Labor and Delivery — MCQs

Labor and Delivery Indian Medical PG Practice Questions and MCQs

Question 1051: Which of the following is an absolute indication for caesarean section?

A. Central placenta previa (Correct Answer)
B. Breech presentation
C. Bad obstetric history
D. Previous caesarean delivery

Explanation: ***Central placenta previa*** - This condition involves the **placenta completely covering the internal cervical os**, blocking the birth canal. - A vaginal delivery would lead to severe, life-threatening **hemorrhage** for both the mother and the fetus, making a C-section mandatory. *Breech presentation* - While many breech presentations are delivered by C-section, it is not an absolute indication. - In certain situations, such as **frank breech** with adequate maternal pelvis and experienced obstetrician, a **vaginal delivery can be attempted** after careful evaluation. *Bad obstetric history* - This refers to a history of adverse pregnancy outcomes, but it is a **relative indication** and not an absolute one for C-section. - The decision for C-section would depend on the **specific nature of the previous adverse outcomes** and current pregnancy complications. *Previous caesarean delivery* - A prior C-section is a very common indication for repeat C-section, but it is **not an absolute indication** for all subsequent deliveries. - Many women with a previous C-section can safely undergo a **trial of labor after cesarean (TOLAC)**, especially if the prior incision was a low transverse uterine incision.

Question 1052: Persistent OP position is most common in which pelvis?

A. Android pelvis
B. Gynaecoid pelvis
C. Anthropoid pelvis (Correct Answer)
D. Mixed pelvis

Explanation: ***Anthropoid pelvis*** - The **anthropoid pelvis** has an **oval-shaped inlet** with a **long anteroposterior diameter** and **narrow transverse diameter**. - This pelvic configuration is most commonly associated with **persistent occiput posterior (OP) position** because the narrow transverse diameter limits rotation, while the long AP diameter accommodates the fetal head in the OP or direct OA position. - The fetal head tends to engage and remain in the **direct OP or direct OA position** rather than rotating to the transverse position. - This is the **classic pelvic type associated with persistent OP delivery**. *Android pelvis* - The **android pelvis** has a heart-shaped or triangular inlet, narrow subpubic arch, and prominent ischial spines. - This pelvic type is associated with **difficult labor**, **transverse arrest**, and **deep transverse arrest** of the fetal head. - While it can cause malposition, it is more characteristically associated with **arrest disorders** rather than persistent OP position. *Gynaecoid pelvis* - The **gynaecoid pelvis** is the ideal and most common female pelvic type, with a rounded inlet, wide subpubic arch, and adequate dimensions. - This pelvic shape allows for **optimal fetal head rotation** from OP to OA position during labor. - Persistent OP position is **uncommon** with this pelvic type. *Mixed pelvis* - A **mixed pelvis** exhibits characteristics of more than one fundamental pelvic type. - The likelihood of persistent OP depends on which features predominate, but it is not a specific classic association.

Question 1053: Engagement of head in labour means?

A. Smallest horizontal plane of the presenting part has crossed the pelvic outlet
B. Greatest horizontal plane of the presenting part has crossed the pelvic outlet
C. Smallest diameter of the presenting part has crossed the pelvic brim
D. Largest diameter of the presenting part has crossed the pelvic brim (Correct Answer)

Explanation: ***Largest diameter of the presenting part has crossed the pelvic brim*** - **Engagement** is defined as the descent of the widest transverse diameter of the fetal presenting part (typically the **biparietal diameter** for a cephalic presentation) below the **pelvic inlet** or brim. - This signifies that the fetal head has successfully navigated the widest part of the maternal pelvis, indicating that the pelvis is generally adequate for vaginal delivery. *Smallest diameter of the presenting part has crossed the pelvic brim* - This statement is incorrect because engagement refers to the **widest** rather than the smallest diameter negotiating the pelvic inlet. - The smallest diameter crossing the brim would not be a definitive indicator of the head being truly engaged in the pelvis. *Smallest horizontal plane of the presenting part has crossed the pelvic outlet* - This option refers to the **pelvic outlet**, which is a later stage in labor after engagement has already occurred. - Furthermore, referring to the "smallest horizontal plane" is not the standard anatomical description for assessing engagement. *Greatest horizontal plane of the presenting part has crossed the pelvic outlet* - Similar to the previous option, this describes passage through the **pelvic outlet**, not engagement at the pelvic brim. - While "greatest horizontal plane" is closer to the concept of the widest diameter, its location at the outlet makes this definition incorrect for engagement.

Question 1054: Which of the following is NOT a contraindication for induction of labour?

A. Hypertensive disease of pregnancy (Correct Answer)
B. Heart disease of pregnancy
C. Pelvic tumor
D. Vasa previa

Explanation: ***Hypertensive disease of pregnancy*** - **Hypertensive disorders** including **preeclampsia** and **gestational hypertension** are actually **INDICATIONS for induction of labor**, not contraindications - **Delivery is the definitive treatment** for preeclampsia and is recommended when maternal or fetal risks outweigh the benefits of expectant management - Induction is frequently performed in these conditions to prevent progression to severe complications like **eclampsia**, **HELLP syndrome**, or **placental abruption** - This is the correct answer as it is NOT a contraindication *Heart disease of pregnancy* - Most women with heart disease can safely undergo induction of labor with appropriate cardiac monitoring and support - However, **severe decompensated heart disease** (NYHA Class III-IV), **severe pulmonary hypertension**, **severe aortic stenosis**, or **peripartum cardiomyopathy** may require special consideration - While not an absolute contraindication to induction, severe cardiac conditions may favor planned cesarean delivery to minimize cardiac stress - The statement is somewhat imprecise but represents conditions where induction requires careful evaluation *Pelvic tumor* - A **pelvic tumor obstructing the birth canal** is an **absolute contraindication** to vaginal delivery and therefore to induction of labor - Examples include large **cervical fibroids**, **ovarian masses**, or other pelvic masses preventing descent of the presenting part - **Cesarean section** is mandatory in such cases to avoid **obstructed labor** and potential **uterine rupture** *Vasa previa* - **Vasa previa** is an **absolute contraindication** to both induction of labor and vaginal delivery - Unprotected fetal vessels crossing the **internal cervical os** are at high risk of rupture during cervical dilation or membrane rupture - This would result in rapid **fetal exsanguination** and **fetal death** - Requires **elective cesarean section** at 36-37 weeks before onset of labor

Question 1055: Which is the engaging diameter in occipitoposterior presentation?

A. Suboccipitofrontal (Correct Answer)
B. Mento vertical
C. Submentovertical
D. Bitrochanteric

Explanation: ***Suboccipitofrontal*** - In an occipitoposterior presentation, the fetal head is usually deflexed, causing the **suboccipitofrontal diameter** (approximately 10 cm) to be the engaging diameter. - This diameter extends from the junction of the occiput and the neck to the anterior part of the forehead (glabella). *Mentovertical* - The **mentovertical diameter** is the engaging diameter in a brow presentation, which is typically around 13.5 cm and usually makes vaginal birth impossible. - This diameter extends from the chin to the very top of the head (vertex). *Submentovertical* - The **submentovertical diameter** is the engaging diameter in a face presentation, measuring about 11.5 cm. - This diameter extends from below the chin to the vertex of the head. *Bitrochanteric* - The **bitrochanteric diameter** refers to the width between the fetal **trochanters** (hips) and is relevant for breech presentations, but not for cephalic presentations. - It is typically around 10 cm and is not involved in head engagement.

Question 1056: What is the most common position of engagement in vertex presentation?

A. Left Occiput Anterior (LOA) (Correct Answer)
B. Right Occiput Anterior (ROA)
C. Right Occiput Posterior (ROP)
D. Left Occiput Posterior (LOP)

Explanation: ***Left Occiput Anterior (LOA)*** - This is the **most common** fetal position for engagement, as the fetal head's **occiput** aligns with the maternal pelvis's **left anterior quadrant**. - The **long axis** of the fetal head is generally aligned with the **oblique diameter** of the maternal pelvis, facilitating descent. *Right Occiput Anterior (ROA)* - While an anterior position, **LOA** is more common due to the typical orientation of the **uterus and fetal spine**. - The fetal occiput is in the **right anterior quadrant** of the maternal pelvis. *Right Occiput Posterior (ROP)* - This is a **malposition** that can lead to **prolonged labor** and increased pain due to direct pressure on the sacrum. - The fetal occiput is in the **right posterior quadrant** of the maternal pelvis. *Left Occiput Posterior (LOP)* - Similar to ROP, this is also a **malposition** that may require significant **rotation** for successful vaginal delivery. - The fetal occiput is in the **left posterior quadrant** of the maternal pelvis.

Question 1057: A multigravida patient with a 4 kg fetus has been in labor for 15 hours, with cervical dilation at 5 cm for the last 8 hours. What is the most appropriate management for this patient?

A. Cesarean section (Correct Answer)
B. Observe and monitor the patient
C. Perform amniotomy if indicated
D. Administer oxytocin for augmentation of labor

Explanation: ***Cesarean section*** - This patient is experiencing **arrest of active phase labor**, defined by no cervical change for ≥4 hours with adequate contractions, or ≥6 hours with inadequate contractions. With **8 hours of arrest at 5 cm**, this patient has exceeded both diagnostic thresholds, indicating **failure to progress**. - The presence of a **4 kg fetus (macrosomia)** in a multigravida who is not progressing despite adequate time suggests **cephalopelvic disproportion (CPD)**, making vaginal delivery unlikely to succeed. - Prolonged labor arrest significantly increases risks of **maternal exhaustion**, **chorioamnionitis**, **fetal distress**, and **postpartum hemorrhage**, making cesarean section the safest definitive management at this point. *Observe and monitor the patient* - Continued observation without intervention is inappropriate after **8 hours of cervical arrest**, as this far exceeds the diagnostic criteria for arrest of labor. - Further delay increases risks of **maternal morbidity** (infection, exhaustion, dehydration) and **fetal compromise** (acidosis, sepsis) without improving the likelihood of vaginal delivery. *Perform amniotomy if indicated* - Amniotomy can be used to **augment labor** and assess amniotic fluid for meconium, potentially shortening labor duration. - However, after **8 hours of arrest** with a likely **cephalopelvic disproportion** (4 kg fetus in arrested labor), amniotomy alone is insufficient and unlikely to resolve the underlying mechanical problem preventing descent and cervical dilation. *Administer oxytocin for augmentation of labor* - Oxytocin is appropriate for **augmenting inadequate contractions** in cases of protraction or early arrest of labor. - However, after **8 hours of arrest at 5 cm**, oxytocin would likely have already been attempted as part of active management. If labor has not progressed despite adequate time (exceeding the 6-hour threshold even with inadequate contractions), continuing oxytocin risks **uterine hyperstimulation**, **fetal distress**, and **uterine rupture** (especially in a multigravida) without achieving vaginal delivery given the probable CPD with a macrosomic fetus.

Question 1058: Which of the following is not typically given to a patient with preterm labor?

A. Tocolytic drugs
B. Antibiotics
C. Glucocorticoids
D. Beta blocker (Correct Answer)

Explanation: ***Beta blocker*** - **Beta blockers** are generally avoided in preterm labor because they can worsen **fetal bradycardia** and **neonatal hypoglycemia**. - They are not used to manage uterine contractions or promote fetal lung maturity. *Glucocorticoids* - **Glucocorticoids** (e.g., **betamethasone**) are administered to promote **fetal lung maturity** and reduce the risk of **respiratory distress syndrome** in preterm infants. - They are a crucial intervention in managing preterm labor. *Tocolytic drugs* - **Tocolytic drugs** (e.g., **nifedipine**, **terbutaline**) are used to **suppress uterine contractions** and delay delivery in preterm labor. - This allows time for glucocorticoids to take effect and for transfer to a facility with neonatal intensive care. *Antibiotics* - Although not routinely given to all patients with preterm labor, **antibiotics** are prescribed if there is evidence of an **intrauterine infection** or if the patient is positive for **Group B Streptococcus (GBS)**. - Infection can be a trigger for preterm labor, and treating it can help prolong pregnancy or prevent neonatal sepsis.

Question 1059: Which type of pelvis is most accommodating for the occipitoposterior position during labor?

A. Anthropoid (Correct Answer)
B. Android
C. Gynaecoid
D. Platypelloid

Explanation: ***Anthropoid*** - The **anthropoid pelvis** is characterized by a long anteroposterior diameter and a narrow transverse diameter, which allows the fetal head in an **occipitoposterior (OP) position** to accommodate more easily. - Its oval shape facilitates a direct anterior-posterior delivery, reducing the need for extensive rotation when the occiput is posterior. *Android pelvis* - The **android pelvis** is heart-shaped with a narrow pubic arch and reduced diameters, making it unfavorable for *any* fetal presentation, especially OP. - This pelvic type is associated with a higher incidence of **arrest of labor** and requires more interventions during delivery. *Gynaecoid* - The **gynaecoid pelvis** is considered the classic female pelvis, with a rounded inlet and good proportions for vaginal delivery in an **occipitoanterior (OA) position**. - While generally favorable, its broader transverse diameter makes accommodation of an OP position less optimal compared to the anthropoid pelvis. *Platypelloid* - The **platypelloid pelvis** has a flattened shape with a short anteroposterior diameter and a wide transverse diameter. - This shape is highly unfavorable for vaginal delivery, as it obstructs engagement and descent of the fetal head in both OA and OP positions, leading to complications.

Question 1060: A primigravida presents to the labor room at 40 weeks of gestation with lower abdominal pain. She has been in labor for 3 hours. Which of the following will determine if she is in active labor?

A. Fetal head 5/5 palpable on abdominal examination
B. Two contractions lasting for 10 seconds in 10 minutes
C. Rupture of membranes
D. Cervical dilatation of 6 cm or more with regular contractions (Correct Answer)

Explanation: ***Cervical dilatation of 6 cm or more with regular contractions*** - Active labor is officially defined by **cervical dilatation of 6 cm or more** according to the ACOG and SMFM 2014 consensus guidelines, which redefined the labor curve based on the Consortium on Safe Labor study. - This represents a shift from the traditional Friedman curve definition of 4 cm, recognizing that **significant progressive cervical change** with regular uterine contractions is the hallmark of active labor. - Complete effacement typically occurs during the latent phase, and while regular contractions accompany active labor, **cervical dilatation ≥6 cm is the primary diagnostic criterion**. *Fetal head 5/5 palpable on abdominal examination* - This finding indicates a **high fetal head** that is not engaged (0/5 of the head has entered the pelvis), which does not determine whether active labor has begun. - **Fetal station and engagement** are important for assessing labor progression and potential for cephalopelvic disproportion, but are not the primary criteria for diagnosing active labor. *Two contractions lasting for 10 seconds in 10 minutes* - These contractions are **infrequent and very short**, more characteristic of latent labor or Braxton Hicks contractions. - Active labor typically involves **3-5 contractions in 10 minutes, each lasting 45-60 seconds**, with sufficient intensity to cause progressive cervical change. *Rupture of membranes* - **Rupture of membranes (ROM)**, whether spontaneous or artificial, is an important event but does not by itself indicate active labor. - A woman can have ROM in the **latent phase** or even before labor begins (prelabor ROM or PROM), and **cervical dilatation remains the primary determinant** of active labor.

Practice by Chapter

Physiology of Labor

Practice Questions

Stages of Labor and Normal Progression

Practice Questions

Fetal Monitoring Techniques

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Pain Management in Labor

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Induction and Augmentation of Labor

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Operative Delivery (Forceps and Vacuum)

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Cesarean Section: Indications and Techniques

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Dystocia and Abnormal Labor Patterns

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Obstetric Emergencies

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Postpartum Hemorrhage Management

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