"Labor & Delivery" — Practice

Question 1

Which fetal head diameter presents in a well-flexed vertex?

Accepted Answer

B

Question 2

Which cardiotocograph feature is most concerning?

Accepted Answer

C

Question 3

According to the WHO Labour Care Guide, at what cervical dilatation does the active first stage begin?

Accepted Answer

C

Question 4

A multipara in prolonged labour has a transverse groove across the lower abdomen and a high head. What does this indicate?

Accepted Answer

A

Question 5

Which manoeuvre is contraindicated in shoulder dystocia?

Accepted Answer

C

Question 6

Why do late decelerations occur after the contraction rather than during it?

Accepted Answer

Because the mechanism is chemical rather than mechanical, and chemistry takes time. Early decelerations are mechanical: pressure on the fetal head raises intracranial pressure and triggers an immediate vagal reflex, so the deceleration is simultaneous with the contraction and mirrors it exactly.

Late decelerations arise instead from impaired gas exchange. During a contraction the spiral arteries are compressed and intervillous perfusion falls. In a fetus with adequate placental reserve nothing happens, but where reserve is already marginal, oxygen delivery falls below requirement.

The resulting fall in fetal arterial oxygen must then be sensed by chemoreceptors and produce a vagally mediated slowing, and that sequence takes time to develop. Recovery similarly requires perfusion to be restored and the oxygen debt repaid. The deceleration therefore begins after the contraction has peaked and persists after it has ended, and that lag is the diagnostic feature of uteroplacental insufficiency.

Question 7

Why did WHO relax the minimum acceptable cervical dilatation rate from 1 cm/h to 0.5 cm/h?

Accepted Answer

B

Question 8

Why does uterine hyperstimulation cause fetal hypoxia even though contractions are what drive labour?

Accepted Answer

B

Question 9

A woman with one previous caesarean section labours spontaneously and develops fetal bradycardia, scar tenderness and cessation of contractions. What has happened?

Accepted Answer

B

Practice — "Labor & Delivery"

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