Labor and Delivery Practice Questions

Q: The first-line drug for intrapartum prophylaxis against Group β Streptococcal (GBS) infection in pregnancy is

penicillin. ***penicillin*** - **Penicillin G** is the drug of choice for intrapartum GBS prophylaxis due to its **narrow spectrum** and proven efficacy in preventing neonatal GBS disease. - It rapidly achieves bactericidal concentrations in the amniotic fluid, effectively eradicating GBS from the maternal genital tract during labor. *doxycycline* - **Doxycycline** is a **tetracycline antibiotic** generally contraindicated in pregnancy due to potential adverse effects on fetal bone and tooth development. - It is not effective against GBS and is not used for its treatment or prophylaxis in pregnant women. *vancomycin* - **Vancomycin** is reserved for pregnant women with **severe penicillin allergy** (e.g., anaphylaxis) or isolates with known resistance to penicillin and clindamycin. - Its use is limited due to the need for intravenous administration and potential for ototoxicity or nephrotoxicity. *azithromycin* - **Azithromycin** is sometimes used for GBS prophylaxis in cases of penicillin allergy but is **less preferred** than clindamycin due to emerging GBS resistance. - It is not considered a first-line agent, and susceptibility testing is crucial if it is considered for use.

Q: During the first stage of labour, the intrauterine pressure is increased up to

40–50 mm of Hg. ***40–50 mm of Hg*** - This pressure range is typical during **uterine contractions** in the first stage of labor, effectively causing cervical effacement and dilation. - These pressures provide sufficient force to facilitate the progression of labor while maintaining adequate **uteroplacental blood flow** between contractions. *100–120 mm of Hg* - This pressure range is generally too high for the first stage of labor and is more commonly seen in the **second stage** or during prolonged, abnormal contractions. - Such elevated pressures could potentially compromise **fetal well-being** due to reduced uteroplacental perfusion. *8–10 mm of Hg* - This pressure range represents the **resting tone** of the uterus between contractions, not the peak pressure during a contraction. - It is too low to cause significant cervical changes or *advance labor*. *2–3 mm of Hg* - This pressure is significantly below the normal resting tone of the uterus and is not associated with any stage of active labor. - Such low pressures would indicate **uterine inactivity** or atony, not active contractions.

Q: Uterine rupture is most commonly encountered after which one of the following surgeries?

Classical cesarean. ***Classical cesarean*** - A **classical cesarean section** involves a vertical incision in the **upper uterine segment**, which contains fewer muscle fibers and heals less strongly than the lower segment. - This weaker scar is more prone to rupture in subsequent pregnancies or during labor, leading to a significantly higher risk compared to other uterine surgeries. *Hysterotomy* - **Hysterotomy** is a surgical incision into the uterus, often performed for fetal surgery, but **uterine rupture** risk is heavily dependent on the type and location of the incision. - While it creates a uterine scar, the risk of rupture varies with the depth and extent of the incision, and it is generally associated with a lower rupture risk than a single, full-thickness classical incision. *Metroplasty* - **Metroplasty** is a reconstructive surgery of the uterus, typically performed to correct uterine anomalies like a **septate uterus**, improving reproductive outcomes. - While it involves cutting and suturing uterine tissue, the goal is to create a more functional and robust uterus, and if performed meticulously, the risk of subsequent rupture is relatively low. *Myomectomy* - **Myomectomy** involves the surgical removal of **fibroids** (leiomyomas) from the uterus while preserving the uterus. - The risk of **uterine rupture** after myomectomy is proportional to the number, size, and depth of the fibroids removed, especially if the uterine cavity is entered; deep intramural fibroids pose a higher risk, but generally less than a classical cesarean.

Q: What is the maternal risk of using misoprostol for ripening of cervix during induction of labour?

Tachysystole/hyperstimulation of uterus. ***Tachysystole/hyperstimulation of uterus*** - Misoprostol, a **prostaglandin E1 analog**, increases uterine contractility to ripen the cervix and induce labor. - This heightened uterine activity can lead to **tachysystole** (more than 5 contractions in 10 minutes) or **uterine hyperstimulation**, posing risks to both mother and fetus. *Bradycardia* - **Maternal bradycardia** is not a direct or common maternal side effect of misoprostol; however, **fetal bradycardia** can occur secondary to uterine hyperstimulation and reduced placental perfusion. - Misoprostol's primary effect is on uterine smooth muscle, not directly on maternal heart rate regulation. *Hypotension* - While some prostaglandins can have vasodilatory effects, significant **maternal hypotension** is not a typical or well-known adverse effect of misoprostol used for cervical ripening. - The doses used for cervical ripening usually do not lead to systemic circulatory collapse. *Tachycardia* - **Maternal tachycardia** is not a primary or direct side effect of misoprostol; however, it could indirectly occur due to **maternal stress** or other complications. - The drug's mechanism of action primarily involves uterine contractility and cervical changes, not direct cardiac stimulation.

Q: Misoprostol can be used in obstetric practice by the following routes except:

Intravenous. ***Intravenous*** - Misoprostol is **not used intravenously** in obstetric practice due to safety concerns - IV administration could lead to **rapid, uncontrolled systemic effects** including severe adverse events like **cardiovascular collapse** and anaphylactoid reactions - The drug formulation is not intended for IV use, and its rapid absorption via this route would pose significant maternal risk - All approved obstetric uses employ **oral, sublingual, vaginal, or buccal routes** *Vaginal* - Vaginal administration is commonly used in obstetrics for **cervical ripening** and **labor induction** - Also used for **management of miscarriage** and **postpartum hemorrhage** - Allows for **gradual absorption** with local effect on the cervix and uterus *Sub-lingual* - Sublingual misoprostol is effectively absorbed through the **oral mucosa** - Used for **labor induction** and **management of postpartum hemorrhage** - Offers **rapid onset of action** and bypasses first-pass metabolism *Oral* - Oral administration is used for **medical abortion**, **miscarriage management**, and **labor induction** - Also approved for prevention of **NSAID-induced gastric ulcers** (non-obstetric indication) - Absorption is slower with lower peak concentrations compared to sublingual or vaginal routes

Q: Which of the following is a uterine compression suture during management of atonic postpartum haemorrhage?

B-Lynch suture. **B-Lynch suture** - The **B-Lynch suture** is a specific type of surgical technique involving the placement of sutures across the uterine fundus and lower uterine segment to compress the uterus. - This compression helps to reduce blood loss by mechanically occluding the endometrial vessels, making it highly effective in managing **atonic postpartum hemorrhage**. *Sturmdorf suture* - The Sturmdorf suture is primarily used in **cervical cone biopsy** or **trachelectomy** to close the cervical stump. - It involves everting and suturing the cervical mucosa to provide hemostasis and promote healing of the cervix, not for uterine compression. *Fothergill's suture* - Fothergill's operation (Manchester operation) is used for **pelvic organ prolapse**, particularly uterine prolapse. - It typically involves shortening the cardinal ligaments and repairing the perineum, but does not involve uterine compression for hemorrhage. *Moscowitz suture* - The Moscowitz suture is used for **obliteration of the cul-de-sac (pouch of Douglas)** to prevent **enterocele** formation during pelvic floor repair. - This technique involves plicating the peritoneum over the pouch of Douglas, and is not a uterine compression suture for atonic hemorrhage.

Q: The following are the signs of placental separation except :

The fundal height decreases. ***The fundal height decreases*** - Following placental separation, the uterus often rises in the abdomen due to the pooling of blood behind the placenta, causing the **fundal height to appear to increase**, not decrease. - A decrease in fundal height is not a recognized sign of placental separation. *The uterus becomes hard and globular* - As the placenta separates, the uterus naturally contracts firmly to prevent postpartum hemorrhage, thus becoming **hard and globular** to the touch. - This **sustained contraction** is a key clinical sign indicating effective uterine retrieval and placental detachment. *Permanent lengthening of the cord* - Once the placenta detaches from the uterine wall and descends into the lower uterine segment or vagina, the **umbilical cord will appear to lengthen** permanently outside the vulva. - This external lengthening signifies that the placenta has moved from its intrauterine position. *Fresh bleeding occurs* - Fresh bleeding is expected after placental separation because the detachment process exposes maternal blood vessels, leading to **external blood loss**. - This **active bleeding** is a normal physiological sign indicating the placenta is no longer attached to the uterine wall.

Q: Face to pubis delivery is common in which type of pelvis ?

Anthropoid. ***Anthropoid*** - The **anthropoid pelvis** has an oval inlet with a long anteroposterior (AP) diameter, which favors **persistent occiput posterior (OP) positions**. - In OP position, the fetal occiput faces the maternal sacrum, and the fetal face faces the maternal pubis, resulting in **"face to pubis" delivery**. - This pelvic shape aligns the fetal head to enter and descend in the AP diameter, increasing the likelihood of the occiput remaining posterior throughout labor, leading to delivery in the OP position. *Android* - An **android pelvis** is heart-shaped and narrow, often associated with complications like **failure to progress** and fetal head arrest, but not specifically face to pubis deliveries. - Its narrow forepelvis makes internal rotation difficult, often leading to **transverse arrest** of the fetal head rather than persistent OP position. *Gynaecoid* - The **gynaecoid pelvis** is the ideal and most common female pelvic type, characterized by a rounded inlet and adequate diameters, typically allowing for delivery in the favorable **occiput anterior (OA) position**. - It facilitates **spontaneous internal rotation** to OA position, making face to pubis (OP) delivery uncommon. *Platypelloid* - A **platypelloid pelvis** has a flattened inlet with a short anteroposterior and a wide transverse diameter, often leading to **transverse arrest** of the fetal head. - This shape is unfavorable for vaginal delivery in general and does not specifically predispose to face to pubis presentations.

Q: Normal pH of foetal scalp blood is :

7.30. ***7.30*** - A **normal foetal scalp pH** is generally considered to be above 7.25, with an ideal range being closer to **7.30-7.35**. - A pH of **7.30** indicates adequate oxygenation and acid-base balance, suggesting the foetus is not experiencing significant hypoxia or acidosis. *7.20* - A pH of **7.20** is typically considered a **borderline acidic** value in foetal scalp blood. - While not immediately critical, it often warrants close monitoring or further assessment of foetal well-being, as it may indicate mild **acidosis**. *7.0* - A pH of **7.0** in foetal scalp blood is a significantly **acidotic** value. - This level suggests considerable **foetal distress and hypoxemia**, often necessitating urgent intervention like expedited delivery. *7.10* - A pH of **7.10** is indicative of definite **foetal acidosis**. - This level is a strong indicator of **foetal compromise** and would typically prompt immediate action to resolve the underlying issue or deliver the baby.

Question 1

The first-line drug for intrapartum prophylaxis against Group β Streptococcal (GBS) infection in pregnancy is

Accepted Answer

penicillin

Answer

doxycycline

Answer

vancomycin

Answer

azithromycin

Question 2

In which of the following situations might delayed cord clamping be contraindicated?

Accepted Answer

Need for immediate neonatal resuscitation where delayed clamping interferes

Answer

Placental abruption with maternal compromise

Answer

Severe maternal hemorrhage requiring immediate resuscitation

Answer

Cord prolapse requiring immediate delivery

Question 3

During the first stage of labour, the intrauterine pressure is increased up to

Accepted Answer

40–50 mm of Hg

Answer

100–120 mm of Hg

Answer

8–10 mm of Hg

Answer

2–3 mm of Hg

Question 4

Uterine rupture is most commonly encountered after which one of the following surgeries?

Accepted Answer

Classical cesarean

Answer

Hysterotomy

Answer

Metroplasty

Answer

Myomectomy

Question 5

What is the maternal risk of using misoprostol for ripening of cervix during induction of labour?

Accepted Answer

Tachysystole/hyperstimulation of uterus

Answer

Bradycardia

Answer

Hypotension

Answer

Tachycardia

Question 6

Misoprostol can be used in obstetric practice by the following routes except:

Accepted Answer

Intravenous

Answer

Vaginal

Answer

Sub-lingual

Answer

Oral

Question 7

Which of the following is a uterine compression suture during management of atonic postpartum haemorrhage?

Accepted Answer

B-Lynch suture

Answer

Sturmdorf suture

Answer

Fothergill's suture

Answer

Moscowitz suture

Question 8

The following are the signs of placental separation except :

Accepted Answer

The fundal height decreases

Answer

The uterus becomes hard and globular

Answer

Permanent lengthening of the cord

Answer

Fresh bleeding occurs

Question 9

Face to pubis delivery is common in which type of pelvis ?

Accepted Answer

Anthropoid

Answer

Android

Answer

Gynaecoid

Answer

Platypelloid

Question 10

Normal pH of foetal scalp blood is :

Accepted Answer

7.30

Answer

7.20

Answer

7.0

Answer

7.10

Labor and Delivery — MCQs

Labor and Delivery — MCQs

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