Labor and Delivery Practice Questions

Q: Indications and prerequisites for delivery with the ventouse include which of the following? 1. Delay in the second stage of labour 2. Non-reassuring fetal heart rate 3. Gestation age less than 34 weeks of pregnancy 4. Vertex presentation.

1, 2 and 4. ***1, 2 and 4*** - **Ventouse delivery** is indicated for **delay in the second stage of labor** and **non-reassuring fetal heart rate**, when expeditious delivery is required. - A crucial prerequisite is **vertex presentation**, ensuring proper application of the vacuum cup to the fetal head. *2, 3 and 4* - **Gestation age less than 34 weeks of pregnancy** is a contraindication for ventouse delivery due to the increased risk of **fetal scalp trauma** and **intracranial hemorrhage** in premature infants. - While **non-reassuring fetal heart rate** and **vertex presentation** are valid points, the inclusion of premature gestation makes this option incorrect. *1, 2 and 3* - Again, **gestation age less than 34 weeks of pregnancy** is a contraindication, not an indication or prerequisite, for ventouse delivery. - Although **delay in the second stage** and **non-reassuring fetal heart rate** are correct factors, the inclusion of prematurity renders this option incorrect. *1, 3 and 4* - This option incorrectly lists **gestation age less than 34 weeks of pregnancy** as a prerequisite. - While **delay in the second stage** and **vertex presentation** are appropriate, the prematurity contraindication makes this an unsuitable choice.

Q: During the first stage of labour, the intrauterine pressure is increased up to

40–50 mm of Hg. ***40–50 mm of Hg*** - This pressure range is typical during **uterine contractions** in the first stage of labor, effectively causing cervical effacement and dilation. - These pressures provide sufficient force to facilitate the progression of labor while maintaining adequate **uteroplacental blood flow** between contractions. *100–120 mm of Hg* - This pressure range is generally too high for the first stage of labor and is more commonly seen in the **second stage** or during prolonged, abnormal contractions. - Such elevated pressures could potentially compromise **fetal well-being** due to reduced uteroplacental perfusion. *8–10 mm of Hg* - This pressure range represents the **resting tone** of the uterus between contractions, not the peak pressure during a contraction. - It is too low to cause significant cervical changes or *advance labor*. *2–3 mm of Hg* - This pressure is significantly below the normal resting tone of the uterus and is not associated with any stage of active labor. - Such low pressures would indicate **uterine inactivity** or atony, not active contractions.

Q: Uterine rupture is most commonly encountered after which one of the following surgeries?

Classical cesarean. ***Classical cesarean*** - A **classical cesarean section** involves a vertical incision in the **upper uterine segment**, which contains fewer muscle fibers and heals less strongly than the lower segment. - This weaker scar is more prone to rupture in subsequent pregnancies or during labor, leading to a significantly higher risk compared to other uterine surgeries. *Hysterotomy* - **Hysterotomy** is a surgical incision into the uterus, often performed for fetal surgery, but **uterine rupture** risk is heavily dependent on the type and location of the incision. - While it creates a uterine scar, the risk of rupture varies with the depth and extent of the incision, and it is generally associated with a lower rupture risk than a single, full-thickness classical incision. *Metroplasty* - **Metroplasty** is a reconstructive surgery of the uterus, typically performed to correct uterine anomalies like a **septate uterus**, improving reproductive outcomes. - While it involves cutting and suturing uterine tissue, the goal is to create a more functional and robust uterus, and if performed meticulously, the risk of subsequent rupture is relatively low. *Myomectomy* - **Myomectomy** involves the surgical removal of **fibroids** (leiomyomas) from the uterus while preserving the uterus. - The risk of **uterine rupture** after myomectomy is proportional to the number, size, and depth of the fibroids removed, especially if the uterine cavity is entered; deep intramural fibroids pose a higher risk, but generally less than a classical cesarean.

Q: What is the maternal risk of using misoprostol for ripening of cervix during induction of labour?

Tachysystole/hyperstimulation of uterus. ***Tachysystole/hyperstimulation of uterus*** - Misoprostol, a **prostaglandin E1 analog**, increases uterine contractility to ripen the cervix and induce labor. - This heightened uterine activity can lead to **tachysystole** (more than 5 contractions in 10 minutes) or **uterine hyperstimulation**, posing risks to both mother and fetus. *Bradycardia* - **Maternal bradycardia** is not a direct or common maternal side effect of misoprostol; however, **fetal bradycardia** can occur secondary to uterine hyperstimulation and reduced placental perfusion. - Misoprostol's primary effect is on uterine smooth muscle, not directly on maternal heart rate regulation. *Hypotension* - While some prostaglandins can have vasodilatory effects, significant **maternal hypotension** is not a typical or well-known adverse effect of misoprostol used for cervical ripening. - The doses used for cervical ripening usually do not lead to systemic circulatory collapse. *Tachycardia* - **Maternal tachycardia** is not a primary or direct side effect of misoprostol; however, it could indirectly occur due to **maternal stress** or other complications. - The drug's mechanism of action primarily involves uterine contractility and cervical changes, not direct cardiac stimulation.

Q: "Variable decelerations" on an electronic fetal heart rate monitor imply

Umbilical cord compression. ***Umbilical cord compression*** - **Variable decelerations** are characterized by an **abrupt decrease** in fetal heart rate, which varies in timing, depth, and duration relative to uterine contractions. - This pattern is most commonly caused by **umbilical cord compression**, which temporarily reduces blood flow to the fetus, leading to immediate baroreceptor-mediated bradycardia. *Fetal head compression* - **Early decelerations** are typically associated with **fetal head compression** during contractions. - These are characterized by a gradual decrease in fetal heart rate that mirrors the contraction, with the nadir coinciding with the peak of the contraction. *Utero-placental insufficiency* - **Late decelerations** are associated with **utero-placental insufficiency**, indicating inadequate oxygen delivery to the fetus. - These are characterized by a gradual decrease in fetal heart rate that begins after the peak of the contraction and recovers after the contraction has ended. *Fetal anemia* - **Fetal anemia** can lead to a variety of fetal heart rate abnormalities, including **sinusoidal patterns** or **tachycardia**, as the fetus attempts to compensate for reduced oxygen-carrying capacity. - It does not typically present as isolated variable decelerations.

Q: The maximum chances of HIV infection being transmitted to the fetus/infant in an HIV infected mother are during

During labour. ***During labour*** - The **highest risk** of mother-to-child HIV transmission occurs during labor and delivery due to the infant's exposure to maternal blood and genital secretions. - The process of passing through the **birth canal** can lead to inoculation with HIV-infected cells and viral particles. *Third trimester* - While some transmission can occur in the third trimester, the risk is significantly **lower** than during labor. - The placenta generally provides a barrier, though there's a risk of **transplacental passage** if the placental integrity is compromised. *First trimester* - The **lowest risk** of HIV transmission occurs during the first trimester. - The developing fetus is relatively protected by the placenta, and the viral load in maternal blood might be lower compared to later stages without intervention. *During breast feeding* - **Breastfeeding** is a known route of HIV transmission, but its risk is generally **lower per exposure** compared to labor and delivery, especially if the mother is on antiretroviral therapy. - The risk is **cumulative** over the duration of breastfeeding.

Q: Among the causes of maternal mortality, which of the following is correct in descending order of maternal deaths in India ?

Haemorrhage, sepsis, abortion, obstructed labour. ***Haemorrhage, sepsis, abortion, obstructed labour*** - This order reflects the **leading causes of maternal mortality in India** as per data available during 2010-2013 period. - **Haemorrhage** (38%) is the primary cause due to postpartum hemorrhage, antepartum bleeding, and complications during delivery. - **Sepsis** (11%) includes puerperal sepsis and infections following unsafe deliveries. - **Abortion** (8%) complications, particularly from unsafe procedures, remain a significant contributor. - **Obstructed labour** causes have decreased with improved access to cesarean sections and skilled birth attendance. *Obstructed labour, haemorrhage, abortion, sepsis* - This order is incorrect as **haemorrhage** consistently ranks as the leading cause of maternal deaths in India, not obstructed labour. - Obstructed labour has significantly declined due to better access to emergency obstetric care. *Haemorrhage, obstructed labour, abortion, sepsis* - This order is incorrect because **sepsis** accounts for a higher percentage of maternal deaths than obstructed labour. - While haemorrhage is correctly placed first, sepsis should come before obstructed labour in the ranking. *Sepsis, obstructed labour, abortion, haemorrhage* - This order is completely incorrect as **haemorrhage** is overwhelmingly the leading cause of maternal mortality in India. - Placing haemorrhage last contradicts all epidemiological data on maternal deaths in India.

Q: What is the commonest cause of Vulvo-Vaginal Fistula in developing countries ?

Obstructed labour. ***Obstructed labour*** - **Prolonged obstructed labor** causes **ischemic necrosis** of the tissues between the vagina and the bladder or rectum due to continuous pressure from the fetal head, leading to a fistula. - This is the **most common cause** of vulvo-vaginal fistulas in developing countries, often due to limited access to emergency obstetric care like C-sections. *Carcinoma of bladder* - While bladder carcinoma can cause fistulas, they are more typically **vesicovaginal fistulas** and are less common than those resulting from obstructed labor in developing countries. - Fistulas due to malignancy often involve **tissue destruction** and may be associated with prior radiation therapy. *Injury during hysterectomy* - Iatrogenic injury during a **hysterectomy** can lead to a fistula, but this is more common in developed healthcare settings with higher rates of surgical interventions. - This cause is less prevalent globally compared to the widespread issue of obstructed labor in resource-limited regions. *Radiotherapy for treatment of carcinoma cervix* - **Radiotherapy** for cervical carcinoma can cause **radiation-induced necrosis** and lead to fistulas, particularly **rectovaginal** or **vesicovaginal** types. - While a significant cause in cancer patients, it is not the commonest overall cause in developing countries compared to the sheer volume of cases resulting from obstructed labor.

Question 1

Regarding the phenomenon of ‘lightening’ in primigravida at term pregnancy, which one of the following statements is correct?

Accepted Answer

It is a welcome sign since it indicates descent fetal head into pelvis.

Answer

It occurs earlier in primigravida compared to multigravida.

Answer

There are no bladder or bowel symptoms associated with this phenomenon.

Answer

It is associated with worsening cardiorespiratory embarrassment in mother.

Question 2

In which of the following situations might delayed cord clamping be contraindicated?

Accepted Answer

Need for immediate neonatal resuscitation where delayed clamping interferes

Answer

Placental abruption with maternal compromise

Answer

Severe maternal hemorrhage requiring immediate resuscitation

Answer

Cord prolapse requiring immediate delivery

Question 3

Indications and prerequisites for delivery with the ventouse include which of the following?

1. Delay in the second stage of labour
2. Non-reassuring fetal heart rate
3. Gestation age less than 34 weeks of pregnancy
4. Vertex presentation.

Accepted Answer

1, 2 and 4

Answer

2, 3 and 4

Answer

1, 2 and 3

Answer

1, 3 and 4

Question 4

During the first stage of labour, the intrauterine pressure is increased up to

Accepted Answer

40–50 mm of Hg

Answer

100–120 mm of Hg

Answer

8–10 mm of Hg

Answer

2–3 mm of Hg

Question 5

Uterine rupture is most commonly encountered after which one of the following surgeries?

Accepted Answer

Classical cesarean

Answer

Hysterotomy

Answer

Metroplasty

Answer

Myomectomy

Question 6

What is the maternal risk of using misoprostol for ripening of cervix during induction of labour?

Accepted Answer

Tachysystole/hyperstimulation of uterus

Answer

Bradycardia

Answer

Hypotension

Answer

Tachycardia

Question 7

"Variable decelerations" on an electronic fetal heart rate monitor imply

Accepted Answer

Umbilical cord compression

Answer

Fetal head compression

Answer

Utero-placental insufficiency

Answer

Fetal anemia

Question 8

The maximum chances of HIV infection being transmitted to the fetus/infant in an HIV infected mother are during

Accepted Answer

During labour

Answer

Third trimester

Answer

First trimester

Answer

During breast feeding

Question 9

Among the causes of maternal mortality, which of the following is correct in descending order of maternal deaths in India ?

Accepted Answer

Haemorrhage, sepsis, abortion, obstructed labour

Answer

Obstructed labour, haemorrhage, abortion, sepsis

Answer

Haemorrhage, obstructed labour, abortion, sepsis

Answer

Sepsis, obstructed labour, abortion, haemorrhage

Question 10

What is the commonest cause of Vulvo-Vaginal Fistula in developing countries ?

Accepted Answer

Obstructed labour

Answer

Carcinoma of bladder

Answer

Injury during hysterectomy

Answer

Radiotherapy for treatment of carcinoma cervix

Labor and Delivery — MCQs

Labor and Delivery — MCQs

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