UPSC-CMS 2020 - Obstetrics and Gynecology Practice Questions

Q: Consider the following cardinal movements of mechanism of normal labor: 1. Engagement 2. Internal rotation 3. Flexion 4. Restitution 5. Crowning 6. External rotation What is the correct sequence of movements in labor in occipito-lateral position?

1, 3, 2, 5, 4 and 6. ***1, 3, 2, 5, 4 and 6*** - This sequence accurately represents the order of events during normal vaginal delivery **in occipito-lateral position**, starting with **engagement** and progressing through the cardinal movements. - The sequence follows: **Engagement (1)** → **Flexion (3)** → **Internal rotation (2)** from occipito-lateral to occipito-anterior → **Crowning (5)** during extension phase → **Restitution (4)** → **External rotation (6)**. - While **crowning** is not technically a cardinal movement, it occurs during the **extension** phase and marks the emergence of the fetal head at the introitus. - In **occipito-lateral position**, internal rotation is essential for converting the position to occipito-anterior for delivery. *3, 1, 2, 4, 6 and 5* - This sequence incorrectly places **flexion before engagement**, which is physiologically impossible as the fetal head must first engage in the pelvic inlet before significant flexion occurs. - **Crowning** is placed after external rotation, but crowning occurs during the extension phase, well before restitution and external rotation. *1, 2, 3, 4, 5 and 6* - This sequence incorrectly places **internal rotation before flexion**, whereas flexion typically occurs first to reduce the presenting diameter and facilitate internal rotation. - The sequence also places **crowning after restitution**, which contradicts the normal progression where crowning occurs during extension, before restitution. *2, 1, 3, 4, 5 and 6* - This sequence incorrectly begins with **internal rotation before engagement**, which is physiologically impossible as the fetal head must be engaged in the pelvis before it can rotate. - **Engagement** must always be the first cardinal movement.

Q: Which one of the following IUDs is associated with a low pregnancy rate (0.2 per 100), less number of ectopic pregnancies and lower menstrual blood loss?

LNG-20 (Mirena). ***LNG-20 (Mirena)*** - This **levonorgestrel-releasing IUD** (Mirena) has a very low pregnancy rate (0.2 per 100 women-years). - It significantly **reduces menstrual blood loss** and cramps and is associated with a lower risk of ectopic pregnancies compared to copper IUDs because it thins the endometrial lining, making implantation less likely. *Cu T-380A* - The **Cu T-380A copper IUD** has a slightly higher pregnancy rate (around 0.6-0.8 per 100 women-years) compared to Mirena. - It is known to **increase menstrual blood loss** and dysmenorrhea, which is contrary to the question's criteria. *ML-Cu 375* - The **Multiload Cu 375** is another type of copper IUD, with a pregnancy rate similar to or slightly higher than the TCu-380A. - Like other copper IUDs, it typically **increases menstrual flow** and may worsen menstrual pain. *Progestasert* - **Progestasert** was an early progesterone-releasing IUD that had a higher failure rate and a shorter lifespan (1 year) compared to newer LNG-IUDs. - While it aimed to reduce menstrual blood loss, its **overall efficacy and duration of action** were inferior to the LNG-20 system.

Question 1

Consider the following cardinal movements of mechanism of normal labor:

1. Engagement
2. Internal rotation
3. Flexion
4. Restitution
5. Crowning
6. External rotation

What is the correct sequence of movements in labor in occipito-lateral position?

Accepted Answer

1, 3, 2, 5, 4 and 6

Answer

3, 1, 2, 4, 6 and 5

Answer

1, 2, 3, 4, 5 and 6

Answer

2, 1, 3, 4, 5 and 6

Question 2

Which one of the following IUDs is associated with a low pregnancy rate (0.2 per 100), less number of ectopic pregnancies and lower menstrual blood loss?

Accepted Answer

LNG-20 (Mirena)

Answer

Cu T-380A

Answer

ML-Cu 375

Answer

Progestasert

UPSC-CMS 2020 — Obstetrics and Gynecology