Labor and Delivery Practice Questions

Q: A woman with post-term pregnancy with unripe cervix should not be induced with misoprostol if she has:

Decompensated heart disease. ***Decompensated heart disease*** - Misoprostol can cause rapid and significant uterine contractions, leading to a **sudden increase in circulating blood volume** due to displacement from the uterus. - In patients with **decompensated heart disease**, this acute volume shift can precipitate **pulmonary edema** or **cardiac decompensation**, making it a contraindication. *Asthma* - While some prostaglandins can be bronchoconstrictive, **misoprostol (a synthetic prostaglandin E1 analog)** is generally considered safe for use in patients with asthma. - **Uterotonics like carboprost (PGF2a)** are contraindicated in asthma due to their bronchoconstrictive effects, but misoprostol does not share this contraindication. *Diabetes* - **Diabetes mellitus** is not a contraindication for the use of misoprostol for cervical ripening or induction. - Glucose control and fetal surveillance remain important, but misoprostol itself does not typically pose specific risks unique to diabetic patients. *Hepatitis B antigen positive* - **Hepatitis B positivity** in the mother does not contraindicate the use of misoprostol for labor induction. - The primary concern in this scenario is managing the risk of **vertical transmission** to the neonate, which is addressed through immunoprophylaxis, not by altering induction methods.

Q: Consider the following presentations: 1. Brow presentation 2. Left mento anterior position 3. Occipito posterior position 4. Breech presentation In which of the above Vaginal delivery is NOT possible?

1 only. ***1 only*** - A **brow presentation** presents the fetal head at an unfavorable diameter (**mentovertical diameter**), making vaginal delivery impossible due to **mechanical obstruction**. - With the brow presenting, the head cannot adequately mold or engage in the maternal pelvis, necessitating a **cesarean section** for safe delivery. *1, 2 and 3* - While **brow presentation** (1) is not amenable to vaginal delivery, **left mento anterior position** (2) generally allows for successful vaginal delivery. - **Occipito posterior position** (3) can often be delivered vaginally, sometimes requiring rotation, making this option incorrect. *4 only* - **Breech presentation** (4) can sometimes be delivered vaginally, although it carries higher risks and often warrants a **cesarean section**, but it is not universally impossible. - This option incorrectly suggests that only breech presentation is impossible for vaginal delivery, while brow presentation is a definitive contraindication. *1 and 3 only* - **Brow presentation** (1) is indeed a contraindication for vaginal delivery. - However, **occipito posterior position** (3) does not inherently preclude vaginal delivery, as many cases can be delivered vaginally, making this option incorrect.

Q: For vaginal breech delivery, ideal selection criteria would include: 1. Fetus not compromised 2. Adequate pelvis 3. Flexed breech presentation 4. Estimated fetal weight < 3.5 kg Select the correct answer using the code given below:

1, 2, 3 and 4. ***1, 2, 3 and 4*** - All listed criteria (fetus not compromised, adequate pelvis, **flexed breech presentation**, and estimated fetal weight < 3.5 kg) are considered **ideal selection criteria** for a safe vaginal breech delivery. - **Flexed (frank) breech** with hips flexed and knees extended is the **most favorable type** for vaginal delivery, as it presents the smallest diameter and has the lowest risk of cord prolapse. - While many institutions now favor elective cesarean section for breech presentations, these criteria represent conditions under which a **vaginal delivery can be safely attempted** with minimal risk. *2 and 4 only* - This option is incomplete as it correctly identifies adequate pelvis and estimated fetal weight < 3.5 kg but omits other crucial factors like **fetal well-being** and the **type of breech presentation**. - A successful vaginal breech delivery also requires the fetus to be **uncompromised** and ideally in a **flexed (frank) breech** presentation. *1, 3 and 4 only* - This option overlooks the critical importance of an **adequate maternal pelvis**, which is fundamental for allowing the passage of the fetus during vaginal delivery regardless of fetal presentation. - While fetal status, presentation, and weight are important, a **contracted or inadequate pelvis** would contraindicate vaginal delivery. *1, 2 and 3 only* - This option excludes the **estimated fetal weight** being less than 3.5 kg, which is a significant factor in assessing the feasibility of vaginal breech delivery. - Larger fetuses (typically >3.5-4 kg) have a **higher risk of birth trauma** and **head entrapment** during vaginal breech delivery, even with an adequate pelvis and favorable presentation.

Q: A 25 year old, G2P1L1 came with amenorrhoea of two and half months followed by bleeding PV and pain abdomen. On examination cervical OS is open with slight bleeding. The uterus is 10 weeks size with no tenderness in the fornices. The probable clinical diagnosis is:

Inevitable abortion. ***Inevitable abortion*** - The presence of **amenorrhea** followed by **vaginal bleeding** and **abdominal pain**, with an **open cervical os**, indicates that the abortion process cannot be halted. - Critically, there is **no history of passage of products of conception**, which means the abortion is inevitable but has not yet occurred. - The uterus size being consistent with **10 weeks of gestation** confirms an intrauterine pregnancy in the process of being expelled. *Incomplete abortion* - This diagnosis also involves vaginal bleeding and an open cervical os, but it is characterized by the **partial expulsion of products of conception**. - The key differentiator is that incomplete abortion requires **history or evidence of tissue passage**, which is not mentioned in this clinical scenario. - In inevitable abortion, the os is open and bleeding is present, but expulsion has not yet begun. *Missed abortion* - A missed abortion involves fetal demise without symptoms like bleeding or pain, and a **closed cervical os**. - This patient presents with active bleeding and pain, and an open cervical os, which contradicts the features of a missed abortion. - The uterus may be smaller than expected for dates in missed abortion. *Ectopic pregnancy* - Although an ectopic pregnancy can cause amenorrhea, vaginal bleeding, and abdominal pain, the uterus in an ectopic pregnancy is typically **smaller than expected for gestational age** or normal in size, and there is often **significant adnexal tenderness or mass**. - The finding of a **10-week sized uterus** strongly suggests an intrauterine pregnancy rather than ectopic, and the absence of adnexal tenderness makes ectopic pregnancy unlikely.

Q: In case of Labour complicated with cord prolapse, which of the following statements are correct? 1. Reposition the patient in exaggerated Sims position 2. To replace the cord in the vagina 3. To replace the cord inside the uterus 4. Early amniotomy can prevent cord prolapse Select the correct answer using the code given below:

1 only. ***Correct: 1 only*** **Statement 1 - Reposition the patient in exaggerated Sims position** ✓ - **Correct** - Immediate repositioning (knee-chest, Trendelenburg, or exaggerated Sims position) is crucial to reduce pressure on the prolapsed cord and relieve compression - This helps displace the presenting part away from the cord using gravity **Statement 2 - To replace the cord in the vagina** ✗ - **Incorrect** - Manipulation or replacement of the prolapsed cord is **contraindicated** as it can cause vasospasm and further compromise fetal circulation - The correct approach is to **elevate the presenting part manually** (pushing it up off the cord) while keeping the cord moist and warm, NOT to reposition the cord itself **Statement 3 - To replace the cord inside the uterus** ✗ - **Incorrect** - This is contraindicated as it carries high risk of uterine infection, cord trauma, and vasospasm - Does not reliably prevent recurrence of prolapse **Statement 4 - Early amniotomy can prevent cord prolapse** ✗ - **Incorrect** - Early amniotomy actually **increases** the risk of cord prolapse, especially when the presenting part is not well-engaged - It removes the cushioning effect of forewaters that help keep the cord in place **Correct management of cord prolapse includes:** - Immediate repositioning (Trendelenburg/knee-chest position) - Manual elevation of presenting part to relieve cord compression - Keeping the prolapsed cord moist and warm - Avoiding cord manipulation - Emergency cesarean delivery or instrumental delivery if feasible *Incorrect: 1 and 2 only* - While statement 1 is correct, statement 2 (replacing the cord in vagina) is medically incorrect and contraindicated *Incorrect: 3 and 4 only* - Both statements are incorrect as explained above *Incorrect: 1, 2, 3 and 4* - Only statement 1 is correct; statements 2, 3, and 4 are all incorrect

Q: Which of the following are indications of vaginal examinations during labour? 1. To stretch the vagina intermittently 2. At the onset of labour 3. To monitor progress of labour 4. Following rupture of membranes

2, 3 and 4. ***2, 3 and 4*** * Regular vaginal examinations are crucial for **monitoring the progress of labour**, assessing cervical dilation, effacement, and fetal station. * Examinations at the **onset of labour** establish a baseline for progress, and after **rupture of membranes**, they are important to check for **cord prolapse** and confirm fetal presentation. * *1, 3 and 4* * **Stretching the vagina intermittently** is not a standard indication for vaginal examination in labour. Labour progress is assessed, not physically hastened by stretching. * While monitoring progress and examining after membrane rupture are correct indications, the inclusion of "stretching the vagina" makes this option incorrect. * *1, 2 and 4* * Similar to the previous option, including **stretching the vagina intermittently** as an indication is incorrect. * Vaginal examinations are for assessment, not for mechanically dilating the vagina. * *1, 2 and 3* * This option again incorrectly includes **stretching the vagina intermittently** as an indication. * While examinations at the onset and for monitoring progress are valid, the presence of an incorrect indication makes the entire option invalid.

Q: In the mechanism of normal labour the engaging transverse diameter is

Biparietal diameter (9.5 cm). ***Biparietal diameter (9.5 cm)*** - In normal labor, with the fetus in a **flexed attitude**, the **biparietal diameter** is the widest transverse diameter of the fetal head that engages in the maternal pelvis. - This diameter measures approximately **9.5 cm** and indicates the distance between the two parietal eminences. *Bimastoid diameter (7.5 cm)* - The **bimastoid diameter** measures the widest transverse diameter at the base of the skull, going from one mastoid process to the other. - At **7.5 cm**, it is too small to be the primary engaging transverse diameter of the fetal head in normal labor, which involves the broader cranial vault. *Suboccipitofrontal diameter (10 cm)* - The **suboccipitofrontal diameter** is typically the engaging diameter when the fetal head is in a **deflexed attitude** (e.g., military presentation). - This diameter measures approximately **10 cm**, indicating moderate extension, which is not characteristic of normal labor where good flexion is expected. *Suboccipitobregmatic diameter (9.5 cm)* - The **suboccipitobregmatic diameter** is the smallest and most favorable anteroposterior diameter for engagement when the fetal head is **well-flexed**. - While it also measures **9.5 cm**, it is an **anteroposterior diameter**, not a transverse diameter, and hence not the answer to the question regarding transverse engaging diameter.

Q: The normal rate of dilatation of the cervix in a primigravida in the active phase of labor is

1 cm/hour. ***1 cm/hour*** - The **active phase** of labor in a **primigravida** (first-time mother) is characterized by a cervical dilatation rate of at least 1 cm per hour. - This rate signifies good progress and is often used as a benchmark on a **partogram** to monitor labor. *0.25 cm/hour* - This rate is significantly **slower** than normal for the active phase of labor in a primigravida and would indicate **abnormal labor progression**, possibly requiring intervention. - Such a slow rate might be seen in the **latent phase** or in cases of **protracted labor**. *0.75 cm/hour* - While closer, this rate is still **below the expected minimum** for a primigravida in the active phase, suggesting slightly slower than optimal progress. - It could still indicate a **protracted active phase**, particularly if it persists. *0.5 cm/hour* - This rate is **substantially slower** than the typical progress in the active phase of labor for a primigravida. - It would be a strong indicator of **failure to progress** and would likely warrant a thorough evaluation for potential causes such as **cephalopelvic disproportion** or ineffective uterine contractions.

Q: A patient who just delivered at home presents with a third degree perineal tear. You will do the repair:

immediately. ***immediately*** - Repair of a **third-degree perineal tear** should be done **immediately** after diagnosis to minimize complications like infection, pain, and long-term functional issues. - Prompt repair helps to restore **anatomical integrity** and improve outcomes for continence and discomfort. *after 24 hours.* - Delaying the repair by 24 hours increases the risk of **infection**, **edema**, and further tissue damage, making the repair more difficult and less successful. - This delay could also lead to increased **blood loss** and patient discomfort. *after 6 weeks* - Waiting 6 weeks would allow for scar tissue formation and potential infection, making a primary repair much more challenging and possibly requiring a more complex secondary repair. - This delay would significantly increase the risk of **fecal incontinence** and other long-term complications. *after 3 months* - A three-month delay is inappropriate for a fresh perineal tear as it guarantees significant **scarring**, **fibrosis**, and high risk of **infection**. - By this time, the tear would likely have healed by secondary intention, resulting in poor anatomical and functional outcomes, often necessitating a more complicated and less effective **secondary repair**.

Question 1

A woman with post-term pregnancy with unripe cervix should not be induced with misoprostol if she has:

Accepted Answer

Decompensated heart disease

Answer

Asthma

Answer

Diabetes

Answer

Hepatitis B antigen positive

Question 2

Consider the following presentations:

1. Brow presentation
2. Left mento anterior position
3. Occipito posterior position
4. Breech presentation

In which of the above Vaginal delivery is NOT possible?

Accepted Answer

1 only

Answer

1, 2 and 3

Answer

4 only

Answer

1 and 3 only

Question 3

For vaginal breech delivery, ideal selection criteria would include:

1. Fetus not compromised
2. Adequate pelvis
3. Flexed breech presentation
4. Estimated fetal weight < 3.5 kg

Select the correct answer using the code given below:

Accepted Answer

1, 2, 3 and 4

Answer

2 and 4 only

Answer

1, 3 and 4 only

Answer

1, 2 and 3 only

Question 4

A 25 year old, G2P1L1 came with amenorrhoea of two and half months followed by bleeding PV and pain abdomen. On examination cervical OS is open with slight bleeding. The uterus is 10 weeks size with no tenderness in the fornices. The probable clinical diagnosis is:

Accepted Answer

Inevitable abortion

Answer

Incomplete abortion

Answer

Missed abortion

Answer

Ectopic pregnancy

Question 5

In case of Labour complicated with cord prolapse, which of the following statements are correct?

1. Reposition the patient in exaggerated Sims position
2. To replace the cord in the vagina
3. To replace the cord inside the uterus
4. Early amniotomy can prevent cord prolapse

Select the correct answer using the code given below:

Accepted Answer

1 only

Answer

1 and 2 only

Answer

3 and 4 only

Answer

1, 2, 3 and 4

Question 6

Which of the following are the hypotheses for the onset of Labor?

1. Uterine distension
2. Activation of fetal hypothalamic-pituitary-adrenal axis
3. Increase in prostaglandins
4. Increase in serum calcium levels

Select the correct answer using the code given below:

Accepted Answer

1, 2 and 3

Answer

1 and 3 only

Answer

2, 3 and 4

Answer

1, 2 and 4

Question 7

Which of the following are indications of vaginal examinations during labour?

1. To stretch the vagina intermittently
2. At the onset of labour
3. To monitor progress of labour
4. Following rupture of membranes

Accepted Answer

2, 3 and 4

Answer

1, 3 and 4

Answer

1, 2 and 4

Answer

1, 2 and 3

Question 8

In the mechanism of normal labour the engaging transverse diameter is

Accepted Answer

Biparietal diameter (9.5 cm)

Answer

Bimastoid diameter (7.5 cm)

Answer

Suboccipitofrontal diameter (10 cm)

Answer

Suboccipitobregmatic diameter (9.5 cm)

Question 9

The normal rate of dilatation of the cervix in a primigravida in the active phase of labor is

Accepted Answer

1 cm/hour

Answer

0.25 cm/hour

Answer

0.75 cm/hour

Answer

0.5 cm/hour

Question 10

A patient who just delivered at home presents with a third degree perineal tear. You will do the repair:

Accepted Answer

immediately

Answer

after 24 hours.

Answer

after 6 weeks

Answer

after 3 months

Labor and Delivery — MCQs

Labor and Delivery — MCQs

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