Labor and Delivery Practice Questions

Q: Hypertonic dysfunctional labor is characterized by which of the following?

Fetal distress occurs early. **Explanation:** **Hypertonic dysfunctional labor** (also known as colicky uterus or incoordinate uterine action) is characterized by an increase in resting uterine tone (tonus) and frequent, irregular, and painful contractions that are ineffective at dilating the cervix. 1. **Why Option A is correct:** In hypertonic labor, the basal tone of the uterus remains high between contractions. This constant pressure compresses the intramural vessels, significantly reducing placental perfusion and intervillous blood flow. Because the fetus does not receive adequate oxygenation during the "relaxation" phase (which is absent or incomplete), **fetal distress occurs early** in the course of labor. 2. **Why the other options are incorrect:** * **Option B:** The reaction to oxytocin is not variable; it is **contraindicated**. Oxytocin increases uterine tone further, which can lead to uterine rupture or total fetal asphyxia. * **Option C:** **Sedation is the primary treatment.** Morphine or pethidine helps provide rest, relieves pain, and often resets the uterine rhythm, allowing the patient to wake up in normal labor or with the hypertonicity resolved. * **Option D:** It is **less common** than hypotonic labor. Hypotonic dysfunction (weak, infrequent contractions) is the most common type of primary power failure in labor. **High-Yield Clinical Pearls for NEET-PG:** * **Definition:** Resting tone rises above the normal 10 mmHg (often >20 mmHg). * **Patient Profile:** More common in primigravidae and associated with an "anxious" personality. * **Clinical Sign:** The uterus is tender to touch and does not relax between contractions (unlike hypotonic labor where the uterus is soft). * **Management:** Therapeutic rest (Sedation), hydration, and excluding Cephalopelvic Disproportion (CPD). If distress persists, Cesarean Section is indicated.

Q: Which of the following is NOT a technique for delivering the aftercoming head in a breech presentation?

Lobst's maneuver. In breech presentation, the delivery of the aftercoming head is the most critical stage. The correct answer is **Lobst's maneuver** because it is used for the **delivery of extended arms**, not the head. ### Explanation of Options: * **Lobst’s Maneuver (Correct Answer):** This technique involves rotating the fetus 180 degrees while maintaining downward traction to bring the posterior arm to the anterior position, allowing for the delivery of extended arms. Since it addresses the shoulders/arms, it is not a technique for the head. * **Burns-Marshall Method:** A classic technique where the baby is allowed to hang by its own weight to encourage flexion. Once the nape of the neck is visible, the feet are grasped and swept in a wide arc over the mother’s abdomen to deliver the head. * **Modified Mauriceau-Smellie-Viet (MSV) Technique:** Considered the most common manual method. It uses malar flexion (fingers on the cheekbones) and fetal body support on the clinician's forearm to maintain flexion of the head during delivery. * **Forceps Delivery:** **Piper’s forceps** are specifically designed for the aftercoming head. They have a long perineal curve to reach the head while the body is held aloft. ### High-Yield Clinical Pearls for NEET-PG: * **Prerequisite for Head Delivery:** The most important factor is maintaining **flexion** of the fetal head. * **Wigand-Martin-Winckel Maneuver:** Another method for the head where one hand is in the vagina (on the jaw) and the other hand applies suprapubic pressure. * **Pinard’s Maneuver:** Used for bringing down the legs in a frank breech. * **Løvset Maneuver:** Often confused with Lobst; Løvset involves rotation and traction to deliver the shoulders.

Q: Which pelvic plane is most important in obstructed labor?

Plane of least pelvic dimension. ### Explanation The **Plane of Least Pelvic Dimension** (also known as the **Mid-pelvis**) is the most critical plane in obstructed labor because it is the narrowest part of the pelvic canal through which the fetal head must pass. **1. Why the Correct Answer is Right:** The plane of least pelvic dimension is bounded anteriorly by the lower border of the symphysis pubis, laterally by the **ischial spines**, and posteriorly by the tip of the sacrum. Because the interspinous diameter (approx. 10.5 cm) is the shortest diameter of the entire pelvis, this plane represents the most common site of **arrest of descent**. Internal rotation of the fetal head typically occurs at this level; failure to rotate or descend through this "bottleneck" results in obstructed labor. **2. Why the Other Options are Incorrect:** * **Plane of Inlet (A):** While "cephalopelvic disproportion" can occur here, the inlet is generally wider (transverse diameter ~13 cm). If the head engages, the inlet is bypassed. * **Plane of Outlet (B):** The outlet is diamond-shaped and consists of two muscle-bound triangles. It is rarely the primary site of obstruction unless there is a severe coccygeal deformity or an extremely narrow pubic arch. * **Plane of Greatest Pelvic Dimension (C):** As the name suggests, this is the roomiest part of the pelvis (extending from the mid-symphysis to the junction of S2-S3). Obstruction never occurs here. **3. NEET-PG High-Yield Pearls:** * **Obstetric Conjugate:** The most important diameter of the pelvic **inlet** (measured as Diagonal Conjugate minus 1.5–2 cm). * **Station Zero:** The fetal bony vertex is at the level of the **ischial spines** (Plane of least dimension). * **Mid-pelvic Contraction:** Suspected if the interspinous diameter is <10 cm. * **Clinical Landmark:** The ischial spines are the landmarks for administering a **pudendal nerve block**.

Q: Which of the following drugs is contraindicated for controlling atonic hemorrhage in a preeclamptic woman?

Methylergonovine. **Explanation:** The management of Postpartum Hemorrhage (PPH) in a patient with preeclampsia requires careful selection of uterotonics to avoid exacerbating underlying hypertension. **Why Methylergonovine is the Correct Answer:** Methylergonovine (Methergine), an ergot alkaloid, acts directly on the smooth muscles of the uterus and blood vessels. Its primary side effect is **generalized vasoconstriction**, which can lead to a sudden and severe increase in blood pressure (hypertensive crisis), stroke, or myocardial infarction. In a preeclamptic patient who already has compromised vascular resistance and endothelial dysfunction, Methylergonovine is **strictly contraindicated**. **Analysis of Incorrect Options:** * **Oxytocin (Option A):** This is the first-line drug for PPH in all patients, including those with preeclampsia. It causes rhythmic uterine contractions without significant effects on blood pressure when given as a slow infusion. * **Misoprostol (Option B):** A PGE1 analogue that is safe in hypertensive patients. It is typically administered sublingually or rectally and does not affect blood pressure. * **PGF2 alfa (Carboprost) (Option D):** This is a potent uterotonic used when oxytocin fails. While it is **contraindicated in asthmatics** (due to bronchoconstriction), it is safe to use in preeclamptic patients as it does not significantly elevate systemic blood pressure. **High-Yield Clinical Pearls for NEET-PG:** * **Methergine Contraindication:** Hypertension/Preeclampsia/Eclampsia. * **Carboprost (PGF2α) Contraindication:** Asthma. * **Misoprostol (PGE1) Contraindication:** Known hypersensitivity (generally safe in most systemic diseases). * **Active Management of Third Stage of Labor (AMTSL):** Oxytocin (10 IU IM) is the drug of choice. * **Ergotism:** Chronic toxicity of ergot alkaloids leading to gangrene (due to vasoconstriction) or convulsions.

Q: What is the treatment of choice in a primigravida at term in labor with a transverse lie and cervical dilatation of 6 cm with intact membranes?

Lower segment cesarean section. **Explanation:** In a **primigravida** at term with a **transverse lie**, the fetus cannot be delivered vaginally. Once labor has commenced (indicated here by 6 cm cervical dilatation), the risk of complications such as cord prolapse or obstructed labor with impending uterine rupture increases significantly. **1. Why Lower Segment Cesarean Section (LSCS) is the Correct Choice:** For a transverse lie at term in labor, **LSCS is the treatment of choice**. In a primigravida, the uterus is non-compliant, and the risk of uterine rupture during any intrauterine manipulation is high. Since the patient is already in active labor (6 cm), external cephalic version is contraindicated. LSCS ensures the safety of both the mother and the fetus by avoiding the trauma of obstructed labor. **2. Why Other Options are Incorrect:** * **Wait and watch:** A transverse lie is an absolute mechanical obstruction. Waiting will lead to "neglected shoulder presentation," cord prolapse, or uterine rupture. * **Internal Podalic Version (IPV):** IPV is strictly contraindicated in a singleton pregnancy at term with a live fetus. It is currently only indicated for the delivery of the **second twin** (non-vertex). * **Bipolar Version:** This is an obsolete procedure (MacDonald’s version) used in the past for placenta previa or to bring down a foot; it has no role in modern obstetric management of transverse lie. **Clinical Pearls for NEET-PG:** * **Most common cause** of transverse lie in primigravida: Pelvic contraction or placenta previa. * **Management of Transverse Lie:** * *Not in labor:* External Cephalic Version (ECV) can be attempted after 37 weeks. * *In labor:* Always LSCS (regardless of whether membranes are intact or ruptured). * **The "Hand-Prolapse":** If you see a hand prolapsing through the vagina in labor, the diagnosis is transverse lie; the immediate step is LSCS.

Q: What is the most common cause of breech presentation?

Prematurity. **Explanation:** **1. Why Prematurity is the Correct Answer:** The most significant factor determining fetal presentation is the relationship between fetal size and amniotic fluid volume. In early pregnancy, the fetus is small relative to the volume of liquor, allowing for free movement. As the pregnancy advances towards term, the fetus grows and the "Law of Accommodation" takes effect: the fetus maneuvers to fit its bulkier part (the buttocks and lower limbs) into the wider fundus of the uterus, while the smaller head engages in the narrower lower segment. Since the majority of fetuses spontaneously version to cephalic by 34 weeks, any delivery occurring before this time (prematurity) is statistically the most common cause of breech presentation. At 28 weeks, approximately 25% of fetuses are breech, whereas only 3-4% remain breech at term. **2. Analysis of Incorrect Options:** * **Contracted Pelvis:** While a narrow pelvis can prevent the head from engaging (leading to malpresentation), it is a much rarer clinical finding compared to the frequency of preterm births. * **Oligohydramnios:** Reduced amniotic fluid actually restricts fetal movement. While it can "trap" a fetus in a breech position if it is already there, it is not the *most common* cause. * **Placenta Previa:** A low-lying placenta can occupy the lower uterine segment, preventing the head from entering the pelvis. While a recognized risk factor, it occurs in less than 1% of pregnancies. **3. NEET-PG High-Yield Pearls:** * **Most common type of breech:** Frank breech (especially in primigravidae at term). * **Most common cause of breech at term:** Idiopathic. * **Best time for External Cephalic Version (ECV):** 36 weeks in primigravida; 37 weeks in multigravida. * **Prerequisite for vaginal breech delivery:** Spontaneous onset of labor, frank breech, and an estimated fetal weight between 2.5kg and 3.5kg.

Question 1

Which of the following statements related to rupture uterus is incorrect?

Accepted Answer

The risk of lower segment scar rupture is high compared to classical scar rupture.

Answer

A lower segment scar rarely ruptures during pregnancy.

Answer

In incomplete rupture, the peritoneal coat remains intact.

Answer

A classical caesarean scar often ruptures during late pregnancy.

Question 2

Which of the following statements is true regarding the relaxation of pelvic joints at term in pregnancy?

Accepted Answer

Displacement of the sacroiliac joint increases outlet diameters by 1.5 to 2.0 cm in the dorsal lithotomy position.

Answer

It is permanent and not accentuated in subsequent pregnancies.

Answer

It allows for an increase in the transverse diameter of the mid-pelvis.

Answer

It results in marked mobility of the pelvis at term because of a downward gliding movement of the sacroiliac joint.

Question 3

Hypertonic dysfunctional labor is characterized by which of the following?

Accepted Answer

Fetal distress occurs early

Answer

Reaction to oxytocin is variable

Answer

Sedation is of little value

Answer

Occurs more frequently than hypotonic labor

Question 4

Which of the following is NOT a technique for delivering the aftercoming head in a breech presentation?

Accepted Answer

Lobst's maneuver

Answer

Burns-Marshall method

Answer

Forceps delivery

Answer

Modified Mauriceau-Smellie-Viet technique

Question 5

Which pelvic plane is most important in obstructed labor?

Accepted Answer

Plane of least pelvic dimension

Answer

Plane of inlet

Answer

Plane of outlet

Answer

Plane of greatest pelvic dimension

Question 6

Inversion of the uterus is not caused by which of the following?

Accepted Answer

Controlled cord traction

Answer

Undue fundal pressure

Answer

Fundal attachment of placenta

Answer

Faulty placental extraction

Question 7

Which of the following drugs is contraindicated for controlling atonic hemorrhage in a preeclamptic woman?

Accepted Answer

Methylergonovine

Answer

Oxytocin

Answer

Misoprostol

Answer

PGF2 alfa

Question 8

All of the following are features of obstructed labor, except?

Accepted Answer

Unruptured membranes present

Answer

Hot dry vagina

Answer

Bandl's Ring

Answer

Tonic contracted uterus

Question 9

What is the treatment of choice in a primigravida at term in labor with a transverse lie and cervical dilatation of 6 cm with intact membranes?

Accepted Answer

Lower segment cesarean section

Answer

Wait and watch until full dilation of the cervix

Answer

Internal podalic version and breech extraction

Answer

Bipolar version

Question 10

What is the most common cause of breech presentation?

Accepted Answer

Prematurity

Answer

Contracted pelvis

Answer

Oligohydramnios

Answer

Placenta previa

Labor and Delivery — MCQs

Labor and Delivery — MCQs

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