Labor and Delivery Practice Questions

Q: Variable decelerations are associated with which of the following?

Cord compression. ***Cord compression*** - **Variable decelerations** are characterized by an abrupt decrease in fetal heart rate, varying in timing and amplitude relative to uterine contractions. This pattern is classically associated with **umbilical cord compression**. - When the umbilical cord is compressed, blood flow (and thus oxygen delivery) to the fetus is transiently reduced, causing a **baroreflex-mediated vagal response** that slows the heart rate. *Head compression* - **Head compression** typically causes **early decelerations**, which are gradual, symmetrical drops in fetal heart rate that mirror the uterine contraction. - This is due to an increase in **intracranial pressure** leading to a vagal response. *Uteroplacental insufficiency* - **Uteroplacental insufficiency** (e.g., placental abruption, preeclampsia) is associated with **late decelerations**, which are gradual, symmetrical decreases in fetal heart rate that begin after the peak of the contraction and return to baseline after the contraction ends. - This reflects **fetal hypoxemia** due to insufficient oxygen exchange at the placenta. *None of the options* - This option is incorrect because **variable decelerations** specifically indicate **cord compression**, a well-established association in fetal monitoring.

Q: Which of the following statements about the management of uterine inversion is false?

Surgical management is hysterectomy. ***Surgical management is hysterectomy*** - While hysterectomy is a possible outcome in severe, intractable cases, it is *not* the primary or routine surgical management for uterine inversion. - The goal of surgical intervention, when manual repositioning fails, is typically to *reposition the uterus* through laparotomy, not to remove it. *May require laparotomy* - **Laparotomy** (abdominal incision) may be necessary if **manual repositioning** of the inverted uterus is unsuccessful or if there are other complications requiring direct surgical access. - This approach allows the surgeon to directly visualize and manipulate the uterus to correct the inversion. *In case of delayed presentation repositioning to be attempted only after securing IV lines and adequate anesthesia* - For **delayed presentation** of uterine inversion, it is crucial to ensure maternal stability before attempting repositioning, as the patient may be in shock or have significant blood loss. - **Securing IV lines** for fluid resuscitation and ensuring **adequate anesthesia** are critical preparatory steps to manage pain and facilitate uterine relaxation. *Repositioning of uterus should be attempted immediately if diagnosed at the time of inversion* - **Immediate manual repositioning** (Johnson maneuver) is the primary first-line treatment for acute uterine inversion diagnosed at the time of delivery. - Prompt action is essential to minimize **blood loss**, prevent **shock**, and increase the chances of successful uterine replacement.

Q: Which of the following is NOT an indicator of impending uterine rupture during labor?

Passage of meconium. ***Passage of meconium*** - While **meconium passage** in labor is a sign of **fetal stress** or hypoxia, it is not a direct indicator of impending uterine rupture. - It results from increased vagal tone and relaxation of the anal sphincter, often in response to **fetal compromise**, but doesn't specifically point to uterine integrity. *Fetal distress* - **Fetal distress**, as indicated by persistent **fetal heart rate abnormalities** (e.g., late decelerations, prolonged bradycardia), can be a critical sign of impending uterine rupture due to disrupted placental blood flow. - The sudden onset of these changes, especially after a period of normal tracing, should raise high suspicion. *Hematuria* - **Hematuria** (blood in the urine) during labor can result from trauma to the **bladder** caused by the stretching or tearing of the lower uterine segment, which often precedes rupture. - It signifies that the bladder is being compromised or directly damaged, indicating severe pressure or injury alongside uterine compromise. *Fresh bleeding per vaginum* - **Fresh, bright red vaginal bleeding** in labor, especially if sudden and not associated with cervical changes, is a significant sign of impending or actual **uterine rupture**. - This blood often originates from the disrupted uterine vessels and indicates a loss of uterine integrity.

Q: Which of the following is a known cause of breech presentation?

Hydramnios. ***Hydramnios*** - **Excessive amniotic fluid** (polyhydramnios) increases the space available for fetal movement, preventing the fetus from settling into a stable cephalic position - This allows **increased fetal mobility** and is a well-recognized cause of **malpresentation including breech presentation** - The lack of normal space constraints means the fetus can freely move and fail to engage in vertex position *Septate uterus* - **Uterine anomalies** including septate uterus can restrict the intrauterine space and are recognized causes of breech presentation - However, they are **less common** than other causes and may also lead to recurrent pregnancy loss or preterm delivery - While a valid cause, it's not as frequently encountered as polyhydramnios in clinical practice *Hydrocephalus* - **Fetal hydrocephalus** with enlarged head can prevent normal engagement of the fetal head in the maternal pelvis - This can lead to malpresentation, though the mechanism is more about **disproportion** preventing cephalic engagement rather than causing breech directly - It's a recognized but less common fetal factor compared to other causes *Uterine fibroids* - **Large uterine fibroids**, particularly those in the lower uterine segment, can obstruct fetal descent and cause malpresentation - They alter uterine cavity shape and can prevent normal version to cephalic presentation - However, they are a **less frequent** direct cause compared to conditions like polyhydramnios or oligohydramnios

Q: Macerated foetus is indicative of:

Stillborn. ***Still born*** - A **macerated fetus** is characterized by the breakdown of fetal tissues due to **autolysis** in utero, which occurs when the fetus has died and remained in the womb for an extended period (usually >12-24 hours). - This condition is the hallmark of an **intrauterine fetal death** before delivery, defining it as a **stillbirth**. *Dead born* - While a **stillborn** fetus is technically "dead born," the term "dead born" is less precise and does not specifically imply the tissue changes (maceration) that occur with prolonged retention in utero. - The term **dead born** can encompass fetuses delivered immediately after death without significant tissue autolysis. *Live born* - A **liveborn** infant shows signs of life at birth, such as breathing, heart beat, umbilical cord pulsation, or definite voluntary muscle movement, none of which would be present in a macerated fetus. - **Maceration** is a post-mortem finding, directly indicating the fetus was not alive at birth. *IUGR* - **Intrauterine growth restriction (IUGR)** refers to a fetus that has not reached its genetically determined growth potential, resulting in an estimated fetal weight below the 10th percentile for gestational age. - While IUGR can be a risk factor for stillbirth, it is a **growth abnormality**, not a direct indicator or consequence of fetal death or maceration itself.

Q: Diagonal conjugate is defined as the distance between

Lower border of symphysis pubis and the sacral promontory. ***Lower border of symphysis pubis and the sacral promontory*** - The **diagonal conjugate** is a clinically measurable diameter that extends from the **inferior border of the symphysis pubis** to the **sacral promontory**. - This measurement helps to estimate the **obstetrical conjugate**, which is the true anteroposterior diameter of the pelvic inlet. *Upper border of symphysis pubis and the sacral promontory* - This description corresponds to neither a clinically measurable nor an anatomically significant pelvic diameter. - The **anatomical conjugate** extends from the **upper border of the symphysis pubis** to the sacral promontory, but this is not the diagonal conjugate. *Lower border of symphysis pubis and the third piece of sacrum* - Measuring to the **third piece of the sacrum** is not a standard anatomical landmark for pelvic measurements used in obstetrics. - The important landmark for pelvic inlet dimensions is the **sacral promontory**. *Lower border of symphysis pubis and tip of sacrum* - The **tip of the sacrum** is too inferior and posterior to be relevant for measuring the diagonal conjugate and estimating the pelvic inlet. - The **sacral promontory** is the key superior point on the sacrum for this measurement.

Q: Which is the most common complication during vaginal delivery in a diabetic woman?

Shoulder dystocia. ***Shoulder dystocia*** - **Fetal macrosomia**, common in diabetic pregnancies, leads to disproportionate shoulder circumference relative to the head, increasing the risk of **shoulder dystocia**. - This complication occurs when the fetal shoulders get stuck behind the maternal pubic bone after the head has been delivered, requiring specific maneuvers for resolution. *Uterine inertia* - While possible, **uterine inertia** is not the most common complication specifically associated with vaginal delivery in diabetic women. - It involves inefficient uterine contractions and may lead to prolonged labor, but **fetal macrosomia** presents a more direct and frequent mechanical obstruction. *Postpartum hemorrhage* - **Postpartum hemorrhage** (PPH) is a significant complication in diabetic women, often due to **uterine atony** (a floppy uterus that doesn't contract well) resulting from overdistension by a macrosomic infant. - However, **shoulder dystocia** is a more direct and immediate mechanical complication related to fetal size during the pushing phase and is statistically more frequent during the actual delivery in these cases. *Excessive moulding of head* - **Excessive moulding** of the fetal head is more commonly associated with cephalopelvic disproportion where the fetal head is too large for the maternal pelvis, irrespective of diabetes. - In diabetic pregnancies, the primary issue is typically the disproportionate size of the fetal shoulders and trunk (macrosomia), rather than the head's ability to mold through the birth canal.

Q: Which is the most common position in breech presentation?

Left sacroanterior. ***Left sacroanterior*** - This is the **most common position** for a fetus in a **breech presentation**. - The fetal **sacrum (S)** is pointing towards the mother's **left (L)** and **anterior (A)** pelvis. *Right sacroanterior* - In this position, the fetal sacrum is pointing towards the mother's **right (R)** and **anterior (A)** pelvis. - While possible, it is **less common** than the left sacroanterior position. *Right sacroposterior* - Here, the fetal sacrum is pointing towards the mother's **right (R)** and **posterior (P)** pelvis. - **Sacroposterior positions** often lead to more difficult deliveries and are less common. *Left sacroposterior* - In this position, the fetal sacrum is pointing towards the mother's **left (L)** and **posterior (P)** pelvis. - Like right sacroposterior, it is **less frequent** than anterior presentations and can pose delivery challenges.

Question 1

Variable decelerations are associated with which of the following?

Accepted Answer

Cord compression

Answer

Head compression

Answer

Uteroplacental insufficiency

Answer

None of the options

Question 2

Among the following malpresentations, which is most favorable for vaginal delivery?

Accepted Answer

Face presentation with mentum anterior (chin toward symphysis pubis)

Answer

Face presentation when the chin lies direct to the sacrum

Answer

Brow presentation

Answer

Shoulder presentation

Question 3

Which of the following statements about the management of uterine inversion is false?

Accepted Answer

Surgical management is hysterectomy

Answer

May require laparotomy

Answer

In case of delayed presentation repositioning to be attempted only after securing IV lines and adequate anesthesia

Answer

Repositioning of uterus should be attempted immediately if diagnosed at the time of inversion

Question 4

Which of the following is NOT an indicator of impending uterine rupture during labor?

Accepted Answer

Passage of meconium

Answer

Hematuria

Answer

Fresh bleeding per vaginum

Answer

Fetal distress

Question 5

Which of the following is a known cause of breech presentation?

Accepted Answer

Hydramnios

Answer

Septate uterus

Answer

Hydrocephalus

Answer

Uterine fibroids

Question 6

Macerated foetus is indicative of:

Accepted Answer

Stillborn

Answer

Live born

Answer

Deadborn

Answer

IUGR

Question 7

Diagonal conjugate is defined as the distance between

Accepted Answer

Lower border of symphysis pubis and the sacral promontory

Answer

Upper border of symphysis pubis and the sacral promontory

Answer

Lower border of symphysis pubis and the third piece of sacrum

Answer

Lower border of symphysis pubis and tip of sacrum

Question 8

Which is the most common complication during vaginal delivery in a diabetic woman?

Accepted Answer

Shoulder dystocia

Answer

Excessive moulding of head

Answer

Uterine inertia

Answer

Postpartum hemorrhage

Question 9

What is true about the partograph?

Accepted Answer

Alert and action lines are separated by a difference of 4 hours in a standard partograph.

Answer

Partograph recording should be started at a cervical dilation of 4 cm.

Answer

Each small square represents 30 minutes.

Answer

Send the patient to the first referral unit if the labor progression line crosses the action line.

Question 10

Which is the most common position in breech presentation?

Accepted Answer

Left sacroanterior

Answer

Right sacroanterior

Answer

Right sacroposterior

Answer

Left sacroposterior

Labor and Delivery — MCQs

Labor and Delivery — MCQs

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