UPSC-CMS 2013 - Obstetrics and Gynecology Practice Questions

Q: Normal pH of foetal scalp blood is :

7.30. ***7.30*** - A **normal foetal scalp pH** is generally considered to be above 7.25, with an ideal range being closer to **7.30-7.35**. - A pH of **7.30** indicates adequate oxygenation and acid-base balance, suggesting the foetus is not experiencing significant hypoxia or acidosis. *7.20* - A pH of **7.20** is typically considered a **borderline acidic** value in foetal scalp blood. - While not immediately critical, it often warrants close monitoring or further assessment of foetal well-being, as it may indicate mild **acidosis**. *7.0* - A pH of **7.0** in foetal scalp blood is a significantly **acidotic** value. - This level suggests considerable **foetal distress and hypoxemia**, often necessitating urgent intervention like expedited delivery. *7.10* - A pH of **7.10** is indicative of definite **foetal acidosis**. - This level is a strong indicator of **foetal compromise** and would typically prompt immediate action to resolve the underlying issue or deliver the baby.

Q: Face to pubis delivery is common in which type of pelvis ?

Anthropoid. ***Anthropoid*** - The **anthropoid pelvis** has an oval inlet with a long anteroposterior (AP) diameter, which favors **persistent occiput posterior (OP) positions**. - In OP position, the fetal occiput faces the maternal sacrum, and the fetal face faces the maternal pubis, resulting in **"face to pubis" delivery**. - This pelvic shape aligns the fetal head to enter and descend in the AP diameter, increasing the likelihood of the occiput remaining posterior throughout labor, leading to delivery in the OP position. *Android* - An **android pelvis** is heart-shaped and narrow, often associated with complications like **failure to progress** and fetal head arrest, but not specifically face to pubis deliveries. - Its narrow forepelvis makes internal rotation difficult, often leading to **transverse arrest** of the fetal head rather than persistent OP position. *Gynaecoid* - The **gynaecoid pelvis** is the ideal and most common female pelvic type, characterized by a rounded inlet and adequate diameters, typically allowing for delivery in the favorable **occiput anterior (OA) position**. - It facilitates **spontaneous internal rotation** to OA position, making face to pubis (OP) delivery uncommon. *Platypelloid* - A **platypelloid pelvis** has a flattened inlet with a short anteroposterior and a wide transverse diameter, often leading to **transverse arrest** of the fetal head. - This shape is unfavorable for vaginal delivery in general and does not specifically predispose to face to pubis presentations.

Q: The following are the signs of placental separation except :

The fundal height decreases. ***The fundal height decreases*** - Following placental separation, the uterus often rises in the abdomen due to the pooling of blood behind the placenta, causing the **fundal height to appear to increase**, not decrease. - A decrease in fundal height is not a recognized sign of placental separation. *The uterus becomes hard and globular* - As the placenta separates, the uterus naturally contracts firmly to prevent postpartum hemorrhage, thus becoming **hard and globular** to the touch. - This **sustained contraction** is a key clinical sign indicating effective uterine retrieval and placental detachment. *Permanent lengthening of the cord* - Once the placenta detaches from the uterine wall and descends into the lower uterine segment or vagina, the **umbilical cord will appear to lengthen** permanently outside the vulva. - This external lengthening signifies that the placenta has moved from its intrauterine position. *Fresh bleeding occurs* - Fresh bleeding is expected after placental separation because the detachment process exposes maternal blood vessels, leading to **external blood loss**. - This **active bleeding** is a normal physiological sign indicating the placenta is no longer attached to the uterine wall.

Q: The following conditions are associated with molar pregnancy except:

Gestational diabetes. **Gestational diabetes** - Gestational diabetes is not directly associated with a **molar pregnancy**. Its pathogenesis is related to **insulin resistance** and pancreatic beta-cell dysfunction during pregnancy. - While both conditions can occur during pregnancy, there is no increased risk of gestational diabetes in the presence of a molar pregnancy. *Thyrotoxicosis* - **Molar pregnancies** produce very high levels of **human chorionic gonadotropin (hCG)**, which has a structural similarity to thyroid-stimulating hormone (TSH). - This high hCG can stimulate the thyroid gland, leading to **hyperthyroidism** or thyrotoxicosis in some patients. *Hyperemesis gravidarum* - The extremely high levels of **hCG** produced in a **molar pregnancy** are strongly linked to the severity of nausea and vomiting experienced during pregnancy. - This often manifests as **hyperemesis gravidarum**, which is more common and severe in molar pregnancies due to the exaggerated hormonal response. *Pregnancy induced hypertension* - Patients with **molar pregnancies** are at an increased risk of developing **pregnancy-induced hypertension (PIH)**, often presenting earlier in gestation than typical pre-eclampsia. - The precise mechanism is thought to involve the abnormal placental development and exaggerated maternal inflammatory response associated with molar tissue.

Q: What is the commonest cause of retention of urine at 12-14 weeks of pregnancy ?

Retroverted gravid uterus. ***Retroverted gravid uterus*** - A **retroverted uterus** can become "trapped" in the pelvis as it enlarges during pregnancy, causing the **cervix to push against the urethra, leading to outflow obstruction**. - This typically occurs between **12-14 weeks of gestation** before the uterus ascents out of the pelvis. *Diminished bladder tone* - While bladder tone can be affected in pregnancy, it's not the primary or most common cause of **acute urinary retention** at this specific gestational age. - **Decreased bladder sensation** and volume capacity changes are more gradual and less likely to cause acute retention until later stages. *Prolapse of uterus* - **Uterine prolapse** is more common in **multiparous women** and tends to cause symptoms like pressure, discomfort, and potentially urinary incontinence, rather than acute retention, particularly in early pregnancy. - A prolapsed uterus is usually located **lower in the pelvic cavity**, which would not typically obstruct the urethra in the manner of a retroverted uterus. *Impacted pelvic tumour* - An **impacted pelvic tumour** could cause urinary retention, but it is a **less common cause** than a retroverted gravid uterus in the context of a healthy 12-14 week pregnancy. - This would be a more serious and typically pre-existing condition, often with other associated symptoms, and not a physiological consequence of pregnancy.

Q: Which of the following is a uterine compression suture during management of atonic postpartum haemorrhage?

B-Lynch suture. **B-Lynch suture** - The **B-Lynch suture** is a specific type of surgical technique involving the placement of sutures across the uterine fundus and lower uterine segment to compress the uterus. - This compression helps to reduce blood loss by mechanically occluding the endometrial vessels, making it highly effective in managing **atonic postpartum hemorrhage**. *Sturmdorf suture* - The Sturmdorf suture is primarily used in **cervical cone biopsy** or **trachelectomy** to close the cervical stump. - It involves everting and suturing the cervical mucosa to provide hemostasis and promote healing of the cervix, not for uterine compression. *Fothergill's suture* - Fothergill's operation (Manchester operation) is used for **pelvic organ prolapse**, particularly uterine prolapse. - It typically involves shortening the cardinal ligaments and repairing the perineum, but does not involve uterine compression for hemorrhage. *Moscowitz suture* - The Moscowitz suture is used for **obliteration of the cul-de-sac (pouch of Douglas)** to prevent **enterocele** formation during pelvic floor repair. - This technique involves plicating the peritoneum over the pouch of Douglas, and is not a uterine compression suture for atonic hemorrhage.

Q: The hormone Relaxin of pregnancy is secreted by:

Ovary. ***Ovary*** - During early pregnancy, **relaxin** is primarily produced by the **corpus luteum** in the ovary. - Subsequently, towards late pregnancy, the **decidua** and **placenta** also contribute to relaxin production. *Pituitary gland* - The **pituitary gland** produces hormones such as **FSH**, **LH**, **prolactin**, and **oxytocin**, but not relaxin. - These hormones play roles in **menstrual cycle regulation**, **lactation**, and **uterine contractions**. *Vagina* - The **vagina** is a muscular canal that serves as the birth canal; it does not produce hormones. - Its primary functions are in **sexual intercourse** and **childbirth**. *Fallopian tube* - The **fallopian tubes** are responsible for transporting eggs from the ovaries to the uterus and are sites of fertilization. - They do not have a role in the production of **pregnancy hormones** like relaxin.

Q: All of the following are eligibility criteria for female sterilization except :

At least two living children should be present. ***At least two living children should be present*** - The number of **living children** is NOT a mandatory eligibility criterion for female sterilization in India. - The **Ministry of Health and Family Welfare** has explicitly removed parity requirements to expand access to sterilization services. - Current guidelines emphasize **informed consent** and **voluntary participation**, not the number of children. - This is the correct answer as it is clearly NOT an eligibility criterion. *Client should be married* - **Marital status** is also NOT a mandatory eligibility criterion in current Indian family planning guidelines. - However, this has been inconsistently applied, and the removal of the **two-child norm** is more explicitly documented. - Modern guidelines focus on individual autonomy and informed choice regardless of marital status. *Client's age should not be less than 22 years or more than 49 years* - **Minimum age of 22 years** is a valid eligibility criterion to ensure maturity and informed decision-making. - The upper age limit is generally aligned with reproductive age, though this varies. - Age restriction is a legitimate criterion under Indian guidelines. *Client or her spouse must not have undergone sterilisation in the past* - This is a logical eligibility consideration to prevent **duplicate sterilization** within a couple. - If one partner is already sterilized, the other typically does not need the procedure. - This ensures efficient use of resources and prevents unnecessary surgeries.

Question 1

Normal pH of foetal scalp blood is :

Accepted Answer

7.30

Answer

7.20

Answer

7.0

Answer

7.10

Question 2

Face to pubis delivery is common in which type of pelvis ?

Accepted Answer

Anthropoid

Answer

Android

Answer

Gynaecoid

Answer

Platypelloid

Question 3

The following are the signs of placental separation except :

Accepted Answer

The fundal height decreases

Answer

The uterus becomes hard and globular

Answer

Permanent lengthening of the cord

Answer

Fresh bleeding occurs

Question 4

The following conditions are associated with molar pregnancy except:

Accepted Answer

Gestational diabetes

Answer

Thyrotoxicosis

Answer

Hyperemesis gravidarum

Answer

Pregnancy induced hypertension

Question 5

What is the commonest cause of retention of urine at 12-14 weeks of pregnancy ?

Accepted Answer

Retroverted gravid uterus

Answer

Diminished bladder tone

Answer

Prolapse of uterus

Answer

Impacted pelvic tumour

Question 6

Which of the following is a uterine compression suture during management of atonic postpartum haemorrhage?

Accepted Answer

B-Lynch suture

Answer

Sturmdorf suture

Answer

Fothergill's suture

Answer

Moscowitz suture

Question 7

The hormone Relaxin of pregnancy is secreted by:

Accepted Answer

Ovary

Answer

Pituitary gland

Answer

Vagina

Answer

Fallopian tube

Question 8

Following are the contraindications for laparoscopic female sterilization except :

Accepted Answer

Hiatus hernia

Answer

Respiratory dysfunction

Answer

Heart disease

Answer

Obesity

Question 9

A man underwent vasectomy, but 6 months later his wife was 16 week pregnant. What is the most likely cause ?

Accepted Answer

Failure to use additional contraception in postoperative period

Answer

Recanalisation of vas

Answer

Pregnancy antedating vasectomy

Answer

Failure of operative procedure

Question 10

All of the following are eligibility criteria for female sterilization except :

Accepted Answer

At least two living children should be present

Answer

Client should be married

Answer

Client's age should not be less than 22 years or more than 49 years

Answer

Client or her spouse must not have undergone sterilisation in the past

UPSC-CMS 2013 — Obstetrics and Gynecology