Labor and Delivery Practice Questions

Q: The following CTG tracing shows:

Late deceleration. ***Late deceleration*** - This tracing shows a **fetal heart rate (FHR) deceleration** that begins **after the onset of the uterine contraction** and recovers after the contraction ends. - This pattern is characteristic of **uteroplacental insufficiency** and indicates fetal hypoxia. *Early deceleration* - **Early decelerations** mirror the contractions, beginning and ending with the uterine contraction, and are typically due to **head compression**. - The FHR decrease in early decelerations starts at or just before the peak of the contraction, unlike the tracing shown. *Sinusoidal pattern* - A **sinusoidal pattern** is a smooth, undulating wave-like FHR with fixed amplitude and frequency, usually associated with severe fetal anemia or hypoxia. - The tracing here shows discrete drops in FHR, not a continuous wave-like pattern. *Variable deceleration* - **Variable decelerations** are characterized by an **abrupt decrease in FHR**, variable in shape, duration, and depth, and are often unrelated to the timing of uterine contractions. - They are typically associated with **umbilical cord compression**, which is not indicated by the uniform and consistent pattern seen here.

Q: The following CTG shows:

Variable deceleration. ***Variable deceleration*** - This CTG shows **abrupt decreases** in fetal heart rate (FHR) that are **variable in their onset, depth, and duration**, which is characteristic of variable decelerations. - The FHR tracing drops sharply and then recovers quickly, often not directly coinciding with uterine contractions (which are not shown here but understood to be present with decelerations). *Early deceleration* - **Early decelerations** are typically **gradual, symmetrical decreases** in FHR that **mirror uterine contractions**, with the nadir of the deceleration coinciding with the peak of the contraction. - They are considered **benign** and usually indicate **fetal head compression**. *Late deceleration* - **Late decelerations** are **gradual, symmetrical decreases** in FHR that begin **after the peak of the uterine contraction** and recover only after the contraction has ended. - This pattern is associated with **uteroplacental insufficiency** and indicates fetal hypoxia. *Sinusoidal pattern* - A **sinusoidal pattern** is characterized by a **smooth, undulating FHR baseline** with a frequency of 2-5 cycles per minute and an amplitude of 5-15 bpm. - It suggests severe fetal anemia or hypoxia and is distinctly different from the abrupt, irregular drops seen in the given CTG.

Q: The following CTG shows:

Early deceleration. ***Early deceleration*** - This CTG shows a **deceleration** in fetal heart rate that mirrors the uterine contraction. The drop in FHR begins with the onset of the contraction, reaches its lowest point at the peak of the contraction, and recovers by the end of the contraction. The deceleration is gradual and symmetric, with onset-to-nadir ≥30 seconds. - Early decelerations are usually **benign** and are caused by **head compression** during contractions, which leads to a vagal response. - Importantly, early decelerations can occur in an otherwise **Category I (normal) tracing**; their presence alone does not render the tracing abnormal. *Late deceleration* - **Late decelerations** begin after the peak of the contraction and return to baseline only after the contraction has ended. - They are often associated with **uteroplacental insufficiency** and can indicate fetal hypoxia. *Sinusoidal pattern* - A **sinusoidal pattern** is characterized by a smooth, sine wave-like undulating FHR with a fixed frequency and amplitude, resembling a sine wave. - This pattern is **rare** but ominous, often indicating severe fetal anemia or hypoxia. *Variable deceleration* - **Variable decelerations** are abrupt in onset and variable in timing, shape, and duration relative to uterine contractions. - They are typically caused by **umbilical cord compression** and, when repetitive or severe, may indicate fetal compromise. - Unlike early decelerations, repetitive late or variable decelerations would preclude Category I classification.

Q: The following CTG indicates:

Cord compression. ***Cord compression*** - The CTG shows **variable decelerations**, characterized by an abrupt onset and a variable relationship to contractions (as indicated by the green arrows and lower graph). - Variable decelerations are caused by **cord compression**, which triggers a vagal response resulting in abrupt drops in fetal heart rate that vary in timing, duration, and shape relative to uterine contractions. *Fetal head compression* - **Early decelerations** are associated with fetal head compression and are characterized by a gradual decrease in FHR that mirrors the contraction onset, with the nadir coinciding with the peak of the contraction. - The pattern displayed here is abrupt and variable in its relationship to contractions, not the smooth, mirror-image pattern seen in early decelerations. *Normal tracing* - A normal tracing would show a **baseline FHR within the normal range**, moderate variability, and either no decelerations or only occasional, reassuring accelerations. - The repeated decelerations observed here indicate a physiological response to contractions and therefore do not represent a completely normal tracing. The clinical significance of variable decelerations depends on their recurrence, duration, depth, and the overall clinical context. *Fetal anemia* - Fetal anemia can cause a variety of FHR patterns, including **tachycardia** (due to increased cardiac output) or **sinusoidal heart rate patterns**, which are smooth, undulating FHR tracings. - The decelerations seen in this CTG are not characteristic of fetal anemia.

Q: The following CTG indicates:

Variable deceleration. ***Variable deceleration*** - This CTG shows **abrupt, irregular drops in fetal heart rate (FHR)**. The onset, depth, and duration of the decelerations vary, which is characteristic of variable decelerations. - Variable decelerations are often associated with **umbilical cord compression**, leading to a transient decrease in blood flow to the fetus. *Early deceleration* - Early decelerations are **gradual, symmetrical drops in FHR** that mirror the shape of the uterine contraction, meaning they begin and end with the contraction. - They are typically benign and caused by **fetal head compression** during contractions. *Late deceleration* - Late decelerations are **gradual, symmetrical drops in FHR** where the nadir of the deceleration occurs after the peak of the uterine contraction, and the recovery to baseline also occurs after the contraction has ended. - They are indicative of **uteroplacental insufficiency** and can be a sign of fetal hypoxia. *Sinusoidal pattern* - A sinusoidal pattern is characterized by a **smooth, undulating, sine wave-like FHR rhythm** with an amplitude of 5-15 bpm and a frequency of 2-5 cycles per minute, lasting for 20 minutes or more. - This pattern is highly concerning and is associated with **severe fetal anemia** or hypoxia.

Q: The following partogram shows (using traditional partogram terminology):

Secondary arrest. ***Secondary arrest*** - The **cervical dilatation line** (blue line) progresses initially but then **plateaus** at 6 cm, remaining flat for several hours and crossing the **action line**. - This pattern indicates that cervical dilation was occurring, but then it completely stopped before full dilation, which is characteristic of a **secondary arrest of labor** in traditional partogram terminology. - Note: This question is based on traditional partogram pattern recognition. In contemporary clinical practice, a diagnosis of active-phase arrest additionally requires documentation of membrane status (ruptured membranes), adequate uterine contractions, and a sufficient duration of no cervical change (≥4 hours with adequate contractions, or ≥6 hours with inadequate contractions). *Normal* - A **normal partogram** shows continuous, progressive cervical dilation along or to the left of the **alert line**. - In this partogram, the cervical dilation line crosses both the **alert** and **action lines**, indicating a deviation from normal labor progress. *Prolonged active phase* - A **prolonged active phase** refers to a slower than expected rate of cervical dilation (slower than the applicable expected threshold for primigravidas or multiparas), but not a complete arrest. - Here, the dilatation completely stops, rather than just slowing down. *Prolonged latent phase* - The **latent phase** of labor involves cervical effacement and dilation up to 3-4 cm. A prolonged latent phase would show a delay in reaching this initial active phase. - In this case, the cervix dilates from 4 cm to 6 cm within the expected timeframe before arresting, so the latent phase was not prolonged.

Q: Which of the following is obstetric conjugate? (DNB Pattern 2018)

Line B. *Line A* - Line A in the diagram represents the **anatomical conjugate (true conjugate)**, which extends from the **sacral promontory** to the **superior border of the symphysis pubis**. - This is the longest anteroposterior diameter of the pelvic inlet but is not the clinically relevant measurement for fetal head descent. ***Line B*** - Line B represents the **obstetric conjugate**, which extends from the **sacral promontory** to the **nearest point on the posterior surface of the symphysis pubis** (i.e., the posterior superior border of the symphysis pubis). - This measurement cannot be directly measured by clinical examination, but it is the **obstetric conjugate** that determines the anteroposterior diameter of the pelvic inlet for fetal head descent. - The obstetric conjugate is estimated by subtracting 1.5 cm from the diagonal conjugate. *Line C* - Line C represents the **diagonal conjugate**, which is measured from the **sacral promontory** to the **inferior border of the symphysis pubis**. - This is the only conjugate that can be estimated by **vaginal examination**. *None* - This is incorrect because Line B clearly depicts the **obstetric conjugate**, which is a key measurement in pelvimetry. - The diagram provides a clear anatomical representation of the different pelvic conjugates.

Q: Name the maneuver shown in the image: (DNB Pattern 2018)

Mauriceau-Smellie-Veit maneuver. ***Mauriceau-Smellie-Veit maneuver*** - This maneuver is used for **controlled delivery of the aftercoming head** in breech presentation. - The baby's body straddles the operator's forearm with the **index and middle fingers placed on the maxilla** (not in the mouth) to flex the fetal head. - The **other hand applies traction on the shoulders** from above while an assistant may apply **suprapubic pressure** to maintain flexion of the head. - This technique ensures controlled flexion and delivery of the fetal head through the birth canal. *Pinard maneuver* - The Pinard maneuver involves **flexing and abducting the fetal thigh** to deliver the extended legs in a breech presentation. - This is used specifically for **delivering the legs**, not the head, and involves sweeping the leg out of the birth canal. *Loveset maneuver* - The Loveset maneuver is used to deliver the **shoulders and arms** in a breech presentation when they are extended. - It involves **rotating the fetal trunk 180 degrees** to bring each posterior shoulder anteriorly under the pubic symphysis for delivery. - This does not involve head delivery. *Burns Marshall method* - The Burns Marshall method involves **allowing the fetal body to hang** until the nape of the neck is visible, after which the baby's trunk is lifted upward in an arc to deliver the **flexed aftercoming head**. - The head delivers by flexion as the body is elevated in an arc over the maternal abdomen.

Q: A 25-year-old primigravida has presented in obstructed labour. On examination she is exhausted and has a tender uterus with a groove felt per abdomen as shown in the image. Fetal parts are not felt. What is the diagnosis? (DNB Pattern 2018)

Retraction ring. ***Retraction ring*** - The description of a "groove felt per abdomen" along with signs of **obstructed labor** and a **tender uterus** is characteristic of a pathological **retraction ring (Bandl's ring)**. - This sign indicates an extreme thinning and overdistension of the lower uterine segment, signifying impending uterine rupture due to prolonged obstructed labor. *Constriction ring* - A constriction ring is a **localized spasm** of the uterine muscle, typically identified as a pathological ring, but it does not cause the clear abdominal groove or the severe overdistension of the lower uterine segment seen with a retraction ring. - Unlike a retraction ring, a constriction ring does not necessarily indicate impending uterine rupture but can still cause obstructed labor. *Abruptio placentae* - While abruptio placentae can cause a **tender and rigid uterus**, it is primarily characterized by **vaginal bleeding** (though concealed in some cases) and **fetal distress**, not usually an externally palpable groove with a distended lower segment. - The absence of fetal parts being palpable is consistent with significant uterine tonus, but the formation of a pathological ring is not a feature of abruption. *Cervical dystocia* - **Cervical dystocia** is a failure of the cervix to dilate during labor, leading to obstruction. While it contributes to obstructed labor, it does not typically present with a palpable groove in the abdomen due to the formation of a pathological retraction ring. - The primary defect is at the cervix itself, not a delineation within the uterine body.

Question 1

The following CTG tracing shows:

Accepted Answer

Late deceleration

Answer

Early deceleration

Answer

Sinusoidal pattern

Answer

Variable deceleration

Question 2

The following CTG shows:

Accepted Answer

Variable deceleration

Answer

Early deceleration

Answer

Late deceleration

Answer

Sinusoidal pattern

Question 3

The following CTG shows:

Accepted Answer

Early deceleration

Answer

Variable deceleration

Answer

Sinusoidal pattern

Answer

Late deceleration

Question 4

The following CTG indicates:

Accepted Answer

Cord compression

Answer

Fetal head compression

Answer

Normal tracing

Answer

Fetal anemia

Question 5

The following CTG indicates:

Accepted Answer

Variable deceleration

Answer

Early deceleration

Answer

Late deceleration

Answer

Sinusoidal pattern

Question 6

The following partogram shows (using traditional partogram terminology):

Accepted Answer

Secondary arrest

Answer

Normal

Answer

Prolonged active phase

Answer

Prolonged latent phase

Question 7

Which of the following is obstetric conjugate? (DNB Pattern 2018)

Accepted Answer

Line B

Answer

None

Answer

Line A

Answer

Line C

Question 8

Which of the following combinations is correct? (DNB Pattern 2018)

Accepted Answer

A = Vertex (well flexed head), B = Brow, C = Face presentation

Answer

A = Vertex (deflexed head), B = Brow, C = Face presentation

Answer

A = Vertex (well flexed head), B = Face presentation, C = Brow

Answer

A = Vertex (deflexed head), B = Face presentation, C = Brow

Question 9

Name the maneuver shown in the image: (DNB Pattern 2018)

Accepted Answer

Mauriceau-Smellie-Veit maneuver

Answer

Pinard maneuver

Answer

Loveset maneuver

Answer

Burns Marshall method

Question 10

A 25-year-old primigravida has presented in obstructed labour. On examination she is exhausted and has a tender uterus with a groove felt per abdomen as shown in the image. Fetal parts are not felt. What is the diagnosis? (DNB Pattern 2018)

Accepted Answer

Retraction ring

Answer

Constriction ring

Answer

Abruptio placentae

Answer

Cervical dystocia

Labor and Delivery — MCQs

Labor and Delivery — MCQs

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