Labour and Delivery: SBA Questions

and Janesh Gupta2

(1)
Fetal Medicine, Rainbow Hospitals, Hyderabad, Telangana, India
(2)
University of Birmingham Birmingham Women’s Hospital, Birmingham, UK
 

LD1

Q1. Mrs X, primigravida at term is in second stage of labour. After delivery of the fatal head, shoulder dystocia was diagnosed and the McRoberts manoeuvre has nor effected the delivery of the shoulders, which is the next method to be used:
A.
All-fours position
 
B.
Delivery of posterior arm
 
C.
Suprapubic pressure
 
D.
Internal rotation manoeuvres
 
E.
Zavanelli manoeuvre
 

LD2

Elective caesarean section is best recommended to prevent morbidity from shoulder dystocia in which of the following clinical situations:
A.
All women at term with suspected macrosomia
 
B.
Diabetic women with suspected macrosomia
 
C.
Prelabour rupture of membranes at term
 
D.
Previous shoulder dystocia
 
E.
Women with previous two caesarean births
 

LD3

Q.3 Which of the following statements about timing of delivery in multiple pregnancy is true?
A.
All monochorionic twin pregnancies should be delivered by elective caesarean section.
 
B.
Monochorionic monoamniotic twins should be monitored by weekly biophysical profiles till 36 weeks of gestation.
 
C.
Women with triplets should be offered delivery after 35 completed weeks of pregnancy after a course of antenatal corticosteroids.
 
D.
Women with uncomplicated dichorionic twin pregnancies should not be offered elective delivery prior to 40 weeks of gestation.
 
E.
Women with uncomplicated monochorionic twin pregnancies should be offered delivery after 35 completed weeks of pregnancy after a course of antenatal corticosteroids.
 

LD4

Regarding shoulder dystocia, which of the following statements is true?
A.
A large majority of infants with a birth weight of ≥4500 g do not develop shoulder dystocia.
 
B.
All women with history of shoulder dystocia should be offered elective caesarean section in their subsequent pregnancies.
 
C.
Conventional risk factors predicted about 96 % of shoulder dystocia that resulted in infant morbidity.
 
D.
Induction of labour prevents shoulder dystocia in nondiabetic women with a suspected macrosomic fetus.
 
E.
While managing shoulder dystocia, suprapubic pressure should not be used.
 

LD5

All of the following are known factors for anal sphincter injury during delivery except:
A.
Expected fetal weight more than 4 kg
 
B.
Induction of labour
 
C.
Mediolateral episiotomy
 
D.
Primiparous
 
E.
Second stage more than 1 h
 

LD6

Massive blood loss is defined as loss of:
A.
1 blood volume in 12 h
 
B.
1 blood volume in 24 h
 
C.
50 % of blood volume loss in 2 h
 
D.
50 % of blood volume loss in 4 h
 
E.
50 % of blood volume loss in 24 h
 

LD7

Of the following, the most consistent finding in uterine rupture is:
A.
Abnormal CTG
 
B.
Acute scar tenderness
 
C.
Haematuria
 
D.
Maternal tachycardia
 
E.
Severe abdominal pain referred to the shoulder tip
 

LD8

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:
A.
50 %
 
B.
60–67 %
 
C.
72–76 %
 
D.
D.85–90 %
 
E.
99 %
 

LD9

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 membranes, vertex at spines.
What is the next appropriate step in managing her labour?
A.
Adequate progress of labour. VE in 4 h
 
B.
ARM + oxytocin + VE in 2 h
 
C.
ARM + oxytocin + VE in 4 h
 
D.
ARM + VE in 2 h
 
E.
ARM + VE in 4 h
 

LD10

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?
A.
ERCS is usually performed at commencement of 38th week of gestation.
 
B.
ERCS is recommended as chances of successful VBAC are less than 50 %.
 
C.
Future pregnancy, after two caesarean deliveries, is not recommended due to increased surgical risks of a third caesarean delivery.
 
D.
If planning VBAC, induction of labour is safer than spontaneous onset of labour.
 
E.
The risk of uterine scar rupture in spontaneous onset of labour and planned VBAC is 0.2–0.5 %.
 

LD11

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 counselling she will receive?
A.
About 10 % of twin pregnancies result in spontaneous birth before 37 weeks, 0 days.
 
B.
Continuing twin pregnancies beyond 38 weeks, 0 days increases the risk of fetal death.
 
C.
Maternal antenatal corticosteroids are routinely recommended for all twin pregnancies.
 
D.
Offer elective birth from 37 weeks, 0 days after a course of maternal corticosteroids has been administered.
 
E.
There is strong evidence to show caesarean delivery is safer for mother and fetuses than vaginal mode of delivery.
 

LD12

Which one of the following statements is correct in relation to the third stage of labour?
A.
Active management reduces the risk of haemorrhage and shortens the third stage compared to physiological management.
 
B.
Early cord clamping achieves better infant haematological outcomes than delayed cord clamping.
 
C.
If actively managed, the mean duration is 30 min.
 
D.
If the placenta is retained, then its manual removal should only be conducted under general anaesthesia.
 
E.
Physiological management involves cord clamping, and the placenta is delivered by controlled cord traction, but no use of oxytocin.
 

LD13

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?
A.
Apart from CNS, there is no evidence of any other organ dysfunction (e.g. kidney, lungs, liver, heart, intestines).
 
B.
Five-minute Apgar score is >9.
 
C.
Mild hypothermia via selective head cooling is neuroprotective in term neonates with HIE.
 
D.
In most cases, there are no identifiable preconception, antenatal or intrapartum risk factors that increase susceptibility for HIE.
 
E.
Umbilical cord artery pH at birth is between 7.25 and 7.30.
 

LD14

Which ONE of the following statements represents the correct sequence of events in relation to the mechanism of labour for a vertex presentation?
A.
Descent, flexion, engagement, internal rotation, restitution and external rotation, extension, expulsion
 
B.
Descent, engagement, flexion, extension, restitution and external rotation, internal rotation, expulsion
 
C.
Engagement, descent, flexion, extension, restitution and external rotation, internal rotation, expulsion
 
D.
Engagement, descent, flexion, internal rotation, restitution and external rotation, extension, expulsion
 
E.
Engagement, descent, flexion, internal rotation, extension, restitution and external rotation, expulsion
 

LD15

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 counselling about elective LSCS, which one of the following statements is valid?
A.
All women should receive antibiotic prophylaxis just prior to skin incision.
 
B.
All women should receive thromboprophylaxis with low molecular weight heparin just prior to skin incision.
 
C.
Elective LSCS should be performed at 40 weeks +0 days gestation to maximise fetal growth.
 
D.
General anaesthesia is safer than regional anaesthesia.
 
E.
On average, women need 5 days to recover in hospital following LSCS.
 

LD16

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?
A.
Caesarean section delivery
 
B.
Episiotomy
 
C.
Fetal blood sampling
 
D.
Instrumental delivery
 
E.
Start IV oxytocin augmentation
 

LD17

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?
May 5, 2017 | Posted by in GYNECOLOGY | Comments Off on Labour and Delivery: SBA Questions

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