Labor and Delivery Practice Questions

Q: Which degree of perineal tear is seen here?

Second degree. ***Second degree*** - The image shows a laceration involving the **perineal muscles** but the **anal sphincter** is intact. - This corresponds to a **second-degree** tear, where the perineal muscles are torn but the anal sphincter complex is preserved. *First degree* - This degree of tear involves only the **perineal skin** and **vaginal mucosa**, without affecting underlying fascia or muscle. - The image clearly shows involvement of the perineal muscles, which is beyond a first-degree tear. *Third degree* - A third-degree tear requires injury to the **external and/or internal anal sphincter**. - The image shows an intact anal sphincter, which is not consistent with a third-degree tear. *Fourth degree* - This is the most severe tear, involving the **anal sphincter complex** and extending through the **anal epithelium** (mucosa) into the lumen of the rectum. - The anal sphincter and epithelium both appear intact in the depicted image, ruling out a fourth-degree injury.

Q: Which of the following causes of dysfunctional labour is shown below?

Bandl's ring. ***Bandl's ring*** - The image shows a **pathological retraction ring (Bandl's ring)**, which is an abnormal constriction of the uterus at the junction of the upper contracting segment and the lower passively dilating segment. The ring is visible as a transverse groove on the abdomen or as a demarcation line between the thickened upper uterine segment and the abnormally thinned, distended lower uterine segment. - This ring occurs when there is prolonged obstructed labor, indicating impending **uterine rupture** due to excessive thinning of the lower uterine segment. - Bandl's ring is a **sign of obstructed labor** and requires immediate intervention to prevent uterine rupture. *Uterine tetany* - **Uterine tetany** refers to excessively frequent and strong uterine contractions that are not effectively coordinated for labor progression. - This condition affects the overall uterine muscle tone and contraction pattern, rather than forming a distinct constricting ring as depicted. *Cervical dystocia* - **Cervical dystocia** is a failure of the cervix to dilate adequately, despite effective uterine contractions. - While it prolongs labor, it is a problem with cervical thinning and opening, not a physical constriction ring within the body of the uterus. *Uterine inertia* - **Uterine inertia** describes weak or infrequent uterine contractions, leading to slow or arrested labor progression. - This is characterized by a lack of effective contractile force, an entirely different issue from the pathological retraction ring shown, which indicates strong but ineffective contractions above the constriction.

Q: The following delivery is seen with which type of pelvis? (The pelvic inlet has an oval shape that is wider in the anteroposterior diameter than the transverse diameter.)

Anthropoid pelvis. ***Anthropoid pelvis*** - This image illustrates the typical presentation of an **anthropoid pelvis**, characterized by an **oval-shaped inlet** that is wider from front to back than side to side. - This pelvic shape often facilitates a persistent **occiput posterior (OP)** position of the fetal head, as seen in the image, due to the longer anteroposterior diameter. *Gynecoid pelvis* - The **gynecoid pelvis** is considered the classic female pelvis, with a **rounded, slightly oval inlet** and a well-suited shape for vaginal delivery, allowing for normal fetal rotation. - It does not typically result in the persistent occiput posterior presentation and the more anterior/posterior orientation of the fetal skull shown. *Android pelvis* - An **android pelvis** has a **heart-shaped inlet** and prominent ischial spines, making it less favorable for vaginal delivery, often requiring descent in an occiput posterior position but with a narrower subpubic arch. - Unlike the anthropoid pelvis, the android pelvis has a transverse diameter that is wider than the anteroposterior diameter, with a narrowed forepelvis — distinguishing it from the oval, AP-dominant inlet described here. *Platypelloid pelvis* - The **platypelloid pelvis** is characterized by a **flattened oval inlet** with a wide transverse diameter and a short anteroposterior diameter, making it the least common and least favorable for vaginal delivery. - This shape often results in the fetal head entering in a transverse arrest position, rather than the anteroposterior orientation suggested by the image.

Q: The image shows:

Naegele pelvis. ***Naegele pelvis*** - The image illustrates an **obliquely contracted pelvis** characterized by **atrophy or absence of one sacral ala** and ankylosis of the corresponding sacroiliac joint. - These features are characteristic of a Naegele pelvis, which results in a highly **asymmetrical, severely distorted pelvic inlet** due to unilateral underdevelopment of the sacrum. *Rachitic pelvis* - A rachitic pelvis results from **rickets** (vitamin D deficiency) in childhood, leading to softened bones and deformities due to gravitational and muscular forces. - It presents with a **flattened anteroposterior diameter** and a **pronounced protrusion of the sacrum** into the pelvic cavity — a symmetrical deformity that is distinct from the asymmetrical oblique contraction seen in the image. *Osteomalacic pelvis* - An osteomalacic pelvis, while also due to poor bone mineralization, typically presents with a **triradiate or trefoil shape** resulting from indentation of the acetabula and collapse of the sacrum into the pelvic canal, leading to a **heart-shaped inlet**. - This symmetrical deformation pattern is distinct from the asymmetrical oblique contraction depicted in the image. *Scoliotic pelvis* - A scoliotic pelvis shows **asymmetry** in the pelvic bones due to **lateral curvature of the spine**, involving a **twisting or rotation** of the pelvis. - However, the defining feature of the image — unilateral sacral ala absence with ipsilateral sacroiliac ankylosis — is not consistent with scoliotic pelvis.

Q: The following diameter is called \qquad and engages in \qquad presentation.

Mentovertical, Brow. ***Mentovertical, Brow*** - The diagram shows the **mentovertical diameter**, which extends from the mentum (chin) to the highest point of the vertex (top of the skull). - This diameter measures approximately **13.5 cm** and engages in **brow presentation**. - It is the largest anteroposterior diameter of the fetal skull and is characteristic of brow presentation, which is often non-deliverable vaginally and may require cesarean section.

Q: What is the name of this manoeuvre?

Ritgen. ***Ritgen*** - The Ritgen maneuver involves applying pressure to the fetal chin through the perineum while simultaneously applying pressure to the occiput, which helps to control the **expulsion of the fetal head** and prevent perineal tears. - This maneuver assists in extending the head, guiding it through the birth canal, and protecting the maternal perineum. *Pinard* - The Pinard maneuver is used in **breech delivery** to deliver the fetal legs by abducting and flexing the thigh while exerting pressure in the popliteal fossa. - This maneuver is not applicable to a cephalic presentation, as depicted in the image. *Loveset* - The Loveset maneuver is primarily used in **breech deliveries** to rotate the fetal trunk and deliver the anterior arm first, followed by the posterior arm. - This technique is specifically for managing the arms during a breech extraction, which is not shown here. *Burns Marshall* - The Burns Marshall maneuver is another technique for delivering the aftercoming head in a **breech delivery**, where the baby's body is held in the supine position and allowed to hang, facilitating the delivery of the head by gravity and gentle traction. - This maneuver is only relevant for breech presentations and not for the cephalic presentation illustrated.

Q: Identify the presentation shown below:

Complete breech. ***Complete breech*** - In a **complete breech** presentation, both the baby's hips and knees are **flexed**, allowing the feet to be positioned near the buttocks. - The image clearly shows the infant's knees bent and feet tucked close to the body, which is characteristic of this presentation. - This represents approximately 25% of all breech presentations. *Frank breech* - In a **frank breech** presentation, the baby's hips are flexed, but the knees are **extended**, causing the legs to be positioned straight up towards the head. - The image does not show extended knees; instead, both knees are visibly flexed. - Frank breech is the most common type, occurring in 65-70% of breech presentations. *Incomplete breech* - An **incomplete breech** (also called footling breech) occurs when one or both hips are not fully flexed, allowing one foot or knee to present below the buttocks. - This differs from the image, which shows both hips and knees fully flexed with feet tucked near the buttocks rather than presenting downward. - Incomplete breech accounts for about 10% of breech presentations. *Footling presentation* - A **footling presentation** is a type of incomplete breech where one or both of the baby's feet are positioned to deliver first. - The image clearly shows the feet tucked up near the buttocks in a flexed position rather than extended downwards or presenting first.

Q: According to the Caldwell-Moloy classification, which of the following pelvic types is the LEAST common in women?

Platypelloid. ***Platypelloid*** - The **platypelloid pelvis** is characterized by a **flattened oval inlet** with a short anteroposterior diameter and wide transverse diameter, making it the **least common** type in women at only **3-5%** prevalence. - This pelvis type poses significant **obstetric challenges** due to the reduced anteroposterior diameter, leading to difficulties in fetal head **engagement and descent** during labor. *Gynecoid* - The **gynecoid pelvis** is the **most common** type, found in approximately **50%** of women, and represents the **ideal pelvis for childbirth**. - It features a **round or slightly oval inlet** with wide sacrosciatic notch and subpubic angle, facilitating smooth **vaginal delivery**. *Anthropoid* - The **anthropoid pelvis** has an **oval inlet** that is longer in the **anteroposterior diameter** than the transverse, occurring in about **20-30%** of women. - This type can accommodate successful vaginal delivery, often with the fetus in an **occipitoposterior position** due to the elongated anteroposterior dimension. *Android* - The **android pelvis** is characterized by a **heart-shaped inlet** and **narrow subpubic angle**, found in approximately **20-30%** of female pelves. - It is associated with more **difficult labor** due to the narrow mid-pelvis and **convergent side walls**, which can impede fetal descent.

Question 1

Which degree of perineal tear is seen here?

Accepted Answer

Second degree

Answer

Fourth degree

Answer

Third degree

Answer

First degree

Question 2

Which of the following causes of dysfunctional labour is shown below?

Accepted Answer

Bandl's ring

Answer

Uterine tetany

Answer

Cervical dystocia

Answer

Uterine inertia

Question 3

The following delivery is seen with which type of pelvis? (The pelvic inlet has an oval shape that is wider in the anteroposterior diameter than the transverse diameter.)

Accepted Answer

Anthropoid pelvis

Answer

Gynecoid pelvis

Answer

Android pelvis

Answer

Platypelloid pelvis

Question 4

The image shows:

Accepted Answer

Naegele pelvis

Answer

Scoliotic pelvis

Answer

Osteomalacic pelvis

Answer

Rachitic pelvis

Question 5

The following diameter is called \qquad and engages in \qquad presentation.

Accepted Answer

Mentovertical, Brow

Answer

Supersubparietal, Face

Answer

Suboccipitofrontal, Vertex

Answer

Submentobregmatic, Vertex

Question 6

What is the name of this manoeuvre?

Accepted Answer

Ritgen

Answer

Pinard

Answer

Loveset

Answer

Burns Marshall

Question 7

A 25-year-old primigravida at 38POG presents with painful uterine contractions and rupture of bag of water. On examination her cervix is 5 cm dilated and the malpresentation is as shown. Fetal heart rate tracing is reactive. Which of the following is the best method to achieve delivery?

Accepted Answer

Perform emergency C-section

Answer

Vaginally by breech extraction

Answer

Perform internal podalic version

Answer

Deliver vaginally after external cephalic version

Question 8

Identify the presentation shown below:

Accepted Answer

Complete breech

Answer

Frank breech

Answer

Incomplete breech

Answer

Footling presentation

Question 9

According to the Caldwell-Moloy classification, which of the following pelvic types is the LEAST common in women?

Accepted Answer

Platypelloid

Answer

Gynecoid

Answer

Anthropoid

Answer

Android

Question 10

Which is incorrect about the presentation shown below?

Accepted Answer

The presenting diameter is the suboccipitobregmatic diameter

Answer

Vaginal delivery generally requires conversion to vertex or face presentation

Answer

Associated with anencephaly

Answer

Head is partially extended

Labor and Delivery — MCQs

Labor and Delivery — MCQs

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