Labor and Delivery Practice Questions

Q: Which of the following features are correct regarding onset of true labour? 1. Regular uterine contractions 2. Progressive cervical dilation and effacement 3. Presence of show 4. Labour and delivery are synonymous Select the answer using the code given below.

1, 2 and 3. ***Correct: 1, 2 and 3*** - **Regular uterine contractions** (statement 1) are a hallmark of true labor, occurring at regular intervals with increasing frequency, duration, and intensity. - **Progressive cervical dilation and effacement** (statement 2) is the definitive diagnostic criterion for true labor, distinguishing it from false labor (Braxton Hicks contractions). - **Presence of 'show'** (statement 3) - the expulsion of the cervical mucus plug mixed with blood - is a common and reliable indicator of true labor onset. - Statement 4 is **incorrect**: labor and delivery are **not synonymous**. **Labor** is the entire process of childbirth (contractions, cervical changes, descent of fetus), while **delivery** refers specifically to the expulsion of the baby. *Incorrect: 2, 3 and 4* - Incorrectly includes statement 4, which falsely claims labor and delivery are synonymous. - Omits statement 1 (regular uterine contractions), which is a fundamental feature of true labor. *Incorrect: 1, 3 and 4* - Incorrectly includes statement 4 about labor and delivery being synonymous. - Critically omits statement 2 (progressive cervical dilation and effacement), which is the most important diagnostic criterion for true labor. *Incorrect: 1, 2 and 4* - Incorrectly includes statement 4, which is false. - Omits statement 3 (presence of show), which is a valid indicator of true labor onset.

Q: What is the most immediate intervention in the management of cord prolapse during delivery? 1. Bladder filling 2. Knee-chest position of the patient 3. Preferably caesarean delivery 4. Lifting up the presenting part off the cord

4. Lifting up the presenting part off the cord. ***Correct: Lifting up the presenting part off the cord*** - **Manual elevation of the presenting part** is the **FIRST and most immediate intervention** in cord prolapse to relieve compression on the umbilical cord. - This can be done by inserting a hand into the vagina and pushing the presenting part upward, maintaining this position until delivery. - This immediate action prevents **fetal hypoxia** by restoring blood flow through the umbilical cord. - This maneuver should be maintained continuously while other interventions are being arranged. *Incorrect: Knee-chest position of the patient* - While **maternal positioning** (knee-chest, Trendelenburg, or exaggerated Sims position) is an important immediate intervention, it is the **second step** after manual elevation. - Positioning uses gravity to help relieve pressure on the prolapsed cord but takes slightly longer to implement than manual elevation. - Both interventions are typically done simultaneously, but manual elevation is the most immediate action. *Incorrect: Preferably caesarean delivery* - **Emergency cesarean delivery** is the **definitive management** for most cases of cord prolapse, not the most immediate intervention. - Surgical delivery requires preparation time, anesthesia, and operating room setup. - Immediate interventions (manual elevation, positioning) must be performed first to protect the fetus while preparing for delivery. *Incorrect: Bladder filling* - **Bladder filling** (with 500-700 ml of saline via catheter) is an adjunctive measure that can help elevate the presenting part and relieve cord compression. - This is a secondary intervention, not the most immediate action. - Note: The management involves bladder **filling** (not emptying) to create upward displacement of the presenting part.

Q: The first-line drug for intrapartum prophylaxis against Group β Streptococcal (GBS) infection in pregnancy is

penicillin. ***penicillin*** - **Penicillin G** is the drug of choice for intrapartum GBS prophylaxis due to its **narrow spectrum** and proven efficacy in preventing neonatal GBS disease. - It rapidly achieves bactericidal concentrations in the amniotic fluid, effectively eradicating GBS from the maternal genital tract during labor. *doxycycline* - **Doxycycline** is a **tetracycline antibiotic** generally contraindicated in pregnancy due to potential adverse effects on fetal bone and tooth development. - It is not effective against GBS and is not used for its treatment or prophylaxis in pregnant women. *vancomycin* - **Vancomycin** is reserved for pregnant women with **severe penicillin allergy** (e.g., anaphylaxis) or isolates with known resistance to penicillin and clindamycin. - Its use is limited due to the need for intravenous administration and potential for ototoxicity or nephrotoxicity. *azithromycin* - **Azithromycin** is sometimes used for GBS prophylaxis in cases of penicillin allergy but is **less preferred** than clindamycin due to emerging GBS resistance. - It is not considered a first-line agent, and susceptibility testing is crucial if it is considered for use.

Q: During the first stage of labour, the intrauterine pressure is increased up to

40–50 mm of Hg. ***40–50 mm of Hg*** - This pressure range is typical during **uterine contractions** in the first stage of labor, effectively causing cervical effacement and dilation. - These pressures provide sufficient force to facilitate the progression of labor while maintaining adequate **uteroplacental blood flow** between contractions. *100–120 mm of Hg* - This pressure range is generally too high for the first stage of labor and is more commonly seen in the **second stage** or during prolonged, abnormal contractions. - Such elevated pressures could potentially compromise **fetal well-being** due to reduced uteroplacental perfusion. *8–10 mm of Hg* - This pressure range represents the **resting tone** of the uterus between contractions, not the peak pressure during a contraction. - It is too low to cause significant cervical changes or *advance labor*. *2–3 mm of Hg* - This pressure is significantly below the normal resting tone of the uterus and is not associated with any stage of active labor. - Such low pressures would indicate **uterine inactivity** or atony, not active contractions.

Q: Uterine rupture is most commonly encountered after which one of the following surgeries?

Classical cesarean. ***Classical cesarean*** - A **classical cesarean section** involves a vertical incision in the **upper uterine segment**, which contains fewer muscle fibers and heals less strongly than the lower segment. - This weaker scar is more prone to rupture in subsequent pregnancies or during labor, leading to a significantly higher risk compared to other uterine surgeries. *Hysterotomy* - **Hysterotomy** is a surgical incision into the uterus, often performed for fetal surgery, but **uterine rupture** risk is heavily dependent on the type and location of the incision. - While it creates a uterine scar, the risk of rupture varies with the depth and extent of the incision, and it is generally associated with a lower rupture risk than a single, full-thickness classical incision. *Metroplasty* - **Metroplasty** is a reconstructive surgery of the uterus, typically performed to correct uterine anomalies like a **septate uterus**, improving reproductive outcomes. - While it involves cutting and suturing uterine tissue, the goal is to create a more functional and robust uterus, and if performed meticulously, the risk of subsequent rupture is relatively low. *Myomectomy* - **Myomectomy** involves the surgical removal of **fibroids** (leiomyomas) from the uterus while preserving the uterus. - The risk of **uterine rupture** after myomectomy is proportional to the number, size, and depth of the fibroids removed, especially if the uterine cavity is entered; deep intramural fibroids pose a higher risk, but generally less than a classical cesarean.

Q: What is the maternal risk of using misoprostol for ripening of cervix during induction of labour?

Tachysystole/hyperstimulation of uterus. ***Tachysystole/hyperstimulation of uterus*** - Misoprostol, a **prostaglandin E1 analog**, increases uterine contractility to ripen the cervix and induce labor. - This heightened uterine activity can lead to **tachysystole** (more than 5 contractions in 10 minutes) or **uterine hyperstimulation**, posing risks to both mother and fetus. *Bradycardia* - **Maternal bradycardia** is not a direct or common maternal side effect of misoprostol; however, **fetal bradycardia** can occur secondary to uterine hyperstimulation and reduced placental perfusion. - Misoprostol's primary effect is on uterine smooth muscle, not directly on maternal heart rate regulation. *Hypotension* - While some prostaglandins can have vasodilatory effects, significant **maternal hypotension** is not a typical or well-known adverse effect of misoprostol used for cervical ripening. - The doses used for cervical ripening usually do not lead to systemic circulatory collapse. *Tachycardia* - **Maternal tachycardia** is not a primary or direct side effect of misoprostol; however, it could indirectly occur due to **maternal stress** or other complications. - The drug's mechanism of action primarily involves uterine contractility and cervical changes, not direct cardiac stimulation.

Q: Misoprostol can be used in obstetric practice by the following routes except:

Intravenous. ***Intravenous*** - Misoprostol is **not used intravenously** in obstetric practice due to safety concerns - IV administration could lead to **rapid, uncontrolled systemic effects** including severe adverse events like **cardiovascular collapse** and anaphylactoid reactions - The drug formulation is not intended for IV use, and its rapid absorption via this route would pose significant maternal risk - All approved obstetric uses employ **oral, sublingual, vaginal, or buccal routes** *Vaginal* - Vaginal administration is commonly used in obstetrics for **cervical ripening** and **labor induction** - Also used for **management of miscarriage** and **postpartum hemorrhage** - Allows for **gradual absorption** with local effect on the cervix and uterus *Sub-lingual* - Sublingual misoprostol is effectively absorbed through the **oral mucosa** - Used for **labor induction** and **management of postpartum hemorrhage** - Offers **rapid onset of action** and bypasses first-pass metabolism *Oral* - Oral administration is used for **medical abortion**, **miscarriage management**, and **labor induction** - Also approved for prevention of **NSAID-induced gastric ulcers** (non-obstetric indication) - Absorption is slower with lower peak concentrations compared to sublingual or vaginal routes

Question 1

Which of the following features are correct regarding onset of true labour?

1. Regular uterine contractions
2. Progressive cervical dilation and effacement
3. Presence of show
4. Labour and delivery are synonymous Select the answer using the code given below.

Accepted Answer

1, 2 and 3

Answer

2, 3 and 4

Answer

1, 3 and 4

Answer

1, 2 and 4

Question 2

Which of the following statements represents the PRIMARY obstetric significance at the level of plane of least pelvic dimensions?

1. It is a landmark used for pudendal nerve block analgesia.
2. Deep transverse arrest usually occurs at this plane.
3. It is at this plane that the internal rotation of the fetal head occurs during labour.
4. It marks the beginning of the backward curve of the pelvic axis.

Accepted Answer

1. It is a landmark used for pudendal nerve block analgesia.

Answer

4. It marks the beginning of the backward curve of the pelvic axis.

Answer

2. Deep transverse arrest usually occurs at this plane.

Answer

3. It is at this plane that the internal rotation of the fetal head occurs during labour.

Question 3

What is the most immediate intervention in the management of cord prolapse during delivery?

1. Bladder filling
2. Knee-chest position of the patient
3. Preferably caesarean delivery
4. Lifting up the presenting part off the cord

Accepted Answer

4. Lifting up the presenting part off the cord

Answer

2. Knee-chest position of the patient

Answer

1. Bladder filling

Answer

3. Preferably caesarean delivery

Question 4

Which of the following statements is correct regarding constriction ring?

1. Premature rupture of membranes is a high risk factor.
2. It is situated at the junction of upper and lower uterine segment.
3. Uterus never ruptures.
4. The ring is felt per abdomen.

Accepted Answer

1. Premature rupture of membranes is a high risk factor.

Answer

2. It is situated at the junction of upper and lower uterine segment.

Answer

4. The ring is felt per abdomen.

Answer

3. Uterus never ruptures.

Question 5

The first-line drug for intrapartum prophylaxis against Group β Streptococcal (GBS) infection in pregnancy is

Accepted Answer

penicillin

Answer

doxycycline

Answer

vancomycin

Answer

azithromycin

Question 6

In which of the following situations might delayed cord clamping be contraindicated?

Accepted Answer

Need for immediate neonatal resuscitation where delayed clamping interferes

Answer

Placental abruption with maternal compromise

Answer

Severe maternal hemorrhage requiring immediate resuscitation

Answer

Cord prolapse requiring immediate delivery

Question 7

During the first stage of labour, the intrauterine pressure is increased up to

Accepted Answer

40–50 mm of Hg

Answer

100–120 mm of Hg

Answer

8–10 mm of Hg

Answer

2–3 mm of Hg

Question 8

Uterine rupture is most commonly encountered after which one of the following surgeries?

Accepted Answer

Classical cesarean

Answer

Hysterotomy

Answer

Metroplasty

Answer

Myomectomy

Question 9

What is the maternal risk of using misoprostol for ripening of cervix during induction of labour?

Accepted Answer

Tachysystole/hyperstimulation of uterus

Answer

Bradycardia

Answer

Hypotension

Answer

Tachycardia

Question 10

Misoprostol can be used in obstetric practice by the following routes except:

Accepted Answer

Intravenous

Answer

Vaginal

Answer

Sub-lingual

Answer

Oral

Labor and Delivery — MCQs

Labor and Delivery — MCQs

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