Labor and Delivery Practice Questions

Q: What is the name of this manoeuvre?

Ritgen. ***Ritgen*** - The Ritgen maneuver involves applying pressure to the fetal chin through the perineum while simultaneously applying pressure to the occiput, which helps to control the **expulsion of the fetal head** and prevent perineal tears. - This maneuver assists in extending the head, guiding it through the birth canal, and protecting the maternal perineum. *Pinard* - The Pinard maneuver is used in **breech delivery** to deliver the fetal legs by abducting and flexing the thigh while exerting pressure in the popliteal fossa. - This maneuver is not applicable to a cephalic presentation, as depicted in the image. *Loveset* - The Loveset maneuver is primarily used in **breech deliveries** to rotate the fetal trunk and deliver the anterior arm first, followed by the posterior arm. - This technique is specifically for managing the arms during a breech extraction, which is not shown here. *Burns Marshall* - The Burns Marshall maneuver is another technique for delivering the aftercoming head in a **breech delivery**, where the baby's body is held in the supine position and allowed to hang, facilitating the delivery of the head by gravity and gentle traction. - This maneuver is only relevant for breech presentations and not for the cephalic presentation illustrated.

Q: Identify the presentation shown below:

Complete breech. ***Complete breech*** - In a **complete breech** presentation, both the baby's hips and knees are **flexed**, allowing the feet to be positioned near the buttocks. - The image clearly shows the infant's knees bent and feet tucked close to the body, which is characteristic of this presentation. - This represents approximately 25% of all breech presentations. *Frank breech* - In a **frank breech** presentation, the baby's hips are flexed, but the knees are **extended**, causing the legs to be positioned straight up towards the head. - The image does not show extended knees; instead, both knees are visibly flexed. - Frank breech is the most common type, occurring in 65-70% of breech presentations. *Incomplete breech* - An **incomplete breech** (also called footling breech) occurs when one or both hips are not fully flexed, allowing one foot or knee to present below the buttocks. - This differs from the image, which shows both hips and knees fully flexed with feet tucked near the buttocks rather than presenting downward. - Incomplete breech accounts for about 10% of breech presentations. *Footling presentation* - A **footling presentation** is a type of incomplete breech where one or both of the baby's feet are positioned to deliver first. - The image clearly shows the feet tucked up near the buttocks in a flexed position rather than extended downwards or presenting first.

Q: According to the Caldwell-Moloy classification, which of the following pelvic types is the LEAST common in women?

Platypelloid. ***Platypelloid*** - The **platypelloid pelvis** is characterized by a **flattened oval inlet** with a short anteroposterior diameter and wide transverse diameter, making it the **least common** type in women at only **3-5%** prevalence. - This pelvis type poses significant **obstetric challenges** due to the reduced anteroposterior diameter, leading to difficulties in fetal head **engagement and descent** during labor. *Gynecoid* - The **gynecoid pelvis** is the **most common** type, found in approximately **50%** of women, and represents the **ideal pelvis for childbirth**. - It features a **round or slightly oval inlet** with wide sacrosciatic notch and subpubic angle, facilitating smooth **vaginal delivery**. *Anthropoid* - The **anthropoid pelvis** has an **oval inlet** that is longer in the **anteroposterior diameter** than the transverse, occurring in about **20-30%** of women. - This type can accommodate successful vaginal delivery, often with the fetus in an **occipitoposterior position** due to the elongated anteroposterior dimension. *Android* - The **android pelvis** is characterized by a **heart-shaped inlet** and **narrow subpubic angle**, found in approximately **20-30%** of female pelves. - It is associated with more **difficult labor** due to the narrow mid-pelvis and **convergent side walls**, which can impede fetal descent.

Q: The following CTG tracing shows:

Late deceleration. ***Late deceleration*** - This tracing shows a **fetal heart rate (FHR) deceleration** that begins **after the onset of the uterine contraction** and recovers after the contraction ends. - This pattern is characteristic of **uteroplacental insufficiency** and indicates fetal hypoxia. *Early deceleration* - **Early decelerations** mirror the contractions, beginning and ending with the uterine contraction, and are typically due to **head compression**. - The FHR decrease in early decelerations starts at or just before the peak of the contraction, unlike the tracing shown. *Sinusoidal pattern* - A **sinusoidal pattern** is a smooth, undulating wave-like FHR with fixed amplitude and frequency, usually associated with severe fetal anemia or hypoxia. - The tracing here shows discrete drops in FHR, not a continuous wave-like pattern. *Variable deceleration* - **Variable decelerations** are characterized by an **abrupt decrease in FHR**, variable in shape, duration, and depth, and are often unrelated to the timing of uterine contractions. - They are typically associated with **umbilical cord compression**, which is not indicated by the uniform and consistent pattern seen here.

Q: The following CTG shows:

Variable deceleration. ***Variable deceleration*** - This CTG shows **abrupt decreases** in fetal heart rate (FHR) that are **variable in their onset, depth, and duration**, which is characteristic of variable decelerations. - The FHR tracing drops sharply and then recovers quickly, often not directly coinciding with uterine contractions (which are not shown here but understood to be present with decelerations). *Early deceleration* - **Early decelerations** are typically **gradual, symmetrical decreases** in FHR that **mirror uterine contractions**, with the nadir of the deceleration coinciding with the peak of the contraction. - They are considered **benign** and usually indicate **fetal head compression**. *Late deceleration* - **Late decelerations** are **gradual, symmetrical decreases** in FHR that begin **after the peak of the uterine contraction** and recover only after the contraction has ended. - This pattern is associated with **uteroplacental insufficiency** and indicates fetal hypoxia. *Sinusoidal pattern* - A **sinusoidal pattern** is characterized by a **smooth, undulating FHR baseline** with a frequency of 2-5 cycles per minute and an amplitude of 5-15 bpm. - It suggests severe fetal anemia or hypoxia and is distinctly different from the abrupt, irregular drops seen in the given CTG.

Q: The following CTG shows:

Early deceleration. ***Early deceleration*** - This CTG shows a **deceleration** in fetal heart rate that mirrors the uterine contraction. The drop in FHR begins with the contraction, reaches its lowest point at the peak of the contraction, and recovers by the end of the contraction. - Early decelerations are usually **benign** and are caused by **head compression** during contractions, which leads to a vagal response. *Late deceleration* - **Late decelerations** begin after the peak of the contraction and return to baseline only after the contraction has ended. - They are often associated with **uteroplacental insufficiency** and can indicate fetal hypoxia. *Sinusoidal pattern* - A **sinusoidal pattern** is characterized by a smooth, sine wave-like undulating FHR with a fixed frequency and amplitude, resembling a sine wave. - This pattern is **rare** but ominous, often indicating severe fetal anemia or hypoxia. *Normal tracing* - A **normal tracing** would exhibit a baseline FHR between 110-160 bpm, moderate variability (6-25 bpm), and the presence of accelerations and/or the absence of decelerations. - The presence of repetitive decelerations in the provided CTG indicates it is not a normal tracing.

Q: The following CTG indicates:

Fetal head compression. ***Fetal head compression*** - The CTG shows **early decelerations**, characterized by a gradual decrease in fetal heart rate (FHR) that mirrors the contraction onset (as indicated by the green arrows and lower graph). - Early decelerations are typically benign and are caused by **fetal head compression**, which increases intracranial pressure and stimulates the vagus nerve. *Cord compression* - **Variable decelerations** are associated with cord compression and are characterized by an abrupt, jagged decrease in FHR that is variable in timing and shape relative to contractions. - The pattern displayed here is smooth and consistent with contractions, not the abrupt changes seen in variable decelerations. *Normal tracing* - A normal tracing would show a **baseline FHR within the normal range**, moderate variability, and either no decelerations or only occasional, reassuring accelerations. - The repeated decelerations observed here, while benign, indicate a physiological response to contractions and therefore do not represent a completely normal tracing. *Fetal anemia* - Fetal anemia can cause a variety of FHR patterns, including **tachycardia** (due to increased cardiac output) or **sinusoidal heart rate patterns**, which are smooth, undulating FHR tracings. - The decelerations seen in this CTG are not characteristic of fetal anemia.

Q: The following CTG indicates:

Variable deceleration. ***Variable deceleration*** - This CTG shows **abrupt, irregular drops in fetal heart rate (FHR)** that do not consistently correspond to uterine contractions. The onset, depth, and duration of the decelerations vary, which is characteristic of variable decelerations. - Variable decelerations are often associated with **umbilical cord compression**, leading to a transient decrease in blood flow to the fetus. *Early deceleration* - Early decelerations are **gradual, symmetrical drops in FHR** that mirror the shape of the uterine contraction, meaning they begin and end with the contraction. - They are typically benign and caused by **fetal head compression** during contractions. *Late deceleration* - Late decelerations are **gradual, symmetrical drops in FHR** where the nadir of the deceleration occurs after the peak of the uterine contraction, and the recovery to baseline also occurs after the contraction has ended. - They are indicative of **uteroplacental insufficiency** and can be a sign of fetal hypoxia. *Sinusoidal pattern* - A sinusoidal pattern is characterized by a **smooth, undulating, sine wave-like FHR rhythm** with an amplitude of 5-15 bpm and a frequency of 2-5 cycles per minute, lasting for 20 minutes or more. - This pattern is highly concerning and is associated with **severe fetal anemia** or hypoxia.

Question 1

What is the name of this manoeuvre?

Accepted Answer

Ritgen

Answer

Pinard

Answer

Loveset

Answer

Burns Marshall

Question 2

A 25-year-old primigravida at 38POG presents with painful uterine contractions and rupture of bag of water. On examination her cervix is 5 cm dilated and the malpresentation is as shown. Fetal heart rate tracing is reactive. Which of the following is the best method to achieve delivery?

Accepted Answer

Perform emergency C-section

Answer

Vaginally by breech extraction

Answer

Perform internal podalic version

Answer

Deliver vaginally after external cephalic version

Question 3

Identify the presentation shown below:

Accepted Answer

Complete breech

Answer

Frank breech

Answer

Incomplete breech

Answer

Footling presentation

Question 4

According to the Caldwell-Moloy classification, which of the following pelvic types is the LEAST common in women?

Accepted Answer

Platypelloid

Answer

Gynecoid

Answer

Anthropoid

Answer

Android

Question 5

Which is incorrect about the presentation shown below?

Accepted Answer

Mark commonly seen with platypelloid pelvis

Answer

Associated with anencephaly

Answer

Head is partially extended

Answer

Vaginal delivery is possible

Question 6

The following CTG tracing shows:

Accepted Answer

Late deceleration

Answer

Early deceleration

Answer

Sinusoidal pattern

Answer

Variable deceleration

Question 7

The following CTG shows:

Accepted Answer

Variable deceleration

Answer

Early deceleration

Answer

Late deceleration

Answer

Sinusoidal pattern

Question 8

The following CTG shows:

Accepted Answer

Early deceleration

Answer

Late deceleration

Answer

Sinusoidal pattern

Answer

Normal tracing

Question 9

The following CTG indicates:

Accepted Answer

Fetal head compression

Answer

Cord compression

Answer

Normal tracing

Answer

Fetal anemia

Question 10

The following CTG indicates:

Accepted Answer

Variable deceleration

Answer

Early deceleration

Answer

Late deceleration

Answer

Sinusoidal pattern

Labor and Delivery — MCQs

Labor and Delivery — MCQs

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