Labor and Delivery Practice Questions

Q: A primipara is in labor and an episiotomy is about to be cut. Compared with a midline episiotomy, an advantage of mediolateral episiotomy is

Less extension of the incision. ***Less extension of the incision.*** - A **mediolateral episiotomy** is less likely to extend into the rectum and anal sphincter, thus preventing a **third- or fourth-degree laceration**. - This oblique incision is directed away from the midline, significantly reducing the risk of involving the **external anal sphincter** and **rectal mucosa**. *Ease of repair* - **Midline episiotomies** are generally easier to repair due to their linear nature and involvement of fewer tissue layers. - Mediolateral episiotomies involve more complex tissue planes and angles, often making their repair more challenging and time-consuming. *Less blood loss* - **Midline episiotomies** typically result in less blood loss because they cut through less vascular tissue. - **Mediolateral incisions** cut across more muscle fibers and blood vessels, often leading to increased blood loss. *Fewer breakdowns* - **Midline episiotomies**, when properly repaired, tend to have a lower risk of tissue breakdown and infection because they are less traumatic to the surrounding structures. - Mediolateral episiotomies involve a larger tissue area and more complex wound architecture, which can increase the risk of delayed healing or breakdown.

Q: A pelvis characterized by an anteroposterior diameter of the inlet greater than the transverse diameter is classified as

Anthropoid. ***Anthropoid*** - An **anthropoid pelvis** is characterized by an **oval-shaped inlet** where the **anteroposterior diameter is greater than the transverse diameter**. - This pelvic shape is often associated with a **more favorable prognosis for vaginal delivery** when the fetal head engages in an occiput anterior or posterior position. *Gynecoid* - The **gynecoid pelvis** is considered the **"true female pelvis"**, with a rounded inlet and approximate equality of the anteroposterior and transverse diameters. - It is the most common pelvic type and is generally associated with the **easiest vaginal delivery**. *Platypelloid* - A **platypelloid pelvis** has a **transversely oval inlet** where the **transverse diameter is greater than the anteroposterior diameter**. - This shape is relatively uncommon and can be associated with **difficulties during labor**, particularly with fetal head engagement and rotation. *Android* - The **android pelvis** has a **heart-shaped or wedge-shaped inlet**, with a **narrower anterior segment** and prominent ischial spines. - This pelvic type is often associated with the **male pelvis** and can lead to **labor dystocia** due to reduced pelvic capacity.

Q: Incidence of scar rupture in previous lower segment caesarean section:

1%. ***1%*** - The incidence of **uterine rupture** in a subsequent pregnancy after a **low transverse uterine incision** (previous lower segment caesarean section) is approximately **0.5-1%**. This low risk allows for considering a trial of labor after cesarean (TOLAC) in appropriate candidates. - This value represents the general risk and is a critical factor in counseling patients about the safety of **vaginal birth after cesarean (VBAC)**. *5%* - An incidence of **5%** for scar rupture is significantly higher than what is observed for a **lower segment caesarean section**. - This higher percentage might be associated with a **classical uterine incision** (vertical incision in the upper uterine segment) which carries a much greater risk of uterine rupture. *7%* - A **7%** incidence of scar rupture is also substantially higher than the typical risk associated with a previous **lower segment caesarean section**. - This rate would generally be considered prohibitive for most cases of **TOLAC** due to the increased maternal and fetal risks. *6%* - An incidence of **6%** for scar rupture is not consistent with the known rates for a **lower segment caesarean section**. - This figure indicates a risk much higher than the actual average and would likely lead to recommendations against **TOLAC**.

Q: The shortest anteroposterior diameter of the pelvic inlet is:

Obstetric conjugate. ***Obstetric conjugate*** - The **obstetric conjugate** is the shortest anteroposterior diameter of the pelvic inlet, measured from the posterior superior aspect of the pubic symphysis to the sacral promontory. - This is the **narrowest available anteroposterior diameter** through which the fetal head must pass during labor, making it clinically significant. *All are equal* - This statement is incorrect as the various pelvic conjugate measurements have **distinct lengths** and clinical implications. - The different conjugated diameters are measured between specific anatomical points and are not uniform. *True conjugate* - The **true conjugate** (anatomical conjugate) extends from the middle of the sacral promontory to the superior posterior margin of the pubic symphysis. - While it is a key pelvic inlet measurement, it is slightly longer than the obstetric conjugate because it measures to the *superior* rather than the *posterior superior* aspect of the symphysis, which has a small posterior projection. *Diagonal conjugate* - The **diagonal conjugate** is measured clinically via vaginal examination from the inferior border of the pubic symphysis to the sacral promontory. - This measurement is typically about **1.5-2 cm longer** than the true conjugate and is an indirect estimate of the obstetric conjugate.

Q: To obtain true conjugate, the following factor should be subtracted from the diagonal conjugate:

1.2 cm. ***1.2 cm*** - The **true conjugate** is estimated by subtracting **1.5-2.0 cm** from the **diagonal conjugate**. - In clinical practice, **1.5 cm** is the commonly used value for this subtraction. - This subtraction accounts for the thickness of the **symphysis pubis** and overlying soft tissues. - Some sources may use values ranging from **1.2 to 2.0 cm** depending on clinical context. *3.0 cm* - Subtracting 3.0 cm would result in significant **underestimation** of the true conjugate. - This would lead to incorrect assessment of **pelvic adequacy** and potentially unnecessary interventions. - This value is well above the standard correction range. *0.5 cm* - Subtracting only 0.5 cm would lead to **overestimation** of the true conjugate. - This does not adequately account for the **symphysis pubis thickness** and soft tissue depth. - This could result in missed cases of **cephalopelvic disproportion**. *2.5 cm* - While 2.5 cm falls within some reported ranges, it is at the higher end of the correction spectrum. - Using this value might lead to slight **underestimation** of pelvic capacity. - The standard teaching emphasizes **1.5-2.0 cm** as the typical range.

Q: All of the following are treatments for deep transverse arrest except:

Craniotomy. ***Craniotomy*** - A **craniotomy** is a destructive procedure performed on the fetal head to reduce its size for delivery, typically reserved for instances of **fetal demise**. - This is **not a treatment for deep transverse arrest in a viable fetus** but a destructive procedure for a non-viable fetus. - In modern obstetric practice, craniotomy is not used for managing deep transverse arrest in living fetuses. *Cesarean section* - A **cesarean section** is a common and appropriate treatment for deep transverse arrest, especially when vaginal delivery is not achievable or safe. - It bypasses the need for rotation and forceps, thus being a direct method of delivery for this type of arrest. *Manual rotation with outlet forceps* - **Manual rotation** converts the transverse arrest to an anterior-posterior position, allowing for vaginal delivery, often assisted by **forceps** once rotated. - This technique is a direct intervention for deep transverse arrest, aiming to achieve a vaginal delivery in cases where the fetal head is arrested in the transverse diameter of the maternal pelvis. - Manual rotation followed by forceps application is a well-established treatment option. *Ventouse* - **Ventouse** (vacuum extraction) is a method to assist vaginal delivery by applying suction to the fetal head and is often used for deep transverse arrest after rotation has been achieved. - It helps to extract the fetus when descent is arrested, acting as a direct delivery method in these scenarios.

Q: A 37-year-old G2P1 woman at 38 weeks' gestation presents to the obstetrics clinic for a prenatal visit. The patient had difficulty becoming pregnant but was successful after using in vitro fertilization. She has a history of recurrent herpes outbreaks and is currently experiencing genital pain and tingling. Her first pregnancy was complicated by failure to progress, which resulted in a cesarean birth. Routine rectovaginal culture at 36 weeks was positive for Group B streptococci. Which of the following would be an absolute indication for delivering the child by LSCS (Lower Segment Cesarean Section):

Current symptoms of genital pain and tingling. ***Current symptoms of genital pain and tingling*** - **Genital pain and tingling** in a patient with a history of recurrent herpes outbreaks strongly suggests a **prodromal or active herpes outbreak**. - An active maternal **genital herpes lesion** at the time of labor is an absolute indication for **cesarean delivery** to prevent neonatal herpes simplex virus (HSV) infection, which can be life-threatening. *History of previous cesarean section* - A **prior cesarean section** is a relative indication for a repeat cesarean, but many women are candidates for a **trial of labor after cesarean (TOLAC)** if certain criteria are met. - It is not an absolute contraindication to vaginal delivery itself, especially if the previous cesarean was for a non-recurrent indication like **failure to progress**. *Maternal colonization with Group B streptococci* - **Group B streptococcus (GBS) colonization** is typically managed with **intrapartum antibiotic prophylaxis (IAP)** to prevent early-onset neonatal GBS disease. - It does not necessitate a cesarean section for delivery; rather, antibiotics are given once labor begins or membranes rupture. *In vitro fertilization* - **In vitro fertilization (IVF)** is a method of conception and does not inherently determine the mode of delivery. - Pregnancy achieved through IVF does not, by itself, increase the risk of complications that would mandate a **cesarean section**, unless there are other associated factors like multiple gestations or specific maternal conditions.

Q: Burns-Marshall technique is used to deliver the:

After-coming head. ***After-coming head*** - The **Burns-Marshall technique** is a method specifically designed for the delivery of the **after-coming head** in a **breech presentation**, typically when the body has already been delivered. - This technique involves suprapubic pressure and gentle upward traction on the baby's ankles to facilitate flexion and delivery of the head. *Leg* - The Burns-Marshall maneuver is not used to deliver the leg; the legs are typically delivered earlier in a **frank or complete breech delivery**. - Delivery of the legs usually involves assisting the natural progression of labor or specific maneuvers if there is a problem. *Placenta* - The **placenta** is delivered in the **third stage of labor**, after the baby has been born, and is not associated with the Burns-Marshall technique. - Methods for placental delivery include spontaneous expulsion or controlled cord traction. *Head* - While the maneuver relates to the head, it is specifically for the **after-coming head** in a breech presentation, not the initial delivery of the head in a **cephalic presentation**. - In a cephalic presentation, the head is typically delivered first through flexion and extension, guided by the maternal pelvis.

Q: Subpubic angle in gynecoid pelvis is?

100o. ***Correct Option: 100°*** - A **subpubic angle of 90-100 degrees** is characteristic of a **gynecoid pelvis**, which is the most favorable pelvis type for childbirth. - The gynecoid pelvis has a **rounded pelvic inlet** and a **wide subpubic arch** (≥90°), allowing optimal space for fetal head descent. - **100 degrees** falls within the normal range and represents a well-formed gynecoid pelvis with an adequate pelvic outlet. *Incorrect Option: 80°* - A **subpubic angle of 80 degrees** is more characteristic of an **anthropoid pelvis** or represents the lower limit of normal. - This narrower angle, while still permitting vaginal delivery, is not the typical measurement for a classic gynecoid pelvis. - Gynecoid pelvis typically has angles **≥90 degrees**. *Incorrect Option: 120°* - A **subpubic angle of 120 degrees** is excessively wide and not characteristic of a gynecoid pelvis. - Such an extreme angle would suggest unusual pelvic anatomy and is not a standard measurement in pelvic classification. *Incorrect Option: 75°* - A **subpubic angle of 75 degrees** is characteristic of an **android (male-type) pelvis**, which has a narrow subpubic arch. - This narrow angle can restrict fetal head passage through the pelvic outlet, increasing the risk of obstructed labor. - This is significantly below the gynecoid pelvis range of ≥90 degrees.

Question 1

A primipara is in labor and an episiotomy is about to be cut. Compared with a midline episiotomy, an advantage of mediolateral episiotomy is

Accepted Answer

Less extension of the incision

Answer

Ease of repair

Answer

Less blood loss

Answer

Fewer breakdowns

Question 2

A pelvis characterized by an anteroposterior diameter of the inlet greater than the transverse diameter is classified as

Accepted Answer

Anthropoid

Answer

Gynecoid

Answer

Platypelloid

Answer

Android

Question 3

Incidence of scar rupture in previous lower segment caesarean section:

Accepted Answer

1%

Answer

5%

Answer

7%

Answer

6%

Question 4

The shortest anteroposterior diameter of the pelvic inlet is:

Accepted Answer

Obstetric conjugate

Answer

All are equal

Answer

True conjugate

Answer

Diagonal conjugate

Question 5

Which of the following is FALSE regarding the diameters of the normal female pelvis?

Accepted Answer

Obstetric conjugate is calculated by adding 1.5 cm to diagonal conjugate

Answer

Oblique diameter is the largest diameter of inlet

Answer

Obstetric conjugate indicates status of mid pelvis

Answer

AP Diameter is the shortest diameter at brim

Question 6

To obtain true conjugate, the following factor should be subtracted from the diagonal conjugate:

Accepted Answer

1.2 cm

Answer

3.0 cm

Answer

0.5 cm

Answer

2.5 cm

Question 7

All of the following are treatments for deep transverse arrest except:

Accepted Answer

Craniotomy

Answer

Cesarean section

Answer

Manual rotation with outlet forceps

Answer

Ventouse

Question 8

A 37-year-old G2P1 woman at 38 weeks' gestation presents to the obstetrics clinic for a prenatal visit. The patient had difficulty becoming pregnant but was successful after using in vitro fertilization. She has a history of recurrent herpes outbreaks and is currently experiencing genital pain and tingling. Her first pregnancy was complicated by failure to progress, which resulted in a cesarean birth. Routine rectovaginal culture at 36 weeks was positive for Group B streptococci. Which of the following would be an absolute indication for delivering the child by LSCS (Lower Segment Cesarean Section):

Accepted Answer

Current symptoms of genital pain and tingling

Answer

History of previous cesarean section

Answer

Maternal colonization with Group B streptococci

Answer

In vitro fertilization

Question 9

Burns-Marshall technique is used to deliver the:

Accepted Answer

After-coming head

Answer

Leg

Answer

Placenta

Answer

Head

Question 10

Subpubic angle in gynecoid pelvis is?

Accepted Answer

100o

Answer

80o

Answer

120o

Answer

75o

Labor and Delivery — MCQs

Labor and Delivery — MCQs

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