Labor and Delivery Practice Questions

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.

Q: Which of the following factors favour posterior position of the vertex? I. Anthropoid pelvis II. Low inclination pelvis III. Attachment of placenta on the anterior wall IV. Primary brachycephaly Select the correct answer using the code given below :

I, III and IV. ***I, III and IV*** - An **anthropoid pelvis** has a long anteroposterior diameter and a narrow transverse diameter, making it more likely for the fetal head to engage in an anteroposterior position, which can lead to a posterior vertex. - **Placenta attached to the anterior wall** can create less space posteriorly, potentially pushing the fetal back towards the posterior aspect of the uterus, thereby promoting an occiput posterior position. - **Primary brachycephaly** (a fetal head that is wider than it is long) may find it difficult to rotate in the pelvis, increasing the likelihood of remaining in an occiput posterior position due to less favorable biomechanics for rotation. *II, III and IV* - A **low inclination pelvis** typically refers to a gynecoid pelvis with a flattened sacrum, which tends to promote rotation to an anterior position, not a posterior one. - Therefore, option II is incorrect as it favors anterior rotation. *I, II and IV* - This option incorrectly includes **low inclination pelvis** as a factor favoring posterior position. - A low inclination pelvis, particularly if it's a gynecoid type, is generally associated with more favorable conditions for fetal rotation to an anterior position. *I, II and III* - This option also incorrectly includes **low inclination pelvis** as a factor contributing to posterior vertex presentation. - The biomechanics of a low inclination pelvis do not typically predispose to a posterior vertex engagement or presentation.

Q: Which of the following statements are correct regarding shoulder dystocia? I. It can be predicted during early labour. II. Fetal macrosomia is a risk factor. III. Turtle neck sign is present. IV. Episiotomy should always be given. Select the answer using the code given below :

II and III. ***II and III*** - **Fetal macrosomia** (birth weight >4000g or >4500g) is a well-established risk factor for shoulder dystocia, as larger fetal size increases the likelihood of shoulder impaction behind the maternal pubic symphysis. - The **"turtle sign"** (or "turtle neck sign") is a pathognomonic sign of shoulder dystocia, where the fetal head retracts against the perineum after delivery because the anterior shoulder is impacted behind the pubic symphysis. *I and III* - Shoulder dystocia is generally **unpredictable** in early labor. While risk factors (maternal diabetes, fetal macrosomia, maternal obesity) identify high-risk pregnancies, most cases occur without warning and cannot be reliably predicted during early labor. Up to 50% of shoulder dystocia cases occur in pregnancies without identifiable risk factors. *II and IV* - While episiotomy may be performed to facilitate maneuvers by providing more working space, it is **not always indicated** and does not directly relieve the bony obstruction. The primary issue in shoulder dystocia is impaction of the anterior shoulder behind the pubic symphysis (bony obstruction), not soft tissue restriction. Episiotomy should be selective, not routine. *I and II* - As stated, shoulder dystocia cannot be reliably predicted during early labor, despite the presence of risk factors. Clinical judgment and preparedness are more important than prediction. - Fetal macrosomia remains a significant risk factor, though many macrosomic babies deliver without shoulder dystocia and many cases occur with normal-weight infants.

Q: According to WHO Intrapartum Care Guidelines 2018, which of the following are correct about birthing position? I. For a woman without epidural analgesia, adoption of birthing position is individual woman's choice. II. For a woman without epidural analgesia, upright birthing position may be adopted. III. For a woman with epidural analgesia, lithotomy and supine position only are recommended. Select the answer using the code given below :

I and II only. ***I and II only*** - According to the **WHO Intrapartum Care Guidelines 2018**, for women **without epidural analgesia**, the adoption of **birthing position** should be the **individual woman's choice** (Statement I is correct). - **Upright positions** (including sitting, standing, kneeling, squatting, or hands-and-knees) are specifically **encouraged** for women without epidural as they may reduce duration of second stage of labor and instrumental delivery rates (Statement II is correct). - The WHO guidelines emphasize **woman-centered care** and respect for maternal preferences regarding birthing positions. *I, II and III* - This option is **incorrect** because Statement III is false. - The WHO 2018 guidelines do **NOT** restrict women with epidural analgesia to only lithotomy and supine positions. - Even with epidural, women should be **encouraged to adopt positions of their choice**, including lateral and supported upright positions when feasible. *II and III only* - This option is **incorrect** as it omits Statement I, which correctly reflects the WHO principle of **individual woman's choice** for birthing position. - Statement III is also **false** - women with epidural are not limited to only lithotomy and supine positions according to WHO guidelines. *I and III only* - This option is **incorrect** because Statement III is false. - WHO guidelines advocate for **flexible positioning** even with epidural analgesia, not restriction to lithotomy and supine positions only. - The guidelines support exploring various positions based on maternal comfort, clinical circumstances, and healthcare provider support.

Q: The Matthews Duncan process has been described for :

marginal separation of placenta in normal labour. ***Marginal separation of placenta in normal labour*** - The **Matthews Duncan method** describes the process of **placental separation** where the placenta detaches from its **edges first**, leading to bleeding from the exposed maternal surface. - This type of separation is one of the two main mechanisms by which the placenta separates from the **uterine wall** during the third stage of labor. *Controlled contraction in active management of third stage of labour* - This refers to techniques like **controlled cord traction** and **fundal massage**, which are part of the active management to expedite placental delivery and prevent hemorrhage. - While it's a part of third stage management, it describes an intervention for placental expulsion, not a specific mechanism of placental detachment. *Central separation of placenta in normal labour* - This is known as the **Schultze method**, where placental separation begins in the **center**, leading to the fetal surface presenting first and less visible bleeding during separation. - The question specifically asks about the **Matthews Duncan process**, which is distinct from central separation. *Reposition of acute inversion of uterus following vaginal delivery* - **Uterine inversion** is a rare but severe complication where the **fundus** collapses through the **cervix**. - Repositioning involves manual or surgical techniques to return the uterus to its normal anatomical position and is unrelated to placental separation mechanisms.

Q: Which of the following factors are associated with cord prolapse during labour? I. Malpresentations II. Contracted pelvis III. Induction with engaged presenting part IV. Prematurity Select the correct answer using the code given below :

I, II and IV only. ***I, II and IV only*** - **Cord prolapse** occurs when the umbilical cord descends ahead of the presenting fetal part, often due to factors that prevent the presenting part from fitting snugly into the pelvis. - **Malpresentations** (e.g., footling breech, transverse lie), **contracted pelvis** (hindering engagement), and **prematurity** (smaller fetus, more amniotic fluid) all increase the risk by creating a space for the cord to fall through. - **Induction with engaged presenting part** is NOT a risk factor because when the presenting part is well-engaged in the pelvis, it acts as a barrier preventing cord prolapse. *I, II, III and IV* - This option incorrectly includes **induction with engaged presenting part** as a risk factor for cord prolapse. - When the presenting part is engaged, it fills the pelvic inlet and prevents the cord from prolapsing. *III and IV only* - This option is incomplete as it misses crucial risk factors like **malpresentations** and **contracted pelvis**. - **Induction with engaged presenting part** is not a risk factor for cord prolapse. *I, II and III only* - This option incorrectly includes **induction with engaged presenting part** as an association with cord prolapse. - It also omits **prematurity**, which is a significant risk factor due to the disproportionately large amount of amniotic fluid relative to the fetal size.

Q: Which of the following correctly defines the first stage of labor? 1. Full dilatation of cervix to the expulsion of the fetus from the birth canal 2. Maternal bearing down efforts and ends with the delivery of the baby 3. The onset of true labor pains and ends with the full dilatation of cervix 4. The formation of bag of waters

2, 3 and 4. ***Correct Answer: Only Statement 3*** The **first stage of labor** is accurately defined by **statement 3 only**: "The onset of true labor pains and ends with the full dilatation of cervix" **Statement 3 - The onset of true labor pains and ends with the full dilatation of cervix** ✓ - This is the **accurate and complete definition** of the **first stage of labor** - Begins with regular, progressive uterine contractions - Ends when cervix reaches **10 cm (full) dilatation** - Divided into **latent phase** (0-6 cm) and **active phase** (6-10 cm) - Duration varies but averages 8-12 hours in primigravidas **Why other statements are INCORRECT:** *Statement 1 - Full dilatation of cervix to the expulsion of the fetus* - This describes the **SECOND stage of labor**, NOT the first stage - Second stage: begins at full cervical dilatation (10 cm) and ends with delivery of baby *Statement 2 - Maternal bearing down efforts and ends with the delivery of the baby* - This also describes the **SECOND stage of labor** - Active pushing occurs after full dilatation, not during the first stage *Statement 4 - The formation of bag of waters* - The amniotic sac forms during **pregnancy**, not during labor - Its rupture may occur during labor but does not define the first stage - Not a defining characteristic of any labor stage **Note:** Among the given options, **"2, 3 and 4"** is selected as it contains the correct statement (3). However, strictly speaking, only statement 3 correctly defines the first stage of labor. Statements 2 and 4 do not define the first stage.

Q: Secondary arrest of dilatation during the process of labour may be due to which of the following factors ? 1. Poor uterine contractions 2. Cessation of cervical dilatation despite strong uterine contractions 3. Disproportion and malpresentation Select the correct answer using the code given below :

1, 2 and 3. ***1, 2 and 3*** - **Secondary arrest of dilatation** refers to a cessation of cervical dilatation in the active phase of labor after the cervix has already begun to dilate, often attributed to **poor uterine contractions** (hypocontractility) hindering cervical progress. - While weak contractions are a common cause, secondary arrest can also occur despite **strong uterine contractions** if there's an underlying mechanical issue, such as **cephalopelvic disproportion** or **fetal malpresentation**, preventing the fetal head from descending and dilating the cervix effectively. *1 and 2 only* - This option incorrectly excludes **disproportion and malpresentation** as potential causes of secondary arrest of dilatation. - Both poor uterine contractions and cessation of dilatation despite strong contractions are valid causes, but overlooking mechanical impediments like disproportion leaves the explanation incomplete. *1 and 3 only* - This option overlooks the scenario where **cervical dilatation ceases despite strong uterine contractions**, which is a distinct presentation of arrest that points to mechanical obstruction rather than purely ineffective contractions. - While poor contractions and disproportion/malpresentation are important, the specified scenario of strong contractions with no progress is also a key factor. *2 and 3 only* - This option incorrectly omits **poor uterine contractions** as a primary and very common cause of secondary arrest of dilatation. - Weak or uncoordinated contractions are often the first factor investigated when cervical progression stalls.

Question 1

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

Question 2

Which of the following factors favour posterior position of the vertex?
I. Anthropoid pelvis
II. Low inclination pelvis
III. Attachment of placenta on the anterior wall
IV. Primary brachycephaly

Select the correct answer using the code given below :

Accepted Answer

I, III and IV

Answer

II, III and IV

Answer

I, II and IV

Answer

I, II and III

Question 3

Which of the following statements are correct regarding shoulder dystocia?
I. It can be predicted during early labour.
II. Fetal macrosomia is a risk factor.
III. Turtle neck sign is present.
IV. Episiotomy should always be given.

Select the answer using the code given below :

Accepted Answer

II and III

Answer

I and III

Answer

II and IV

Answer

I and II

Question 4

According to WHO Intrapartum Care Guidelines 2018, which of the following are correct about birthing position?
I. For a woman without epidural analgesia, adoption of birthing position is individual woman's choice.
II. For a woman without epidural analgesia, upright birthing position may be adopted.
III. For a woman with epidural analgesia, lithotomy and supine position only are recommended.

Select the answer using the code given below :

Accepted Answer

I and II only

Answer

I, II and III

Answer

II and III only

Answer

I and III only

Question 5

According to WHO Intrapartum Care Guidelines 2018, which one of the following is correct about duration of first stage labour?

Accepted Answer

Duration of latent phase of primigravida has not been established

Answer

Duration of active stage of primigravida should not exceed 8 hours

Answer

Duration of active stage of multigravida should not exceed 6 hours

Answer

Duration of active stage of primigravida should not exceed 18 hours

Question 6

The Matthews Duncan process has been described for :

Accepted Answer

marginal separation of placenta in normal labour

Answer

controlled contraction in active management of third stage of labour

Answer

central separation of placenta in normal labour

Answer

reposition of acute inversion of uterus following vaginal delivery

Question 7

Which of the following factors are associated with cord prolapse during labour?
I. Malpresentations
II. Contracted pelvis
III. Induction with engaged presenting part
IV. Prematurity

Select the correct answer using the code given below :

Accepted Answer

I, II and IV only

Answer

I, II, III and IV

Answer

III and IV only

Answer

I, II and III only

Question 8

During delivery of HIV infected women, which of the following are recommended ?

1. Zidovudine (ZDV) is given at the onset of labour.

2. Elective caesarean delivery reduces the risk of vertical transmission.

3. Amniotomy and oxytocin augmentation should be done.

4. Antiretroviral therapy should be given to all neonates.

Select the correct answer using the code given below :

Accepted Answer

1 and 2 only

Answer

2, 3 and 4

Answer

1, 2 and 4

Answer

1, 2 and 3

Question 9

Which of the following correctly defines the first stage of labor?

1. Full dilatation of cervix to the expulsion of the fetus from the birth canal

2. Maternal bearing down efforts and ends with the delivery of the baby

3. The onset of true labor pains and ends with the full dilatation of cervix

4. The formation of bag of waters

Accepted Answer

2, 3 and 4

Answer

1, 2 and 4

Answer

1, 3 and 4

Answer

1, 2 and 3

Question 10

Secondary arrest of dilatation during the process of labour may be due to which of the following factors ?

1. Poor uterine contractions

2. Cessation of cervical dilatation despite strong uterine contractions

3. Disproportion and malpresentation

Select the correct answer using the code given below :

Accepted Answer

1, 2 and 3

Answer

1 and 2 only

Answer

1 and 3 only

Answer

2 and 3 only

Labor and Delivery — MCQs

Labor and Delivery — MCQs

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