Labor and Delivery Practice Questions

Q: As per the classification of Obstetric Anal Sphincter Injury (RCOG-2007), complete tear of External Anal Sphincter is of degree :

3c. ***3c*** - A **3c tear** involves a **complete tear** of the **external anal sphincter (EAS)**, often along with the internal anal sphincter (IAS) being involved in any degree during obstetric anal sphincter injury (OASI). - According to the RCOG (Royal College of Obstetricians and Gynaecologists) 2007 classification, this signifies a severe and complete disruption of the external sphincter. *2c* - A **2c tear** would typically refer to a **more extensive second-degree perineal tear** involving deeper muscle layers, but it does **not involve the anal sphincters**. - Second-degree tears involve the skin, vaginal mucosa, and perineal muscles but spare the anal sphincter complex. *3b* - A **3b tear** signifies a **partial tear of the external anal sphincter (EAS)**, with **more than 50%** of the muscle thickness being torn. - While it involves the EAS, it is not a complete tear as described in the question, differentiating it from a 3c tear. *3a* - A **3a tear** indicates an **involvement of the external anal sphincter (EAS)**, specifically a partial tear of the EAS involving **less than 50%** of its thickness. - This is a less severe injury than a 3b or 3c tear and does not represent a complete tear of the EAS.

Q: Which are the parts of active management of third stage of labour? 1. Injection oxytocin 10 units IM within 1 minute of delivery of baby 2. Uterine massage after placental delivery 3. Controlled cord traction 4. Delayed cord clamping as per indications Select the correct answer using the code given below:

1, 2 and 3. ***1, 2 and 3*** - **Active management of the third stage of labor (AMTSL)** consists of three key interventions: **prophylactic uterotonic administration** (oxytocin 10 units IM within 1 minute of delivery), **controlled cord traction**, and **uterine massage after placental delivery**. - These interventions work synergistically to prevent **postpartum hemorrhage** by promoting rapid uterine contraction and complete placental expulsion. - This combination represents the **WHO-recommended standard** for AMTSL. *1, 2 and 4* - **Delayed cord clamping** (4) is an important **neonatal intervention** for improving iron stores and hemoglobin levels in the newborn, but it is **not a component of AMTSL**. - While this option correctly includes **oxytocin administration** (1) and **uterine massage** (2), it omits **controlled cord traction** (3), which is essential for safe placental delivery. - Delayed cord clamping is typically performed **before** AMTSL interventions begin. *2, 3 and 4* - This option omits **immediate prophylactic oxytocin** (1), which is the **most critical component** of AMTSL for preventing postpartum hemorrhage. - Without prompt uterotonic administration, the risk of **uterine atony** and subsequent hemorrhage increases significantly. - Additionally, **delayed cord clamping** (4) is not part of the AMTSL protocol. *1, 3 and 4* - This option omits **uterine massage after placental delivery** (2), which is important for ensuring sustained uterine contraction and detecting early signs of atony. - While **oxytocin** (1) and **controlled cord traction** (3) are correctly included, **delayed cord clamping** (4) is **not a component of AMTSL**. - The absence of uterine massage reduces the completeness of active management.

Q: Which of the following are the characteristics of true labour pains ? 1. Intensity and duration of contractions increase progressively 2. Progressive effacement and dilatation of the cervix 3. Formation of the 'bag of forewaters' 4. Pain is confined to lower abdomen and groin Select the correct answer using the code given below :

1, 2 and 3. ***Correct Answer: 1, 2 and 3*** - **Progressive increase in intensity and duration of contractions** (1) is a hallmark of true labor, as uterine activity becomes more coordinated and forceful over time. - **Progressive effacement and dilatation of the cervix** (2) are the definitive signs of true labor, indicating that the uterus is actively working to prepare for birth. - The **formation of the 'bag of forewaters'** (3) occurs as the lower uterine segment stretches and the fetal head descends, causing the membranes to bulge into the cervical os, which is characteristic of advancing labor. *Incorrect: 1, 2 and 4* - While options 1 and 2 are true, the statement that **pain is confined to the lower abdomen and groin** (4) is incorrect; true labor pain typically **starts in the back and radiates anteriorly** to the lower abdomen. - True labor pain is typically felt as a **wave-like contraction** that encompasses the entire uterus, not just localized to the lower abdomen and groin. *Incorrect: 1, 3 and 4* - Options 1 and 3 are correct diagnostic characteristics, but **pain confined to the lower abdomen and groin** (4) is not accurate for true labor pain, which usually involves the back as well. - The absence of **progressive cervical changes** (2) makes this option incomplete as a definition of true labor. *Incorrect: 2, 3 and 4* - While **progressive effacement and dilatation of the cervix** (2) and **formation of the 'bag of forewaters'** (3) are signs of true labor, the characteristic that **pain is confined to the lower abdomen and groin** (4) is incorrect. - This option also omits the crucial feature of **increasing intensity and duration of contractions** (1), which is a primary indicator of true labor.

Q: A 28-year-old female G2P1L1 with history of previous cesarean presents to the gynaecology emergency in labour. On examination, she is hypotensive, foetal heart sounds are absent and foetal parts are easily palpable. What is her diagnosis?

Uterine rupture. ***Uterine rupture*** - The patient's presentation with **hypotension**, **absent fetal heart sounds**, and **easily palpable fetal parts** following a previous cesarean section strongly suggests uterine rupture. - A **previous cesarean section** is a significant risk factor for uterine rupture, as the scar tissue can be weakened and tear during labor. *Hydatidiform mole* - This condition involves abnormal growth of placental tissue, often presenting with a **grape-like appearance** and **high hCG levels**. - It does not typically cause acute maternal hypotension or easily palpable fetal parts in the context of labor. *Oligohydramnios* - Characterized by **low amniotic fluid volume**, which can lead to complications such as **fetal compression** or developmental issues. - It does not directly cause maternal hypotension, absent fetal heart sounds, or the sensation of easily palpable fetal parts during active labor. *Abruptio placentae* - Involves the **premature separation of the placenta** from the uterine wall, leading to vaginal bleeding, abdominal pain, and fetal distress. - While it can cause fetal compromise and maternal hypotension, the finding of **easily palpable fetal parts** is more indicative of a disrupted uterus rather than just placental separation.

Q: The diameter of engagement of foetal skull in marked deflexion is

occipitofrontal diameter. ***occipitofrontal diameter*** - In cases of **marked deflexion** (also called **persistent occipitoposterior** or **military attitude** in some contexts), the fetal head presents with extension, causing the **occipitofrontal diameter** to engage. - This diameter extends from the **occipital protuberance to the root of the nose (glabella)**, measuring approximately **11.5 cm**. - This represents a **moderately extended** attitude of the fetal head, making vaginal delivery more challenging than with flexion. *suboccipitofrontal diameter* - This diameter measures about **10.0 cm** and engages with **partial deflexion**. - It extends from the **subocciput to the glabella** (center of forehead). - This is an intermediate position between full flexion and marked deflexion. *suboccipitobregmatic diameter* - This is the diameter of engagement in a **well-flexed head** (normal vertex presentation), measuring approximately **9.5 cm**. - It extends from the **subocciput to the bregma** (anterior fontanelle). - This is the **ideal diameter** for vaginal birth as it presents the smallest diameter. *mentovertical diameter* - This diameter is relevant in **brow presentation** (maximum deflexion/extension), measuring about **13-13.5 cm**. - It extends from the **chin (mentum) to the vertex**. - Brow presentation is **highly unfavorable** for vaginal delivery due to this very large engaging diameter and typically requires cesarean section.

Q: According to the WHO Intrapartum Care Guidelines, 2018, the active phase of labour starts from what dilation of cervix?

5 cm. ***5 cm*** - According to the **WHO Intrapartum Care Guidelines, 2018**, the active first stage of labor is defined as starting when the cervix is dilated to **5 cm**. - The WHO guidelines state: "The active first stage is the period of time from 5 cm of cervical dilatation until full cervical dilatation." - This updated definition aims to reduce unnecessary interventions, as cervical dilation before 5 cm (latent phase) can be slow and variable, which is part of normal labor progression. *6 cm* - **6 cm cervical dilation** is beyond the threshold defined by WHO 2018 guidelines for the start of active phase. - While some clinicians may use 6 cm as a benchmark in practice, the **official WHO 2018 guideline** specifically designates **5 cm** as the starting point. *4 cm* - Historically, **4 cm cervical dilation** was considered the start of the active phase in older definitions (Friedman curve). - This earlier benchmark led to premature diagnosis of "failure to progress" and increased interventions. - The **WHO 2018 guidelines** revised this upward to **5 cm** to reflect a more expectant management approach for slow but normal labor progression. *3 cm* - A **cervical dilation of 3 cm** is typically within the latent phase of labor, where cervical changes are usually slower and less predictable. - Defining the active phase at this early stage would significantly increase the possibility of diagnosing **abnormal labor patterns** prematurely and lead to unnecessary interventions.

Q: Which of the following features are correct regarding onset of true labour? 1. Regular uterine contractions 2. Progressive cervical dilation and effacement 3. Presence of show 4. Labour and delivery are synonymous Select the answer using the code given below.

1, 2 and 3. ***Correct: 1, 2 and 3*** - **Regular uterine contractions** (statement 1) are a hallmark of true labor, occurring at regular intervals with increasing frequency, duration, and intensity. - **Progressive cervical dilation and effacement** (statement 2) is the definitive diagnostic criterion for true labor, distinguishing it from false labor (Braxton Hicks contractions). - **Presence of 'show'** (statement 3) - the expulsion of the cervical mucus plug mixed with blood - is a common and reliable indicator of true labor onset. - Statement 4 is **incorrect**: labor and delivery are **not synonymous**. **Labor** is the entire process of childbirth (contractions, cervical changes, descent of fetus), while **delivery** refers specifically to the expulsion of the baby. *Incorrect: 2, 3 and 4* - Incorrectly includes statement 4, which falsely claims labor and delivery are synonymous. - Omits statement 1 (regular uterine contractions), which is a fundamental feature of true labor. *Incorrect: 1, 3 and 4* - Incorrectly includes statement 4 about labor and delivery being synonymous. - Critically omits statement 2 (progressive cervical dilation and effacement), which is the most important diagnostic criterion for true labor. *Incorrect: 1, 2 and 4* - Incorrectly includes statement 4, which is false. - Omits statement 3 (presence of show), which is a valid indicator of true labor onset.

Q: What is the most immediate intervention in the management of cord prolapse during delivery? 1. Bladder filling 2. Knee-chest position of the patient 3. Preferably caesarean delivery 4. Lifting up the presenting part off the cord

4. Lifting up the presenting part off the cord. ***Correct: Lifting up the presenting part off the cord*** - **Manual elevation of the presenting part** is the **FIRST and most immediate intervention** in cord prolapse to relieve compression on the umbilical cord. - This can be done by inserting a hand into the vagina and pushing the presenting part upward, maintaining this position until delivery. - This immediate action prevents **fetal hypoxia** by restoring blood flow through the umbilical cord. - This maneuver should be maintained continuously while other interventions are being arranged. *Incorrect: Knee-chest position of the patient* - While **maternal positioning** (knee-chest, Trendelenburg, or exaggerated Sims position) is an important immediate intervention, it is the **second step** after manual elevation. - Positioning uses gravity to help relieve pressure on the prolapsed cord but takes slightly longer to implement than manual elevation. - Both interventions are typically done simultaneously, but manual elevation is the most immediate action. *Incorrect: Preferably caesarean delivery* - **Emergency cesarean delivery** is the **definitive management** for most cases of cord prolapse, not the most immediate intervention. - Surgical delivery requires preparation time, anesthesia, and operating room setup. - Immediate interventions (manual elevation, positioning) must be performed first to protect the fetus while preparing for delivery. *Incorrect: Bladder filling* - **Bladder filling** (with 500-700 ml of saline via catheter) is an adjunctive measure that can help elevate the presenting part and relieve cord compression. - This is a secondary intervention, not the most immediate action. - Note: The management involves bladder **filling** (not emptying) to create upward displacement of the presenting part.

Question 1

As per the classification of Obstetric Anal Sphincter Injury (RCOG-2007), complete tear of External Anal Sphincter is of degree :

Accepted Answer

3c

Answer

2c

Answer

3b

Answer

3a

Question 2

Which are the parts of active management of third stage of labour?

1. Injection oxytocin 10 units IM within 1 minute of delivery of baby
2. Uterine massage after placental delivery
3. Controlled cord traction
4. Delayed cord clamping as per indications

Select the correct answer using the code given below:

Accepted Answer

1, 2 and 3

Answer

1, 2 and 4

Answer

2, 3 and 4

Answer

1, 3 and 4

Question 3

Which of the following are the characteristics of true labour pains ?

1. Intensity and duration of contractions increase progressively
2. Progressive effacement and dilatation of the cervix
3. Formation of the 'bag of forewaters'
4. Pain is confined to lower abdomen and groin

Select the correct answer using the code given below :

Accepted Answer

1, 2 and 3

Answer

1, 2 and 4

Answer

1, 3 and 4

Answer

2, 3 and 4

Question 4

A 28-year-old female G2P1L1 with history of previous cesarean presents to the gynaecology emergency in labour. On examination, she is hypotensive, foetal heart sounds are absent and foetal parts are easily palpable. What is her diagnosis?

Accepted Answer

Uterine rupture

Answer

Hydatidiform mole

Answer

Oligohydramnios

Answer

Abruptio placentae

Question 5

The diameter of engagement of foetal skull in marked deflexion is

Accepted Answer

occipitofrontal diameter

Answer

suboccipitofrontal diameter

Answer

suboccipitobregmatic diameter

Answer

mentovertebral diameter

Question 6

According to the WHO Intrapartum Care Guidelines, 2018, the active phase of labour starts from what dilation of cervix?

Accepted Answer

5 cm

Answer

4 cm

Answer

3 cm

Answer

6 cm

Question 7

Which of the following features are correct regarding onset of true labour?

1. Regular uterine contractions
2. Progressive cervical dilation and effacement
3. Presence of show
4. Labour and delivery are synonymous Select the answer using the code given below.

Accepted Answer

1, 2 and 3

Answer

2, 3 and 4

Answer

1, 3 and 4

Answer

1, 2 and 4

Question 8

Which of the following statements represents the PRIMARY obstetric significance at the level of plane of least pelvic dimensions?

1. It is a landmark used for pudendal nerve block analgesia.
2. Deep transverse arrest usually occurs at this plane.
3. It is at this plane that the internal rotation of the fetal head occurs during labour.
4. It marks the beginning of the backward curve of the pelvic axis.

Accepted Answer

1. It is a landmark used for pudendal nerve block analgesia.

Answer

4. It marks the beginning of the backward curve of the pelvic axis.

Answer

2. Deep transverse arrest usually occurs at this plane.

Answer

3. It is at this plane that the internal rotation of the fetal head occurs during labour.

Question 9

What is the most immediate intervention in the management of cord prolapse during delivery?

1. Bladder filling
2. Knee-chest position of the patient
3. Preferably caesarean delivery
4. Lifting up the presenting part off the cord

Accepted Answer

4. Lifting up the presenting part off the cord

Answer

2. Knee-chest position of the patient

Answer

1. Bladder filling

Answer

3. Preferably caesarean delivery

Question 10

Which of the following statements is correct regarding constriction ring?

1. Premature rupture of membranes is a high risk factor.
2. It is situated at the junction of upper and lower uterine segment.
3. Uterus never ruptures.
4. The ring is felt per abdomen.

Accepted Answer

1. Premature rupture of membranes is a high risk factor.

Answer

2. It is situated at the junction of upper and lower uterine segment.

Answer

4. The ring is felt per abdomen.

Answer

3. Uterus never ruptures.

Labor and Delivery — MCQs

Labor and Delivery — MCQs

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