When the fetus is at station +2 and the fetal skull reaches the pelvic floor, which of the following statements is MOST clinically relevant?
Which is not a risk factor for gestational hypertension
Which of the following methods is not used for managing shoulder dystocia?
What is the primary clinical advantage of the occipitoanterior position in childbirth?
What is the FDA-recommended time interval between Mifepristone and Misoprostol administration in medical termination of pregnancy?
The best method for inducing mid trimester abortion is :
Which of the following conditions is ruled out in a twin pregnancy of the same age and sex?
Duration of second stage of labor (propulsive stage) in multipara
What would be the type of presentation when the engaging diameter is mentovertical?
Which of the following statements about abdominal pregnancy is true?
NEET-PG 2015 - Obstetrics and Gynecology NEET-PG Practice Questions and MCQs
Question 51: When the fetus is at station +2 and the fetal skull reaches the pelvic floor, which of the following statements is MOST clinically relevant?
- A. Forceps may be applied if necessary. (Correct Answer)
- B. Crowning occurs at this stage.
- C. There is a risk of deep transverse arrest.
- D. Episiotomy must be performed at this station.
Explanation: ***Forceps may be applied if necessary.*** - At **station +2**, the fetal head has progressed significantly into the pelvis (2 cm below the ischial spines), indicating a **low-lying head** where instrumental delivery with **forceps** or a **vacuum extractor** can be safely performed if indicated (e.g., maternal exhaustion, fetal distress). - This station qualifies as **low forceps** or **outlet forceps** delivery, which are considered safe procedures when properly indicated. - The fetal head at this level has reached or is approaching the **pelvic floor**, meeting the prerequisites for assisted vaginal delivery. *Crowning occurs at this stage.* - **Crowning** specifically refers to the stage when the largest diameter of the fetal head is visible at the **vaginal introitus** and does not recede between contractions. - This occurs at approximately **station +4 to +5**, not at station +2. - While station +2 indicates significant descent, the fetus must descend further before crowning occurs. *There is a risk of deep transverse arrest.* - **Deep transverse arrest** occurs when the fetal head fails to internally rotate from the transverse position to an occipito-anterior or occipito-posterior position. - This complication typically occurs at **station 0 to +1** (mid-pelvis level), not at station +2. - By the time the fetal head reaches station +2 and the pelvic floor, internal rotation should have already occurred. *Episiotomy must be performed at this station.* - **Episiotomy** is **not mandatory** at any particular fetal station. - It is a selective procedure performed when indicated, typically just before crowning (around station +3 to +4), to prevent severe perineal trauma or expedite delivery. - The decision is based on clinical factors like fetal size, maternal tissue quality, and risk of severe laceration—not solely on fetal station.
Question 52: Which is not a risk factor for gestational hypertension
- A. Primigravida
- B. Factor V Leiden mutation
- C. Smoking (Correct Answer)
- D. Low maternal age
Explanation: ***Smoking*** - **Smoking** paradoxically shows a *protective effect* against gestational hypertension and preeclampsia, making it the correct answer as it is NOT a risk factor for gestational hypertension. - This well-documented phenomenon may be related to smoking's vasodilatory effects and reduced production of anti-angiogenic factors. - However, smoking carries numerous other serious risks including **intrauterine growth restriction (IUGR)**, **placental abruption**, **preterm birth**, and **perinatal mortality**. *Primigravida* - **Primigravida** (first pregnancy) is a well-established risk factor for gestational hypertension and preeclampsia. - First-time exposure to paternal antigens and incomplete immune tolerance may contribute to this increased risk. - The risk decreases in subsequent pregnancies with the same partner. *Factor V Leiden mutation* - The **Factor V Leiden mutation** is the most common inherited thrombophilia and significantly increases the risk of gestational hypertension and preeclampsia. - This mutation causes resistance to activated protein C, leading to a hypercoagulable state that can impair placental perfusion. - Associated with increased risk of venous thromboembolism during pregnancy. *Low maternal age* - **Low maternal age** (adolescent pregnancy, <20 years) is actually a recognized *risk factor* for gestational hypertension. - Young mothers may have incomplete physical and cardiovascular maturity to handle pregnancy-related physiological changes. - Adolescent pregnancies are associated with higher rates of hypertensive disorders of pregnancy.
Question 53: Which of the following methods is not used for managing shoulder dystocia?
- A. Zavanelli maneuver
- B. Wood's maneuver
- C. Hegar's maneuver (Correct Answer)
- D. McRobert's maneuver
Explanation: *McRobert's maneuver* - This maneuver is a common first-line intervention for shoulder dystocia, involving sharp **flexion of the mother's hips** back towards her abdomen to flatten the sacrum and rotate the symphysis pubis anteriorly. - It works by increasing the functional diameter of the **pelvic outlet**, potentially dislodging the anterior shoulder. ***Hegar's maneuver*** - **Hegar's sign** is a clinical finding related to early pregnancy, indicating the **softening of the lower uterine segment** (isthmus) upon bimanual examination. - It is a diagnostic sign of pregnancy and **not a method used to resolve shoulder dystocia**. *Zavanelli maneuver* - The **Zavanelli maneuver** is a last-resort intervention for shoulder dystocia, involving the **replacement of the fetal head into the uterus** followed by immediate delivery via **cesarean section**. - This is a highly invasive procedure with significant risks to both mother and fetus, used when other maneuvers have failed. *Wood's maneuver* - **Wood's maneuver** involves **rotating the fetal shoulders** by applying pressure to the posterior aspect of the anterior shoulder or the anterior aspect of the posterior shoulder to achieve a corkscrew effect. - This rotation can help dislodge an impacted shoulder or facilitate its passage under the symphysis pubis.
Question 54: What is the primary clinical advantage of the occipitoanterior position in childbirth?
- A. It is the most favorable position for vaginal delivery.
- B. It allows optimal fetal head flexion reducing the presenting diameter. (Correct Answer)
- C. Anterior fontanelle is anterior in this position.
- D. It is associated with shorter labor duration and fewer complications.
Explanation: ***It allows optimal fetal head flexion reducing the presenting diameter.*** - In the occipitoanterior (OA) position, the fetal head is **well-flexed**, allowing the **smallest diameter** of the fetal head to present to the maternal pelvis - The presenting diameter is the **suboccipitobregmatic diameter** (~9.5 cm), which is the smallest anteroposterior diameter of the fetal head - This optimal flexion is the **primary clinical advantage** as it facilitates easier passage through the birth canal and reduces maternal and fetal trauma - The **occiput (posterior fontanelle)** faces anteriorly in this position, which is a key anatomical landmark used to diagnose OA position during vaginal examination *It is the most favorable position for vaginal delivery.* - While this statement is true, it is **too general** and doesn't explain the specific anatomical or mechanical reason - It describes an outcome rather than explaining the **primary clinical advantage** in terms of fetal head mechanics *Anterior fontanelle is anterior in this position.* - This statement is **anatomically incorrect** - In occipitoanterior position, the **occiput (posterior fontanelle)** is anterior, not the anterior fontanelle - The anterior fontanelle (bregma) is actually positioned **posteriorly** in the OA position *It is associated with shorter labor duration and fewer complications.* - This is a **consequence** of the favorable OA position, not the primary clinical advantage itself - The shorter labor and fewer complications result from the optimal fetal head flexion and smaller presenting diameter - This option describes an **outcome** rather than the underlying anatomical/mechanical advantage
Question 55: What is the FDA-recommended time interval between Mifepristone and Misoprostol administration in medical termination of pregnancy?
- A. 96 hours
- B. 48 hours
- C. 24-48 hours (Correct Answer)
- D. 72 hours
Explanation: ***24-48 hours*** - The FDA-approved protocol for medical abortion with mifepristone and misoprostol specifies a **24- to 48-hour interval** between the administration of the two drugs. - This timing ensures optimal efficacy as it allows mifepristone to adequately sensitize the uterus to the effects of misoprostol. *48 hours* - While 48 hours falls within the recommended range, specifically stating "48 hours" as the only option is less precise than the **24-48 hour window**. - No specific clinical advantage or disadvantage is generally reported for waiting exactly 48 hours over, for instance, 24 hours. *96 hours* - A 96-hour interval is significantly longer than the **FDA-recommended window** and is not part of the standard, evidence-based protocol. - Delaying misoprostol administration beyond 48 hours may **reduce the effectiveness** of the medical abortion and increase the risk of complications. *72 hours* - A 72-hour interval exceeds the upper limit of the **FDA-recommended window** for optimal efficacy. - While some studies have explored extended intervals, the *standard clinical practice* and FDA guidelines do not endorse 72 hours as the primary recommended interval.
Question 56: The best method for inducing mid trimester abortion is :
- A. Dilation and Curettage (D&C)
- B. Injection of Hypertonic Saline
- C. Ethacrydine Lactate
- D. Prostaglandins (Correct Answer)
Explanation: ***Prostaglandins*** - **Prostaglandins** (e.g., dinoprostone, misoprostol) are highly effective in inducing uterine contractions and cervical ripening, making them the preferred method for **mid-trimester abortion**. - They can be administered through various routes (vaginal, oral, buccal) and offer a good balance of efficacy and safety for this gestational age. - Prostaglandins are considered the **current gold standard** for second-trimester medical termination of pregnancy. *Injection of Hypertonic Saline* - Historically used, but **intra-amniotic hypertonic saline** carries significant risks, including hypernatremia, disseminated intravascular coagulation (DIC), and uterine rupture. - It has largely been replaced by safer and more effective methods like prostaglandins due to its adverse event profile. - This method is now considered obsolete in most clinical settings. *Ethacrydine Lactate* - **Ethacrydine lactate** (ethacridine lactate/Rivanol) is an antiseptic agent that was historically used for mid-trimester abortion via intra-amniotic injection. - While it was effective in inducing abortion, it has been largely abandoned due to complications, prolonged induction time, and the availability of safer alternatives. - It is **not the preferred method** compared to prostaglandins, which have better safety profiles and efficacy. *Dilation and Curettage (D&C)* - **Dilation and curettage (D&C)** is primarily used for first-trimester abortions or for managing incomplete abortions and miscarriages. - In the mid-trimester, the uterus is larger and the fetal tissue is more substantial, making D&C less safe and often requiring extensive dilation or potentially leading to complications like uterine perforation or hemorrhage. - **Dilation and evacuation (D&E)** may be used in mid-trimester but requires specialized training and equipment.
Question 57: Which of the following conditions is ruled out in a twin pregnancy of the same age and sex?
- A. Monozygotic twins
- B. Superfetation (Correct Answer)
- C. Superfecundation
- D. None of the following
Explanation: ***Superfetation*** - **Superfetation** refers to the fertilization of an ovum when another pregnancy is already established in the uterus, resulting in two fetuses of **different gestational ages**. - As the question specifies a twin pregnancy of the **same age**, superfetation is ruled out. *Monozygotic twins* - **Monozygotic twins** originate from a single zygote that splits, resulting in genetically identical individuals of the **same sex** and age. - This condition is consistent with the given scenario of same-sex, same-aged twins. *Superfecundation* - **Superfecundation** is the fertilization of two or more ova from the same ovulatory cycle by sperm from **different acts of coitus** (which may involve different partners). - The twins are of the **same gestational age** (same cycle) but are **dizygotic**, and can be either the same sex or different sexes. - This condition is NOT ruled out by the criteria given in the question. *None of the following* - This option is incorrect because **superfetation** is definitively ruled out by the criteria of the question (twins of the same age).
Question 58: Duration of second stage of labor (propulsive stage) in multipara
- A. Approximately 20 minutes (Correct Answer)
- B. 40 minutes
- C. 1 hour
- D. 10 minutes
Explanation: ***Approximately 20 minutes*** - In **multiparas**, the second stage of labor, also known as the **propulsive stage**, is typically shorter due to prior experience with childbirth. - While there is variability, an average duration of **20 minutes** for this stage is commonly observed in multiparous women. *40 minutes* - A duration of 40 minutes for the propulsive stage would be considered on the longer side for a **multipara**, often approaching the upper limits of normal. - While not necessarily abnormal, it is longer than the **average expected time** for multiparous women. *1 hour* - A second stage duration of **1 hour** in a multipara would generally be considered prolonged and might warrant intervention or closer monitoring. - This duration is more consistent with the **upper limit of normal** in nulliparous women or cases of arrest of labor in multiparas. *10 minutes* - While some multiparous women may have a very rapid second stage, **10 minutes** is on the shorter end of the average. - This could indicate a **precipitous labor**, which can carry its own risks such as maternal lacerations and neonatal complications.
Question 59: What would be the type of presentation when the engaging diameter is mentovertical?
- A. Face
- B. Vertex
- C. Brow (Correct Answer)
- D. Breech
Explanation: ***Brow*** - The **mentovertical diameter** (13.5 cm) is the engaging diameter in **brow presentation**. - This diameter extends from the **chin (mentum) to the vertex** of the fetal head. - Brow presentation occurs when the fetal head is **partially deflexed**, presenting the area between the orbital ridge and the anterior fontanelle. - This is the **largest anteroposterior diameter** of the fetal head and makes vaginal delivery extremely difficult or impossible. *Face* - In **face presentation**, the fetal head is **completely hyperextended**, and the engaging diameter is **submentobregmatic** (9.5 cm), not mentovertical. - This diameter extends from below the chin to the bregma. - Face presentation can allow vaginal delivery if the mentum is anterior. *Vertex* - **Vertex presentation** is the most common and favorable presentation, with the fetal head fully flexed. - The engaging diameter is **suboccipitobregmatic** (9.5 cm), from the subocciput to the bregma. - The occiput presents first in this presentation. *Breech* - **Breech presentation** involves the fetal buttocks or feet presenting first. - The engaging diameter is **bitrochanteric** (transverse diameter), not related to cephalic diameters like mentovertical.
Question 60: Which of the following statements about abdominal pregnancy is true?
- A. Primary abdominal pregnancy is a common condition.
- B. Most fetuses in abdominal pregnancies survive to term.
- C. Leaving the placenta behind can lead to infection. (Correct Answer)
- D. Separation of the placenta is always necessary.
Explanation: ***f6629bc8-61b2-4393-bb4c-9c32cd943e34*** - **Placenta acreta-like implantation** of the placenta into intra-abdominal organs or the abdominal wall makes removal dangerous due to potential damage and massive hemorrhage. - While leaving it in place can lead to serious complications like **infection**, **abscess formation**, or **secondary hemorrhage** as it degenerates, the risks of immediate removal often outweigh these, necessitating careful observation and management. *020c0067-d7b2-4fc2-85ae-2d6ba40ab437* - **Primary abdominal pregnancy** is extremely rare, accounting for less than 1% of all extrauterine pregnancies. - Abdominal pregnancies are generally **secondary** due to tubal abortion or rupture with subsequent reimplantation. *3560b92d-a63d-4966-8872-e4f56a82882f* - **Fetal survival rates** in abdominal pregnancies are very low, with a high incidence of **fetal anomalies** and **perinatal mortality**. - The abnormal placental implantation and lack of amniotic fluid protection lead to significant **growth restriction** and compression deformities. *5ab987e0-68ca-43f2-a8f2-238a5eb0c4f8* - The decision to remove the **placenta** in an abdominal pregnancy is complex and depends on its implantation site; often, it is left in situ due to the high risk of **hemorrhage** from attempting removal. - Removing the placenta can cause **uncontrollable bleeding**, especially if it is attached to vital organs or large blood vessels.