Labor and Delivery Practice Questions

Q: True labor pains is represented by:

Show. **Explanation:** The diagnosis of **True Labor** is based on the presence of regular, rhythmic uterine contractions that increase in frequency and intensity, leading to progressive cervical effacement and dilatation. **Why "Show" is correct:** "Show" refers to the expulsion of the cervical mucus plug mixed with a small amount of blood (from the rupture of small capillaries as the cervix dilates). It is a classic clinical sign of true labor, indicating that cervical changes are actively occurring. While not every patient experiences a visible show, its presence is a strong diagnostic indicator of true labor. **Analysis of Incorrect Options:** * **A. Pain and discomfort in the abdomen:** In true labor, pain typically starts in the **back** and radiates to the front of the abdomen. Pain confined only to the lower abdomen or groin is more characteristic of false labor. * **C. Relieved by enema and administration of sedative:** This is a hallmark of **False Labor**. True labor pains are not relieved by sedatives, enemas, or walking; in fact, they often intensify with activity. * **D. Dull in nature:** True labor pains are described as **colicky and rhythmic**, not dull. They have a distinct pattern of contraction and relaxation. **NEET-PG High-Yield Pearls:** * **The Definitive Sign:** The single most important feature of true labor is **progressive cervical dilatation and effacement**. * **False Labor (Braxton Hicks):** Characterized by irregular contractions, no cervical changes, and relief with sedation/rest. * **Formation of Bag of Waters:** In true labor, the membranes become detached from the lower uterine segment, leading to the formation of the "bag of waters" due to cervical dilatation.

Q: What is the first-line drug for atonic postpartum hemorrhage?

Oxytocin. **Explanation:** **Atonic Postpartum Hemorrhage (PPH)** is the most common cause of PPH (approx. 80%). The primary goal of management is to stimulate uterine contractions to compress the spiral arteries. **Why Oxytocin is the Correct Answer:** Oxytocin is the **first-line drug** for both the prevention (Active Management of Third Stage of Labor - AMTSL) and treatment of atonic PPH. It acts rapidly (within 2–3 minutes when given IM), has a predictable response, and carries a low side-effect profile compared to other uterotonics. It is administered as a slow IV infusion or IM injection. **Analysis of Incorrect Options:** * **A. Methylergometrine:** This is a second-line agent. It is highly effective but **contraindicated in patients with hypertension** or pre-eclampsia, as it causes peripheral vasoconstriction. * **C. PGE1 (Misoprostol):** Usually reserved for settings where oxytocin is unavailable or as an adjunct. It has a slower onset of action and common side effects like shivering and pyrexia. * **D. Carboprost (15-methyl PGF2α):** A potent second-line uterotonic used when oxytocin fails. It is **contraindicated in patients with asthma** due to its bronchoconstrictor effects. **High-Yield Clinical Pearls for NEET-PG:** * **Drug of Choice (DOC) for AMTSL:** Oxytocin (10 IU IM). * **DOC for PPH in a Hypertensive Patient:** Oxytocin (Avoid Methylergometrine). * **DOC for PPH in an Asthmatic Patient:** Oxytocin or Methylergometrine (Avoid Carboprost). * **Maximum Dose of Oxytocin:** 40 IU in 500ml/1L of crystalloid. * **Surgical Step (if drugs fail):** Uterine massage → Bimanual compression → Uterine packing/Balloon tamponade → Surgical ligation/B-Lynch suture → Hysterectomy (last resort).

Q: Which of the following statements regarding episiotomy is false?

Episiotomy should be routinely given in all primigravidas.. **Explanation:** The correct answer is **D**. Historically, episiotomy was performed routinely in primigravidas based on the belief that it prevented pelvic floor relaxation and fetal intracranial hemorrhage. However, current evidence-based guidelines (ACOG and WHO) recommend **restrictive use** rather than routine use. Routine episiotomy is associated with an increased risk of third- and fourth-degree perineal tears, higher rates of infection, and increased postpartum pain without providing significant benefits to the mother or neonate. **Analysis of other options:** * **Option A:** In **Frank breech delivery**, a generous episiotomy is often indicated to facilitate the application of forceps to the after-coming head or to allow easier execution of maneuvers (like Pinard’s) to deliver the legs, thereby reducing fetal trauma. * **Option B (Perineal integrity/breakdown):** While the provided text is slightly unclear, the clinical concept is that routine episiotomy actually increases the risk of extension into the anal sphincter (rectal injury) compared to spontaneous tears. * **Option C:** Large randomized trials have proven that routine episiotomy does **not** protect the perineum from severe trauma; in fact, it is a risk factor for extension into the rectum (3rd and 4th-degree tears). **High-Yield Clinical Pearls for NEET-PG:** * **Type of Episiotomy:** Mediolateral is the most common type used in India as it carries a lower risk of anal sphincter injury compared to the midline type. * **Timing:** It should be performed at the "crowning" phase when the perineum is thinned out. * **Indications for Restrictive Use:** Fetal distress, instrumental delivery (forceps/vacuum), shoulder dystocia, and breech delivery. * **Suture Material:** Polyglactin 910 (Vicryl) is the preferred absorbable suture for repair.

Q: All of the following can be administered in acute hypertension during labor except?

IV diazoxide. **Explanation:** The management of acute hypertensive emergencies during labor (often due to Preeclampsia/Eclampsia) requires rapid-acting antihypertensives that are safe for both the mother and the fetus. **Why IV Diazoxide is the correct answer:** While **IV Diazoxide** is a potent vasodilator, it is **contraindicated** during labor. Its primary drawback is that it causes profound **uterine relaxation (tocolysis)**, which can arrest labor and lead to significant postpartum hemorrhage (PPH). Furthermore, it can cause severe maternal hypotension and hyperglycemia, making it an unsafe choice compared to modern alternatives. **Analysis of Incorrect Options:** * **IV Labetalol:** This is the **first-line drug** for acute hypertension in pregnancy. It is a combined alpha and beta-blocker that lowers blood pressure without causing reflex tachycardia, maintaining stable uteroplacental perfusion. * **IV Dihydralazine:** A direct vasodilator that has been a traditional mainstay in obstetric practice. It is effective for rapid BP control, though it may cause reflex tachycardia and headache. * **IV Nitroprusside:** Reserved as a **last-resort** agent for refractory hypertension. While it carries a theoretical risk of fetal cyanide toxicity with prolonged use, it can be used briefly in life-threatening emergencies when other drugs fail. **High-Yield Clinical Pearls for NEET-PG:** * **Target BP:** In acute hypertensive crisis, the goal is to bring Systolic BP to 140–150 mmHg and Diastolic BP to 90–100 mmHg (avoiding sudden drops to prevent placental hypoperfusion). * **Oral Alternative:** Oral **Nifedipine** (10mg) is the preferred non-parenteral option for rapid reduction of BP. * **Drug of Choice for Seizures:** **Magnesium Sulfate (MgSO₄)** remains the gold standard for seizure prophylaxis and control in Eclampsia (Pritchard Regimen).

Q: All of the following statements are true regarding stargazer breech fetus except?

Forceps are indicated for delivery. ### Explanation The **"Stargazer" fetus** refers to a breech presentation where the fetal head is in **extreme hyperextension** (deflexed). This condition poses significant risks during delivery and requires specific management strategies. **Why Option A is the correct answer (The "Except" statement):** Forceps (such as Piper’s forceps) are typically used to assist in the delivery of the after-coming head in a *normal* breech. However, in a stargazer breech, the hyperextension increases the diameters of the head presenting to the birth canal. Attempting a vaginal delivery—with or without forceps—carries a high risk of **spinal cord transection** or vertebral fracture due to the "clamping" effect of the maternal symphysis against the hyperextended neck. Therefore, forceps are **not** indicated; they are contraindicated in favor of a Cesarean Section. **Analysis of other options:** * **Option B:** True. The hallmark of a stargazer fetus is the hyperextension of the fetal head (occiput touching the back). * **Option C:** True. **Cesarean delivery** is the safest and preferred route to avoid mechanical trauma to the fetal neck. * **Option D:** True. During vaginal delivery, the traction applied to the body while the head is hyperextended can lead to severe **cervical spinal cord injury**. ### High-Yield Clinical Pearls for NEET-PG: * **Diagnosis:** Usually made via ultrasound or X-ray (showing the "stargazing" posture). * **Incidence:** Occurs in approximately 5% of breech presentations. * **Etiology:** Can be caused by fetal neck masses (e.g., goiter, cystic hygroma), uterine anomalies, or increased fetal muscle tone. * **Management Rule:** If the angle of extension is **>90 degrees**, vaginal delivery is absolutely contraindicated.

Question 1

True labor pains is represented by:

Accepted Answer

Show

Answer

Pain and discomfort in the abdomen

Answer

Relieved by enema and administration of sedative

Answer

Dull in nature

Question 2

Regarding insulin management during labor, all are true except?

Accepted Answer

Blood glucose level during labor should be maintained above 140 mg/dL.

Answer

Usual dose of intermediate-acting insulin is given at bedtime.

Answer

Morning dose of insulin is withheld.

Answer

Once labor begins, normal saline infusion is changed to 5% dextrose.

Question 3

All of the following are true about the delivery of the placenta in the third stage of labor, EXCEPT?

Accepted Answer

Separation of the placenta always manifests as revealed bleeding per vaginam, and is the most specific sign.

Answer

Lengthening of the umbilical cord is a sign of placental separation.

Answer

The fundus of the uterus must be palpated after placental delivery to rule out atonicity.

Answer

Placenta accreta may be a cause for retained placenta.

Question 4

At this stage of delivery, shown in a video clip, which complication can occur and what is its management?

Accepted Answer

Shoulder dystocia, McRobe's manoeuvre

Answer

Shoulder dystocia, Fundal Pressure

Answer

Deep Transverse arrest, Manual rotation & forceps extraction

Answer

Asynclitic head, fundal pressure

Question 5

What is the first-line drug for atonic postpartum hemorrhage?

Accepted Answer

Oxytocin

Answer

Methylergometrine

Answer

PGE1 (Misoprostol)

Answer

Carboprost

Question 6

Which of the following statements regarding episiotomy is false?

Accepted Answer

Episiotomy should be routinely given in all primigravidas.

Answer

Frank breech delivery should be preceded by a generous episiotomy.

Answer

Perineal was is incorrect, should be 'washes' or similar. Assuming 'Perineal stitches increase the risk of episiotomy breakdown.'

Answer

Routine episiotomy does not reduce the risk of rectal injury.

Question 7

All of the following can be administered in acute hypertension during labor except?

Accepted Answer

IV diazoxide

Answer

IV labetalol

Answer

IV nitroprusside

Answer

IV dihydralazine

Question 8

Which of the following statements regarding the management of twin pregnancy in labor is true?

Accepted Answer

Internal podalic version can be performed for the second twin if it is in a transverse lie.

Answer

Intramuscular methylergometrine should be administered after the delivery of the first twin to mitigate the increased risk of postpartum hemorrhage due to uterine atony.

Answer

External cephalic version can be attempted at 36 weeks gestation if the first twin is not in a cephalic presentation.

Answer

A first twin in cephalic presentation and a second twin in breech presentation is a contraindication for a trial of labor.

Question 9

All of the following statements are true regarding stargazer breech fetus except?

Accepted Answer

Forceps are indicated for delivery

Answer

Fetal head is hyperextended

Answer

Cesarean delivery is the safest route for delivery

Answer

Cervical spinal cord can be injured during vaginal delivery

Question 10

In a case of prolonged labor with persistent occiput posterior presentation, what is the recommended management?

Accepted Answer

Manual or forceps rotation followed by forceps delivery

Answer

Oxytocin drip

Answer

Cesarean section

Answer

Artificial rupture of membranes

Labor and Delivery — MCQs

Labor and Delivery — MCQs

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