Labor and Delivery — MCQs

According to WHO Intrapartum Care Guidelines 2018, which of the following are correct about birthing position? I. For a woman without epidural analgesia, adoption of birthing position is individual woman's choice. II. For a woman without epidural analgesia, upright birthing position may be adopted. III. For a woman with epidural analgesia, lithotomy and supine position only are recommended. Select the answer using the code given below :

Q854

According to WHO Intrapartum Care Guidelines 2018, which one of the following is correct about duration of first stage labour?

Q855

The Matthews Duncan process has been described for :

Q856

Which of the following factors are associated with cord prolapse during labour? I. Malpresentations II. Contracted pelvis III. Induction with engaged presenting part IV. Prematurity Select the correct answer using the code given below :

Q857

During delivery of HIV infected women, which of the following are recommended ? 1. Zidovudine (ZDV) is given at the onset of labour. 2. Elective caesarean delivery reduces the risk of vertical transmission. 3. Amniotomy and oxytocin augmentation should be done. 4. Antiretroviral therapy should be given to all neonates. Select the correct answer using the code given below :

Q858

Which of the following correctly defines the first stage of labor? 1. Full dilatation of cervix to the expulsion of the fetus from the birth canal 2. Maternal bearing down efforts and ends with the delivery of the baby 3. The onset of true labor pains and ends with the full dilatation of cervix 4. The formation of bag of waters

Q859

Secondary arrest of dilatation during the process of labour may be due to which of the following factors ? 1. Poor uterine contractions 2. Cessation of cervical dilatation despite strong uterine contractions 3. Disproportion and malpresentation Select the correct answer using the code given below :

Q860

As per the classification of Obstetric Anal Sphincter Injury (RCOG-2007), complete tear of External Anal Sphincter is of degree :

Labor and Delivery Indian Medical PG Practice Questions and MCQs

Question 851: Which of the following factors favour posterior position of the vertex? I. Anthropoid pelvis II. Low inclination pelvis III. Attachment of placenta on the anterior wall IV. Primary brachycephaly Select the correct answer using the code given below :

A. I, III and IV (Correct Answer)
B. II, III and IV
C. I, II and IV
D. I, II and III

Explanation: ***I, III and IV*** - An **anthropoid pelvis** has a long anteroposterior diameter and a narrow transverse diameter, making it more likely for the fetal head to engage in an anteroposterior position, which can lead to a posterior vertex. - **Placenta attached to the anterior wall** can create less space posteriorly, potentially pushing the fetal back towards the posterior aspect of the uterus, thereby promoting an occiput posterior position. - **Primary brachycephaly** (a fetal head that is wider than it is long) may find it difficult to rotate in the pelvis, increasing the likelihood of remaining in an occiput posterior position due to less favorable biomechanics for rotation. *II, III and IV* - A **low inclination pelvis** typically refers to a gynecoid pelvis with a flattened sacrum, which tends to promote rotation to an anterior position, not a posterior one. - Therefore, option II is incorrect as it favors anterior rotation. *I, II and IV* - This option incorrectly includes **low inclination pelvis** as a factor favoring posterior position. - A low inclination pelvis, particularly if it's a gynecoid type, is generally associated with more favorable conditions for fetal rotation to an anterior position. *I, II and III* - This option also incorrectly includes **low inclination pelvis** as a factor contributing to posterior vertex presentation. - The biomechanics of a low inclination pelvis do not typically predispose to a posterior vertex engagement or presentation.

Question 852: Which of the following statements are correct regarding shoulder dystocia? I. It can be predicted during early labour. II. Fetal macrosomia is a risk factor. III. Turtle neck sign is present. IV. Episiotomy should always be given. Select the answer using the code given below :

A. I and III
B. II and IV
C. II and III (Correct Answer)
D. I and II

Explanation: ***II and III*** - **Fetal macrosomia** (birth weight >4000g or >4500g) is a well-established risk factor for shoulder dystocia, as larger fetal size increases the likelihood of shoulder impaction behind the maternal pubic symphysis. - The **"turtle sign"** (or "turtle neck sign") is a pathognomonic sign of shoulder dystocia, where the fetal head retracts against the perineum after delivery because the anterior shoulder is impacted behind the pubic symphysis. *I and III* - Shoulder dystocia is generally **unpredictable** in early labor. While risk factors (maternal diabetes, fetal macrosomia, maternal obesity) identify high-risk pregnancies, most cases occur without warning and cannot be reliably predicted during early labor. Up to 50% of shoulder dystocia cases occur in pregnancies without identifiable risk factors. *II and IV* - While episiotomy may be performed to facilitate maneuvers by providing more working space, it is **not always indicated** and does not directly relieve the bony obstruction. The primary issue in shoulder dystocia is impaction of the anterior shoulder behind the pubic symphysis (bony obstruction), not soft tissue restriction. Episiotomy should be selective, not routine. *I and II* - As stated, shoulder dystocia cannot be reliably predicted during early labor, despite the presence of risk factors. Clinical judgment and preparedness are more important than prediction. - Fetal macrosomia remains a significant risk factor, though many macrosomic babies deliver without shoulder dystocia and many cases occur with normal-weight infants.

Question 853: According to WHO Intrapartum Care Guidelines 2018, which of the following are correct about birthing position? I. For a woman without epidural analgesia, adoption of birthing position is individual woman's choice. II. For a woman without epidural analgesia, upright birthing position may be adopted. III. For a woman with epidural analgesia, lithotomy and supine position only are recommended. Select the answer using the code given below :

A. I, II and III
B. II and III only
C. I and II only (Correct Answer)
D. I and III only

Explanation: ***I and II only*** - According to the **WHO Intrapartum Care Guidelines 2018**, for women **without epidural analgesia**, the adoption of **birthing position** should be the **individual woman's choice** (Statement I is correct). - **Upright positions** (including sitting, standing, kneeling, squatting, or hands-and-knees) are specifically **encouraged** for women without epidural as they may reduce duration of second stage of labor and instrumental delivery rates (Statement II is correct). - The WHO guidelines emphasize **woman-centered care** and respect for maternal preferences regarding birthing positions. *I, II and III* - This option is **incorrect** because Statement III is false. - The WHO 2018 guidelines do **NOT** restrict women with epidural analgesia to only lithotomy and supine positions. - Even with epidural, women should be **encouraged to adopt positions of their choice**, including lateral and supported upright positions when feasible. *II and III only* - This option is **incorrect** as it omits Statement I, which correctly reflects the WHO principle of **individual woman's choice** for birthing position. - Statement III is also **false** - women with epidural are not limited to only lithotomy and supine positions according to WHO guidelines. *I and III only* - This option is **incorrect** because Statement III is false. - WHO guidelines advocate for **flexible positioning** even with epidural analgesia, not restriction to lithotomy and supine positions only. - The guidelines support exploring various positions based on maternal comfort, clinical circumstances, and healthcare provider support.

Question 854: According to WHO Intrapartum Care Guidelines 2018, which one of the following is correct about duration of first stage labour?

A. Duration of active stage of primigravida should not exceed 8 hours
B. Duration of active stage of multigravida should not exceed 6 hours
C. Duration of active stage of primigravida should not exceed 18 hours
D. Duration of latent phase of primigravida has not been established (Correct Answer)

Explanation: ***Duration of latent phase of primigravida has not been established*** - The **WHO Intrapartum Care Guidelines 2018** state that for both primigravid and multiparous women, the duration of the **latent phase of labor** has significant variability and a specific maximum duration to define prolonged labor has not been established. - This reflects the understanding that the latent phase can be variable and does not necessarily require intervention if the woman and fetus are well. *Duration of active stage of primigravida should not exceed 8 hours* - The 2018 WHO guidelines suggest that the **active phase of first-stage labor** for a **primigravida** can be up to **12 hours** or even longer, as long as there is continuous progress in cervical dilation. - The concept of a rigid 8-hour limit for all primigravidae in the active phase is not supported by current evidence-based guidelines, which emphasize individual progress. *Duration of active stage of multigravida should not exceed 6 hours* - For **multigravid women**, the active phase of the first stage of labor is generally shorter than for primigravidae, but the WHO guidelines do not set a strict upper limit of 6 hours. - Instead, they emphasize that progress in cervical dilation should be monitored, and interventions should be based on a lack of progress along with other clinical indicators, rather than a fixed time frame. *Duration of active stage of primigravida should not exceed 18 hours* - While the active phase of labor can be prolonged, a "should not exceed 18 hours" limit is not explicitly defined in the way it is presented. - The **WHO guidelines** advocate for continuous monitoring of cervical dilation, with an expected rate of at least 1 cm/hour during the active phase, acknowledging that some women may have slower but still physiological progress.

Question 855: The Matthews Duncan process has been described for :

A. controlled contraction in active management of third stage of labour
B. central separation of placenta in normal labour
C. marginal separation of placenta in normal labour (Correct Answer)
D. reposition of acute inversion of uterus following vaginal delivery

Explanation: ***Marginal separation of placenta in normal labour*** - The **Matthews Duncan method** describes the process of **placental separation** where the placenta detaches from its **edges first**, leading to bleeding from the exposed maternal surface. - This type of separation is one of the two main mechanisms by which the placenta separates from the **uterine wall** during the third stage of labor. *Controlled contraction in active management of third stage of labour* - This refers to techniques like **controlled cord traction** and **fundal massage**, which are part of the active management to expedite placental delivery and prevent hemorrhage. - While it's a part of third stage management, it describes an intervention for placental expulsion, not a specific mechanism of placental detachment. *Central separation of placenta in normal labour* - This is known as the **Schultze method**, where placental separation begins in the **center**, leading to the fetal surface presenting first and less visible bleeding during separation. - The question specifically asks about the **Matthews Duncan process**, which is distinct from central separation. *Reposition of acute inversion of uterus following vaginal delivery* - **Uterine inversion** is a rare but severe complication where the **fundus** collapses through the **cervix**. - Repositioning involves manual or surgical techniques to return the uterus to its normal anatomical position and is unrelated to placental separation mechanisms.

Question 856: Which of the following factors are associated with cord prolapse during labour? I. Malpresentations II. Contracted pelvis III. Induction with engaged presenting part IV. Prematurity Select the correct answer using the code given below :

A. I, II, III and IV
B. III and IV only
C. I, II and IV only (Correct Answer)
D. I, II and III only

Explanation: ***I, II and IV only*** - **Cord prolapse** occurs when the umbilical cord descends ahead of the presenting fetal part, often due to factors that prevent the presenting part from fitting snugly into the pelvis. - **Malpresentations** (e.g., footling breech, transverse lie), **contracted pelvis** (hindering engagement), and **prematurity** (smaller fetus, more amniotic fluid) all increase the risk by creating a space for the cord to fall through. - **Induction with engaged presenting part** is NOT a risk factor because when the presenting part is well-engaged in the pelvis, it acts as a barrier preventing cord prolapse. *I, II, III and IV* - This option incorrectly includes **induction with engaged presenting part** as a risk factor for cord prolapse. - When the presenting part is engaged, it fills the pelvic inlet and prevents the cord from prolapsing. *III and IV only* - This option is incomplete as it misses crucial risk factors like **malpresentations** and **contracted pelvis**. - **Induction with engaged presenting part** is not a risk factor for cord prolapse. *I, II and III only* - This option incorrectly includes **induction with engaged presenting part** as an association with cord prolapse. - It also omits **prematurity**, which is a significant risk factor due to the disproportionately large amount of amniotic fluid relative to the fetal size.

Question 857: During delivery of HIV infected women, which of the following are recommended ? 1. Zidovudine (ZDV) is given at the onset of labour. 2. Elective caesarean delivery reduces the risk of vertical transmission. 3. Amniotomy and oxytocin augmentation should be done. 4. Antiretroviral therapy should be given to all neonates. Select the correct answer using the code given below :

A. 1 and 2 only (Correct Answer)
B. 2, 3 and 4
C. 1, 2 and 4
D. 1, 2 and 3

Explanation: ***1 and 2 only*** - **Zidovudine (ZDV)** is administered intravenously to the mother at the onset of labor and during delivery as part of the **PMTCT (Prevention of Mother-to-Child Transmission)** protocol. It reduces viral load and provides pre-exposure prophylaxis to the fetus, significantly decreasing the risk of **vertical HIV transmission**. - **Elective cesarean section** is recommended for HIV-infected women with **viral loads >1,000 copies/mL** or unknown viral loads near term (performed at 38 weeks). This reduces neonatal exposure to maternal blood and genital tract secretions during vaginal delivery, thereby **reducing perinatal HIV transmission risk by approximately 50%** compared to vaginal delivery in women not on effective antiretroviral therapy. - Statement 3 is **incorrect**: **Amniotomy (artificial rupture of membranes) and oxytocin augmentation are contraindicated** in HIV-infected women as these procedures increase fetal exposure to maternal blood and bodily fluids, thereby **increasing the risk of vertical transmission**. Guidelines recommend avoiding invasive obstetric procedures. - Statement 4 is **incorrect**: While **antiretroviral prophylaxis** (typically zidovudine syrup) is given to all neonates born to HIV-infected mothers for 4-6 weeks, **full antiretroviral therapy (ART)** is only initiated if the infant tests positive for HIV. The statement incorrectly uses "therapy" instead of "prophylaxis." *1, 2 and 3* - This option incorrectly includes statement 3. **Amniotomy and oxytocin augmentation should be avoided**, not recommended, in HIV-infected women as they increase the risk of vertical transmission through increased fetal exposure to maternal blood. *2, 3 and 4* - Statement 3 is **incorrect** as amniotomy and oxytocin augmentation are **contraindicated** in HIV management during labor. - Statement 4 is **incorrect** as all neonates receive **prophylaxis**, not full antiretroviral **therapy**. *1, 2 and 4* - While statements 1 and 2 are correct, statement 4 is **incorrect** because neonates receive **antiretroviral prophylaxis** (not therapy). Full **ART** is reserved for confirmed HIV-positive infants.

Question 858: Which of the following correctly defines the first stage of labor? 1. Full dilatation of cervix to the expulsion of the fetus from the birth canal 2. Maternal bearing down efforts and ends with the delivery of the baby 3. The onset of true labor pains and ends with the full dilatation of cervix 4. The formation of bag of waters

A. 1, 2 and 4
B. 1, 3 and 4
C. 1, 2 and 3
D. 2, 3 and 4 (Correct Answer)

Explanation: ***Correct Answer: Only Statement 3*** The **first stage of labor** is accurately defined by **statement 3 only**: "The onset of true labor pains and ends with the full dilatation of cervix" **Statement 3 - The onset of true labor pains and ends with the full dilatation of cervix** ✓ - This is the **accurate and complete definition** of the **first stage of labor** - Begins with regular, progressive uterine contractions - Ends when cervix reaches **10 cm (full) dilatation** - Divided into **latent phase** (0-6 cm) and **active phase** (6-10 cm) - Duration varies but averages 8-12 hours in primigravidas **Why other statements are INCORRECT:** *Statement 1 - Full dilatation of cervix to the expulsion of the fetus* - This describes the **SECOND stage of labor**, NOT the first stage - Second stage: begins at full cervical dilatation (10 cm) and ends with delivery of baby *Statement 2 - Maternal bearing down efforts and ends with the delivery of the baby* - This also describes the **SECOND stage of labor** - Active pushing occurs after full dilatation, not during the first stage *Statement 4 - The formation of bag of waters* - The amniotic sac forms during **pregnancy**, not during labor - Its rupture may occur during labor but does not define the first stage - Not a defining characteristic of any labor stage **Note:** Among the given options, **"2, 3 and 4"** is selected as it contains the correct statement (3). However, strictly speaking, only statement 3 correctly defines the first stage of labor. Statements 2 and 4 do not define the first stage.

Question 859: Secondary arrest of dilatation during the process of labour may be due to which of the following factors ? 1. Poor uterine contractions 2. Cessation of cervical dilatation despite strong uterine contractions 3. Disproportion and malpresentation Select the correct answer using the code given below :

A. 1 and 2 only
B. 1, 2 and 3 (Correct Answer)
C. 1 and 3 only
D. 2 and 3 only

Explanation: ***1, 2 and 3*** - **Secondary arrest of dilatation** refers to a cessation of cervical dilatation in the active phase of labor after the cervix has already begun to dilate, often attributed to **poor uterine contractions** (hypocontractility) hindering cervical progress. - While weak contractions are a common cause, secondary arrest can also occur despite **strong uterine contractions** if there's an underlying mechanical issue, such as **cephalopelvic disproportion** or **fetal malpresentation**, preventing the fetal head from descending and dilating the cervix effectively. *1 and 2 only* - This option incorrectly excludes **disproportion and malpresentation** as potential causes of secondary arrest of dilatation. - Both poor uterine contractions and cessation of dilatation despite strong contractions are valid causes, but overlooking mechanical impediments like disproportion leaves the explanation incomplete. *1 and 3 only* - This option overlooks the scenario where **cervical dilatation ceases despite strong uterine contractions**, which is a distinct presentation of arrest that points to mechanical obstruction rather than purely ineffective contractions. - While poor contractions and disproportion/malpresentation are important, the specified scenario of strong contractions with no progress is also a key factor. *2 and 3 only* - This option incorrectly omits **poor uterine contractions** as a primary and very common cause of secondary arrest of dilatation. - Weak or uncoordinated contractions are often the first factor investigated when cervical progression stalls.

Question 860: As per the classification of Obstetric Anal Sphincter Injury (RCOG-2007), complete tear of External Anal Sphincter is of degree :

A. 2c
B. 3c (Correct Answer)
C. 3b
D. 3a

Explanation: ***3c*** - A **3c tear** involves a **complete tear** of the **external anal sphincter (EAS)**, often along with the internal anal sphincter (IAS) being involved in any degree during obstetric anal sphincter injury (OASI). - According to the RCOG (Royal College of Obstetricians and Gynaecologists) 2007 classification, this signifies a severe and complete disruption of the external sphincter. *2c* - A **2c tear** would typically refer to a **more extensive second-degree perineal tear** involving deeper muscle layers, but it does **not involve the anal sphincters**. - Second-degree tears involve the skin, vaginal mucosa, and perineal muscles but spare the anal sphincter complex. *3b* - A **3b tear** signifies a **partial tear of the external anal sphincter (EAS)**, with **more than 50%** of the muscle thickness being torn. - While it involves the EAS, it is not a complete tear as described in the question, differentiating it from a 3c tear. *3a* - A **3a tear** indicates an **involvement of the external anal sphincter (EAS)**, specifically a partial tear of the EAS involving **less than 50%** of its thickness. - This is a less severe injury than a 3b or 3c tear and does not represent a complete tear of the EAS.

Practice by Chapter

Physiology of Labor

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Stages of Labor and Normal Progression

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Fetal Monitoring Techniques

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Pain Management in Labor

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Induction and Augmentation of Labor

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Operative Delivery (Forceps and Vacuum)

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Cesarean Section: Indications and Techniques

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Dystocia and Abnormal Labor Patterns

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Obstetric Emergencies

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Postpartum Hemorrhage Management

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