Operative Obstetrics Practice Questions

Q: Uterine rupture is least common with which of the following surgical techniques?

LSCS. ***LSCS*** - A **low transverse uterine incision** (LSCS) is associated with the **lowest risk of uterine rupture** in subsequent pregnancies due to the lower uterine segment's thinner muscle and better healing properties. - The scar from an LSCS is less likely to undergo dehiscence during labor compared to incisions in the thicker, more contractile upper uterine segment. *Classical section* - A **classical uterine incision** (vertical incision in the upper uterine segment) carries the **highest risk of uterine rupture** in subsequent pregnancies. - This is because the upper uterine segment is thicker and more contractile, leading to a weaker scar that is more prone to tearing during labor. *T Shaped incision* - A **T-shaped incision** involves a transverse cut with a vertical extension, carrying a **high risk of uterine rupture**. - The combination of perpendicular incisions compromises the uterine wall's integrity more severely than a simple transverse cut. *Inverted T shaped incision* - An **inverted T-shaped incision** is a complex uterine incision that extends vertically into the fundus from a transverse cut, making it structurally weaker. - This type of incision significantly **increases the risk of uterine rupture** in future pregnancies due to the extensive scarring across multiple planes of muscle fibers.

Q: What is a potential complication of performing internal podalic version for a transverse lie?

Uterine rupture. ***Uterine rupture*** - **Internal podalic version** involves inserting a hand into the uterus to grasp the fetal feet and forcibly manipulate the fetus, carrying a **significant risk of uterine trauma**. - This risk is particularly high with **transverse lie**, especially if the uterus is already thinned, scarred from previous surgeries (e.g., cesarean section), or if contractions are present. - **Uterine rupture** is the most serious and characteristic complication of this procedure, which is why internal podalic version is now largely **obsolete** in modern obstetrics. *Uterine atony* - **Uterine atony** refers to loss of myometrial tone causing postpartum hemorrhage, typically occurring *after* placental delivery. - This is not a direct complication of the internal podalic version *procedure itself*, but rather a consequence of uterine exhaustion after prolonged labor or retained placental tissue. *Cervical laceration* - **Cervical lacerations** can occur during vaginal delivery, particularly with rapid or precipitous delivery, but are not the primary risk of internal podalic version. - The procedure focuses on intrauterine manipulation of the fetus, not on the cervix, making cervical trauma a secondary concern compared to uterine rupture. *Vaginal laceration* - **Vaginal lacerations** are typically associated with passage of the fetal head during delivery, instrumental deliveries, or episiotomies. - While delivery following version may carry this risk, the version procedure itself primarily threatens the uterine wall, not the vagina.

Q: The immediate complication of vesicular mole evacuation is:

Hemorrhage. **Hemorrhage** - **Excessive bleeding** is the most common and immediate complication following the evacuation of a **vesicular mole**, due to the highly vascularized nature of the molar pregnancy tissue and the dilated uterine vessels. - The risk of hemorrhage is increased with larger uterine size or more aggressive suction curettage, necessitating careful monitoring and prompt intervention. *Post-operative infection* - While a potential complication, **infection** typically manifests with a slight delay (hours to days post-procedure) rather than being an immediate concern. - Prophylactic antibiotics are often given to mitigate this risk. *Residual tissue* - The presence of **residual molar tissue** is a common and important long-term complication leading to persistent trophoblastic disease, but it is usually not an immediate event that poses a direct threat to the patient's immediate stability upon evacuation. - It requires subsequent monitoring of hCG levels and potentially further intervention. *Septic shock* - **Septic shock** is a severe, life-threatening condition resulting from an uncontrolled infection, which is a rare and delayed complication of molar evacuation, not an immediate one. - It would typically be preceded by signs of infection and severe systemic inflammation.

Q: A multigravida at term with a transverse lie and hand prolapse, along with a fetal heart rate of 140/min, is best managed by:

Cesarean delivery. ***Cesarean delivery*** - A **transverse lie** at term is a contraindication to vaginal delivery, as the fetus cannot pass through the birth canal in this orientation. - The presence of **hand prolapse** further complicates the situation, increasing the risk of umbilical cord prolapse and fetal distress, making cesarean section the safest option. *External cephalic version* - This procedure is performed to change a **breech or transverse lie** to a cephalic presentation, but it is typically done *before* term, usually between 36-37 weeks. - It is contraindicated once labor has started or with **membrane rupture** and fetal parts prolapsed, as is implied by hand prolapse in this term patient. *Breech delivery* - Breech delivery involves the fetus presenting buttocks or feet first, which is not the case here; the presentation is **transverse lie** and **hand prolapse**. - While some breech deliveries can be attempted vaginally under specific circumstances, this patient's presentation makes it an inappropriate option. *Internal podalic version* - This procedure involves changing a **transverse lie** to a **breech presentation** by internal manipulation, often performed in cases of twin delivery for the second twin or in specific scenarios of malpresentation in earlier gestations. - It is rarely performed for a single fetus at term due to risks for both mother and fetus, especially with a **term fetus** and **hand prolapse**.

Question 1

Uterine rupture is least common with which of the following surgical techniques?

Accepted Answer

LSCS

Answer

Classical section

Answer

T Shaped incision

Answer

Inverted T shaped incision

Question 2

What is a potential complication of performing internal podalic version for a transverse lie?

Accepted Answer

Uterine rupture

Answer

Uterine atony

Answer

Cervical laceration

Answer

Vaginal laceration

Question 3

The immediate complication of vesicular mole evacuation is:

Accepted Answer

Hemorrhage

Answer

Post-operative infection

Answer

Residual tissue

Answer

Septic shock

Question 4

A multigravida at term with a transverse lie and hand prolapse, along with a fetal heart rate of 140/min, is best managed by:

Accepted Answer

Cesarean delivery

Answer

External cephalic version

Answer

Breech delivery

Answer

Internal podalic version

Operative Obstetrics — MCQs

Operative Obstetrics — MCQs

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