Caesarean Section and Vaginal Birth After Caesarean (VBAC) MCQs

Explanation: Fetal heart rate acceleration is primarily mediated by the autonomic nervous system. Sympathetic stimulation (via noradrenaline) increases heart rate, especially during fetal movement or external stimuli. Parasympathetic (vagal) tone slows heart rate ; transient withdrawal of vagal activity can also cause accelerations. Fetal heart rate accelerations are considered a sign of fetal well-being and neurological integrity. Neither baroreceptors nor chemoreceptors play a primary role in causing accelerations, though they are involved in other fetal heart rate responses (Option A, B, D ruled out). Clinical episodes of acceleration often occur with fetal activity or stimulation, confirming autonomic system involvement. Reference: https://pmc.ncbi.nlm.nih.gov/articles/PMC8061630/ , http://www.perinatology.com/Fetal%20Monitoring/Intrapartum%20Monitoring.htm

Vagina has got an anterior, a posterior and two lateral walls. The anterior and posterior walls are opposed together but the lateral walls are comparatively stiffer especially at its middle, as such, it looks “H” shaped on the transverse section. The length of the anterior wall is about 7 cm and that of the posterior wall is about 9 cm. Reference: DC Dutta textbook of obstetrics, 8th edition; chapter 1

Placenta Accreta Spectrum(PAS) disorder has disastrous outcome for both mother and fetus. Chances of bowel injury are very rare It includes: Placenta A ccreta: Placenta A dherent to myometrium Placenta I ncreta: Placenta I nvading myometrium Placenta P ercreta: Placenta P erforating through myometrium Cause: Due to absence of Nitabuch's layer It should be terminated at tertiary care center. Complication of surgery for PAS includes: Long operative time Blood and blood product transfusion(Option D) Surgical complications like bladder injury(Option B) ICU admission Increased length of stay Management: Caesarean Hysterectomy(Option C)

Creamy white discharge with fishy odor is characteristic of bacterial vaginosis (M/C cause Gardnerella) -Drug of choice for management of bacterial vaginosis/Gardnerella vaginitis is Metronidazole: Dose - 500 mg oral metronidazole is given twice daily for 7 days Alternatively, metronidazole gel (can be applied once daily for 5 days or clindamycin cream (2%) at bedtime for 5 days. Note: Treatment of male sexual partner is not required in bacterial vaginosis. In pregnancy : Bacterial vaginosis is associated with preterm birth and premature rupture of membranes. Treatment is reserved for symptomatic women who usually complain of fishy odor. DOC - Metronidazole (oral) in the 2nd and the 3rd trimester. Reference: Shaw 15th/ed p 131; William's Gynae 1st/ed p 51.

Most common site for uterine incision during cesarean is lower segment of uterus.(LSCS) The uterus is pear shaped and consists of two major but unequal parts. The upper, larger portion is the body or corpus, whereas the lower smaller cervix projects into the vagina. The isthmus is the union site of these two. It is limited above by the anatomical internal os and below by the histological internal os It is of special obstetrical significance because it forms the lower uterine segment during pregnancy. Reference: DC Dutta textbook of obstetrics, 8th edition; chapter 1

Ans A. Half hour A healthy baby is put to the breast immediately or at most % to 1 hr following normal delivery. Following caesarean sections a period of 4-6 hours may be sufficient for the mother to feed her baby.

The at-risk mothers, likely to rupture, should have mandatory hospital delivery. General anesthesia should not be used to give undue force in an external version. Judicious selection of cases with previous history of cesarean sections for vaginal delivery (VBAC) Judicious selection of cases and careful watch are mandatory during oxytocin infusion either for induction or augmentation of labor. Internal podalic version should never be done in obstructed labor as an alternative to destructive operation or cesarean delivery. Attempted forceps delivery or breech extraction through incompletely dilated cervix should be avoided. Destructive vaginal operations, Manual removal in morbidly adherent placenta—should be done by a senior person Reference: D C Dutta’s textbook of obstetrics 8 th edition, chapter 29

Management options in abruption: (a) Immediate delivery (b) Management of complications if there is any (c) Expectant management (rare). Definitive treatment (immediate delivery): The patient is in labor: The labor is accelerated by low rupture of the membranes. Rupture of the membranes with escape of liquor amnii accelerates labor and it increases the uterine tone also. Oxytocin drip may be started to accelerate labor when needed. The patient is not in labor: Delivery either by (A) induction of labor or (B) caesarean section. Reference:-D C Dutta’s textbook of obstetrics 8 th edition, chapter 19