Labor and Delivery Practice Questions

Q: Which of the following are indications of vaginal examinations during labour? 1. To stretch the vagina intermittently 2. At the onset of labour 3. To monitor progress of labour 4. Following rupture of membranes

2, 3 and 4. ***2, 3 and 4*** * Regular vaginal examinations are crucial for **monitoring the progress of labour**, assessing cervical dilation, effacement, and fetal station. * Examinations at the **onset of labour** establish a baseline for progress, and after **rupture of membranes**, they are important to check for **cord prolapse** and confirm fetal presentation. * *1, 3 and 4* * **Stretching the vagina intermittently** is not a standard indication for vaginal examination in labour. Labour progress is assessed, not physically hastened by stretching. * While monitoring progress and examining after membrane rupture are correct indications, the inclusion of "stretching the vagina" makes this option incorrect. * *1, 2 and 4* * Similar to the previous option, including **stretching the vagina intermittently** as an indication is incorrect. * Vaginal examinations are for assessment, not for mechanically dilating the vagina. * *1, 2 and 3* * This option again incorrectly includes **stretching the vagina intermittently** as an indication. * While examinations at the onset and for monitoring progress are valid, the presence of an incorrect indication makes the entire option invalid.

Q: In the mechanism of normal labour the engaging transverse diameter is

Biparietal diameter (9.5 cm). ***Biparietal diameter (9.5 cm)*** - In normal labor, with the fetus in a **flexed attitude**, the **biparietal diameter** is the widest transverse diameter of the fetal head that engages in the maternal pelvis. - This diameter measures approximately **9.5 cm** and indicates the distance between the two parietal eminences. *Bimastoid diameter (7.5 cm)* - The **bimastoid diameter** measures the widest transverse diameter at the base of the skull, going from one mastoid process to the other. - At **7.5 cm**, it is too small to be the primary engaging transverse diameter of the fetal head in normal labor, which involves the broader cranial vault. *Suboccipitofrontal diameter (10 cm)* - The **suboccipitofrontal diameter** is typically the engaging diameter when the fetal head is in a **deflexed attitude** (e.g., military presentation). - This diameter measures approximately **10 cm**, indicating moderate extension, which is not characteristic of normal labor where good flexion is expected. *Suboccipitobregmatic diameter (9.5 cm)* - The **suboccipitobregmatic diameter** is the smallest and most favorable anteroposterior diameter for engagement when the fetal head is **well-flexed**. - While it also measures **9.5 cm**, it is an **anteroposterior diameter**, not a transverse diameter, and hence not the answer to the question regarding transverse engaging diameter.

Q: The normal rate of dilatation of the cervix in a primigravida in the active phase of labor is

1 cm/hour. ***1 cm/hour*** - The **active phase** of labor in a **primigravida** (first-time mother) is characterized by a cervical dilatation rate of at least 1 cm per hour. - This rate signifies good progress and is often used as a benchmark on a **partogram** to monitor labor. *0.25 cm/hour* - This rate is significantly **slower** than normal for the active phase of labor in a primigravida and would indicate **abnormal labor progression**, possibly requiring intervention. - Such a slow rate might be seen in the **latent phase** or in cases of **protracted labor**. *0.75 cm/hour* - While closer, this rate is still **below the expected minimum** for a primigravida in the active phase, suggesting slightly slower than optimal progress. - It could still indicate a **protracted active phase**, particularly if it persists. *0.5 cm/hour* - This rate is **substantially slower** than the typical progress in the active phase of labor for a primigravida. - It would be a strong indicator of **failure to progress** and would likely warrant a thorough evaluation for potential causes such as **cephalopelvic disproportion** or ineffective uterine contractions.

Q: A patient who just delivered at home presents with a third degree perineal tear. You will do the repair:

immediately. ***immediately*** - Repair of a **third-degree perineal tear** should be done **immediately** after diagnosis to minimize complications like infection, pain, and long-term functional issues. - Prompt repair helps to restore **anatomical integrity** and improve outcomes for continence and discomfort. *after 24 hours.* - Delaying the repair by 24 hours increases the risk of **infection**, **edema**, and further tissue damage, making the repair more difficult and less successful. - This delay could also lead to increased **blood loss** and patient discomfort. *after 6 weeks* - Waiting 6 weeks would allow for scar tissue formation and potential infection, making a primary repair much more challenging and possibly requiring a more complex secondary repair. - This delay would significantly increase the risk of **fecal incontinence** and other long-term complications. *after 3 months* - A three-month delay is inappropriate for a fresh perineal tear as it guarantees significant **scarring**, **fibrosis**, and high risk of **infection**. - By this time, the tear would likely have healed by secondary intention, resulting in poor anatomical and functional outcomes, often necessitating a more complicated and less effective **secondary repair**.

Q: Face to pubes delivery occurs in which of the foetal position?

Occipito-sacral. ***Occipito-sacral (Occipito-posterior)*** - **"Face to pubes" delivery** is the classic mechanism in **persistent occipito-posterior (OP)** positions where the occiput is directed toward the maternal sacrum. - In this position, the fetal head delivers with **maximum extension**, and the **face passes under the pubic symphysis** (hence "face to pubes"). - The occiput sweeps over the perineum posteriorly, leading to increased perineal trauma and potential for third/fourth-degree tears. - This delivery mechanism is associated with **prolonged labor, increased back pain**, and higher rates of operative delivery. *Mentoanterior* - In **mentoanterior (MA)** face presentation, the fetal chin is anterior, and delivery occurs by **flexion after the chin passes under the symphysis**. - The mechanism involves the chin sweeping the perineum, NOT "face to pubes" delivery. - While mentoanterior can deliver vaginally, the delivery mechanism is distinctly different from occipito-posterior positions. *Brow presentation* - In **brow presentation**, the head is partially extended with the **frontal bone and anterior fontanelle presenting**. - This presents the **largest diameter (mento-vertical ~13.5 cm)** to the pelvis, making vaginal delivery virtually impossible. - Almost always requires **cesarean section** for safe delivery. *Mentoposterior* - In **mentoposterior (MP)** face presentation, the fetal chin is directed posteriorly toward the maternal sacrum. - This position **cannot deliver vaginally** as further extension of the already extended head is impossible. - Requires **rotation to mentoanterior** or cesarean section for delivery.

Q: A G 2 P 1 A 0 presents with full term pregnancy with transverse lie in the first stage of labour. On examination, cervix is 5 cm dilated, membranes are intact and foetal heart sounds are regular. The appropriate management would be:

Caesarean section. ***Caesarean section*** - A **transverse lie** at term in the first stage of labor is a contraindication to vaginal delivery due to the high risk of **cord prolapse**, **uterine rupture**, and fetal distress. - **Caesarean section** is the safest mode of delivery for both mother and fetus in this scenario, as it prevents these complications. *External cephalic version* - **External cephalic version** is typically attempted in cases of **breech presentation** in the late third trimester (around 36-37 weeks) to convert it to a cephalic presentation. - It is **contraindicated** in transverse lie during active labor, especially with cervical dilation, as it has a low success rate and can lead to complications such as **placental abruption** or **cord prolapse**. *Internal podalic version* - **Internal podalic version** is a procedure typically reserved for the delivery of the second twin in a **transverse or oblique lie**, or in some cases of breech presentation. - It carries significant risks, including **uterine rupture** and fetal injury, and is generally not performed for a singleton pregnancy with cervical dilation. *Wait for spontaneous evolution and expulsion* - **Spontaneous evolution** (where the fetus rotates to a longitudinal lie) is extremely rare in a transverse lie presentation at term, especially once labor has started. - Waiting for spontaneous rotation would lead to **prolonged labor**, increased risk of **uterine rupture**, and severe fetal compromise due to obstruction.

Q: Which one of the following is not a complication of shoulder dystocia?

Placental abruption. ***Placental abruption*** - **Placental abruption** is the premature detachment of the placenta from the uterine wall, typically occurring before or during labour. It is not directly caused by the mechanical obstruction during shoulder dystocia. - Complications of shoulder dystocia are primarily related to mechanical forces exerted on the baby and mother during delivery, such as nerve injuries or uterine atony, not placental conditions. *Brachial plexus palsy* - **Brachial plexus palsy** is a common complication of shoulder dystocia, often resulting from excessive lateral traction on the fetal head or neck during delivery. - This traction can stretch or tear the nerves of the brachial plexus, leading to varying degrees of paralysis or weakness in the arm and hand. *Postpartum haemorrhage* - **Postpartum haemorrhage** is a significant risk following shoulder dystocia due to the prolonged and often traumatic nature of the delivery. - The increased manipulation and potential for uterine atony or soft tissue trauma during resolution of shoulder dystocia can predispose the mother to excessive bleeding. *Facial palsy* - **Facial palsy** can occur during shoulder dystocia if there is compression or stretching of the facial nerve (cranial nerve VII) against the maternal pelvis or other structures during delivery. - While less common than brachial plexus palsy, it can result from the abnormal forces and positions during a difficult shoulder dystocia delivery.

Q: Immediately after third stage of labour in a case of full term delivery, the fundus of the uterus is:

At the level of umbilicus. ***At the level of umbilicus*** - Immediately after delivery of the placenta (third stage of labor), the **fundus** typically contracts down to the level of the **umbilicus**. - This contraction helps to compress uterine blood vessels and prevent **postpartum hemorrhage**. *At the level of xiphisternum* - The uterus reaches the **xiphisternum** only in late third trimester, as the fetus grows. - After delivery, the uterus significantly reduces in size, so it would not remain this high. *Below the level of umbilicus* - While the uterus will eventually descend below the umbilicus during **involution** (shrinking back to pre-pregnancy size), this process takes several days to weeks, not immediately after delivery. - A fundus below the umbilicus immediately after delivery might suggest a failure of proper contraction. *Just above the symphysis pubis* - The uterus is at the level of the **symphysis pubis** much earlier in pregnancy, typically around **12 weeks gestation**. - A fundus at this level immediately after delivery would indicate an abnormally small uterus or an incomplete emptying.

Question 1

Which of the following are the hypotheses for the onset of Labor?

1. Uterine distension
2. Activation of fetal hypothalamic-pituitary-adrenal axis
3. Increase in prostaglandins
4. Increase in serum calcium levels

Select the correct answer using the code given below:

Accepted Answer

1, 2 and 3

Answer

1 and 3 only

Answer

2, 3 and 4

Answer

1, 2 and 4

Question 2

Which of the following are indications of vaginal examinations during labour?

1. To stretch the vagina intermittently
2. At the onset of labour
3. To monitor progress of labour
4. Following rupture of membranes

Accepted Answer

2, 3 and 4

Answer

1, 3 and 4

Answer

1, 2 and 4

Answer

1, 2 and 3

Question 3

In the mechanism of normal labour the engaging transverse diameter is

Accepted Answer

Biparietal diameter (9.5 cm)

Answer

Bimastoid diameter (7.5 cm)

Answer

Suboccipitofrontal diameter (10 cm)

Answer

Suboccipitobregmatic diameter (9.5 cm)

Question 4

The normal rate of dilatation of the cervix in a primigravida in the active phase of labor is

Accepted Answer

1 cm/hour

Answer

0.25 cm/hour

Answer

0.75 cm/hour

Answer

0.5 cm/hour

Question 5

A patient who just delivered at home presents with a third degree perineal tear. You will do the repair:

Accepted Answer

immediately

Answer

after 24 hours.

Answer

after 6 weeks

Answer

after 3 months

Question 6

Face to pubes delivery occurs in which of the foetal position?

Accepted Answer

Occipito-sacral

Answer

Brow presentation

Answer

Mentoanterior

Answer

Mentoposterior

Question 7

A G 2 P 1 A 0 presents with full term pregnancy with transverse lie in the first stage of labour. On examination, cervix is 5 cm dilated, membranes are intact and foetal heart sounds are regular. The appropriate management would be:

Accepted Answer

Caesarean section

Answer

External cephalic version

Answer

Internal podalic version

Answer

Wait for spontaneous evolution and expulsion

Question 8

Which of the following methods for induction of labour should not be used in the patient with previous lower segment caesarean section?

Accepted Answer

Vaginal prostaglandin gel

Answer

Stripping of the membrane

Answer

Oxytocin drip

Answer

Oral prostaglandin tablet

Question 9

Which one of the following is not a complication of shoulder dystocia?

Accepted Answer

Placental abruption

Answer

Brachial plexus palsy

Answer

Postpartum haemorrhage

Answer

Facial palsy

Question 10

Immediately after third stage of labour in a case of full term delivery, the fundus of the uterus is:

Accepted Answer

At the level of umbilicus

Answer

At the level of xiphisternum

Answer

Below the level of umbilicus

Answer

Just above the symphysis pubis

Labor and Delivery — MCQs

Labor and Delivery — MCQs

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