Labor and Delivery Practice Questions

Q: Given below are the Obstetric maneuvers and their indications. Which one of the following is correctly matched?

Ritgen's maneuver – Controlled delivery of fetal head. ***Ritgen's maneuver*** - This maneuver is used for the **controlled delivery of the fetal head** to prevent rapid expulsion, which can lead to maternal perineal trauma. - It involves applying pressure to the fetal chin through the perineum while simultaneously applying pressure to the occiput to facilitate slow and controlled extension of the head. *McRobert's maneuver* - McRobert's maneuver is used to manage **shoulder dystocia**, not after the delivery of the head in a breech presentation. - It involves hyperflexing the mother's hips towards her abdomen to rotate the symphysis pubis and increase the pelvic outlet dimension. *Lovset's maneuver* - Lovset's maneuver is used to deliver the **arms in a breech presentation**, not the foot. - It involves rotating the fetal trunk to bring the anterior shoulder under the maternal symphysis pubis, allowing the delivery of the posterior arm. *Pinard's maneuver* - Pinard's maneuver is used for the delivery of the **extended legs in a breech presentation**, not an extended arm. - It involves pressure in the popliteal fossa to flex the knee, allowing the foot to be grasped and delivered.

Q: Consider the following cardinal movements of mechanism of normal labor: 1. Engagement 2. Internal rotation 3. Flexion 4. Restitution 5. Crowning 6. External rotation What is the correct sequence of movements in labor in occipito-lateral position?

1, 3, 2, 5, 4 and 6. ***1, 3, 2, 5, 4 and 6*** - This sequence accurately represents the order of events during normal vaginal delivery **in occipito-lateral position**, starting with **engagement** and progressing through the cardinal movements. - The sequence follows: **Engagement (1)** → **Flexion (3)** → **Internal rotation (2)** from occipito-lateral to occipito-anterior → **Crowning (5)** during extension phase → **Restitution (4)** → **External rotation (6)**. - While **crowning** is not technically a cardinal movement, it occurs during the **extension** phase and marks the emergence of the fetal head at the introitus. - In **occipito-lateral position**, internal rotation is essential for converting the position to occipito-anterior for delivery. *3, 1, 2, 4, 6 and 5* - This sequence incorrectly places **flexion before engagement**, which is physiologically impossible as the fetal head must first engage in the pelvic inlet before significant flexion occurs. - **Crowning** is placed after external rotation, but crowning occurs during the extension phase, well before restitution and external rotation. *1, 2, 3, 4, 5 and 6* - This sequence incorrectly places **internal rotation before flexion**, whereas flexion typically occurs first to reduce the presenting diameter and facilitate internal rotation. - The sequence also places **crowning after restitution**, which contradicts the normal progression where crowning occurs during extension, before restitution. *2, 1, 3, 4, 5 and 6* - This sequence incorrectly begins with **internal rotation before engagement**, which is physiologically impossible as the fetal head must be engaged in the pelvis before it can rotate. - **Engagement** must always be the first cardinal movement.

Q: Which one of the following is NOT a sign of separation of placenta?

The fundal height reduces further. ***The fundal height reduces further*** - A **reduction in fundal height** is not a sign of placental separation; rather, the fundus often rises slightly as the separated placenta descends into the lower uterine segment. - After separation, the uterus typically becomes **globular** and the fundus may rise to a level above the umbilicus. *Apparent lengthening of the cord with slight gush of vaginal bleeding* - **Lengthening of the umbilical cord** outside the vagina is a classic sign of placental separation, indicating the placenta has descended. - A **gush of blood** often occurs as the placenta detaches from the uterine wall, releasing pooled blood from the retroplacental space. *Uterus becomes globular, firm and ballotable* - After separation, the uterus contracts strongly, becoming more **globular** and **firm** as it expels the placenta. - The uterus may feel **ballotable** if the placenta is still within the uterine cavity but detached. *Slight bulging in the suprapubic region* - A **slight bulging in the suprapubic region** (above the symphysis pubis) indicates that the separated placenta has descended into the lower uterine segment or vagina, creating a palpable mass. - This sign is often referred to as a "boggy" or "fullness" sensation in the lower abdomen due to the descended placenta.

Q: Which of the following information are provided by partograph? 1. Colour of liquor 2. Uterine contractions with duration and frequency 3. Dilatation of cervix Select the correct answer using the code given below:

1, 2 and 3. ***1, 2 and 3*** - A **partograph** is a composite graphical record of key maternal and fetal parameters during labor, specifically designed to monitor the progress of labor and to identify deviations from normal. - It includes charting the **colour of liquor**, **uterine contractions (frequency and duration)**, and **cervical dilatation** to assess the progression of labor. *2 and 3 only* - This option is incorrect because the partograph also records the **colour of liquor** in addition to uterine contractions and cervical dilatation. - The colour of liquor provides vital information about fetal well-being, such as the presence of **meconium**, which indicates fetal distress. *1 and 3 only* - This option is incorrect because the partograph also records the **frequency and duration of uterine contractions**, which are crucial for assessing the power and effectiveness of labor. - Uterine contractions are fundamental to the progress of cervical dilatation and fetal descent. *1 and 2 only* - This option is incorrect because the partograph also records the **dilatation of the cervix**, which is the primary indicator of the progress of the first stage of labor. - The rate of cervical dilatation is crucial for determining if labor is progressing normally or if there is a **protracted labor** requiring intervention.

Q: The components of partograph are all EXCEPT:

Maternal respiratory rate. ***Maternal respiratory rate*** - While important for overall maternal well-being, **maternal respiratory rate** is not a standard component recorded on a partograph. - The partograph primarily focuses on monitoring fetal well-being, cervical dilation, and uterine contractions to track labor progress. *Fetal heart rate* - **Fetal heart rate** is a crucial component of the partograph, regularly plotted to assess fetal well-being and identify signs of distress. - It helps in detecting fetal hypoxia and guiding interventions if necessary during labor. *Time* - **Time** is a fundamental axis on the partograph, allowing for the plotting of all other parameters against a temporal scale. - This enables the healthcare provider to visualize the progression of labor and identify deviations from normal patterns. *Maternal urine analysis* - **Maternal urine analysis** for protein, acetone, or glucose is a standard component of the partograph. - It helps in assessing maternal hydration status and detecting potential complications like pre-eclampsia or gestational diabetes that might impact labor or fetal health.

Q: Which one of the following is NOT a component of active phase in the partograph?

Phase of expulsion. ***Phase of expulsion*** - The **phase of expulsion** (or the second stage of labor) begins after the cervix is fully dilated and ends with the birth of the baby. - While it immediately follows the active phase, it is not considered a component of the **active phase** itself, which primarily focuses on cervical dilation progress. *Acceleration phase* - The **acceleration phase** is an early part of the active phase of labor where the rate of cervical dilation begins to increase. - It marks the transition from the latent phase to the more rapid dilation characteristic of active labor. *Phase of deceleration* - The **phase of deceleration** occurs towards the end of the active phase, just before full cervical dilation, where the rate of dilation slows down. - This phase is typically associated with the advancing fetal head encountering the pelvic floor. *Phase of maximum slope* - The **phase of maximum slope** (or maximum ascent) is the steepest part of the active phase, where cervical dilation occurs at its fastest rate. - This is the most efficient period of cervical change during labor.

Q: Successful external cephalic version of breech presentation is likely in case all of the following EXCEPT:

Breech with extended legs. ***Breech with extended legs*** - An extended leg presentation (frank breech) makes successful external cephalic version **less likely** because the **fetal legs splint the fetus**, creating a rigid, elongated configuration that resists rotation. - The extended posture restricts fetal mobility necessary for successful manipulation. - Frank breech is the **least favorable type** for ECV success. *Non engaged breech* - A **non-engaged breech** presentation indicates the fetal buttocks or feet are not yet fixed in the maternal pelvis, allowing **greater mobility** and making successful external cephalic version **more likely**. - Lack of engagement means there is ample space for the fetus to turn. *Adequate amniotic fluid* - **Adequate amniotic fluid** provides essential space and cushioning for the fetus to move, which is crucial for a successful external cephalic version. - It reduces friction and allows for easier manipulation of the fetus during the procedure. - Oligohydramnios is a relative contraindication to ECV. *Complete breech with sacroanterior position* - A **complete breech** (with flexed hips and knees) is generally **more favorable** for external cephalic version compared to frank breech, as the flexed posture creates a more compact, mobile configuration. - The fetal position (sacroanterior, sacrotransverse, or sacroposterior) has less impact on ECV success than the **type of breech presentation** (complete vs. frank). - Complete breech allows easier manipulation than the rigid frank breech configuration.

Q: Which one of the following is NOT a method of management of Deep Transverse Arrest with the living fetus?

Delivery by ventouse. ***Delivery by ventouse*** - **Vacuum extraction (ventouse)** requires the fetal head to be engaged and the leading part to be no higher than 1/5th above the symphysis pubis, and it does not allow for rotation once applied. - In a **deep transverse arrest**, the fetal head is unrotated, and direct application of a ventouse without prior rotation is unsafe and ineffective, as it would apply traction in an improper direction, risking scalp injury without resolving the arrest. *Caesarean section* - **Caesarean section** is a viable and often necessary option for deep transverse arrest, especially when other rotational or instrumental delivery methods are contraindicated or unsuccessful. - It ensures safe delivery for both mother and fetus in cases of **cephalopelvic disproportion** or failed operative vaginal delivery. *Manual rotation and application of forceps* - **Manual rotation** involves an obstetrician manually turning the fetal head from the transverse to the occipito-anterior or posterior position. - After successful manual rotation, **forceps** can then be applied to facilitate vaginal delivery, provided there are no other contraindications. *Delivery by application of forceps to the unrotated head* - **Kielland's forceps** are specifically designed for rotation and delivery in cases of **deep transverse arrest** and can be applied to an unrotated head to achieve rotation without prior manual intervention. - While other types of forceps typically require the head to be in an occipito-anterior position, Kielland's forceps allow for the necessary rotation before traction is applied, making it a suitable method for managing deep transverse arrest.

Q: Based on the educational diagram showing different degrees of perineal tears, which degree involves only the perineal skin and vaginal mucosa without affecting the underlying muscle?

1st degree. ***1st degree*** - Involves only the **perineal skin** and **vaginal mucosa** without affecting underlying muscle tissue. - The **pelvic floor muscles (PFM)** remain completely intact, making this the most superficial type of perineal tear. *2nd degree* - Extends deeper to involve the **perineal muscles** including the pelvic floor muscles, but spares the anal sphincter. - Requires **muscle repair** in addition to skin closure, making it more complex than 1st degree tears. *3rd degree* - Involves the **anal sphincter complex** (external and/or internal anal sphincter) extending toward the anus. - Requires specialized **sphincter reconstruction** to prevent future fecal incontinence complications. *4th degree* - The most severe tear extending through the **anal sphincter** and into the **rectal mucosa**. - Requires **multilayer repair** including rectal mucosa, sphincter complex, and perineal tissues to restore anatomy.

Q: Which of the following is not a contraindication for External Cephalic Version (ECV)?

Primigravida. ***Primigravida*** - Being a **primigravida** (first pregnancy) is not a contraindication for ECV, though it might be associated with a slightly lower success rate compared to multiparous women due to a less pliable uterus. - While it may indicate a potentially more challenging ECV due to higher uterine tone, it does not preclude the procedure if other conditions are favorable. *Placenta previa* - **Placenta previa** is a contraindication because the manipulation of the uterus during ECV could dislodge the placenta, leading to **severe hemorrhage** and potential fetal compromise. - This condition involves the placenta covering the cervical opening, making any uterine intervention risky. *Twin pregnancy* - **Twin pregnancy** is a contraindication as ECV is generally not recommended in multiple gestations due to increased complexity and risk of complications. - The risk of **umbilical cord entanglement**, disruption of twin positioning, and potential harm to either fetus makes ECV unsafe in twin pregnancies. *PROM (Premature Rupture of Membranes)* - **Premature Rupture of Membranes (PROM)** is a contraindication due to the increased risk of uterine infection and **cord prolapse** during manipulation. - Once membranes are ruptured, the natural cushioning provided by the amniotic fluid is lost, making ECV potentially traumatic for both the mother and the fetus.

Question 1

Given below are the Obstetric maneuvers and their indications. Which one of the following is correctly matched?

Accepted Answer

Ritgen's maneuver – Controlled delivery of fetal head

Answer

McRobert's maneuver – After coming head of breech

Answer

Lovset's maneuver – Delivery of foot in breech

Answer

Pinard's maneuver – Delivery of extended arm

Question 2

Consider the following cardinal movements of mechanism of normal labor:

1. Engagement
2. Internal rotation
3. Flexion
4. Restitution
5. Crowning
6. External rotation

What is the correct sequence of movements in labor in occipito-lateral position?

Accepted Answer

1, 3, 2, 5, 4 and 6

Answer

3, 1, 2, 4, 6 and 5

Answer

1, 2, 3, 4, 5 and 6

Answer

2, 1, 3, 4, 5 and 6

Question 3

Which one of the following is NOT a sign of separation of placenta?

Accepted Answer

The fundal height reduces further

Answer

Apparent lengthening of the cord with slight gush of vaginal bleeding

Answer

Uterus becomes globular, firm and ballotable

Answer

Slight bulging in the suprapubic region

Question 4

Which of the following information are provided by partograph?

1. Colour of liquor
2. Uterine contractions with duration and frequency
3. Dilatation of cervix

Select the correct answer using the code given below:

Accepted Answer

1, 2 and 3

Answer

2 and 3 only

Answer

1 and 3 only

Answer

1 and 2 only

Question 5

The components of partograph are all EXCEPT:

Accepted Answer

Maternal respiratory rate

Answer

Fetal heart rate

Answer

Time

Answer

Maternal urine analysis

Question 6

Which one of the following is NOT a component of active phase in the partograph?

Accepted Answer

Phase of expulsion

Answer

Acceleration phase

Answer

Phase of deceleration

Answer

Phase of maximum slope

Question 7

Successful external cephalic version of breech presentation is likely in case all of the following EXCEPT:

Accepted Answer

Breech with extended legs

Answer

Non engaged breech

Answer

Adequate amniotic fluid

Answer

Complete breech with sacroanterior position

Question 8

Which one of the following is NOT a method of management of Deep Transverse Arrest with the living fetus?

Accepted Answer

Delivery by ventouse

Answer

Caesarean section

Answer

Manual rotation and application of forceps

Answer

Delivery by application of forceps to the unrotated head

Question 9

Based on the educational diagram showing different degrees of perineal tears, which degree involves only the perineal skin and vaginal mucosa without affecting the underlying muscle?

Accepted Answer

1st degree

Answer

2nd degree

Answer

3rd degree

Answer

4th degree

Question 10

Which of the following is not a contraindication for External Cephalic Version (ECV)?

Accepted Answer

Primigravida

Answer

Placenta previa

Answer

Twin pregnancy

Answer

PROM (Premature Rupture of Membranes)

Labor and Delivery — MCQs

Labor and Delivery — MCQs

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