Labor and Delivery Practice Questions

Q: Regarding placental separation in III stage of labour, consider the following statements: 1. Separation of placenta occurs at decidua spongiosa 2. In Schultze method, separation of placenta starts at centre 3. In Matthews Duncan's method, separation begins at margin Which of the statements given above is/are correct?

1, 2 and 3. ***1, 2 and 3*** - Correctly states that placental separation occurs at the level of the **decidua spongiosa**, which is the physiological cleavage plane permitting placental detachment after birth. - Correctly identifies that in the **Schultze method**, placental separation starts centrally, leading to the fetal surface presenting first. In the **Matthews Duncan method**, separation begins at the margin, causing the maternal surface to present first. *1 and 2 only* - This option is incorrect because while statements 1 and 2 are true, statement 3 is also correct and needs to be included for a complete answer. - It overlooks the accurate description of the **Matthews Duncan method** of placental separation. *2 and 3 only* - This option is incorrect because it fails to acknowledge the fundamental physiological fact that placental separation occurs at the **decidua spongiosa**, which is statement 1. - It omits the correct statement regarding the physiological plane of **placental separation**. *1 only* - This option is incorrect because it only includes statement 1, which is true, but excludes the correct statements 2 and 3 regarding the different methods of placental separation. - It does not account for the accurate descriptions of both the **Schultze** and **Matthews Duncan** methods.

Q: Consider the following pairs regarding foetal heart during labour:

2 and 3. ***2 and 3*** - The description for **late decelerations** correctly identifies them as resulting from causes like **maternal hypotension**, **placental insufficiency**, or **excessive uterine activity**, which lead to uteroplacental insufficiency and fetal hypoxia. - The description for **variable decelerations** accurately states that they are caused by **umbilical cord compression**, which is the characteristic cause of this deceleration pattern. Variable decelerations have an abrupt onset and variable timing relative to contractions. *1 and 2* - The first statement regarding **early decelerations** is incorrect if it states they are caused by **cord compression**. Early decelerations are actually caused by **fetal head compression leading to vagal stimulation**, not cord compression. - While the second statement about late decelerations is correct, combining it with an incorrect statement about early decelerations makes this option incorrect. *2 only* - While the description for **late decelerations** is correct, this option is incomplete because the description for **variable decelerations** (statement 3) is also correct. - Answering "2 only" would imply that statement 3 is incorrect, which is not true. *1 and 3* - The first statement regarding **early decelerations** is incorrect if it attributes them to **cord compression** rather than **fetal head compression**. - While the third statement regarding **variable decelerations** is correctly described as being due to **umbilical cord compression**, the incorrectness of the first statement makes this option invalid.

Q: The engaging diameter of brow presentation is:

Mento‐vertical. ***Mento-vertical*** - In a **brow presentation**, the fetal head is incompletely extended, and the presenting part is the brow. - The **mento-vertical diameter** is the longest antero-posterior diameter of the fetal head, measuring approximately **13.5 cm**, and is the engaging diameter in a brow presentation. *Submento-bregmatic* - This diameter is measured from the junction of the neck and chin to the anterior fontanelle (bregma), reflecting the engaging diameter in a **face presentation** with full extension. - Its typical measurement is about **9.5 cm**, significantly shorter than the mento-vertical diameter. *Submento-vertical* - This diameter is not a standard engaging diameter used to describe typical fetal head presentations. - Standard obstetrical terminology focuses on submento-bregmatic for face and suboccipito-bregmatic for vertex presentations. *Suboccipito-bregmatic* - This is the engaging diameter for a **flexed vertex presentation** (occiput or crown of the head), which is the most common and favorable presentation. - It measures approximately **9.5 cm**, representing the optimal diameter for passage through the birth canal.

Q: Modified Bishop’s score includes all EXCEPT:

Position of occiput. ***Position of occiput*** - The **position of the occiput** (fetal head position) is assessed during labor but is not a component of either the original or modified Bishop's score. - The Bishop's score universally evaluates **cervical ripeness** and does not incorporate fetal station or position. *Position of os* - The **position of the cervix (os)**, whether anterior, posterior, or mid-position, is a crucial component of the Bishop's score. - A more **anterior cervix** indicates a higher likelihood of successful induction. *Consistency of cervix* - **Cervical consistency** (firm, medium, soft) is a key factor in the Bishop's score, reflecting the degree of cervical ripening. - A **softer cervix** is more favorable for induction and spontaneous labor progression. *Cervical length and dilatation* - **Cervical effacement** (length) and **dilatation** are essential parameters in the Bishop's score, indicating the readiness of the cervix for labor. - A **shorter and more dilated cervix** correlates with a higher Bishop's score and increased success of labor induction.

Q: The main cause of perinatal mortality in ‘Frank breech presentation’ is:

Intracranial haemorrhage. ***Intracranial haemorrhage*** - In **breech deliveries**, the head, being the largest and least compressible part, is born last, subjecting it to rapid compression and decompression forces. - This can lead to **tentorial tears** and **intracranial haemorrhage**, especially in frank breech presentation where the head is not well-flexed, and the uterine forces are exerted more directly and forcefully on it during the final stages of delivery. *Prolapse of umbilical cord* - While **cord prolapse** is a risk in breech presentations, it is most common in **footling breech** due to incomplete filling of the pelvis by the presenting part. - In **frank breech**, the buttocks and flexed legs tend to fill the lower uterine segment more effectively, making cord prolapse less likely than in other breech types. *Trauma to foetal viscera* - **Visceral trauma** is possible in breech deliveries but is less common as a primary cause of mortality compared to intracranial injury. - It usually results from excessive traction or manipulation during extraction, which can cause injuries to organs like the liver or spleen. *Foetal abnormalities* - Although **foetal anomalies** are an underlying cause of breech presentation in a significant number of cases (up to 15-20%), they are the predisposing factor, not the direct cause of perinatal mortality during delivery itself. - The mortality from "frank breech presentation" refers to the complications arising from the **mode of delivery** rather than the underlying reason for the presentation.

Q: A 20 year old full term primigravida is admitted with full dilatation of the cervix and breech presentation. The breech is not engaged. Foetal heart is normal. The proper procedure for the management would be:

Caesarean section. ***Caesarean section*** - For a **primigravida** with a full-term breech presentation where the foetus is **not engaged** at full dilatation and the **foetal heart is normal**, a Caesarean section is the safest option to prevent complications. - This approach minimizes risks of **foetal distress**, cord prolapse, and trauma associated with vaginal breech delivery in an unengaged presentation, especially in a first pregnancy. *Oxytocin drip augmentation* - Oxytocin is used to **augment contractions** in cases of uterine inertia or slow cervical dilation but is **contraindicated** in breech presentation that is not engaged at full dilation due to the risk of uterine rupture and foetal compromise. - Augmenting contractions in this scenario would increase the risk of an **incomplete, traumatic vaginal delivery** of a breech baby, particularly with an unengaged presentation. *To bring down the leg* - **Bringing down the leg** is a maneuver typically performed during a **planned vaginal breech delivery** to convert a complete or incomplete breech to a single footling breech to aid delivery. - This procedure is not appropriate for a primigravida with an unengaged breech at full dilatation, as it carries a high risk of **cord prolapse** and other complications without prior engagement and favourable conditions for a vaginal delivery. *Breech extraction* - **Breech extraction** is a procedure used in specific circumstances, such as delivery of a second twin or in cases where there is an umbilical cord prolapse and immediate delivery is required. - It is generally **not recommended for a primigravida** with an unengaged breech at full dilatation primarily due to the high risk of **foetal trauma** and maternal complications associated with such an intervention without prior engagement.

Q: During labour, which one of the foetal heart patterns is ominous?

Late deceleration. ***Late deceleration*** - **Late decelerations** are an ominous sign as they indicate **uteroplacental insufficiency** and **fetal hypoxia**. - They are characterized by a gradual decrease in fetal heart rate that begins after the peak of the uterine contraction and returns to baseline after the contraction has ended. *Variable deceleration* - **Variable decelerations** are characterized by an **abrupt decrease** in fetal heart rate, 15 bpm below baseline and lasting at least 15 seconds. - They are usually associated with **umbilical cord compression** and are not necessarily ominous unless they are prolonged or severe. *Early deceleration* - **Early decelerations** are generally benign and are caused by **head compression** during uterine contractions. - They mirror the contractions, starting and ending with the contraction, and are typically not associated with fetal hypoxia. *Tachycardia* - **Fetal tachycardia** (baseline heart rate >160 bpm) can be caused by various factors, including **maternal fever**, infection, or fetal compromise. - While it can be a sign of distress, it is not as acutely ominous as late decelerations, which directly reflect hypoxemia.

Q: Prophylactic intravenous methergin should not be given in cases of:

Heart disease complicating pregnancy. **Heart disease complicating pregnancy** - **Methergine** (methylergonovine) is an **ergot alkaloid** that causes generalized **vasoconstriction**, leading to an increase in blood pressure. - In patients with **heart disease**, particularly those with conditions sensitive to increased afterload or blood pressure elevation, Methergine can precipitate **cardiac decompensation**, **myocardial ischemia**, or **hypertensive crises**. *Anaemia* - **Anaemia** itself is not a contraindication to **Methergine** use. - The medication primarily affects uterine contractility and vascular tone, with no direct adverse effects on red blood cell production or function. *Hydramnios* - **Hydramnios** (polyhydramnios) is not a contraindication for **Methergine**. - While it may be associated with increased risk of postpartum hemorrhage due to uterine overdistension, Methergine can still be safely used to promote uterine contraction and prevent excessive bleeding. *Multipara* - **Multiparity** is not a contraindication to **Methergine** use. - In fact, multiparous women may have a slightly increased risk of uterine atony and postpartum hemorrhage, making prophylactic uterotonics like Methergine potentially beneficial to prevent excessive bleeding.

Q: The progress of labour can be monitored by observing the following except:

The formation of caput by vaginal examination. ***The formation of caput by vaginal examination*** - The formation of a **caput succedaneum** (swelling on the fetal scalp) indicates **prolonged pressure** on the fetal head, which can be a sign of **cephalopelvic disproportion** or prolonged labor, rather than a direct measure of labor progression. - While its presence is noted during labor, caput formation itself does not actively monitor the *progress* of cervical dilatation or fetal descent in a positive way; rather, it often signals a potential **complication** or **stalling** of labor. *Gradual increase in cervical dilatation by vaginal examination* - **Cervical dilatation** is a primary indicator of the **first stage of labor progression**, as the cervix opens to allow passage of the fetus. - Regular **vaginal examinations** determine the rate and extent of cervical opening, crucial for deciding management. *The descent of foetal head by abdominal examination* - **Fetal head descent**, assessed by **abdominal palpation** (e.g., using the "fifths palpable" method), indicates the baby's movement through the birth canal. - This is a key measure of **progress in the second stage of labor** and helps identify potential obstructed labor. *The intensity of uterine contractions by abdominal examination* - The **intensity, frequency, and duration of uterine contractions** directly correlate with the forces driving labor progression. - While palpation provides a good estimate, this helps monitor the **effectiveness of uterine activity** in causing cervical changes and fetal descent.

Q: The most common sign of rupture of previous LSCS scar during labour is:

Non-reassuring fetal heart rate pattern. ***Non-reassuring fetal heart rate pattern*** - A **sudden, sustained deceleration** or **bradycardia** in the fetal heart rate is the **most common and earliest sign** of uterine rupture, occurring in **55-87%** of cases. - This occurs due to compromised uteroplacental blood flow and **acute fetal hypoxia** as the uterus tears. - **Continuous electronic fetal monitoring** during TOLAC (Trial of Labor After Cesarean) is critical for early detection. - Changes may include **prolonged decelerations**, **bradycardia (<110 bpm)**, or sudden loss of variability. *Cessation of uterine contractions* - While a sudden **cessation of contractions** can occur with uterine rupture, it is **not consistently the most common** initial sign. - It often follows other changes, particularly fetal heart rate abnormalities, as the uterus loses its contractile ability. - Detected more reliably with intrauterine pressure catheter monitoring. *Tenderness in lower abdomen* - **Abdominal pain** and tenderness can be present, especially localized to the lower uterine segment scar area. - However, it is often **subjective and masked by normal labor pain**, making it an unreliable early indicator. - Not as specific or consistently observable as fetal heart rate changes. *Haemorrhagic shock* - **Haemorrhagic shock** with hypotension and tachycardia is a **serious late complication** indicating significant intraperitoneal or vaginal bleeding. - It usually manifests **after fetal distress** has already appeared and represents advanced rupture. - Requires immediate surgical intervention but is not an early warning sign.

Question 1

Regarding placental separation in III stage of labour, consider the following statements:

1. Separation of placenta occurs at decidua spongiosa
2. In Schultze method, separation of placenta starts at centre
3. In Matthews Duncan's method, separation begins at margin

Which of the statements given above is/are correct?

Accepted Answer

1, 2 and 3

Answer

1 and 2 only

Answer

2 and 3 only

Answer

1 only

Question 2

Consider the following pairs regarding foetal heart during labour:

Accepted Answer

2 and 3

Answer

1 and 2

Answer

2 only

Answer

1 and 3

Question 3

The engaging diameter of brow presentation is:

Accepted Answer

Mento‐vertical

Answer

Submento‐bregmatic

Answer

Submento‐vertical

Answer

Suboccipito‐bregmatic

Question 4

Modified Bishop’s score includes all EXCEPT:

Accepted Answer

Position of occiput

Answer

Position of os

Answer

Consistency of cervix

Answer

Cervical length and dilatation

Question 5

The main cause of perinatal mortality in ‘Frank breech presentation’ is:

Accepted Answer

Intracranial haemorrhage

Answer

Prolapse of umbilical cord

Answer

Trauma to foetal viscera

Answer

Foetal abnormalities

Question 6

A 20 year old full term primigravida is admitted with full dilatation of the cervix and breech presentation. The breech is not engaged. Foetal heart is normal. The proper procedure for the management would be:

Accepted Answer

Caesarean section

Answer

Oxytocin drip augmentation

Answer

To bring down the leg

Answer

Breech extraction

Question 7

During labour, which one of the foetal heart patterns is ominous?

Accepted Answer

Late deceleration

Answer

Variable deceleration

Answer

Early deceleration

Answer

Tachycardia

Question 8

Prophylactic intravenous methergin should not be given in cases of:

Accepted Answer

Heart disease complicating pregnancy

Answer

Anaemia

Answer

Hydramnios

Answer

Multipara

Question 9

The progress of labour can be monitored by observing the following except:

Accepted Answer

The formation of caput by vaginal examination

Answer

Gradual increase in cervical dilatation by vaginal examination

Answer

The descent of foetal head by abdominal examination

Answer

The intensity of uterine contractions by abdominal examination

Question 10

The most common sign of rupture of previous LSCS scar during labour is:

Accepted Answer

Non-reassuring fetal heart rate pattern

Answer

Cessation of uterine contractions

Answer

Tenderness in lower abdomen

Answer

Haemorrhagic shock

Labor and Delivery — MCQs

Labor and Delivery — MCQs

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