Labor and Delivery Practice Questions

Q: To obtain true conjugate, the following factor should be subtracted from the diagonal conjugate:

1.2 cm. ***1.2 cm*** - The **true conjugate** is estimated by subtracting **1.5-2.0 cm** from the **diagonal conjugate**. - In clinical practice, **1.5 cm** is the commonly used value for this subtraction. - This subtraction accounts for the thickness of the **symphysis pubis** and overlying soft tissues. - Some sources may use values ranging from **1.2 to 2.0 cm** depending on clinical context. *3.0 cm* - Subtracting 3.0 cm would result in significant **underestimation** of the true conjugate. - This would lead to incorrect assessment of **pelvic adequacy** and potentially unnecessary interventions. - This value is well above the standard correction range. *0.5 cm* - Subtracting only 0.5 cm would lead to **overestimation** of the true conjugate. - This does not adequately account for the **symphysis pubis thickness** and soft tissue depth. - This could result in missed cases of **cephalopelvic disproportion**. *2.5 cm* - While 2.5 cm falls within some reported ranges, it is at the higher end of the correction spectrum. - Using this value might lead to slight **underestimation** of pelvic capacity. - The standard teaching emphasizes **1.5-2.0 cm** as the typical range.

Q: All of the following are treatments for deep transverse arrest except:

Craniotomy. ***Craniotomy*** - A **craniotomy** is a destructive procedure performed on the fetal head to reduce its size for delivery, typically reserved for instances of **fetal demise**. - This is **not a treatment for deep transverse arrest in a viable fetus** but a destructive procedure for a non-viable fetus. - In modern obstetric practice, craniotomy is not used for managing deep transverse arrest in living fetuses. *Cesarean section* - A **cesarean section** is a common and appropriate treatment for deep transverse arrest, especially when vaginal delivery is not achievable or safe. - It bypasses the need for rotation and forceps, thus being a direct method of delivery for this type of arrest. *Manual rotation with outlet forceps* - **Manual rotation** converts the transverse arrest to an anterior-posterior position, allowing for vaginal delivery, often assisted by **forceps** once rotated. - This technique is a direct intervention for deep transverse arrest, aiming to achieve a vaginal delivery in cases where the fetal head is arrested in the transverse diameter of the maternal pelvis. - Manual rotation followed by forceps application is a well-established treatment option. *Ventouse* - **Ventouse** (vacuum extraction) is a method to assist vaginal delivery by applying suction to the fetal head and is often used for deep transverse arrest after rotation has been achieved. - It helps to extract the fetus when descent is arrested, acting as a direct delivery method in these scenarios.

Q: A 37-year-old G2P1 woman at 38 weeks' gestation presents to the obstetrics clinic for a prenatal visit. The patient had difficulty becoming pregnant but was successful after using in vitro fertilization. She has a history of recurrent herpes outbreaks and is currently experiencing genital pain and tingling. Her first pregnancy was complicated by failure to progress, which resulted in a cesarean birth. Routine rectovaginal culture at 36 weeks was positive for Group B streptococci. Which of the following would be an absolute indication for delivering the child by LSCS (Lower Segment Cesarean Section):

Current symptoms of genital pain and tingling. ***Current symptoms of genital pain and tingling*** - **Genital pain and tingling** in a patient with a history of recurrent herpes outbreaks strongly suggests a **prodromal or active herpes outbreak**. - An active maternal **genital herpes lesion** at the time of labor is an absolute indication for **cesarean delivery** to prevent neonatal herpes simplex virus (HSV) infection, which can be life-threatening. *History of previous cesarean section* - A **prior cesarean section** is a relative indication for a repeat cesarean, but many women are candidates for a **trial of labor after cesarean (TOLAC)** if certain criteria are met. - It is not an absolute contraindication to vaginal delivery itself, especially if the previous cesarean was for a non-recurrent indication like **failure to progress**. *Maternal colonization with Group B streptococci* - **Group B streptococcus (GBS) colonization** is typically managed with **intrapartum antibiotic prophylaxis (IAP)** to prevent early-onset neonatal GBS disease. - It does not necessitate a cesarean section for delivery; rather, antibiotics are given once labor begins or membranes rupture. *In vitro fertilization* - **In vitro fertilization (IVF)** is a method of conception and does not inherently determine the mode of delivery. - Pregnancy achieved through IVF does not, by itself, increase the risk of complications that would mandate a **cesarean section**, unless there are other associated factors like multiple gestations or specific maternal conditions.

Q: Burns-Marshall technique is used to deliver the:

After-coming head. ***After-coming head*** - The **Burns-Marshall technique** is a method specifically designed for the delivery of the **after-coming head** in a **breech presentation**, typically when the body has already been delivered. - This technique involves suprapubic pressure and gentle upward traction on the baby's ankles to facilitate flexion and delivery of the head. *Leg* - The Burns-Marshall maneuver is not used to deliver the leg; the legs are typically delivered earlier in a **frank or complete breech delivery**. - Delivery of the legs usually involves assisting the natural progression of labor or specific maneuvers if there is a problem. *Placenta* - The **placenta** is delivered in the **third stage of labor**, after the baby has been born, and is not associated with the Burns-Marshall technique. - Methods for placental delivery include spontaneous expulsion or controlled cord traction. *Head* - While the maneuver relates to the head, it is specifically for the **after-coming head** in a breech presentation, not the initial delivery of the head in a **cephalic presentation**. - In a cephalic presentation, the head is typically delivered first through flexion and extension, guided by the maternal pelvis.

Q: Subpubic angle in gynecoid pelvis is?

100o. ***Correct Option: 100°*** - A **subpubic angle of 90-100 degrees** is characteristic of a **gynecoid pelvis**, which is the most favorable pelvis type for childbirth. - The gynecoid pelvis has a **rounded pelvic inlet** and a **wide subpubic arch** (≥90°), allowing optimal space for fetal head descent. - **100 degrees** falls within the normal range and represents a well-formed gynecoid pelvis with an adequate pelvic outlet. *Incorrect Option: 80°* - A **subpubic angle of 80 degrees** is more characteristic of an **anthropoid pelvis** or represents the lower limit of normal. - This narrower angle, while still permitting vaginal delivery, is not the typical measurement for a classic gynecoid pelvis. - Gynecoid pelvis typically has angles **≥90 degrees**. *Incorrect Option: 120°* - A **subpubic angle of 120 degrees** is excessively wide and not characteristic of a gynecoid pelvis. - Such an extreme angle would suggest unusual pelvic anatomy and is not a standard measurement in pelvic classification. *Incorrect Option: 75°* - A **subpubic angle of 75 degrees** is characteristic of an **android (male-type) pelvis**, which has a narrow subpubic arch. - This narrow angle can restrict fetal head passage through the pelvic outlet, increasing the risk of obstructed labor. - This is significantly below the gynecoid pelvis range of ≥90 degrees.

Q: Childbirth trauma leading to urine incontinence is seen least in females with:

Gynecoid pelvis. ***Gynecoid pelvis*** - The **gynecoid pelvis** is considered the **ideal female pelvis** for childbirth, with a **round inlet** and well-proportioned dimensions. - It facilitates the **easiest vaginal delivery** with optimal pelvic capacity and favorable diameters. - Due to the smooth and uncomplicated labor process, it is associated with the **least childbirth trauma** and consequently the **lowest risk of urinary incontinence** from pelvic floor damage. *Android pelvis* - The **android pelvis** has a **heart-shaped inlet** and generally **narrower pelvic cavity**, characteristic of the male pelvis. - This shape leads to **difficult and prolonged labor** with higher rates of operative delivery. - Associated with the **highest incidence of birth trauma** and subsequent complications like **stress urinary incontinence** from pelvic floor injury. *Anthropoid pelvis* - The **anthropoid pelvis** has an **oval inlet** with a long anterior-posterior diameter and relatively short transverse diameter. - While generally favorable for delivery, it may be associated with **occiput posterior positions** and potentially longer labors. - Moderate risk of birth trauma, more than gynecoid but less than android pelvis. *Platypelloid pelvis* - The **platypelloid pelvis** has a **flat, oval inlet** with wide transverse diameter but very short anterior-posterior diameter. - This shape causes **difficulty with engagement and descent** of the fetal head. - Associated with higher risk of operative delivery and birth trauma compared to gynecoid pelvis.

Q: ARM is contraindicated in:

Placenta previa. ***Placenta previa*** - **Placenta previa** is an **absolute contraindication** to ARM because the placenta covers the cervical os. - Rupturing membranes in placenta previa would directly **lacerate the placenta**, leading to **catastrophic hemorrhage** that is life-threatening to both mother and fetus. - ARM should **never be performed** in cases of placenta previa; cesarean section is the mode of delivery. *Hydramnios* - **Hydramnios** (polyhydramnios) is a **relative contraindication** requiring caution, not an absolute contraindication. - ARM can be performed with proper precautions: **controlled rupture** with fingers at the cervix to regulate fluid flow, ensuring the presenting part is well-applied to prevent **cord prolapse**. - The risk is manageable with careful technique, making it a cautionary situation rather than an absolute contraindication. *Accidental Hemorrhage* - **Accidental hemorrhage** (placental abruption) is not a contraindication to ARM. - In fact, ARM may be indicated to accelerate labor and reduce intrauterine pressure if the fetus is viable, which can help manage the abruption. *Twins* - **Twin pregnancies** do not contraindicate ARM. - ARM may be used for the first twin to induce labor or for the second twin after delivery of the first, depending on clinical circumstances.

Q: As compared to mediolateral episiotomy, median episiotomy has complications because of:

Extension to rectum. ***Extension to rectum*** - Median episiotomy involves a straight incision towards the anus, which places it at a higher risk of extending directly into the **rectum** or **anal sphincter**, leading to third- or fourth-degree lacerations. - This proximity to the anal canal significantly increases the potential for **fecal incontinence** and other severe complications. *Cosmetic problem* - While scar formation can occur with any incision, median episiotomies are generally considered to have a **better cosmetic outcome** compared to mediolateral episiotomies due to a more anatomical scar formation. - Therefore, cosmetic problems are not the primary reason for considering median episiotomies more complicated. *More blood loss* - Mediolateral episiotomies typically involve cutting across muscle fibers and several blood vessels, often leading to **more blood loss** than median episiotomies. - Median episiotomies generally involve less vascular tissue, resulting in **less intraoperative bleeding**. *Poor repair* - Median episiotomies are generally **easier to repair** than mediolateral episiotomies due to their straight, anatomically aligned incision. - The layers are typically well-defined, facilitating a more straightforward and often less painful repair.

Q: Uterine rupture is most common in -

Anterior lower segment. ***Anterior lower segment*** - The **anterior lower segment** is the most common site for **uterine rupture** due to prior **cesarean sections** or other uterine surgeries which are often performed anteriorly. - This area is thinner and more prone to stretching and tearing during labor, especially in cases of repeated surgical scars. *Posterior lower segment* - While rupture can occur in the **posterior lower segment**, it is less common than the anterior location. - This area is usually less stressed by previous surgical incisions compared to the anterior wall. *Upper uterine segment* - Rupture in the **upper uterine segment** typically involves an **unscarred uterus** and is a rare event, often associated with a **grand multiparous patient** or **oxytocin hyperstimulation**. - This type of rupture is usually spontaneous and more catastrophic due to the rich vascularity of the upper segment. *Lateral uterine wall* - Rupture of the **lateral uterine wall** is uncommon and usually associated with **trauma** or **manual extraction of the placenta**, rather than prior surgical scars. - It is not the most frequent site for spontaneous or scar-related uterine rupture.

Question 1

Which of the following is FALSE regarding the diameters of the normal female pelvis?

Accepted Answer

Obstetric conjugate is calculated by adding 1.5 cm to diagonal conjugate

Answer

Oblique diameter is the largest diameter of inlet

Answer

Obstetric conjugate indicates status of mid pelvis

Answer

AP Diameter is the shortest diameter at brim

Question 2

To obtain true conjugate, the following factor should be subtracted from the diagonal conjugate:

Accepted Answer

1.2 cm

Answer

3.0 cm

Answer

0.5 cm

Answer

2.5 cm

Question 3

All of the following are treatments for deep transverse arrest except:

Accepted Answer

Craniotomy

Answer

Cesarean section

Answer

Manual rotation with outlet forceps

Answer

Ventouse

Question 4

A 37-year-old G2P1 woman at 38 weeks' gestation presents to the obstetrics clinic for a prenatal visit. The patient had difficulty becoming pregnant but was successful after using in vitro fertilization. She has a history of recurrent herpes outbreaks and is currently experiencing genital pain and tingling. Her first pregnancy was complicated by failure to progress, which resulted in a cesarean birth. Routine rectovaginal culture at 36 weeks was positive for Group B streptococci. Which of the following would be an absolute indication for delivering the child by LSCS (Lower Segment Cesarean Section):

Accepted Answer

Current symptoms of genital pain and tingling

Answer

History of previous cesarean section

Answer

Maternal colonization with Group B streptococci

Answer

In vitro fertilization

Question 5

Burns-Marshall technique is used to deliver the:

Accepted Answer

After-coming head

Answer

Leg

Answer

Placenta

Answer

Head

Question 6

Subpubic angle in gynecoid pelvis is?

Accepted Answer

100o

Answer

80o

Answer

120o

Answer

75o

Question 7

Childbirth trauma leading to urine incontinence is seen least in females with:

Accepted Answer

Gynecoid pelvis

Answer

Platypelloid pelvis

Answer

Anthropoid pelvis

Answer

Android pelvis

Question 8

ARM is contraindicated in:

Accepted Answer

Placenta previa

Answer

Accidental Hemorrhage

Answer

Twins

Answer

Hydramnios

Question 9

As compared to mediolateral episiotomy, median episiotomy has complications because of:

Accepted Answer

Extension to rectum

Answer

Cosmetic problem

Answer

More blood loss

Answer

Poor repair

Question 10

Uterine rupture is most common in -

Accepted Answer

Anterior lower segment

Answer

Posterior lower segment

Answer

Upper uterine segment

Answer

Lateral uterine wall

Labor and Delivery — MCQs

Labor and Delivery — MCQs

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