Labor and Delivery Practice Questions

Q: The engaging diameter of brow presentation is:

Mento‐vertical. ***Mento-vertical*** - In a **brow presentation**, the fetal head is incompletely extended, and the presenting part is the brow. - The **mento-vertical diameter** is the longest antero-posterior diameter of the fetal head, measuring approximately **13.5 cm**, and is the engaging diameter in a brow presentation. *Submento-bregmatic* - This diameter is measured from the junction of the neck and chin to the anterior fontanelle (bregma), reflecting the engaging diameter in a **face presentation** with full extension. - Its typical measurement is about **9.5 cm**, significantly shorter than the mento-vertical diameter. *Submento-vertical* - This diameter is not a standard engaging diameter used to describe typical fetal head presentations. - Standard obstetrical terminology focuses on submento-bregmatic for face and suboccipito-bregmatic for vertex presentations. *Suboccipito-bregmatic* - This is the engaging diameter for a **flexed vertex presentation** (occiput or crown of the head), which is the most common and favorable presentation. - It measures approximately **9.5 cm**, representing the optimal diameter for passage through the birth canal.

Q: Modified Bishop’s score includes all EXCEPT:

Position of occiput. ***Position of occiput*** - The **position of the occiput** (fetal head position) is assessed during labor but is not a component of either the original or modified Bishop's score. - The Bishop's score universally evaluates **cervical ripeness** and does not incorporate fetal station or position. *Position of os* - The **position of the cervix (os)**, whether anterior, posterior, or mid-position, is a crucial component of the Bishop's score. - A more **anterior cervix** indicates a higher likelihood of successful induction. *Consistency of cervix* - **Cervical consistency** (firm, medium, soft) is a key factor in the Bishop's score, reflecting the degree of cervical ripening. - A **softer cervix** is more favorable for induction and spontaneous labor progression. *Cervical length and dilatation* - **Cervical effacement** (length) and **dilatation** are essential parameters in the Bishop's score, indicating the readiness of the cervix for labor. - A **shorter and more dilated cervix** correlates with a higher Bishop's score and increased success of labor induction.

Q: The main cause of perinatal mortality in ‘Frank breech presentation’ is:

Intracranial haemorrhage. ***Intracranial haemorrhage*** - In **breech deliveries**, the head, being the largest and least compressible part, is born last, subjecting it to rapid compression and decompression forces. - This can lead to **tentorial tears** and **intracranial haemorrhage**, especially in frank breech presentation where the head is not well-flexed, and the uterine forces are exerted more directly and forcefully on it during the final stages of delivery. *Prolapse of umbilical cord* - While **cord prolapse** is a risk in breech presentations, it is most common in **footling breech** due to incomplete filling of the pelvis by the presenting part. - In **frank breech**, the buttocks and flexed legs tend to fill the lower uterine segment more effectively, making cord prolapse less likely than in other breech types. *Trauma to foetal viscera* - **Visceral trauma** is possible in breech deliveries but is less common as a primary cause of mortality compared to intracranial injury. - It usually results from excessive traction or manipulation during extraction, which can cause injuries to organs like the liver or spleen. *Foetal abnormalities* - Although **foetal anomalies** are an underlying cause of breech presentation in a significant number of cases (up to 15-20%), they are the predisposing factor, not the direct cause of perinatal mortality during delivery itself. - The mortality from "frank breech presentation" refers to the complications arising from the **mode of delivery** rather than the underlying reason for the presentation.

Q: A 20 year old full term primigravida is admitted with full dilatation of the cervix and breech presentation. The breech is not engaged. Foetal heart is normal. The proper procedure for the management would be:

Caesarean section. ***Caesarean section*** - For a **primigravida** with a full-term breech presentation where the foetus is **not engaged** at full dilatation and the **foetal heart is normal**, a Caesarean section is the safest option to prevent complications. - This approach minimizes risks of **foetal distress**, cord prolapse, and trauma associated with vaginal breech delivery in an unengaged presentation, especially in a first pregnancy. *Oxytocin drip augmentation* - Oxytocin is used to **augment contractions** in cases of uterine inertia or slow cervical dilation but is **contraindicated** in breech presentation that is not engaged at full dilation due to the risk of uterine rupture and foetal compromise. - Augmenting contractions in this scenario would increase the risk of an **incomplete, traumatic vaginal delivery** of a breech baby, particularly with an unengaged presentation. *To bring down the leg* - **Bringing down the leg** is a maneuver typically performed during a **planned vaginal breech delivery** to convert a complete or incomplete breech to a single footling breech to aid delivery. - This procedure is not appropriate for a primigravida with an unengaged breech at full dilatation, as it carries a high risk of **cord prolapse** and other complications without prior engagement and favourable conditions for a vaginal delivery. *Breech extraction* - **Breech extraction** is a procedure used in specific circumstances, such as delivery of a second twin or in cases where there is an umbilical cord prolapse and immediate delivery is required. - It is generally **not recommended for a primigravida** with an unengaged breech at full dilatation primarily due to the high risk of **foetal trauma** and maternal complications associated with such an intervention without prior engagement.

Q: During labour, which one of the foetal heart patterns is ominous?

Late deceleration. ***Late deceleration*** - **Late decelerations** are an ominous sign as they indicate **uteroplacental insufficiency** and **fetal hypoxia**. - They are characterized by a gradual decrease in fetal heart rate that begins after the peak of the uterine contraction and returns to baseline after the contraction has ended. *Variable deceleration* - **Variable decelerations** are characterized by an **abrupt decrease** in fetal heart rate, 15 bpm below baseline and lasting at least 15 seconds. - They are usually associated with **umbilical cord compression** and are not necessarily ominous unless they are prolonged or severe. *Early deceleration* - **Early decelerations** are generally benign and are caused by **head compression** during uterine contractions. - They mirror the contractions, starting and ending with the contraction, and are typically not associated with fetal hypoxia. *Tachycardia* - **Fetal tachycardia** (baseline heart rate >160 bpm) can be caused by various factors, including **maternal fever**, infection, or fetal compromise. - While it can be a sign of distress, it is not as acutely ominous as late decelerations, which directly reflect hypoxemia.

Q: The progress of labour can be monitored by observing the following except:

The formation of caput by vaginal examination. ***The formation of caput by vaginal examination*** - The formation of a **caput succedaneum** (swelling on the fetal scalp) indicates **prolonged pressure** on the fetal head, which can be a sign of **cephalopelvic disproportion** or prolonged labor, rather than a direct measure of labor progression. - While its presence is noted during labor, caput formation itself does not actively monitor the *progress* of cervical dilatation or fetal descent in a positive way; rather, it often signals a potential **complication** or **stalling** of labor. *Gradual increase in cervical dilatation by vaginal examination* - **Cervical dilatation** is a primary indicator of the **first stage of labor progression**, as the cervix opens to allow passage of the fetus. - Regular **vaginal examinations** determine the rate and extent of cervical opening, crucial for deciding management. *The descent of foetal head by abdominal examination* - **Fetal head descent**, assessed by **abdominal palpation** (e.g., using the "fifths palpable" method), indicates the baby's movement through the birth canal. - This is a key measure of **progress in the second stage of labor** and helps identify potential obstructed labor. *The intensity of uterine contractions by abdominal examination* - The **intensity, frequency, and duration of uterine contractions** directly correlate with the forces driving labor progression. - While palpation provides a good estimate, this helps monitor the **effectiveness of uterine activity** in causing cervical changes and fetal descent.

Q: The most common sign of rupture of previous LSCS scar during labour is:

Non-reassuring fetal heart rate pattern. ***Non-reassuring fetal heart rate pattern*** - A **sudden, sustained deceleration** or **bradycardia** in the fetal heart rate is the **most common and earliest sign** of uterine rupture, occurring in **55-87%** of cases. - This occurs due to compromised uteroplacental blood flow and **acute fetal hypoxia** as the uterus tears. - **Continuous electronic fetal monitoring** during TOLAC (Trial of Labor After Cesarean) is critical for early detection. - Changes may include **prolonged decelerations**, **bradycardia (<110 bpm)**, or sudden loss of variability. *Cessation of uterine contractions* - While a sudden **cessation of contractions** can occur with uterine rupture, it is **not consistently the most common** initial sign. - It often follows other changes, particularly fetal heart rate abnormalities, as the uterus loses its contractile ability. - Detected more reliably with intrauterine pressure catheter monitoring. *Tenderness in lower abdomen* - **Abdominal pain** and tenderness can be present, especially localized to the lower uterine segment scar area. - However, it is often **subjective and masked by normal labor pain**, making it an unreliable early indicator. - Not as specific or consistently observable as fetal heart rate changes. *Haemorrhagic shock* - **Haemorrhagic shock** with hypotension and tachycardia is a **serious late complication** indicating significant intraperitoneal or vaginal bleeding. - It usually manifests **after fetal distress** has already appeared and represents advanced rupture. - Requires immediate surgical intervention but is not an early warning sign.

Q: A woman with post-term pregnancy with unripe cervix should not be induced with misoprostol if she has:

Decompensated heart disease. ***Decompensated heart disease*** - Misoprostol can cause rapid and significant uterine contractions, leading to a **sudden increase in circulating blood volume** due to displacement from the uterus. - In patients with **decompensated heart disease**, this acute volume shift can precipitate **pulmonary edema** or **cardiac decompensation**, making it a contraindication. *Asthma* - While some prostaglandins can be bronchoconstrictive, **misoprostol (a synthetic prostaglandin E1 analog)** is generally considered safe for use in patients with asthma. - **Uterotonics like carboprost (PGF2a)** are contraindicated in asthma due to their bronchoconstrictive effects, but misoprostol does not share this contraindication. *Diabetes* - **Diabetes mellitus** is not a contraindication for the use of misoprostol for cervical ripening or induction. - Glucose control and fetal surveillance remain important, but misoprostol itself does not typically pose specific risks unique to diabetic patients. *Hepatitis B antigen positive* - **Hepatitis B positivity** in the mother does not contraindicate the use of misoprostol for labor induction. - The primary concern in this scenario is managing the risk of **vertical transmission** to the neonate, which is addressed through immunoprophylaxis, not by altering induction methods.

Question 1

The engaging diameter of brow presentation is:

Accepted Answer

Mento‐vertical

Answer

Submento‐bregmatic

Answer

Submento‐vertical

Answer

Suboccipito‐bregmatic

Question 2

Modified Bishop’s score includes all EXCEPT:

Accepted Answer

Position of occiput

Answer

Position of os

Answer

Consistency of cervix

Answer

Cervical length and dilatation

Question 3

The main cause of perinatal mortality in ‘Frank breech presentation’ is:

Accepted Answer

Intracranial haemorrhage

Answer

Prolapse of umbilical cord

Answer

Trauma to foetal viscera

Answer

Foetal abnormalities

Question 4

A 20 year old full term primigravida is admitted with full dilatation of the cervix and breech presentation. The breech is not engaged. Foetal heart is normal. The proper procedure for the management would be:

Accepted Answer

Caesarean section

Answer

Oxytocin drip augmentation

Answer

To bring down the leg

Answer

Breech extraction

Question 5

A case of ante-partum haemorrhage is seen at a Primary Health Centre. The treatment will consist of:

Accepted Answer

Assessment of general condition of the patient, intravenous drip and reference to a hospital

Answer

Packing the vagina to stop the bleeding and then reference to a hospital

Answer

Internal podalic version and delivery

Answer

Vaginal examination and reference to a hospital only if diagnosed as placenta praevia

Question 6

During labour, which one of the foetal heart patterns is ominous?

Accepted Answer

Late deceleration

Answer

Variable deceleration

Answer

Early deceleration

Answer

Tachycardia

Question 7

The progress of labour can be monitored by observing the following except:

Accepted Answer

The formation of caput by vaginal examination

Answer

Gradual increase in cervical dilatation by vaginal examination

Answer

The descent of foetal head by abdominal examination

Answer

The intensity of uterine contractions by abdominal examination

Question 8

The most common sign of rupture of previous LSCS scar during labour is:

Accepted Answer

Non-reassuring fetal heart rate pattern

Answer

Cessation of uterine contractions

Answer

Tenderness in lower abdomen

Answer

Haemorrhagic shock

Question 9

Regimen for medical abortion upto 7 weeks of gestation as per Government of India guidelines includes:

Accepted Answer

200 mg of mifepristone on D1 followed by 800 µg of misoprostol on D3

Answer

400 mg of mifepristone on D1 followed by 400 µg of misoprostol on D3

Answer

400 mg of mifepristone on D1 followed by 800 µg of misoprostol on D3

Answer

200 mg of mifepristone on D1 followed by 400 µg of misoprostol on D3

Question 10

A woman with post-term pregnancy with unripe cervix should not be induced with misoprostol if she has:

Accepted Answer

Decompensated heart disease

Answer

Asthma

Answer

Diabetes

Answer

Hepatitis B antigen positive

Labor and Delivery — MCQs

Labor and Delivery — MCQs

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