Labor and Delivery Practice Questions

Q: Most common breech presentation in primigravida is?

Frank breech presentation. ***Frank breech presentation*** - This is the most common type of breech presentation, accounting for **65-70% of all breech presentations**, especially in **primigravida**. - The baby's **hips are flexed and knees are extended**, with the feet near the head. - The extended legs splint the fetal body and contribute to a more stable position within the uterus. *Complete breech presentation* - In a **complete breech**, the baby's hips and knees are both flexed, with the buttocks presenting first and the feet near the buttocks. - Accounts for approximately **5-10% of breech presentations**. - While common, it is significantly less frequent than frank breech, particularly in primigravidas. *Footling breech presentation* - In a **footling breech**, one or both feet present first through the cervix. - Accounts for approximately **10-30% of breech presentations**. - Associated with higher risks including premature rupture of membranes, umbilical cord prolapse, and is less stable during delivery. *Incomplete breech presentation* - This is a general term that includes **footling and kneeling breech** presentations, where the presentation is neither frank nor complete. - It's an encompassing category rather than a specific single presentation type. - Less common than frank breech as the most frequent single type in primigravidas.

Q: What is the risk of scar rupture in the lower segment of the uterus in patients with a previous cesarean section?

0.5 - 1.5%. ***0.5 - 1.5%*** - The risk of **uterine scar rupture** in a **lower segment Cesarean section** (LSCS) is generally low, ranging from 0.5% to 1.5% during a Trial of Labor After Cesarean (TOLAC). - This low risk is why **Vaginal Birth After Cesarean (VBAC)** is often considered a safe option for selected patients. *15 - 25%* - This percentage is significantly higher than the actual risk for a **lower segment Cesarean scar rupture**. Risks this high would generally lead to reconsideration of VBAC as a safe option. - Such a high risk is usually associated with a **classical (vertical) incision** on the uterus or multiple previous Cesarean sections. *2.5 - 3.5%* - This range is higher than the typical risk for a single **lower segment Cesarean scar rupture**. - While still relatively low, it might be observed in specific populations or with certain risk factors like a short inter-delivery interval or a single-layer uterine closure. *3.5 - 4.5%* - This risk is considerably elevated compared to the established risk for a **lower segment Cesarean scar rupture** and would generally lead to a more cautious approach to TOLAC. - This range can be associated with specific risk factors for scar dehiscence or rupture such as a history of multiple previous Cesarean sections or certain uterine anomalies.

Q: Persistent OP position is most common in which pelvis?

Anthropoid pelvis. ***Anthropoid pelvis*** - The **anthropoid pelvis** has an **oval-shaped inlet** with a **long anteroposterior diameter** and **narrow transverse diameter**. - This pelvic configuration is most commonly associated with **persistent occiput posterior (OP) position** because the narrow transverse diameter limits rotation, while the long AP diameter accommodates the fetal head in the OP or direct OA position. - The fetal head tends to engage and remain in the **direct OP or direct OA position** rather than rotating to the transverse position. - This is the **classic pelvic type associated with persistent OP delivery**. *Android pelvis* - The **android pelvis** has a heart-shaped or triangular inlet, narrow subpubic arch, and prominent ischial spines. - This pelvic type is associated with **difficult labor**, **transverse arrest**, and **deep transverse arrest** of the fetal head. - While it can cause malposition, it is more characteristically associated with **arrest disorders** rather than persistent OP position. *Gynaecoid pelvis* - The **gynaecoid pelvis** is the ideal and most common female pelvic type, with a rounded inlet, wide subpubic arch, and adequate dimensions. - This pelvic shape allows for **optimal fetal head rotation** from OP to OA position during labor. - Persistent OP position is **uncommon** with this pelvic type. *Mixed pelvis* - A **mixed pelvis** exhibits characteristics of more than one fundamental pelvic type. - The likelihood of persistent OP depends on which features predominate, but it is not a specific classic association.

Q: Duration of second stage of labor depends upon -

Parity. ***Parity*** - **Nulliparous** women (first birth) typically have a longer second stage of labor due to less efficient pushing efforts and less compliant soft tissues. - **Multiparous** women (subsequent births) usually experience a shorter second stage because their pelvic floor and birth canal have stretched previously, making descent and expulsion of the fetus easier. *Size of fetus* - While a **macrosomic fetus** could potentially prolong the second stage, it is not the primary determinant compared to parity. - The duration of the second stage is more influenced by the **mother's physiology** and prior birth experience. *Mother's build* - A mother's general build or weight does **not directly determine** the duration of the second stage of labor. - Pelvic structure (pelvimetry) is more relevant than overall build, but even then, parity is a stronger predictive factor. *Lie of fetus* - The **lie of the fetus** (longitudinal, transverse, oblique) is crucial for the initiation and progression of labor, but once the fetus is in a longitudinal lie and engagement occurs, it is not the primary factor determining the *duration* of the second stage itself. - An **unfavorable lie** would likely prevent the onset of effective labor or necessitate a C-section before the second stage is even reached.

Q: Mediolateral episiotomy is preferred because?

Reduces damage to anal sphincter and anal canal. ***Reduces damage to anal sphincter and anal canal*** - The **mediolateral episiotomy** is cut at an angle away from the midline, significantly reducing the risk of extending into the **anal sphincter** and **rectum**. - This angulation helps to avoid severe perineal tears, protecting against **fecal incontinence** and other long-term complications. *Less blood loss* - **Mediolateral episiotomies** often result in more blood loss compared to midline episiotomies due to cutting across more muscle and blood vessels. - The angled incision involves a larger area of vascular tissue, increasing the potential for bleeding. *Easy to suture* - **Mediolateral episiotomies** are generally more complex and difficult to repair than midline episiotomies due to the irregular nature of the angled incision. - Achieving proper anatomical alignment and hemostasis can be challenging. *Easy technique* - While a commonplace procedure, the **mediolateral episiotomy** requires precise angulation and depth to ensure effective tissue release and avoid critical structures. - **Midline episiotomies** are technically simpler to perform due to their straightforward, sagittal incision, though they carry higher risks of severe tears.

Q: What is the optimal timing for the repair of an old complete perineal tear?

3 to 6 months after injury. ***3 to 6 months after injury*** - This timing allows sufficient time for **inflammation** to subside, **scar tissue** to mature, and tissues to heal, optimizing surgical outcomes for a stable repair. - Delaying the repair beyond the immediate postpartum period decreases **tissue friability** and the risk of **wound dehiscence**, which are common in acute repairs. *Immediately after injury* - Immediate repair of an **old complete perineal tear** is not indicated as the tissues are typically **inflamed**, **friable**, and potentially **infected**, leading to a high failure rate. - This timing is suitable for **acute perineal tears** (within hours after delivery), not for old, established tears. *6 to 9 months after injury* - While still feasible, waiting this long may lead to more **fibrotic tissue** and **atrophy** of the anal sphincter muscles, potentially complicating surgical dissection and recovery. - The optimal window for tissue condition for repair is generally considered to be somewhat earlier. *9 to 12 months after injury* - At this stage, the tissues may be more significantly **fibrotic** and less pliable, which can make surgical repair technically more challenging and potentially compromise the long-term functional outcome. - There is no added benefit to waiting this long compared to earlier repair, and functional recovery may be delayed.

Q: Transverse lie is caused by all except which of the following?

Maternal diabetes. ***Maternal diabetes*** - **Maternal diabetes** is primarily associated with **macrosomia** (larger-than-average fetus) and increased risk of shoulder dystocia, not typically transverse lie. - While it can complicate labor, it does not directly predispose to the fetus lying sideways in the uterus. *Multiparity* - **Multiparity** (multiple prior pregnancies) can lead to **lax abdominal and uterine musculature**, which reduces the integrity of the uterus to maintain fetal orientation. - This laxity allows the fetus more room to move and settle into an abnormal lie, including transverse. *Prematurity* - In **premature deliveries**, the fetus is often smaller and has more space to move within the uterus, increasing the likelihood of an **unstable lie**. - The relative proportions of fetal size to uterine cavity are less constrained in premature infants, facilitating non-longitudinal positions. *Placenta previa* - **Placenta previa** (placenta covering or near the cervix) can physically obstruct the descent of the fetal head into the pelvis, preventing it from engaging in a longitudinal lie. - The placenta's position forces the fetus to lie in a **transverse or oblique orientation** because the lower uterine segment is occupied, preventing proper fetal alignment.

Q: Which type of pelvis is most accommodating for the occipitoposterior position during labor?

Anthropoid. ***Anthropoid*** - The **anthropoid pelvis** is characterized by a long anteroposterior diameter and a narrow transverse diameter, which allows the fetal head in an **occipitoposterior (OP) position** to accommodate more easily. - Its oval shape facilitates a direct anterior-posterior delivery, reducing the need for extensive rotation when the occiput is posterior. *Android pelvis* - The **android pelvis** is heart-shaped with a narrow pubic arch and reduced diameters, making it unfavorable for *any* fetal presentation, especially OP. - This pelvic type is associated with a higher incidence of **arrest of labor** and requires more interventions during delivery. *Gynaecoid* - The **gynaecoid pelvis** is considered the classic female pelvis, with a rounded inlet and good proportions for vaginal delivery in an **occipitoanterior (OA) position**. - While generally favorable, its broader transverse diameter makes accommodation of an OP position less optimal compared to the anthropoid pelvis. *Platypelloid* - The **platypelloid pelvis** has a flattened shape with a short anteroposterior diameter and a wide transverse diameter. - This shape is highly unfavorable for vaginal delivery, as it obstructs engagement and descent of the fetal head in both OA and OP positions, leading to complications.

Question 1

Most common breech presentation in primigravida is?

Accepted Answer

Frank breech presentation

Answer

Footling breech presentation

Answer

Incomplete breech presentation

Answer

Complete breech presentation

Question 2

Engagement of head in labour means?

Accepted Answer

Largest diameter of the presenting part has crossed the pelvic brim

Answer

Smallest horizontal plane of the presenting part has crossed the pelvic outlet

Answer

Greatest horizontal plane of the presenting part has crossed the pelvic outlet

Answer

Smallest diameter of the presenting part has crossed the pelvic brim

Question 3

What is the risk of scar rupture in the lower segment of the uterus in patients with a previous cesarean section?

Accepted Answer

0.5 - 1.5%

Answer

15 - 25%

Answer

2.5 - 3.5%

Answer

3.5 - 4.5%

Question 4

Persistent OP position is most common in which pelvis?

Accepted Answer

Anthropoid pelvis

Answer

Android pelvis

Answer

Gynaecoid pelvis

Answer

Mixed pelvis

Question 5

Duration of second stage of labor depends upon -

Accepted Answer

Parity

Answer

Size of fetus

Answer

Mother's build

Answer

Lie of fetus

Question 6

Mediolateral episiotomy is preferred because?

Accepted Answer

Reduces damage to anal sphincter and anal canal

Answer

Less blood loss

Answer

Easy to suture

Answer

Easy technique

Question 7

What is the optimal timing for the repair of an old complete perineal tear?

Accepted Answer

3 to 6 months after injury

Answer

Immediately after injury

Answer

6 to 9 months after injury

Answer

9 to 12 months after injury

Question 8

Transverse lie is caused by all except which of the following?

Accepted Answer

Maternal diabetes

Answer

Prematurity

Answer

Placenta previa

Answer

Multiparity

Question 9

Which of the following is NOT a contraindication for induction of labour?

Accepted Answer

Hypertensive disease of pregnancy

Answer

Heart disease of pregnancy

Answer

Pelvic tumor

Answer

Vasa previa

Question 10

Which type of pelvis is most accommodating for the occipitoposterior position during labor?

Accepted Answer

Anthropoid

Answer

Android

Answer

Gynaecoid

Answer

Platypelloid

Labor and Delivery — MCQs

Labor and Delivery — MCQs

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