NEET-PG 2024 - Obstetrics and Gynecology Practice Questions

Q: A pregnant female at 37 weeks of gestation with a history of prosthetic heart valves is currently taking warfarin. She comes for a routine antenatal check-up. What is the appropriate management advice?

Switch to low molecular weight heparin. ***Switch to low molecular weight heparin*** - **Warfarin** is **teratogenic** and carries a significant risk of **fetal bleeding** and **malformations**, especially close to term. Switching to **low molecular weight heparin (LMWH)** is crucial at 37 weeks. - **LMWH** does not cross the placenta, making it a safer alternative for anticoagulation in late pregnancy for women with prosthetic heart valves. *Immediate induction of labor* - While delivery is approaching, immediate induction of labor without addressing the **warfarin** use directly puts the fetus at high risk of **bleeding complications** during delivery. - This option does not specify concurrent management of the anticoagulation, which is the primary concern. *Perform LSCS (Lower Segment Cesarean Section)* - Similar to induction of labor, performing a C-section while the mother is on **warfarin** significantly increases the risk of **maternal and fetal hemorrhage**. - A C-section is an invasive procedure, and the immediate priority is to switch the anticoagulant rather than select the mode of delivery without addressing the current medication. *Continue the same medication* - Continuing **warfarin** at 37 weeks is highly dangerous due to the increased risk of **fetal intracranial hemorrhage** during labor and delivery. - This approach disregards the well-established **teratogenic effects** and **bleeding risks** associated with warfarin in late pregnancy.

Q: A pregnant lady delivers a healthy baby via normal delivery. What is the earliest time at which an intrauterine contraceptive device (IUCD) can be inserted?

Within 48 hours. ***Within 48 hours*** - **Immediate postpartum insertion** (within 48 hours of delivery) is considered safe and effective, with high client satisfaction and continuation rates. - While there's a slightly higher risk of **expulsion** compared to later insertions, it provides immediate contraception for women who might not return for follow-up. *After 6 weeks* - This is a common time for postpartum check-ups and a traditional window for IUCD insertion, after the uterus has largely involuted. - However, it is not the **earliest possible time**, as immediate postpartum insertion is also an option. *After 3 months* - Delaying IUCD insertion until three months postpartum is unnecessarily late if the woman desires contraception sooner. - This longer delay could increase the risk of an **unintended pregnancy** during the interim. *After 1 month* - Insertion at one month postpartum is also a safe option, after early uterine involution. - However, similar to the six-week option, it is not the **earliest possible time** for insertion.

Q: What is the method of delivery for fetuses $A$ and $B$ as shown in the image

LSCS in both. ***LSCS in both*** - Fetus A is in a **breech presentation**, which is an indication for cesarean section in twin pregnancy, especially when it is the first (presenting) twin. - Once the decision is made to perform a **cesarean section (LSCS)** for fetus A, **both twins must be delivered through the same cesarean incision** during the same operative procedure. - It is **not possible or safe** to deliver one twin by cesarean section and then attempt vaginal delivery for the second twin. Once the uterine incision is made, both babies are delivered through that incision. - This is the standard obstetric practice for twin deliveries requiring cesarean section. *LSCS, vaginal* - This option is **medically incorrect** and represents a misunderstanding of cesarean delivery principles. - Once a cesarean section is initiated for twin A, **both twins are delivered through the uterine incision** during the same surgery. - There is no scenario where one twin is delivered by cesarean and the other vaginally in the same delivery episode - this would be unsafe and is not practiced. *Vaginal, LSCS* - This is incorrect because fetus A (the presenting/first twin) is in **breech presentation**, which typically contraindicates vaginal delivery as the first twin. - In twin pregnancies, when the first twin is breech, **cesarean section is generally recommended** to avoid complications such as head entrapment or cord prolapse. - The mode of delivery for the first twin determines the approach, and a breech first twin usually necessitates cesarean delivery for both. *Induce delivery in both* - Induction of labor aims to initiate contractions but does not address the **breech presentation of fetus A**. - With fetus A in breech presentation, induction would still lead to the need for cesarean section due to the unfavorable presentation of the first twin. - Induction is not an appropriate management strategy when the presenting twin is breech in twin pregnancy.

Q: A G2P1L1 woman with a history of previous cesarean section presents with complications related to the placenta. The image below shows the gross appearance of the uterus. What is the most likely diagnosis?

Placenta accreta. ***Placenta accreta*** - A previous **cesarean section** is a strong risk factor for placenta accreta, as it can lead to scarring and defects in the uterine wall, allowing the placenta to implant too deeply. - The image suggests a placenta that is **firmly adhered and possibly invasive** into the uterine wall, making separation difficult, which is characteristic of accreta due to the absence of a proper decidual layer. *Uterine inversion* - This condition involves the **fundus of the uterus collapsing inward** or turning inside out, which is a clinical event during postpartum and not a morphological feature visible in a resected specimen like this. - The image shows an attached placenta within a uterine specimen, not an inverted uterus. *Placental abruption* - Placental abruption is the **premature separation of the placenta** from the uterine wall before delivery, often leading to retroplacental hemorrhage. - While it's a serious complication, the image does not show evidence of a separated placenta or a large retroplacental clot; instead, it depicts an abnormally adherent placenta. *Placenta previa* - Placenta previa occurs when the **placenta implants over the cervical os**, which would be diagnosed prenatally based on its location in the uterus. - The image does not provide information about the placental location relative to the cervix, but rather illustrates the manner of placental attachment.

Q: Identify the instrument shown in the image below: ![img-52.jpeg](img-52.jpeg)

Wrigley. ***Wrigley*** - The image depicts short-bladed forceps with a pelvic curve that is characteristic of Wrigley's forceps. - Wrigley's forceps are designed for **outlet or low-cavity forceps deliveries** where the fetal head is already visible or very low in the birth canal. *Kielland* - Kielland forceps have a very slight pelvic curve or are straight, and they lack a cephalic curve, which is distinct from the instrument shown. - They are primarily used for **rotational deliveries** and can be applied to the fetal head in various positions. *Pipers* - Piper's forceps have very long, curved shanks and are specifically designed for **delivery of the after-coming head in breech presentations**. - The instrument in the image does not show the characteristic long shanks of Piper's forceps. *Simpson* - Simpson's forceps have a prominent **pelvic curve** and a **cephalic curve** with blades that are longer than those depicted in the image. - They are commonly used for **mid-cavity deliveries** when rotation is not the primary concern.

Q: Based on the educational diagram showing different degrees of perineal tears, which degree involves only the perineal skin and vaginal mucosa without affecting the underlying muscle?

1st degree. ***1st degree*** - Involves only the **perineal skin** and **vaginal mucosa** without affecting underlying muscle tissue. - The **pelvic floor muscles (PFM)** remain completely intact, making this the most superficial type of perineal tear. *2nd degree* - Extends deeper to involve the **perineal muscles** including the pelvic floor muscles, but spares the anal sphincter. - Requires **muscle repair** in addition to skin closure, making it more complex than 1st degree tears. *3rd degree* - Involves the **anal sphincter complex** (external and/or internal anal sphincter) extending toward the anus. - Requires specialized **sphincter reconstruction** to prevent future fecal incontinence complications. *4th degree* - The most severe tear extending through the **anal sphincter** and into the **rectal mucosa**. - Requires **multilayer repair** including rectal mucosa, sphincter complex, and perineal tissues to restore anatomy.

Q: Identify the maneuver shown in the image:

Mauriceau-Smellie-Veit. ***Mauriceau-Smellie-Veit*** - This maneuver is used for **head delivery in a breech presentation**, where the fetus's body is supported while pressure is applied to the maxilla or mandible to flex the head. - The image typically shows the operator's hand supporting the fetus's body and fingers placed on the fetal jaw to facilitate head flexion and delivery. *Burn Marshall* - The Burn Marshall maneuver involves **delivering the fetal head by applying suprapubic pressure** to the maternal abdomen while the fetal body is gently swept upwards over the maternal abdomen. - This maneuver is generally used for a **spontaneous breech delivery** if the head does not deliver easily after the body. *Lovset* - The Lovset maneuver is employed to **deliver the fetal shoulders** in a breech presentation by rotating the fetal trunk to bring the anterior shoulder under the pubic arch and then the posterior shoulder. - This maneuver aims to extract the shoulders sequentially, which might be necessary if they are impacted. *None of the options* - The visual representation aligns with the steps of the Mauriceau-Smellie-Veit maneuver, making this option incorrect. - This maneuver is clearly depicted by the hand placement and objective of aiding head delivery in breech.

Question 1

A pregnant female at 37 weeks of gestation with a history of prosthetic heart valves is currently taking warfarin. She comes for a routine antenatal check-up. What is the appropriate management advice?

Accepted Answer

Switch to low molecular weight heparin

Answer

Immediate induction of labor

Answer

Perform LSCS (Lower Segment Cesarean Section)

Answer

Continue the same medication

Question 2

A pregnant lady delivers a healthy baby via normal delivery. What is the earliest time at which an intrauterine contraceptive device (IUCD) can be inserted?

Accepted Answer

Within 48 hours

Answer

After 6 weeks

Answer

After 3 months

Answer

After 1 month

Question 3

What is the method of delivery for fetuses $A$ and $B$ as shown in the image

Accepted Answer

LSCS in both

Answer

LSCS, vaginal

Answer

Induce delivery in both

Answer

Vaginal, LSCS

Question 4

A G2P1L1 woman with a history of previous cesarean section presents with complications related to the placenta. The image below shows the gross appearance of the uterus. What is the most likely diagnosis?

Accepted Answer

Placenta accreta

Answer

Uterine inversion

Answer

Placental abruption

Answer

Placenta previa

Question 5

Identify the instrument shown in the image below:
![img-52.jpeg](img-52.jpeg)

Accepted Answer

Wrigley

Answer

Kielland

Answer

Pipers

Answer

Simpson

Question 6

Based on the educational diagram showing different degrees of perineal tears, which degree involves only the perineal skin and vaginal mucosa without affecting the underlying muscle?

Accepted Answer

1st degree

Answer

2nd degree

Answer

3rd degree

Answer

4th degree

Question 7

Identify the maneuver shown in the image:

Accepted Answer

Mauriceau-Smellie-Veit

Answer

Burn Marshall

Answer

Lovset

Answer

None of the options

NEET-PG 2024 — Obstetrics and Gynecology