Labor and Delivery Practice Questions

Q: Which technique of intrapartum fetal monitoring is shown here?

Fetal scalp pH sampling. ***Fetal scalp pH sampling*** - The image shows a device inserted through the cervix to the fetus's scalp, suggesting a procedure to obtain a sample, characteristic of **fetal scalp pH sampling**. - This technique is used to assess fetal well-being by directly measuring the pH of a small blood sample from the fetal scalp, typically in cases of ambiguous or non-reassuring cardiotocography (CTG) patterns. *Cardiotocography* - **Cardiotocography (CTG)** involves external transducers placed on the maternal abdomen to monitor fetal heart rate and uterine contractions, which is not depicted in the image. - While CTG is a primary method of fetal monitoring, the illustrative setup here does not represent its application. *Fetal pulse oximetry* - **Fetal pulse oximetry** would involve a sensor placed on the fetal face or head to measure oxygen saturation directly, but the device shown is designed for blood sampling, not continuous oxygen monitoring. - This technique is less commonly used and involves a different type of sensor and placement. *Fetal movement monitor* - A **fetal movement monitor** typically relies on maternal perception or external sensors for detecting fetal activity, which is not what the invasive device in the image is designed to do. - This method is usually non-invasive and does not involve direct contact with the fetal scalp for sampling.

Q: Which degree of obstetric anal sphincter injury is seen here?

Third degree. ***Third degree*** - The image shows a laceration involving the **anal sphincter complex** but the **anal epithelium** is intact. - This corresponds to a **third-degree** tear, where the external and/or internal anal sphincter is torn but the mucosa 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 anal sphincter, which is beyond a first-degree tear. *Second degree* - This involves the **perineal muscles** but the **anal sphincter** is intact. - The image illustrates that the anal sphincter itself is torn, not just the perineal muscles superficial to it. *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. - In the depicted image, the anal epithelium appears to be intact, differentiating it from 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 black arrow clearly points to the constriction. - 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?

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 superior 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. - This type of pelvis is associated with higher rates of C-sections due to potential for cephalopelvic disproportion, and the fetal head typically encounters more difficulty at the outlet. *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:

Rachitic pelvis. ***Rachitic pelvis*** - The image illustrates a **flattened anteroposterior diameter** and a **pronounced protrusion of the sacrum** into the pelvic cavity. - These features are characteristic of a rachitic pelvis, which results from **rickets** (vitamin D deficiency) in childhood, leading to softened bones and deformities due to gravitational and muscular forces. *Scoliotic pelvis* - A scoliotic pelvis would show **asymmetry** in the pelvic bones due to **lateral curvature of the spine**, which is not the primary symmetrical flattening seen here. - This condition involves a **twisting or rotation** of the pelvis, rather than the anteroposterior compression depicted. *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**. - While related to vitamin D deficiency, the specific deformation pattern in the image with characteristic flattening is more indicative of a rachitic pelvis from childhood rather than adult-onset osteomalacia. *Naegele pelvis* - A Naegele pelvis is an **obliquely contracted pelvis** characterized by **atrophy or absence of one sacral ala** and ankylosis of the corresponding sacroiliac joint. - This results in a highly asymmetrical, severely distorted pelvic inlet, which is distinct from the symmetrical flattening observed in the image.

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

Suboccipitofrontal, Vertex. ***Suboccipitofrontal, Vertex*** - The diagram shows the **suboccipitofrontal diameter**, which extends from the junction of the occiput and neck to the frontal prominence (glabella). - This diameter measures approximately **10 cm** and engages in a **partially deflexed vertex presentation**. - This is one of the common engaging diameters in vertex presentations when the head is not fully flexed. *Submentobregmatic, Vertex* - The **submentobregmatic diameter** measures from the junction of the chin and neck to the bregma (anterior fontanelle). - This diameter measures approximately **9.5 cm** but engages in **face presentation, NOT vertex presentation**. - This is a critical distinction in obstetric terminology - submentobregmatic diameter is associated with face presentation. *Mentovertical, Brow* - The **mentovertical diameter** runs from the chin to the highest point of the skull (vertex). - This is the largest anteroposterior diameter of the fetal skull measuring approximately **13.5 cm**. - It is characteristic of **brow presentation**, which is often non-deliverable vaginally and may require cesarean section. *Supersubparietal, Face* - The term **supersubparietal** is not a standard fetal skull diameter used in obstetric literature. - Face presentation involves engagement of the **submentobregmatic diameter** (9.5 cm), not this non-existent diameter.

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 technique of intrapartum fetal monitoring is shown here?

Accepted Answer

Fetal scalp pH sampling

Answer

Cardiotocography

Answer

Fetal pulse oximetry

Answer

Fetal movement monitor

Question 2

Which degree of obstetric anal sphincter injury is seen here?

Accepted Answer

Third degree

Answer

First degree

Answer

Second degree

Answer

Fourth degree

Question 3

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 4

The following delivery is seen with which type of pelvis?

Accepted Answer

Anthropoid pelvis

Answer

Gynecoid pelvis

Answer

Android pelvis

Answer

Platypelloid pelvis

Question 5

The image shows:

Accepted Answer

Rachitic pelvis

Answer

Scoliotic pelvis

Answer

Osteomalacic pelvis

Answer

Naegele pelvis

Question 6

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

Accepted Answer

Suboccipitofrontal, Vertex

Answer

Mentovertical, Brow

Answer

Submentobregmatic, Vertex

Answer

Supersubparietal, Face

Question 7

What is the name of this manoeuvre?

Accepted Answer

Ritgen

Answer

Pinard

Answer

Loveset

Answer

Burns Marshall

Question 8

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 9

Identify the presentation shown below:

Accepted Answer

Complete breech

Answer

Frank breech

Answer

Incomplete breech

Answer

Footling presentation

Question 10

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

Labor and Delivery — MCQs

Labor and Delivery — MCQs

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