Labor and Delivery — MCQs

Labor and Delivery Indian Medical PG Practice Questions and MCQs

Question 941: McRoberts manoeuvre is used during labour for management of:

A. Delivery of after coming head of breech
B. Shoulder dystocia (Correct Answer)
C. Normal labour to assist extension of head
D. Extended arms of breech during assisted breech delivery

Explanation: ***Shoulder dystocia*** - **McRoberts manoeuvre** involves sharp flexion of the maternal thighs against the abdomen, which straightens the **sacrum** and rotates the **symphysis pubis** anteriorly. - This maneuver increases the functional size of the pelvic outlet and helps to dislodge the impacted fetal shoulder in cases of **shoulder dystocia**. - It is the **first-line intervention** for managing shoulder dystocia and is successful in resolving the majority of cases. *Delivery of after coming head of breech* - Management of an after-coming head in breech delivery typically involves maneuvers like the **Mauriceau-Smellie-Veit** maneuver or **Prague maneuver**. - **McRoberts manoeuvre** does not directly facilitate the delivery of the fetal head in a breech presentation. *Normal labour to assist extension of head* - In normal labor, the fetal head typically delivers by **extension** as it passes under the symphysis pubis, and no specific maneuver is usually required. - McRoberts manoeuvre is a specific intervention for a complication (**shoulder dystocia**), not a routine aid for head extension during normal delivery. *Extended arms of breech during assisted breech delivery* - Extended arms in a breech presentation are managed by maneuvers designed to free the arms, such as **Løvset's maneuver**. - **McRoberts manoeuvre** primarily addresses shoulder impaction, not arm entrapment in breech delivery.

Question 942: Early deceleration of foetal heart rate in labour is due to:

A. Hyperpyrexia
B. Umbilical cord compression
C. Congenital heart block
D. Foetal head compression (Correct Answer)

Explanation: ***Foetal head compression*** - **Early decelerations** are a direct result of **foetal head compression** during uterine contractions, leading to increased intracranial pressure. - This pressure causes a **reflex vagal response**, resulting in **slowing of the foetal heart rate** which mirrors the contraction pattern. *Hyperpyrexia* - **Maternal hyperpyrexia** typically causes **foetal tachycardia**, which is an elevated heart rate, not deceleration. - This is a response to the increased maternal and foetal metabolic rate and can be a sign of infection. *Umbilical cord compression* - **Umbilical cord compression** usually leads to **variable decelerations**, which are sharp, abrupt drops in heart rate not uniformly related to contractions. - This occurs due to transient occlusion of the umbilical vessels, reducing blood flow to the foetus. *Congenital heart block* - **Congenital heart block** is a persistent bradycardia (slow heart rate) that is present throughout labour and is not directly linked to uterine contractions. - It is a structural abnormality of the foetal cardiac conduction system.

Question 943: Deep transverse arrest of head in labour occurs in:

A. Anthropoid pelvis
B. Platypelloid pelvis
C. Gynaecoid pelvis
D. Android pelvis (Correct Answer)

Explanation: ***Android pelvis*** - An **android pelvis** has a heart-shaped inlet with a narrow forepelvis, causing the fetal head to engage in a transverse or occiput posterior position. - The narrow midpelvis and convergent side walls in an android pelvis can lead to deep **transverse arrest**, as the fetal head cannot easily rotate to the anterior position. *Anthropoid pelvis* - The **anthropoid pelvis** is characterized by a long anteroposterior diameter and a relatively narrow transverse diameter. - This pelvic shape typically favors engagement in the **occiput anterior** or **occiput posterior** positions, making deep transverse arrest less common. *Platypelloid pelvis* - A **platypelloid pelvis** has a wide transverse diameter and a very short anteroposterior diameter, leading to a flattened shape. - This shape often results in the fetal head engaging in the **transverse position**, but arrest usually occurs at the inlet rather than deep in the pelvis, or the head fails to engage at all. *Gynaecoid pelvis* - The **gynaecoid pelvis** is considered the ideal female pelvis, with a rounded inlet and adequate diameters in all planes. - This shape allows for easy engagement and rotation of the fetal head, making deep **transverse arrest** very unlikely.

Question 944: Contraindications to Uterine Cerclage for Incompetent os are all EXCEPT:

A. Previous history suggestive of abortion due to incompetent os (Correct Answer)
B. Bulging membrane
C. History of vaginal bleeding
D. Ruptured membrane

Explanation: ***Previous history suggestive of abortion due to incompetent os*** - A **history of recurrent second-trimester abortions or deliveries** attributed to **cervical insufficiency** is an **indication** for a cerclage, not a contraindication. - Cerclage aims to reinforce a weakened cervix, preventing premature dilation and expulsion of the fetus in future pregnancies. *Bulging membrane* - A **bulging membrane** (prolapse of the amniotic sac into the vagina) indicates significant cervical dilation and puts the membranes at high risk of **rupture during the cerclage procedure**. - Performing a cerclage in this situation can precipitate **preterm labor, infection**, or membrane rupture. *History of vaginal bleeding* - **Vaginal bleeding** suggests potential complications such as **placental abruption** or ongoing **preterm labor**, making cerclage contraindicated. - A cerclage should not be performed if there is an active process threatening the pregnancy, as it would not resolve the underlying issue and could worsen outcomes. *Ruptured membrane* - **Ruptured membranes** mean the amniotic sac has broken, and the primary concern becomes infection and delivery, not cervical reinforcement. - Performing a cerclage with ruptured membranes is contraindicated due to the high risk of **chorioamnionitis** and would not salvage the pregnancy.

Question 945: Consider the following regarding the use of Magnesium Sulphate: 1. Used as tocolytic 2. As neuroprotective agent 3. Used in management of postpartum eclampsia Which of the statements given above are correct?

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

Explanation: ***1, 2 and 3*** - **Magnesium sulfate** is a well-established **tocolytic agent**, used to delay preterm labor by relaxing the uterine smooth muscle. - It is also utilized for its **neuroprotective effects** in preterm infants, reducing the risk of cerebral palsy and other neurological sequelae when administered to mothers at risk of preterm birth. - Furthermore, magnesium sulfate is the **drug of choice** for the prevention and management of **eclampsia and pre-eclampsia**, which can occur both during pregnancy and in the postpartum period. *1 and 3 only* - This option correctly identifies the use of **magnesium sulfate** as a **tocolytic** and for **postpartum eclampsia**, but incorrectly omits its significant role as a **neuroprotective agent**. - The neuroprotective effect, particularly in reducing the risk of cerebral palsy in preterm infants, is a crucial indication for magnesium sulfate use. *2 and 3 only* - This option correctly recognizes **magnesium sulfate's** application as a **neuroprotective agent** and in **postpartum eclampsia**, but overlooks its primary role as a **tocolytic** for preterm labor. - Its ability to relax uterine contractions makes it a vital medication in managing threatened preterm delivery. *1 and 2 only* - This option accurately states the use of **magnesium sulfate** as a **tocolytic** and a **neuroprotective agent**, but fails to include its critical role in the management of **postpartum eclampsia**. - Eclampsia, defined by seizures in a pre-eclamptic patient, is effectively prevented and treated with magnesium sulfate.

Question 946: Labour is called normal if it fulfills the following criteria EXCEPT:

A. Spontaneous onset at term
B. Vertex presentation
C. Vaginal delivery with episiotomy
D. Vaginal breech delivery (Correct Answer)

Explanation: ***Vaginal breech delivery*** - A **breech presentation** (where the baby's buttocks or feet are descended first) is **definitively NOT considered normal labor**. - Normal labor requires **cephalic (vertex) presentation** as a fundamental criterion. - While vaginal breech delivery may be attempted in select cases, it carries **significantly higher risks** and is classified as **abnormal presentation**, making this the correct answer to the EXCEPT question. *Spontaneous onset at term* - **Spontaneous onset** (not induced) occurring **at term** (37-42 weeks of gestation) is a **core characteristic of normal labor**. - This ensures physiologic readiness and fetal maturity. *Vertex presentation* - **Vertex (cephalic) presentation** with the occiput as the presenting part is the **defining requirement** for normal labor. - This is the optimal presentation allowing the smallest diameter to navigate the birth canal. *Vaginal delivery with episiotomy* - Traditionally, vaginal delivery with episiotomy has been included in definitions of normal labor, though episiotomy itself is a surgical intervention. - **Note**: Modern obstetric guidelines (WHO, NICE) emphasize that **routine episiotomy should be avoided** and normal birth should be spontaneous without operative interventions. However, for examination purposes and based on traditional definitions used in this PYQ, vaginal delivery (even with episiotomy) is distinguished from operative delivery (forceps/vacuum) or cesarean section. - The key distinction: **breech presentation** itself (regardless of delivery mode) makes labor abnormal, whereas episiotomy is a **procedural intervention** during an otherwise potentially normal labor.

Question 947: Consider the following statements regarding diameters of a normal female pelvis: 1. AP diameter is the shortest diameter at brim 2. Oblique diameter is the largest diameter of inlet 3. Diagonal conjugate cannot be directly measured Which of the statements given above is/are correct?

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

Explanation: ***1 only*** - The **anteroposterior (AP) diameter** (true conjugate/obstetric conjugate) is indeed the **shortest diameter at the brim** of the normal female pelvis, measuring approximately **11 cm**. - At the pelvic inlet, the **transverse diameter is the longest (13 cm)**, followed by the **oblique diameter (12 cm)**, and the **AP diameter is the shortest (11 cm)**. - This is the correct answer as only Statement 1 is accurate. *1 and 2 only* - While Statement 1 is correct, Statement 2 is **incorrect**. - The **oblique diameter (12 cm)** is NOT the largest diameter of the inlet. The **transverse diameter (13-13.5 cm)** is the largest diameter at the pelvic inlet. - This is a common misconception that must be clarified. *2 only* - Statement 2 is **incorrect**. The **transverse diameter**, not the oblique diameter, is the largest diameter of the pelvic inlet. - In a normal gynecoid pelvis: Transverse (13 cm) > Oblique (12 cm) > AP diameter (11 cm). *1, 2 and 3* - Statement 1 is correct, but Statements 2 and 3 are **incorrect**. - Statement 2: The oblique diameter is not the largest; the **transverse diameter** is. - Statement 3: The **diagonal conjugate CAN be measured clinically** during vaginal examination (from lower border of symphysis pubis to sacral promontory) and typically measures 12.5 cm.

Question 948: Given below are the Obstetric maneuvers and their indications. Which one of the following is correctly matched?

A. McRobert's maneuver – After coming head of breech
B. Lovset's maneuver – Delivery of foot in breech
C. Pinard's maneuver – Delivery of extended arm
D. Ritgen's maneuver – Controlled delivery of fetal head (Correct Answer)

Explanation: ***Ritgen's maneuver*** - This maneuver is used for the **controlled delivery of the fetal head** to prevent rapid expulsion, which can lead to maternal perineal trauma. - It involves applying pressure to the fetal chin through the perineum while simultaneously applying pressure to the occiput to facilitate slow and controlled extension of the head. *McRobert's maneuver* - McRobert's maneuver is used to manage **shoulder dystocia**, not after the delivery of the head in a breech presentation. - It involves hyperflexing the mother's hips towards her abdomen to rotate the symphysis pubis and increase the pelvic outlet dimension. *Lovset's maneuver* - Lovset's maneuver is used to deliver the **arms in a breech presentation**, not the foot. - It involves rotating the fetal trunk to bring the anterior shoulder under the maternal symphysis pubis, allowing the delivery of the posterior arm. *Pinard's maneuver* - Pinard's maneuver is used for the delivery of the **extended legs in a breech presentation**, not an extended arm. - It involves pressure in the popliteal fossa to flex the knee, allowing the foot to be grasped and delivered.

Question 949: Consider the following cardinal movements of mechanism of normal labor: 1. Engagement 2. Internal rotation 3. Flexion 4. Restitution 5. Crowning 6. External rotation What is the correct sequence of movements in labor in occipito-lateral position?

A. 1, 3, 2, 5, 4 and 6 (Correct Answer)
B. 3, 1, 2, 4, 6 and 5
C. 1, 2, 3, 4, 5 and 6
D. 2, 1, 3, 4, 5 and 6

Explanation: ***1, 3, 2, 5, 4 and 6*** - This sequence accurately represents the order of events during normal vaginal delivery **in occipito-lateral position**, starting with **engagement** and progressing through the cardinal movements. - The sequence follows: **Engagement (1)** → **Flexion (3)** → **Internal rotation (2)** from occipito-lateral to occipito-anterior → **Crowning (5)** during extension phase → **Restitution (4)** → **External rotation (6)**. - While **crowning** is not technically a cardinal movement, it occurs during the **extension** phase and marks the emergence of the fetal head at the introitus. - In **occipito-lateral position**, internal rotation is essential for converting the position to occipito-anterior for delivery. *3, 1, 2, 4, 6 and 5* - This sequence incorrectly places **flexion before engagement**, which is physiologically impossible as the fetal head must first engage in the pelvic inlet before significant flexion occurs. - **Crowning** is placed after external rotation, but crowning occurs during the extension phase, well before restitution and external rotation. *1, 2, 3, 4, 5 and 6* - This sequence incorrectly places **internal rotation before flexion**, whereas flexion typically occurs first to reduce the presenting diameter and facilitate internal rotation. - The sequence also places **crowning after restitution**, which contradicts the normal progression where crowning occurs during extension, before restitution. *2, 1, 3, 4, 5 and 6* - This sequence incorrectly begins with **internal rotation before engagement**, which is physiologically impossible as the fetal head must be engaged in the pelvis before it can rotate. - **Engagement** must always be the first cardinal movement.

Question 950: Which one of the following is NOT a sign of separation of placenta?

A. Apparent lengthening of the cord with slight gush of vaginal bleeding
B. Uterus becomes globular, firm and ballotable
C. Slight bulging in the suprapubic region
D. The fundal height reduces further (Correct Answer)

Explanation: ***The fundal height reduces further*** - A **reduction in fundal height** is not a sign of placental separation; rather, the fundus often rises slightly as the separated placenta descends into the lower uterine segment. - After separation, the uterus typically becomes **globular** and the fundus may rise to a level above the umbilicus. *Apparent lengthening of the cord with slight gush of vaginal bleeding* - **Lengthening of the umbilical cord** outside the vagina is a classic sign of placental separation, indicating the placenta has descended. - A **gush of blood** often occurs as the placenta detaches from the uterine wall, releasing pooled blood from the retroplacental space. *Uterus becomes globular, firm and ballotable* - After separation, the uterus contracts strongly, becoming more **globular** and **firm** as it expels the placenta. - The uterus may feel **ballotable** if the placenta is still within the uterine cavity but detached. *Slight bulging in the suprapubic region* - A **slight bulging in the suprapubic region** (above the symphysis pubis) indicates that the separated placenta has descended into the lower uterine segment or vagina, creating a palpable mass. - This sign is often referred to as a "boggy" or "fullness" sensation in the lower abdomen due to the descended placenta.

Practice by Chapter

Physiology of Labor

Practice Questions

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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