Labor and Delivery Practice Questions

Q: The following partogram shows:

Secondary arrest. ***Secondary arrest*** - The **cervical dilatation line** (blue line) progresses initially but then **plateaus** at 6 cm, remaining flat for several hours and crossing the **action line**. - This pattern indicates that cervical dilation was occurring, but then it completely stopped before full dilation, which is characteristic of a **secondary arrest of labor**. *Normal* - A **normal partogram** shows continuous, progressive cervical dilation along or to the left of the **alert line**. - In this partogram, the cervical dilation line crosses both the **alert** and **action lines**, indicating a deviation from normal labor progress. *Prolonged active phase* - A **prolonged active phase** refers to a slower than expected rate of cervical dilation (more than 1 cm/hour for primigravidas or 1.2-1.5 cm/hour for multiparas), but not a complete arrest. - Here, the dilatation completely stops, rather than just slowing down. *Prolonged latent phase* - The **latent phase** of labor involves cervical effacement and dilation up to 3-4 cm. A prolonged latent phase would show a delay in reaching this initial active phase. - In this case, the cervix dilates from 4 cm to 6 cm within the expected timeframe before arresting, so the latent phase was not prolonged.

Q: Which of the following is obstetric conjugate? (DNB Pattern 2018)

A. ***A*** - Line A in the diagram represents the **obstetric conjugate**, which extends from the **sacral promontory** to the mid-point of the **symphysis pubis**. - This measurement cannot be directly measured by clinical examination, but it is the **true conjugate** that determines the anteroposterior diameter of the pelvic inlet for fetal head descent. *B* - Line B represents the **diagonal conjugate**, which is measured from the **sacral promontory** to the **inferior border of the symphysis pubis**. - This is the only conjugate that can be estimated by **vaginal examination**, and the obstetric conjugate is estimated by subtracting 1.5 cm from the diagonal conjugate. *C* - Line C points generally towards the **ischial spines**, which are important landmarks for determining the **station of the fetal head**. - The **interspinous diameter** is the narrowest part of the mid-pelvis and is crucial for assessing potential mid-pelvic dystocia. *None* - This is incorrect because line A clearly depicts the **obstetric conjugate**, which is a key measurement in pelvimetry. - The diagram provides a clear anatomical representation of the different pelvic conjugates.

Q: Name the maneuver shown in the image: (DNB Pattern 2018)

Mauriceau-Smellie-Veit maneuver. ***Mauriceau-Smellie-Veit maneuver*** - This maneuver is used for **controlled delivery of the aftercoming head** in breech presentation. - The baby's body straddles the operator's forearm with the **index and middle fingers placed on the maxilla** (not in the mouth) to flex the fetal head. - The **other hand applies traction on the shoulders** from above while an assistant may apply **suprapubic pressure** to maintain flexion of the head. - This technique ensures controlled flexion and delivery of the fetal head through the birth canal. *Pinard maneuver* - The Pinard maneuver involves **flexing and abducting the fetal thigh** to deliver the extended legs in a breech presentation. - This is used specifically for **delivering the legs**, not the head, and involves sweeping the leg out of the birth canal. *Loveset maneuver* - The Loveset maneuver is used to deliver the **shoulders and arms** in a breech presentation when they are extended. - It involves **rotating the fetal trunk 180 degrees** to bring each posterior shoulder anteriorly under the pubic symphysis for delivery. - This does not involve head delivery. *Burns Marshall method* - The Burns Marshall method involves **allowing spontaneous delivery of the fetal head** by lifting the baby's trunk upward in an arc over the maternal abdomen. - The head delivers by extension as the body is elevated, using **gravity and maternal effort** rather than manual manipulation of the head itself.

Q: A 25-year-old primigravida has presented in obstructed labour. On examination she is exhausted and has a tender uterus with a groove felt per abdomen as shown in the image. Fetal parts are not felt. What is the diagnosis? (DNB Pattern 2018)

Retraction ring. ***Retraction ring*** - The description of a "groove felt per abdomen" along with signs of **obstructed labor** and a **tender uterus** is characteristic of a pathological **retraction ring (Bandl's ring)**. - This sign indicates an extreme thinning and overdistension of the lower uterine segment, signifying impending uterine rupture due to prolonged obstructed labor. *Constriction ring* - A constriction ring is a **localized spasm** of the uterine muscle, typically identified as a pathological ring, but it does not cause the clear abdominal groove or the severe overdistension of the lower uterine segment seen with a retraction ring. - Unlike a retraction ring, a constriction ring does not necessarily indicate impending uterine rupture but can still cause obstructed labor. *Abruptio placentae* - While abruptio placentae can cause a **tender and rigid uterus**, it is primarily characterized by **vaginal bleeding** (though concealed in some cases) and **fetal distress**, not usually an externally palpable groove with a distended lower segment. - The absence of fetal parts being palpable is consistent with significant uterine tonus, but the formation of a pathological ring is not a feature of abruption. *Cervical dystocia* - **Cervical dystocia** is a failure of the cervix to dilate during labor, leading to obstruction. While it contributes to obstructed labor, it does not typically present with a palpable groove in the abdomen due to the formation of a pathological retraction ring. - The primary defect is at the cervix itself, not a delineation within the uterine body.

Q: Which of the following factors favour posterior position of the vertex? I. Anthropoid pelvis II. Low inclination pelvis III. Attachment of placenta on the anterior wall IV. Primary brachycephaly Select the correct answer using the code given below :

I, III and IV. ***I, III and IV*** - An **anthropoid pelvis** has a long anteroposterior diameter and a narrow transverse diameter, making it more likely for the fetal head to engage in an anteroposterior position, which can lead to a posterior vertex. - **Placenta attached to the anterior wall** can create less space posteriorly, potentially pushing the fetal back towards the posterior aspect of the uterus, thereby promoting an occiput posterior position. - **Primary brachycephaly** (a fetal head that is wider than it is long) may find it difficult to rotate in the pelvis, increasing the likelihood of remaining in an occiput posterior position due to less favorable biomechanics for rotation. *II, III and IV* - A **low inclination pelvis** typically refers to a gynecoid pelvis with a flattened sacrum, which tends to promote rotation to an anterior position, not a posterior one. - Therefore, option II is incorrect as it favors anterior rotation. *I, II and IV* - This option incorrectly includes **low inclination pelvis** as a factor favoring posterior position. - A low inclination pelvis, particularly if it's a gynecoid type, is generally associated with more favorable conditions for fetal rotation to an anterior position. *I, II and III* - This option also incorrectly includes **low inclination pelvis** as a factor contributing to posterior vertex presentation. - The biomechanics of a low inclination pelvis do not typically predispose to a posterior vertex engagement or presentation.

Q: Which of the following statements are correct regarding shoulder dystocia? I. It can be predicted during early labour. II. Fetal macrosomia is a risk factor. III. Turtle neck sign is present. IV. Episiotomy should always be given. Select the answer using the code given below :

II and III. ***II and III*** - **Fetal macrosomia** (birth weight >4000g or >4500g) is a well-established risk factor for shoulder dystocia, as larger fetal size increases the likelihood of shoulder impaction behind the maternal pubic symphysis. - The **"turtle sign"** (or "turtle neck sign") is a pathognomonic sign of shoulder dystocia, where the fetal head retracts against the perineum after delivery because the anterior shoulder is impacted behind the pubic symphysis. *I and III* - Shoulder dystocia is generally **unpredictable** in early labor. While risk factors (maternal diabetes, fetal macrosomia, maternal obesity) identify high-risk pregnancies, most cases occur without warning and cannot be reliably predicted during early labor. Up to 50% of shoulder dystocia cases occur in pregnancies without identifiable risk factors. *II and IV* - While episiotomy may be performed to facilitate maneuvers by providing more working space, it is **not always indicated** and does not directly relieve the bony obstruction. The primary issue in shoulder dystocia is impaction of the anterior shoulder behind the pubic symphysis (bony obstruction), not soft tissue restriction. Episiotomy should be selective, not routine. *I and II* - As stated, shoulder dystocia cannot be reliably predicted during early labor, despite the presence of risk factors. Clinical judgment and preparedness are more important than prediction. - Fetal macrosomia remains a significant risk factor, though many macrosomic babies deliver without shoulder dystocia and many cases occur with normal-weight infants.

Q: According to WHO Intrapartum Care Guidelines 2018, which of the following are correct about birthing position? I. For a woman without epidural analgesia, adoption of birthing position is individual woman's choice. II. For a woman without epidural analgesia, upright birthing position may be adopted. III. For a woman with epidural analgesia, lithotomy and supine position only are recommended. Select the answer using the code given below :

I and II only. ***I and II only*** - According to the **WHO Intrapartum Care Guidelines 2018**, for women **without epidural analgesia**, the adoption of **birthing position** should be the **individual woman's choice** (Statement I is correct). - **Upright positions** (including sitting, standing, kneeling, squatting, or hands-and-knees) are specifically **encouraged** for women without epidural as they may reduce duration of second stage of labor and instrumental delivery rates (Statement II is correct). - The WHO guidelines emphasize **woman-centered care** and respect for maternal preferences regarding birthing positions. *I, II and III* - This option is **incorrect** because Statement III is false. - The WHO 2018 guidelines do **NOT** restrict women with epidural analgesia to only lithotomy and supine positions. - Even with epidural, women should be **encouraged to adopt positions of their choice**, including lateral and supported upright positions when feasible. *II and III only* - This option is **incorrect** as it omits Statement I, which correctly reflects the WHO principle of **individual woman's choice** for birthing position. - Statement III is also **false** - women with epidural are not limited to only lithotomy and supine positions according to WHO guidelines. *I and III only* - This option is **incorrect** because Statement III is false. - WHO guidelines advocate for **flexible positioning** even with epidural analgesia, not restriction to lithotomy and supine positions only. - The guidelines support exploring various positions based on maternal comfort, clinical circumstances, and healthcare provider support.

Q: The Matthews Duncan process has been described for :

marginal separation of placenta in normal labour. ***Marginal separation of placenta in normal labour*** - The **Matthews Duncan method** describes the process of **placental separation** where the placenta detaches from its **edges first**, leading to bleeding from the exposed maternal surface. - This type of separation is one of the two main mechanisms by which the placenta separates from the **uterine wall** during the third stage of labor. *Controlled contraction in active management of third stage of labour* - This refers to techniques like **controlled cord traction** and **fundal massage**, which are part of the active management to expedite placental delivery and prevent hemorrhage. - While it's a part of third stage management, it describes an intervention for placental expulsion, not a specific mechanism of placental detachment. *Central separation of placenta in normal labour* - This is known as the **Schultze method**, where placental separation begins in the **center**, leading to the fetal surface presenting first and less visible bleeding during separation. - The question specifically asks about the **Matthews Duncan process**, which is distinct from central separation. *Reposition of acute inversion of uterus following vaginal delivery* - **Uterine inversion** is a rare but severe complication where the **fundus** collapses through the **cervix**. - Repositioning involves manual or surgical techniques to return the uterus to its normal anatomical position and is unrelated to placental separation mechanisms.

Question 1

The following partogram shows:

Accepted Answer

Secondary arrest

Answer

Normal

Answer

Prolonged active phase

Answer

Prolonged latent phase

Question 2

Which of the following is obstetric conjugate? (DNB Pattern 2018)

Accepted Answer

A

Answer

B

Answer

C

Answer

None

Question 3

Which of the following combinations is correct? (DNB Pattern 2018)

Accepted Answer

A = Vertex (well flexed head), B = Brow, C = Face presentation

Answer

A = Vertex (deflexed head), B = Brow, C = Face presentation

Answer

A = Vertex (well flexed head), B = Face presentation, C = Brow

Answer

A = Vertex (deflexed head), B = Face presentation, C = Brow

Question 4

Name the maneuver shown in the image: (DNB Pattern 2018)

Accepted Answer

Mauriceau-Smellie-Veit maneuver

Answer

Pinard maneuver

Answer

Loveset maneuver

Answer

Burns Marshall method

Question 5

A 25-year-old primigravida has presented in obstructed labour. On examination she is exhausted and has a tender uterus with a groove felt per abdomen as shown in the image. Fetal parts are not felt. What is the diagnosis? (DNB Pattern 2018)

Accepted Answer

Retraction ring

Answer

Constriction ring

Answer

Abruptio placentae

Answer

Cervical dystocia

Question 6

Which of the following factors favour posterior position of the vertex?
I. Anthropoid pelvis
II. Low inclination pelvis
III. Attachment of placenta on the anterior wall
IV. Primary brachycephaly

Select the correct answer using the code given below :

Accepted Answer

I, III and IV

Answer

II, III and IV

Answer

I, II and IV

Answer

I, II and III

Question 7

Which of the following statements are correct regarding shoulder dystocia?
I. It can be predicted during early labour.
II. Fetal macrosomia is a risk factor.
III. Turtle neck sign is present.
IV. Episiotomy should always be given.

Select the answer using the code given below :

Accepted Answer

II and III

Answer

I and III

Answer

II and IV

Answer

I and II

Question 8

According to WHO Intrapartum Care Guidelines 2018, which of the following are correct about birthing position?
I. For a woman without epidural analgesia, adoption of birthing position is individual woman's choice.
II. For a woman without epidural analgesia, upright birthing position may be adopted.
III. For a woman with epidural analgesia, lithotomy and supine position only are recommended.

Select the answer using the code given below :

Accepted Answer

I and II only

Answer

I, II and III

Answer

II and III only

Answer

I and III only

Question 9

According to WHO Intrapartum Care Guidelines 2018, which one of the following is correct about duration of first stage labour?

Accepted Answer

Duration of latent phase of primigravida has not been established

Answer

Duration of active stage of primigravida should not exceed 8 hours

Answer

Duration of active stage of multigravida should not exceed 6 hours

Answer

Duration of active stage of primigravida should not exceed 18 hours

Question 10

The Matthews Duncan process has been described for :

Accepted Answer

marginal separation of placenta in normal labour

Answer

controlled contraction in active management of third stage of labour

Answer

central separation of placenta in normal labour

Answer

reposition of acute inversion of uterus following vaginal delivery

Labor and Delivery — MCQs

Labor and Delivery — MCQs

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