Operative Obstetrics Practice Questions

Q: All the following drugs are used in various regimens of medical termination of pregnancy except?

Mefenamic acid. In medical termination of pregnancy (MTP), the goal is to induce uterine contractions and cervical ripening to expel the products of conception. **Why Mefenamic Acid is the Correct Answer:** Mefenamic acid is a Non-Steroidal Anti-Inflammatory Drug (NSAID) that acts as a **prostaglandin synthetase inhibitor**. By inhibiting the enzyme cyclooxygenase (COX), it reduces the production of prostaglandins. Since prostaglandins are essential for uterine contractions, Mefenamic acid actually antagonizes the process of abortion. It is clinically used to *reduce* menstrual pain and heavy bleeding, not to induce MTP. **Explanation of Other Options:** * **Mifepristone (RU-486):** An anti-progesterone that sensitizes the myocardium to prostaglandins and causes decidual necrosis, leading to detachment of the embryo. It is the first step in the standard medical MTP regimen. * **Misoprostol:** A PGE1 analogue that causes cervical softening and potent uterine contractions. It is used following Mifepristone to expel the products of conception. * **Methotrexate:** A folate antagonist that inhibits dihydrofolate reductase. It is toxic to rapidly dividing trophoblastic cells and is used as an alternative regimen for MTP (especially in very early or ectopic pregnancies). **High-Yield Clinical Pearls for NEET-PG:** * **Standard Regimen (up to 9 weeks/63 days):** 200 mg Mifepristone orally followed by 800 mcg Misoprostol (vaginal/oral/sublingual) after 24–48 hours. * **MTP Act (India) Update:** Medical termination is now legal up to **24 weeks** for specific categories of women, though medical regimens (drugs) are most effective in the first trimester. * **Contraindication:** Medical MTP is contraindicated in suspected ectopic pregnancy (unless using specific Methotrexate protocols), chronic adrenal failure, and patients on long-term corticosteroid therapy.

Q: Following molar pregnancy evacuation, in which timeframe do post-treatment HCG levels typically normalize?

9 weeks. **Explanation:** The normalization of Human Chorionic Gonadotropin (hCG) levels is the primary marker for monitoring the resolution of a hydatidiform mole and screening for Gestational Trophoblastic Neoplasia (GTN). **1. Why 9 weeks is correct:** Following the suction evacuation of a molar pregnancy, serum β-hCG levels undergo a progressive decline. According to standard obstetric literature (including Williams Obstetrics), the average time for hCG to reach undetectable levels (<5 mIU/mL) is approximately **9 weeks**. While a complete mole may take slightly longer than a partial mole, the mean duration across studies for surveillance to reach the baseline is 9 weeks. **2. Analysis of Incorrect Options:** * **A (3 weeks):** This is too early. While hCG levels drop sharply in the first 48 hours post-evacuation, the remaining trophoblastic tissue takes significantly longer to regress completely. * **B (6 weeks):** This is the typical timeframe for the involution of the uterus and normalization of physiological changes in a normal pregnancy, but it is generally insufficient for molar hCG clearance. * **D (12 weeks):** While some cases may take up to 12–14 weeks to normalize, it is not the "typical" or mean timeframe. If levels remain elevated or plateau by this stage, it often raises suspicion for persistent GTN. **3. High-Yield Clinical Pearls for NEET-PG:** * **Follow-up Protocol:** Check hCG levels every 1–2 weeks until three consecutive weekly samples are negative (<5 mIU/mL). * **Surveillance Duration:** Once negative, follow up monthly for 6 months (for complete moles). * **Contraception:** Reliable contraception (preferably OCPs) is mandatory during the follow-up period to ensure a new pregnancy does not mask the rise of GTN. * **GTN Diagnosis (FIGO Criteria):** Suspect malignancy if hCG levels plateau (4 values over 3 weeks) or rise (3 values over 2 weeks).

Q: What is the name of the procedure used to resolve head entrapment?

Duhrssen's incisions. **Explanation:** **Duhrssen’s Incisions** are surgical incisions made in the cervix at the 2, 6, and 10 o'clock positions to facilitate the delivery of the **entrapped aftercoming head** of a breech fetus or a trapped head in a cephalic presentation when the cervix is not fully dilated. This procedure is typically a last resort when the cervix is thin and effaced but not sufficiently dilated to allow the head to pass, posing an immediate risk of fetal asphyxia. **Analysis of Incorrect Options:** * **Symphysiotomy (Option A):** This involves the surgical division of the pubic symphysis to increase the pelvic diameters. It is used for obstructed labor or severe shoulder dystocia, not specifically for cervical entrapment of the head. * **Pinard Maneuver (Option B):** This is a maneuver used in breech extraction to bring down the fetal legs in a frank breech presentation by applying pressure to the popliteal fossa. * **Zavanelli Maneuver (Option C):** This involves cephalic replacement (pushing the fetal head back into the uterus) followed by an emergency Cesarean section. It is the definitive management for catastrophic **shoulder dystocia**, not head entrapment by the cervix. **High-Yield Clinical Pearls for NEET-PG:** * **Location:** Incisions are made at **2, 6, and 10 o'clock** to avoid the uterine arteries (located at 3 and 9 o'clock). * **Prerequisite:** The cervix must be fully effaced. * **Complication:** The most significant risk is maternal hemorrhage or extension of the incision into the lower uterine segment. * **Modern Practice:** Due to the availability of Cesarean sections, Duhrssen’s incisions are rarely performed today but remain a critical "rescue" procedure in resource-limited settings or sudden breech entrapment.

Question 1

At which gestational age is the Shirodkar stitch typically performed during pregnancy?

Accepted Answer

14-16 weeks

Answer

6 weeks

Answer

12 weeks

Answer

20-24 weeks

Question 2

All the following drugs are used in various regimens of medical termination of pregnancy except?

Accepted Answer

Mefenamic acid

Answer

Methotrexate

Answer

Mifepristone

Answer

Misoprostol

Question 3

Following molar pregnancy evacuation, in which timeframe do post-treatment HCG levels typically normalize?

Accepted Answer

9 weeks

Answer

3 weeks

Answer

6 weeks

Answer

12 weeks

Question 4

What is the name of the procedure used to resolve head entrapment?

Accepted Answer

Duhrssen's incisions

Answer

Symphysiotomy

Answer

Pinard maneuver

Answer

Zavanelli maneuver

Question 5

What is the best method to prevent cardiac failure in a pregnant woman with severe mitral stenosis, who is likely to experience failure during the antenatal period?

Accepted Answer

Balloon mitral valvuloplasty in the second trimester

Answer

Furosemide throughout pregnancy

Answer

Digoxin for all patients

Answer

Admission at 30 weeks gestation

Operative Obstetrics — MCQs

Operative Obstetrics — MCQs

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