Recovery After Cesarean Delivery — MCQs

10 questions

In pregnancies complicated by intrauterine growth restriction (IUGR) with otherwise reassuring fetal surveillance, what is the recommended gestational age for planned delivery to optimize neonatal outcomes?

Which of the following steps has proven benefit in decreasing puerperal infection following cesarean section?

How do you manage placenta accreta?

Absolute indication for cesarean section is :

Which of the following is an absolute indication for elective repeat caesarean section in a patient with previous caesarean delivery?

Postpartum VVF is best repaired after:

A pregnant woman at 32 weeks presents with recurrent bacterial vaginosis despite multiple treatments. She has history of preterm labor in previous pregnancy. Current symptoms include discharge and burning. Partner is untreated. Which management approach is most appropriate?

In a 34-week pregnancy with low-lying placenta previa and a floating head, with a hemoglobin level of 11 gm%, what should be the further line of management?

Kegel's exercises should begin after?

Q10

In non-lactating mothers, after delivery, ovulation

Recovery After Cesarean Delivery Indian Medical PG Practice Questions and MCQs

Question 1: In pregnancies complicated by intrauterine growth restriction (IUGR) with otherwise reassuring fetal surveillance, what is the recommended gestational age for planned delivery to optimize neonatal outcomes?

A. 39 weeks
B. 37 weeks
C. 40 weeks
D. 38 weeks (Correct Answer)

Explanation: ***38 weeks*** - For pregnancies complicated by **IUGR (Intrauterine Growth Restriction)** with reassuring fetal surveillance, planned delivery at **38-39 weeks** is recommended by **ACOG guidelines** to optimize neonatal outcomes. - Among the given options, **38 weeks** represents the earliest point in this recommended range, balancing the risks of continued intrauterine compromise with the risks of **prematurity** such as **respiratory distress syndrome**. - This timing is appropriate for **mild to moderate IUGR** without concerning Doppler findings or other complications. *39 weeks* - **39 weeks** is actually within the acceptable range (38-39 weeks) for IUGR delivery per current guidelines. - However, many obstetricians prefer **38 weeks** to minimize the risk of continued **fetal compromise** from **placental insufficiency**, making 38 weeks the more commonly cited benchmark. - The distinction between 38 and 39 weeks is nuanced and depends on individual case factors and surveillance findings. *37 weeks* - Delivery at **37 weeks** is considered **early term** and carries higher risk of **neonatal morbidities**, particularly **respiratory complications** and **hypoglycemia**. - This timing may be appropriate for **severe IUGR** with abnormal **umbilical artery Doppler** findings, **absent or reversed end-diastolic flow**, or other concerning features, but not for routine IUGR with reassuring surveillance. - It is not the standard recommendation for uncomplicated IUGR to optimize outcomes. *40 weeks* - Delivering at **40 weeks** in an IUGR pregnancy is **not recommended** due to increased risk of **stillbirth** and complications from ongoing **placental insufficiency**. - The risks of adverse outcomes escalate with expectant management beyond 38-39 weeks in IUGR pregnancies. - Minimal additional fetal growth occurs beyond this point while risks continue to increase.

Question 2: Which of the following steps has proven benefit in decreasing puerperal infection following cesarean section?

A. Administration of single dose of ampicillin or 1st generation cephalosporin at the time of cesarean (Correct Answer)
B. Non closure of peritoneum
C. Single layer uterine closure
D. Skin closure with staples than with suture

Explanation: ***Administration of single dose of ampicillin or 1st generation cephalosporin at the time of cesarean*** - Prophylactic **antibiotics** administered prior to skin incision significantly reduce the risk of **puerperal infection** (e.g., endometritis, wound infection) following cesarean section. - The timing of administration (within 60 minutes of skin incision) is crucial for optimal effectiveness, typically using a **first-generation cephalosporin** or **ampicillin** for broad-spectrum coverage. *Non closure of peritoneum* - Studies have shown that **non-closure of the visceral and parietal peritoneum** during cesarean section has no significant impact on the rate of puerperal infection. - While it may shorten operative time and reduce pain, it does not offer a demonstrable benefit in reducing postoperative infections. *Single layer uterine closure* - **Single-layer uterine closure** has been found to be comparable to double-layer closure in terms of postoperative infection rates and uterine healing. - There is no strong evidence to suggest that single-layer closure specifically decreases the incidence of puerperal infection more effectively than double-layer closure. *Skin closure with staples than with suture* - The choice between **staples and sutures** for skin closure after cesarean section does not show a consistent difference in the incidence of **wound infection**. - While staples may be faster and might reduce suture-related complications, they do not inherently decrease the overall risk of puerperal infection compared to traditional suturing.

Question 3: How do you manage placenta accreta?

A. Classical cesarean; hysterectomy (Correct Answer)
B. Low vertical cesarean; hysterectomy
C. Low transverse cesarean; hysterectomy
D. Classical cesarean; myometrial resection

Explanation: ***Classical cesarean; hysterectomy*** - A **classical cesarean section** (vertical incision in the upper uterine segment) allows for delivery of the fetus without disturbing the **placenta accreta** in the lower uterine segment. - Subsequent **hysterectomy** is often necessary due to the high risk of severe hemorrhage from the morbidly adherent placenta, which cannot be safely separated. *Low vertical cesarean; hysterectomy* - A **low vertical incision** is made in the lower uterine segment, which could potentially incise through the placenta accreta if it extends to that region, leading to significant hemorrhage. - While hysterectomy is likely indicated, the initial uterine incision might complicate management. *Low transverse cesarean; hysterectomy* - A **low transverse incision** is the most common type for routine cesarean sections but is contra-indicated in placenta accreta as the placenta is frequently implanted in the lower uterine segment. - Incising through the **placenta** during a low transverse cut would cause immediate massive hemorrhage, making this approach unsuitable. *Classical cesarean; myometrial resection* - While a **classical cesarean** would be the appropriate initial step for fetal delivery, **myometrial resection** to remove only the affected area of the myometrium is generally insufficient and carries a high risk of residual placental tissue and severe hemorrhage, often necessitating a hysterectomy anyway. - This approach is typically not recommended as a primary definitive management strategy for established placenta accreta.

Question 4: Absolute indication for cesarean section is :

A. Breech presentation
B. Dystocia
C. Fetal distress
D. Previous rupture of uterus (Correct Answer)

Explanation: ***Previous rupture of uterus*** - A prior **rupture of the uterus** creates a significant risk of **re-rupture** in subsequent pregnancies with labor contractions, posing a severe threat to both maternal and fetal life. - Due to the high risk of catastrophic hemorrhage and fetal distress, **elective cesarean section** before the onset of labor is mandated to prevent recurrence. *Breech presentation* - While many breech presentations result in a cesarean section, it is not an absolute indication, as **vaginal breech delivery** can be attempted in selected cases under strict criteria. - Factors like type of breech, estimated fetal weight, and maternal pelvis can influence the decision, making it a relative rather than an absolute indication. *Dystocia* - **Dystocia**, or difficult labor, is a common reason for cesarean section, but often interventions like **oxytocin augmentation** or **instrumental delivery** (forceps, vacuum) are attempted first. - A cesarean section is indicated when dystocia is severe or fails to respond to other measures, making it a relative indication based on progression of labor. *Fetal distress* - **Fetal distress**, indicated by non-reassuring fetal heart rate patterns, often necessitates prompt delivery, but the mode of delivery depends on the clinical situation. - If vaginal delivery is imminent and safe, it may be preferred, but if not, **cesarean section** is performed; therefore, it's an urgent relative indication rather than an absolute one.

Question 5: Which of the following is an absolute indication for elective repeat caesarean section in a patient with previous caesarean delivery?

A. Placenta accreta spectrum
B. Previous classical incision (Correct Answer)
C. Failed TOLAC (Trial of Labor After Cesarean)
D. Uterine rupture/scar dehiscence

Explanation: ***Previous classical incision*** - A **classical incision** (vertical uterine incision in the upper uterine segment) carries a **4-9% risk of uterine rupture** in subsequent pregnancies, compared to 0.5-1% with low transverse incisions. - **VBAC (Vaginal Birth After Cesarean) is absolutely contraindicated** with a previous classical incision due to the high rupture risk. - This is a **standing absolute indication** for elective repeat cesarean section at 36-37 weeks gestation. - Other absolute indications include previous T-incision, J-incision, and previous uterine rupture. *Uterine rupture/scar dehiscence* - **Uterine rupture** is a catastrophic **intrapartum emergency** requiring immediate cesarean delivery. - This is not a pre-existing "indication" but rather an **acute complication** that occurs during labor. - Previous uterine rupture (not active rupture) would be an absolute indication for planned repeat C-section. *Placenta accreta spectrum* - This involves abnormal placental invasion and is strongly associated with previous C-sections. - While it requires cesarean delivery with possible hysterectomy, it is a **complication of placental implantation**, not a direct indication based on the previous uterine incision type. - It necessitates C-section but is not specific to the type of previous cesarean scar. *Failed TOLAC (Trial of Labor After Cesarean)* - A **failed TOLAC** means cesarean delivery is required because vaginal delivery could not be achieved. - This is an **intrapartum decision** based on failure to progress or fetal compromise, not a pre-existing indication for planned repeat C-section.

Question 6: Postpartum VVF is best repaired after:

A. 6 months
B. 6 weeks
C. 8 weeks
D. 3 months (Correct Answer)

Explanation: ***3 months*** - Waiting at least **3 months** for VVF repair allows for complete resolution of **acute inflammation**, **edema**, and infection in surrounding tissues. - This waiting period helps tissues to **regain their normal vascularity** and pliancy, which is crucial for a successful surgical outcome and reduced risk of recurrence. *6 months* - While waiting longer may seem safer, 6 months is generally **unnecessarily long** for most postpartum VVF repairs. - Prolonged waiting can lead to **increased psychological distress** for the patient due to persistent leakage and discomfort. *6 weeks* - Repairing a VVF at 6 weeks postpartum is generally **too early** as the tissues are still highly friable and inflamed. - This early intervention significantly **increases the risk of dehiscence** and failure of the repair due to poor tissue healing. *8 weeks* - Similar to 6 weeks, 8 weeks postpartum is usually **insufficient time** for complete resolution of acute inflammation and edema. - Operating at this stage can still lead to **poor tissue integrity** and a higher chance of a failed repair.

Question 7: A pregnant woman at 32 weeks presents with recurrent bacterial vaginosis despite multiple treatments. She has history of preterm labor in previous pregnancy. Current symptoms include discharge and burning. Partner is untreated. Which management approach is most appropriate?

A. Topical azole cream only
B. Single dose metronidazole with observation
C. Extended oral clindamycin with probiotics (Correct Answer)
D. Delay treatment until postpartum

Explanation: ***Extended oral clindamycin with probiotics*** - Given the **recurrent BV** and history of **preterm labor**, an extended course of oral clindamycin (or metronidazole) is the most appropriate management to eradicate the infection and reduce risk of preterm birth. - **Extended/suppressive therapy** (typically 10-14 days followed by twice weekly suppression) is recommended for recurrent BV in pregnancy, especially with preterm labor history. - **Probiotics** (particularly Lactobacillus) may help restore healthy vaginal flora and reduce recurrence, though evidence is mixed. - **Partner treatment is NOT routinely recommended** for BV as studies show it does not reduce recurrence rates. *Topical azole cream only* - **Topical azole creams** are used for fungal infections (candidiasis), not bacterial vaginosis. - This treatment would be **ineffective** against BV and would not address the serious risk of preterm birth. *Single dose metronidazole with observation* - A **single dose of metronidazole** is insufficient for recurrent bacterial vaginosis and does not provide adequate suppression. - Given the history of **preterm labor**, extended/suppressive therapy rather than mere observation is essential to prevent recurrence and complications. *Delay treatment until postpartum* - **Delaying treatment** is inappropriate and dangerous given the **recurrent BV** and history of **preterm labor**. - Untreated BV during pregnancy significantly increases the risk of **preterm birth**, premature rupture of membranes, and chorioamnionitis.

Question 8: In a 34-week pregnancy with low-lying placenta previa and a floating head, with a hemoglobin level of 11 gm%, what should be the further line of management?

A. Expectant management (Correct Answer)
B. Cesarean section
C. Blood transfusion
D. Induction of labor

Explanation: ***Expectant management*** - With a 34-week pregnancy, **placenta previa**, and no active bleeding or severe maternal/fetal compromise, **expectant management** is generally preferred to allow for fetal lung maturity. - The hemoglobin level of 11 gm% is within a reasonable range for pregnancy and does not immediately warrant intervention. *Induction of labor* - **Induction of labor** is contraindicated in placenta previa due to the risk of severe hemorrhage as the cervix dilates. - This approach would significantly endanger both the mother and the fetus. *Cesarean section* - While a **cesarean section** is likely the eventual mode of delivery for placenta previa, performing it at 34 weeks without evidence of fetal distress or active bleeding would be premature. - It would increase the risk of neonatal complications associated with prematurity. *Blood transfusion* - A hemoglobin level of **11 gm%** is considered mild anemia in pregnancy and does not typically warrant a **blood transfusion** unless there is active, significant blood loss or symptoms of severe anemia. - Transfusing blood without an immediate need carries its own risks.

Question 9: Kegel's exercises should begin after?

A. 24 hours after delivery
B. 3 weeks after delivery
C. 6 weeks after delivery
D. Immediately after delivery (Correct Answer)

Explanation: ***Immediately after delivery*** - **Kegel's exercises** can be initiated as soon as possible after delivery, provided the woman feels comfortable and there are no contraindications. - Early commencement helps **restore pelvic floor muscle tone**, reduce urinary incontinence, and promote healing. *24 hours after delivery* - While it is not strictly incorrect to start at 24 hours, waiting unnecessarily delays the potential benefits of **pelvic floor muscle training** for postpartum recovery. - The goal is to start as early as comfort allows, which can often be within the first few hours. *3 weeks after delivery* - Waiting three weeks to begin **Kegel's exercises** would be a significant delay in postpartum recovery. - Early engagement is crucial for **optimal rehabilitation** of the pelvic floor and prevention of long-term issues. *6 weeks after delivery* - Six weeks after delivery is typically the time for the **postpartum check-up**, but it is too late to *begin* Kegel's exercises for optimal benefit. - By this point, opportunities for **early muscle re-education** and symptom prevention would have been missed.

Question 10: In non-lactating mothers, after delivery, ovulation

A. may occur as early as 4 weeks
B. may occur as early as 2 weeks (Correct Answer)
C. is unusual before 6 weeks
D. may occur as early as 6 weeks

Explanation: ***may occur as early as 2 weeks*** - In non-lactating mothers, the **hypothalamic-pituitary-ovarian axis** recovers relatively quickly after delivery because it is not suppressed by prolactin. - The earliest documented return of ovulation can be as soon as **2 weeks postpartum**, although 4-6 weeks is more common. *may occur as early as 4 weeks* - While 4 weeks is a common timeframe for ovulation to resume in non-lactating mothers, it is not the **earliest possible occurrence**. - This option misses the possibility of an even earlier return of **fertility**. *is unusual before 6 weeks* - This statement is incorrect as ovulation can, and frequently does, occur **before 6 weeks postpartum** in non-lactating women. - Delaying ovulation until 6 weeks is more typical in breast-feeding women due to **prolactin's inhibitory effect** on gonadotropin-releasing hormone. *may occur as early as 6 weeks* - Similar to the 4-week option, while ovulation can occur at 6 weeks, it is not the **earliest possible time point** for a non-lactating mother. - Assuming 6 weeks as the earliest timeframe could lead to an underestimation of the **risk of conception**.

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free