Operative Obstetrics Practice Questions

Q: Use of ventose is preferred over forceps in the delivery of :

occipito posterior position. ***occipito posterior position*** - In **occipito posterior positions**, the ventouse appliance can be used to achieve **rotation of the fetal head** to an occipito-anterior position, making delivery easier and less traumatic than forceps. - The suction cup applies traction to the fetal head, which can facilitate rotation, especially when the fetal head is still high or partially engaged. *face presentation* - **Ventouse is contraindicated** in face presentations because it can cause severe trauma to the fetal face, which is delicate and not designed for suction application. - The use of forceps in face presentation is also generally avoided due to the risk of facial nerve palsy or other trauma unless a mentum-anterior position is achieved. *aftercoming head in breech* - Forceps, specifically **Piper's forceps**, are typically preferred for the delivery of the **aftercoming head in a breech presentation** to provide controlled traction and minimize pressure on the fetal neck and cerebellum. - The ventouse is **not suitable** for the aftercoming head due to its inability to provide firm, controlled traction on the fetal head in this orientation, which can lead to cervical spine injury or detachment of the cup. *foetal distress* - In cases of **severe fetal distress** requiring immediate delivery, **forceps delivery** is often preferred over ventouse, especially if the head is low, due to the ability to achieve **faster delivery**. - While both can expedite delivery, the ventouse may take longer to apply effective traction due to the time required to build suction, making forceps a faster choice when every second counts for fetal well-being.

Q: A second gravida, whose first baby is alive, has been in the second stage of labour for more than one hour. On examination, her cervix is fully dilated. The pelvis is adequate and the station of the vertex is +2. The occiput is in right, occipito-posterior position and the fetal heart rate is 120/min. The most appropriate management will be

Forceps application. ***Forceps application*** - With a fully dilated cervix, adequate pelvis, and **vertex at +2 station**, instrumental delivery is indicated to expedite delivery, especially given the **prolonged second stage of labor** (>1 hour in a multigravida). - **Occipito-posterior position** can be managed with rotational forceps (Kielland's forceps) to correct the malposition and facilitate delivery. - The fetal heart rate of 120/min is at the lower end of normal, and combined with the prolonged second stage, instrumental delivery is warranted to prevent further delay and potential complications. *Vacuum extraction* - While vacuum extraction is an option for instrumental delivery, **forceps are generally preferred in cases of occipito-posterior position** as they offer greater control for rotation and extraction. - Rotational maneuvers are more controlled with forceps compared to vacuum extraction. - The risk of **failed extraction** is higher with vacuum in occipito-posterior positions. *Wait and watch policy* - This is inappropriate given the **prolonged second stage** of labor (over one hour in a multigravida with good uterine contractions). - Modern guidelines allow up to 2 hours for second stage in multiparas, but with malposition (occipito-posterior) and lack of progress, active intervention is preferred. - Delaying intervention could lead to **fetal distress**, maternal exhaustion, or obstructed labor. *Caesarean section* - A Caesarean section is too invasive given the favorable conditions for vaginal delivery, including a **fully dilated cervix**, **adequate pelvis**, and **low station of the vertex (+2)**. - Instrumental delivery is the preferred approach with lower maternal morbidity in this scenario. - LSCS in second stage carries higher risks of hemorrhage and bladder injury.

Q: A pregnant mother is referred with a prolonged second stage of labour. On examination, the foetal heart sound is 120/min, and the head is at -1 station with severe moulding. What will be the most appropriate management?

Perform LSCS. ***Perform LSCS*** - The combination of **prolonged second stage of labor**, fetal head at **-1 station**, and **severe molding** strongly suggests **cephalopelvic disproportion** or **obstructed labor**. - **LSCS is the safest option** to prevent maternal complications (uterine rupture, cervical lacerations) and fetal complications (hypoxia, trauma), as the severe molding indicates prolonged compression and failed descent despite adequate time in second stage. *Start pitocin drip* - **Contraindicated** with severe molding and high station as it suggests **cephalopelvic disproportion**. - Increased contractions could lead to **uterine rupture** without achieving delivery and would worsen fetal head molding, potentially causing **fetal distress**. *Apply ventouse and deliver* - **Contraindicated** - Ventouse requires fetal head engagement (preferably **+2 station or below**), but the head is at **-1 station**. - At -1 station with severe molding, ventouse application would be **ineffective and dangerous**, with risk of scalp lacerations, **cephalohematoma**, and failed extraction. *Apply obstetric forceps and deliver* - **Contraindicated** - Forceps require fetal head to be engaged (at least **0 station**), but at **-1 station**, forceps application is **dangerous and inappropriate**. - Attempting forceps at high station risks severe **maternal trauma** (cervical lacerations, uterine rupture) and **fetal injury**, as standard obstetric guidelines prohibit forceps use above 0 station.

Q: The indications of an elective caesarean section include all of the following, except

cephalopelvic disproportion. ***Cephalopelvic disproportion*** - **Cephalopelvic disproportion (CPD)** is a diagnosis made during labor when the fetal head cannot fit through the maternal pelvis, preventing vaginal delivery despite adequate contractions. - This condition is typically diagnosed *during* labor when there is **failure to progress**, making it an indication for an **emergency** or **intrapartum** cesarean section, not an elective one. *Carcinoma cervix* - **Cervical cancer** can obstruct the birth canal and is associated with a risk of excessive bleeding and tumor dissemination during vaginal delivery. - An **elective cesarean section** is indicated to avoid trauma to the tumor and prevent potential spread of cancer cells. *Previous lower segment caesarean section* - A history of a **previous lower segment cesarean section (LSCS)** carries a risk of **uterine rupture** in subsequent pregnancies, especially if attempting a **vaginal birth after cesarean (VBAC)**. - Many women (or their doctors) with a prior LSCS opt for a **repeat elective cesarean section** to mitigate this risk. *Placenta previa* - **Placenta previa** occurs when the placenta covers part or all of the cervix, blocking the birth canal. - Vaginal delivery is contraindicated due to the high risk of severe **hemorrhage** to both mother and fetus, making an **elective cesarean section** necessary.

Q: Regarding the use of a ventouse, which one of the following statements is not correct?

It can be applied when the cervix is incompletely dilated. ***It can be applied when the cervix is incompletely dilated*** - A **ventouse delivery** (vacuum extraction) should only be attempted when the cervix is **fully dilated** and effaced. - Applying a ventouse to an incompletely dilated cervix risks **cervical lacerations**, uterine rupture, and significant maternal and fetal trauma. *The cup should be centrally placed on the vertex* - Proper placement of the vacuum cup is crucial for effective traction and to minimize fetal injury. - The cup should be placed over the **flexion point** (posterior fontanelle) of the fetal head, ensuring strong suction and optimal force distribution. *The largest size of the cup is preferred* - Using the **largest appropriate size** cup for vacuum extraction helps distribute the traction force over a wider area of the fetal scalp. - This reduces the risk of **scalp trauma**, such as cephalhematoma and chignon formation, by minimizing concentrated pressure. *The maximum pressure should not exceed 0.8 kg/cm²* - Maintaining the vacuum pressure below **0.8 kg/cm²** (or 50-60 cmHg) is a safety guideline to prevent excessive pressure on the fetal scalp. - Higher pressures increase the risk of **scalp lacerations**, intracranial hemorrhage, and other fetal complications.

Question 1

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

Accepted Answer

A→4  B→3  C→2  D→1

Answer

A→1  B→2  C→3  D→4

Answer

A→3  B→4  C→1  D→2

Answer

A→4  B→1  C→2  D→3

Question 2

Use of ventose is preferred over forceps in the delivery of :

Accepted Answer

occipito posterior position

Answer

face presentation

Answer

aftercoming head in breech

Answer

foetal distress

Question 3

A multiparous woman presenting with postpartum haemorrhage due to placenta increta is best managed by

Accepted Answer

Hysterectomy

Answer

Internal iliac artery ligation

Answer

Hysterectomy with the removal of the adherent placenta

Answer

Packing the uterus followed by a course of methotrexate

Question 4

A 34-week multiparous gravida comes in labour. On examination, the cervix is fully dilated, the head is at +2 station and the foetal heart rate is 172/min. The appropriate management will be

Accepted Answer

Immediate LSCS (Lower Segment Caesarean Section)

Answer

Wait and watch

Answer

Apply ventouse and deliver

Answer

Apply forceps and deliver

Question 5

A second gravida, whose first baby is alive, has been in the second stage of labour for more than one hour. On examination, her cervix is fully dilated. The pelvis is adequate and the station of the vertex is +2. The occiput is in right, occipito-posterior position and the fetal heart rate is 120/min. The most appropriate management will be

Accepted Answer

Forceps application

Answer

Vacuum extraction

Answer

Wait and watch policy

Answer

Caesarean section

Question 6

A pregnant mother is referred with a prolonged second stage of labour. On examination, the foetal heart sound is 120/min, and the head is at -1 station with severe moulding. What will be the most appropriate management?

Accepted Answer

Perform LSCS

Answer

Start pitocin drip

Answer

Apply ventouse and deliver

Answer

Apply obstetric forceps and deliver

Question 7

The indications of an elective caesarean section include all of the following, except

Accepted Answer

cephalopelvic disproportion

Answer

carcinoma cervix

Answer

previous lower segment caesarean section

Answer

placenta previa

Question 8

Regarding the use of a ventouse, which one of the following statements is not correct?

Accepted Answer

It can be applied when the cervix is incompletely dilated

Answer

The cup should be centrally placed on the vertex

Answer

The largest size of the cup is preferred

Answer

The maximum pressure should not exceed 0.8 kg/cm²

Question 9

A 20-year-old nulli-term primigravida is brought to the casualty with labour pains for last 24 hours and a hand prolapse. On examination, she has pulse 96/min, BP 120/80 mm Hg, and mild pallor. The abdominal examination reveals the uterine height at 32 weeks, the foetus in transverse lie and absent foetal heart sounds. On vaginal examination, the left arm of the foetus is prolapsed and the foetal ribs are palpable. The pelvis is adequate. What would be the best management option?

Accepted Answer

Decapitation and delivering the baby vaginally

Answer

External cephalic version

Answer

Lower segment caesarean section

Answer

Internal podalic version

Question 10

Which of the following is the most appropriate management in a ruptured tubal pregnancy?

Accepted Answer

Quick resuscitation followed by laparotomy and excision of the offending tube

Answer

Autotransfusion of the fresh blood harvested from the peritoneal cavity

Answer

Blood transfusion immediately after the clamps have been placed to control the bleeding

Answer

Excision of the offending tube and the ipsilateral ovary (salpingo-oophorectomy)

Operative Obstetrics — MCQs

Operative Obstetrics — MCQs

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