Labor and Delivery Practice Questions

Q: After delivering a baby boy, a 25 -year-old mother developed acute PPH and hypovolemic shock, and major blood transfusion occurred. All of the following are complications of blood transfusion except?

Hypokalemia. ***Hypokalemia*** - **Hypokalemia is NOT a typical complication of massive blood transfusion**. In fact, massive transfusion is characteristically associated with **hyperkalemia**, not hypokalemia. - **Stored blood** contains high levels of extracellular potassium due to **red blood cell lysis** during storage (potassium levels can reach 30-50 mEq/L in units stored >21 days). - Rapid transfusion of multiple units delivers a significant **potassium load**, making **hyperkalemia** the expected electrolyte abnormality. - While hypokalemia could theoretically occur later due to **alkalosis from citrate metabolism** or during the **rewarming/correction phase**, this is **indirect, uncommon, and not a recognized acute complication** of the transfusion itself. - Therefore, hypokalemia is the exception among the listed options. *Hypothermia* - **Direct and common complication** when cold blood products (stored at 1-6°C) are rapidly infused without adequate warming. - Can cause **coagulopathy**, cardiac arrhythmias, decreased drug metabolism, and leftward shift of oxygen-hemoglobin dissociation curve. - Prevention requires use of **blood warmers** during massive transfusion. *Hypocalcemia* - **Very common complication** of massive transfusion due to **citrate toxicity**. - **Citrate** (anticoagulant in stored blood) chelates ionized calcium in the recipient's circulation. - Normally metabolized by the liver, but rapid transfusion overwhelms hepatic metabolism, leading to **symptomatic hypocalcemia**. - Can cause **cardiac dysfunction, hypotension, and prolonged QT interval**. *Hypomagnesemia* - Can occur with massive transfusion as **magnesium is also chelated by citrate**, similar to calcium. - Less commonly recognized than hypocalcemia but documented in massive transfusion protocols. - Can contribute to **cardiac arrhythmias and neuromuscular irritability**.

Q: A primigravida is in labor. Her per-vaginal examination revealed a posterior cervix with 5 cm cervical length, 1 cm dilatation, soft consistency, and head at -1 station. Calculate the Bishop score.

5. ***5*** - The Bishop score calculation: **cervical position** (posterior = 0), **cervical effacement** (5 cm length = 0), **dilation** (1 cm = 1), **consistency** (soft = 2), and **station** (-1 = 1). - According to standard **Dutta textbook** references, this totals to 5 points (0 + 0 + 1 + 2 + 1), with soft consistency correctly scoring 2 points. *3* - This score incorrectly assigns only **1 point for soft consistency** instead of the standard 2 points. - The miscalculation underestimates the **cervical readiness** for labor induction. *0* - A score of 0 would require all parameters to be at their **minimum values** (firm consistency, closed cervix, high station). - The given parameters show **1 cm dilation**, **soft consistency**, and **-1 station**, each contributing positive points. *8* - A high score of 8 indicates a **very favorable cervix** with significant effacement, anterior position, and greater dilation. - The current findings show **minimal effacement** (5 cm length), **posterior position**, and only **1 cm dilation**, inconsistent with such a high score.

Q: Which of the following is a part of AMTSL?

Controlled cord traction. ***Controlled cord traction*** - **Controlled cord traction (CCT)** is a key component of Active Management of Third Stage of Labor (AMTSL) performed during placental delivery. - This technique involves applying gentle, sustained traction to the umbilical cord while simultaneously providing counter-traction to the fundus (Brandt-Andrews maneuver) to prevent **uterine inversion**. - CCT is performed after administering a uterotonic and is the primary active maneuver for delivering the placenta. *Uterine massage* - **Uterine massage** is also a component of AMTSL, but it is performed **after placental delivery** to ensure adequate uterine contraction and prevent postpartum hemorrhage. - The three components of AMTSL per WHO recommendations are: (1) Uterotonic administration, (2) Controlled cord traction, (3) Uterine massage after placental delivery. - While technically part of AMTSL, **controlled cord traction** is the more specific answer as it refers to the active maneuver during placental separation and delivery itself. *Early cord clamping* - **Early cord clamping** (within 60 seconds of birth) has been removed from AMTSL recommendations in favor of **delayed cord clamping** (1-3 minutes or when pulsation stops). - Current WHO guidelines recommend delayed cord clamping for all births while still performing AMTSL, as delayed clamping provides neonatal benefits without increasing maternal hemorrhage risk. *Uterotonics after delivery of placenta* - **Uterotonics** (oxytocin 10 IU IM/IV) are administered **within 1 minute of birth** of the baby, which is *before* placental delivery, not after. - This prophylactic administration is the cornerstone of AMTSL and reduces postpartum hemorrhage risk by approximately 60%. - Administering uterotonics *after* placental delivery does not constitute proper AMTSL timing.

Q: After a normal delivery in a 27-year-old female, placenta is still attached to the uterus. Most common complication which can occur due to forceful traction of cord?

Uterine inversion. ***Uterine inversion*** - Forceful traction on the umbilical cord when the placenta is still firmly attached can pull the **fundus of the uterus inside out**, leading to uterine inversion. - This is a rare obstetric emergency associated with significant **hemorrhage** and shock. *Hemorrhage* - While hemorrhage is a common complication of retained placenta and uterine inversion, it is a *consequence* of these conditions, not the direct complication of forceful cord traction itself in the same way uterine inversion is. - The direct mechanical complication from forceful traction is the pulling out of the uterus, which then *causes* the significant hemorrhage. *Uterine rupture* - Uterine rupture during the third stage of labor is exceptionally rare and usually associated with a **previously scarred uterus** or excessive uterine overdistension, not typically caused by forceful cord traction. - Forceful cord traction is more likely to cause inversion or avulsion of the cord, rather than a tear in the uterine wall. *Placental abruption* - Placental abruption involves the **premature separation of a normally implanted placenta** *before* the delivery of the fetus. - This event occurs during pregnancy or labor before birth, not after delivery when the placenta is simply retained.

Q: 32 years old lady with twin dichorionic diamniotic pregnancy, first baby breech presentation and second baby cephalic presentation. What is the management?

C - Section. ***C-Section*** - When **twin A is in breech presentation** in a dichorionic diamniotic twin pregnancy, **elective Cesarean section** is the recommended mode of delivery according to ACOG and most international guidelines. - The primary concern is the **increased risk of complications with breech delivery** of the first twin, including **head entrapment**, **cord prolapse**, and **birth trauma**. - While twin B is cephalic (which would be favorable for vaginal delivery if it were the presenting twin), the non-cephalic presentation of twin A dictates the mode of delivery for both twins. *Assisted breech* - While breech extraction may be considered in select cases where **twin A is cephalic and twin B is breech**, attempting vaginal breech delivery when twin A presents as breech is generally not recommended. - The risks of breech delivery for the first twin include **difficulty delivering the aftercoming head**, **cord prolapse**, and **birth asphyxia**, which are unacceptable in an elective situation where cesarean section is readily available. *Instrumental delivery* - Instrumental delivery (forceps or vacuum) is used to assist delivery of a **cephalic presentation** in the second stage of labor. - It cannot be used for **breech presentation** of twin A, making it inappropriate as a primary management strategy in this scenario. *Normal vaginal delivery* - Vaginal delivery with **twin A in non-cephalic (breech) presentation** is contraindicated in most modern obstetric guidelines due to significantly increased perinatal morbidity and mortality. - Even though twin B is cephalic, the presentation of twin A determines the overall delivery approach in twin pregnancies.

Q: Among the following the plane of least pelvic dimension is:

Mid-cavity. ***Mid-cavity*** - The **mid-cavity** or **mid-pelvis** is the plane of smallest dimensions during labor, defined by the ischial spines laterally [1]. - This plane is crucial for determining if a fetus can successfully navigate the birth canal, as it represents the narrowest point [1]. *Inlet* - The **pelvic inlet** is the widest part of the pelvis and usually poses less of a restriction during the descent of the fetal head [1]. - It is bounded by the sacral promontory, arcuate line, pectineal line, and pubic crest [2]. *False pelvis* - The **false pelvis** is the upper, broader part of the pelvis and does not play a direct role in guiding the fetal head through the birth canal [1]. - Its boundaries are largely abdominal and do not define crucial dimensions for passage [2]. *Outlet* - The **pelvic outlet** is the final opening that the fetal head must pass through, and while its dimensions are important, the mid-cavity is generally the narrowest point. - Its dimensions are measured from the pubic arch to the tip of the coccyx [3].

Q: A primipara is in labor and an episiotomy is about to be cut. Compared with a midline episiotomy, an advantage of mediolateral episiotomy is

Less extension of the incision. ***Less extension of the incision.*** - A **mediolateral episiotomy** is less likely to extend into the rectum and anal sphincter, thus preventing a **third- or fourth-degree laceration**. - This oblique incision is directed away from the midline, significantly reducing the risk of involving the **external anal sphincter** and **rectal mucosa**. *Ease of repair* - **Midline episiotomies** are generally easier to repair due to their linear nature and involvement of fewer tissue layers. - Mediolateral episiotomies involve more complex tissue planes and angles, often making their repair more challenging and time-consuming. *Less blood loss* - **Midline episiotomies** typically result in less blood loss because they cut through less vascular tissue. - **Mediolateral incisions** cut across more muscle fibers and blood vessels, often leading to increased blood loss. *Fewer breakdowns* - **Midline episiotomies**, when properly repaired, tend to have a lower risk of tissue breakdown and infection because they are less traumatic to the surrounding structures. - Mediolateral episiotomies involve a larger tissue area and more complex wound architecture, which can increase the risk of delayed healing or breakdown.

Q: A pelvis characterized by an anteroposterior diameter of the inlet greater than the transverse diameter is classified as

Anthropoid. ***Anthropoid*** - An **anthropoid pelvis** is characterized by an **oval-shaped inlet** where the **anteroposterior diameter is greater than the transverse diameter**. - This pelvic shape is often associated with a **more favorable prognosis for vaginal delivery** when the fetal head engages in an occiput anterior or posterior position. *Gynecoid* - The **gynecoid pelvis** is considered the **"true female pelvis"**, with a rounded inlet and approximate equality of the anteroposterior and transverse diameters. - It is the most common pelvic type and is generally associated with the **easiest vaginal delivery**. *Platypelloid* - A **platypelloid pelvis** has a **transversely oval inlet** where the **transverse diameter is greater than the anteroposterior diameter**. - This shape is relatively uncommon and can be associated with **difficulties during labor**, particularly with fetal head engagement and rotation. *Android* - The **android pelvis** has a **heart-shaped or wedge-shaped inlet**, with a **narrower anterior segment** and prominent ischial spines. - This pelvic type is often associated with the **male pelvis** and can lead to **labor dystocia** due to reduced pelvic capacity.

Q: Incidence of scar rupture in previous lower segment caesarean section:

1%. ***1%*** - The incidence of **uterine rupture** in a subsequent pregnancy after a **low transverse uterine incision** (previous lower segment caesarean section) is approximately **0.5-1%**. This low risk allows for considering a trial of labor after cesarean (TOLAC) in appropriate candidates. - This value represents the general risk and is a critical factor in counseling patients about the safety of **vaginal birth after cesarean (VBAC)**. *5%* - An incidence of **5%** for scar rupture is significantly higher than what is observed for a **lower segment caesarean section**. - This higher percentage might be associated with a **classical uterine incision** (vertical incision in the upper uterine segment) which carries a much greater risk of uterine rupture. *7%* - A **7%** incidence of scar rupture is also substantially higher than the typical risk associated with a previous **lower segment caesarean section**. - This rate would generally be considered prohibitive for most cases of **TOLAC** due to the increased maternal and fetal risks. *6%* - An incidence of **6%** for scar rupture is not consistent with the known rates for a **lower segment caesarean section**. - This figure indicates a risk much higher than the actual average and would likely lead to recommendations against **TOLAC**.

Q: The shortest anteroposterior diameter of the pelvic inlet is:

Obstetric conjugate. ***Obstetric conjugate*** - The **obstetric conjugate** is the shortest anteroposterior diameter of the pelvic inlet, measured from the posterior superior aspect of the pubic symphysis to the sacral promontory. - This is the **narrowest available anteroposterior diameter** through which the fetal head must pass during labor, making it clinically significant. *All are equal* - This statement is incorrect as the various pelvic conjugate measurements have **distinct lengths** and clinical implications. - The different conjugated diameters are measured between specific anatomical points and are not uniform. *True conjugate* - The **true conjugate** (anatomical conjugate) extends from the middle of the sacral promontory to the superior posterior margin of the pubic symphysis. - While it is a key pelvic inlet measurement, it is slightly longer than the obstetric conjugate because it measures to the *superior* rather than the *posterior superior* aspect of the symphysis, which has a small posterior projection. *Diagonal conjugate* - The **diagonal conjugate** is measured clinically via vaginal examination from the inferior border of the pubic symphysis to the sacral promontory. - This measurement is typically about **1.5-2 cm longer** than the true conjugate and is an indirect estimate of the obstetric conjugate.

Question 1

After delivering a baby boy, a 25 -year-old mother developed acute PPH and hypovolemic shock, and major blood transfusion occurred. All of the following are complications of blood transfusion except?

Accepted Answer

Hypokalemia

Answer

Hypothermia

Answer

Hypocalcemia

Answer

Hypomagnesemia

Question 2

A primigravida is in labor. Her per-vaginal examination revealed a posterior cervix with 5 cm cervical length, 1 cm dilatation, soft consistency, and head at -1 station. Calculate the Bishop score.

Accepted Answer

5

Answer

0

Answer

8

Answer

3

Question 3

Which of the following is a part of AMTSL?

Accepted Answer

Controlled cord traction

Answer

Uterine massage

Answer

Early cord clamping

Answer

Uterotonics after delivery of placenta

Question 4

After a normal delivery in a 27-year-old female, placenta is still attached to the uterus. Most common complication which can occur due to forceful traction of cord?

Accepted Answer

Uterine inversion

Answer

Hemorrhage

Answer

Uterine rupture

Answer

Placental abruption

Question 5

32 years old lady with twin dichorionic diamniotic pregnancy, first baby breech presentation and second baby cephalic presentation. What is the management?

Accepted Answer

C - Section

Answer

Assisted breech

Answer

Instrumental delivery

Answer

Normal vaginal delivery

Question 6

Among the following the plane of least pelvic dimension is:

Accepted Answer

Mid-cavity

Answer

Inlet

Answer

False pelvis

Answer

Outlet

Question 7

A primipara is in labor and an episiotomy is about to be cut. Compared with a midline episiotomy, an advantage of mediolateral episiotomy is

Accepted Answer

Less extension of the incision

Answer

Ease of repair

Answer

Less blood loss

Answer

Fewer breakdowns

Question 8

A pelvis characterized by an anteroposterior diameter of the inlet greater than the transverse diameter is classified as

Accepted Answer

Anthropoid

Answer

Gynecoid

Answer

Platypelloid

Answer

Android

Question 9

Incidence of scar rupture in previous lower segment caesarean section:

Accepted Answer

1%

Answer

5%

Answer

7%

Answer

6%

Question 10

The shortest anteroposterior diameter of the pelvic inlet is:

Accepted Answer

Obstetric conjugate

Answer

All are equal

Answer

True conjugate

Answer

Diagonal conjugate

Labor and Delivery — MCQs

Labor and Delivery — MCQs

On this page

Practice by Chapter

Want unlimited practice?