Labor and Delivery Practice Questions

Q: Match List-I with List-II and select the correct answer using the code given below: List-I (Obstetric Manoeuvres): A) Pinard's manoeuvre B) Lovset's manoeuvre C) Mauriceau-Smellie-Veit manoeuvre D) External cephalic version List-II (Indications/Purposes): 1) Conversion of breech to cephalic presentation 2) Delivery in breech presentation at term 3) Delivery of after-coming head in breech 4) Delivery of anterior shoulder and arms in breech Select the correct matching:

A→1 B→4 C→3 D→2. ***A→2 B→4 C→3 D→1*** - **Pinard's manoeuvre** (A) is used for **delivery in breech presentation at term** (2) by flexing the fetal knee and abducting the thigh to bring down extended legs. - This is the correct matching as each manoeuvre corresponds to its specific **obstetric indication**: **Lovset's** for shoulder delivery, **Mauriceau-Smellie-Veit** for after-coming head, and **External cephalic version** for presentation conversion. *A→4 B→1 C→3 D→2* - Incorrectly matches **Pinard's manoeuvre** to shoulder/arm delivery, which is actually the role of **Lovset's manoeuvre**. - **Lovset's manoeuvre** is mismatched to presentation conversion rather than its specific purpose of **delivering shoulders and arms** in breech presentation. *A→3 B→1 C→4 D→2* - **Pinard's manoeuvre** is wrongly matched to **after-coming head delivery**, which is specifically performed by **Mauriceau-Smellie-Veit manoeuvre**. - **Mauriceau-Smellie-Veit manoeuvre** is incorrectly matched to shoulder delivery instead of its actual purpose of **controlled delivery of the fetal head**. *A→1 B→4 C→3 D→2* - **Pinard's manoeuvre** is incorrectly matched to **presentation conversion**, which is performed **antepartum** by **External cephalic version**. - **External cephalic version** is wrongly matched to delivery during labor rather than its **prenatal** role in converting **breech to cephalic presentation**.

Q: The presence of a retraction ring at the junction of upper and lower uterine segment in labour indicates

obstructed labour. ***Obstructed labour*** - A **pathological retraction ring (Bandl's ring)** forms when the upper uterine segment thickens and retracts, while the lower segment thins and distends due to **obstructed labour**. - This is distinct from the normal physiological retraction ring present in all labours—Bandl's ring is abnormally prominent, may be visible or palpable abdominally, and rises progressively higher. - This physical sign indicates an impending **uterine rupture** if the obstruction is not relieved and constitutes an obstetric emergency. *Cervical dystocia* - Refers to a cervix that fails to efface or dilate in the presence of adequate uterine contractions, but it does not directly cause the formation of a **pathological retraction ring**. - While it can lead to prolonged labour, the specific finding of a retraction ring at an abnormally high level points more directly to **obstruction**. *Precipitate labour* - Characterized by rapid labour lasting less than three hours from the onset of contractions to delivery. - It is the opposite of obstructed labour and does not involve the formation of a **pathological retraction ring**. *Prolonged labour* - Refers to labour that exceeds 20 hours for nulliparous women or 14 hours for multiparous women. - While obstructed labour can lead to prolonged labour, the presence of a **pathological retraction ring (Bandl's ring)** is a specific sign of obstruction, indicating a more severe and immediate threat than general prolongation.

Q: B-Lynch stitch is applied on the uterus for the treatment of

atonic PPH. ***atonic PPH*** - The **B-Lynch stitch** is a **compression suture** applied surgically to the uterus to control severe **postpartum hemorrhage (PPH)** caused by **uterine atony**. - It works by mechanically compressing the uterus, thereby reducing blood flow and promoting uterine contraction, which is critical when the uterus fails to contract sufficiently after childbirth. *incompetent os* - An **incompetent cervical os** is typically managed with a **cervical cerclage**, a stitch placed around the cervix to prevent premature dilation during pregnancy. - The B-Lynch stitch is designed for uterine hemostasis, not cervical support. *ruptured ulcerations* - While bleeding might occur from **ruptured ulcerations**, this term is vague in an obstetrical context and does not apply to uterine bleeding specifically. - The B-Lynch stitch is used for severe uterine hemorrhage, most commonly due to atony, not general ulcerations which would require different treatment. *bleeding from placental bed of placenta previa* - **Placenta previa** bleeding often results from the placenta implanting over or near the cervix, which might require a **cesarean section** and careful placental removal. - While a B-Lynch stitch *could* be used as an adjunct in severe cases of PPH following placenta previa if atony develops, it is not the primary or typical treatment for bleeding *from the placental bed itself* which usually involves direct uterine incision or placental site hemostasis.

Q: Abnormal foetal heart-rate patterns on electronic foetal monitoring include the following, except

early decelerations. ***Early decelerations*** - **Early decelerations** are considered a **benign finding** on electronic fetal monitoring, reflecting fetal head compression during contractions. - They tend to **mirror the contractions** and do not indicate fetal distress or hypoxia. *Tachycardia >170/minute lasting for 15 minutes* - Fetal **tachycardia** (heart rate >160 bpm) lasting for 10 minutes or more is considered an abnormal finding or baseline change. - A persistent fetal heart rate **>170 bpm for 15 minutes** or longer specifically indicates significant fetal tachycardia, which can be a sign of infection (e.g., chorioamnionitis), maternal fever, or fetal hypoxia. *Bradycardia <120/minute lasting for 15 minutes* - Fetal **bradycardia** (heart rate <110 bpm) lasting for 10 minutes or more is considered an abnormal finding or baseline change. - A fetal heart rate **<120 bpm lasting for 15 minutes** or longer, as specified, indicates significant fetal bradycardia, which can be associated with fetal hypoxia, cord compression, or placental insufficiency. *Late decelerations* - **Late decelerations** are a concerning sign of fetal distress, often indicative of **uteroplacental insufficiency** and fetal hypoxia. - They begin after the peak of the contraction and return to baseline after the contraction ends, reflecting a delayed fetal response to hypoxia.

Q: Regarding placental separation in III stage of labour, consider the following statements: 1. Separation of placenta occurs at decidua spongiosa 2. In Schultze method, separation of placenta starts at centre 3. In Matthews Duncan's method, separation begins at margin Which of the statements given above is/are correct?

1, 2 and 3. ***1, 2 and 3*** - Correctly states that placental separation occurs at the level of the **decidua spongiosa**, which is the physiological cleavage plane permitting placental detachment after birth. - Correctly identifies that in the **Schultze method**, placental separation starts centrally, leading to the fetal surface presenting first. In the **Matthews Duncan method**, separation begins at the margin, causing the maternal surface to present first. *1 and 2 only* - This option is incorrect because while statements 1 and 2 are true, statement 3 is also correct and needs to be included for a complete answer. - It overlooks the accurate description of the **Matthews Duncan method** of placental separation. *2 and 3 only* - This option is incorrect because it fails to acknowledge the fundamental physiological fact that placental separation occurs at the **decidua spongiosa**, which is statement 1. - It omits the correct statement regarding the physiological plane of **placental separation**. *1 only* - This option is incorrect because it only includes statement 1, which is true, but excludes the correct statements 2 and 3 regarding the different methods of placental separation. - It does not account for the accurate descriptions of both the **Schultze** and **Matthews Duncan** methods.

Q: Consider the following pairs regarding foetal heart during labour:

2 and 3. ***2 and 3*** - The description for **late decelerations** correctly identifies them as resulting from causes like **maternal hypotension**, **placental insufficiency**, or **excessive uterine activity**, which lead to uteroplacental insufficiency and fetal hypoxia. - The description for **variable decelerations** accurately states that they are caused by **umbilical cord compression**, which is the characteristic cause of this deceleration pattern. Variable decelerations have an abrupt onset and variable timing relative to contractions. *1 and 2* - The first statement regarding **early decelerations** is incorrect if it states they are caused by **cord compression**. Early decelerations are actually caused by **fetal head compression leading to vagal stimulation**, not cord compression. - While the second statement about late decelerations is correct, combining it with an incorrect statement about early decelerations makes this option incorrect. *2 only* - While the description for **late decelerations** is correct, this option is incomplete because the description for **variable decelerations** (statement 3) is also correct. - Answering "2 only" would imply that statement 3 is incorrect, which is not true. *1 and 3* - The first statement regarding **early decelerations** is incorrect if it attributes them to **cord compression** rather than **fetal head compression**. - While the third statement regarding **variable decelerations** is correctly described as being due to **umbilical cord compression**, the incorrectness of the first statement makes this option invalid.

Q: The engaging diameter of brow presentation is:

Mento‐vertical. ***Mento-vertical*** - In a **brow presentation**, the fetal head is incompletely extended, and the presenting part is the brow. - The **mento-vertical diameter** is the longest antero-posterior diameter of the fetal head, measuring approximately **13.5 cm**, and is the engaging diameter in a brow presentation. *Submento-bregmatic* - This diameter is measured from the junction of the neck and chin to the anterior fontanelle (bregma), reflecting the engaging diameter in a **face presentation** with full extension. - Its typical measurement is about **9.5 cm**, significantly shorter than the mento-vertical diameter. *Submento-vertical* - This diameter is not a standard engaging diameter used to describe typical fetal head presentations. - Standard obstetrical terminology focuses on submento-bregmatic for face and suboccipito-bregmatic for vertex presentations. *Suboccipito-bregmatic* - This is the engaging diameter for a **flexed vertex presentation** (occiput or crown of the head), which is the most common and favorable presentation. - It measures approximately **9.5 cm**, representing the optimal diameter for passage through the birth canal.

Q: Modified Bishop’s score includes all EXCEPT:

Position of occiput. ***Position of occiput*** - The **position of the occiput** (fetal head position) is assessed during labor but is not a component of either the original or modified Bishop's score. - The Bishop's score universally evaluates **cervical ripeness** and does not incorporate fetal station or position. *Position of os* - The **position of the cervix (os)**, whether anterior, posterior, or mid-position, is a crucial component of the Bishop's score. - A more **anterior cervix** indicates a higher likelihood of successful induction. *Consistency of cervix* - **Cervical consistency** (firm, medium, soft) is a key factor in the Bishop's score, reflecting the degree of cervical ripening. - A **softer cervix** is more favorable for induction and spontaneous labor progression. *Cervical length and dilatation* - **Cervical effacement** (length) and **dilatation** are essential parameters in the Bishop's score, indicating the readiness of the cervix for labor. - A **shorter and more dilated cervix** correlates with a higher Bishop's score and increased success of labor induction.

Q: The main cause of perinatal mortality in ‘Frank breech presentation’ is:

Intracranial haemorrhage. ***Intracranial haemorrhage*** - In **breech deliveries**, the head, being the largest and least compressible part, is born last, subjecting it to rapid compression and decompression forces. - This can lead to **tentorial tears** and **intracranial haemorrhage**, especially in frank breech presentation where the head is not well-flexed, and the uterine forces are exerted more directly and forcefully on it during the final stages of delivery. *Prolapse of umbilical cord* - While **cord prolapse** is a risk in breech presentations, it is most common in **footling breech** due to incomplete filling of the pelvis by the presenting part. - In **frank breech**, the buttocks and flexed legs tend to fill the lower uterine segment more effectively, making cord prolapse less likely than in other breech types. *Trauma to foetal viscera* - **Visceral trauma** is possible in breech deliveries but is less common as a primary cause of mortality compared to intracranial injury. - It usually results from excessive traction or manipulation during extraction, which can cause injuries to organs like the liver or spleen. *Foetal abnormalities* - Although **foetal anomalies** are an underlying cause of breech presentation in a significant number of cases (up to 15-20%), they are the predisposing factor, not the direct cause of perinatal mortality during delivery itself. - The mortality from "frank breech presentation" refers to the complications arising from the **mode of delivery** rather than the underlying reason for the presentation.

Question 1

A vaginal examination conducted during the second stage of labour reveals occipito-posterior position of the vertex. This occipito-posterior position of the vertex was diagnosed on the basis of which of the following findings ?

Accepted Answer

Posterior fontanelle positioned posteriorly with the sagittal suture anteroposterior

Answer

Anterior fontanelle not reached

Answer

Posterior fontanelle in the subpubic area

Answer

Sagittal suture in transverse in the pelvic cavity

Question 2

Match List-I with List-II and select the correct answer using the code given below:

List-I (Obstetric Manoeuvres):
A) Pinard's manoeuvre
B) Lovset's manoeuvre
C) Mauriceau-Smellie-Veit manoeuvre
D) External cephalic version

List-II (Indications/Purposes):
1) Conversion of breech to cephalic presentation
2) Delivery in breech presentation at term
3) Delivery of after-coming head in breech
4) Delivery of anterior shoulder and arms in breech

Select the correct matching:

Accepted Answer

A→1  B→4  C→3  D→2

Answer

A→4  B→1  C→3  D→2

Answer

A→3  B→1  C→4  D→2

Answer

A→2  B→4  C→3  D→1

Question 3

The presence of a retraction ring at the junction of upper and lower uterine segment in labour indicates

Accepted Answer

obstructed labour

Answer

cervical dystocia

Answer

precipitate labour

Answer

prolonged labour

Question 4

B-Lynch stitch is applied on the uterus for the treatment of

Accepted Answer

atonic PPH

Answer

incompetent os

Answer

ruptured ulcerations

Answer

bleeding from placental bed of placenta previa

Question 5

Abnormal foetal heart-rate patterns on electronic foetal monitoring include the following, except

Accepted Answer

early decelerations

Answer

tachycardia >170/minute lasting for 15 minutes

Answer

bradycardia <120/minute lasting for 15 minutes

Answer

late decelerations

Question 6

Regarding placental separation in III stage of labour, consider the following statements:

1. Separation of placenta occurs at decidua spongiosa
2. In Schultze method, separation of placenta starts at centre
3. In Matthews Duncan's method, separation begins at margin

Which of the statements given above is/are correct?

Accepted Answer

1, 2 and 3

Answer

1 and 2 only

Answer

2 and 3 only

Answer

1 only

Question 7

Consider the following pairs regarding foetal heart during labour:

Accepted Answer

2 and 3

Answer

1 and 2

Answer

2 only

Answer

1 and 3

Question 8

The engaging diameter of brow presentation is:

Accepted Answer

Mento‐vertical

Answer

Submento‐bregmatic

Answer

Submento‐vertical

Answer

Suboccipito‐bregmatic

Question 9

Modified Bishop’s score includes all EXCEPT:

Accepted Answer

Position of occiput

Answer

Position of os

Answer

Consistency of cervix

Answer

Cervical length and dilatation

Question 10

The main cause of perinatal mortality in ‘Frank breech presentation’ is:

Accepted Answer

Intracranial haemorrhage

Answer

Prolapse of umbilical cord

Answer

Trauma to foetal viscera

Answer

Foetal abnormalities

Labor and Delivery — MCQs

Labor and Delivery — MCQs

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