Operative Obstetrics Practice Questions

Q: Which gynecological surgery utilizes the instrument shown in the image?

Myomectomy. ***Myomectomy*** - The instrument shown is a **myoma screw** (spiral/corkscrew forceps), specifically designed to grasp and manipulate **uterine fibroids** during their surgical removal. - This specialized instrument allows secure grip on the **fibroid tissue** while minimizing trauma to surrounding **myometrium** during enucleation. *Tubectomy* - Uses standard **laparoscopic instruments** like **electrocautery** or **clips** for fallopian tube occlusion or removal. - The myoma screw has no application in tubal procedures as it's designed for **solid tissue manipulation**, not tubular structures. *Cesarean section* - Employs **scalpels**, **forceps**, and **retractors** for uterine incision and fetal delivery. - The myoma screw is unnecessary as cesarean delivery focuses on **uterine incision** and **fetal extraction**, not fibroid manipulation. *Hysterectomy* - Uses **clamps**, **scissors**, and **electrocautery** for systematic removal of the entire uterus. - The myoma screw is not needed since the **entire uterus** is removed rather than selectively extracting specific masses.

Q: Pregnancy resulting from contraceptive failure can be terminated as per which indication of the Medical Termination of Pregnancy (MTP) Act?

Social indication. ### Explanation The Medical Termination of Pregnancy (MTP) Act of 1971 (amended in 2021) outlines specific legal grounds under which a pregnancy can be terminated. **1. Why "Social Indication" is correct:** Contraceptive failure is categorized under **Social Indications**. The law recognizes that a pregnancy resulting from the failure of a contraceptive device or method (used by a woman or her partner) can cause significant mental agony and social distress. This provision is unique as it acknowledges the psychological impact of an unplanned pregnancy on the woman’s mental health. **2. Analysis of Incorrect Options:** * **A. To save the life of the mother (Therapeutic Indication):** This refers to situations where the continuation of pregnancy poses a risk to the life of the pregnant woman or causes grave injury to her physical or mental health (e.g., severe cardiac disease). * **C. Eugenic Indication:** This applies when there is a substantial risk that if the child were born, it would suffer from serious physical or mental abnormalities (e.g., major structural anomalies or genetic disorders). * **Humanitarian Indication (Not listed):** This refers to pregnancies resulting from sexual assault or rape. **3. High-Yield Facts for NEET-PG:** * **Gestational Age Limit:** Under the 2021 Amendment, the upper limit for MTP is **24 weeks** for specific categories (rape survivors, minors, etc.). For contraceptive failure, it is generally up to **20 weeks**. * **Opinion Required:** One RMP (Registered Medical Practitioner) is needed for termination up to 20 weeks; two RMPs are required for 20–24 weeks. * **Anomalies:** There is **no upper gestation limit** for termination if a Medical Board confirms substantial fetal abnormalities. * **Confidentiality:** The name and particulars of the woman must not be revealed, punishable by up to one year in prison.

Q: Ward Mayo's operation is indicated in:

Procidentia. **Explanation:** **Ward Mayo’s Operation** is a surgical procedure involving a **Vaginal Hysterectomy with Pelvic Floor Repair**. It is the gold-standard treatment for **Procidentia** (third-degree or total uterine prolapse) in postmenopausal women or those who have completed their family. 1. **Why Procidentia is correct:** In cases of procidentia, the uterus is completely herniated outside the introitus. Ward Mayo’s operation addresses this by removing the uterus vaginally and performing an anterior colporrhaphy and posterior colpoperineorrhaphy to strengthen the weakened pelvic supports (cystocele and rectocele repair). 2. **Why other options are incorrect:** * **Carcinoma of the uterus/cervix:** Malignancies require radical surgeries (like Wertheim’s Hysterectomy) and lymph node dissection, usually performed via an abdominal or laparoscopic approach to ensure oncological clearance. Vaginal hysterectomy is generally contraindicated in invasive cancers. * **Prolapse in a nulliparous patient:** In young or nulliparous patients who wish to preserve fertility, "Uterine Sparing" surgeries are preferred. Examples include **Shirodkar’s or Khanna’s Fothergill operation** (Manchester repair) or **Sling operations** (e.g., Shirodkar’s abdominal sling). **High-Yield Clinical Pearls for NEET-PG:** * **Manchester Operation:** Indicated for uterine prolapse when the patient wants to preserve the uterus (involves cervical amputation and Fothergill’s stitch). * **Le Fort’s Colpocleisis:** Indicated for procidentia in **very elderly** patients who are not sexually active and are unfit for major surgery (involves partial closure of the vagina). * **Step of Ward Mayo’s:** The most crucial step to prevent future vault prolapse is the high ligation of the uterosacral ligaments.

Q: In which genetic condition is this most likely to be seen?

Trisomy 21. ***Trisomy 21*** - The **double bubble sign** (duodenal atresia) on prenatal ultrasound has a strong association with **Down syndrome**, occurring in approximately **30%** of cases. - **Trisomy 21** is the most common viable autosomal trisomy and frequently presents with gastrointestinal anomalies including **duodenal atresia**. *Trisomy 16* - **Most common trisomy** in spontaneous miscarriages but is **not compatible with life** beyond early pregnancy. - Does not typically present with duodenal atresia as affected fetuses do not survive to term. *Monosomy X* - **Turner syndrome** classically presents with **cystic hygroma**, **coarctation of aorta**, and **webbed neck** on prenatal imaging. - Gastrointestinal anomalies like duodenal atresia are **not characteristic** features of this condition. *Trisomy 13* - **Patau syndrome** typically presents with **holoprosencephaly**, **polydactyly**, and severe central nervous system malformations. - While gastrointestinal anomalies can occur, **duodenal atresia** is not a classic association with this condition.

Q: What is the recommended pressure range employed during suction evacuation in MTP?

400-600 mm Hg. ### Explanation **Suction Evacuation (Vacuum Aspiration)** is the gold standard surgical method for Medical Termination of Pregnancy (MTP) in the first trimester (up to 12 weeks). **1. Why 400-600 mm Hg is Correct:** To effectively detach and aspirate the products of conception (decidua and chorionic tissue) from the uterine wall, a negative pressure of **400–600 mm Hg** (or 60–80 kPa) is required. This range provides sufficient suction to empty the uterus quickly while minimizing the risk of trauma to the myometrium. **2. Analysis of Incorrect Options:** * **A (200-400 mm Hg):** This pressure is generally **insufficient** to dislodge the gestational sac and placental tissue, leading to incomplete evacuation and increased procedure time. * **C & D (600-1000 mm Hg):** Pressures exceeding 600 mm Hg are **excessive**. High negative pressure increases the risk of uterine perforation, Asherman syndrome (due to over-denudation of the basal layer of the endometrium), and cervical injury. **3. Clinical Pearls for NEET-PG:** * **Cannula Size Rule:** The size of the Karman cannula (in mm) should correspond to the weeks of gestation (e.g., an 8 mm cannula for 8 weeks of pregnancy). * **Manual Vacuum Aspiration (MVA):** Uses a handheld syringe (60cc) that creates a constant vacuum of approximately **600 mm Hg**. * **Signs of Completion:** The procedure is complete when "gritty" sensations are felt against the cannula, bubbles appear in the tube, and the uterus contracts around the cannula. * **MTP Act Update:** Remember that under the MTP (Amendment) Act 2021, the upper gestation limit for termination has been increased to **24 weeks** for specific categories of women.

Q: A 38-year-old primigravida, pregnant following IVF, has a sonogram at 12 weeks 4 days gestation showing a nuchal translucency of 5 mm. Which of the following is the only true statement?

The embryo has a high risk of cardiac malformation.. **Explanation:** **1. Why Option B is Correct:** Nuchal Translucency (NT) is the sonographic appearance of a collection of fluid under the skin behind the fetal neck in the first trimester (11 to 13+6 weeks). A measurement of **≥3.5 mm** is considered significantly increased. While NT is primarily used to screen for aneuploidies (like Down syndrome), an increased NT in a **euploid (chromosomally normal) fetus** is strongly associated with **congenital heart defects (CHDs)**, such as Tetralogy of Fallot or Septal defects. This is likely due to transient heart failure or altered hemodynamics during development. **2. Why the Other Options are Incorrect:** * **Option A:** Neural tube defects (NTDs) are associated with abnormal maternal serum alpha-fetoprotein (MSAFP) and specific second-trimester ultrasound findings (e.g., lemon sign, banana sign), not increased NT. * **Option C:** Increased NT usually **resolves** or evolves into a cystic hygroma or nuchal edema by the second trimester; it does not typically "enlarge" as a standard progression. * **Option D:** While Turner syndrome (45,X) is associated with very high NT/cystic hygroma, the **most common** aneuploidy associated with increased NT is **Trisomy 21 (Down syndrome)**. **Clinical Pearls for NEET-PG:** * **Ideal Timing for NT:** 11 weeks to 13 weeks 6 days (CRL 45–84 mm). * **Combined Screening:** NT + PAPP-A + hCG (Detection rate for Down syndrome ~85-90%). * **Next Step:** If NT is increased, the patient should be offered invasive testing (CVS/Amniocentesis) for karyotyping and a **Fetal Echocardiogram** at 18–22 weeks. * **IVF Pregnancy:** IVF itself is an independent risk factor for cardiac malformations, further increasing the relevance of this finding.

Question 1

Which gynecological surgery utilizes the instrument shown in the image?

Accepted Answer

Myomectomy

Answer

Tubectomy

Answer

Cesarean section

Answer

Hysterectomy

Question 2

A 26-year-old primipara at term gestation with labour pains presents with cervical dilation 3 cm, 60% effacement, meconium-stained liquor, and decreased fetal heart rate. What is the most appropriate management?

Accepted Answer

Provide oxygen and shift to the operating theatre for emergency lower segment caesarean section (LSCS).

Answer

Administer oxytocin drip to accelerate labour.

Answer

Administer IV drotaverine to improve cervical dilatation.

Answer

Attempt a vacuum delivery.

Question 3

Which of the following is NOT a benefit of surgical evacuation compared to medical regimens?

Accepted Answer

Invasive procedure

Answer

Lower failure rate

Answer

No need for follow-up

Answer

Predictable bleeding

Question 4

Pregnancy resulting from contraceptive failure can be terminated as per which indication of the Medical Termination of Pregnancy (MTP) Act?

Accepted Answer

Social indication

Answer

To save the life of the mother

Answer

Eugenic indication

Answer

None of the above

Question 5

Ward Mayo's operation is indicated in:

Accepted Answer

Procidentia

Answer

Carcinoma of the uterus

Answer

Prolapse in a nulliparous patient

Answer

Carcinoma of the cervix

Question 6

Which of the following statements is NOT related to symphysiotomy?

Accepted Answer

The operation is done only when obstruction is anticipated

Answer

Isolated outlet contraction is the ideal case

Answer

Fetal heart sounds must be present

Answer

Ventouse is preferable to forceps for extraction

Question 7

During a cesarean section, how is the lower uterine segment physically identified?

Accepted Answer

Loose attachment of visceral peritoneum

Answer

Presence of dilated venous sinuses

Answer

Deflection of the uterine artery towards the upper segment

Answer

Thinness of its wall compared to the upper segment

Question 8

In which genetic condition is this most likely to be seen?

Accepted Answer

Trisomy 21

Answer

Trisomy 16

Answer

Monosomy X

Answer

Trisomy 13

Question 9

What is the recommended pressure range employed during suction evacuation in MTP?

Accepted Answer

400-600 mm Hg

Answer

200-400 mm Hg

Answer

600-800 mm Hg

Answer

800-1000 mm Hg

Question 10

A 38-year-old primigravida, pregnant following IVF, has a sonogram at 12 weeks 4 days gestation showing a nuchal translucency of 5 mm. Which of the following is the only true statement?

Accepted Answer

The embryo has a high risk of cardiac malformation.

Answer

The embryo has a high risk of neural tube defect.

Answer

The nuchal translucency will enlarge by 20 weeks.

Answer

If the embryo is aneuploid, the most likely diagnosis is Turner syndrome.

Operative Obstetrics — MCQs

Operative Obstetrics — MCQs

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