Labor and Delivery Practice Questions

Q: Face to pubes delivery occurs in which of the foetal position?

Occipito-sacral. ***Occipito-sacral (Occipito-posterior)*** - **"Face to pubes" delivery** is the classic mechanism in **persistent occipito-posterior (OP)** positions where the occiput is directed toward the maternal sacrum. - In this position, the fetal head delivers with **maximum extension**, and the **face passes under the pubic symphysis** (hence "face to pubes"). - The occiput sweeps over the perineum posteriorly, leading to increased perineal trauma and potential for third/fourth-degree tears. - This delivery mechanism is associated with **prolonged labor, increased back pain**, and higher rates of operative delivery. *Mentoanterior* - In **mentoanterior (MA)** face presentation, the fetal chin is anterior, and delivery occurs by **flexion after the chin passes under the symphysis**. - The mechanism involves the chin sweeping the perineum, NOT "face to pubes" delivery. - While mentoanterior can deliver vaginally, the delivery mechanism is distinctly different from occipito-posterior positions. *Brow presentation* - In **brow presentation**, the head is partially extended with the **frontal bone and anterior fontanelle presenting**. - This presents the **largest diameter (mento-vertical ~13.5 cm)** to the pelvis, making vaginal delivery virtually impossible. - Almost always requires **cesarean section** for safe delivery. *Mentoposterior* - In **mentoposterior (MP)** face presentation, the fetal chin is directed posteriorly toward the maternal sacrum. - This position **cannot deliver vaginally** as further extension of the already extended head is impossible. - Requires **rotation to mentoanterior** or cesarean section for delivery.

Q: A G 2 P 1 A 0 presents with full term pregnancy with transverse lie in the first stage of labour. On examination, cervix is 5 cm dilated, membranes are intact and foetal heart sounds are regular. The appropriate management would be:

Caesarean section. ***Caesarean section*** - A **transverse lie** at term in the first stage of labor is a contraindication to vaginal delivery due to the high risk of **cord prolapse**, **uterine rupture**, and fetal distress. - **Caesarean section** is the safest mode of delivery for both mother and fetus in this scenario, as it prevents these complications. *External cephalic version* - **External cephalic version** is typically attempted in cases of **breech presentation** in the late third trimester (around 36-37 weeks) to convert it to a cephalic presentation. - It is **contraindicated** in transverse lie during active labor, especially with cervical dilation, as it has a low success rate and can lead to complications such as **placental abruption** or **cord prolapse**. *Internal podalic version* - **Internal podalic version** is a procedure typically reserved for the delivery of the second twin in a **transverse or oblique lie**, or in some cases of breech presentation. - It carries significant risks, including **uterine rupture** and fetal injury, and is generally not performed for a singleton pregnancy with cervical dilation. *Wait for spontaneous evolution and expulsion* - **Spontaneous evolution** (where the fetus rotates to a longitudinal lie) is extremely rare in a transverse lie presentation at term, especially once labor has started. - Waiting for spontaneous rotation would lead to **prolonged labor**, increased risk of **uterine rupture**, and severe fetal compromise due to obstruction.

Q: Which one of the following is not a complication of shoulder dystocia?

Placental abruption. ***Placental abruption*** - **Placental abruption** is the premature detachment of the placenta from the uterine wall, typically occurring before or during labour. It is not directly caused by the mechanical obstruction during shoulder dystocia. - Complications of shoulder dystocia are primarily related to mechanical forces exerted on the baby and mother during delivery, such as nerve injuries or uterine atony, not placental conditions. *Brachial plexus palsy* - **Brachial plexus palsy** is a common complication of shoulder dystocia, often resulting from excessive lateral traction on the fetal head or neck during delivery. - This traction can stretch or tear the nerves of the brachial plexus, leading to varying degrees of paralysis or weakness in the arm and hand. *Postpartum haemorrhage* - **Postpartum haemorrhage** is a significant risk following shoulder dystocia due to the prolonged and often traumatic nature of the delivery. - The increased manipulation and potential for uterine atony or soft tissue trauma during resolution of shoulder dystocia can predispose the mother to excessive bleeding. *Facial palsy* - **Facial palsy** can occur during shoulder dystocia if there is compression or stretching of the facial nerve (cranial nerve VII) against the maternal pelvis or other structures during delivery. - While less common than brachial plexus palsy, it can result from the abnormal forces and positions during a difficult shoulder dystocia delivery.

Q: Immediately after third stage of labour in a case of full term delivery, the fundus of the uterus is:

At the level of umbilicus. ***At the level of umbilicus*** - Immediately after delivery of the placenta (third stage of labor), the **fundus** typically contracts down to the level of the **umbilicus**. - This contraction helps to compress uterine blood vessels and prevent **postpartum hemorrhage**. *At the level of xiphisternum* - The uterus reaches the **xiphisternum** only in late third trimester, as the fetus grows. - After delivery, the uterus significantly reduces in size, so it would not remain this high. *Below the level of umbilicus* - While the uterus will eventually descend below the umbilicus during **involution** (shrinking back to pre-pregnancy size), this process takes several days to weeks, not immediately after delivery. - A fundus below the umbilicus immediately after delivery might suggest a failure of proper contraction. *Just above the symphysis pubis* - The uterus is at the level of the **symphysis pubis** much earlier in pregnancy, typically around **12 weeks gestation**. - A fundus at this level immediately after delivery would indicate an abnormally small uterus or an incomplete emptying.

Q: McRoberts manoeuvre is used during labour for management of:

Shoulder dystocia. ***Shoulder dystocia*** - **McRoberts manoeuvre** involves sharp flexion of the maternal thighs against the abdomen, which straightens the **sacrum** and rotates the **symphysis pubis** anteriorly. - This maneuver increases the functional size of the pelvic outlet and helps to dislodge the impacted fetal shoulder in cases of **shoulder dystocia**. - It is the **first-line intervention** for managing shoulder dystocia and is successful in resolving the majority of cases. *Delivery of after coming head of breech* - Management of an after-coming head in breech delivery typically involves maneuvers like the **Mauriceau-Smellie-Veit** maneuver or **Prague maneuver**. - **McRoberts manoeuvre** does not directly facilitate the delivery of the fetal head in a breech presentation. *Normal labour to assist extension of head* - In normal labor, the fetal head typically delivers by **extension** as it passes under the symphysis pubis, and no specific maneuver is usually required. - McRoberts manoeuvre is a specific intervention for a complication (**shoulder dystocia**), not a routine aid for head extension during normal delivery. *Extended arms of breech during assisted breech delivery* - Extended arms in a breech presentation are managed by maneuvers designed to free the arms, such as **Løvset's maneuver**. - **McRoberts manoeuvre** primarily addresses shoulder impaction, not arm entrapment in breech delivery.

Q: Early deceleration of foetal heart rate in labour is due to:

Foetal head compression. ***Foetal head compression*** - **Early decelerations** are a direct result of **foetal head compression** during uterine contractions, leading to increased intracranial pressure. - This pressure causes a **reflex vagal response**, resulting in **slowing of the foetal heart rate** which mirrors the contraction pattern. *Hyperpyrexia* - **Maternal hyperpyrexia** typically causes **foetal tachycardia**, which is an elevated heart rate, not deceleration. - This is a response to the increased maternal and foetal metabolic rate and can be a sign of infection. *Umbilical cord compression* - **Umbilical cord compression** usually leads to **variable decelerations**, which are sharp, abrupt drops in heart rate not uniformly related to contractions. - This occurs due to transient occlusion of the umbilical vessels, reducing blood flow to the foetus. *Congenital heart block* - **Congenital heart block** is a persistent bradycardia (slow heart rate) that is present throughout labour and is not directly linked to uterine contractions. - It is a structural abnormality of the foetal cardiac conduction system.

Q: Deep transverse arrest of head in labour occurs in:

Android pelvis. ***Android pelvis*** - An **android pelvis** has a heart-shaped inlet with a narrow forepelvis, causing the fetal head to engage in a transverse or occiput posterior position. - The narrow midpelvis and convergent side walls in an android pelvis can lead to deep **transverse arrest**, as the fetal head cannot easily rotate to the anterior position. *Anthropoid pelvis* - The **anthropoid pelvis** is characterized by a long anteroposterior diameter and a relatively narrow transverse diameter. - This pelvic shape typically favors engagement in the **occiput anterior** or **occiput posterior** positions, making deep transverse arrest less common. *Platypelloid pelvis* - A **platypelloid pelvis** has a wide transverse diameter and a very short anteroposterior diameter, leading to a flattened shape. - This shape often results in the fetal head engaging in the **transverse position**, but arrest usually occurs at the inlet rather than deep in the pelvis, or the head fails to engage at all. *Gynaecoid pelvis* - The **gynaecoid pelvis** is considered the ideal female pelvis, with a rounded inlet and adequate diameters in all planes. - This shape allows for easy engagement and rotation of the fetal head, making deep **transverse arrest** very unlikely.

Q: Labour is called normal if it fulfills the following criteria EXCEPT:

Vaginal breech delivery. ***Vaginal breech delivery*** - A **breech presentation** (where the baby's buttocks or feet are descended first) is **definitively NOT considered normal labor**. - Normal labor requires **cephalic (vertex) presentation** as a fundamental criterion. - While vaginal breech delivery may be attempted in select cases, it carries **significantly higher risks** and is classified as **abnormal presentation**, making this the correct answer to the EXCEPT question. *Spontaneous onset at term* - **Spontaneous onset** (not induced) occurring **at term** (37-42 weeks of gestation) is a **core characteristic of normal labor**. - This ensures physiologic readiness and fetal maturity. *Vertex presentation* - **Vertex (cephalic) presentation** with the occiput as the presenting part is the **defining requirement** for normal labor. - This is the optimal presentation allowing the smallest diameter to navigate the birth canal. *Vaginal delivery with episiotomy* - Traditionally, vaginal delivery with episiotomy has been included in definitions of normal labor, though episiotomy itself is a surgical intervention. - **Note**: Modern obstetric guidelines (WHO, NICE) emphasize that **routine episiotomy should be avoided** and normal birth should be spontaneous without operative interventions. However, for examination purposes and based on traditional definitions used in this PYQ, vaginal delivery (even with episiotomy) is distinguished from operative delivery (forceps/vacuum) or cesarean section. - The key distinction: **breech presentation** itself (regardless of delivery mode) makes labor abnormal, whereas episiotomy is a **procedural intervention** during an otherwise potentially normal labor.

Question 1

Face to pubes delivery occurs in which of the foetal position?

Accepted Answer

Occipito-sacral

Answer

Brow presentation

Answer

Mentoanterior

Answer

Mentoposterior

Question 2

A G 2 P 1 A 0 presents with full term pregnancy with transverse lie in the first stage of labour. On examination, cervix is 5 cm dilated, membranes are intact and foetal heart sounds are regular. The appropriate management would be:

Accepted Answer

Caesarean section

Answer

External cephalic version

Answer

Internal podalic version

Answer

Wait for spontaneous evolution and expulsion

Question 3

Which of the following methods for induction of labour should not be used in the patient with previous lower segment caesarean section?

Accepted Answer

Vaginal prostaglandin gel

Answer

Stripping of the membrane

Answer

Oxytocin drip

Answer

Oral prostaglandin tablet

Question 4

Which one of the following is not a complication of shoulder dystocia?

Accepted Answer

Placental abruption

Answer

Brachial plexus palsy

Answer

Postpartum haemorrhage

Answer

Facial palsy

Question 5

Immediately after third stage of labour in a case of full term delivery, the fundus of the uterus is:

Accepted Answer

At the level of umbilicus

Answer

At the level of xiphisternum

Answer

Below the level of umbilicus

Answer

Just above the symphysis pubis

Question 6

A 20 year old primigravida is admitted with full term pregnancy and labour pains. At 4 A.M. she goes into active phase of labour with 4 cm cervical dilatation. Membranes rupture during p/v examination showing clear liquor. A repeat p/v after 4 hours of good uterine contractions reveals a cervical dilatation of 5 cm. What should be the next step in management?

Accepted Answer

Reassess for occipitoposterior position and cephalopelvic disproportion

Answer

Oxytocin drip

Answer

Immediate caesarean section

Answer

Reassess after 4 hours

Question 7

McRoberts manoeuvre is used during labour for management of:

Accepted Answer

Shoulder dystocia

Answer

Delivery of after coming head of breech

Answer

Normal labour to assist extension of head

Answer

Extended arms of breech during assisted breech delivery

Question 8

Early deceleration of foetal heart rate in labour is due to:

Accepted Answer

Foetal head compression

Answer

Hyperpyrexia

Answer

Umbilical cord compression

Answer

Congenital heart block

Question 9

Deep transverse arrest of head in labour occurs in:

Accepted Answer

Android pelvis

Answer

Anthropoid pelvis

Answer

Platypelloid pelvis

Answer

Gynaecoid pelvis

Question 10

Labour is called normal if it fulfills the following criteria EXCEPT:

Accepted Answer

Vaginal breech delivery

Answer

Spontaneous onset at term

Answer

Vertex presentation

Answer

Vaginal delivery with episiotomy

Labor and Delivery — MCQs

Labor and Delivery — MCQs

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