Labor and Delivery Practice Questions

Q: Which of the following factors are associated with cord prolapse during labour? I. Malpresentations II. Contracted pelvis III. Induction with engaged presenting part IV. Prematurity Select the correct answer using the code given below :

I, II and IV only. ***I, II and IV only*** - **Cord prolapse** occurs when the umbilical cord descends ahead of the presenting fetal part, often due to factors that prevent the presenting part from fitting snugly into the pelvis. - **Malpresentations** (e.g., footling breech, transverse lie), **contracted pelvis** (hindering engagement), and **prematurity** (smaller fetus, more amniotic fluid) all increase the risk by creating a space for the cord to fall through. - **Induction with engaged presenting part** is NOT a risk factor because when the presenting part is well-engaged in the pelvis, it acts as a barrier preventing cord prolapse. *I, II, III and IV* - This option incorrectly includes **induction with engaged presenting part** as a risk factor for cord prolapse. - When the presenting part is engaged, it fills the pelvic inlet and prevents the cord from prolapsing. *III and IV only* - This option is incomplete as it misses crucial risk factors like **malpresentations** and **contracted pelvis**. - **Induction with engaged presenting part** is not a risk factor for cord prolapse. *I, II and III only* - This option incorrectly includes **induction with engaged presenting part** as an association with cord prolapse. - It also omits **prematurity**, which is a significant risk factor due to the disproportionately large amount of amniotic fluid relative to the fetal size.

Q: Which of the following correctly defines the first stage of labor? 1. Full dilatation of cervix to the expulsion of the fetus from the birth canal 2. Maternal bearing down efforts and ends with the delivery of the baby 3. The onset of true labor pains and ends with the full dilatation of cervix 4. The formation of bag of waters

2, 3 and 4. ***Correct Answer: Only Statement 3*** The **first stage of labor** is accurately defined by **statement 3 only**: "The onset of true labor pains and ends with the full dilatation of cervix" **Statement 3 - The onset of true labor pains and ends with the full dilatation of cervix** ✓ - This is the **accurate and complete definition** of the **first stage of labor** - Begins with regular, progressive uterine contractions - Ends when cervix reaches **10 cm (full) dilatation** - Divided into **latent phase** (0-6 cm) and **active phase** (6-10 cm) - Duration varies but averages 8-12 hours in primigravidas **Why other statements are INCORRECT:** *Statement 1 - Full dilatation of cervix to the expulsion of the fetus* - This describes the **SECOND stage of labor**, NOT the first stage - Second stage: begins at full cervical dilatation (10 cm) and ends with delivery of baby *Statement 2 - Maternal bearing down efforts and ends with the delivery of the baby* - This also describes the **SECOND stage of labor** - Active pushing occurs after full dilatation, not during the first stage *Statement 4 - The formation of bag of waters* - The amniotic sac forms during **pregnancy**, not during labor - Its rupture may occur during labor but does not define the first stage - Not a defining characteristic of any labor stage **Note:** Among the given options, **"2, 3 and 4"** is selected as it contains the correct statement (3). However, strictly speaking, only statement 3 correctly defines the first stage of labor. Statements 2 and 4 do not define the first stage.

Q: Secondary arrest of dilatation during the process of labour may be due to which of the following factors ? 1. Poor uterine contractions 2. Cessation of cervical dilatation despite strong uterine contractions 3. Disproportion and malpresentation Select the correct answer using the code given below :

1, 2 and 3. ***1, 2 and 3*** - **Secondary arrest of dilatation** refers to a cessation of cervical dilatation in the active phase of labor after the cervix has already begun to dilate, often attributed to **poor uterine contractions** (hypocontractility) hindering cervical progress. - While weak contractions are a common cause, secondary arrest can also occur despite **strong uterine contractions** if there's an underlying mechanical issue, such as **cephalopelvic disproportion** or **fetal malpresentation**, preventing the fetal head from descending and dilating the cervix effectively. *1 and 2 only* - This option incorrectly excludes **disproportion and malpresentation** as potential causes of secondary arrest of dilatation. - Both poor uterine contractions and cessation of dilatation despite strong contractions are valid causes, but overlooking mechanical impediments like disproportion leaves the explanation incomplete. *1 and 3 only* - This option overlooks the scenario where **cervical dilatation ceases despite strong uterine contractions**, which is a distinct presentation of arrest that points to mechanical obstruction rather than purely ineffective contractions. - While poor contractions and disproportion/malpresentation are important, the specified scenario of strong contractions with no progress is also a key factor. *2 and 3 only* - This option incorrectly omits **poor uterine contractions** as a primary and very common cause of secondary arrest of dilatation. - Weak or uncoordinated contractions are often the first factor investigated when cervical progression stalls.

Q: As per the classification of Obstetric Anal Sphincter Injury (RCOG-2007), complete tear of External Anal Sphincter is of degree :

3c. ***3c*** - A **3c tear** involves a **complete tear** of the **external anal sphincter (EAS)**, often along with the internal anal sphincter (IAS) being involved in any degree during obstetric anal sphincter injury (OASI). - According to the RCOG (Royal College of Obstetricians and Gynaecologists) 2007 classification, this signifies a severe and complete disruption of the external sphincter. *2c* - A **2c tear** would typically refer to a **more extensive second-degree perineal tear** involving deeper muscle layers, but it does **not involve the anal sphincters**. - Second-degree tears involve the skin, vaginal mucosa, and perineal muscles but spare the anal sphincter complex. *3b* - A **3b tear** signifies a **partial tear of the external anal sphincter (EAS)**, with **more than 50%** of the muscle thickness being torn. - While it involves the EAS, it is not a complete tear as described in the question, differentiating it from a 3c tear. *3a* - A **3a tear** indicates an **involvement of the external anal sphincter (EAS)**, specifically a partial tear of the EAS involving **less than 50%** of its thickness. - This is a less severe injury than a 3b or 3c tear and does not represent a complete tear of the EAS.

Q: Which are the parts of active management of third stage of labour? 1. Injection oxytocin 10 units IM within 1 minute of delivery of baby 2. Uterine massage after placental delivery 3. Controlled cord traction 4. Delayed cord clamping as per indications Select the correct answer using the code given below:

1, 2 and 3. ***1, 2 and 3*** - **Active management of the third stage of labor (AMTSL)** consists of three key interventions: **prophylactic uterotonic administration** (oxytocin 10 units IM within 1 minute of delivery), **controlled cord traction**, and **uterine massage after placental delivery**. - These interventions work synergistically to prevent **postpartum hemorrhage** by promoting rapid uterine contraction and complete placental expulsion. - This combination represents the **WHO-recommended standard** for AMTSL. *1, 2 and 4* - **Delayed cord clamping** (4) is an important **neonatal intervention** for improving iron stores and hemoglobin levels in the newborn, but it is **not a component of AMTSL**. - While this option correctly includes **oxytocin administration** (1) and **uterine massage** (2), it omits **controlled cord traction** (3), which is essential for safe placental delivery. - Delayed cord clamping is typically performed **before** AMTSL interventions begin. *2, 3 and 4* - This option omits **immediate prophylactic oxytocin** (1), which is the **most critical component** of AMTSL for preventing postpartum hemorrhage. - Without prompt uterotonic administration, the risk of **uterine atony** and subsequent hemorrhage increases significantly. - Additionally, **delayed cord clamping** (4) is not part of the AMTSL protocol. *1, 3 and 4* - This option omits **uterine massage after placental delivery** (2), which is important for ensuring sustained uterine contraction and detecting early signs of atony. - While **oxytocin** (1) and **controlled cord traction** (3) are correctly included, **delayed cord clamping** (4) is **not a component of AMTSL**. - The absence of uterine massage reduces the completeness of active management.

Q: Which of the following are the characteristics of true labour pains ? 1. Intensity and duration of contractions increase progressively 2. Progressive effacement and dilatation of the cervix 3. Formation of the 'bag of forewaters' 4. Pain is confined to lower abdomen and groin Select the correct answer using the code given below :

1, 2 and 3. ***Correct Answer: 1, 2 and 3*** - **Progressive increase in intensity and duration of contractions** (1) is a hallmark of true labor, as uterine activity becomes more coordinated and forceful over time. - **Progressive effacement and dilatation of the cervix** (2) are the definitive signs of true labor, indicating that the uterus is actively working to prepare for birth. - The **formation of the 'bag of forewaters'** (3) occurs as the lower uterine segment stretches and the fetal head descends, causing the membranes to bulge into the cervical os, which is characteristic of advancing labor. *Incorrect: 1, 2 and 4* - While options 1 and 2 are true, the statement that **pain is confined to the lower abdomen and groin** (4) is incorrect; true labor pain typically **starts in the back and radiates anteriorly** to the lower abdomen. - True labor pain is typically felt as a **wave-like contraction** that encompasses the entire uterus, not just localized to the lower abdomen and groin. *Incorrect: 1, 3 and 4* - Options 1 and 3 are correct diagnostic characteristics, but **pain confined to the lower abdomen and groin** (4) is not accurate for true labor pain, which usually involves the back as well. - The absence of **progressive cervical changes** (2) makes this option incomplete as a definition of true labor. *Incorrect: 2, 3 and 4* - While **progressive effacement and dilatation of the cervix** (2) and **formation of the 'bag of forewaters'** (3) are signs of true labor, the characteristic that **pain is confined to the lower abdomen and groin** (4) is incorrect. - This option also omits the crucial feature of **increasing intensity and duration of contractions** (1), which is a primary indicator of true labor.

Q: A 28-year-old female G2P1L1 with history of previous cesarean presents to the gynaecology emergency in labour. On examination, she is hypotensive, foetal heart sounds are absent and foetal parts are easily palpable. What is her diagnosis?

Uterine rupture. ***Uterine rupture*** - The patient's presentation with **hypotension**, **absent fetal heart sounds**, and **easily palpable fetal parts** following a previous cesarean section strongly suggests uterine rupture. - A **previous cesarean section** is a significant risk factor for uterine rupture, as the scar tissue can be weakened and tear during labor. *Hydatidiform mole* - This condition involves abnormal growth of placental tissue, often presenting with a **grape-like appearance** and **high hCG levels**. - It does not typically cause acute maternal hypotension or easily palpable fetal parts in the context of labor. *Oligohydramnios* - Characterized by **low amniotic fluid volume**, which can lead to complications such as **fetal compression** or developmental issues. - It does not directly cause maternal hypotension, absent fetal heart sounds, or the sensation of easily palpable fetal parts during active labor. *Abruptio placentae* - Involves the **premature separation of the placenta** from the uterine wall, leading to vaginal bleeding, abdominal pain, and fetal distress. - While it can cause fetal compromise and maternal hypotension, the finding of **easily palpable fetal parts** is more indicative of a disrupted uterus rather than just placental separation.

Q: The diameter of engagement of foetal skull in marked deflexion is

occipitofrontal diameter. ***occipitofrontal diameter*** - In cases of **marked deflexion** (also called **persistent occipitoposterior** or **military attitude** in some contexts), the fetal head presents with extension, causing the **occipitofrontal diameter** to engage. - This diameter extends from the **occipital protuberance to the root of the nose (glabella)**, measuring approximately **11.5 cm**. - This represents a **moderately extended** attitude of the fetal head, making vaginal delivery more challenging than with flexion. *suboccipitofrontal diameter* - This diameter measures about **10.0 cm** and engages with **partial deflexion**. - It extends from the **subocciput to the glabella** (center of forehead). - This is an intermediate position between full flexion and marked deflexion. *suboccipitobregmatic diameter* - This is the diameter of engagement in a **well-flexed head** (normal vertex presentation), measuring approximately **9.5 cm**. - It extends from the **subocciput to the bregma** (anterior fontanelle). - This is the **ideal diameter** for vaginal birth as it presents the smallest diameter. *mentovertical diameter* - This diameter is relevant in **brow presentation** (maximum deflexion/extension), measuring about **13-13.5 cm**. - It extends from the **chin (mentum) to the vertex**. - Brow presentation is **highly unfavorable** for vaginal delivery due to this very large engaging diameter and typically requires cesarean section.

Q: According to the WHO Intrapartum Care Guidelines, 2018, the active phase of labour starts from what dilation of cervix?

5 cm. ***5 cm*** - According to the **WHO Intrapartum Care Guidelines, 2018**, the active first stage of labor is defined as starting when the cervix is dilated to **5 cm**. - The WHO guidelines state: "The active first stage is the period of time from 5 cm of cervical dilatation until full cervical dilatation." - This updated definition aims to reduce unnecessary interventions, as cervical dilation before 5 cm (latent phase) can be slow and variable, which is part of normal labor progression. *6 cm* - **6 cm cervical dilation** is beyond the threshold defined by WHO 2018 guidelines for the start of active phase. - While some clinicians may use 6 cm as a benchmark in practice, the **official WHO 2018 guideline** specifically designates **5 cm** as the starting point. *4 cm* - Historically, **4 cm cervical dilation** was considered the start of the active phase in older definitions (Friedman curve). - This earlier benchmark led to premature diagnosis of "failure to progress" and increased interventions. - The **WHO 2018 guidelines** revised this upward to **5 cm** to reflect a more expectant management approach for slow but normal labor progression. *3 cm* - A **cervical dilation of 3 cm** is typically within the latent phase of labor, where cervical changes are usually slower and less predictable. - Defining the active phase at this early stage would significantly increase the possibility of diagnosing **abnormal labor patterns** prematurely and lead to unnecessary interventions.

Question 1

Which of the following factors are associated with cord prolapse during labour?
I. Malpresentations
II. Contracted pelvis
III. Induction with engaged presenting part
IV. Prematurity

Select the correct answer using the code given below :

Accepted Answer

I, II and IV only

Answer

I, II, III and IV

Answer

III and IV only

Answer

I, II and III only

Question 2

During delivery of HIV infected women, which of the following are recommended ?

1. Zidovudine (ZDV) is given at the onset of labour.

2. Elective caesarean delivery reduces the risk of vertical transmission.

3. Amniotomy and oxytocin augmentation should be done.

4. Antiretroviral therapy should be given to all neonates.

Select the correct answer using the code given below :

Accepted Answer

1 and 2 only

Answer

2, 3 and 4

Answer

1, 2 and 4

Answer

1, 2 and 3

Question 3

Which of the following correctly defines the first stage of labor?

1. Full dilatation of cervix to the expulsion of the fetus from the birth canal

2. Maternal bearing down efforts and ends with the delivery of the baby

3. The onset of true labor pains and ends with the full dilatation of cervix

4. The formation of bag of waters

Accepted Answer

2, 3 and 4

Answer

1, 2 and 4

Answer

1, 3 and 4

Answer

1, 2 and 3

Question 4

Secondary arrest of dilatation during the process of labour may be due to which of the following factors ?

1. Poor uterine contractions

2. Cessation of cervical dilatation despite strong uterine contractions

3. Disproportion and malpresentation

Select the correct answer using the code given below :

Accepted Answer

1, 2 and 3

Answer

1 and 2 only

Answer

1 and 3 only

Answer

2 and 3 only

Question 5

As per the classification of Obstetric Anal Sphincter Injury (RCOG-2007), complete tear of External Anal Sphincter is of degree :

Accepted Answer

3c

Answer

2c

Answer

3b

Answer

3a

Question 6

Which are the parts of active management of third stage of labour?

1. Injection oxytocin 10 units IM within 1 minute of delivery of baby
2. Uterine massage after placental delivery
3. Controlled cord traction
4. Delayed cord clamping as per indications

Select the correct answer using the code given below:

Accepted Answer

1, 2 and 3

Answer

1, 2 and 4

Answer

2, 3 and 4

Answer

1, 3 and 4

Question 7

Which of the following are the characteristics of true labour pains ?

1. Intensity and duration of contractions increase progressively
2. Progressive effacement and dilatation of the cervix
3. Formation of the 'bag of forewaters'
4. Pain is confined to lower abdomen and groin

Select the correct answer using the code given below :

Accepted Answer

1, 2 and 3

Answer

1, 2 and 4

Answer

1, 3 and 4

Answer

2, 3 and 4

Question 8

A 28-year-old female G2P1L1 with history of previous cesarean presents to the gynaecology emergency in labour. On examination, she is hypotensive, foetal heart sounds are absent and foetal parts are easily palpable. What is her diagnosis?

Accepted Answer

Uterine rupture

Answer

Hydatidiform mole

Answer

Oligohydramnios

Answer

Abruptio placentae

Question 9

The diameter of engagement of foetal skull in marked deflexion is

Accepted Answer

occipitofrontal diameter

Answer

suboccipitofrontal diameter

Answer

suboccipitobregmatic diameter

Answer

mentovertebral diameter

Question 10

According to the WHO Intrapartum Care Guidelines, 2018, the active phase of labour starts from what dilation of cervix?

Accepted Answer

5 cm

Answer

4 cm

Answer

3 cm

Answer

6 cm

Labor and Delivery — MCQs

Labor and Delivery — MCQs

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