (appearing within 12 hours) and is less commonly tested or specific compared to Spalding's sign in clinical scenarios. * **Option B (Halo’s Sign):** This refers to the elevation of the scalp fat layer due to edema, creating a "halo" appearance. While associated with IUFD (Deuel’s halo sign), it is non-specific and can also be seen in cases of fetal hydrops or maternal diabetes. * **Option D (Decreased amniotic fluid):** While oligohydramnios may be associated with the cause of death (e.g., renal agenesis or placental insufficiency), it is not a diagnostic radiological sign of the death itself. **Clinical Pearls for NEET-PG:** * **Earliest Sign of IUFD:** Robert’s Sign (Gas in the heart/great vessels). * **Most Common Sign:** Spalding’s Sign. * **Confirmatory Test of Choice:** Real-time Ultrasound showing absence of fetal cardiac activity. * **Spalding’s Sign Mimic:** Can be false-positive in a live fetus during active labor due to molding or in cases of severe dehydration.

Q: What cervical length is associated with an increased risk of preterm delivery?

2.5 cm. **Explanation:** The cervical length (CL) measured via **Transvaginal Ultrasound (TVS)** is a powerful predictor of spontaneous preterm birth (PTB). In a normal pregnancy, the cervix remains long and closed until near term. A cervical length of **<25 mm (2.5 cm)** before 24 weeks of gestation is the standard diagnostic threshold for a "short cervix," which significantly increases the risk of preterm delivery. **Why 2.5 cm is correct:** Statistically, 2.5 cm represents the 10th percentile for cervical length at mid-gestation. As the cervix shortens, the structural integrity of the birth canal is compromised, often preceded by "funneling" (protrusion of the amniotic sac into the internal os). Clinical trials have shown that women with a CL <25 mm benefit from interventions like **vaginal progesterone** or **cervical cerclage** to reduce PTB risk. **Analysis of Incorrect Options:** * **3.0 cm, 3.5 cm, and 4.0 cm:** These values are considered within the normal range during the second trimester. A cervix measuring 3.0 cm or more has a high negative predictive value, meaning the likelihood of delivery within the next 7–14 days is extremely low. **NEET-PG High-Yield Pearls:** * **Gold Standard Imaging:** Transvaginal Ultrasound (TVS) is superior to transabdominal ultrasound and digital examination for measuring CL. * **Timing:** Screening is typically performed between **18–24 weeks** of gestation. * **Management:** If CL <25 mm in a singleton pregnancy without prior PTB, **vaginal progesterone** is the treatment of choice. If there is a history of prior PTB and a short cervix, **cervical cerclage** (e.g., McDonald or Shirodkar technique) is indicated. * **Funneling:** The sequence of cervical change often follows the **T-Y-V-U** pattern (Trust Your Vaginal Ultrasound).

Question 1

Bandl's ring is associated with which of the following?

Accepted Answer

Cephalopelvic disproportion

Answer

Fetal death

Answer

Uterine inertia

Answer

Placenta previa

Question 2

In which type of abortion does the gestational age correspond to the uterine size?

Accepted Answer

Threatened

Answer

Inevitable

Answer

Complete

Answer

Mixed

Question 3

In which fetal presentation can vaginal delivery be expected?

Accepted Answer

Face presentation when the chin lies under the symphysis pubis

Answer

Face presentation when the chin lies directly to the sacrum

Answer

Brow presentation

Answer

Shoulder presentation

Question 4

True about intrauterine fetal death (IUD)?

Accepted Answer

Overlapping of skull bones

Answer

Gas bubbles in great vessels

Answer

Halo's sign +ve

Answer

Decreased amniotic fluid volume

Question 5

Regarding Braxton Hicks contractions, which of the following statements is correct?

Accepted Answer

Occur in early pregnancy and may be palpated in the second trimester.

Answer

Intensity varies between 20 and 40 mmHg.

Answer

These contractions become more regular later in pregnancy.

Answer

Both 'Occur in early pregnancy and may be palpated in the second trimester' and 'These contractions become more regular later in pregnancy'.

Question 6

What cervical length is associated with an increased risk of preterm delivery?

Accepted Answer

2.5 cm

Answer

3.0 cm

Answer

3.5 cm

Answer

4.0 cm

Question 7

Which of the following is NOT a complication of shoulder dystocia?

Accepted Answer

Shoulder dystocia

Answer

Fetal death

Answer

Uterine rupture

Answer

Obstructed labor

Question 8

Which of the following is NOT an indication for urgent delivery of the second twin?

Accepted Answer

Breech presentation of the second baby

Answer

Abruptio placentae

Answer

Cord prolapse of the second baby

Answer

Inadvertent use of IV ergometrine with the delivery of the anterior shoulder of the first baby

Question 9

Bandle's ring on the uterus in labor suggests:

Accepted Answer

Obstructed labor

Answer

Cervical dystocia

Answer

Colicky uterus

Answer

Hypertonic lower uterine segment

Question 10

Which of the following is not a contraindication for vaginal delivery after a previous cesarean section?

Accepted Answer

Breech presentation

Answer

Previous classical cesarean section

Answer

No previous vaginal delivery

Answer

Puerperal infection in the previous pregnancy

Labor and Delivery — MCQs

Labor and Delivery — MCQs

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