FMGE 2023 - Obstetrics and Gynecology Practice Questions

Q: In which of the following cases is the drug below contraindicated? ![img-52.jpeg](img-52.jpeg)

Malpresentation of fetus. ***Malpresentation of fetus*** - Administering **oxytocin** with fetal malpresentation (e.g., transverse lie, breech) is contraindicated as the powerful contractions against an undeliverable fetus can cause **uterine rupture**. - It also significantly increases the risk of **fetal distress**, cord prolapse, and birth trauma, making a cesarean section the necessary and safer mode of delivery. *Heart disease in mother* - Oxytocin is not absolutely contraindicated and is often used cautiously for labor induction or to prevent **postpartum hemorrhage**, which would be especially dangerous in a patient with heart disease. - Careful monitoring is required due to its potential antidiuretic and cardiovascular effects, but its benefits in preventing hemorrhage often outweigh the risks. *Premature labour* - While **tocolytics** are used to stop premature labor, oxytocin may be used to *induce* labor if a preterm delivery is medically indicated (e.g., severe preeclampsia, fetal distress). - Therefore, prematurity itself is not a contraindication; the clinical goal (stopping vs. inducing labor) determines the appropriate medication. *Hypothyroidism* - Maternal hypothyroidism, when properly managed, is not a contraindication for the use of **oxytocin**. - The drug's mechanism of action on uterine smooth muscle is unrelated to thyroid hormone pathways.

Q: Which of the following is the process of breaking the clavicle during delivery?

Cleidotomy. ***Cleidotomy*** - This is a destructive obstetric procedure where the fetal clavicle is intentionally broken or cut to reduce the **bisacromial diameter**. It is utilized primarily in cases of severe, unrelieved **shoulder dystocia**, especially if the fetus has already succumbed (**Fetal demise**). *Craniotomy* - This is a destructive procedure aimed at reducing the size of the **fetal head** by crushing or perforating the skull. It is performed when the fetal head is impacted and delivery is otherwise impossible, usually only if there is **fetal demise**. *Symphysiotomy* - This procedure involves surgically incising the **fibrocartilage** of the **pubic symphysis** to widen the pelvic outlet. It is used to relieve **obstructed labor** due to minor cephalopelvic disproportion, allowing vaginal delivery. *Zavanelli manoeuvre* - This is an emergency procedure for severe **shoulder dystocia** where the delivered fetal head is pushed back into the birth canal (**cephalic replacement**). It mandates immediate delivery via **Cesarean section** following the replacement.

Q: Which of the following is the best parameter for estimation of fetal age by ultrasound in 1st trimester?

Crown rump length. ***Crown rump length*** - The **Crown Rump Length (CRL)** is the most accurate parameter for estimating gestational age during the **first trimester** (up to 12 weeks of gestation). - This is because biological variation between fetuses is minimal during early development, providing a narrow range of error (typically ±5-7 days). *Biparietal Diameter* - **Biparietal Diameter (BPD)** becomes the primary parameter for dating in the **second trimester** (after 12 weeks of gestation). - Its accuracy in the first trimester is significantly lower than CRL due to difficulty in obtaining standardized measurements and higher potential for measurement variability. *Head circumference* - **Head circumference (HC)** is highly utilized, often alongside BPD, for fetal growth assessment and dating near the mid-to-late second trimester. - Like BPD, HC is not the most precise measure for dating during the **first trimester** when CRL dominates. *Abdominal circumference* - **Abdominal circumference (AC)** is mainly used to assess **fetal weight** and growth, often becoming inaccurate for dating due to high biological variability later in gestation. - It is the least accurate parameter for establishing gestational age in the **first trimester** compared to CRL, BPD, and HC.

Question 1

In which of the following cases is the drug below contraindicated? ![img-52.jpeg](img-52.jpeg)

Accepted Answer

Malpresentation of fetus

Answer

Heart disease in mother

Answer

Premature labour

Answer

Hypothyroidism

Question 2

Which of the following is the process of breaking the clavicle during delivery?

Accepted Answer

Cleidotomy

Answer

Zavanelli manoeuvre

Answer

Craniotomy

Answer

Symphysiotomy

Question 3

Which of the following is the best parameter for estimation of fetal age by ultrasound in 1st trimester?

Accepted Answer

Crown rump length

Answer

Biparietal Diameter

Answer

Abdominal circumference

Answer

Head circumference

FMGE 2023 — Obstetrics and Gynecology