Management of Labour & Delivery Extra Questions Batch A – MCQ

1. Mrs X, primigravida at term is in second stage of labour. After delivery of the fetal head, shoulder dystocia was diagnosed and the McRoberts manoeuvre has not effected the delivery of the shoulders, which is the next method to be used:

2. Elective caesarean section is best recommended to prevent morbidity from shoulder dystocia in which of the following clinical situations:

3. Which of the following statements about timing of delivery in multiple pregnancy is true?

4. Regarding shoulder dystocia, which of the following statements is true?

5. All of the following are known factors for anal sphincter injury during delivery except:

6. Massive blood loss is defined as loss of:

7. Of the following, the most consistent finding in uterine rupture is:

8. History of previous vaginal birth in a woman with a caesarean section attempting to deliver vaginally is associated with the planned VBAC success rate of:

9. Ms XY is a primigravida, gestational diabetic, 38 weeks in spontaneous labour. She was assessed at 13:00 h and had progressed to 5 cms cervical dilatation. She was examined at 17:00 h and was found to be 6 cms dilated, 0.5 long, with intact mem- branes, vertex at spines.

What is the next appropriate step in managing her labour?

10. A 20-year-old woman is 36 weeks pregnant in her second pregnancy and is being reviewed in the antenatal clinic. She has had a previous caesarean delivery. A recent obstetric growth scan confirms cephalic presentation of a normally grown fetus. She has no other complicating medical or obstetric disorders. She is deciding between planned vaginal birth after caesarean (VBAC) and elective repeat caesarean section (ERCS) modes of delivery. Which one of the following is correct in relation to the counselling she will receive?

11. A 32-year-old woman is 36 weeks pregnant in first pregnancy with DCDA (dichorionic diamniotic) twins and is being reviewed in the antenatal clinic. A recent obstetric growth scan confirms both fetuses are normally grown. Both twins are longitudinal lie and cephalic presentation. She has no other complicating medical or obstetric disorders. She is deciding between planned vaginal or elective caesarean modes of delivery. Which ONE of the following is correct in relation to the counsel- ling she will receive?

12. Which one of the following statements is correct in relation to the third stage of labour?

13. Hypoxic-ischaemic encephalopathy (HIE) is a rare neonatal condition that is a consequence of intrapartum fetal oxygen deprivation. Which ONE of the following statements is characteristic of neonates diagnosed with HIE?

14. Which ONE of the following statements represents the correct sequence of events in relation to the mechanism of labour for a vertex presentation?

15. A 38-year-old woman has breech presentation at 39 weeks and is opting for elective caesarean section (LSCS) for mode of delivery. Her BMI is 28. She has no other medical or obstetric disorders and has not had any previous surgery. When counsel- ling about elective LSCS, which one of the following statements is valid?

16. A 25 year old, who is 40 weeks pregnant in her first pregnancy, is in the second stage of labour. She has been actively pushing for 2 h and is exhausted. CTG shows a baseline of 150 bpm, normal baseline variability, occasional accelerations and infrequent typical variable decelerations. She is contracting 3–4 every 10 min. Vaginal examination reveals a fully dilated cervix with the fetal head in a direct occipito-anterior position and at station +1 below spines. Which of the following is the most appropriate next management step?

17. A 25 year old, who is 40 weeks pregnant in her first pregnancy, is in the second stage of labour. She has been actively pushing for 1 h. CTG shows a baseline of 180 bpm, reduced baseline variability, no accelerations and frequent atypical variable decelerations. She is contracting 3–4 every 10 min. Vaginal examination reveals a fully dilated cervix with the fetal head in a direct occipito-anterior position and at station +1 below spines. Which of the following is the most appropriate next management step?

18. Mrs. X, 32-year-old second gravida, previous vaginal birth, suffered a spinal cord injury at the level of T8 at 32 weeks of gestation. She had a singleton fetus with an anterior high placenta, and her fetal scan after the accident revealed an AGA fetus with normal amniotic fluid, fetal activity, Dopplers and no signs of internal bleeding in the placenta.

She was managed as an inpatient with multidisciplinary care at the obstetric unit. Which of the following statements is appropriate for her care?

19. You are counselling a 28-year-old primigravida with a singleton pregnancy at the antenatal clinic at 38 weeks regarding her options for delivery. Her clinical history has been normal so far and is perceiving good fetal movements, and she has a fetus in cephalic presentation. Which of the following statements is incorrect?

20. Induction of labour should not be offered if:

21. Ms XY is 30/40 weeks pregnant in her first pregnancy. She is in established preterm labour, although not in advanced labour. The cause of preterm labour appears to be an untreated E. coli UTI. Ms XY is haemodynamically stable and apyrexial. Her lactate levels are 0.5. Which treatment is most likely to improve neonatal outcome?

22. What is the risk of neonatal transmission with vaginal births and recurrent genital herpes?

23. While counselling a low-risk primigravida about planning her delivery, the following information should be given to her:

24. Ms XY is a G3P2 at 30 weeks with a previous CS done 3 years ago for presumed fetal distress. She would like to attempt a VBAC this time. What success rate would you quote for VBAC?

25. Ms XY is 38/40 weeks pregnant with one previous CS. She presents in spontaneous labour and has an agreed plan for a VBAC. She now complains of pain in the site of the CS scar. Which of the following is most consistently associated with a uterine rupture?

26. Ms XY is 32/40 weeks pregnant with a cervical cerclage inserted at 14/40. She presents to the labour suite with a confirmed diagnosis of PPROM.

Inflammatory markers are normal. Ms XY is clinically well and demonstrates no uterine activity. Which of the following treatment options are best suited to her?

27. Which of the following women should be offered intrapartum antibiotic prophylaxis for prevention of early-onset GBS disease in the neonate?

28. You are evaluating Mrs X who has been in first stage of labour for the past 10 h. Which of the following information is least relevant to your further clinical management?

29. A 23-year-old primigravida is in threatened preterm labour at 32 weeks of gestation. As there is a possibility of imminent preterm birth, a decision to administer antenatal corticosteroids is taken. While explaining the rationale of this treatment to her, all of the following statements are correct except that antenatal corticosteroids:

30. A 32-year-old primigravida presents at 38 weeks with history of leaking of clear fluid per vaginam for the last 2 h. On clinical examination, fundal height is about 36 weeks, uterus is relaxed, cephalic presentation (3/5 palpable) and fetal heart rate is normal. Per speculum examination confirms clear fluid leaking. What would you tell her about her condition?

31. The recommended gestational age to offer delivery to an uncomplicated triplet pregnancy is:

32. Mrs X, a 28-year-old primigravida has leaking of fluid per vaginam for the past 3 h at 32 weeks of gestation. Per speculum examination confirms leakage of clear amniotic fluid per vaginam. She is clinically stable with no signs of infection. Ultrasound shows a singleton fetus in cephalic presentation, appropriate for gestation with normal liquor and Dopplers.

You are explaining her clinical situation to her. You would be correct to say that:

33. Which of the following is correct regarding the use of misoprostol for induction of labour

34. The overall risk of obstetric anal sphincter injury during vaginal deliveries is:

35. A primigravida at term, in first stage of labour had uterine hyperstimulation following oxytocin augmentation. The oxytocin drip was stopped, but after a few minutes, she had hypotension, tachycardia and a feeble pulse showing signs of collapse. Resuscitative efforts could not restore any cardiac output for 4 min, and a decision for perimortem caesarean section was taken. Which of the following is the correct approach in conducting the perimortem caesarean section?

36. Ms XY is 38/40 weeks pregnant in her first pregnancy. She has been treated for a GBS UTI at 32 weeks. She presents with a history of PROM with clear liquor. CTG is reassuring. Which of the following treatment options are best suited to her?

37. Ms XY is a G3P2 and term undergoing an emergency caesarean section under GA, as she presents in labour with previous 2 caesarean sections with an APH. During the CS, an anterior low-lying placenta fails to separate after delivery of the baby. A clear cleavage plane cannot be identified. The bleeding is minimal. She has consented to a sterilisation, as her family is now complete. Which of the following treatment options are best suited to her?

38. Ms XY is primigravida at 41/40 weeks in spontaneous labour. She is Indian (Asian ethnic- ity) and has a baby in direct OP position. She has been pushing for 2 h and using epidural analgesia. The total duration of her second stage has been 3 h. She has been consented for a trial of instrumental delivery in theatre as birth is not imminent. Which of the following risk factors has the strongest association with obstetric anal sphincter injury?

39. Which type of female pelvis favours direct occipito-posterior position?

40. Ms XY is 39/40 weeks pregnant. She presents to the labour suite in active labour with intact membranes. Her recent vaginal swabs were negative for GBS. Her previous baby has been affected by early-onset neonatal GBS disease. Which of the following treatment options are best suited to her?

41. Ms XY is a primigravida who is 38 weeks pregnant. She presents with a history of PROM for a few hours. Examination reveals clear liquor. Maternal observations are normal.
What is the percentage of women that will spontaneously labour in 24 h of PROM at term?

42. Which of the following is recommended as a method of induction of labour?

43. Ms XY is 35/40 weeks pregnant in her first pregnancy. Her USS today reveals a baby with extended breech presentation.

What is the incidence of breech presentation at term?

44. Ms XY is 35/40 weeks pregnant in her first pregnancy and presented to her GP with white vaginal itchy discharge. Her vaginal swab collected 2 days ago revealed the presence of Group B streptococcus. She is very concerned and would like antibiotics for the same. Which of the following treatment options are best suited to her?

45. Ms XY is primigravida at 41/40 weeks in spontaneous labour. She is Indian (Asian ethnicity) and has a baby in direct OA position. She has been pushing for 1 h and using epidural analgesia. Birth is imminent. Perineum appears overstretched and dis- tended. What angle of a mediolateral episiotomy is most likely to prevent an OASI?

46. Ms XY is a primigravida who is 38 weeks pregnant. She presents with a history of PROM for a few hours. Examination reveals clear liquor. Maternal observations are normal. What is the risk of serious neonatal infection with ruptured membranes at term?

47. Ms XY is a primigravida who is 39 weeks pregnant in spontaneous active labour. She also has diet-controlled GDM. She is theatre as the FHR/CTG showed a fetal bradycardia for 8 mins. At 9 mins in theatre, the FHR has recovered. Examination reveals she is 7 cms dilated with clear liquor in direct OA position. Ms XY is very keen on a vaginal birth only if it safe for her labour to continue. She is currently using Entonox for analgesia.

What should be the next appropriate management plan?

48. Ms XY is 38/40 weeks pregnant. She has developed confirmed primary genital herpes. She is presently being treated with acyclovir. She has confirmed SROM since 2 h. Which of the following treatment options are best suited to her?

49. 32-year-old second gravida came in preterm labour at 29 weeks of gestation. She was administered the first dose of antenatal corticosteroids, but she delivered just after 6 h of the first dose. It will be correct to tell her that the effect of the antenatal corticosteroids in her case:

50. You are conducting a lower segment caesarean section on a full-term primigravida with a free-floating fetal head. Peroperatively, there is difficulty is delivering the fetal head. Choose the single best option from the alternatives given below: