Preterm Labor and Delivery — MCQs
A primigravida presents to the labor room at 40 weeks of gestation with lower abdominal pain. She has been in labor for 3 hours. Which of the following will determine if she is in active labor?
Which method is most appropriate for cervical ripening in a term pregnancy with oligohydramnios and reactive NST?
Which of the following drugs used for management of preterm labor also has neuroprotective role in fetus:
What is the preferred management for patent ductus arteriosus (PDA) in a preterm infant?
Female with 41 wk gestation confirmed by radiological investigation, very sure of her LMP, no uterine contractions, no effacement and no dilatation. What should be done to induce labor?
Which of the following is not associated with maternal age?
Which of the following genital infections is associated with preterm labour?
What procedure is being demonstrated in the image?
Which of the following is not typically given to a patient with preterm labor?
Abortions in the second trimester mainly occur due to
Preterm Labor and Delivery Indian Medical PG Practice Questions and MCQs
Question 1: A primigravida presents to the labor room at 40 weeks of gestation with lower abdominal pain. She has been in labor for 3 hours. Which of the following will determine if she is in active labor?
- A. Fetal head 5/5 palpable on abdominal examination
- B. Two contractions lasting for 10 seconds in 10 minutes
- C. Rupture of membranes
- D. Cervical dilatation of 6 cm or more with regular contractions (Correct Answer)
Explanation: ***Cervical dilatation of 6 cm or more with regular contractions*** - Active labor is officially defined by **cervical dilatation of 6 cm or more** according to the ACOG and SMFM 2014 consensus guidelines, which redefined the labor curve based on the Consortium on Safe Labor study. - This represents a shift from the traditional Friedman curve definition of 4 cm, recognizing that **significant progressive cervical change** with regular uterine contractions is the hallmark of active labor. - Complete effacement typically occurs during the latent phase, and while regular contractions accompany active labor, **cervical dilatation ≥6 cm is the primary diagnostic criterion**. *Fetal head 5/5 palpable on abdominal examination* - This finding indicates a **high fetal head** that is not engaged (0/5 of the head has entered the pelvis), which does not determine whether active labor has begun. - **Fetal station and engagement** are important for assessing labor progression and potential for cephalopelvic disproportion, but are not the primary criteria for diagnosing active labor. *Two contractions lasting for 10 seconds in 10 minutes* - These contractions are **infrequent and very short**, more characteristic of latent labor or Braxton Hicks contractions. - Active labor typically involves **3-5 contractions in 10 minutes, each lasting 45-60 seconds**, with sufficient intensity to cause progressive cervical change. *Rupture of membranes* - **Rupture of membranes (ROM)**, whether spontaneous or artificial, is an important event but does not by itself indicate active labor. - A woman can have ROM in the **latent phase** or even before labor begins (prelabor ROM or PROM), and **cervical dilatation remains the primary determinant** of active labor.
Question 2: Which method is most appropriate for cervical ripening in a term pregnancy with oligohydramnios and reactive NST?
- A. Dinoprostone gel 0.5mg
- B. Foley catheter (Correct Answer)
- C. Misoprostol 25mcg vaginal
- D. Oxytocin infusion
Explanation: **Foley catheter** - **Mechanical methods** like the Foley catheter are preferred for cervical ripening in the presence of **oligohydramnios** because they do not carry the risk of inducing uterine hyperstimulation, which can further compromise fetal well-being. - The reactive non-stress test (NST) indicates the fetus is currently healthy, but oligohydramnios suggests a need to minimize any potential stress, making mechanical ripening a safer choice. *Dinoprostone gel 0.5mg* - **Prostaglandins** like dinoprostone can increase the risk of **uterine hyperstimulation**, which could be particularly dangerous for a fetus with oligohydramnios as it restricts blood flow and oxygen. - While effective for ripening, the risk profile is higher compared to mechanical methods when fetal compromise (like oligohydramnios) is present. *Misoprostol 25mcg vaginal* - **Misoprostol** is a potent prostaglandin analog that carries a significant risk of **uterine tachysystole** and hyperstimulation. - In cases with **oligohydramnios**, any drug-induced increase in uterine activity could further strain fetal oxygenation and well-being. *Oxytocin infusion* - **Oxytocin** is primarily used for **induction of labor** (to stimulate contractions) and not for cervical ripening directly. - Initiating oxytocin without a ripened cervix is less effective and carries a higher risk of failed induction and potentially C-section, and it does not address the need for cervical changes first.
Question 3: Which of the following drugs used for management of preterm labor also has neuroprotective role in fetus:
- A. Ritodrine
- B. MgSO4 (Correct Answer)
- C. Nifedipine
- D. Isoxsuprine
Explanation: ***MgSO4*** - **Magnesium sulfate (MgSO4)** is a commonly used tocolytic for preterm labor that also offers significant **neuroprotective benefits** for the fetus. - It reduces the risk and severity of **cerebral palsy** and other neurological morbidities in preterm infants. *Ritodrine* - **Ritodrine** is a **beta-2 adrenergic agonist** that relaxes uterine smooth muscle, thereby inhibiting contractions. - It has no known neuroprotective effects on the fetus; its primary role is solely to **delay preterm labor**. *Nifedipine* - **Nifedipine** is a **calcium channel blocker** that inhibits the entry of calcium into uterine smooth muscle cells, reducing contractions. - While effective as a tocolytic, it does not confer specific neuroprotective benefits to the fetus. *Isoxsuprine* - **Isoxsuprine** is a **beta-adrenergic agonist** that, similar to ritodrine, acts by relaxing uterine musculature. - It is used for tocolysis but lacks any documented neuroprotective properties for the developing fetus.
Question 4: What is the preferred management for patent ductus arteriosus (PDA) in a preterm infant?
- A. Surgical ligation
- B. Diuretics
- C. IV Indomethacin (Correct Answer)
- D. Oxygen therapy
Explanation: ***IV Indomethacin*** - **Indomethacin** is a **prostaglandin synthesis inhibitor** that promotes the constriction and closure of the patent ductus arteriosus. - It is preferred due to its effectiveness in closing PDA non-invasively in preterm infants. *Surgical ligation* - This is an **invasive procedure** reserved for cases where medical management with indomethacin fails or is contraindicated. - While effective, it carries surgical risks such as **infection** and potential **vocal cord paralysis**. *Diuretics* - **Diuretics** are used to manage **pulmonary edema** or **heart failure symptoms** associated with a large PDA by reducing fluid overload. - They do not directly cause the closure of the patent ductus arteriosus itself. *Oxygen therapy* - **Oxygen therapy** is crucial for managing respiratory distress and maintaining adequate oxygen saturation in preterm infants. - However, oxygen can sometimes *inhibit* ductal closure in preterm infants by reducing pulmonary vascular resistance, and therefore, it is not the primary intervention for PDA closure.
Question 5: Female with 41 wk gestation confirmed by radiological investigation, very sure of her LMP, no uterine contractions, no effacement and no dilatation. What should be done to induce labor?
- A. PGE1 tab (Correct Answer)
- B. PGE2 gel
- C. PGF2alpha
- D. Intracervical foley’s
Explanation: ***PGE1 tab*** - **Misoprostol (PGE1)** is an effective agent for **cervical ripening** and labor induction in cases of an unfavorable cervix (no effacement, no dilatation). - It is cost-effective, stable at room temperature, and widely used in resource-limited settings. - Can be administered orally or vaginally with good efficacy for cervical ripening at term. - In this post-term pregnancy with unfavorable cervix, pharmacological ripening is appropriate. *PGE2 gel* - **PGE2 (dinoprostone)** gel or cervical insert is also an effective option for cervical ripening. - Both PGE1 and PGE2 are acceptable first-line agents; the choice may depend on availability, cost, and institutional protocols. - PGE2 formulations are FDA-approved and widely used, though may be more expensive than misoprostol. *PGF2alpha* - **PGF2alpha (carboprost)** is primarily used for the **management of postpartum hemorrhage** due to its potent myometrial contracting effect. - It is **not indicated** for induction of labor at term as its strong uterine contractions can cause excessive uterine stimulation and fetal distress. *Intracervical foley's* - An **intracervical Foley catheter** is a mechanical method that causes cervical ripening through direct pressure and stimulation of local prostaglandin release. - It is an evidence-based alternative with lower risk of uterine hyperstimulation compared to pharmacological methods. - Both mechanical and pharmacological methods are acceptable first-line options for cervical ripening in post-term pregnancy with unfavorable cervix.
Question 6: Which of the following is not associated with maternal age?
- A. Preterm labour
- B. Aneuploidy
- C. Hydatidiform mole
- D. Post maturity (Correct Answer)
Explanation: ***Post maturity*** - **Post-maturity** (post-term pregnancy, >42 weeks) does NOT have a consistent or strong association with maternal age in current obstetric literature. - While some older studies suggested associations, modern evidence shows **no significant independent effect of maternal age** on post-term pregnancy rates. - Post-term pregnancy is more related to factors like **first pregnancy**, **prior post-term delivery**, and **fetal sex** (males more common). *Preterm labour* - **Preterm birth is strongly associated with maternal age**, particularly at both extremes: - **Teenage mothers** (<20 years): Increased risk due to biological immaturity and socioeconomic factors - **Advanced maternal age** (≥35 years): Increased risk due to higher rates of maternal complications (hypertension, diabetes) and placental dysfunction - This is well-established in obstetric literature and clinical guidelines. *Aneuploidy* - The risk of **aneuploidy**, particularly **Down syndrome (Trisomy 21)**, **increases dramatically with advancing maternal age**. - At age 35: ~1/350 risk; at age 40: ~1/100 risk; at age 45: ~1/30 risk - Due to age-related decline in oocyte quality causing meiotic errors during egg formation. *Hydatidiform mole* - **Gestational trophoblastic disease** (hydatidiform mole) is strongly associated with **extremes of maternal age**: - **Women >40 years**: 5-10 fold increased risk - **Teenagers**: 1.5-2 fold increased risk - Related to abnormal fertilization events more common at age extremes.
Question 7: Which of the following genital infections is associated with preterm labour?
- A. Human Papilloma Virus
- B. Monilial vaginitis
- C. Bacterial vaginosis (Correct Answer)
- D. Trichomonas vaginalis
Explanation: ***Bacterial vaginosis*** - Bacterial vaginosis (BV) is strongly associated with an increased risk of **preterm labor** and **premature rupture of membranes** due to the production of proteases and phospholipases by anaerobic bacteria. - The imbalance of vaginal flora, particularly the overgrowth of anaerobic bacteria, can lead to ascending infection and inflammation of the **chorioamniotic membranes**. - BV has the **strongest and most consistent** evidence linking it to preterm birth among genital infections. *Human Papilloma Virus* - HPV infection is primarily known for causing **genital warts** and increasing the risk of **cervical dysplasia** and cancer. - It is not directly linked to an increased risk of preterm labor. *Monilial vaginitis* - Monilial vaginitis, or **vulvovaginal candidiasis** (yeast infection), is a common cause of vaginal discomfort, itching, and discharge. - While uncomfortable, it is not consistently associated with an increased risk of preterm labor or other adverse pregnancy outcomes. *Trichomonas vaginalis* - *Trichomonas vaginalis* infection is a sexually transmitted infection that can cause **vaginitis**, cervicitis, and urethritis. - While some studies suggest a possible association with adverse pregnancy outcomes, the evidence is **inconsistent and significantly weaker** compared to bacterial vaginosis, making BV the most established cause of preterm labor among these options.
Question 8: What procedure is being demonstrated in the image?
- A. Artificial rupture of membranes
- B. Fetal scalp pH monitoring
- C. Amniocentesis (Correct Answer)
- D. Paracervical block
Explanation: ***Amniocentesis*** - The image clearly depicts a needle being inserted through the maternal abdomen into the **amniotic sac** to withdraw **amniotic fluid**, which is the procedure for amniocentesis. - This procedure is typically performed for prenatal diagnosis of genetic conditions, **fetal lung maturity assessment**, or to evaluate for uterine infections. *Artificial rupture of membranes* - This procedure involves using a specialized instrument (amniohook) to **break the amniotic sac** through the cervix during active labor to facilitate delivery, which is not what is shown. - The image shows an abdominal approach and aspiration of fluid, not membrane rupture through the vagina. *Fetal scalp pH monitoring* - Fetal scalp pH monitoring involves taking a small **blood sample from the fetal scalp** during labor to assess for fetal acidosis, typically done vaginally and not via abdominal puncture. - The instrument shown is a needle for fluid aspiration, not a blood sampling device or pH electrode. *Paracervical block* - A paracervical block is a regional anesthetic procedure involving injections into the **cervical tissue** to relieve pain during labor, which is not depicted in the image. - The image shows a procedure involving access to the amniotic fluid, not local anesthesia of the cervix.
Question 9: Which of the following is not typically given to a patient with preterm labor?
- A. Tocolytic drugs
- B. Antibiotics
- C. Glucocorticoids
- D. Beta blocker (Correct Answer)
Explanation: ***Beta blocker*** - **Beta blockers** are generally avoided in preterm labor because they can worsen **fetal bradycardia** and **neonatal hypoglycemia**. - They are not used to manage uterine contractions or promote fetal lung maturity. *Glucocorticoids* - **Glucocorticoids** (e.g., **betamethasone**) are administered to promote **fetal lung maturity** and reduce the risk of **respiratory distress syndrome** in preterm infants. - They are a crucial intervention in managing preterm labor. *Tocolytic drugs* - **Tocolytic drugs** (e.g., **nifedipine**, **terbutaline**) are used to **suppress uterine contractions** and delay delivery in preterm labor. - This allows time for glucocorticoids to take effect and for transfer to a facility with neonatal intensive care. *Antibiotics* - Although not routinely given to all patients with preterm labor, **antibiotics** are prescribed if there is evidence of an **intrauterine infection** or if the patient is positive for **Group B Streptococcus (GBS)**. - Infection can be a trigger for preterm labor, and treating it can help prolong pregnancy or prevent neonatal sepsis.
Question 10: Abortions in the second trimester mainly occur due to
- A. congenital anomalies of the uterus
- B. retroflected gravid uterus
- C. congenital anomalies of the foetus (Correct Answer)
- D. hormonal deficiencies
Explanation: ***congenital anomalies of the foetus*** - Among the given options, **fetal congenital anomalies** (chromosomal abnormalities and structural malformations) are a significant cause of second-trimester pregnancy loss. - These anomalies often become apparent during routine prenatal screenings or ultrasounds performed in the second trimester, leading to spontaneous loss or termination. - **Note:** In clinical practice, **cervical incompetence** is actually the most common cause of second-trimester abortion, but it is not listed among the options in this question. *congenital anomalies of the uterus* - **Uterine anomalies** like septate or bicornuate uterus are more commonly associated with **recurrent first-trimester miscarriages** or **preterm labor** in the third trimester. - While they can contribute to pregnancy loss, they are less frequently the primary cause of second-trimester abortions compared to fetal anomalies. *retroflected gravid uterus* - A **retroflected gravid uterus** typically resolves spontaneously as the uterus grows and rises out of the pelvis by 12-14 weeks. - If it remains retroverted and becomes incarcerated, it can cause **pelvic pain** and **urinary retention**, but this is a very rare cause of miscarriage, especially in the second trimester. *hormonal deficiencies* - **Hormonal deficiencies**, such as insufficient **progesterone** production by the corpus luteum, are a more common cause of **first-trimester miscarriages**. - By the second trimester, the placenta has taken over progesterone production (by 8-10 weeks), making hormonal deficiencies a much less common cause of abortion during this period.
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