Labor and Delivery Practice Questions

Q: Which of the following is not an etiology of umbilical cord prolapse?

Dextrorotated uterus. **Explanation:** Umbilical cord prolapse occurs when the cord descends below or alongside the presenting part after the rupture of membranes. The fundamental pathophysiology involves a **poor fit** between the presenting part and the pelvic inlet, leaving space for the cord to slip through. **1. Why Dextrorotated Uterus is the Correct Answer:** Dextrorotation (the slight clockwise rotation of the uterus toward the right due to the presence of the rectosigmoid colon on the left) is a **normal physiological finding** in pregnancy. It does not interfere with the engagement of the fetal head or create gaps at the pelvic inlet; therefore, it is not an etiological factor for cord prolapse. **2. Analysis of Incorrect Options:** * **Contracted Pelvis:** This prevents the fetal head from engaging properly in the pelvic brim. The resulting "high-floating" head leaves ample space for the cord to prolapse when membranes rupture. * **Hydramnios:** The excessive volume of amniotic fluid creates high hydrostatic pressure. When membranes rupture, the sudden gush of fluid can wash the cord down past the presenting part. * **Placenta Previa:** A low-lying placenta can physically prevent the presenting part from deeply engaging in the lower uterine segment, creating a gap that predisposes to cord prolapse. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause:** Malpresentations (specifically Footling Breech). * **Most common fetal presentation associated:** Transverse lie. * **Immediate Management:** Place the patient in the **Trendelenburg or Knee-chest position** and manually displace the presenting part upward to relieve cord compression until an emergency Cesarean section can be performed. * **Diagnosis:** Sudden fetal bradycardia or variable decelerations following the rupture of membranes should always raise suspicion of cord prolapse.

Q: Which prostaglandin helps in cervical ripening?

Prostaglandin E2 (PGE2). **Explanation:** **Prostaglandin E2 (PGE2)**, also known as **Dinoprostone**, is the gold standard pharmacological agent used for cervical ripening. Cervical ripening involves the biochemical breakdown of collagen fibers and an increase in submucosal water content (glycosaminoglycans), which softens and thins the cervix (effacement). PGE2 acts by stimulating the enzyme collagenase and altering the extracellular matrix, making the cervix favorable for induction of labor. **Analysis of Options:** * **Prostaglandin E2 (PGE2):** Correct. It specifically targets cervical connective tissue. Common clinical forms include intracervical gels (Prepidil) or vaginal inserts (Cervidil). * **Prostaglandin F2α (PGF2α):** Incorrect. While it is a potent uterine stimulant (oxytocic), its primary clinical use is in the management of **Postpartum Hemorrhage (PPH)** (e.g., Carboprost) due to its ability to cause strong myometrial contractions. It is not used for ripening. * **Prostaglandin I2 (PGI2):** Also known as Prostacyclin. It is a potent vasodilator and inhibitor of platelet aggregation; it does not play a role in cervical ripening. * **Prostaglandin D2 (PGD2):** This is primarily involved in allergic and inflammatory responses (mast cell mediator) and sleep regulation, with no role in obstetrics. **High-Yield Clinical Pearls for NEET-PG:** * **PGE1 (Misoprostol):** Also used for cervical ripening and induction. It is cheaper and more stable than PGE2 but carries a higher risk of uterine tachysystole. * **Bishop Score:** The clinical tool used to assess the "readiness" of the cervix. A score of **≤6** indicates an unripe cervix, necessitating the use of PGE2. * **Contraindication:** Prostaglandins should be avoided in patients with a previous Cesarean section due to the increased risk of **uterine rupture**.

Q: Physiological chill in labour is typically seen in which stage?

Third stage. **Explanation:** The correct answer is **C. Third stage**. **Physiological Chill in Labour:** A physiological chill (shivering) is a common, non-pathological phenomenon observed in approximately 25–50% of women immediately following the delivery of the fetus, which marks the beginning of the **third stage of labor**. The underlying medical mechanism is multifactorial: 1. **Fetomaternal Transfusion:** Small amounts of fetal blood enter the maternal circulation during placental separation, causing a mild immunological reaction. 2. **Thermal Loss:** Rapid loss of body heat occurs due to the delivery of the warm fetus and amniotic fluid, alongside the evaporation of sweat. 3. **Hormonal/Neurological Shift:** The sudden decrease in intra-abdominal pressure and the rapid shift in fluid compartments (autotransfusion from the uterus) trigger a sympathetic nervous system response. **Analysis of Incorrect Options:** * **First Stage (A):** This stage involves cervical effacement and dilation. While maternal exhaustion or anxiety may occur, the specific "physiological chill" related to placental separation is not characteristic here. * **Second Stage (B):** This is the stage of fetal expulsion. The mother is usually physically active ("pushing"), which generates metabolic heat, making a chill unlikely during this phase. * **Fourth Stage (D):** This is the hour following placental delivery (observation period). While shivering can persist into this stage, it typically *originates* in the third stage. **NEET-PG High-Yield Pearls:** * **Management:** Reassurance and warm blankets are sufficient. It does not require antibiotics unless accompanied by a high-grade fever (suggestive of chorioamnionitis). * **Third Stage Duration:** Usually lasts 5–15 minutes; it is considered "prolonged" if it exceeds 30 minutes. * **Most Common Cause of PPH:** Atony of the uterus (occurs in the third/fourth stage).

Q: In the Bishop score, which of the following components is NOT included?

Interspinal diameter. The **Bishop Score** (also known as the Pelvic Score) is a clinical tool used to assess the "ripeness" of the cervix and predict the likelihood of a successful vaginal delivery following the induction of labor. ### Why "Interspinal Diameter" is the Correct Answer The Bishop score evaluates five specific parameters related to the **cervix** and the **position of the fetus** within the birth canal. **Interspinal diameter** refers to the distance between the ischial spines (part of the pelvic outlet assessment) and is a fixed anatomical measurement of the maternal pelvis. It does not change during the onset of labor and is therefore not a component of the Bishop score. ### Explanation of Incorrect Options The five components of the Bishop score are: * **Dilatation of the cervix (Option B):** Measures how open the cervix is (0 to >5 cm). * **Effacement of the cervix (Option A):** Measures the thinning/shortening of the cervix (0 to >80%). * **Station of the fetal head (Option C):** Measures the descent of the fetal presenting part relative to the ischial spines (-3 to +2). * **Consistency of the cervix:** Categorized as firm, medium, or soft. * **Position of the cervix:** Categorized as posterior, mid-position, or anterior. ### High-Yield Clinical Pearls for NEET-PG * **Mnemonic:** To remember the components, use **"St. Bishop's CPD"** (Station, Consistency, Position, Dilatation, Effacement). * **Scoring:** Each component is scored 0–2 or 0–3, with a maximum total score of **13**. * **Interpretation:** * A score of **≥8** suggests a "ripe" cervix with a high probability of successful induction (similar to spontaneous labor). * A score of **≤6** suggests an "unripe" cervix, often requiring cervical ripening agents (e.g., Dinoprostone/PGE2) before induction. * **Modified Bishop Score:** Often replaces effacement (in %) with **cervical length (in cm)** for easier clinical measurement.

Q: Which of the following is the most probable cause for the deceleration shown below?

Head Compression. ***Head Compression*** - **Early decelerations** show a characteristic **mirror-image pattern** with uterine contractions, caused by fetal head compression during contractions triggering a **vagal reflex**. - These decelerations are **gradual** in onset and recovery, considered **benign**, and do not indicate fetal compromise. *Cord Compression* - Causes **variable decelerations** with **abrupt onset and recovery**, often described as having a **W or V shape** on CTG. - These decelerations are **unpredictable** in timing and do not follow the contraction pattern like early decelerations do. *Fetal Hypoxia* - Results in **late decelerations** due to **uteroplacental insufficiency**, showing gradual onset but **delayed recovery** after contractions end. - These are **ominous signs** indicating fetal acidosis and require immediate intervention, unlike the benign nature of early decelerations. *Feto-Maternal Hemorrhage* - Typically causes **sinusoidal pattern** on CTG with smooth, undulating baseline resembling a **sine wave**. - Associated with severe fetal anemia and does not produce the **mirror-image deceleration pattern** seen with head compression.

Q: Which of the following is a sign of placental separation in stage III of labor?

Gushing of blood. ### Explanation The third stage of labor begins after the delivery of the fetus and ends with the expulsion of the placenta. Placental separation occurs due to the sudden reduction in uterine size, leading to a shearing force at the decidua-placental interface. **Why Option A is Correct:** As the placenta detaches from the uterine wall, the retroplacental hematoma (formed between the decidua and the placenta) escapes through the cervix. This results in a **sudden gush of blood**, which is one of the classic clinical signs of separation. **Analysis of Incorrect Options:** * **B. Discoid uterus:** Upon separation, the uterus changes from a flat, **discoid shape** to a firm, **globular shape**. It also rises in the abdomen (Schroeder’s sign) because the placenta moves into the lower uterine segment. * **C. Filling of placenta in vagina:** While the placenta eventually enters the vagina, the clinical sign of separation is the **lengthening of the umbilical cord** at the vulva (modified Brandt-Andrews maneuver), indicating the placenta has descended from the uterus. * **D. Increase in blood pressure:** Hemodynamic changes in the third stage are usually minimal unless there is significant postpartum hemorrhage (PPH), which would cause a *decrease* in blood pressure, not an increase. **High-Yield Clinical Pearls for NEET-PG:** * **Classic Signs of Placental Separation:** 1. **Globular shape** of the uterus (most reliable). 2. **Gush of blood.** 3. **Permanent lengthening of the cord** (does not retract when the uterus is pushed up). 4. **Suprapubic bulge** (due to placenta in the lower segment). * **Management:** Active Management of Third Stage of Labor (AMTSL) is the gold standard to prevent PPH, involving prophylactic oxytocin, controlled cord traction (CCT), and uterine massage.

Q: A 32-week pregnant female with preterm contractions was treated with tocolytic agents. She further developed pulmonary edema. Which of the following tocolytic agents is most likely to have caused pulmonary edema in this patient?

Ritodrine. **Explanation:** The correct answer is **Ritodrine**. **1. Why Ritodrine is correct:** Ritodrine is a **Beta-2 adrenergic agonist**. While it works as a tocolytic by relaxing the uterine smooth muscle, it also has significant Beta-1 stimulatory effects. This leads to tachycardia, increased cardiac output, and sodium/water retention. When administered intravenously (especially alongside corticosteroids for fetal lung maturity or large volumes of IV fluids), it can lead to **pulmonary edema**. This occurs due to a combination of fluid overload and increased capillary permeability. **2. Why the other options are incorrect:** * **Nifedipine (Calcium Channel Blocker):** Currently the first-line tocolytic. Its main side effects are hypotension, flushing, and headache. While rare cases of pulmonary edema are reported, it is significantly less common than with Beta-mimetics. * **Indomethacin (NSAID):** Works by inhibiting prostaglandin synthesis. Its primary concerns are fetal (premature closure of the ductus arteriosus and oligohydramnios), not maternal pulmonary edema. * **Atosiban (Oxytocin Receptor Antagonist):** Known for having the fewest maternal side effects. It is highly specific to the uterus and does not typically cause cardiovascular or pulmonary complications. **Clinical Pearls for NEET-PG:** * **Drug of Choice (DOC):** Nifedipine is the current DOC for tocolysis (24–34 weeks). * **Beta-mimetics (Ritodrine/Terbutaline) Contraindications:** Maternal cardiac disease, uncontrolled hyperthyroidism, and uncontrolled diabetes (due to risk of hyperglycemia and hypokalemia). * **Magnesium Sulfate:** Used for neuroprotection (<32 weeks); toxicity presents with loss of knee jerk reflex (first sign) and respiratory depression. * **Atosiban:** Though expensive, it is the safest tocolytic for patients with multiple pregnancies or cardiac comorbidities.

Question 1

Of the following events in labor and delivery, arrange them in their correct sequence of appearance:

Accepted Answer

Engagement, Descent, Flexion, Internal Rotation, Delivery by Extension, Restitution, External Rotation

Answer

Engagement, Flexion, Descent, Delivery by Extension, Internal Rotation, External Rotation, Restitution

Answer

Engagement, Flexion, Delivery by Extension, Descent, Delivery by Extension, Restitution, External Rotation

Answer

Descent, Engagement, Flexion, Delivery by Extension, Internal Rotation, Restitution, External Rotation

Question 2

Which of the following is not an etiology of umbilical cord prolapse?

Accepted Answer

Dextrorotated uterus

Answer

Contracted pelvis

Answer

Hydramnios

Answer

Placenta previa

Question 3

Which prostaglandin helps in cervical ripening?

Accepted Answer

Prostaglandin E2 (PGE2)

Answer

Prostaglandin I2 (PGI2)

Answer

Prostaglandin F2 (PGF2)

Answer

Prostaglandin D2 (PGD2)

Question 4

Physiological chill in labour is typically seen in which stage?

Accepted Answer

Third stage

Answer

First stage

Answer

Second stage

Answer

Fourth stage

Question 5

What is the most common cause of vulval hematoma?

Accepted Answer

Episiotomy

Answer

Vaginal vault rupture

Answer

Lower segment uterine rupture

Answer

Rupture of paravaginal sinuses

Question 6

In the Bishop score, which of the following components is NOT included?

Accepted Answer

Interspinal diameter

Answer

Effacement of the cervix

Answer

Dilatation of the cervix

Answer

Station of the fetal head

Question 7

Which of the following is the most probable cause for the deceleration shown below?

Accepted Answer

Head Compression

Answer

Cord Compression

Answer

Fetal Hypoxia

Answer

Feto-Maternal Hemorrhage

Question 8

Which of the following is a sign of placental separation in stage III of labor?

Accepted Answer

Gushing of blood

Answer

Discoid uterus

Answer

Filling of placenta in vagina

Answer

Increase in blood pressure

Question 9

The usual site of spontaneous rupture of the intact uterus during pregnancy is the:

Accepted Answer

Body of the uterus

Answer

Anterior lower uterine segment

Answer

Posterior lower uterine segment

Answer

Level of internal os

Question 10

A 32-week pregnant female with preterm contractions was treated with tocolytic agents. She further developed pulmonary edema. Which of the following tocolytic agents is most likely to have caused pulmonary edema in this patient?

Accepted Answer

Ritodrine

Answer

Nifedipine

Answer

Indomethacin

Answer

Atosiban

Labor and Delivery — MCQs

Labor and Delivery — MCQs

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